Spine diseases/syndromes of the spine Flashcards
degenerative causes of sensory symptoms in the cervical spine?
- stenosis
- disc herniation
- cynovial cyst
extradural neoplasms in the cervical back?
- metastases
- primary bone-tumours
intramedullary neoplasms in the cervical spine?
- Ependymoma
- Astrocytoma
- Hemangioblastoma
Characteristics of ependymoma on MRI?
Hypointensities correlating to hemosiderin above and below the tumor on T2W images.
Characteristics of intramedullary Astrocytomas?
- longer than 6 vertebras
- Cysts within the lesion
*rarely hemorrhage at the margins - May have mixed enhancement pattern
+ Younger patients
Intradural, extramedullary neoplasms in the cervical spine
- Meningioma
- Schwannoma
- Neurofibroma
- Ganglioneuroma
most common cause of anterior cord syndrome
infarction/compression of the anterior spinal artery.
Presentation of anterior cord syndrome?
- Paraplegia. (If above C7 = Quadriplegia)
- Loss of pain and temperature sensation (spinothalamic tract)
- Preserved 2 point discrimination, joint position sense, deep pressure sensation
(posterior column functions)
- Preserved 2 point discrimination, joint position sense, deep pressure sensation
When is it reasonable to consider surgery in anterior cord syndrome?
- in cord compressions
- In instability
What are signs of central cord syndrome?
- Disproportionate greater motor deficits in the upper compared to the lower extremities.
WHat is burning hand syndrome?
Cause of central cord syndrome?
This is a watershed area and therefore sensistive. Usually due to hyperextension injuries in the presence of osteophytic spurs.
When is surgery applied for central cord syndromes?
- In ongoing compression, usually in a non-emergency basis.
What are the entities running in the spinothalamic tract?
pain and temperature sense.
What is Brown Sequard syndrome?
?
What usually causes Brown Sequard syndrome?
- penetrating trauma
- radiating myelopathy
- Cord compression (eg epidural HT)
- cervical disc herniation
(tumors, AVMs, cervical spondylosis, herniation)
Clinical findings of Brown Sequard Syndrome
- Ipsilateral:
*Motor paresis below lesion
*Loss of posterior column function - Contralateral:
* Loss of pain and temperature sensation - 1-2 segments below injury
preserved light (crude) touch.
What is “posterior cord syndrome”
?
Clinical findings of “posterior cord syndrome”
mild paresis in UE and
PAIN and PARESTHESIA (often burning) in neck, upper arms and torso.
How common is Brown Sequard syndrome?
?
How common is central cord syndrome?
?
How common is posterior cord syndrome?
?
Which of the cord-syndromes may be surpassing?
- central cord syndrome
? more?
What is different from central/posterolateral disc herniation in Foraminal and extraforaminal lumbar disc herniations?
- less common
- compression of exiting nerve root at the index level
- typically manifest with radiopathy and focal sensorimotor deficits.
What structure might be compressed in foraminal/extraforaminal lumbar disc herniation?
Dorsal root ganglion
Due to compression of the dorsal root ganglion, how might the pain appear ?
burning, dysthetic.
What is spondylolisthesis?
What three types of disc herniations are there?
- protrusion
- extrusion (a line of anulus = contained or uncontained= no anulus seen around the protrusion anymore)
- sequestration
Which are the most common locations of lumbar disc herniation?
Central and posteriolateral.
What are the symptoms from central lumbar disc herniation?
- cauda equina
- nerve root compression:
‘radiculopathy
*sensorimotor deficits - bowel/bladder issues
- neurogenic claudicatio
- lower back pain.
Other names for posterolateral disc herniatin?
- paracentral
- subarticular
- lateral recess herniation
What nerve is usually affected in a posterolateral disc herniation?
The traversing nerve root at that level. Ex. herniation at L4-L5 often affect the L5 nerveroot that traverse the L4-L5 level and exits at the L5 level.
If a posterolateral disc herniation is very large/wide, it might also compress another nerve. which?
The exiting nerve root in the foraminal zone.
When should surgical resection be considered for a lumbar disc herniation?
- significant neurological symtoms
- Failed nonoperative treatment
foraminal/extraforaminal/faar lateral L4-L5 herniation would cause a nerve compression…on what level?
L4 compression