Spinal Pathologies Flashcards
What sensory and Motor deficits would compressio of L3 radiculopathy lead to?
Usually due to radiculopathy disk L2-3
Motor: Weakness Hip flexion, Knee extension, Hip adduction
Sensory: Anterolateral aspect of thigh to the knee
Reflexes: reduced patella reflex
What sensory and Motor deficits would compressio of L4 radiculopathy lead to?
Usually due to radiculopathy disk L3-4
Motor: Kee extension (Hip adduction)
Sensory: Kee and anteromedial aspect of leg (+medial malleolus and anterolateral aspect of thigh)
Reflexes: reduced patella reflex
What sensory and Motor deficits would compressio of L5 radiculopathy lead to?
Usually due to disk compression L4-5
Sensory: Big toe (Lateral aspect of the thigh and knee, anterolateral aspect of the leg, dorsum of the foot, and the big toe)
Motor: weakness foot and big toe dorsiflexion (tibialis anterior + flexor hallucis longus)
What sensory and Motor deficits would compressio of S1 radiculopathy lead to?
Usually due to radiculopathy L5-S1
Motor: Weakness foor eversion and plantarflexion (weakness on toewalking)
Sensory: Lateral aspect of foot
Reflexes: Achilles (ankle) reflex weakness
What sensory and Motor deficits would compressio of S2 radiculopathy lead to?
Same as S2, S3, and S4 radiculopathy
Sensory: Posterior aspect of the thigh and leg (S2), perineum (S3–S4), perianal (S4)
No motor component
What is the definition of radiculopathy?
**Compression or irritation of a nerve root **that manifests with pain, paresthesia, weakness, and/or hyporeflexia along the distribution of the nerve root.
What are the most common causes of radiculopathy?
- compressive intervertebral disc herniation
- degenerative spondylosis
What is Spondylosis?
A broad term used to describe degenerative changes of the joints of the spine (sponylosis) that may result in irritation and/or damage of the adjacent nerve roots or spinal cord
What is Myelopathy?
A neurologic disorder caused by injury to the spinal cord =spinal cord compression
What are the most common causes of Myelopathy/ spinal cord compression?
Degenrative disk disease (e.g. central disk herniation)
Others:
* neoplasms
* vertebral metastases
* trauma (epidural hematoma, vertebral fracture)
* and epidural abscess
What does the Straight leg test test?
Test to perform when testing for radiculopathy
If ipsilaterally positive (pain worse when lifting leg and better when not) indicating radiculopathy
Which features would indicate myelopathy/ cauda equina over radicolopathy?
- Bilateral symptoms
- Severe or progressive motor deficits
- urinary/ faecal incontinence or retention
- In spinal cord compression: UMN signs
- Saddle anesthesia (im cauda equina)
- Decreased rectal tone (cauda equina)
Then MRI (also if high risk/ signs of infection (spinal abscess or Cancer or spinal fracture)
What is sciatica?
Lumbar radicolopathy
What is the management plan for people with sciatica (without red flags)
If acutely
- Self care - encourage movement (even though might provoke pain), no bed rest + Physiotherapy
- Medical - Analgesia - first-line NSAIDS
- not paracetamol alone (couple with NSAIDs or codeine)
- consider NSAIDs (limited evidence, PPI+ talk about side-effects)
- If not sufficient codeine or co-codamol (opioids only for acute back pain, not recommended for cronic back pain >3months)
Not recommended: gabapentin, benzodiazepines, antidepressants etc.
Referral is symptoms not resolve within 6 weeks
When should sciatica without red flag symptoms be referred to secondary care?
- Severe radicular pain at 2–6 weeks (depending on severity and improvement).
- Non-tolerable radicular pain at 6 weeks.
- Acute and severe sciatica — for consideration for an epidural corticosteroid/local anaesthetic injection.
- Sciatica when non-surgical treatment has not improved pain or function — for consideration for spinal decompression.