spine and spinal cord

Question 1

What is a myelopathy?

Answer 1

impingement on the spinal cord (central)

Question 2

What is a radiculopathy?

Answer 2

impingement on the nerve root (lateral)

Question 3

What kind of impingement occurs below the conus?

Answer 3

polyridiculopathy- can lead to bladder and bowel disc function.
Can also get singular ridiculopathy if the impingement is more lateral

Question 4

What occurs with hypertrophy of the ligamentum flavum?

Answer 4

Myelopathy due to impingement

Question 5

What are the types of pain that can occur with spinal impingement?

Answer 5

Lhermitte’s sign- lightning bolt sensation with neck extension

Question 6

What are the types of pain that can occur with nerve root impingement?

Answer 6

Spurling’s sign- Turn head toward narrow foramen- shock that radiates out with the nerve root
Lasegue’s sign- elevate leg to stretch sciatic nerve- pain

Question 7

What is paresthesia?

Answer 7

abnormal sensation

Question 8

What are some frequent symptoms of spinal cord and nerve root impingement?

Answer 8

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Question 9

What is the somatotopy in the different tracts in the spinal cord?

Answer 9

Anterior Spinothalamic tract
Dorsal column
Lateral corticospinal tract

Question 10

Which are the most important dermatomes?

Answer 10

C5- posterior shoulder and lateral arm
C6- Thumb
C7- Middle finger
L4- Anterior aspect of the leg and medial malleolus
L5- Dorsum of foot and great toe
S1- small toe and heel
T4- nipple
T6- xyphoid
T10- umbilicus

Question 11

What are the motor effects of each nerve root?

Answer 11

C5- Deltoid, infraspinatus, Biceps (Biceps reflex)
C6- Wrist extens, biceps (Biceps, brachioradialis)
C7- ???????????????????????
L4- Psoas, Quads
L5-
S1
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Question 12

What ridiculopathy can be produced by L4 disc herniation?

Answer 12

In lumbosacral spine, it is more likely to impinge on the traversing root, so it is most likely to actually cause radiculopathy in L5, not L4 (too lateral)

Question 13

How do you know how full your bladder is?

Answer 13

Afferents from bladder wall and pelvic floor in lumrosacral cord to CNS.

Question 14

How do you control bladder continence?

Answer 14

Sacral reflex due to stretch causes the detrusor to contract and relax external sphincter. ????????

Question 15

How do you assess discriminative touch, vibration (dorsal column)?

Answer 15

Use a piece of gauze and have a patient tell you when they feel touch. Use a tuning fork and have a patient tell you when they feel vibration. Test proprioception by moving the toe up or down. Use two point discrimination

Question 16

How do you assess pain and temperature?

Answer 16

Use a sterilized safety pin and ask if it is sharp or dull. use cold side of the reflex hammer.

Question 17

How do you assess motor function?

Answer 17

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Question 18

What are the reflexes that should be assessed

Answer 18

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Question 19

What is the sequence of symptoms in lesions outside the cord (meningioma, schwannoma)?

Answer 19

Early pain, later loss of bladder and bowel control. Pain and temperature should develop in an ascending pattern

Question 20

What is the sequence of symptoms in lesions inside the cord (often ependymomas or subependymomas)?

Answer 20

Weakness early, then paresthesias that work their way down and urinary incontinence. Very little pain.

Question 21

What is the difference between conus medullaris and cauda equina syndromes?

Answer 21

Usually cauda equina is external and conus medularis is internal.
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Question 22

What is lumbar spinal stenosis? What symptoms would you expect?

Answer 22

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Question 23

What is spinal shock?

Answer 23

Physiologic disruption of the axons. You know it is resolved when the bulbocavernosus reflex returns
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Question 24

What is neurogenic shock?

Answer 24

Disruption of descending sympathetic outflow.

Question 25

How do you classify the spinal cord injury?

Answer 25

Complete- ????????

Incomplete- ????????????

Question 26

What are the sequelae of spinal cord injury?

Answer 26

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