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.
What is cauda equina syndrome?
Compression of the
nerve fibers L3–S5 located below L2
leading to
* saddle anesthesia (often gradual onset and initially unilateral)
* asymmetricl, arreflexis paresis of legs
* autonomic disfunction (incontience, retention, reduced rectal tone)
What is the preferred investigation for cauda equina syndrome and spinal cord compression?
Non-contrast MRI
What is the managment of confirmed Cauda equina syndrome?
Emenergency decompression surgery
- within 12h but latest 24h of symptom onset
- Supportive therapy
How should chronic lower back pain be managed?
- Regular Paracetamol
- NSAIDS only if useful and maximum of 3 months
- No opioids
And pain clinic referral
* with additional therapies
* amitryptiline might be useful but not routienly offered, similar with gapapentin
What is the prognosis of radiclopathy due to disk compression?
Usually good recovery and resolving of symptoms
- regardless of use of NSAIDs
- but 30% (unclear numbers) might still be in pain after 8 weeks
What is spinal stenosis?
Narrowing of the spinal canal usually due to chornic degenerative changes
What is a classical presentation of patients with spinal stenosis?
Neurogenic claudication characterised by back and leg pain and lower extremity paraesthesia brought on by ambulation and relieved by sitting.
What investigations should be performed in patients presenting with symptoms of spinal stenosis?
- Lumbosacral spine X-ray (degenerative changes) show overgrowth of the facet joints, narrowing of the disc spaces, and osteophyte formation
- CT spine/ MRI spine for closer inspection +/- surgical planning)
What is spondylolisthesis?
s a condition in which a vertebral body slips anteriorly in relation to the subjacent vertebrae.
Usually due to degenerative changes and
Very common (up to 10% of people in US) and usually is asymptomatic but can present as back pain or spinal stenosis
How should patinets with spinal stenosis be managed?
If significant acute neurological deficits or significant symptoms despite medical management: spinal decompression surgery
Otherwise
- analgesia NSAIDS first line (paracetamol 2nd)
- if uncontrolled: short course oral corticosteorids (5-7 days)
- pain affecting quality of life and/or functional activities: epidural corticosteroids
For chonric management
- gabapentin
- or amytriptiline might be useful
What ist the managemen of spondylolisthesis?
Usually conservative approach and analgesis accordign to spinal stenosis
Surgical decompression and fusion can be considered if neurological deficits and/or impact on life
What are the red-flag symptoms indicating a spinal fracture?
- Sudden onset of severe central spinal pain which is relieved by lying down.
- A history of major trauma (such as a road traffic collision or fall from a height)
- minor trauma, or even just strenuous lifting in people with osteoporosis.
- Structural deformity of the spine (such as a step from one vertebra to an adjacent vertebra).
- Point tenderness over a vertebral body.
What investigations should be done in patients with spinal fractures?
- plain x-rays
- MRI if soft tissue/ Spinal cord involvement (+ can distinguish between fracture and metastasis etc.)
- CT spine for bony visualisation
What is the general management approach to spinal fractures?
- Bed Rest until stability established
- If osteoporosis and anterior column alone (most osteoporotic fractures): no risk of instability and NO prolonged bed rest (only 24-48h) + early moibilisation
- I posterior/middle column involvement: spinal referral due to risk of instability (strict bed red and planning of management)
Otherwise immuobilisation + analgesia+ spinal opinion
