Myelopathy and radiculopathy Flashcards
(39 cards)
Give 2 causes of spinal cord compression
- Vertebral body neoplasms - metastases
- Disc prolapse/ herniation
Spinal tumours can be secondary to metastatic disease such as…
Lung cancer
Breast
Prostate
Kidney
Thyroid
Give 6 features of spinal cord compression
- Back pain (mc)
- Progressive lower limb weakness - unsteady gait
- Lesions above L1: UMN signs in legs
- Lesions below L1: LMN signs in legs and perianal numbess
- Bladder/ bowel incontinence - late Sx
- Numbness/ tingling of toes/ fingers
What is normally the first symptom that presents in spinal cord compression
Back pain
State 3 things that could exacerbate the back pain in a spinal cord compression
- Lying down
- Coughing
- Straining
Give 2 RFs for malignant spinal cord compression
- Known cancer
- > 40
What is the gold standard investigation for a spinal cord compression
urgent Gadolinium enhanced MRI of the whole spine within 24hrs of presentation
When is the gold standard investigation for a spinal cord compression contraindicated and what is the alternative imaging offered
- CI - Px with implanted pacemaker or claustrophobia etc
- CT myelography is alternative
How is malignant spinal cord compression managed
- oral dexamethasone ASAP
- Urgent oncological assessment for consideration of radiotherapy or surgical decompression
When are corticosteroids contraindicated in treatment of spinal cord compression
Confirmed or significant suspicion of lymphoma
Why is malignant spinal cord compression considered a medical emergency
Can lead to paralysis
What spinal nerves combine to form the sciatic nerve?
L4-S3
What does the sciatic nerve supply sensory innervation to?
Lateral lower leg and foot
Which muscle groups receive motor function from the sciatic nerve?
Posterior thigh, lower leg, and foot.
What are 2 causes of sciatica
- Disc herniation/ prolapse at L4/5 or L5/S1
- Spinal stenosis
What type of pain characterises sciatica
Unilateral pain from the buttock radiating down the back of the thigh to below the knee or feet, often described as “electric” or “shooting” pain.
State the features of an L3 nerve root compression
- Sensory loss over anterior thigh
- Weak hip flexion, knee extension and hip adduction
- Reduced knee reflex
- Positive femoral stretch test
State the features of an L4 nerve root compression
- Sensory loss - anterior aspect of knee and medial malleolus
- Weak knee extension and hip adduction
- Reduced knee reflex
- Positive femoral stretch test
State the features of an L5 nerve root compression
- Sensory loss dorsum of foot
- Weakness dorsiflexion, inversion and eversion of the ankle
- Reflexes intact
- Positive sciatic nerve stretch test
State the features of an S1 nerve root compression
- Sensory loss in posterolateral aspect of leg and lateral aspect of foot
- Weakness in plantar flexion of foot
- Reduced ankle reflex
- Positive sciatic nerve stretch test
How is sciatica diagnosed
- Clinical exam
- MRI spine (GS) - referral if 4-6w of conservative management has failed
How is sciatica managed
- Physio
- Analgesia - NSAIDs
- PPi
- Amitriptyline or duloxetine
- Spinal decompression if chronic
What is cauda equina syndrome (CES)?
A surgical emergency in which the lumbosacral nerve roots that extend below the spinal cord are compressed
What are the primary causes of cauda equina syndrome
- MC - central disc prolapse at the L4/5 or L5/S1 level and spinal canal stenosis
- Less commonly: tumours, infections (abscess), haematoma or trauma
