Surgical Diseases of the Spinal Cord and Nerve Roots Flashcards
What are 4 regions of the spinal column?
- Cervical vertebrae
- Thoracic vertebrae
- Lumbar vertebrae
- Sacrum and coccyx
What are the 5 vertebral ligaments?
- Anterior longitudinal ligament
- Posterior longitudinal ligament
- Ligamentum flavum
- Interspinal ligament
- Supraspinous ligament
Where does the spinal cord extend from?
C1-L2
What runs inferiorly to the spinal cord?
Cauda equina
What myotome is C5?
Elbow flexors
What myotome is C6?
Wrist extensors
What myotome is C7?
Elbow extensors
What myotome is C8?
Finger extensors
What myotome is T1?
Intrinsic hand muscles
What myotome is L2?
Hip flexors
What myotome is L3?
Knee extensors
What myotome is L4?
Ankle dorsiflexors
What myotome is L5?
Long toe extensors
What myotome is S1?
Ankle plantar flexors
UMN: Weakness
Present
UMN: Atrophy
Absent
UMN: Reflexes
Increased
UMN: Tone
Increased
UMN: Fasciculation’s:
Absent
UMN: Babinski
Present
LMN: Weakness
Present
LMN: Atrophy
Present
LMN: Reflexes
Decreased
LMN: Tone
Decreased
LMN: Fasciculation’s
Present
LMN: Babinski
Absent
How can a lesion be localised?
- Pain
- Sensory level
- Weakness
- UMN vs LMN
What type of lesion results in myelopathy?
UMN
What is myelopathy?
Neurological deficit due to compression of spinal cord
What would a C6 spinal cord lesion present with?
- Weakness in elbow below
- Sensory level at C6
- Increased tone in legs
- Brisk reflexes
- Babinski +ve
What type of lesion results in radiculopathy?
LMN
What is radiculopathy?
Compression of nerve root leading to dermatomal and myotomal deficits
What would a L4 nerve root lesion present with?
- Pain down ipsilateral leg
- Numbness in L4 dermatome
- Weakness in ankle dorsiflexion
- Reduced knee jerk
What types of disease may result in spinal surgery?
- Congenital
- Degenerative
- Tumours
- Infection
- Trauma
What is important to differentiate between causes of spinal injury?
- History (pain, speed of onset, PMH)
- Examination
- Investigations (Bloods, X-rays, CT, MRI)
What is disc prolapse?
Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord
Who is usually affected by prolapsed discs?
Younger patients
How does the pain usually present in disc prolapse?
Acute onset of pain
What can central disc prolapse of the cervical region result in?
Cervical myelopathy
What can lateral disc prolapse of the cervical region result in?
Cervical radiculopathy
What can central disc prolapse of the lumbar region result in?
Cauda equine syndrome
What can lateral disc prolapse of the lumbar region result in?
Lumbar radiculopathy
How does disc prolapse present?
- Acute pain down leg/arm
- Numbness and weakness in distribution of nerve root involved
How is disc prolapse investigated?
MRI
How is disc prolapse managed?
- Rehabilitation
- Nerve root inject
- Lumbar/cervical discectomy
What are the red flag symptoms of cauda equine syndrome?
- Bilateral sciatica
- Saddle anaesthesia
- Urinary dysfunction
How should cauda equine syndrome be approached?
As a medical emergency
How is the diagnosis of cauda equine syndrome made?
Clinico-radiological diagnosis
What urgent investigation is required in cauda equine syndrome?
MRI
What is the treatment for cauda equine syndrome?
Emergency lumbar discectomy
What do degenerative spinal disease result in?
Loss of normal spinal structure
Who is usually affected by degenerative spinal diseases?
Older patients
What is degenerative spinal disease the product of?
- Disc prolapse
- Ligamentum hypertrophy
- Osteophyte formation
What can degenerative spinal disease lead to?
- Myelopathy
- Radiculopathy
What is cervical spondylosis?
Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression
What can a patient with cervical spondylosis present with?
Patient can present with either myelopathy or radiculopathy (or both)
What is the speed of onset of cervical spondylosis?
Speed of onset is usually months to years
How is cervical spondylosis managed?
- Conservative if no/mild myelopathy
- Surgery for progressive moderate to severe myelopathy
- Anterior and posterior approaches
How does lumbar spinal stenosis present?
- Pain down both legs ‘spinal claudication’
- Worse on walking/standing and relieved by sitting or bending forward
How is lumbar spinal stenosis managed?
Lumbar laminectomy
Give examples of intradural spinal tumours.
- Meningioma
- Neurofibroma
- Lipoma
Give examples of intramedullary spinal tumours.
- Astrocytoma
- Ependymoma
- Teratoma
- Haemangioblastoma
Give examples of extradural spinal tumours.
- Metastases (lung, breast, prostate)
- Primar bone tumours ( chrodomas, osteoblastomas, osteiud osteoma)
Where can spinal tumours affect?
- 55% extradural
- 40% intradural
- 5% intramedullary
How does a patient with malignant cord compression present?
Patient presents with pain, weakness and sphincter disturbance
What should be done if a known cancer patient presents with back pain?
Urgent MRI
How is malignant cord compression managed?
Surgical decompression and radiotherapy
Give examples of spinal infections.
- Osteomyelitis
- Discitis
- Epidural abscess
Osteomyelitis
Infection within vertebral body
Discitis
Infection of intervertebral disc
Epidural avscess
Infection in the epidural space
What is the triad associated with epidural abscess?
- Back pain
- Pyrexia
- Focal neurology
What should someone presenting with epidural abscess triad undergo?
Urgent MRI
What are the risk factors for epidural abscess?
- IV drug abuse
- Diabetes
- Chronic renal failure
- Alcoholism
What organisms are associated with epidural abscesses?
- Staph aureus
- Streptococcus
- E coli
How are epidural abscesses managed?
Urgent surgical decompression and long term IV antibiotics
What are the risk factors for osteomyelitis?
- IV drug abuse
- Diabetes
- Chronic renal failure
- Alcoholism
- AIDS
How is osteomyelitis managed?
Management is with antibiotics. Surgery if evidence of neurology
