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MSK > Spinal Surgery > Flashcards

Spinal Surgery Flashcards

0
Q

What is the most likely cause of EHL weakness with decreased dorsal medial sensation of the foot?

A

Lateral L5/S1 disc herniation

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1
Q

What is the most common cause of SCI?

A

MVA

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2
Q

What is the most common cause of death in SCI?

A

Respiratory Failure

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3
Q

What are the criteria for clearing a C-Spine?

A
  • No neck pain or tenderness
  • No abnormal neurological symptoms / signs
  • Normal conscious state
  • No alcohol or drugs
  • No distracting injury
  • No significant injury above clavicles
    THEN test for
  • Normal, unassisted head control
  • Pain-free movement
    If any of the above are present, cervical x-rays (lateral, AP, odontoid) are required.
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4
Q

What sensations are carried in the dorsal columns and spinothamic pathways?

A

Dorsal Columns: vibration, light touch, proprioception

Spinothalamic: crude touch, temperature, pain

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5
Q

Where do the spinal columns decussate?

A

Spinothalamic: 2-3 spinal levels above nerve roots
Dorsal Columns: medulla
Corticospinal: medulla

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6
Q

What are the clinical features of Central Cord Syndrome?

A

Motor impairment that is worse in arms than legs
Variable sensory loss below the level of injury
LMNL weakness at injury level, UMNL spasticity below injury level
(caused by hyperextension injury)

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7
Q

What are the clinical features of Posterior Cord Syndrome?

A

Loss of proprioception and vibration sensation (dorsal columns)

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8
Q

What are the clinical features of Anterior Cord Syndrome?

A

Complete motor paralysis below lesion (corticospinal)
Loss of pain and temperature sensation (spinothalamic)
Autonomic dysfunction
Preserved proprioception and vibration (dorsal columns)
(due to occlusion of anterior spinal artery)

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9
Q

What are the clinical features of Cauda Equina Syndrome?

A 
Lower back pain / sciatica
Saddle anaesthesia
Bladder / bowel dysfunction
Variable motor / sensory loss
(LMNL due to compression of cauda equina, below L2)
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10
Q

What are the atlas and axis and what movement is each responsible for?

A 
Atlas = C1 (flexion/extension - nodding)
Axis = C2 (rotation - shaking)
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11
Q

At what level does the spinal cord end?

A

L1/L2 (conus medullaris)

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12
Q

Are nerve roots upper or lower motor neurons?

A

Lower

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13
Q

From anterior to posterior, what are the spinous ligaments?

A 
Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flavum
Interspinous ligament
Supraspinous ligament
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14
Q

Which spinous ligament is the strongest?

A

Ligamentum flavum

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15
Q

What is the blood supply to the spinal cord?

A

1 x anterior spinal artery (to 2/3 spinal cord)

2 x posterior spinal arteries (to 1/3 spinal cord)

16
Q

What are the spinal tracts, where do they decussate and what is their function?

A

Anterior + lateral corticospinal (medulla) - motor
Dorsal columns (medulla) - vibration, proprioception, crude touch
Spinothalamic (at spinal level) - pain, temperature, light touch

17
Q

What is the gold standard for assessing the cervical spine?

A

CT

18
Q

Which x-ray views comprise a C-spine trauma series?

A

Lateral
AP
Odontoid peg (open mouth)
+/- Swimmer’s view (not routine)

19
Q

What are the indications for a facet joint injection with anaesthetic?

A

Degenerative / arthritis conditions

20
Q

What are the indications for an epidural injection with anaesthetic?

A

Radicular pain (nerve root compression

21
Q

How can a complete and incomplete spinal cord injury be clinically differentiated from one another?

A 
Complete = no voluntary movement or sensation in lowest sacral nerves
Incomplete = some preserved sensation in lowest sacral dermatomes
22
Q

What are the red flags for back pain?

A 
B - Bladder / bowel dysfunction
A - Anaesthesia (saddle)
C - Constitutional symptoms (fatigue, weight loss, night sweats)
K - Kronic disease
P - Paraesthesia
A - Age >50
I - IV drug use
N - Neuromotor dysfunction
24
Q

What is spondylolisthesis?

A

Forward ‘slip’ of vertebra (especially L5), often due to spondylolysis (defect of pars interarticularis)

25
Q

Foot drop is caused by weakness of which muscles supplied by which nerve root?

A

Tibialis anterior and ankle/toe extensors supplied by L5 (common peroneal nerve)

26
Q

Which nerve and nerve roots supply the quadriceps?

A

Femoral nerve, L2-4

27
Q

What is cauda equina syndrome?

A

Compression of the cauda equina (LMNL of multiple lumbosacral nerves)

28
Q

What is conus medullaris syndrome?

A

Compression of conus medullaris (UMNL affecting L1-2)

29
Q

At what spinal level is a lumbar puncture performed?

A

L3-4 or L4-5

MSK (3 decks)

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