Neurosurgery Module- Spine

Question 1

what parts of the spinal cord contain a lateral horn?

Answer 1

thoracic and upper lumbar spine

Question 2

what does the lateral horn contain?

Answer 2

sympathetics

Question 3

dermatome for medial malleolus?

Answer 3

L4

Question 4

dermatome for toes 4 + 5 + lateral malleolus?

Answer 4

S1

Question 5

dermatome for dorsum of the foot and toes 1-3

Answer 5

L5

Question 6

what vertebrae have short and bifid spinous processes

Answer 6

C3-C5

Question 7

most common locations for lumbar disc herniation?

Answer 7

L4/5

L5/S1

Question 8

most common direction of a disc prolapse? what nerve will be affected from this?

Answer 8

posterolateral

will affect the lower nerve

Question 9

what is a radicuopathy?

Answer 9

dysfunction of a nerve root causing a dermatomal sensory deficit with weakness of the affected nerve’s muscle groups

Question 10

describe sciatic pain?

Answer 10

shooting pain from bum down to posterior leg/knee

exaggerated by valsalva

Question 11

presentation of a prolapsed L5/S1 disc with S1 damage?

Answer 11

pain along posterior thigh with radiation to heel
weakness of plantar flexions
sensory loss in lateral foot
reduced/absent ankle jerk

Question 12

pain in anterior thigh and wasting of the quad muscles and a reduced knee jerk is likely to indicate what nerve root’s pathology?

Answer 12

L4

Question 13

what would make you do a discectomy?

Answer 13

failure of physio and drugs
pain
central disc prolapse
tumour
neuro deficit

Question 14

bilateral sciatica indicates a central disc prolapse T or F

Answer 14

T

Question 15

a disc prolapse where can cause cauda equina syndrome?

Answer 15

L4/5 midline herniation

Question 16

causes of cauda equina?

Answer 16

prolapsed lumbar disc
tumour compression
trauma
infection
haematoma

Question 17

Ix for cauda equina?

Answer 17

MRI lumbosacral spine

PR exam

Question 18

Tx for cauda equina syndrome from disc herniation/

Answer 18

discectomy

Question 19

Tx for cauda equina syndrome from fracture?

Answer 19

decompression + fixation

Question 20

symptomatic lumbar spinal stenosis most commonly occurs at what levels?

Answer 20

L4/5

L3/4 is next most common

Question 21

causes of spinal stenosis

Answer 21

hypertrophy of facet joints and ligamentum flavum
protruding intervertebral discs
spondylolisthesis

Question 22

presentation of spinal stenosis?

Answer 22

unilateral burning hip/buttocks/leg pain 
insidious onset
relieved by sitting/lumbar flexion
better walking downhill
neurogenic intermittent claudication

Question 23

Ix of neurogenic claudication?

Answer 23

MRI lumbosacral spine

Question 24

surgical Tx of lumbar spinal stenosis

Answer 24

lumbar laminectomy

Question 25

pathological process in cervical spondylosis?

Answer 25

degenerative arthritis involving cervical spine and IV discs

Question 26

does a radiculopathy cause UMN or LMN signs

Answer 26

LMN

Question 27

clinical features of a cervical spondylosis?

Answer 27

radiculopathy | myelopathy

Question 28

classic radiographic appearance of cervical spondylosis?

Answer 28

narrowing of disc space | osteophytes

Question 29

Tx of cervical spondylosis?

Answer 29

laminectomy if due to osteophytes | discetomy if disc prolapse

Question 30

does myelopathy cause UMN or LMN signs?

Answer 30

UMN

Question 31

symptoms are more prominent where in degenerative cervical myelopathy

Answer 31

lower limbs hence FALLS

Question 32

presentation of degenerative cervical myelopathy?

Answer 32

imbalance of gait -> falls clumsy hands non-dermatomal pain weakness

Question 33

examination findings of cervical myelopathy?

Answer 33

``` weakness hyperreflexia spasticity +ve babinski and hoffman's signs loss of dexterity ```

Question 34

Ix for cervical myelopathy?

Answer 34

MRI c spine

Question 35

cause of anterior cord syndrome?

Answer 35

infarction of the area supplied by the anterior spinal artery

Question 36

presentation of anterior cord syndrome?

Answer 36

BELOW the level of injury: paralysis loss of pain temperature

Question 37

what cord functions are unaffected in anterior cord syndrome?

Answer 37

proprioception | vibration sensation

Question 38

presentation of a complete cord transection?

Answer 38

spinal shock THEN UMN symptoms

Question 39

ipsilateral UMN paralysis and contralateral loss of pain and temp sensation below the level of the lesion indicates what condition..

Answer 39

brown sequard syndrome

Question 40

bilateral upper limb weakness with some lower limb weakness is indicated by what condition and why?

Answer 40

central cord syndrome | the fibres for the arms are more medial to that for the legs so a central cord lesion will affect them more