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Nervous System > Surgical Diseases of the Spinal Cord > Flashcards

Surgical Diseases of the Spinal Cord Flashcards

1
Q

what is the myotome for C5?

A

elbow flexor

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2
Q

what spinal level is the wrist extensor supplied by?

A

C6

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3
Q

what is the myotome of c7?

A

elbow extensor

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4
Q

what is the myotome of C8?

A

finger extensors

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5
Q

what spinal level nerve is are the intrinsic hand muscle supplied by?

A

T1

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6
Q

what myotome of supplied by L2?

A

hip flexor

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7
Q

what myotome is supplied by L3?

A

knee extensor

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8
Q

what myotome is supplied by L4?

A

ankle dorsiflexors

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9
Q

what myotome is supplied by L5?

A

long toe extensors

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10
Q

what myotome is supplied by S1?

A

ankle plantar flexors

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11
Q

describe upper motor neuron lesion signs

A

> weakness
increased reflexes
increased tone
Babinski

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12
Q

describe lower motor neuron lesion signs

A 
> weakness
> atrophy
> reflexes decreased
> tone decreased
> fasciculations
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13
Q

what is myelopathy?

A

> upper motor neuron problem

> neurological deficit due to compression of the spinal cord

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14
Q

describe some signs that may be seen in a myelopathy with a lesion at C6?

A

> weakness in elbow
increased tone
brisk reflexes
Babinski positive

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15
Q

what is radiculopathy?

A

> lower motor neuron

> compression of the nerve root leading to dermatomal and myotomal deficits

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16
Q

what signs could you expect to see in a radiculopathy, L4 nerve root lesion?

A

> pain down ipsilateral leg
numbness in L4 dermatome
weakness in ankle dorsiflexion
reduced knee jerk

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17
Q

what are the core diagnostic tests?

A

> CT

> MRI

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18
Q

what is disc prolapse?

A

acute herniation of the intervertebral disc causing compression of the spinal roots or spinal cord

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19
Q

what would a central cervical disc prolapse cause?

A

cervical myelopathy

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20
Q

what would a lateral cervical disc prolapse cause?

A

cervical radiculopathy

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21
Q

what would a central lumbar disc prolapse cause?

A

cauda equina syndrome

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22
Q

what would a lateral lumbar disc prolapse cause?

A

lumbar radiculopathy

23
Q

is pain associated with disc prolapse?

A

yes shooting down the arm/leg

24
Q

what investigation would you carry out for disc prolapse?

A

MRI

25
Q

how could you manage disc prolapse?

A

> rehabilitation
nerve root injection
lumbar/cervical discectomy

26
Q

what are the red flags in cauda equine syndrome?

A

> bilateral sciatica
saddle anaesthesia
urinary dysfunction

27
Q

what investigation does cauda equine syndrome warrant?

A

an urgent MRI

28
Q

what is the management for cauda equine syndrome?

A

emergency lumbar discectomy

29
Q

in older patients what degenerative loss of spinal structure can lead to myelopathy and radiculopathy?

A

> disc prolapse
ligamentum hypertrophy
osteophyte formation

30
Q

what is cervical spondylosis?

A

umbrella term for degenerative change in cervical spine leading to spine and nerve root compression

31
Q

in cervical spondylosis does the patient present with myelopathy or radiculopathy?

A

either or both

32
Q

what is the speed of onset of cervical spondylosis?

A

months to years

33
Q

what is the management for cervical spondylosis?

A

> conservative if there is no/mild myelopathy

> surgery for progressive moderate/ severe myelopathy

34
Q

what are the signs and symptoms in lumbar spinal stenosis?

A

spinal claudication (pain down both legs):

  • worse on walking/standing
  • relieved by sitting/bending forward
35
Q

what is the management in lumbar spinal stenosis?

A

lumbar laminectomy

36
Q

is lumbar spinal stenosis an emergency?

A

no and is usually seen in older patients

37
Q

name some intradural spinal tumours

A

> meningioma
neurofibroma
lipoma

38
Q

name some intramedullary spinal tumours

A

> astrocytoma
ependymoma
teratoma
haemagioblastoma

39
Q

what type of spinal tumour is the most common:
> extradural
> intradural
> intramedullary

A

extradural

40
Q

name some extradural spinal tumours

A

> metastasis

> primary bone

41
Q

how may a patient with malignant cord compression present?

A

> pain
weakness
sphincter disturbance

42
Q

someone with known cancer develops back pain what should you do?

A

get an urgent MRI as there may be malignant cord compression

43
Q

what is the management for malignant cord compression?

A

surgical decompression and radiotherapy

44
Q

what is osteomyelitis?

A

infection within the vertebral body

45
Q

what is discitis?

A

infection of the intervertebral disc

46
Q

what is epidural abscess?

A

infection in the epidural space

47
Q

what is the triad of signs and symptoms for an epidural abscess?

A

> back pain
pyrexia
focal neurology

48
Q

what investigation is carried out in a patient with back pain, pyrexia and focal neurology?

A

in urgent MRI as this could be an epidural abscess

49
Q

what is an epidural abscess?

A

an extradural collection of pus

50
Q

what are the risk factors for and epidural abscess?

A

> IV drug abuse
diabetes
chronic renal failure
alcoholism

51
Q

what organisms are involved in an epidural abscess?

A

> staph aureus
streptococcus
e coli

52
Q

how is an epidural abscess managed?

A

> urgent surgical decompression

> long term IV antibiotics

53
Q

what are the risk factors for osteomyelitis?

A 
> IV drug abuse
> diabetes
> chronic renal failure
> alcoholism
> AIDS
54
Q

how is osteomyelitis managed?

A

> antibiotics

> surgery if there is evidence of neurology

Nervous System (45 decks)

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