Spinal problems Flashcards
What is lordosis?
Inward curvature of spine
What is kyphosis?
Outward curvature of the spine
What curvature do the cervical, thoracic, and lumbar spine have?
Cervical - lordosis
Thoracic - Kyphosis
Lumbar - lordosis
What muscles are contained within the erector spinae?
Iliocostalis
Longissimus
Spinalis
What is a dermatome?
An area of skin mainly supplied by a single nerve
What is a myotome?
Group of muscles that a single spinal nerve innervates
What are myotomes of the upper limb?
C5 - shoulder abduction (deltoid) C6 - Elbow flexion/wrist extensors (biceps) C7 - Elbow extensors (triceps) C8 - Long finger flexors T1 - Finger abduction
What are myotomes for the lower limbs?
L2 - Hip flexion (iliopsoas) L3/4 - Knee extension (quadriceps) L4 - ankle dorsiflexion L5 - Big toe extension S1 - Ankle plantar flexion
What are the most common causes of spinal cord injury?
Fall
Road traffic accident
Sport
What are features of complete spinal cord injury?`
No motor or sensory function distal to lesion No anal squeeze No sacral sensation ASIA grade A No chance of recovery
What are features of incomplete spinal cord injury?
Some function is present below site of injury
More favourable prognosis
What is Grade A ASIA classification?
Complete. No sensory or motor function preserved in sacral segments S4-S5
What is ASIA classification?
American spinal cord injury association degree of injury
What is grade B ASIA classification?
Incomplete. Sensory but not motor function preserved below the neurological level and extending through sacral segments S4-S5
What is grade C ASIA classification?
Incomplete. Motor function preserved below the neurological level, majority have a grade of <3
What is grade D ASIA classification?
Motor function preserved below the neurological level, majority of key muscles have grade >3
What is grade E ASIA classification?
Normal motor and sensory function
What is tetraplegia?
Partial or total loss of use of all four limbs and the trunk, loss of motor/sensory function in cervical segments of the spinal cord
What causes tetraplegia?
Cervical fracture
What are potential fatal consequences of cervical fracture?
Loss of innervation of diaphragm - phrenic nerve - leading to resp failure
What is spasticity?
Increased muscle tone
What causes spasticity?
Upper motor neuron lesion - spinal cord and above
What is paraplegia?
Partial or total loss of lower limbs - impairment or loss of motor/sensory functions in thoracic, lumbar, or sacral segments
Arm function spared
What causes paraplegia?
Thoracic/lumbar fractures
Associated chest or abdominal injuries
What is central cord syndrome?
Hyperextension injury causing damage to cervical tracts
What are features of central cord syndrome?
Older patients with arthritic neck
Weakness of arms>legs
Perianal sensation and lower extremity power preserved
What are features of anterior cord syndrome?
Profound weakness
Fine touch and proprioception preserved
What is anterior cord syndrome?
Hyperflexion injury
Damaged anterior spinal artery
Anterior compression fracture
What is Brown-Sequard syndrome?
Hemi-section of the cord caused by penetrating injuries
What are features of Brown-Sequard syndrome?
Caused by penetrating injuries
Paralysis on affected side
Loss of proprioception and fine discrimination
Loss of pain and temperature on contralateral side below lesion
How is spinal cord injury managed?
Prevention of secondary insult
What imaging should be done in imaging of spinal cord injury?
X-rays
CT scanning - bony anatomy
MRI - if neurological deficit or children
What is long term management of spinal cord injury?
Spinal cord injury unit Physiotherapy Occupational therapy Psychological support Urological/sexual counselling
What is the most common orientation of intervertebral discs?
Postero-lateral
What are features of nerve root pain?
Limb pain worse than back pain Pain in nerve root distribution Root tension signs Root compression signs Dermatomes and myotomes
How is nerve root pain managed?
Physiotherapy
Strong analgesia
Referral after 12 weeks
Monitor with imaging - MRI
What is disc protrusion?
Weakened annulus fibrosis but still intact leading to a bulge
What is disc extrusion?
Nucleus though annulus fibrosis but in continuity
What is disc sequestration?
Dessicated disk material free in canal
What is the most common level for cervical disc prolapse?
C5/6
What are the most common levels for thoracid disc prolapse?
T11/T12
What is cauda equina syndrome?
Compression of cauda equina
How is cauda equina syndrome managed?
Surgical emergency - admission, urgent MRI, emergency operation within 48h of onset, delay results in permanent dysfunction
What can happen as a result of cauda equina syndrome?
Permanent bladder and anal sphincter dysfunction and incontinence
What is aetiology of cauda equina syndrome?
Central lumbar disc prolapse Tumours Trauma Spinal stenosis Infection Iatrogenic
What are features of cauda equina syndrome?
Injury or precipitating event Bilateral buttock and leg pain Varying dysaesthesia and weakness Bowel or bladder dysfunction Saddle anaesthesia High index of suspicion in spinal post-op patients
What is cervical/lumbar spondylitis?
Degenerative change at facet joints, discs, ligaments, etc
If severe can compress whole cord
What are the spinal ligaments?
Anterior longitudinal ligament - along the front of vertebral bodies
Posterior longitudinal ligament - along the backs of vertebral bodies
Ligamentum flavum - between laminae
Interspinous and supraspinous ligament - between spinous processes
Intertransverse ligament - between transverse processes
What is spinal claudication?
Usually bilateral Sensory dysaesthesiae Possible weakness Takes several minutes to ease after stopping walking Worse walking DOWN hills
How is lateral recess stenosis treated?
Nerve root injection
Epidural injection
Surgery
How is central stenosis treated?
Epidural steroid injection
Surgery
How is foraminal stenosis treated?
Nerve root injection
Epidural injection
Surgery
