Surgical Diseases of the Spinal Cord Flashcards
what is the myotome for C5?
elbow flexor
what spinal level is the wrist extensor supplied by?
C6
what is the myotome of c7?
elbow extensor
what is the myotome of C8?
finger extensors
what spinal level nerve is are the intrinsic hand muscle supplied by?
T1
what myotome of supplied by L2?
hip flexor
what myotome is supplied by L3?
knee extensor
what myotome is supplied by L4?
ankle dorsiflexors
what myotome is supplied by L5?
long toe extensors
what myotome is supplied by S1?
ankle plantar flexors
describe upper motor neuron lesion signs
> weakness
increased reflexes
increased tone
Babinski
describe lower motor neuron lesion signs
> weakness > atrophy > reflexes decreased > tone decreased > fasciculations
what is myelopathy?
> upper motor neuron problem
> neurological deficit due to compression of the spinal cord
describe some signs that may be seen in a myelopathy with a lesion at C6?
> weakness in elbow
increased tone
brisk reflexes
Babinski positive
what is radiculopathy?
> lower motor neuron
> compression of the nerve root leading to dermatomal and myotomal deficits
what signs could you expect to see in a radiculopathy, L4 nerve root lesion?
> pain down ipsilateral leg
numbness in L4 dermatome
weakness in ankle dorsiflexion
reduced knee jerk
what are the core diagnostic tests?
> CT
> MRI
what is disc prolapse?
acute herniation of the intervertebral disc causing compression of the spinal roots or spinal cord
what would a central cervical disc prolapse cause?
cervical myelopathy
what would a lateral cervical disc prolapse cause?
cervical radiculopathy
what would a central lumbar disc prolapse cause?
cauda equina syndrome
what would a lateral lumbar disc prolapse cause?
lumbar radiculopathy
is pain associated with disc prolapse?
yes shooting down the arm/leg
what investigation would you carry out for disc prolapse?
MRI
how could you manage disc prolapse?
> rehabilitation
nerve root injection
lumbar/cervical discectomy
what are the red flags in cauda equine syndrome?
> bilateral sciatica
saddle anaesthesia
urinary dysfunction
what investigation does cauda equine syndrome warrant?
an urgent MRI
what is the management for cauda equine syndrome?
emergency lumbar discectomy
in older patients what degenerative loss of spinal structure can lead to myelopathy and radiculopathy?
> disc prolapse
ligamentum hypertrophy
osteophyte formation
what is cervical spondylosis?
umbrella term for degenerative change in cervical spine leading to spine and nerve root compression
in cervical spondylosis does the patient present with myelopathy or radiculopathy?
either or both
what is the speed of onset of cervical spondylosis?
months to years
what is the management for cervical spondylosis?
> conservative if there is no/mild myelopathy
> surgery for progressive moderate/ severe myelopathy
what are the signs and symptoms in lumbar spinal stenosis?
spinal claudication (pain down both legs):
- worse on walking/standing
- relieved by sitting/bending forward
what is the management in lumbar spinal stenosis?
lumbar laminectomy
is lumbar spinal stenosis an emergency?
no and is usually seen in older patients
name some intradural spinal tumours
> meningioma
neurofibroma
lipoma
name some intramedullary spinal tumours
> astrocytoma
ependymoma
teratoma
haemagioblastoma
what type of spinal tumour is the most common:
> extradural
> intradural
> intramedullary
extradural
name some extradural spinal tumours
> metastasis
> primary bone
how may a patient with malignant cord compression present?
> pain
weakness
sphincter disturbance
someone with known cancer develops back pain what should you do?
get an urgent MRI as there may be malignant cord compression
what is the management for malignant cord compression?
surgical decompression and radiotherapy
what is osteomyelitis?
infection within the vertebral body
what is discitis?
infection of the intervertebral disc
what is epidural abscess?
infection in the epidural space
what is the triad of signs and symptoms for an epidural abscess?
> back pain
pyrexia
focal neurology
what investigation is carried out in a patient with back pain, pyrexia and focal neurology?
in urgent MRI as this could be an epidural abscess
what is an epidural abscess?
an extradural collection of pus
what are the risk factors for and epidural abscess?
> IV drug abuse
diabetes
chronic renal failure
alcoholism
what organisms are involved in an epidural abscess?
> staph aureus
streptococcus
e coli
how is an epidural abscess managed?
> urgent surgical decompression
> long term IV antibiotics
what are the risk factors for osteomyelitis?
> IV drug abuse > diabetes > chronic renal failure > alcoholism > AIDS
how is osteomyelitis managed?
> antibiotics
> surgery if there is evidence of neurology
