Surgical diseases of the spinal cord and nerve roots

Question 1

What is the anatomy of the spinal cord

Answer 1

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

Question 2

What is the sigs in an upper motor neurone lesion

Answer 2

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

Question 3

What is the signs in a lower motor neurone lesion

Answer 3

Weakness
atrophy 
decreased reflexes
decreased tone 
fasciculations 
numbness

Question 4

What are five factors that can affect the spine

Answer 4

Degenerative

Tumour

Infection

Trauma - disc prolapse

Congenital - lumbar spinal stenosis

Question 5

What occurs in a disc prolapse

Answer 5

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

(trauma affecting younger people_

Question 6

What is the presentation of disc prolapse

Answer 6

Acute onset pain

Acute pain down leg/arm

Numbness and weakness in distribution of nerve root involved

Question 7

What two parts of the spinal cord does disc prolapse occur

Answer 7

Cervical

Lumbar

Question 8

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

Answer 8

Cauda equina syndrome

Question 9

What is the red flag symptoms of cauda equina syndrome

Answer 9

Bilateral sciatic (pain due to compression)

Saddle anaesthesia (loss of sensation in buttocks area)

Urinary dysfunction

(presents as an emergency)

Question 10

How do you diagnose disc prolapse/cauda equina syndrome

Answer 10

Clinically

MRI

Question 11

What is the management of cauda equina syndrome

Answer 11

Emergency lumbar discectomy

Question 12

What is the management of disc prolapse

Answer 12

Rehabilitation
Nerve root inject
Lumbar/cervical discectomy

Question 13

What occurs in degenerative spines

Answer 13

Loss of spinal structure

Mostly seen in older patients

Question 14

What are potentially causes of degenerative spine

Answer 14

Disc prolapse

Ligamentum hypertrophy

Osteophyte formation

Question 15

What occurs in osteophyte formation

Answer 15

bone spurs are bony projections that form along joint margins

Question 16

What can a degenerative spine cause

Answer 16

Myelopathy

Radiculopathy

Question 17

What is cervical spondylosis

Answer 17

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

Question 18

What is the management of cervical spondylosis

Answer 18

Conservation if no or mild myelopathy

Surgery for progressive moderate to severe myelopathy

Question 19

What is the presentation of lumbar spinal stenosis

Answer 19

Pain down both legs (spinal claudication)

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

Question 20

What is the management of lumbar spinal stenosis

Answer 20

Lumbar laminectomy (remove the back of a vertebra)

Question 21

What is the percentage distribution of tumours affecting the spinal cord

Answer 21

5% - Intramedullary

40% - Intradural

55% - Extradural

Question 22

What is examples of intramedullary tumours affecting the spine

Answer 22

Astrocytome
Ependymoma
Teratoma
Hemangioblastoma

Question 23

What is examples of intradural tumours affecting the spine

Answer 23

Meningioma
Neurofibroma
Lipoma

Question 24

What is examples of extradural tumours affecting the spine

Answer 24

Metastases

• Lung
• breast
• Prostate

Primary bone tumours

• chrodomas
• osteoblastomas
• osteiud osteoma

Question 25

What is the presentation of a malignant cord compression

Answer 25

(known cancer) Pain Weakness Spinchter disturbance

Question 26

What is the management of malignant cord compression

Answer 26

Urgent MRI Surgical decompression Radiotherapy

Question 27

What is three examples of spinal infections

Answer 27

Osteomyelitis Discitis Epidural abscess

Question 28

What occurs on osteomyelitis

Answer 28

Infection within the vertebral body

Question 29

What is the risk factors for osteomyelitis

Answer 29

``` IV drug abuse Diabetes Chronic renal failure Alcoholism AIDS ```

Question 30

What is the management of osteomyelitis

Answer 30

Antiobiotics | Surgery

Question 31

What is Discitis

Answer 31

Infection of the vertebral disc

Question 32

How do diagnose epidural abscess (infection in the epidural space)

Answer 32

Urgent MRI

Question 33

What is the triad of symptoms of epidural abscess

Answer 33

Back pain Pyrexia Focal neurology

Question 34

What is the risk factors for epidural abscess

Answer 34

IV drug abuse Diabetes Chronic renal failure Alcoholism

Question 35

What organisms are responsible for epidural abscess

Answer 35

Staph aureas Streptococcus E.Coli

Question 36

What is the management of epidural abscess

Answer 36

Urgent spinal decompression | Long term IV antibiotics

Question 37

Spinal cord

Answer 37

``` C1-7 T1-12 L1-5 S1-5 Coccyx fused -4 = 33 vertebrae ```