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Musculoskeletal + Rheumatology > Spine Pathology > Flashcards

Spine Pathology Flashcards

1
Q

What is cauda equina syndrome?

A

Compression of cauda equina/sacral nerve roots

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2
Q

What causes cauda equina syndrome?

A

Central lumbar disc prolapse

Malignancy

Trauma: Fractured disc

Spinal stenosis

Infection: Epidural abscess

Iatrogenic: Spinal surgery, Spinal epidural injection

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3
Q

How does cauda equina present?

A

Injury or precipitating event

Bilateral leg and buttock pain and weakness

‘Numb bum’/Saddle Anaesthesia: Perianal loss of sensation, loss of anal tone and anal reflex

Bowel or bladder dysfunction: Urinary retention, Incontinence overflow

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4
Q

What investigation is used in cauda equina diagnosis?

A

Urgent MRI of lumbar-sacral spine within 6 hours

  • If contraindicated then lumbar CT myelogram
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5
Q

How is cauda equina managed?

A

Emergency operation within 24 hours of onset: Realistically ASAP as delay results in permanent dysfunction

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6
Q

Give complications of cauda equina syndrome

A

Sacral nerve roots compressed can result in permanent bladder and anal sphincter dysfunction and incontinence

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7
Q

How does spinal claudication present?

A

Usually bilateral

Sensory dysesthesia

Postural weakness: Foot drop which causes tripping

Takes several minutes to ease after stopping walking

Worse walking down hills as the spinal canal becomes smaller in extension

Better walking uphill or riding bicycle: Vascular is worse going up due to metabolic demand

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8
Q

What causes spinal stenosis?

A

Malignancy

Disc prolapse

Degenerative changes

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9
Q

How does spinal stenosis present?

A

Back pain

  • Relieved by sitting down or leaning forward
  • Worsens with activity
  • Patients find it easier to walk uphill than downhill
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10
Q

What investigations are used in spinal stenosis diagnosis?

A

MRI, demonstrates canal narrowing

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11
Q

What are the two parts of a intervertebral disc?

A

Annulus fibrosus is tough outer layer and nucleus pulposus is gelatinous core

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12
Q

What root is the most common cervical disc prolapse?

A

C5/6

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13
Q

What root is the most common thoracic disc prolapse?

A

75% T8-12, most at T11/12

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14
Q

What roots are the most common lumbar disc prolapse?

A

Usually L4/5 (45%), followed by L5/S1 (40%) then L3/4 (10%)

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15
Q

How do disc prolapses present?

A

Leg pain usually worse than back/dermatomal leg pain

Pain often worse when sitting

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16
Q

How are prolapsed discs managed?

A

Similar to that of other musculoskeletal lower back pain

  • Analgesia/Gabapentin
  • Physiotherapy

if symptoms persist after 4-6 weeks, then referral for consideration of MRI is appropriate

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17
Q

What is spondylolisthesis?

A

Anterior vertebral translation/slippage, often caused by spondylosis

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18
Q

What classification system is used to classify Spondylolisthesis radiographically?

A

Meyerding

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19
Q

What classification system is used to classify spondylolisthesis aeitiologically?

A

Wiltse

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20
Q

Give feaures of spondylolisthesis?

A

Acute back pain

Weakness

Prominent sacrum

Young athletes

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21
Q

How is spondylolisthesis managed?

A

Conservative/Lifestyle changes

Surgery for persistent pain and nerve root entrapment

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22
Q

What is spondylosis?

A

Defect of pars interarticularis usually affecting L4/L5

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23
Q

How does spondylosis present?

A

Lower back pain

24
Q

What causes spinal cord injury?

A

Road traffic accidents

Sport and recreational activities

Falls

Degenerative orthopaedic causes

Tumours

Spinal cord stroke/infarction

Transverse myelitis/infection

Thoracoabdominal aortic aneurysm (TAAA)

25
Q

Describe complete spinal cord injury

A

No function below trauma

No motor or sensory function distal to lesion

No anal squeeze

No sacral sensation (test sacral nerve roots)

ASIA grade A

No chance of recovery

26
Q

Describe incomplete spinal cord injury

A

Variable function

Some function is present below site of injury (sensation in genitals, some lower limb movement etc)

More favourable prognosis overall, trying to prevent further injury

27
Q

Why can’t we determine if spinal cord injury is complete or incomplete acutely?

A

Patient may be in spinal shock

28
Q

What is the classification system for spinal cord injury?

A

ASIA

29
Q

What are the types of spinal cord injury?

A

Tetraplegia/Quadriplegia

Paraplegia

Central cord syndrome

Anterior cord syndrome

Brown-Sequard syndrome

30
Q

What is tetraplegia/quadriplegia?

A

Partial or total loss of use of all four limbs and the trunk

31
Q

What causes tetraplegia/quadriplegia?

A

Cervical fracture

32
Q

How does tetraplegia/quadriplegia present?

A

Respiratory failure due to loss of innervation of the diaphragm (C3-C5)

Spasticity/Increased muscle tone

Loss of motor/sensory function in cervical segments

33
Q

What is paraplegia?

A

Partial or total loss of the use of the lower-limbs

34
Q

What causes paraplegia?

A

Thoracic/lumbar fractures with associated chest or abdominal injuries

35
Q

How does paraplegia present?

A

Arm function spared

Possible impairment of function in trunk

Bladder/bowel function affected

Spasticity if injury of spinal cord (above L1)

Impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments of the spinal cord

36
Q

What causes central cord syndrome?

A

Older patients

Hyperextension injury, due to trip or fall

37
Q

How does central cord syndrome present?

A

Centrally cervical tracts more involved

Weakness of arms > legs

Perianal sensation and lower extremity power preserved

38
Q

What causes anterior cord syndrome?

A

Hyperflexion injury

Anterior compression fracture

Damaged anterior spinal artery (usually due to infarction)

39
Q

How does anterior cord syndrome present?

A

Fine touch and proprioception preserved

Profound weakness

40
Q

What is Brown-Sequard Syndrome?

A

Hemi-section of the cord

41
Q

What causes Brown-Sequard syndrome?

A

Penetrating injuries

42
Q

How does Brown-Sequard syndrome present?

A

Paralysis on affected site (corticospinal)

Loss of proprioception ad fine discrimination (dorsal columns)

Pain and temperature loss on the opposite side below the lesion (spinothalamic)

43
Q

Describe ASIA grade A

A

Complete

No sensory or motor function preserved in sacral segments S4-S5

44
Q

Describe ASIA grade B

A

Incomplete

Sensory but not motor function preserved below the neurologic level and extending through sacral segments S4-S5

45
Q

Describe ASIA grade C

A

Incomplete

Motor functio presevered below the neuroloic level

Majority of key muscles have a grade <3

46
Q

Describe ASIA grade D

A

Incomplete

Motor function preserved below the neurologic level

Majority of key muscls have a grade >3

47
Q

Describe ASIA grade E

A

Normal motor and sensory function

48
Q

What is an iliopsoas abscess?

A

Collection of pus in iliopsoas compartment

49
Q

What organism is most commonly associated with iliopsoas abscess?

A

Staph aureus

50
Q

Give secondary causes of iliopsoas abscesses

A

Crohn’s

Diverticulitis

Colorectal cancer

UTI

Femoral catheter

Endocarditis

IVDU

51
Q

Give features of iliopsoas abscess

A

Fever

Back/flank pain

Lying flat on his back with his knees flexed

Limp

Weight loss

Hyperextension of affected hip should elicit pain as stretches the iliopsoas muscle

52
Q

What investigations are used in iliopsoas abscess diagnosis?

A

CT abdomen

53
Q

How are iliopsoas abscesses managed?

A

Antibiotics

Percutaneous drainage, successful in 90%

Surgery if failure

54
Q

How does discitis present?

A

Back pain

Pyrexia

Rigors

Neurological features if epidural abscess develops

55
Q

What organism is the most common cause of discitis?

A

Staph aureus

56
Q

How is discitis managed?

A

6-8 weeks IV antibiotics

Assess patient for endocarditis

57
Q

What is first line management for lower back pain?

A

Oral NSAIDS

Musculoskeletal + Rheumatology (16 decks)

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