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Musculo-skeletal > Spinal Symposium > Flashcards

Spinal Symposium Flashcards

1
Q

What are the most common causes of spinal cord injuries

A
  • Fall
  • RTA
  • Sport
  • Knocked over/collision/lifting
  • Trauma
  • Sharp trauma/assault
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2
Q

Describe the features of a complete spinal injury

A
  • No motor or sensory function distal to the lesion
  • No anal squeeze
  • No sacral sensation
  • AISA grade A
  • No chance of recovery
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3
Q

Describe the features of an incomplete spinal injury

A
  • Some function is present below site of injury

- More favourable prognosis overall

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4
Q

What are the different patterns of injury in spinal cord injuries?

A
  • Tetraplegia/quadriplegia
  • Paraplegia
  • Central cord syndrome
  • Anterior cord syndrome
  • Brown-Sequard syndrome
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5
Q

Describe the features of tetraplegia

A
  • 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
  • Above C5 - respiratory failure due to loss of innervation of the diaphragm
  • Spasticity (increased muscle tone)
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6
Q

Describe the features of paraplegia

A
  • Partial or total loss of use of the lower limbs
  • Impairment or loss of motor/sensory function on thoracic, lumbar or sacral segments of the spinal cord
  • Arm function spared
  • Possible impairment of function in the trunk
  • Bladder/bowel function affected
  • Spasticity if injury above L1
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7
Q

Describe the features of central cord syndrome

A
  • Older patients
  • Hyperextension injury
  • Centrally cervical tracts more involved
  • Weakness of arms > legs
  • Perianal sensation and lower extremity power preserved
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8
Q

Describe the features of anterior cord syndrome

A
  • Hyperflexion injury
  • Anterior compression fracture
  • Damaged anterior spinal artery
  • Fine touch and proprioception preserved
  • Profound weakness
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9
Q

Describe the features of Brown-Sequard syndrome

A
  • Hemi-section of the cord
  • Penetrating injuries
  • Paralysis on affected side
  • Loss of proprioception and fine discrimination
  • Pain and temperature loss on the opposite side below the lesion
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10
Q

How can spinal cord injuries be managed?

A
  • Prevention of a secondary insult
  • ABCD and ATLS
  • Treat spinal or neurogenic shock
  • Assess neurological function including PR and perianal sensation
  • Log rolling
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11
Q

What are the features of spinal shock?

A
  • Transient depression of cord function below level of injury
  • Flaccid paralysis
  • Areflexia
  • Lasts several hours to days
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12
Q

What are the features of neurogenic shock?

A
  • Hypotension
  • Bradycardia
  • Hypothermia
  • Injuries above T6
  • Secondary to disruption of sympathetic outflow
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13
Q

What imaging should be done for a SCI?

A
  • XR
  • CT
  • MRI: if neurological deficit or child
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14
Q

When should surgical fixation be used?

A

Unstable fractures

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15
Q

What is the long term management of SCI?

A
  • SCI Unit
  • Physio
  • OT
  • Psychological support
  • Urological/sexual counselling
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16
Q

What are the features of nerve root pain?

A
  • Limb pain worse than back pain
  • Pain in a nerve root distribution
  • Root tension and compression signs
  • Dermatomes and myotomes
17
Q

How can nerve root pain be managed?

A
  • Most will settle within 3 months
  • Physio
  • Strong analgesia
  • Referral after 12 weeks
  • MRI
18
Q

What are the different types of disc problems?

A
  • Bulge
  • Protrusion
  • Extrusion
  • Sequestration (dessicated disc material free in the canal)
19
Q

How is cauda equina syndrome managed?

A
  • SURGICAL EMERGENCY

- Admission, urgent MRI scna and emergency operation within 48 hrs

20
Q

What happens if cauda equina syndrome is left untreated for too long?

A

Permanent bladder and anal sphincter and incontinence

21
Q

What is the aetiology of cauda equina syndrome?

A
  • Central lumber disc prolapse
  • Tumours
  • Trauma
  • Infection
  • Iatrogenic
22
Q

What are the clinical features of cauda equina syndrome?

A
  • Injury or precipitating event
  • Bilateral buttock and leg pain + varying dysaesthesiae + weakness
  • Bowel or bladder dysfunction
  • PR exam: saddle anaesthesia, loss of anal tone and anal reflex
23
Q

Which investigation should be done for cauda equina syndrome?

A
  • MRI

- If contraindicated then lumbar CT myelogram

24
Q

What are the features of cervical and lumbar spondylosis?

A
  • Degenerative change at facet joints, discs, ligaments etc.
  • If severe can compress whole cord - causes myelopathy
  • UMN signs in limbs (increased tone, brisk reflexes etc.)
25
Q

What are the features of spinal claudication?

A
  • Usually bilateral
  • Sensory dysaesthesiae
  • Poss weakness
  • Takes several minutes to ease after stopping
  • Worse walking downhill
26
Q

How can lateral recess stenosis be treated>

A
  • Non operative
  • Nerve root injection
  • Epidural injection
  • Surgery
27
Q

How can central stenosis be treated?

A
  • Non-operative
  • Epidural steroid injection
  • Surgery
28
Q

How can foraminal stenosis be treated?

A
  • Non-operative
  • Nerve root injection
  • Epidural injection
  • Surgery

Musculo-skeletal (27 decks)

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