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Neuro 4 > Spinal disorders > Flashcards

Spinal disorders Flashcards

1
Q

Kyphosis vs lordosis

A

Lordosis = amy lord sticking her bum out - kyphosis = rounding (huncback)

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2
Q

What travels through the transverse foramen?

A

vertebral arteries

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3
Q

wWhich cervical spine has no body?

A

C1

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4
Q

Cervial spine spinal provess is

A

bifid, except for C7 which is long and straight

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5
Q

Saggital diamiter of spinal canal

A

decreases the fursther dwn you go eg c3-6 is aorund 18mm, c7 is around 15mm

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6
Q

WHat is te uncinate process, what does it do, and what does it a landmar for?

A

in cervical spine, stops lateral flexion. Landmark for vertebral arteries

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7
Q

Spinous process C7

A

long and straight

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8
Q

Key features of thoracic

A

transverse processes for the ribs, heart shaped body, costal fascets, slanted spinous process

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9
Q

What are the 3 zones in the sacrum and what is the significance of this?

A

Lateral, intermediate, medial

Lateral = crossed by sympathetic trunk, lumbosacral trunk and obturator nerve

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10
Q

What does the anterior antlanto occipital membrane continue as?

A

anterior longitudinal ligament

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11
Q

What is the cruciate and transverse ligament?

A

transverse ligament keeps the dens inplace, and the cruiate ligament extends beyond that to top and below too.

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12
Q

What sis the apical ligament?

A

dens -> anterior part of the foramen magnum

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13
Q

What do the alar ligaments do?

A

limit head rotation (dens - > anterior part of FM)

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14
Q

What does the tetorial membrane continue down beyond c3 as?

A

Anterior longitudinal ligament

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15
Q

WHAT IS THE ATLANNTO-OCCIPITAL JOINT?

A

C1 -> occipital.

yes movements (flexion and extension) - condyloid joint

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16
Q

aTLANTO-AXIAL JOINT ALLOWS WHAT MOVEMENT? wHAT TYPE OF JOINT?

A

No, rotational movement. Synovial pivot

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17
Q

wHERE ARE THE VERTEBRAL DISCS?

A

From C2-3 to L5-S1

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18
Q

wHAT ARE THE COMPONENTS OF THE SPIINTERVERTEBRAL DISC?

A

Nucleus pulposus (middle) and anulus fibrosus.

(fibrocartilaginous - symphysis joint)

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19
Q

wHAT ARE THE 3 COUMNS OF RH SPINE AND WHAT ARE WITHN THEM?

A

Anterior (anterior longitudinal ligament, ant half of vertebral body)

middle (Posterior longitudinal ligament, post half body)

posterior (everything behind that!)

Spinal stability relies on at least 2/3 being intact

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20
Q

hOW ARE OUT 31 PAIRS OF SPINAL NERVES SPLIT UP?

A

8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

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21
Q

wHICH SPINAL NERVE EXITS BETWEEN WHICH SPVERTEBRAL BDODIES?

A

cervicla becuase there is more nerves than bodies, starts above then works down. Then Thoracic and below exits below the level.

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22
Q

dERMATOMAL DISTRIBUTION: t4, t10, t12

A

T4 = nipple
T10 = belly button
T12 = mid inguinal ligament

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23
Q

Dermatomes: C6,7,8 L3, L5,S1

A

C6 = thumb
C7 = middle finger
C8 = little finger

L3 = inside knee
L5 = middle toe
S1 = lateral heel

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24
Q

Myotomes : C5,6,7,8,T1. L2,3,4,5,S1

A

C5 = biceps
C6 = wrist extension
C7 = tricepts
C8 = middle finger
T1 = little finger abduction

L2 = hip flection (illiopsoas)
L3 = knee extension
L4 = ankle dorsifelxion
L5 = big toe extension (dorsiflexion)
S1 = plantar flexion

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25
Q

Reflexes spienal leevels;
-Bicep
Supoinator
Tricep
keneejerk, a
nkle jerl. Which is firs to come back?

A

S1-2 = ankle jerk
L3-4 = knee jerk
C7-8 = triceps
C5-6 = bicep
C6-7 = Supinator

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26
Q

conus medularis ends : , adults, new born , foetus

A

New Born = L3
Foetus = S2
Adults -= L1/2

27
Q

What is neurulation and how long does it take?

A

28 days after conception

-folding of the neural fold to make the neural tube

28
Q

What leads to spina bifida?

A

incomplete closure of he neural tube

29
Q

What are the risk factors for spina bifida?

A

-TOO LITTLE FOLIC ACID
-familiy history
-obesity, diabetes
-sodium valproate

30
Q

What are the types of spina bifida?

A

spina bifida occulta - no out pouch, all intact, just missing say the spinous process

meningocele - outpouch of the meninges - translucent, little/no neurological deficit)

Myelomeningocele - outpouch of meninges AND spinal chord/nerves - membranous sac covering, neurologicla deficit, transopoaque.

31
Q

How do we treat spina bifida?

A

Surgery within 24h.

32
Q

What is a key complication of myelomeningocele?

A

HYDROCEPHALUS - V likely to have - must check!!

33
Q

What is thethered cord syndrome?

A

Fibrous/ thickened/fatty filum terminale.

34
Q

Signs and symptoms of tthered cord syndrome?

A

Neurological, urological, orthopeaedic

35
Q

Pyogenic vertebral oseteomyelitis : presentatiuon, species, location, what o you need ot ask about

A

-axial pain, fever, neuro issues - numbess, muscle weakness.

  • Staphlycoccus Aureus mainly

-recent travel/procedures

36
Q

Investigation in pyogenic vertebral osteomyelitis

A

Blood cultures, MRI (ideally, if not then CT/XR)

CRP, WBC, Erythrocyte sedimentation rate, Uninalysis

37
Q

Good disc means? Bad disc menas?

A

Good disc = bad news (if disc isn’t involved with symptoms, then it is likely to be a tumour)

Bad disc = good news (more likely to be an infection)

38
Q

How to treat pyogenic vertebral osteomyelitlts

A

IV antivbiotics 6-8 weeks. - more specific antibiotics when cultures return (!take cultures before antibiotics start!).
-restrict spine movements
-if needed - surgery

39
Q

What are the indicators for surgery in Pyogenic vertebral oseomyelitis?

A
  • medical management is failing
    -neurologicla deteriation
    -spinal deformity
40
Q

Post op infectins ususally what kinda bact?

A

Ones that ususally live on your skin!

41
Q

How do we prevent post-op infections?

A

Give antibiotics 60 minutes before the start of the op.

42
Q

What are he 3 types f spinal cord tumours?

A

Extradural, intradural - intramedullary (within the actual spinal chord) and extramedullary (outside the spinal chord)

43
Q

How do we investigate spinal chord tumours? How do we treat them?

A

Scans! Ideally MRI or if not hen CT/Xray

Along with clinical findings

44
Q

Spinal epidural compression, cauda equina and conus syndromes are emergencies/non emergncies?

A

EMERGENCY!

45
Q

treatment of spinal haematomas

A

Surgical decompression if needed and correction of coagulopathy

46
Q

Cauda equina incomplete vs complete and symptoms

A

Complete - you get the whole shebang inc. incontinance/bowl retention

47
Q

Causa equina syndrome symptoms and treatment

A

Saddle anaethesia,
bladder/bowl/sexual dysfunciton
leg pain/weakness,
no ankle reflex.

Treatment = MRI

48
Q

Primary Spinal Chord Injury (SCI) is due to what?

A

Trauma - 50% =rta

49
Q

What are the 4 events in secondary SCI?

A

Inflammation, Vascular (ischaemic), Chronic - demylenation and scar formation

50
Q

What is the bulbocavernous reflex?

A

Closure of anal sphincter on squeeze of penis/clitoris.

It is the first reflex to come back following spinal shock.

51
Q

What is spinal shock?

A

transient loss of neurological function below SCI
Hypotension (SBP 80mmHg)

72h - 2 weeks

52
Q

What can we tell after spinal shck ends?

A

the extent of the damage, if complete or incomplete damage

53
Q

What is the most comon type of spinal chord tract?

A

Central Cord Syndrome - “vascular watershed zone”

54
Q

What iare the sign/symptoms for central chord syndrome?

A

Urine retention, sensory loss below level of injury, motor loss -> upper limb more than lower limb, because upper limb are more medial in the corticopsinal tract, and lower limb are more lateral.

55
Q

Anterior Cord Syndrome: what is it? What is it caused by? What does it present with?

A

When the front of the spinal chord is injured.

Can be caused by occlusion of the anterior spinal artery or cord compression.

Presents with loss of motor function - paraplegia or quadriplegia (higher than c7)

pain/temp sensations lost, but 2 point discrimination, vibration, proprioception and pressure sensatsation preserved

56
Q

What can show us c1 c2 in x ray?

A

Odontoid view

57
Q

What are hte indications for early decompressin in patients with a spinal chord injury?

A

Neurological deterioration
Incomplete spinal chord injury

58
Q

Types of cerivcal spine injury :

A

Occipital condyle fracture
-rare
-unconcious, stable, pain, cranial nerves usually intact

Atlanto-occipital dislocation
-children, usually fatal or significant neuro deficit

Atlas fracture
-usually neurologically intact (space, and fracture explodes away)

Axis fracture
-odontoid peg/body/dens off body - hangmans fracture

Atlanto-axial instability

Subaxial c spine

59
Q

How can we differentiate unilateral and bilateral dislocations?

A

Unilateral = displacement under 25%

Bilateral = displacement over 50%

60
Q

Thoraco lumbar spinal inuries: Distraction, Extenspoin, flexion and compression meanings

A

Distraction = stretched, extension = extension, flexion = flexion and compression = comperssion

61
Q

Wht are hte 4 categories of thoraco-lumbar spinal injuries?

A

Compression, burst, seat belt, fracture-dislocaitons

62
Q

Sacral spine fractures

A

Zone 1 (lateral) = l5/sciatic injury

Zone 2 (intermedial) = neuro deficit (28%) but usually still have sphincter

Zone 3 (medial) = most profound neuro defect. may inc bowel and bladder

63
Q

Indications for surgery in spinal fractures?

A

Neuro 4 (8 decks)

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