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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
Describe complete spinal cord injury
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
Describe incomplete spinal cord injury
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
Why can't we determine if spinal cord injury is complete or incomplete acutely?
Patient may be in spinal shock
28
What is the classification system for spinal cord injury?
ASIA
29
What are the types of spinal cord injury?
Tetraplegia/Quadriplegia Paraplegia Central cord syndrome Anterior cord syndrome Brown-Sequard syndrome
30
What is tetraplegia/quadriplegia?
Partial or total loss of use of all four limbs and the trunk
31
What causes tetraplegia/quadriplegia?
Cervical fracture
32
How does tetraplegia/quadriplegia present?
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
What is paraplegia?
Partial or total loss of the use of the lower-limbs
34
What causes paraplegia?
Thoracic/lumbar fractures with associated chest or abdominal injuries
35
How does paraplegia present?
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
What causes central cord syndrome?
Older patients Hyperextension injury, due to trip or fall
37
How does central cord syndrome present?
Centrally cervical tracts more involved Weakness of arms \> legs Perianal sensation and lower extremity power preserved
38
What causes anterior cord syndrome?
Hyperflexion injury Anterior compression fracture Damaged anterior spinal artery (usually due to infarction)
39
How does anterior cord syndrome present?
Fine touch and proprioception preserved Profound weakness
40
What is Brown-Sequard Syndrome?
Hemi-section of the cord
41
What causes Brown-Sequard syndrome?
Penetrating injuries
42
How does Brown-Sequard syndrome present?
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
Describe ASIA grade A
Complete No sensory or motor function preserved in sacral segments S4-S5
44
Describe ASIA grade B
Incomplete Sensory but not motor function preserved below the neurologic level and extending through sacral segments S4-S5
45
Describe ASIA grade C
Incomplete Motor functio presevered below the neuroloic level Majority of key muscles have a grade \<3
46
Describe ASIA grade D
Incomplete Motor function preserved below the neurologic level Majority of key muscls have a grade \>3
47
Describe ASIA grade E
Normal motor and sensory function
48
What is an iliopsoas abscess?
Collection of pus in iliopsoas compartment
49
What organism is most commonly associated with iliopsoas abscess?
Staph aureus
50
Give secondary causes of iliopsoas abscesses
Crohn's Diverticulitis Colorectal cancer UTI Femoral catheter Endocarditis IVDU
51
Give features of iliopsoas abscess
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
What investigations are used in iliopsoas abscess diagnosis?
CT abdomen
53
How are iliopsoas abscesses managed?
Antibiotics Percutaneous drainage, successful in 90% Surgery if failure
54
How does discitis present?
Back pain Pyrexia Rigors Neurological features if epidural abscess develops
55
What organism is the most common cause of discitis?
Staph aureus
56
How is discitis managed?
6-8 weeks IV antibiotics Assess patient for endocarditis
57
What is first line management for lower back pain?
Oral NSAIDS

Musculoskeletal + Rheumatology (16 decks)

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