Diseases of Spinal Cord and Nerve Roots (Surgical)

Question 1

Features of upper motor neurone lesions

Answer 1

Muscle weakness – pyramidal weakness in the extensors of upper limbs or flexors of lower limbs
Decreased control of active movement
Spasticity
Clasp-knife response
Babinski sign – big toe extended rather than flexed on stimulation of sole of foot
Increased deep tendon reflex
Pronator drift

Question 2

Features of lower motor neurone lesions

Answer 2

Muscle paresis/paralysis
Fibrillations
Fasciculations – caused by increased receptor concentration on muscles to compensate for lack of innervation
Hypotonia/atonia
Hyporeflexia
Strength not affected – weakness limited to segmental or focal pattern
Muscle wasting in end-stage

Question 3

Upper motor features of spinal cord compression

Answer 3

Weakness 
Increased tone 
Increased reflexes 
Upgoing plantar repsonse 
Clonus

Question 4

Lower motor features of peripheral nerve root compression

Answer 4

Wasting of muscle 
Fasciculation 
Weakness 
Decreased tone 
Decreased reflexes 
Plantar response decreased or absent

Question 5

What is myelopathy?

Answer 5

Non-specific description of a pathology in the spinal cord

Question 6

What is myelitis?

Answer 6

Inflammatory pathology in the spinal cord

Question 7

Medical causes of myelopathy/myelitis

Answer 7

Demyelination 
Ischaemic 
Transverse myelitis 
Metabolic e.g. B12 deficiency 
Neurodegenerative 
Malignancy/infiltration 
Infective 
Inflammatory

Question 8

Surgical causes of myelopathy/myelitis

Answer 8

Degenerative
Tumour
Vascular abnormality
Trauma

Question 9

What is radiculopathy?

Answer 9

Pathology in the nerve rood

Question 10

What is radiculitis?

Answer 10

Nerve root inflammation

Question 11

Causes of spinal cord ishchaemia

Answer 11

Atheromatous disease 
Thromboembolic disease 
Arterial dissection 
Systemic hypotension 
Thrombotic haematological disease 
Hyperviscosity syndromes 
Vasculitis 
Venous occlusion 
Endovascular procedures
Decompression sickness 
Meningovascular syphilis

Question 12

Presentation of spinal cord stroke

Answer 12

Sudden or progressive onset 
Back/radicular pain 
Visceral referred pain 
Weakness - paraparesis 
Numbness and parasthesia 
Urinary retention 
Bladder and bowel incontinence

Question 13

Spinal stroke treatment

Answer 13

Supportive 
Reduce risk of recurrence 
Occupational therapy 
Physiotherapy 
Manage vascular risk factors

Question 14

What is spondylosis?

Answer 14

Degenerative changes in the spine e.g. degenerative intervertebral disc disease
Can occur in cervical, thoracic or lumbar spine

Question 15

Causes of spondylosis

Answer 15

Ageing

Question 16

Investigation of spondylosis

Answer 16

X-rays
MRI
CT

Question 17

Treatment of spondylosis

Answer 17

Chronic condition 
Surgical treatment controversial 
Spinal decompression surgery 
Physical therapy and analgesia 
Steroids

Question 18

Presentation of prolapsed intervertebral disc

Answer 18

Numbness, tingling, weakness
Pain in shoulder, neck, arm, hand
Pain down the back of each leg from the bottom to the knee
Pain with movement, straining and coughing
Difficulty controlling bladder and bowel

Question 19

Investigations of prolapsed disc

Answer 19

History 
Examination 
X-ray 
CT
MRI

Question 20

Treatment of prolapsed disc

Answer 20

Rest/limited activity 
Ice/cold packs, then heat packs 
Physical therapy 
Exercise 
Anti-inflammatories 
Steroids 
Gabapentin

Question 21

Spinal tumour presentation

Answer 21

Dependent on site 
Back pain, sometimes radiating to other parts of the body 
Loss of sensation 
Difficulty walking 
Decreased sensitivity 
Loss of bladder/bowel function 
Muscle weakness

Question 22

Risk factors for spinal tumour

Answer 22

Neurofibromatosis type 2
Von Hippel-Lindau disease
PMH of cancer

Question 23

Investigations for spinal tumour

Answer 23

Spinal MRI
CT
Biopsy

Question 24

Treatment of spinal tumour

Answer 24

Remove tumour completely, if possible 
Monitoring 
Surgery 
Radiation therapy 
Stereotactic radiosurgery 
Chemotherapy 
Corticosteroids

Question 25

Cause of osteomyelitis

Answer 25

Most commonly staphylococcus aureus | Chronic conditions e.g. diabetes may increase risk

Question 26

Risk factors for osteomyelitis

Answer 26

``` Diabetes Sickle cell disease HIV/AIDS Rheumatoid arthritis IV drug abus Alcoholism Long-term use of steroids Haemodialysis Poor blood supply Recent injury Bone surgery ```

Question 27

Symptoms of osteomyelitis

Answer 27

``` Fever, irritability, fatigue Nausea Tenderness, redness and warmth in area of infection Swelling around the affected bone Loss of range of motion Severe back pain if in the vertebrae ```

Question 28

Treatment of osteomyelitis

Answer 28

X-ray, bloods, MRI, bone biopsy Antibiotics Surgery Combination therapy

Question 29

Causes of epidural abscess

Answer 29

Direct extension of local infection e.g. vertebral osteomyelitis, psoas abscess Haematogenous seeding Invasive procedures/instrumentation

Question 30

Risk factors for epidural abscess

Answer 30

``` Diabetes mellitus Spinal trauma Surgery IV drug abuse Alcoholism Renal insufficiency Immunosuppression Pregnancy Spinal/epidural anaesthesia or injection ```

Question 31

Presentation of spinal abscess

Answer 31

``` Localised spinal pain Radicular pain Parasthesia Muscle weakness Sensory loss Sphincter dysfunction Paralysis Back strain/mild injury ```

Question 32

Symptoms of spinal abscess

Answer 32

``` Fever Localised back pain Radiculopathy with radiating/lancinating pain Chest/abdominal pain Spinal cord syndromes Central cord syndrome Paraparesis Paraplegia Sphincter dysfunction Headache and neck pain ```

Question 33

Treatment of spinal abscess

Answer 33

Surgical decompression and drainage Antibiotics CT-directed needle aspiration

Question 34

Causes of Cauda Equina syndrome

Answer 34

Herniation of spinal disc into lumbar area pressing on the nerves Stenosis of spinal canal Spinal lesion/tumour Spinal inflammation, infection, haemorrhage or fracture Complication from severe lumbar spine injury Birth defect

Question 35

Symptoms of cauda equina syndrome

Answer 35

Severe lower back pain Pain, numbness, weakness in one/both legs – causes stumbling, difficulty getting up from a chair Loss of/altered sensations in legs, bottom, inner thighs, back of legs or feet – severe and worsening (saddle anaesthesia) Loss of bladder/bowel control Sexual dysfunction – come on suddenly

Question 36

Investigations for cauda equina syndrome

Answer 36

Full history and examination MRI Myelogram CT

Question 37

Treatment of cauda equina syndrome

Answer 37

Relieve pressure on nerves Surgery within 48 hours Corticosteroids Antibiotics if infection present