Spine

Question 1

What analgesia is given for nerve root pain?

Answer 1

Gabapentin or avotriptaline.

Question 2

Which area of the spine is most commonly affected by disc prolapse?

Answer 2

Lumbar disc.

Then cervical, thoracic prolapses is very rare.

Question 3

What is the most common lumbar level to have a disc prolapse?

Answer 3

L4/L5

Question 4

Where is L5/S1 disc sensory loss?

Answer 4

Little toe and sole of the foot. Plantar flexion weak, no ankle jerk.

Question 5

Where is the L4/L5 disc sensory loss?

Answer 5

Great toe and 1st web space EHL weakness.

Question 6

Where is L3/L4 disc sensory loss?

Answer 6

Medial lower leg, quad weakness, absent knee jerk.

Question 7

What are the types of disc problems?

Answer 7

Disc bulge
protrusion
extrusion
sequestration

Question 8

What thoracic level is disc prolapse most common at?

Answer 8

T11/T12

Question 9

Which cervical level is disc prolapse most common at?

Answer 9

C5/C6

Question 10

What is cauda equine syndrome?

Answer 10

This is compression of the caudal equina.

Question 11

What is the treatment of cauda equina syndrome?

Answer 11

Decompression surgery = discectomy - must be performed within 48hrs.

Question 12

What causes cauda equina syndrome?

Answer 12

Central lumbar disc prolapse - most common
tumours
trauma
infection
iatrogenic

Question 13

What are the features of cauda equina syndrome?

Answer 13

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.

Question 14

What is the investigation of caudal equina syndrome?

Answer 14

MRI

if contraindicated then do a lumbar CT

Question 15

What indicates a poor prognosis of caudal equina syndrome?

Answer 15

Motor loss - motor nerves are harder to damage than sensory nerves.

Question 16

What are complications of caudal equina syndrome?

Answer 16

abnormal urinary function

sexual dysfunction

Question 17

How is caudal equina syndrome differentiated from spinal osteoarthritis?

Answer 17

Cauda equina wouldn’t have UMN lesion signs.

Question 18

What are the ligaments of the spine?

Answer 18

anterior longitudinal ligament 
supraspinous ligament 
interspinous ligament 
posterior longitudinal ligament 
ligament flava

Question 19

What is spinal claudication?

Answer 19

compression of the spinal cord

Question 20

What is the difference between spinal cord and vascular claudication?

Answer 20

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

Question 21

What is spondylolisthesis?

Answer 21

when one vertebrae is translated onto the other.

Question 22

What is spinal shock?

Answer 22

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.

Question 23

What is a tetraplegia injury?

Answer 23

Spinal injury including all 4 limbs. must be below C5

Question 24

What is a paraplegia injury?

Answer 24

Including the lower limbs only

Question 25

What does central cord syndrome involve?

Answer 25

Older patients with an arthritic neck.
Weakness of Arms>legs.
perianal sensation and lower extremity power is preserved.

Question 26

What does anterior cord syndrome involve?

Answer 26

Most commonly seen in vascular injuries, theres profound weakness.

Question 27

What is brown - squared syndrome?

Answer 27

half section of the spinal cord.
pain and temperature loss on the opposite side
paralysis on the affected side.

Question 28

What is the difference between spinal cord and vascular claudication?

Answer 28

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

Question 29

What is spondylolisthesis?

Answer 29

when one vertebrae is translated onto the other.

Question 30

What is spinal shock?

Answer 30

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.

Question 31

What is a tetraplegia injury?

Answer 31

Spinal injury including all 4 limbs. must be below C5

Question 32

What is a paraplegia injury?

Answer 32

Including the lower limbs only

Question 33

Why does the caudal equina not get UMN lesions?

Answer 33

because the caudal equina is classes as peripheral nerves.

Question 34

How long does spinal shock last for?

Answer 34

48hrs.