Spinal problems Flashcards by Pete McEwan

What is lordosis?

Inward curvature of spine

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What is kyphosis?

Outward curvature of the spine

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What curvature do the cervical, thoracic, and lumbar spine have?

Cervical - lordosis
Thoracic - Kyphosis
Lumbar - lordosis

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What muscles are contained within the erector spinae?

Iliocostalis
Longissimus
Spinalis

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What is a dermatome?

An area of skin mainly supplied by a single nerve

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What is a myotome?

Group of muscles that a single spinal nerve innervates

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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

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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

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What are the most common causes of spinal cord injury?

Fall
Road traffic accident
Sport

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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

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What are features of incomplete spinal cord injury?

Some function is present below site of injury

More favourable prognosis

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What is Grade A ASIA classification?

Complete. No sensory or motor function preserved in sacral segments S4-S5

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What is ASIA classification?

American spinal cord injury association degree of injury

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What is grade B ASIA classification?

Incomplete. Sensory but not motor function preserved below the neurological level and extending through sacral segments S4-S5

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What is grade C ASIA classification?

Incomplete. Motor function preserved below the neurological level, majority have a grade of <3

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What is grade D ASIA classification?

Motor function preserved below the neurological level, majority of key muscles have grade >3

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What is grade E ASIA classification?

Normal motor and sensory function

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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

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What causes tetraplegia?

Cervical fracture

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What are potential fatal consequences of cervical fracture?

Loss of innervation of diaphragm - phrenic nerve - leading to resp failure

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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