Surgical diseases of the spinal cord and nerve roots Flashcards
What is the anatomy of the spinal cord
Extends C1-L2, the continues as the conus medularis and further cause equina
What is the sigs in an upper motor neurone lesion
Weakness (below lesion level)
Increases reflexes
Increased tone
Babinski present
What is the signs in a lower motor neurone lesion
Weakness atrophy decreased reflexes decreased tone fasciculations numbness
What are five factors that can affect the spine
Degenerative
Tumour
Infection
Trauma - disc prolapse
Congenital - lumbar spinal stenosis
What occurs in a disc prolapse
Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord
(trauma affecting younger people_
What is the presentation of disc prolapse
Acute onset pain
Acute pain down leg/arm
Numbness and weakness in distribution of nerve root involved
What two parts of the spinal cord does disc prolapse occur
Cervical
Lumbar
What is it called when disc prolapse occurs centrally in the lumbar region
Cauda equina syndrome
What is the red flag symptoms of cauda equina syndrome
Bilateral sciatic (pain due to compression)
Saddle anaesthesia (loss of sensation in buttocks area)
Urinary dysfunction
(presents as an emergency)
How do you diagnose disc prolapse/cauda equina syndrome
Clinically
MRI
What is the management of cauda equina syndrome
Emergency lumbar discectomy
What is the management of disc prolapse
Rehabilitation
Nerve root inject
Lumbar/cervical discectomy
What occurs in degenerative spines
Loss of spinal structure
Mostly seen in older patients
What are potentially causes of degenerative spine
Disc prolapse
Ligamentum hypertrophy
Osteophyte formation
What occurs in osteophyte formation
bone spurs are bony projections that form along joint margins
What can a degenerative spine cause
Myelopathy
Radiculopathy
What is cervical spondylosis
Degenerative changes in cervical spine leading to spine and nerve root compression
(presents with either myelopathy/radiculopathy)
What is the management of cervical spondylosis
Conservation if no or mild myelopathy
Surgery for progressive moderate to severe myelopathy
What is the presentation of lumbar spinal stenosis
Pain down both legs (spinal claudication)
Worse on walking/standing and relived by sitting or bending forward
What is the management of lumbar spinal stenosis
Lumbar laminectomy (remove the back of a vertebra)
What is the percentage distribution of tumours affecting the spinal cord
5% - Intramedullary
40% - Intradural
55% - Extradural
What is examples of intramedullary tumours affecting the spine
Astrocytome
Ependymoma
Teratoma
Hemangioblastoma
What is examples of intradural tumours affecting the spine
Meningioma
Neurofibroma
Lipoma
What is examples of extradural tumours affecting the spine
Metastases
- Lung
- breast
- Prostate
Primary bone tumours
- chrodomas
- osteoblastomas
- osteiud osteoma
What is the presentation of a malignant cord compression
(known cancer)
Pain
Weakness
Spinchter disturbance
What is the management of malignant cord compression
Urgent MRI
Surgical decompression
Radiotherapy
What is three examples of spinal infections
Osteomyelitis
Discitis
Epidural abscess
What occurs on osteomyelitis
Infection within the vertebral body
What is the risk factors for osteomyelitis
IV drug abuse Diabetes Chronic renal failure Alcoholism AIDS
What is the management of osteomyelitis
Antiobiotics
Surgery
What is Discitis
Infection of the vertebral disc
How do diagnose epidural abscess (infection in the epidural space)
Urgent MRI
What is the triad of symptoms of epidural abscess
Back pain
Pyrexia
Focal neurology
What is the risk factors for epidural abscess
IV drug abuse
Diabetes
Chronic renal failure
Alcoholism
What organisms are responsible for epidural abscess
Staph aureas
Streptococcus
E.Coli
What is the management of epidural abscess
Urgent spinal decompression
Long term IV antibiotics
Spinal cord
C1-7 T1-12 L1-5 S1-5 Coccyx fused -4 = 33 vertebrae
