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Year 3 > Spinal Symposium > Flashcards

Spinal Symposium Flashcards

1
Q

draw a typical vertebae

A

see notes

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2
Q

name the articulations of the rib to the vertebae

A

head of rib to articular facets on vertabrae of number and one above
tubercle of rib to transverse process of same number

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3
Q

name the type of curves in the spine: cervical

A

lordosis

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4
Q

name the type of curves in the spine: thoracic

A

kyphosis

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5
Q

name the type of curves in the spine: lumbar

A

lordosis

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6
Q

myotome: L2

A

hip flexion - iliopsoas

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7
Q

myotome: L3,4

A

knee extension - quads

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8
Q

myotome: L4

A

ankle dorsiflexion - tib ant

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9
Q

myotome: L5

A

big toe extension EHL

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10
Q

myotome: S1

A

ankle plantar flexion gastroc

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11
Q

the majority of people with a spinal cord injury will also have what?

A

accompanying column injury

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12
Q

what is the peak age for spinal cord injuries?

A

20-29

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13
Q

most common causes of spinal cord injuries

A 
fall
RTA
sport
knocked over
trauma
sharp trauma/assault
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14
Q

describe the features of a complete spinal cord injury

A

no motor or sensory function distal to lesion
no anal squeeze
ASIA grade A
no change of recovery

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15
Q

describe the features of an imcomplete spinal cord injury

A

some function is present below site of injury

more favourable prognosis overall

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16
Q

why may it be difficult to determine acutely the extend of spinal cord injury?

A

spinal shock

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17
Q

describe grade A ASIS classification

A

complete

no sensory or motor function preserved in sacral segments S4-5

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18
Q

describe grade B ASIS classification

A

incomplete

sensory but not motor funciton preserved below the neurologic level and extending through sacral segments S4-5

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19
Q

describe grade C ASIS classification

A

incomplete
motor function preserved below the neurologic level
majority of key muscle have a grade <3

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20
Q

describe grade D ASIS classification

A

incomplete
motor function preserved below the neurologic level
majority of key muscle shave a grade > 3

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21
Q

describe grade E ASIS classification

A

normal motor and sensory funciton

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22
Q

what is tetraplegia?

A

quadriplegia
partial or total loss of use of all four limbs and the trunk
loss of motor/sensory funciton in cervical segments of the spinal cord

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23
Q

what may cause tetraplegia?

A

cervical fracture

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24
Q

features of tetraplegia

A

respiratory failure due to loss of the diaphragm (phrenic nerve C3-5)
spasticity

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25
Q

what is spasticity

A

increased muscle tone
upper motor neuron lesion
spinal cord and aboce (CNS)

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26
Q

spasticity occurs in injuries above what level?

A

L1

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27
Q

what is paraplegia

A

partial or total loss of use of the lower-limbs

impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord

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28
Q

features of paraplegia

A

arm function spared
possible impairment of function in trunk
possible spasticity
bladder/bowel funciton affected

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29
Q

causes of paraplegia

A

thoracic/lumbar fractures

associated chest or abdominal injuries

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30
Q

name 3 partial cord syndrome

A

central cord syndrome
anterior cord syndrome
Brown-Sequard syndrome

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31
Q

who gets central cord syndrome?

A

older patients with arthritic neck

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32
Q

cause of central cord syndrome?

A

hyperextension injury

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33
Q

features of central cord syndrome

A

centrally cervical tracts more involved
weakness or arms>legs
perianal sensation and lower extremity power preserved

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34
Q

causes of anterior cord syndrome

A

hyperflexion injury
anterior compression fracture
damaged anterior spinal artery

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35
Q

features of anterior cord syndrome

A

fine touch and proprioception preserved

profound weakness

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36
Q

what is Brown-Sequard Syndrome?

A

hemi-section of the cord

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37
Q

cause of Brown-Sequard Syndrome

A

penetrating injuries

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38
Q

features of Brown-Sequard Syndrome

A

paralysis on affected side (corticospinal)
loss of proprioception and fine discrimination )dorsal columns)
pain and temperature loss on the opposite side below the lesion (spinothalamic)

39
Q

management of spinal cord injuries

A

prevent secondary insult esp in those with incomplete
ABCD
ATLS

40
Q

features of spinal shock

A

transient depression of cord fucntion below level of injury
flaccid paralysis
areflexia
last several hours to days after injury

41
Q

features of neurogenic shock

A 
hypotension
bradycardia
hypothermia
injuries above T6
secondary to disruption of sympathetic outflow
42
Q

long term management of spinal cord injuries

A 
spinal cord injury unit
physiotherapy
occupational therapy
psychological support
urological/sexual counselling
43
Q

what kind of joint is there with IV discs?

A

secondary cartilaginous

44
Q

describe the structure of the IV discs

A

annulus fibrosus - tough outer layer

nucleus pulposus - gelatinous core

45
Q

what is the largest avascular structure in the body?

A

IV disc

46
Q

what causes disc prolapse?

A

annulus tears and nucleus prolapse

47
Q

what can a disc prolapse cause?

A

cord/nerve root compression

48
Q

in what direction do the fibres of the annulus fibrosis (collagen) run?

A

obliquely and alternately between layers

49
Q

what movements to the IV discs prevent?

A

rotational

50
Q

what makes up the nucleus pulposus?

A

water 88%
collagen
proteoglycans

51
Q

shape of IV disc

A

Kidney bean

52
Q

in what direction are most disc prolapses?

A

postero-lateral

53
Q

describe the normal ageing process of the spinal column

A

decreased water content of discs
disc space narrowing
degenerative changes on xrays
degenerative changes in the facet joints

54
Q

pathological processes occurring in the spinal column

A

tearing of annulus fibrosis and protrusion of the nucleus
nerve root compression by osteophytes
central spinal stenosis
abnormal movement - spondylolysis, spondylolisthesis

55
Q

features of nerve root pain

A

limb pain worse than back
pain in a nerve root distribution (radicular)
root tension signs
root compression signs

56
Q

treatment of nerve root pain

A 
most will settle, 90% in 3 months
physio
strong analgesia
referral after 12 weeks
imaging - MRI
57
Q

name the 4 common disc problems

A

bulge
protrusion
extrusion
sequestration

58
Q

draw and describe IV disc problems: bulge

A

generalised
common
majority asymptomatic
?relevance

59
Q

draw and describe IV disc problems: protrusion

A

annulus weakened but still intact

60
Q

draw and describe IV disc problems: extrusion

A

through annulus but in continuity

61
Q

draw and describe IV disc problems: sequestration

A

dessicated disc material free in canal

62
Q

most common site of cervical disc prolapse

A

C5/6

63
Q

most common site of thoracic disc prolapse

A

mid to lower levels T8-12

most common T11/12

64
Q

most common site of lumbar disc prolapse

A

usually L4/5 - 45%
L5/S1 - 40%
L3/4 - 10%

65
Q

least common site of disc prolapse?

A

thoracic - 1%

66
Q

directions of thoracic disc prolapse

A

central, posterolateral and lateral herniations

67
Q

directions of lumbar disc prolapse

A

posterolateral

68
Q

nerve root affected in prolapse: L5/S1

A

S1

69
Q

nerve root affected in prolapse: L4/5

A

L5

70
Q

nerve root affected in prolapse: L3/4

A

L4

71
Q

sensory loss in disc prolapse: L5/S1

A

little toe

sole of foot

72
Q

sensory loss in disc prolapse: L4/5

A

great toes

1st dorsal web space

73
Q

sensory loss in disc prolapse: L3/4

A

medial aspect of lower leg

74
Q

motor weakness in disc prolapse: L5/S1

A

plantar flexion foot

75
Q

motor weakness in disc prolapse: L4/5

A

EHL

76
Q

motor weakness in disc prolapse: L3/4

A

quads

77
Q

reflex change in disc prolapse: L5/S1

A

ankle jerk

78
Q

reflex change in disc prolapse: L4/5

A

none

79
Q

reflex change in disc prolapse: L3/4

A

knee jerk

80
Q

what is cauda equina syndrome?

A

compression of cauda equina

sacral nerve roots compressed - can result in permanent bladder and anal sphincter dysfunction and incontinence

81
Q

treatment of cauda equina syndrome

A

surgical emergency

admission, urgent MRI, emergency op within 48h of onset, delay results in permanent dysfunction

82
Q

causes of cauda equina syndrome

A 
central lumbar disc prolapse 
tumour
trauma - burst or chance # disc
spinal stenosis
infection - epidural abscess
iatrogenic - spinal surgery or manipulation, spinal epidural
83
Q

clinical features of cauda equina syndrome

A

– Injury or precipitating event
– Location of symptoms (bilat buttock & leg pain +
varying dysaethesiae + weakness – beware)
– Bowel or bladder dysfunction (urinary retention
+/- incontinence overflow)
– PR exam - saddle anaesthesia (perianal loss of
sensation), loss of anal tone & anal reflex
– High index of suspicion in spinal post-op
patients with increasing leg pain in presence
of urinary retention

84
Q

outcome of cauda equina syndrome

A

• 30% undergoing discectomy for cauda equina
syndrome did NOT regain normal urinary function
• 25% with motor deficits never regained full power
• 33% with sensory deficits never regained normal
sensation
• 25% with perianal paraesthesiae did not return to
normal
• 26% had persitent sexual dysfunction

85
Q

cervical and lumbar spondylosis results from degenerative change where?

A

facet joints
discs
ligaments

86
Q

if cervical and lumbar spondylosis is severe what can it cause?

A

compression of whole cord causing myelopathy

UMN signs in limbs

87
Q

what movements are there in the lumbar spine?

A

flexion and extension

88
Q

name the ligaments of the spinal column and where they are found

A

• Anterior Longitudinal Ligament (ALL – along the
front of the vertebral bodies – broad, strong)
• Posterior Longitudinal Ligament (PLL – along the
backs of the vertebral bodies, i.e. front of the spinal canal;
narrower)
• Ligamentum Flavum (between laminae)
• Interspinous and Supraspinous Ligaments
(between spinous processes)
• Intertransverse Ligament (between transverse
processes)

89
Q

how can you distinguish spinal claudication from vascular claudication

A 
– Usually bilateral
– Sensory dysaesthesiae
– Poss weakness (drop foot – tripping)
– Takes several minutes to ease after
stopping walking
– Worse walking down hills because the
spinal canal becomes smaller in extension,
better walking uphill or riding bicycle
90
Q

types of spinal stenosis

A

lateral recess stenosis
central stenosis
foraminal stenosis

91
Q

treatment of lateral recess stenosis

A

non-op
nerve root injection
epidural injection
surgery

92
Q

treatment of central stenosis

A

non-op
epidural steroid injection
surgery

93
Q

treatment of foraminal stenosis

A

non-op
nerve root injection
epidural injection
surgery

94
Q

treatment of spondylolisthesis

A

Treatment depends on symptoms
• Conservative with lifestyle changes
• Surgery for persistent pain +/- nerve root
entrapment

Year 3 (164 decks)

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