Spinal disease

Question 1

What are two important differential diagnoses for a patient with leg pain brought on by exercise?

Answer 1

1) Lumbar spinal stenosis
2) Intermittent claudication of peripheral vascular disease

Question 2

How does the pain in lumbar spinal stenosis present?

Answer 2

1) Neurogenic claudication - proximal thigh or buttock cramping pain which radiates down the leg, associated with burning or tingling
2) Pain is worse with exercise but not immediately relieved when standing still, relieved more when seated
3) Pain may be worse in extension e.g. descending stairs and improved in flexion e.g. being able to cycle far in excess of their exercise tolerance on foot

Question 3

What features would suggest spinal stenosis over peripheral vascular disease?

Answer 3

1) Absence of vascular risk factors
2) Absent bruits
3) Present peripheral pulses and warmth, well perfused
4) Skin changes are also uncommon in neurogenic claudication

Question 4

What suggests spinal stenosis over osteoarthritis of the hip?

Answer 4

Highly stereotyped and reproducible pain - suggests more specific abnormality (spinal stenosis) compared to pain on exercise due to generalised MSK disease

Question 5

What is cervical spondylotic myelopathy?

Answer 5

Degenerative disorder of the cervical spine

Question 6

How does cervical spondylotic myelopathy present?

Answer 6

1) Neck pain
2) Radicular upper limb symptoms
3) Spastic paraparesis in the lower limbs

Question 7

Which nerve root supplies the muscles involved in knee extension?

Answer 7

L3

Question 8

Which nerve root supplies the muscles involved in foot eversion?

Answer 8

S1

Question 9

Which nerve root supplies the muscles involved in hip flexion?

Answer 9

L2

Question 10

Which nerve root supplies the muscles involved in foot inversion?

Answer 10

L4

Question 11

Which nerve root supplies dorsiflexion of the big toe?

Answer 11

L5

Question 12

How would you investigate/diagnosis spinal cord compression?

Answer 12

MRI