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Systems: Neurology AB > Surgical Diseases of the Spinal Cord and Nerve Roots > Flashcards

Surgical Diseases of the Spinal Cord and Nerve Roots Flashcards

1
Q

What are 4 regions of the spinal column?

A
  • Cervical vertebrae
  • Thoracic vertebrae
  • Lumbar vertebrae
  • Sacrum and coccyx
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2
Q

What are the 5 vertebral ligaments?

A
  • Anterior longitudinal ligament
  • Posterior longitudinal ligament
  • Ligamentum flavum
  • Interspinal ligament
  • Supraspinous ligament
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3
Q

Where does the spinal cord extend from?

A

C1-L2

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4
Q

What runs inferiorly to the spinal cord?

A

Cauda equina

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5
Q

What myotome is C5?

A

Elbow flexors

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6
Q

What myotome is C6?

A

Wrist extensors

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7
Q

What myotome is C7?

A

Elbow extensors

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8
Q

What myotome is C8?

A

Finger extensors

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9
Q

What myotome is T1?

A

Intrinsic hand muscles

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10
Q

What myotome is L2?

A

Hip flexors

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11
Q

What myotome is L3?

A

Knee extensors

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12
Q

What myotome is L4?

A

Ankle dorsiflexors

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13
Q

What myotome is L5?

A

Long toe extensors

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14
Q

What myotome is S1?

A

Ankle plantar flexors

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15
Q

UMN: Weakness

A

Present

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16
Q

UMN: Atrophy

A

Absent

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17
Q

UMN: Reflexes

A

Increased

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18
Q

UMN: Tone

A

Increased

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19
Q

UMN: Fasciculation’s:

A

Absent

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20
Q

UMN: Babinski

A

Present

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21
Q

LMN: Weakness

A

Present

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22
Q

LMN: Atrophy

A

Present

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23
Q

LMN: Reflexes

A

Decreased

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24
Q

LMN: Tone

A

Decreased

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25
Q

LMN: Fasciculation’s

A

Present

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26
Q

LMN: Babinski

A

Absent

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27
Q

How can a lesion be localised?

A
  • Pain
  • Sensory level
  • Weakness
  • UMN vs LMN
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28
Q

What type of lesion results in myelopathy?

A

UMN

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29
Q

What is myelopathy?

A

Neurological deficit due to compression of spinal cord

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30
Q

What would a C6 spinal cord lesion present with?

A
  • Weakness in elbow below
  • Sensory level at C6
  • Increased tone in legs
  • Brisk reflexes
  • Babinski +ve
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31
Q

What type of lesion results in radiculopathy?

A

LMN

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32
Q

What is radiculopathy?

A

Compression of nerve root leading to dermatomal and myotomal deficits

33
Q

What would a L4 nerve root lesion present with?

A
  • Pain down ipsilateral leg
  • Numbness in L4 dermatome
  • Weakness in ankle dorsiflexion
  • Reduced knee jerk
34
Q

What types of disease may result in spinal surgery?

A
  • Congenital
  • Degenerative
  • Tumours
  • Infection
  • Trauma
35
Q

What is important to differentiate between causes of spinal injury?

A
  • History (pain, speed of onset, PMH)
  • Examination
  • Investigations (Bloods, X-rays, CT, MRI)
36
Q

What is disc prolapse?

A

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

37
Q

Who is usually affected by prolapsed discs?

A

Younger patients

38
Q

How does the pain usually present in disc prolapse?

A

Acute onset of pain

39
Q

What can central disc prolapse of the cervical region result in?

A

Cervical myelopathy

40
Q

What can lateral disc prolapse of the cervical region result in?

A

Cervical radiculopathy

41
Q

What can central disc prolapse of the lumbar region result in?

A

Cauda equine syndrome

42
Q

What can lateral disc prolapse of the lumbar region result in?

A

Lumbar radiculopathy

43
Q

How does disc prolapse present?

A
  • Acute pain down leg/arm

- Numbness and weakness in distribution of nerve root involved

44
Q

How is disc prolapse investigated?

A

MRI

45
Q

How is disc prolapse managed?

A
  • Rehabilitation
  • Nerve root inject
  • Lumbar/cervical discectomy
46
Q

What are the red flag symptoms of cauda equine syndrome?

A
  • Bilateral sciatica
  • Saddle anaesthesia
  • Urinary dysfunction
47
Q

How should cauda equine syndrome be approached?

A

As a medical emergency

48
Q

How is the diagnosis of cauda equine syndrome made?

A

Clinico-radiological diagnosis

49
Q

What urgent investigation is required in cauda equine syndrome?

A

MRI

50
Q

What is the treatment for cauda equine syndrome?

A

Emergency lumbar discectomy

51
Q

What do degenerative spinal disease result in?

A

Loss of normal spinal structure

52
Q

Who is usually affected by degenerative spinal diseases?

A

Older patients

53
Q

What is degenerative spinal disease the product of?

A
  • Disc prolapse
  • Ligamentum hypertrophy
  • Osteophyte formation
54
Q

What can degenerative spinal disease lead to?

A
  • Myelopathy

- Radiculopathy

55
Q

What is cervical spondylosis?

A

Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression

56
Q

What can a patient with cervical spondylosis present with?

A

Patient can present with either myelopathy or radiculopathy (or both)

57
Q

What is the speed of onset of cervical spondylosis?

A

Speed of onset is usually months to years

58
Q

How is cervical spondylosis managed?

A
  • Conservative if no/mild myelopathy
  • Surgery for progressive moderate to severe myelopathy
  • Anterior and posterior approaches
59
Q

How does lumbar spinal stenosis present?

A
  • Pain down both legs ‘spinal claudication’

- Worse on walking/standing and relieved by sitting or bending forward

60
Q

How is lumbar spinal stenosis managed?

A

Lumbar laminectomy

61
Q

Give examples of intradural spinal tumours.

A
  • Meningioma
  • Neurofibroma
  • Lipoma
62
Q

Give examples of intramedullary spinal tumours.

A
  • Astrocytoma
  • Ependymoma
  • Teratoma
  • Haemangioblastoma
63
Q

Give examples of extradural spinal tumours.

A
  • Metastases (lung, breast, prostate)

- Primar bone tumours ( chrodomas, osteoblastomas, osteiud osteoma)

64
Q

Where can spinal tumours affect?

A
  • 55% extradural
  • 40% intradural
  • 5% intramedullary
65
Q

How does a patient with malignant cord compression present?

A

Patient presents with pain, weakness and sphincter disturbance

66
Q

What should be done if a known cancer patient presents with back pain?

A

Urgent MRI

67
Q

How is malignant cord compression managed?

A

Surgical decompression and radiotherapy

68
Q

Give examples of spinal infections.

A
  • Osteomyelitis
  • Discitis
  • Epidural abscess
69
Q

Osteomyelitis

A

Infection within vertebral body

70
Q

Discitis

A

Infection of intervertebral disc

71
Q

Epidural avscess

A

Infection in the epidural space

72
Q

What is the triad associated with epidural abscess?

A
  • Back pain
  • Pyrexia
  • Focal neurology
73
Q

What should someone presenting with epidural abscess triad undergo?

A

Urgent MRI

74
Q

What are the risk factors for epidural abscess?

A
  • IV drug abuse
  • Diabetes
  • Chronic renal failure
  • Alcoholism
75
Q

What organisms are associated with epidural abscesses?

A
  • Staph aureus
  • Streptococcus
  • E coli
76
Q

How are epidural abscesses managed?

A

Urgent surgical decompression and long term IV antibiotics

77
Q

What are the risk factors for osteomyelitis?

A
  • IV drug abuse
  • Diabetes
  • Chronic renal failure
  • Alcoholism
  • AIDS
78
Q

How is osteomyelitis managed?

A

Management is with antibiotics. Surgery if evidence of neurology

Systems: Neurology AB (51 decks)

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