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MSK AM > Spinal issues > Flashcards

Spinal issues Flashcards

1
Q

Who are spinal cord injuries seen in?

A

Males > females

20-29 years

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2
Q

What are the causes of spinal cord injuries?

A 
Trauma
Degenerative orthopaedic
Tumours
Spinal cord infarct
Transverse myelitis
Thoracoabdo aortic aneurysm
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3
Q

What are the most common traumatic causes pf spinal cord injury?

A

Falls
RTA
SPorts

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4
Q

What are the signs and symptoms of a complete spinal cord injury?

A

No motor or sensory function distal to lesion
No anal squeeze
No sacral sensation
ASIA grade A

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5
Q

What are the clinical features of an incomplete spinal cord injury?

A

Some function present below site of injury

ASIA grade B-D

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6
Q

What are the levels of the ASIA classification?

A 
A= complete
B= incomplete, sensory but no motor below lesion
C= incomplete, motor function preserved grade <3
D= incomplete, motor function prserved grade >3
E= normal
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7
Q

What are the patterns of spinal cord injury?

A 
Quadraplegia
Paraplegia
Central cord syndrome
Anterior cord syndrome
Brown- Sequard syndrome
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8
Q

What is quadriplegia?

A

Partial or total loss of use of all limbs and trunk
Spastic weakness
Rest failure if above C5

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9
Q

What is paraplegia?

A

Partial or total loss of use of lower limbs
Spastic weakness if injury above L1
Bladder and bowel involvement
Arms spared but trunk may be involved

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10
Q

Who is central cord syndrome seen in?

A

Older patients

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11
Q

What is central cord syndrome?

A

Hyperextension injury of neck where cervical tracts involved
Weakness of arms
Perianal and lower limbs preserved

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12
Q

What is anterior cord syndrome?

A

Hyperflexion injury causing anterior compression fracture and damaged anterior spinal artery
Profound weakness but vibratory sense, fine discrimination and proprioception spared

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13
Q

What is Brown-Sequard syndrome?

A

Hemisection of cord
Paralysis and loss of proprioception and fine touch of affected side below lesion and loss of pain and temperature sensation on opposite side

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14
Q

What is the most common cause of Brown Squared syndrome?

A

Penetrating injury

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15
Q

What causes neurogenic shock?

A

Injuries above T6

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16
Q

What does neurogenic shock cause?

A

Hypotension, bradycardia and hypotermia

Secondary to disruption of sympathetic outflow

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17
Q

What is spinal shock?

A

Transient depression of cord function below level of injury
Flaccid paralysis, areflexia
Lasts several hours to days

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18
Q

What is the emergent management of a spinal injury?

A

Airway
Breathing
Circulation- IV fluids
Disability- assess neurological function

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19
Q

What imaging is done for spinal injuries?

A

Xray and CT

MRI if neurological deficit or in children

20
Q

What is the indication for surgical fixation in spinal injuries?

A

Unstable fracture

21
Q

What is the long term management of spinal injuries?

A 
Spinal cord injury unit
Physio
OT
Psychological support
Urological/sexual counselling
22
Q

What causes radiculopathy?

A

Compressed nerve roots

23
Q

What are the signs and symptoms of radiculopathy?

A

Limb pain worse than back pain
Root tension signs- using muscle exacerbates pain
Root compression signs- weakness and sensation changes

24
Q

What is the treatment of radiculopathy?

A

Analgesia
Physio
Referral if no improvement after 12 weeks

25
Q

What is disc prolapse?

A

Tearing of annual fibrosis, causing nucleus pulpous to protrude, compressing cord or nerve root

26
Q

What are the types of disc prolapse?

A

Bulge
Protrusion
Extrusion
Sequestration

27
Q

What is the most common type of disc prolapse?

A

Bulge

28
Q

What is a disc protrusion?

A

Annulus weakened but still intact

29
Q

What is a sequestrated disc?

A

Desiccated disc material free in canal

30
Q

At what levels is disc prolapse most common?

A

C5/6
T11/12
L4/5
S1

31
Q

What types of prolapse can happen in T vertebrae?

A

Cantral
Posteriolateral
Lateral

32
Q

What is the most common type of disc hernuaion in lumbar vertebrae?

A

Posteriolateral

33
Q

What are the signs and symptoms of a central disc prolapse?

A

UMN signs and symptoms

Back pain

34
Q

What are the signs and symptoms of a lateral cord compression?

A

Compresses nerve roots
Limb pain is worse than back pain
Root tension signs- using muscle exacerbates pain
Root compression signs- weakness and sensation changes

35
Q

What causes cauda equina syndrome?

A 
Central lumbar disc prolapse
Tumours
Trauma or spinal stenosis
Infection
Iatrogenic
36
Q

What are the clinical features of cauda equina?

A

Bilateral buttock and leg pain
varying dysaethesiae and weakness
Urinary retention +/- incontinence

37
Q

What is the management of cauda equina syndrome?

A

Urgent MRI

Operation within 48 hours of onset

38
Q

What does delay i operating in cauda equina syndrome cause?

A

Permanent dysfunction of bladder and anal sphincter

39
Q

What is cervical and lumbar spondolysis?

A

Essentially OA of spine

Degenerative change, can include facet joints, discs, ligaments…

40
Q

What can severe cervical and lumbar spondolysis cause?

A

Myelopthy and UMN signs in limbs

41
Q

What are the main causes of spinal stenosis?

A 
Ageing
Arthritis
Congenital
Trauma
Tumour
Cysts
42
Q

What are the clinical features of spinal stenosis?

A 
Usually bilateral
Sensory dysaethesia
Posible weakness
Relived by bendingg over, rest, sitting, walking uphill
Worse walking down hill
43
Q

What is the treatment of lateral recess stenosis?

A

Nerve root injection
Epidural
Surgery

44
Q

What is the treatment of central stenosis?

A

Epidural steroid injection

Surgery

45
Q

What is the treatment of foraminal stenosis?

A

Nerve root injection
Epidural injection
Surgery

MSK AM (37 decks)

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