Spinal Issues

Question 1

What sensation is the spinothalamic tract associated with?

Answer 1

Coarse touch
Pain
Temperature

Question 2

A lesion affecting the spinothalamic tract will affect which side of the body?

Answer 2

Affects contralateral side since fibres decussate at spinal level

Question 3

What sensation is the dorsal column associated with?

Answer 3

Fine touch
Proprioception
Vibration

Question 4

A lesion affecting the dorsal column will affect which side of the body?

Answer 4

Affects ipsilateral side since fibres decussate at brainstem

Question 5

Tumours compression spinal cord are usually from metastases. True/False?

Answer 5

True

Question 6

A cervical disc prolapse can cause both neuralgic dermatomal pain and weakness of muscles. True or false?

Answer 6

True

Question 7

A large central cervical disc prolapse can compress the cord and cause what?

Answer 7

Cervical myelopathy with upper motor neurone symptoms and signs

Question 8

What is the first line treatment for a cervical disc prolapse?

Answer 8

Conservative management

Question 9

Are the arms involved in the case of a thoracic disc prolapse?

Answer 9

Rarely but it is possible

Question 10

Which discs in the lumar spine most commonly herniate and cause sciatica?

Answer 10

L4/5 level and L5/S1

Question 11

If a straight leg raise test is +ve (raise of <45 degrees causes pain), what condition does this indicate?

Answer 11

Sciatica

Question 12

What kind of disc prolapse would cause bilateral sciatica and/or sphincter disturbance and diminished perineal sensation

Answer 12

Central disc prolapse

Question 13

A patient has a suspected lumbar disc prolapse but on examination you see UMN signs. What does this mean?

Answer 13

The problem has to be higher than the lumbar spine (think cervical and above)

Question 14

A prolapsed disc at what spinal level most commonly causes cauda equina?

Answer 14

Midline herniation at L4/5

Question 15

What symptoms must be considered cauda equina until proven otherwise?

Answer 15

Any patient with bilateral leg symptoms/signs with any suggestion of altered bladder or bowel function

Question 16

What are the 2 absolutely mandatory investigations in suspected cauda equina?

Answer 16

PR exam and urgent MRI

Question 17

How does spinal claudication symptoms differentiate from intermittent claudication caused by atherosclerosis

(4 main ways)

Answer 17

o The claudication distance is inconsistent

o The pain is burning (rather than cramping)

o Pain is less walking uphill (spine flexion creates more space for the cauda equina) and cycling is easy

o Pedal pulses are preserved

Question 18

What is cervical spondylosis?

Answer 18

Age-related cervical disc degeneration causing accelerated OA

Question 19

Cervical spondylosis causing radiculopathy shows what signs?

Answer 19

Slow onset stiffness and pain in the neck
+
LMN signs in the upper and lower limbs

Question 20

Cervical spondylosis causing myelopathy shows what signs?

Answer 20

Slow onset stiffness and pain in the neck
+
spinal cord compression causing UMN signs

Question 21

Bilateral ‘numb, clumsy hands’ is a buzzword for what condition?

Answer 21

Cervical myelopathy

Question 22

What can cause cervical myelopathy?

Answer 22

Anything that causes cervical spinal cord compression eg:
•	Central cervical disc prolapse 
•	Cervical spondylosis
•	Spinal stenosis
•	Spinal trauma
•	Spinal infections

Question 23

What is the treatment for cervical myelopathy?

Answer 23

• Decompressive spinal surgery - tends to be irreversible. The aim of surgery is to stop it getting worse

Question 24

What are the risk factors for failed back syndrome?

Answer 24

• Presence of mental / emotional disorders (eg, depression, anxiety)
• Surgery is tied to a workers’ compensation case or other legal issue
• Obesity
• Smoking
• Diabetes