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Year 2- CNS > Spine Disorders > Flashcards

Spine Disorders Flashcards

1
Q

Name the five parts of the vertebrae which protects the spinal cord.

A

Cervical
Thoracic
Lumbar
Sacrum
Coccyx

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2
Q

RECAP- which regions of the vertebrae have lordosis curvatures?

A

Lumbar
Cervical

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3
Q

RECAP- which regions of the vertebrae have kyphosis curvatures?

A

Thoracic
Sacral

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4
Q

What is the purpose of the curvatures of the spine?

A

Allows for distribution of weight

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5
Q

There are three regions of the cervical spine- which region is found at C1-2?

A

Atlanto-axial joint

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6
Q

There are three regions of the cervical spine- which region is found at C3-6?`

A

Subaxial spine

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7
Q

There are three regions of the cervical spine- which region is found at C7?

A

Transitional vertebrae

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8
Q

Briefly describe the atlas.

A

No body
No spinous processes
Large transverse processes
Transverse processes are penetrated by the foramen transversarium on each side in which the vertebral arteries pass through.

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9
Q

What name is given to the sticky out point of the axis?

A

Odontoid process/ dens or peg

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10
Q

What does C7 mark?

A

Cervicothoracic junction

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11
Q

What are the uncinate processes of the cervical spine?

A

Bony prominences which restrict lateral flexion

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12
Q

Where would you find the uncovertebral joints?

A

Between the uncinate processes and superior vertebrae

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13
Q

What do the uncovertebral joints serve as a surgical landmark for?

A

Placed closely to vulnerable vertebral artery

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14
Q

What happens to the width and height of the pedicles of the thoracic spine as you go down?

A

Height and width of thoracic pedicles increases

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15
Q

Which bones articulate with the thoracic vertebrae?

A

Ribs at costovertebral joint

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16
Q

Which section of the vertebrae has the biggest body?

A

Lumbar

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17
Q

What crosses the lateral zone of the sacrum laterally?

A

Sympathetic trunk
Lumbosacral trunk
Obturator nerve

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18
Q

Where would you find the anterior and posterior atlanto-occipital membranes?

A

Between C1 and corresponding parts of foramen magnum

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19
Q

The anterior atlanto-occipital membrane continues down as which ligament?

A

Anterior longitudal ligament

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20
Q

Which ligament is a very strong ligament and is important to look at when screening a patient with a spinal problem to ensure the ligament is in tact?

A

Transverse ligament

->the first lecture just goes into loads of detail about the anatomy of the spine, including ligaments and joints. I have stopped making flashcards on them as not sure if it’s a good use of our time but could be worth watching the lecture again to refresh the year one anatomy

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21
Q

What does spinal stability depend on in regards to the three-column theory?

A

At least two intact columns

->if there is a fracture in one part e.g. the anterior part, but the middle and posterior part are fine, spinal stability will be present

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22
Q

How many spinal nerves in each section of the spinal cord?

A

Cervical -8
Thoracic- 12
Lumbar- 5
Sacral- 5
Coccygeal- 1

->eight in cervical as first one arises superior to C1

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23
Q

Therefore, where would the C5 spinal nerve be?

A

Between C4 and 5

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24
Q

Which spinal nerve arises between C7 and T1?

A

C8 spinal nerve

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25
Q

Therefore, which spinal nerve is found between T4 and 5?

A

T4

->this is due to the extra cervical spinal nerve so in the cervical region, always nerve and one above, in the rest, the nerve and the one below

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26
Q

Which reflex is lost in spinal shock?

A

Bulbocavenosus reflex

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27
Q

What is measured to assess neural tube defects in the foetus?

A

Alpha-fetoprotein (AFP)

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28
Q

What causes spina bifida?

A

Failure of closing of the posterior neuropore

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29
Q

What is spina bifida?

A

Birth defect in which there is incomplete closure of the spine and membranes around the spinal cord

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30
Q

What are some risks factors for spina bifida?

A

Lows folic acid levels beforeic acid deficiency
Family history
Diabetes
Obesity
Anti-seizure drugs

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31
Q

What are the two classifications of spina bifida?

A

Spina bifida aperta- open spina bifida
Spina bidifa occulta- closed spina bifida

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32
Q

Spina bifida can occur anywhere along the spine but where is the most common site?

A

Lumbosacral region

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33
Q

In which type of spina bifida is there something seen on the skin of the child, like a sac filled with CSF?

A

Spina bifida aperta (open)

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34
Q

What is the clinical presentation of spina bifida?

A

Back swelling
Lower limb motor defect
Sensory deficit
Sphincteric disturbance
Associated back deformities

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35
Q

Name two types of spina bifida aperta.

A

Meningocele
Myelomeningocele

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36
Q

In which type of spina bifida aperta is there neurological deficit?

A

Myelomeningocele

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37
Q

In which type of spina bifida aperta is there more commonly a skin covered sac?

A

Meningocele

->in myelominingocele, the sac covering is usually membranous

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38
Q

In which type of spina bifida aperta is there more commonly an association with hydrocephalous?

A

Myelomeningocele

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39
Q

What is the treatment of myelomeningele?

A

Primary surgical closure within 24hrs

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40
Q

If the baby with myelomeningocele has other abnormalities which means they cannot have general anaesthetic, what can be done to delay closure?

A

Broad-spectrum antibiotics

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41
Q

If the baby has congenital hydrocephalous, what should b treated first?

A

Hydrocephalous

->sometimes both treated in same surgery

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42
Q

How is hydrocephalous treated?

A

By putting in a VP (ventriculoperitoneal) shunt

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43
Q

Why should hydrocephalous be treated first?

A

If not, the high CSF pressure may open the sutures used to close the spine.
CSF can leak out and meningitis may occur

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44
Q

If a baby is born with myelomengocele and leg weakness, what will surgery do?

A

Will not improve leg weakness but prevents complications

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45
Q

What is tethered cord syndrome?

A

Inelastic anchoring of the caudal spinal cord but abnormally thick or fatty filum terminale

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46
Q

What happens to the spinal cord in tethered cord syndrome?

A

It is abnormally stretched and elongated

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47
Q

List some types of spinal infection.

A

-Pyogenic Vertebral Osteomyelitis and Discitis
-Granulomatous infections
-Epidural infections
-Postoperative infections

48
Q

What does discitis usually arise from?

A

Hamatogenous spread

49
Q

Which region of the spine is most commonly involved in pyogenic infection?

A

Lumbar

50
Q

Which microorganisms are the most common causes of pyogenic vertebral osteomyelitis and discitis?

A

Straph Aureus
Sreptococci

51
Q

How do patients with pyogenic vertebra; osteomyelitis and discitis present clinically?

A

Axial back pain
Fever
Neurological changes in 1/3 of patients

52
Q

What two things should always be asked about in history in patients with infection?

A

Travel history
Recent procedures

53
Q

What would labs show in patients with pyogenic vertebral osteomyelitis and discitis?

A

Possible WBC increase
CRP elevated

->urinalysis and culture should also be investigated

54
Q

Which neuroimaging may be used in pyogenic vertebral osteomyelitis and discitis?

A

Plain x-ray
CT
MRI

55
Q

What is the first-line treatment for vertebral osteomyelitis and discitis?

A

Broad-spectrum IV antibiotics for at least 6-8 weeks until culture-specific regimens may be initiated.

Identify pathogen before initiating treatment e.g. biopsy, bloods etc.

56
Q

When may surgery be appropriate in those with ow do we treat vertebral osteomyelitis and discitis?

A

If:
-appropriate medical management fails
-there is decompression of neural structures
-there is spinal instability or deformity

57
Q

When do postoperative surgical site infections usually arise?

A

Following direct inoculation of the wound with normal skin flora

58
Q

What are some risk factors for postoperative infections?

A

Increased age
Obesity
Diabetes
Smoking
Poor nutrition
Prolonged surgery time

59
Q

How are postoperative infections prevented?

A

Prophylactic antibiotics administered an hour before a spinal procedure.
Additional doses of intraoperative antibiotics should be dispensed for prolonged surgical procedures with significant blood loss or gross contamination.

60
Q

What is the treatment for postoperative infections?

A

IV antibiotics for minimum of six weeks
(can switch to oral depending on course and labs)

61
Q

Spinal cord tumours can be classified as intradural or extradural. What does this mean?

A

Intradural- within dural sac
Extradural- outwith dural sac

62
Q

What would a tumour be classified as if it was within the dural sac but outside neural tissue?

A

Intradural extramedullary tumour

(if inside neural tissue- intramedullary)

63
Q

What does the clinical presentation of spinal cord tumours depend on?

A

Location and extent of cord or nerve root compression

64
Q

Which type of imaging is used to identify spinal cord tumours?

A

Plain x-ray and CT can be used
MRI is gold standard

65
Q

What is the treatment for spinal cord tumours?

A

Surgical excision
Biopsy
Radio and chemotherapy

66
Q

Give some examples of spinal emergencies.

A

-Spinal epidural compression- hematomas or abscesses
-Cauda Equina and Conus Syndromes

67
Q

Spinal hematomas can have many different sites. List them.

A

Subdural, epidural, subarachnoid, intramedullary

68
Q

Spinal hematomas are usually localised dorsally to the spinal cord. Where can subarachnoid hematomas be found?

A

Can extend along the entire subarachnoid space

69
Q

What can cause spinal hematomas?

A

Trauma
Anticoagulant therapy
Vascular malformations
No cause identified in 1/3 cases

70
Q

Symptoms of spinal hematomas depend on location and extent of haemorrhage.
Give some examples of symptoms which may be seen.

A

Motor weakness
Sensory and reflex deficit
Bowel/bladder dysfunction

71
Q

What can epidural and subdural hematomas present with?

A

Intense, knife like pain at location of haemorrhage

72
Q

What can subarachnoid hematomas present with?

A

Meningitis like symptoms

73
Q

Which imaging is gold standard for spinal hematomas?

A

MRI

74
Q

What is the treatment for spinal hematomas?

A

Correction of coagulopathy if present
Emergent surgical decompression if neurological deficit.

75
Q

What is Cauda Equina Syndrome?

A

Surgical emergency resulting from compressive, ischaemic and/or inflammatory neuropathy of multiple lumbar and sacral nerve roots.

76
Q

What can cause cauda equina syndrome?

A

Trauma
Haemorrhage
Inflammatory diseases
Infection
Degenerative spine diseases
Spine tumours

77
Q

Where is the cauda equina?

A

Below L1/2

78
Q

How can cauda equina syndrome present?

A

Leg pain, weakness, anaesthesia
Saddle anaesthesia
Bladder, bowel and sexual dysfunction
Decreased anal tone
Absent ankle reflex

79
Q

Cauda equina syndrome can be complete or incomplete based on the bladder symptoms. What are the symptoms in complete cauda equina syndrome?

A

Urinary and/or bowel retention or incontinence

80
Q

Cauda equina syndrome can be complete or incomplete based on the bladder symptoms. What are the symptoms in incomplete cauda equina syndrome?

A

Loss of urgency
Decreased urinary sensation without incontinence or retention

81
Q

What is the gold standard of imaging for cauda equina syndrome?

A

MRI

82
Q

What is the treatment for cauda equina syndrome?

A

Surgical decompression within 24hrs

83
Q

Which region of the spine is most commonly affected by spinal cord injury?

A

Cervical

(more common higher up, further down, less common)

84
Q

What is primary spinal cord injury?

A

Trauma results in the immediate death of local cells, either by direct damage to cell bodies/neuronal processes or by damage to spinous axons.

85
Q

What happens in spinal cord injury?

A

Overlapping of inflammation, vascular events, chronic phase of injury involving demyelination or scar formation

86
Q

What is spinal shock?

A

Transient loss of all neurological function below the level of the spinal cord injury

87
Q

What does the loss of all neurological function below level of SCI cause to happen?

A

Flaccid paralysis and arefelxia (loss of bulbocavernosus reflex)

88
Q

Shock refers to hypotension, what is the SBP is spinal shock?

A

Systolic BP <80

89
Q

What are the multiple factors of the causes of spinal shock?

A
  1. Interruption of sympathetics which implies SPI above T1
  2. Loss of vascular tone
  3. Relative hypovolemia
  4. True hypovolemia
90
Q

What shows that there has been resolution of the spinal shock?

A

Return of bulbocavernosus reflex.

91
Q

What happens in the bulbocavernous reflex?

A

Squeeze glans penis in men and clitoris in women and see if there is contraction of external anal sphincter

92
Q

After the spinal shock has ended, what would be the symptoms of complete spinal cord injury?

A

Complete loss of motor and/or sensory function below level of injury

93
Q

After the spinal shock has ended, what would be the symptoms of incomplete spinal cord injury?

A

Some residual motor or sensory function below level of injury

94
Q

Give some examples of types of incomplete spinal cord injury.

A

Central cord syndrome
Brown-Sequard syndrome
Anterior cord syndrome
Posterior cord syndrome

95
Q

Which type of incomplete spinal cord injury is the most common?

A

Central cord syndrome

96
Q

How does central cord syndrome usually occur?

A

Due to hyperextension in older patients with pre-existing stenosis

97
Q

What is the clinical presentation for central cord syndrome?

A

Motor weakness in upper limb more than lower limb
Sensory loss below level of injury
Urine retention

98
Q

In central cord syndrome, which limbs recover earlier?

A

Lower limbs

99
Q

What may cause anterior cord syndrome?

A

Occlusion of anterior spinal artery
Anterior cord compression

100
Q

How does anterior cord syndrome present?

A

Paraplegia (quadplegia if higher than C7)
Dissociated sensory loss below lesion, loss of pain and temperature but joint position sense and vibration not affected

101
Q

What does Brown-Sequard Syndrome manifest with?

A

Ipsilateral loss of joint position sense and vibration.
Contralateral loss of pain and temperature
Ipsilateral spastic paresis below level of lesion

102
Q

What does the primary assessment and management of spinal cord management involve?

A

Airway
Breathing
Circulation
Immobilization

103
Q

What does the secondary assessment of spinal cord injury involve?

A

Assessment of conscious level using Glasgow Coma Scale
Identifying any axial, appendicular or pelvic skeleton fractures

104
Q

Which type of X-ray allows good imaging of C1/2?

A

Open mouth (odontoid view) x-ray

105
Q

What are some indications for early decompression in spinal cord injuries?

A

Incomplete spinal cord injury
Patients with progressive neurological deterioration

106
Q

List possible cervical spine fractures.

A

Occipital condyle fracture
Atlanto-occipital dislocation
Atlas fracture
Axis fracture
Subaxial cervical spine fractures

107
Q

What is the most common cause of occipital condyle fractures?

A

Direct blow to head

108
Q

What may patients with occipital condyle fractures present with?

A

Loss of consciousness
Cranio-cervical pain

109
Q

In which age group is atlanto-occipital dislocation common?

A

Children due to smaller size of occipital condyles and soft tissue laxity

110
Q

Atlanto-occipital dislocation is typically an instantly fatal injury. What issues do survivors have?

A

80% of survivors have neurological deficits
20% have normal findings

111
Q

Subaxial cervical spine fractures can be divided into which two types?

A

Ligamentous
Osseous

112
Q

Name the types of thorco-lumbar spine injuries.

A

Compression
Burst
Seat belt
Fractures/dislocations

113
Q

There are three zones of the sacral spine. If there is damage to zone 1 of the sacral spine, which type of injuries will this produce?

A

Neurological injuries
Usually L5 nerve root or sciatic nerve is damaged

114
Q

What are the general indications for surgical treatment in spine fractures?

A
  1. Occipital condyle avulsion fractures
  2. Atlanto-occipital avulsion fractures
  3. More than 5mm C1-2 displacement
  4. Neurological deficits
  5. Biomechanical instability
  6. Non-union after 12 weeks immobilisation
115
Q
A

Year 2- CNS (49 decks)

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