Spinal, Neurological Cobditions

Question 1

What is spinal stenosis?

Answer 1

A narrowing of the spinal canal that may cause spinal pain and/or nerve symptoms

It can occur in the cervical or lumbar spine and may be a normal finding on scans.

Question 2

What might improve symptoms of spinal stenosis?

Answer 2

Flexion activities

Symptoms often worsen with extension.

Question 3

What can central cord compression in the cervical spine cause?

Answer 3

Myelopathy

Question 4

What can central cord compression at the lumbar spine cause?

Answer 4

Cauda equina syndrome

Question 5

What are common management strategies for spinal stenosis?

Answer 5

Conservative management including:
* Advice and education
* Pain management
* Exercise
* Lifestyle changes

Question 6

What is spondylosis?

Answer 6

A generic umbrella term for osteoarthritic changes within the spine

It can affect various spinal components such as vertebrae and intervertebral discs.

Question 7

What are the risk factors for spondylosis?

Answer 7

Normal age-related changes

Like getting wrinkles.

Question 8

What is Whiplash Associated Disorder (WAD)?

Answer 8

A generic term for neck pain following sudden force acceleration/deceleration, commonly from road traffic accidents.

Question 9

What are potential yellow flags in WAD?

Answer 9

Particularly if under an insurance claim

Question 10

What are common symptoms of Ankylosing Spondylitis?

Answer 10

Back pain, stiffness, early-morning pain, and fatigue

Symptoms often improve with exercise.

Question 11

What is the classification of spondylolisthesis grades?

Answer 11

Grades are as follows:
* Grade I: 0-25%
* Grade II: 26-50%
* Grade III: 51-75%
* Grade IV: 76-100%
* Grade V: >100% (spondyloptosis)

Question 12

What is the most common site for spondylolisthesis?

Answer 12

L5/S1 and L4/5

Question 13

What is the difference between specific and non-specific spinal pain?

Answer 13

Specific spinal pain is identifiable with known causes; non-specific spinal pain lacks a clear diagnosis.

Question 14

What percentage of spinal pain is classified as non-specific?

Answer 14

90%

Question 15

What are red flags in spinal pain assessment?

Answer 15

Conditions such as:
* Myelopathy
* Malignancy
* Fractures
* Cauda equina syndrome

Question 16

What is the typical management for non-specific spinal pain?

Answer 16

Conservative management including advice, physiotherapy, and lifestyle modifications.

Question 17

What is the aetiology of scoliosis?

Answer 17

An S-shaped curve in the spine, which may be idiopathic or congenital.

Question 18

What are some risk factors for scoliosis?

Answer 18

Genetics

It is not linked to bad posture or exercise.

Question 19

What is the management approach for scoliosis?

Answer 19

Conservative management is most common; surgery indicated in severe cases.

Question 20

What is the recommended intervention for Whiplash Associated Disorder?

Answer 20

Education and reassurance, along with physiotherapy for pain management.

Question 21

What imaging is typically not needed for non-specific spinal pain?

Answer 21

Scan or X-ray

Question 22

What is a common misconception about disc degeneration?

Answer 22

MRI shows disc degeneration in 60% of asymptomatic individuals aged >40.

Question 23

What is Myelopathy?

Answer 23

Compression on the spinal cord in the central canal.

Usually occurs in the cervical spine and can be caused by central stenosis.

Question 24

What are the management options for Myelopathy?

Answer 24

Conservative or surgical (fusion / stabilisation).

Question 25

What is Cauda Equina Syndrome (CES)?

Answer 25

A rare condition (1-3/100,000) involving compression on the collection of nerves at the bottom of the spinal cord. ## Footnote Most common cause is herniation of a lumbar disc (45%).

Question 26

What are the common causes of Cauda Equina Syndrome?

Answer 26

* Herniation of a lumbar disc * Stenosis * Tumour * Discitis * Trauma

Question 27

What are the urgent medical interventions required for CES?

Answer 27

MRI and bladder scanning within 48 hours.

Question 28

What could happen if Cauda Equina Syndrome symptoms are misdiagnosed?

Answer 28

There could be a massive payout of around £336,000.

Question 29

What is the recommended surgical intervention for true CES?

Answer 29

Immediate surgery (spinal decompression) to try to prevent longstanding symptoms.

Question 30

What are the risk factors for Myelopathy?

Answer 30

* Older age * Degenerative changes * Stenosis * Rheumatoid arthritis * Ankylosing spondylitis * Trauma * Upper cervical instability

Question 31

What are the signs and symptoms of Myelopathy?

Answer 31

* Gait disturbances (ataxia, falls, clumsiness, balance) * Fine motor skill and coordination changes * Possibly neck pain * Bilateral symptoms (pain, weakness, P+N’s, paraesthesia, numbness) * Hyperreflexia * Bladder and bowel disturbances

Question 32

What spinal red flags are associated with Myelopathy?

Answer 32

* Cervical arterial dysfunction (CAD) * Malignancy * Systemic inflammatory disorders * Infections * Fractures * Cauda equina syndrome (CES) * Osteoporosis?

Question 33

What causes Myelopathy?

Answer 33

* Central disc herniation * Age-related changes (bony spurs or osteophytes) * Trauma and/or instability * Spondylolisthesis * Ligament thickening * Postoperative problems * Rarely infections, tumours, cysts

Question 34

What are the signs and symptoms of Cauda Equina Syndrome?

Answer 34

* Retention of urine * Loss of anal tone * Saddle anaesthesia * Bilateral leg pain and/or numbness * Sexual dysfunction

Question 35

What are the signs and symptoms of Radiculopathy?

Answer 35

* Cervical – arm symptoms * Lumbar – leg symptoms * Pain in dermatomal distribution * Sensory symptoms (paraesthesia, anaesthesia, allodynia) * Motor loss in the relevant nerve root (myotome) * Reflex changes (reduced/hyporeflexia)

Question 36

What is Peripheral Nerve Irritation?

Answer 36

A change in neurological function from nerve root compression, irritation, or sensitivity.

Question 37

What investigations are used for neural conditions?

Answer 37

* Myelopathy – full spine MRI * Radiculopathy – MRI of local region (e.g., cervical) * Peripheral nerve entrapment – EMG studies

Question 38

What are the management options for peripheral neuropathies?

Answer 38

* Physiotherapy/non-invasive treatment first * Education * Activity modification * ROM, strength, function * Possibly surgery if conservative management fails

Question 39

What is a Peripheral Nerve Entrapment?

Answer 39

An area in the peripheral nerves where the nerve can become irritated, located at an interface or anatomical space.

Question 40

What is the reflex level for the biceps reflex?

Answer 40

C5/6

Question 41

What muscle is tested by the C2 myotome?

Answer 41

Cervical flexors

Question 42

Fill in the blank: Myelopathy is caused by _______.

Answer 42

[central disc herniation, age-related changes, trauma, etc.]

Question 43

True or False: Cauda Equina Syndrome is a common condition.

Answer 43

False