Surgical diseases of the spinal cord and nerve roots Flashcards
List the number of each type of vertebrae eg cervical
C1-7 T1-12 L1-5 S1-5 coccygeal
What are the 2 components of the vertebral disc
annulus fibrosis
nucleus pulposus
What is ligamentum flavum between?
pedicles
Name the 5 vertebral ligaments from posterior to anterior
supraspinal interspinal ligamentum flavum posterior longitudinal anterior longitudinal
What are the 2 pops heard on lumbar puncture?
ligamentum flavum and dura
Where does the spinal cord extend from and to?
C1-L2
4 ways to localise the lesion
pain
weakness
sensory
UMN vs LMN
List some of the symptoms of C6 spinal cord compression
sensory loss at C6 increased tone in legs weakness in elbow below brisk reflexes Babinski +ve
What is a myelopathy? LMN or UMN?
neurological defecit due to compression of spinal cord
UMN
Symptoms of L4 nerve root lesion
pain down ipsilateral leg
numbness in L4 dermatome
weakness in ankle dorsiflexion
reduced knee jerk
Radiculopathy - what is it? UMN or LMN?
Compression of nerve root leading to dermatomal and myotomal defecits
What is a disc prolapse?
Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord
Disc prolapse -symptoms and age of patients
young patient
acute pain down leg/arm
numbness and weakness in distribution of nerve root involved
Diagnosis and treatment of disc prolapse
MRI
rehab, nerve root inject, lumbar/cervical discectomy
What occurs in central disc prolapse in lumbar region?
cauda equine syndrome
3 red flags of cauda equine syndrome
bilateral sciatica
saddle anaesthesia
urinary dysfunction
What does cauda equine require?
emergency MRI
emergency lumbar discectomy
3 things causing degenerative conditions of spinal cord
oseophyte formation
ligamentum hypertrophy
disc prolapse
Define cervical spondylosis
umbrella term for degenerative change in cervical spine leading to spine and nerve root compression
Would a patient with cervical spondylosis present with myelopathy or radiculopathy?
either or both
Speed of onset of cervical spondylosis
months to years
Management of cervical spondylosis
conservative - no/mild myelopathy
surgery if progressive or severe
anterior and posterior approach
Symptoms of lumbar spine stenosis
pain down both legs - spinal claudication
worse on walking and relieved by sitting or bending forward
Management of lumbar spine stenosis
lumbar laminectomy
Examples of intramedullary tumours
astrocytomas, Teratoma, ependymoma, haemangioblastoma
Examples of intradural tumours
meningioma, neurofibroma, lipoma
Examples of extradural tumours
metastases eg breast, lung, prostate
primary bone tumour eg osteoblastoma
Malignant cord compression symptoms
pain, weakness, sphincter disturbance
If a patient with known cancer and developing back pain presents what would you do?
emergency MRI
Management of malignant cord compression
decompression
radiotherapy
osteomyelitis
infection within vertebra body
discitis
Infection within vertebral disc
epidural abscess
Infection in epidural space
epidural abscess triad for emergency MRI
pyrexia
back pain
focal neurology
Risk factors for epidural abscess
IVDA, diabetes, chronic renal failure, alcoholism
Organisms causing epidural abscess
staph aureus, streptococcus, e coli
Management of epidural abscess
urgent surgical decompression
long term antibiotics
Risk factors of osteomyelitis
IVDU, alcohol, AIDS, chronic renal failure, diabetes
Management of osteomyelitis
antibiotics
surgery if evidence of neurology
