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Spinal Disorders Flashcards

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1
Q

Describe the atlas

A

C1 - ring shaped
Has anterior and posterior arch fusing to lateral masses
No body or spinous process
Foramen transversarium has vertebral arteries in

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2
Q

Describe the axis

A

Has body and odontoid process that projects anteriorly

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3
Q

What are some features of cervical vertebrae?

A

Uncinate processes - bony process of superolateral aspects of C3-7 which resist lateral flexion
Uncovertebral joint - uncinate process and superior vertebrae
Spinous process

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4
Q

What are features of thoracic spine?

A

Heart shaped body, small spinal canal, ribs articulate with transverse process and ribs makes the thoracic spine stiffer

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5
Q

What are features of lumbar spine?

A

Kidney shaped bodies, transmits body weight to sacrum, no costal facets and width increases inferiorly

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6
Q

What are the features of the sacral vertebrae?

A

Fuse and progressively become smaller forming the triangular shape
Transmits weight to pelvis
Divided into 3 zones - lateral, intermediate and medial zones

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7
Q

What are some spinal ligaments?

A

Anterior and posterior atlanto-occipital membrane, transverse ligament, cruciate, apical, alar, anterior longitudinal, posterior longitudinal, ligamentum flavum and supraspinous ligament

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8
Q

Describe the atlanto-occipital and atlanto-axial joints?

A

First one allows flexion, extension and some lateral flexion
Atlanto-axial is median pivot joint

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9
Q

Describe the intervertebral discs

A

Located C2-3 and L5-S1
Has nucleus pulposus, annulus fibrosus and end plates - diffusion of nutrients to bone

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10
Q

What is the three column theory?

A

Anterior - anterior longitudinal ligament, anterior of annulus fibrosis and vertebral body
Middle - posterior longitudinal, posterior annulus fibrosis and vertebral body
Posterior - osseous and ligamentous structures posterior
Stability depends on 2 of these being intact

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10
Q

How many spinal nerves are there?

A

31 pairs
8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

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11
Q

What are the main reflexes of the body?

A

Bicep, supinator, triceps, abdominal, cremasteric, knee, ankle, anal cutaneous and bulbocavernous

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12
Q

When can loss of bulbocavernous reflex be seen?

A

In spinal shock, conus medullaris and cauda equina lesions

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13
Q

What tracts control sensation?

A

Dorsal column - fine touch, joint position, vibration and proprioception
Lateral spinothalamic tract - pain + temp.
Anterior spinothalamic tract - light crude touch

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14
Q

Describe the notochord in embryology

A

Neural plate formed from ectoderm then neural groove to neural fold
This closes to form neural tube - takes 28 days
Tube gives rise to brain and spinal cord
Notochord - mesoderm forms bones of spine

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15
Q

Describe the anterior neuropore

A

Closes at 24 days
Failure to close results in anencephaly which is most common brain defect

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16
Q

Describe the posterior neuropore

A

Closes at 26-28 days
Failure to close results in spinal bifida

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17
Q

What can identify neural tube defects in high risk mothers?

A

Alpha fetoprotein and acetylcholinesterase from amniocentesis

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18
Q

What is spinal bifida?

A

Birth defect where there is incomplete closure of spine and membrane surrounding spinal cord

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19
Q

What are the risk factors of spinal bifida?

A

Low levels of folic acid before and after early pregnancy
FH
Diabetes and obesity
Anti-seizure drugs - sodium valproate

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20
Q

What are the types of spinal bifida?

A

Spinal bifida aperta - includes meningocele and myelomeningocele
Spinal bifida occulta - closed
Mainly in lumbar region but can be cervical

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21
Q

What is the clinical picture of spinal bifida?

A

Back swelling, low back motor deficit, sensory deficit, sphincter disturbance and associated back + lower limb deformities

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22
Q

What are the differences between meningocele and myelomeningocele?

A

Meningocele - covered by normal skin and contains CSF, is translucent, no neurological deficit
Myelomeningocele - sac is usually membranous, contains CSF and neural tissue, trans opaque, neurological deficit and sphincter deficit. Also associated to HCP

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23
Q

What is the treatment for spinal bifida?

A

Myelomeningocele - primary surgical closure
Intra uterine myelomeningocele repair (IUMR)

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24
What is tethered cord syndrome?
Inelastic anchoring of the caudal spinal cord by abnormally thick or fatty filum terminale Results in lumbosacral spinal cord being stretched and elongated Presents with neurological, urological and orthopaedic signs
25
What could cause a spinal infection?
Pyogenic vertebral osteomyelitis and discitis Granulomatous infections Epidural infections Postoperative infections
26
Describe pyogenic vertebral osteomyelitis and discitis
Discitis arises from hematogenous spread Involve mainly the lumbar spine then thoracic then cervical being less Most common - Staph aureus and streptococcus
27
What are the clinical symptoms and signs of pyogenic vertebral osteomyelitis and discitis?
Axial pain is most common and fever Neurological changes in some patients - radicular numbness and muscle weakness
28
What are the investigations for pyogenic vertebral osteomyelitis?
WCC may increase, ESR, CRP is elevated, blood cultures, and urinalysis Neuroimaging - X ray, CT and MRI
29
What is the treatment for pyogenic vertebral osteomyelitis?
Fist line - broad spectrum IV antibiotics for 6-8 weeks Immobilization for reducing pain and stabilises spine Surgery needed if meds fail, neurological deterioration and spinal instability
30
What are the risk factors for postoperative infections?
Increased age, obesity, diabetes, tobacco use, poor nutrition, prolonged surgical time and placement of instrument
31
What is post operative infections associated with?
Longer hospital stays Higher complication rates Increased mortality
32
How is post operative infections prevented?
Prophylactic antibiotics If significant blood loss or gross contamination then intraoperative antibiotics
33
What is the treatment for postoperative infections?
Open irrigation and debridement IV antibiotics for 6 weeks and oral after
34
What are the types of spinal cord tumours?
Extradural Intradural extramedullary Intramedullary
35
What is the imaging used for spinal cord tumours?
Pain X ray and CT MRI is gold standard
36
What is the treatment of spinal cord tumours?
Surgical excision, biopsy and RT + chemo
37
What are spinal emergencies?
Spinal epidural compression Cauda equina and conus syndromes
38
What are the causes of spinal hematomas?
Usually no factor identified Anticoagulant therapy and vascular malformations Trauma
39
Describe spinal hematomas
Subdural, epidural, subarachnoid (can extend the whole length), intramedullary haemorrhage Typically localised dorsally to spinal cord
40
What are the clinical signs and symptoms of spinal hematomas?
Depends on location and extent of haemorrhage - motor weakness, sensory and reflex deficits and acute bladder/bowel dysfunction Epidural and subdural - knife like pain Meningitis like symptoms for subarachnoid
41
What is the imaging and treatment for spinal hematomas?
MRI is gold standard Coagulopathy and surgical decompression Laminectomy
42
What is cauda equina syndrome?
Surgical emergency that results from compressive, ischaemic and or inflammatory neuropathy of multiple lumbar and sacral nerve roots in lumbar spinal canal
43
What is he aetiology of cauda equina syndrome?
Trauma, haemorrhage, inflammatory disease, infection, degenerative spine disease and spine tumours
44
How does cauda equina syndrome present?
Leg pain, weakness, anaesthesia, saddle anaesthesia, bladder/bowel/ sexual dysfunction, decreased anal tone and absence of ankle reflex
45
What are the types of cauda equina syndrome?
Incomplete - loss of urgency and decreased urinary sensation without incontinence of retention Complete - urinary and bowel retention or incontinence
46
What is the imaging and treatment for cauda equina syndrome?
MRI is gold standard Treatment - surgical decompression within 24 hrs
47
What is a primary spinal cord injury?
Trauma results in immediate death of local cells 1 - direct damage to cell bodies and/or neuronal processes 2 - damage to spinal axons
48
What is secondary spinal cord injury?
Inflammation Vascular events Chronic phase of injury - demyelination and scar formation
49
What are the vascular events which happen in spinal cord injury?
Damage to endothelial cells of local blood vessels so impaired blood flow - ischaemia Impaired autoregulation and vasospasm at site - ischaemia Neurogenic shock, bradycardia and hypotension Influx of inflammatory cells so more inflammation and secondary tissue damage
50
What is the definition of spinal shock?
Transient loss of neurological function below level of injury - flaccid paralysis and areflexia Hypotension - shock Duration is 72 hours but persists
51
What are the multiple factors causing spinal shock?
Interruption of sympathetic Loss of vascular tone - bradycardia Relative hypovolemia - skeletal muscle paralysis True hypovolemia - blood loss
52
What is resolution of spinal shock first recognised by?
Return of the bulbocavernous reflex
53
Describe a complete spinal cord injury
Complete loss of motor and sensory function below the level of injury in absence of spinal shock Poor prognosis
54
Describe incomplete spinal cord injury
Any residual motor or sensory function below level of injury Sacral sparing, voluntary anal sphincter contraction or voluntary toe flexion
55
Describe central cord injury
Incomplete - most common Usually results from hyperextension injury in older patients with pre-existing stenosis Can result in cord contusion Associated with cervical fracture/ dislocation and traumatic cervical disc herniation
56
What is the clinical symptoms of central cord syndrome?
Motor - weakness in UL more than LL Sensory - loss below level of injury Urine retention Recovery is usually incomplete - LL first
57
What is anterior cord syndrome?
Cord infarction in the territory supplied by anterior spinal artery Can result from occlusion of anterior spinal artery or cord compression
58
What is the presentation of anterior cord syndrome?
Paraplegia or quadriplegia Dissociated sensory loss below lesion - loss of pain and temp. with preservation of 2 point discrimination, joint position and deep pressure
59
What does Brown Sequard Syndrome manifest with?
Ipsilateral loss of joint position, vibration loss and discrimination, also spastic paresis below level of injury Contralateral loss of pain and temp. one level below lesion
60
What is primary and secondary assessment?
Primary - ATLS, airway, breathing, circulation and immobilisation Secondary - GCS, identify axial skeleton fractures, pelvis fractures and appendicular skeleton
61
What imaging is used for spinal cord injury?
X ray CT MRI
62
What are indications for early decompression?
Incomplete spinal cord injury Patients with progressive neurological deterioration
63
Describe occipital condyle fracture
Rare and usually stable Due to direct blow to head Presents with loss of consciousness, cranio-cervical pain and rarely lower cranial nerve deficits
64
Describe atlanto-occipital dislocation
Is common in children Mechanism - hyperextension, distraction and rotation Typically instant fatal injury and most have neurological deficits
65
Describe fracture of the atlas
Can be of posterior/ anterior arch, both with intact or disrupted ligament, and lateral mass fractures Usually neurologically intact
66
Describe a fracture of the axis
Can be of the odontoid process, traumatic spondylolisthesis of axis and fractures of body
67
Describe subaxial cervical spine fractures
Ligamentous or osseous Can be unilateral (displacement less than 25%), bilateral (more than 50%), tear drop (have neurological deficit) and burst fractures
68
Describe thorco-lumbar spine injuries
Thorco-lumbar junction is most frequently affected segment then lumbar and thoracic segments Can be compression, burst, seat belt and fracture dislocations
69
Describe sacral spinal injuries
Zone 1 - neurological injuries, L5 or sciatic nerve damage 2 - higher incidence of neurological deficit but no sphincter involvement 3 - highest rate of neurological damage as nearer central canal
70
What surgical management of spine fractures?
Occipital condyle avulsion fractures, altanto-occipital dislocation, more than 5mm C1-2 displacement, neurological deficits, biomechanical instability and non union after 12 weeks

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