spinal symposium

Question 1

dermatome

Answer 1

area of skin mainly supplied by single spinal nerve

Question 2

myotome

Answer 2

group of muscles a spingle spinal nerve innervates

Question 3

types of spinal injuries

Answer 3

fracture

spinal cord injury

Question 4

complete spinal cord injury

Answer 4

no motor or sensory function distal to lesion 
no anal squeeze
no sacral sensation 
ASIA grade A
no chance recovery

Question 5

incomplete SCI

Answer 5

some function present below site of injury

more favourable prognosis

Question 6

ASIA classification: Grade A

Answer 6

complete

no sensory or motor function preserved in sacral segments S4-S5

Question 7

ASIA classification: Grade B

Answer 7

incomplete

sensory but not motor function preserved below neurologic level and extending through sacral segments S4-S5

Question 8

ASIA classification: Grade C

Answer 8

incomplete
motor function preserved below neurologic level
majority of key muscles have a grade < 3

Question 9

ASIA classification: Grade D

Answer 9

incomplete
motor function preserved below neurologic level

majority key muscles grade > 3

Question 10

ASIA classification: Grade E

Answer 10

normal motor and sensory function

Question 11

tetraplegia/quadraplegia

Answer 11

partial or total loss of use of all 4 limbs and trunk

loss of motor/sensory function in cervical segments spinal cord

Question 12

spasticity

Answer 12

increased muscle tone

UMN lesion

Question 13

paraplegia

Answer 13

partial or total loss of use of lower limbs

impairment or loss of motor/sensory function in thoracic, lumbar or sacral segments spinal cord

arm function spared

Question 14

partial cord syndromes

Answer 14

central cord syndrome
anterior cord syndrome
brown-sequard syndrome

Question 15

central cord syndrome

Answer 15

impinges onto parts corticospinal tracts

centrally cervical tracts more invovled

weakness arms > legs

perianal sensation and lower extremity power preserved

Question 16

anterior cord syndrome

Answer 16

hyperflexion injury, anterior compression fracture, damage anterior spinal a.

fine touch and proprioception preserved (dorsal coloumns ok)

corticospinal (motor) and spinothalamic (pain) tracts damaged –> profound weakness

Question 17

brown-sequard syndrome

Answer 17

hemi-section of cord
penetrating injuries

paralysis on affected side (corticospinal)
loss proprioception + fine discrimination (dorsal)

pain and temp loss on opposite side below lesion (spinothalamic)

Question 18

key to management of SCI patient

Answer 18

prevent a secondary insult

Question 19

ABCD: A

Answer 19

airway - c spine control

Question 20

ABCD: B

Answer 20

breathing

• ventilation + oxygenation
• concomitant chest injuries

Question 21

ABCD: C

Answer 21

circulation

• IV fluids + access
• consider neurogenic shock
• vasopressors

Question 22

spinal shock

Answer 22

transient depression of cord function below level injury

flaccid paralysus
arreflexia
lasts several hrs to days post injury

Question 23

neurogenic shock

Answer 23

hypotension 
bradycardia 
hypothermia 
injuries above T6
secondary to disruption sympathetic outflow

Question 24

ABCD: D

Answer 24

disability

assess neurological function
incl PR and perianal sensation

Question 25

investifations SCI

Answer 25

X-ray CT MRI

Question 26

surgical fixation

Answer 26

unstable fractures

Question 27

long term management SCI

Answer 27

``` spinal cord injury unit physiotherapy OT psychological support urological/sexual counselling ```

Question 28

type of joint is intervertebral disc

Answer 28

secondary cartilagenous joint

Question 29

normal ageing processes to IV discs

Answer 29

decreased water contents disc disc space narrowing degenerative changes x-ray degenerative changes in facet joints aggravated by smoking, weight gain etc.

Question 30

pathological processes IV discs

Answer 30

- tearing annulus fibrosis and protrusion of nucleus - nerve root compression by osteophytes - central spinal stenosis

Question 31

nerve root pain

Answer 31

limb pain worse than back pain pain in nerve root distribution - radicular root tension and root compression signs

Question 32

IV disc problems: bulge

Answer 32

common majority asymptomatic nucleus contained, annulus slightly bulging

Question 33

IV disc problems: protrusion

Answer 33

annulus weakened but still intact nucleus elongated and moved out place, hasn't breached annulus

Question 34

IV disc problems: extrusion

Answer 34

nucleus through annulus but still in continuity annulus ruptured

Question 35

IV disc problems: sequestration

Answer 35

dessicated disc material free in canal

Question 36

cervical disc prolapse

Answer 36

mostly C5/6

Question 37

thoracic disc prolapse

Answer 37

<12% IVD prolapses | most T11/T12

Question 38

lumbar disc prolapses

Answer 38

L4/5 then L5/S1 then L3/4 most posterolateral: pos longitudinal leg weakness, sciatica central disc may give pain in both legs or back pain only

Question 39

cauda equina syndrome

Answer 39

compression of cauda equina | sacral nerve roots compressed

Question 40

cauda equina causes

Answer 40

``` central lumbar disc prolapse spinal stenosis trauma tumour - 1ry, 2ry haematoma infection - epidural abscess iatrogenic: spinal surgery ```

Question 41

cauda equina classic triad

Answer 41

saddle anaesthesia bilateral leg weakness urinary/faecal incontinence/sexual dysfunction

Question 42

cauda equina other features

Answer 42

poor anal tone back pain and radicular pain LMN signs: hypotonia, hyporeflexia

Question 43

cauda equina investigations

Answer 43

urgent MRI | if contraindicated lumbar CT myelogram

Question 44

cauda equina Rx

Answer 44

surgery within 48hrs: decompression - laminectomy

Question 45

cervical + lumbar spondylosis

Answer 45

OA degenerative changes to facet joints, IV discs and ligaments if severe can compress cord causing myelopathy

Question 46

cervical spondylosis features

Answer 46

axial neck pain | neurological complications: compression, cervical spondylotic radiculopathy

Question 47

cervical spondylosis: cervical spondylotic radiculopathy

Answer 47

arm pain, sensory loss and weakness down nerve root supply

Question 48

distinguish spinal claudication from vasuclar claudication

Answer 48

``` usually bilateral sensory dysthesiae possible weakness several mins to ease after walking worse walking downhill ```

Question 49

spinal stenosis classifications

Answer 49

lateral recess stenosis central stenosis foraminal stenosis

Question 50

spinal stenosis features

Answer 50

back pain activity relation pain leg numbess/paraethesiae pain radiating down legs

Question 51

spinal stenosis Rx: lateral recess stenosis

Answer 51

nerve root steroid injection epidural steroid injection surgery

Question 52

spinal stenosis Rx: central stenosis

Answer 52

epidural steroid injection | surgery

Question 53

spinal stenosis Rx: foraminal stenosis

Answer 53

nerve root steroid injection epidural injection surgery

Question 54

spondilolothesis

Answer 54

one vertebrae translated onto another causes: degenerative, fractures, trauma, infection