Spinal surgery

Question 1

What is the difference between radiculopathy and myelopathy?

Answer 1

radiculopathy= nerve root compression
myelopathy= spinal cord compression

Question 2

What is the pathophysiology of cervical myeloradiculopathy

Answer 2

disc protrusion, facet joint degeneration, osteophyte formation to compress neural structures

Question 3

Does radiculopathy cause UMN or LMN signs?

Answer 3

LMN

Question 4

What pain is typical in radiculopathy pain?

Answer 4

severe shooting arm pain

Question 5

Does myelopathy present with UMN or LMN symptoms?

Answer 5

UMN

Question 6

What is Hoffman’s sign?

Answer 6

loosely holding the middle finger and flicking the fingernail downward, allowing the middle finger to flick upward reflexively. A positive response is seen when there is flexion and adduction of the thumb on the same hand= Babinski reflex in upper limb

Question 7

Is sphincter dysfunction LMN or UMN in origin?

Answer 7

UMN

Question 8

Investigations for cervical myeloradiculopathy?

Answer 8

MRI cervical spine

flexion extension xray

Question 9

Management of cervical myeloradiculopathy?

Answer 9

conservative
analgesia
physio
surgery for ant or post decompression

Question 10

L5 radiculopathy

Answer 10

Numbness and tingling over foot and great toe, weakness= foot drop

Question 11

S1 radiculopathy

Answer 11

numbness on sole of foot and back of calf, weakness of plantar flexion (tippy toes)

Question 12

Red flags for lumbosacral radiculopathy?

Answer 12

significant weakness/foot drop
bilateral leg pain
sphincter symptoms
perineal genital numbness
older/cancer

Question 13

Is sphincter dysfunction in cauda equina syndrome UMN or LMN in origin?

Answer 13

LMN- neuropathic bladder which is atonic and fails to contract, poor flow, dribbling, incomplete emptying, incontinence

Question 14

Is faecal incontinence an early or late sign for cauda equina syndrome?

Answer 14

late signs, irreversible

Question 15

Investigations for cauda equina syndrome?

Answer 15

post void bladder scan
MRI lumbosacral spine
CT if contraindicated

Question 16

What is the surgical management of cauda equina syndrome?

Answer 16

lumbar microdisectomy +- laminectomy

Question 17

List two types of spinal tumours

Answer 17

primary spinal tumour
nerve sheath tumour- neurofibroma and schwannoma
Meningioma
Neoplastic disease of bony disease

Question 18

Which cancers are associated with malignant spinal cord compression

Answer 18

breast, prostate, lung, renal

Question 19

Red flags for malignant spinal cord compression

Answer 19

known cancer
back pain
new onset limn numbness/weakness
sphincter symptoms
new onset
poor balance of legs

Question 20

What is the treatment for malignant spinal cord compression?

Answer 20

surgery

radiotherapy