Spine Flashcards
What analgesia is given for nerve root pain?
Gabapentin or avotriptaline.
Which area of the spine is most commonly affected by disc prolapse?
Lumbar disc.
Then cervical, thoracic prolapses is very rare.
What is the most common lumbar level to have a disc prolapse?
L4/L5
Where is L5/S1 disc sensory loss?
Little toe and sole of the foot. Plantar flexion weak, no ankle jerk.
Where is the L4/L5 disc sensory loss?
Great toe and 1st web space EHL weakness.
Where is L3/L4 disc sensory loss?
Medial lower leg, quad weakness, absent knee jerk.
What are the types of disc problems?
Disc bulge
protrusion
extrusion
sequestration
What thoracic level is disc prolapse most common at?
T11/T12
Which cervical level is disc prolapse most common at?
C5/C6
What is cauda equine syndrome?
This is compression of the caudal equina.
What is the treatment of cauda equina syndrome?
Decompression surgery = discectomy - must be performed within 48hrs.
What causes cauda equina syndrome?
Central lumbar disc prolapse - most common tumours trauma infection iatrogenic
What are the features of cauda equina syndrome?
Bilateral buttocks and leg pain - with varying weakness and sensation. Bowel or bladder dysfunction loss of anal tone and anal reflex Loss of perianal sensation. saddle sensory loss.
What is the investigation of caudal equina syndrome?
MRI
if contraindicated then do a lumbar CT
What indicates a poor prognosis of caudal equina syndrome?
Motor loss - motor nerves are harder to damage than sensory nerves.
What are complications of caudal equina syndrome?
abnormal urinary function
sexual dysfunction
How is caudal equina syndrome differentiated from spinal osteoarthritis?
Cauda equina wouldn’t have UMN lesion signs.
What are the ligaments of the spine?
anterior longitudinal ligament supraspinous ligament interspinous ligament posterior longitudinal ligament ligament flava
What is spinal claudication?
compression of the spinal cord
What is the difference between spinal cord and vascular claudication?
Spinal - numbness, weakness, takes a while to get better after stopping walking, worse when walking downhill (spine compressed), better walking up or sitting on bike
What is spondylolisthesis?
when one vertebrae is translated onto the other.
What is spinal shock?
After spinal injury, the patient will have spinal shock below the level of injury where their spine doesn’t work - so the initial investigation is unreliable.
What is a tetraplegia injury?
Spinal injury including all 4 limbs. must be below C5
What is a paraplegia injury?
Including the lower limbs only
