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MSK > spinal symposium > Flashcards

spinal symposium Flashcards

1
Q

dermatome

A

area of skin mainly supplied by single spinal nerve

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2
Q

myotome

A

group of muscles a spingle spinal nerve innervates

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3
Q

types of spinal injuries

A

fracture

spinal cord injury

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4
Q

complete spinal cord injury

A 
no motor or sensory function distal to lesion 
no anal squeeze
no sacral sensation 
ASIA grade A
no chance recovery
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5
Q

incomplete SCI

A

some function present below site of injury

more favourable prognosis

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6
Q

ASIA classification: Grade A

A

complete

no sensory or motor function preserved in sacral segments S4-S5

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7
Q

ASIA classification: Grade B

A

incomplete

sensory but not motor function preserved below neurologic level and extending through sacral segments S4-S5

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8
Q

ASIA classification: Grade C

A

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

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9
Q

ASIA classification: Grade D

A

incomplete
motor function preserved below neurologic level

majority key muscles grade > 3

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10
Q

ASIA classification: Grade E

A

normal motor and sensory function

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11
Q

tetraplegia/quadraplegia

A

partial or total loss of use of all 4 limbs and trunk

loss of motor/sensory function in cervical segments spinal cord

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12
Q

spasticity

A

increased muscle tone

UMN lesion

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13
Q

paraplegia

A

partial or total loss of use of lower limbs

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

arm function spared

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14
Q

partial cord syndromes

A

central cord syndrome
anterior cord syndrome
brown-sequard syndrome

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15
Q

central cord syndrome

A

impinges onto parts corticospinal tracts

centrally cervical tracts more invovled

weakness arms > legs

perianal sensation and lower extremity power preserved

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16
Q

anterior cord syndrome

A

hyperflexion injury, anterior compression fracture, damage anterior spinal a.

fine touch and proprioception preserved (dorsal coloumns ok)

corticospinal (motor) and spinothalamic (pain) tracts damaged –> profound weakness

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17
Q

brown-sequard syndrome

A

hemi-section of cord
penetrating injuries

paralysis on affected side (corticospinal)
loss proprioception + fine discrimination (dorsal)

pain and temp loss on opposite side below lesion (spinothalamic)

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18
Q

key to management of SCI patient

A

prevent a secondary insult

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19
Q

ABCD: A

A

airway - c spine control

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20
Q

ABCD: B

A

breathing

  • ventilation + oxygenation
  • concomitant chest injuries
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21
Q

ABCD: C

A

circulation

  • IV fluids + access
  • consider neurogenic shock
  • vasopressors
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22
Q

spinal shock

A

transient depression of cord function below level injury

flaccid paralysus
arreflexia
lasts several hrs to days post injury

23
Q

neurogenic shock

A 
hypotension 
bradycardia 
hypothermia 
injuries above T6
secondary to disruption sympathetic outflow
24
Q

ABCD: D

A

disability

assess neurological function
incl PR and perianal sensation

25
Q

investifations SCI

A

X-ray
CT
MRI

26
Q

surgical fixation

A

unstable fractures

27
Q

long term management SCI

A 
spinal cord injury unit 
physiotherapy 
OT 
psychological support 
urological/sexual counselling
28
Q

type of joint is intervertebral disc

A

secondary cartilagenous joint

29
Q

normal ageing processes to IV discs

A

decreased water contents disc
disc space narrowing
degenerative changes x-ray
degenerative changes in facet joints

aggravated by smoking, weight gain etc.

30
Q

pathological processes IV discs

A
  • tearing annulus fibrosis and protrusion of nucleus
  • nerve root compression by osteophytes
  • central spinal stenosis
31
Q

nerve root pain

A

limb pain worse than back pain

pain in nerve root distribution - radicular

root tension and root compression signs

32
Q

IV disc problems: bulge

A

common
majority asymptomatic

nucleus contained, annulus slightly bulging

33
Q

IV disc problems: protrusion

A

annulus weakened but still intact

nucleus elongated and moved out place, hasn’t breached annulus

34
Q

IV disc problems: extrusion

A

nucleus through annulus but still in continuity

annulus ruptured

35
Q

IV disc problems: sequestration

A

dessicated disc material free in canal

36
Q

cervical disc prolapse

A

mostly C5/6

37
Q

thoracic disc prolapse

A

<12% IVD prolapses

most T11/T12

38
Q

lumbar disc prolapses

A

L4/5 then L5/S1 then L3/4

most posterolateral: pos longitudinal leg weakness, sciatica
central disc may give pain in both legs or back pain only

39
Q

cauda equina syndrome

A

compression of cauda equina

sacral nerve roots compressed

40
Q

cauda equina causes

A 
central lumbar disc prolapse
spinal stenosis 
trauma
tumour - 1ry, 2ry
haematoma 
infection - epidural abscess
iatrogenic: spinal surgery
41
Q

cauda equina classic triad

A

saddle anaesthesia
bilateral leg weakness
urinary/faecal incontinence/sexual dysfunction

42
Q

cauda equina other features

A

poor anal tone
back pain and radicular pain
LMN signs: hypotonia, hyporeflexia

43
Q

cauda equina investigations

A

urgent MRI

if contraindicated lumbar CT myelogram

44
Q

cauda equina Rx

A

surgery within 48hrs: decompression - laminectomy

45
Q

cervical + lumbar spondylosis

A

OA
degenerative changes to facet joints, IV discs and ligaments

if severe can compress cord causing myelopathy

46
Q

cervical spondylosis features

A

axial neck pain

neurological complications: compression, cervical spondylotic radiculopathy

47
Q

cervical spondylosis: cervical spondylotic radiculopathy

A

arm pain, sensory loss and weakness down nerve root supply

48
Q

distinguish spinal claudication from vasuclar claudication

A 
usually bilateral
sensory dysthesiae
possible weakness
several mins to ease after walking 
worse walking downhill
49
Q

spinal stenosis classifications

A

lateral recess stenosis
central stenosis
foraminal stenosis

50
Q

spinal stenosis features

A

back pain
activity relation pain
leg numbess/paraethesiae
pain radiating down legs

51
Q

spinal stenosis Rx: lateral recess stenosis

A

nerve root steroid injection
epidural steroid injection
surgery

52
Q

spinal stenosis Rx: central stenosis

A

epidural steroid injection

surgery

53
Q

spinal stenosis Rx: foraminal stenosis

A

nerve root steroid injection
epidural injection
surgery

54
Q

spondilolothesis

A

one vertebrae translated onto another

causes: degenerative, fractures, trauma, infection

MSK (33 decks)

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