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Neurology > Spine Things > Flashcards

Spine Things Flashcards

1
Q

Name some causes of SCC

A 
trauma
vertebral compression fracture
disc herniation
primary or secondary tumour
infection
degeneration e.g. spondylosis
haemorrhage
RA
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2
Q

How would an acute cord transection present?

A

Loss of all motor and sensory modalities below lesion
–> sensory and motor level
Initially spinal shock –> flaccid arreflexic paralysis
Upper motor neurone signs appear later

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3
Q

What is the name for a cord hemisection and how would it present?

A

Brown-Sequard syndrome

  • ipsilateral motor level
  • ipsilateral dorsal column sensory level
  • contralateral spinothalamic sensory level (pain + temperature)
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4
Q

What type of injury causes central cord syndrome?

A

Hyperflexion or extension injury to an already stenotic neck

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5
Q

How does central cord syndrome present?

A
  • distal upper limb weakness
  • ‘cape-like’ spinothalamic sensory loss
  • lower limb power preserved
  • dorsal column preserved
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6
Q

Which types of cancer may be responsible for a metastatic SCC?

A

Lung
Breast
Prostate
Kidney

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7
Q

How do you manage a metastatic SCC?

A 
Dexamethasone 16mg STAT
Urgent MRI spine
Surgery if fit --> decompression/stabilisation
Radiotherapy
Chemotherapy
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8
Q

What are the general back pain red flags?

A

Failure to improve after 4-6 weeks conservative management
Unrelenting pain at night or at rest
Progressive motor or sensory deficit

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9
Q

What are the back pain red flags for AAA?

A

Abdominal pulsating mass

Pain at rest

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10
Q

What are the back pain red flags for cancer?

A

Age over 50
Weight loss
History of cancer
Pain at night or at rest

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11
Q

What are the back pan red flags for infection?

A 
Fever/chills
Recent infection
Immunosuppression
IV drug use
Foreign travel
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12
Q

What are the back pain red flags/risk factors for fracture?

A

Age over 50
Osteoporosis
Significant trauma
Chronic steroids

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13
Q

What are the back pain red flags for cauda equina?

A 
Bilateral sciatica
Urinary incontinence
Decreased anal tone
Saddle anaesthesia
Leg weakness
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14
Q

Describe the straight leg raise and what it’s looking for

A

Flex hip with leg straight until resistance and/or pain
Places sciatic nerve and hamstrings on stretch
Herniating disc causing compression of sacral nerve roots –> back pain radiating to lower extremity
Pain in affected leg when contralateral leg is raised –> highly specific for nerve root entrapment

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15
Q

Which investigations should you do if someone presents with acute lumbar back pain?

A

None –> most patient do not need investigating

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16
Q

When is a plain x-ray useful in back pain?

A

Young men: S1 going to exclude ankylosing spondylitis

Elderly: to exclude vertebral collapse, other fractures, malignancy

17
Q

Which investigation should you do if a patient has back pain with red flags/neurological signs +/- symptoms?

A

MRI

18
Q

Which blood tests would be useful if a patient has back pain with red flag symptoms?

A

Malignancy –> PSA, acid phosphatase, monoclonal bands
Infection markers
Metabolic causes –> ALP, calcium, phosphate, HLA B-27

19
Q

How do you manage back pain (without red flags)?

A 
Exercise, keep moving
Regular analgesia --> NSAIDs + gastroprotection
Opiates if pain severe
Physiotherapy
Alternative therapies
20
Q

Which levels are most common for a lumbar disc herniation and which nerve root is usually affected?

A

L4/5 and L5/S1

Nerve root below usually affected (so L5 and S1 respectively)

21
Q

What is a radiculopathy?

A

Dermatomal sensory deficit + weakness of muscles supplied by that nerve root

22
Q

What is sciatica?

A

Pain along sciatic nerve –> L4-S3

23
Q

What are the clinical features of a lumbar disc herniation?

A

Sciatic pain –> shooting pain from buttocks down to posterior knee/leg
Exaggerated by coughing/sneezing
Numbness/tingling
Weakness
Straight leg raise positive (pain at < 45 degrees)

24
Q

What is the management for lumbar disc herniation?

A

Physiotherapy
Analgesia
Surgery

25
Q

What are the indications for surgery in lumbar disc herniation?

A 
Failed conservative management
Severe pain
Central disc prolapse (bilateral sciatica, sphincter disturbance, reduced perineal sensation)
Tumour
Neuro deficits
26
Q

Which investigations should be done in suspected cauda equina?

A

MRI lumbosacral spine

PR exam to check anal sphincter tone and perianal numbness

27
Q

What is the management of cauda equina?

A

Emergency surgical decompression

28
Q

What is spinal stenosis?

A

Narrowing of the spinal canal compressing the cord/nerve roots

29
Q

What are the clinical features of spinal stenosis?

A

Progressive onset
Unilateral or bilateral hip, buttock or leg pain/burning
Precipitated by standing or back extension
Relieved by sitting, lumbar flexion or walking up hill
Neurogenic intermittent claudication
–> leg weakness, tingling and numbness

30
Q

What is the treatment for spinal stenosis?

A

Physiotherapy
Analgesia
Lumbar laminectomy (remove back of vertebra) –> if symptoms intolerable

31
Q

What is cervical spondylosis and how does it present?

A

Degenerative arthritis of C-spine

  • degenerative cervical myelopathy (UMN signs)
  • radiculopathy (LMN signs)
32
Q

How does degenerative cervical myelopathy present?

A

UMN signs, more prominent in lower limbs

  • imbalance, gait disturbance, falls
  • clumsy hands, tingling
  • incontinence
  • pain
  • legs jump at night due to hyperreflexia
33
Q

Which investigation should be done for suspected degenerative cervical myelopathy?

A

MRI C-spine

34
Q

What is the treatment for degenerative cervical myelopathy?

A

Most patients present too late

Decompressive spinal surgery can prevent deterioration

Neurology (16 decks)

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