Spine Flashcards
Remind yourself of the structure of the roots of spinal nerves

Remind yourself of the structure of intervertbral discs
- Annulus fibrosis= shock absorber of spine. Made of annular bands of collagen in varying orientations. Avascular & aneural.
- Nucleus pulposus= remnant of notochord. Gelatinous and consists of type 2 collagen. Gradually decreases in height during day as water is squeezed out due to mechanical pressure. Also decreases in height with age.

Remind yourself how to differentiate between the different vertebrate

Remind yourself of the myotomes
Remind yourself of the dermatomes

Remind yourself of the peripheral nerve distribution in the upper limb

Remind yourself of sensory distribution of nerves in lower limb

Define dermatome
Define myotome
- Dermatome= area of skin supplied by a single spinal nerve
- Myotome= group of muscles supplied be a single spinal nerve
Define radiculopathy
Conduction block in axons of spinal nerve or it its root; results in weakness (when impacts of motor neurones) and parasthesia or anaesthesia (when impacts on sensory neurones)
Define myelopathy
Myelopathy is neurological signs & symptoms due to pathology of the spinal cord
*NOTE: must be compressing spinal cord e.g. therefore not cauda equina
Define radicular pain
Radicular pain= pain deriving from damage or irritation of the spinal nerve tissue- particularly dorsal root ganglion
*NOTE: different from radiculopathy wich can be thought of as a state of neurologial loss and may or may not be associated with radicular pain
What scale is used for neurologic classification of spinal cord injury?
ASIA impairment scale (American Spinal Injury Association Impairment Scale). Divides spinal cord injuries into 5 categories:
- Complete
- Incomplete sensory
- Incomplete motor (muscle grade below 3)
- Incomplete motor (muscle grade 3 or above)
- Normal

State some potential causes of radiculopathy
Most commonly a result of nerve compression which can be due to:
- Intervertebral disc prolapse (lumbar spine most common)
- Degenerative diseases of spine which lead to neuroforaminal or spinal canal stenosis (cervical spine most common as it is most mobile)
- Fracture (trauma or pathological)
- Malignancy (most commonly metastatic)
- Infection (e.g. extradural abscesses, osteomyelitis, herpes zoster)
Describe clinical features of radiculopathy
- Sensory features: parasthesia, numbness
- Motor features: weakness
- Radicular pain (deep, burning, strap like pain. Can be intermittent)
- Red flag symptoms
State the red flags for:
- Cauda equina
- Infection
- Fracture
- Malignancy/metastatic disease
Cauda Equina
- Bilateral sciatica
- Neurological deficit of legs e.g. motor weakness
- Saddle anaesthesia
- Painless urinary retention
- Erectile dysfunction
- Faecal & urinary incontinence
Infection
- Immunsupression
- IV drug use
- Unexplained fever
- Diabetes
- TB or recent UTI
Fracture
- Significant trauma
- Osteoporosis or metabolic bone disease
- Chronic steroid use (oral steroids =/3 months)
Malignancy/metastatic disease
- History of malignancy
- New onset over 50yrs
- Night pain that disturbs sleep (suggest pain not mechanical/not due to axial loading as pain occuring when supine and spine is not loaded)
*NOTE: be concerned about age <18yrs and >55yrs. Be concerned about thoracic pain as thoracic spine is least mobile so unlikely to be mechanical.

What must you ensure you examine in anyone presenting with symptoms of radiculopathy
- Pin prick sensations all dermatomes
- Motor function (Oxford muscle grading)
- Assess pin prick sensaton in perianal dermatomes (reduced in CES)
- Anocutaneous reflex (diminished or absent in CES)
- Anal tone (reduced in CES)
- Catheter tug (if catheter in situ. Tug catheter and ask pt if they can feel it. Reduced or absent in CES)
- Bladder scan (pre- and post-void. If 200mL or moer= retention)
- Consdier rectal pressure sensation
What is the anocutaenous reflex/how do you assess it?
anocutaneous reflex is assessed by means of stimulation with pinprick in the perianal region, which leads to visible reflexive anal contraction
How do you assess anal tone?
Ask pt to squeeze anus whilst doing DRE and assess for tone. Can also ask to cough and anal tone should increase.
State some differential diagnosis for radicular pain
Differential diagnoses inlcude pseudoradicular pain syndromes (conditions that do not arise due to nerve root dysfunction but cause radiating limb pain in an radicular pattern):
- Referred pain
- Myofascial pain
- Thoracic outlet syndrome
- Greater trochanter bursitis
- Iliotibial band syndrome
- Meralgia parasthetica
- Piriformis syndrome
What is myofascial pain?
- Hip muscles can mimic pain from lumbar radiculopathy
- Shoulder girdle muscles can produce pain radiating to upper extremity
- Examine for tenderness at specific muscle sites which when palpated produce radiating pain
What is meralgia parasethetica?
- Compression of lateral femoral cutaenous nerve of thigh as it passes under inguinal ligament.
- Presents with clearly demarcated area of parasthesia and/or numbness in anterolateral aspect of thigh
Discuss the general principles of the management of radiculopathy
- Depends on underlying cause.
- Main one to identify quickly/rule out is CES as it requires emergency surgical treatment.
What age group is cauda equina syndrome common in?
- 30-50yrs
What is the commonest cause of CES?
slipped disc that fills the spinal canal (2% of all disc prolapses we see)













