10: Spinal cord and root dysfunction

Question 1

Which symptoms do patients with spinal cord problems present with?

Answer 1

Sensory - pain, abnormal sensations

Motor - weakness, sphincter and sexual dysfunction

Question 2

If the arms are involved, which segment of the spine is likely to be involved?

Answer 2

Cervical

Question 3

If a spinal cord prolapse is central, ___ motor neurons are more likely to be involved.

Answer 3

upper

Question 4

If a spinal cord problem is lumbar in origin, which limbs will be involved?

Answer 4

Lower limbs

Question 5

Which chart can be used to diagnose the level of a spinal cord injury?

Answer 5

ASIA chart

Question 6

Which motor neurons are affected by a lateral prolapse?

Answer 6

Lower motor neurons (LMNs)

Question 7

Where does pain occur in cervical disc prolapses?

Answer 7

Arms (tends to be)

Question 8

Which section of the spine does disc prolapse most often occur in?

Answer 8

Lumbar

Question 9

Are upper motor neurons found in the lumbar spine?

Answer 9

No, so if a patient has problems in the lower limbs but they’re typical of UMN lesions (see table), the problem is higher up

Question 10

What is spinal / neurogenic claudicstion?

Answer 10

Pain caused by a narrowing of spine, putting pressure on nerve roots

often compared to vascular but v different

Question 11

Spinal claudication must not be mistaken for ___ claudication.

Answer 11

vascular

Question 12

What can be checked to differentiate spinal claudication from vascular claudication?

Answer 12

Peripheral pulses

Question 13

What is the triad of symptoms in cauda equina syndrome?

Answer 13

Saddle anaesthesia

Leg pain

Bowel/bladder dysfunction (painless retention and loss of anal tone)

Question 14

What type of incontinence do patients with advanced cauda equina get?

Answer 14

Overflow incontinence

too late to treat

Question 15

Which types of sensation should you test for in suspected cauda equina syndrome?

Answer 15

Light touch

Pin prick

Question 16

Which spinal nerves are compressed in cauda equina syndrome?

Answer 16

S2 - 4

Pudendal nerve roots

Question 17

How are patients with suspected cauda equina investigated?

Answer 17

Urgent MRI scan

Question 18

Pain in which spinal region is a red flag?

Answer 18

Thoracic region

Question 19

What are general red flag cancer symptoms?

Answer 19

Weight loss

Fever

Night sweats

Question 20

Pain which patients notice at ___ is a red flag.

Answer 20

night

Question 21

What is cervical myelopathy?

Answer 21

Progressive compression of the spinal cord in the cervical spine due to disc prolapse

Question 22

Are the symptoms of cervical myelopathy unilateral or bilateral?

Answer 22

Bilateral

Question 23

Which motor neurons are affected in cervical myelopathy?

Answer 23

UMNs

Question 24

Which group of patients tend to develop cervical myelopathy?

Answer 24

Elderly

Question 25

What are the symptoms of cervical myelopathy?

Answer 25

‘Numb, clumsy hands’ -> bilateral, difficulty performing ADLs

Gait problems -> falls

Question 26

Describe

a) Babinski’s

b) Hoffman’s

c) Lhermitte’s

signs, which can all be seen in cervical myelopathy.

Answer 26

a) Toes extend on stroking the plantar surface of the foot

b) Thumb, index and middle fingers flex when the nail of middle finger is tapped

c) Patient experiences ‘electric shock’ sensation on neck flexion

Question 27

Does surgery for cervical myelopathy reverse the symptoms?

Answer 27

No, only halts progress

Question 28

What is the conservative treatment for a disc prolapse?

Answer 28

Analgesia

Physiotherapy

Question 29

Does surgery make any difference to the final outcome of most disc prolapses?

Answer 29

No

Tends to speed up recovery, but most patients end up in the same place two years later

Question 30

Surgery for back pain has a lot of potential ___.

Answer 30

complications

Question 31

What is failed back syndrome?

Answer 31

Chronic back pain following surgery

Question 32

What is an upper motor neuron?

What is its path?

Answer 32

Motor neuron connecting the brain (motor cortex) to the spinal cord (at the level of the muscle the next neuron will supply)

Question 33

What is a lower motor neuron?

What is its path?

Answer 33

Motor neuron connecting the spinal cord (anterior horn) to the muscle itself

Question 34

How is muscle tone affected in upper motor neuron disease?

Answer 34

Muscle tone increases

(Hypertonia)

Question 35

How is muscle tone affected in lower motor neuron disease?

Answer 35

Decreased muscle tone

(Hypotonia)

Question 36

What is a consequence of decreased muscle tone in lower motor neuron disease?

Answer 36

Atrophy

Question 37

What is a fasciculation?

Answer 37

Brief muscle twitch

Question 38

In which type of motor neuron disease are fasciculations seen?

Answer 38

Lower motor neuron disease

Question 39

Describe how reflexes change in upper motor neuron disease.

Answer 39

Brisk reflexes

i.e hypersensitive reflexes due to impaired descending controls from the UMNs

Question 40

Describe how reflexes change in lower motor neuron disease.

Answer 40

Decreased / Absent reflexes

because the reflex arc relies on LMNs, which are damaged

Question 41

What is the plantar reflex?

Answer 41

When sole of the foot is stroked, toes should FLEX

Question 42

What is the Babinski reflex?

In which type of motor neuron disease is it found?

Answer 42

When sole of foot is stroked, toes EXTEND (abnormal)

Upper motor neuron disease

Question 43

What is clonus?

In which neurological disease is it sometimes seen?

Answer 43

Involuntary, rhythmic muscle contractions

Epilepsy (see: juvenile myoclonic epilepsy)

Question 44

Clonus can be a feature of (UMN / LMN) disease.

Which common neurological disease may have clonus as one of its symptoms?

Answer 44

UMN disease

Epilepsy (juvenile myoclonic epilepsy)