Surgical diseases of the spinal cord and nerve roots Flashcards

1
Q

What is the anatomy of the spinal cord

A

Extends C1-L2, the continues as the conus medularis and further cause equina

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2
Q

What is the sigs in an upper motor neurone lesion

A

Weakness (below lesion level)
Increases reflexes
Increased tone
Babinski present

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3
Q

What is the signs in a lower motor neurone lesion

A
Weakness
atrophy 
decreased reflexes
decreased tone 
fasciculations 
numbness
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4
Q

What are five factors that can affect the spine

A

Degenerative

Tumour

Infection

Trauma - disc prolapse

Congenital - lumbar spinal stenosis

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5
Q

What occurs in a disc prolapse

A

Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord

(trauma affecting younger people_

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6
Q

What is the presentation of disc prolapse

A

Acute onset pain

Acute pain down leg/arm

Numbness and weakness in distribution of nerve root involved

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7
Q

What two parts of the spinal cord does disc prolapse occur

A

Cervical

Lumbar

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8
Q

What is it called when disc prolapse occurs centrally in the lumbar region

A

Cauda equina syndrome

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9
Q

What is the red flag symptoms of cauda equina syndrome

A

Bilateral sciatic (pain due to compression)

Saddle anaesthesia (loss of sensation in buttocks area)

Urinary dysfunction

(presents as an emergency)

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10
Q

How do you diagnose disc prolapse/cauda equina syndrome

A

Clinically

MRI

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11
Q

What is the management of cauda equina syndrome

A

Emergency lumbar discectomy

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12
Q

What is the management of disc prolapse

A

Rehabilitation
Nerve root inject
Lumbar/cervical discectomy

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13
Q

What occurs in degenerative spines

A

Loss of spinal structure

Mostly seen in older patients

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14
Q

What are potentially causes of degenerative spine

A

Disc prolapse

Ligamentum hypertrophy

Osteophyte formation

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15
Q

What occurs in osteophyte formation

A

bone spurs are bony projections that form along joint margins

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16
Q

What can a degenerative spine cause

A

Myelopathy

Radiculopathy

17
Q

What is cervical spondylosis

A

Degenerative changes in cervical spine leading to spine and nerve root compression
(presents with either myelopathy/radiculopathy)

18
Q

What is the management of cervical spondylosis

A

Conservation if no or mild myelopathy

Surgery for progressive moderate to severe myelopathy

19
Q

What is the presentation of lumbar spinal stenosis

A

Pain down both legs (spinal claudication)

Worse on walking/standing and relived by sitting or bending forward

20
Q

What is the management of lumbar spinal stenosis

A

Lumbar laminectomy (remove the back of a vertebra)

21
Q

What is the percentage distribution of tumours affecting the spinal cord

A

5% - Intramedullary

40% - Intradural

55% - Extradural

22
Q

What is examples of intramedullary tumours affecting the spine

A

Astrocytome
Ependymoma
Teratoma
Hemangioblastoma

23
Q

What is examples of intradural tumours affecting the spine

A

Meningioma
Neurofibroma
Lipoma

24
Q

What is examples of extradural tumours affecting the spine

A

Metastases

  • Lung
  • breast
  • Prostate

Primary bone tumours

  • chrodomas
  • osteoblastomas
  • osteiud osteoma
25
What is the presentation of a malignant cord compression
(known cancer) Pain Weakness Spinchter disturbance
26
What is the management of malignant cord compression
Urgent MRI Surgical decompression Radiotherapy
27
What is three examples of spinal infections
Osteomyelitis Discitis Epidural abscess
28
What occurs on osteomyelitis
Infection within the vertebral body
29
What is the risk factors for osteomyelitis
``` IV drug abuse Diabetes Chronic renal failure Alcoholism AIDS ```
30
What is the management of osteomyelitis
Antiobiotics | Surgery
31
What is Discitis
Infection of the vertebral disc
32
How do diagnose epidural abscess (infection in the epidural space)
Urgent MRI
33
What is the triad of symptoms of epidural abscess
Back pain Pyrexia Focal neurology
34
What is the risk factors for epidural abscess
IV drug abuse Diabetes Chronic renal failure Alcoholism
35
What organisms are responsible for epidural abscess
Staph aureas Streptococcus E.Coli
36
What is the management of epidural abscess
Urgent spinal decompression | Long term IV antibiotics
37
Spinal cord
``` C1-7 T1-12 L1-5 S1-5 Coccyx fused -4 = 33 vertebrae ```