Spine Flashcards
1
Q
Discuss the presentation and management of lumbar disc herniation
A
Pathophysiology - herniation between two vertebral bodies affect the spinal root associated with the lower level Presentation - radiculopathy: shooting pain down leg - weakness and decreased reflex - decreased sensation Treatment - NSAID, pregabalin - corticosteroid injection - surgery
2
Q
Discuss the presentation and management of Cauda Equina Syndrome
A
Pathophysiology - compression of cauda equina (L2-S5) Presentation - acute onset of weakness and bilateral radicular leg pain - saddle anesthesia - urinary retention - fecal incontinence - loss of anal sphincter tone on DRE Investigation - urgent MRI - post void residual >250cc Management - surgical decompression
3
Q
Discuss the presentation and management of spinal stenosis
A
Pathophysiology - spondylosis degenerative arthritis with progressive disc degeneration, facet joint arthropathy and osteophyte formation Presentation - neurogenic claudication - anesthesia - weakness Investigation - MRI Management - physiotherapy - corticosteroid injections - surgery
4
Q
Discuss the presentation and management of an epidural abscess
A
Risk Factors
- IV drug use
- contagious soft tissue or bone infection
Pathophysiology
- bacterial infection that invades the episural space from hematogenous or contiguous extension
- staph aureua, gram negative bacilli, strep
Presentation
- triad of fever, spinal pain and neurological deficit
Investigation
- CBC, ESR, CRP
- MRI with IV contrast to demonstrate ring enhanced lesion and compression
Management
- ceftriaxone, vanco and flagyl
5
Q
Discuss the presentation and management of spinal bone metastasis
A
Metastasis - lung - breast - prostate - thyroid - renal cancer Presentation - known malignancy with new onset back pain that is worse at night - neurological deficit Investigation - ALP and Ca - X-ray Management - treat cancer - symptomatic lytic then osteoclast inhibitor - radiotherapy - surgical decompression
