Spinal Surgery Flashcards
What is the most likely cause of EHL weakness with decreased dorsal medial sensation of the foot?
Lateral L5/S1 disc herniation
What is the most common cause of SCI?
MVA
What is the most common cause of death in SCI?
Respiratory Failure
What are the criteria for clearing a C-Spine?
- 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.
What sensations are carried in the dorsal columns and spinothamic pathways?
Dorsal Columns: vibration, light touch, proprioception
Spinothalamic: crude touch, temperature, pain
Where do the spinal columns decussate?
Spinothalamic: 2-3 spinal levels above nerve roots
Dorsal Columns: medulla
Corticospinal: medulla
What are the clinical features of Central Cord Syndrome?
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)
What are the clinical features of Posterior Cord Syndrome?
Loss of proprioception and vibration sensation (dorsal columns)
What are the clinical features of Anterior Cord Syndrome?
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)
What are the clinical features of Cauda Equina Syndrome?
Lower back pain / sciatica Saddle anaesthesia Bladder / bowel dysfunction Variable motor / sensory loss (LMNL due to compression of cauda equina, below L2)
What are the atlas and axis and what movement is each responsible for?
Atlas = C1 (flexion/extension - nodding) Axis = C2 (rotation - shaking)
At what level does the spinal cord end?
L1/L2 (conus medullaris)
Are nerve roots upper or lower motor neurons?
Lower
From anterior to posterior, what are the spinous ligaments?
Anterior longitudinal ligament Posterior longitudinal ligament Ligamentum flavum Interspinous ligament Supraspinous ligament
Which spinous ligament is the strongest?
Ligamentum flavum
What is the blood supply to the spinal cord?
1 x anterior spinal artery (to 2/3 spinal cord)
2 x posterior spinal arteries (to 1/3 spinal cord)
What are the spinal tracts, where do they decussate and what is their function?
Anterior + lateral corticospinal (medulla) - motor
Dorsal columns (medulla) - vibration, proprioception, crude touch
Spinothalamic (at spinal level) - pain, temperature, light touch
What is the gold standard for assessing the cervical spine?
CT
Which x-ray views comprise a C-spine trauma series?
Lateral
AP
Odontoid peg (open mouth)
+/- Swimmer’s view (not routine)
What are the indications for a facet joint injection with anaesthetic?
Degenerative / arthritis conditions
What are the indications for an epidural injection with anaesthetic?
Radicular pain (nerve root compression
How can a complete and incomplete spinal cord injury be clinically differentiated from one another?
Complete = no voluntary movement or sensation in lowest sacral nerves Incomplete = some preserved sensation in lowest sacral dermatomes
What are the red flags for back pain?
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
What is spondylolisthesis?
Forward ‘slip’ of vertebra (especially L5), often due to spondylolysis (defect of pars interarticularis)
