Spinal Cord Disorder

Question 1

What is spondylosis?

Answer 1

Non-specific OA or degenerative change affecting the spine

Question 2

Who does cervical spondylosis mostly affect?

Answer 2

> 50

Question 3

Give examples of common findings in spondylosis

Answer 3

Osteophytes
Ligament hypertrophy
Nerve root compression

Question 4

What are the clinical features of cervical spondylosis?

Answer 4

Neck pain
Arm pain
Weakness
Paraesthesia

Question 5

What does MRI show in spondylosis?

Answer 5

Compression of nerve roots

Question 6

What is the management of mild cervical spondylosis?

Answer 6

Neck collar

Analgesia

Question 7

What is the management of severe cervical spondylosis?

Answer 7

Surgical decompression

Question 8

What risks are involved in decompression surgery for spondylosis?

Answer 8

Paralysis
CSF leak
Spinal instability

Question 9

What is a lumbar spinal stenosis?

Answer 9

Narrowing of the central spinal canal in the lumbar spine

Question 10

Which age group is most commonly affected by lumbar spinal stenosis?

Answer 10

> 50

Question 11

Give congenital causes of lumbar spinal stenosis

Answer 11

Achondroplasia
Scoliosis
Congenital spondylolisthesis

Question 12

Give causes of acquired lumbar spinal stenosis

Answer 12

Degenerative
Iatrogenic
Traumatic
Inflammatory

Question 13

What are the clinical features of lumbar spinal stenosis?

Answer 13

Chronic progressive lower back, butt and leg pain bilaterally
Paraesthesia in legs bilaterally
Claudication better on bending forward (cycling, walking uphill, etc)

Question 14

What does examination of lumbar spinal stenosis show?

Answer 14

Positive straight leg raise

Mild motor/sensory deficits

Question 15

What investigation is done on suspicion of lumbar spinal stenosis?

Answer 15

MRI

Question 16

How is lumbar spinal stenosis managed first line?

Answer 16

NSAIDs
Gabapentin
Steroid injection into the epidural space

Question 17

When would decompressive surgery be offered in lumbar spinal stenosis?

Answer 17

Neuro symptoms
Not aided by medication
Significant evidence of compression

Question 18

Give causes of cauda equina syndrome?

Answer 18

Herniated lumbar disc
Tumour
Haemorrhage
Fracture
Abscess

Question 19

How does cauda equina present?

Answer 19

Severe lower back and leg pain
Leg weakness bilaterally
Saddle anaesthesia
Bowel/bladder dysfunction

Question 20

What does examination show in cauda equina syndrome?

Answer 20

LMN weakness
Loss of reflexes
Reduced anal tone

Question 21

What investigation is carried out in cauda equina syndrome suspicion?

Answer 21

MRI

Question 22

How is cauda equina syndrome managed?

Answer 22

Surgical decompression within 24 hours

Question 23

What is syringomyelia?

Answer 23

Development of a fluid filled cystic cavity in the central canal of the spinal cord

Question 24

What is syringobulbia?

Answer 24

Development of a fluid filled cystic cavity in the brainstem

Question 25

What congenital abnormality is syringomyelia associated with?

Answer 25

Arnold-Chiari malformation

Question 26

What is an Arnold-Chiara malformation?

Answer 26

Low lying cerebellar tonsils which extend through the foramen magnum

Question 27

What are the clinical features of syringomyelia?

Answer 27

Gradual progression LMN symptoms at level of the lesion Loss of pain and temp sensation UMN features below the level of the lesion

Question 28

How is syringomyelia/bulbia investigated?

Answer 28

MRI

Question 29

How is syringomyelia treated?

Answer 29

Surgical decompression

Question 30

How does spinal cord infarction present?

Answer 30

Sudden, severe back pain with acute onset of neuro symptoms

Question 31

How does an anterior spinal artery infarct present?

Answer 31

Loss of pain and temp sensation

Question 32

How does a posterior spinal artery infarct present?

Answer 32

Loss of fine touch and vibration

Question 33

How is spinal cord infarction investigated?

Answer 33

``` MRI Nerve conduction studies (to rule out GB) Coag screen (for thrombophilia) Angiogram (for malformation) Echo (cardiac embolism) Antibody screen ```

Question 34

What is transverse myelitis?

Answer 34

Acute inflammation of the spinal cord

Question 35

What are the clinical features of transverse myelitis?

Answer 35

Spontaneous para/tetraplegia developed over several days with bowel/bladder dysfunction and sensory loss

Question 36

How is transverse myelitis investigated?

Answer 36

MRI

Question 37

How is transverse myelitis managed?

Answer 37

High dose steroids to reduce inflammation

Question 38

What is subacute combined degeneration of the cord?

Answer 38

Myelopathy and peripheral neuropathy as a result of decreased vit B12

Question 39

What does MRI show in subacute combined degeneration of the cord?

Answer 39

Hyperintense posterior cord

Question 40

How is subacute degeneration of the cord managed?

Answer 40

Vit B12 supplements