Spinal Symposium

Question 1

What is a dermatome?

Answer 1

An area of the skin that is supplied by a single spinal nerve

Question 2

What is a myotome?

Answer 2

The group of muscles that a single spinal nerve innervates

Question 3

What are the 2 categories of spinal injury?

Answer 3

Complete and Incomplete

Question 4

What are the traits found in a complete spinal injury?

Answer 4

No motor or sensory function distal to the lesion
No anal squeeze
No sacral sensation
ASIA Grade A
No chance of recovery

Question 5

What are the traits of an incomplete spinal injury?

Answer 5

Some function is present below the site of injury

More favorable prognosis overall

Question 6

Define ASIA Classification Grade A

Answer 6

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

Question 7

Define ASIA Classification Grade B

Answer 7

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

Question 8

Define ASIA Classification Grade C

Answer 8

Incomplete. Motor function preserved below the neurological level.
Majority of key muscles have a grade <3

Question 9

Define ASIA Classification Grade D

Answer 9

Incomplete. Motor function preserved belwo the neurological level. Majority of key muscles have a grade >3

Question 10

Define ASIA Classification Grade E

Answer 10

Normal motor and sensory function

Question 11

Define Tetrapelgia/Quadraplegia

Answer 11

Partial or total loss of use of all four limbs and the trunk.
Loss of motor and sensory function in cervical segments of the spinal cord.

Question 12

What are come clinical features of Tetraplegia ?

Answer 12

Cervical fracture
Respiratory failure - loss of innervation of diaphragm
(C3-5 keeps you alive)
Spasticity

Question 13

Define Paraplegia

Answer 13

Partial or total loss of the use of the lower limbs - impairment or loss of motor/sensory function in thoracic, lumbar and sacral segments of the spinal cord.

Question 14

What are some clinical features of Paraplegia?

Answer 14

Thoracic/lumbar fractures
Spasticity if injured above L1
Bladder/bowel function affected.

Question 15

Name 3 partial cord syndromes

Answer 15

Central cord syndrome
Anterior cord syndrome
Brown-Sequard Syndrome

Question 16

What are the clinical signs and causes of a central cord syndrome?

Answer 16

Causes:
Arthritic neck
Hyper-extension injury

Clinical signs:
Weakness of arms and legs
Perianal sensation and lower extremity power is preserved

Question 17

What are the causes and clinical signs of anterior cord syndrome?

Answer 17

Causes:
Hyperflexion injury
Anterior compression fracture

Clinical signs:
Damaged anterior spinal artery
Fine tough and proprioception preserved
Profound weakness

Question 18

What are the causes and clinical signs of Brown-Sequard Syndrome?

Answer 18

Affects a hemi-section of the cord.
Caused by - Penetrating injuries.

Clinical signs:
Paralysis on affected side
Loss of proprioception
Pain and temp. loss on the opposite side below the lesion.

Question 19

What are the clinical signs of Spinal shock?

Answer 19

Transient depression of cord function below the level of injury.
Flaccid paralysis.
Areflexia - Absence of reflexes.
Lasts several hours to days after injury.

Question 20

What are the clinical signs of Neurogenic shock?

Answer 20

Hypotension
Bradycardia
Hypothermia
Injuries above T6

Question 21

What is surgical fixation used for?

Answer 21

Unstable fractures.

Question 22

What are the intervertebral discs comprised of?

Answer 22

Annulus Fibrosis - Tough outer layer

Nucelus pulposus - Gelatinous core

Question 23

What is the Annulus fibrosis made of ?

Answer 23

Collagen

Question 24

What is the nucelus pulposus made of ?

Answer 24

~85% water and collagen and proteoglycans

Question 25

How does the normal ageing process affect the intervertebral discs?

Answer 25

Decreased water content of discs Disc space narrowing Degenerative changes in facet joints

Question 26

What are some of the pathological processes which can occur within the cord/discs?

Answer 26

- Tearing of annulus fibrosis - Nerve root compression by osteophytes - Central spinal stenosis - Abnormal movement (i.e. Spondyloysis)

Question 27

What are the 4 main types of disc pathology?

Answer 27

Disc bulge Protrusion Extrusion Sequestration

Question 28

Where does cervical disc prolapse most commonly occur?

Answer 28

C5/6

Question 29

Where does thoracic disc prolapse commonly occur?

Answer 29

T8-12

Question 30

Where do the majority of Lumbar spinal discs prolapses occur?

Answer 30

L4/5

Question 31

What is Cauda Equina Syndrome?

Answer 31

Compression of the cauda equina - The sacral nerve roots compressed.

Question 32

What should be the first course of action if you suspect cauda equina syndrome?

Answer 32

Admission Urgent MRI scan Emergency operation within 48 hours of onset

Question 33

What causes cauda equina syndrome?

Answer 33

``` Central lumbar disc prolapse Tumours Trauma or spinal stenosis Infection (epidural abscess) Iatrogenic (Spinal surgery or manipulation) ```

Question 34

Clinical features of cauda equina?

Answer 34

``` Bilateral buttock and leg pain Urinary retention Incontinence overflow Perianal loss of sensation Loss of anal tone and anal reflex ```

Question 35

What is spinal claudication?

Answer 35

Marked narrowing of the spinal canal

Question 36

What is a characteristic symptom of spinal claudication?

Answer 36

Worse when walking down hills because the spinal canal becomes smaller in extension, better walking uphill or riding a bike

Question 37

What causes spinal claudication/neurogenic claudication?

Answer 37

Spinal stenosis