Spine

Question 1

Where are the two enlargements in the spinal cord?

Answer 1

Cervical

Lumbar

Question 2

What is the name of the tapered cone shape where the spinal cord terminates?

Answer 2

Conus medullaris

Question 3

What is the name of the thin connective tissue cord which is a continuation of the spinal cord after the conus medullar is?

Answer 3

Filum terminale

Question 4

What is the film terminal anchored to?

Answer 4

Dorsum of the coccyx

Question 5

What do the denticulate ligaments keep suspended?

Answer 5

the spinal cord in the canal

Question 6

The dentriculare ligaments are formed from all three layers of the meninges TRUE/FALSE

Answer 6

FALSE

formed of pain and arachnoid tissue, attaches to dura

Question 7

What are the 3 parts of the white matter?

Answer 7

Posterior (dorsal) column
Lateral column
Anterior (ventral) column

Question 8

What are the 4 parts of the grey matter?

Answer 8

Left and Right posterior and anterior horns

Question 9

What is the name of the band of nerve tissue connecting the hemispheres of the brain?

Answer 9

Commissure

Question 10

Of the 3 major longitudinal spinal arteries there is one anterior and two posterior TRUE/FALSE

Answer 10

TRUE

Question 11

Segmental arteries split into anterior and posterior ——– arteries

Answer 11

radicular

Question 12

What is included in the epidural space?

Answer 12

Adipose tissue

Anterior/posterior epidural venous plexus

Question 13

If there is damage to the extradural venous plexus what can be the sequalae?

Answer 13

Epidural haematoma which compresses spinal cord or caudal equina

Question 14

Which part of the spinal vertebrae is responsible for wt bearing?

Answer 14

Vertebral body

Question 15

Which two structures form the vertebral arch?

Answer 15

Pedicles

Laminae

Question 16

What part of the spinal vertebrae serves as an attachment point for the muscles of the back?

Answer 16

Spinous process

Question 17

TRUE/FALE

C3-5 have short and bifid spinous processes

Answer 17

TRUE

Question 18

What is annulus fibrosis?

Answer 18

Outer ring consisting of concentric lamellae of fibrocartilage

Question 19

What is nucleus pulposus?

Answer 19

Contained within the annulus fibrosis and consists mostly of water

Question 20

What does the ligamentum flavum help to maintain?

Answer 20

Maintain posture and assist straightening the spine after flexion

Question 21

Why does the ligamentum flavum appear yellow?

Answer 21

It is rich in elastin

Question 22

Why do you get LMN symptoms is the spinal disease is lateral?

Answer 22

As it is pressing on the nerve root

Question 23

What type of back pain does this describe?

Morning stiffness, resolves with movement and worse by prolonged sitting/rising from a seated position

Answer 23

Mechanical back pain

Question 24

When facet joint hypertrified patients get referred pain from the nerve supplying the facet joint that mimics sciatica. How can you differentiate the two?

Answer 24

The referred pain does not radiate below the knee

Question 25

Some of the Red flags for back pain?

Answer 25

``` Age >60 or <20 Pain not improved by rest Pain wakes patient at night Urinary retention/incontinence & faecal incontinence Saddle anaesthesia History of anaesthesia History of malignancy Unexplained wt loss or fever Immunosupression or IV drug use ```

Question 26

What is lumbar disc herniation?

Answer 26

When nucleus herniates through a tear in the annulus ring and compresses adjacent nerve root

Question 27

What are the most common locations for lumbar disc herniation?

Answer 27

L4/5 | L5/S1

Question 28

What is the most common direction of prolapse?

Answer 28

Paramedian herniated disc (aka posterolateral)

Question 29

What is radiculopathy?

Answer 29

Dysfunction of nerve root | dermatomal sensory deficit w weakness of muscle groups supplied by the nerve

Question 30

What is sciatica?

Answer 30

Pain along the sciatic nerve usually due to compression of its nerve roots (L4-S3)

Question 31

After how long of back pain do you scan?

Answer 31

6wks

Question 32

Why is caudal equina an emergency?

Answer 32

As persistent compression of nerve roots, 48h before complete and irreversible damage

Question 33

85% of sciatica resolves spontaneously TRUE/FALSE

Answer 33

TRUE

Question 34

What condition does this presentation describe? | Painless urinary retention

Answer 34

Cauda equina

Question 35

How is caudal equine treated?

Answer 35

Depends on cause If herniated disc- discectomy If fracture- decompression +- fixation If haematoma- evacuation

Question 36

TRUE/FALSE | IF ankle reflexes are present then it is highly unlikely they the patient has caudal equina syndrome

Answer 36

TRUE As with severe exacerbation of back pain can cause intermittent bladder problems with bladder spasms and small volume incontinence/retention

Question 37

What is neurogenic claudication precipitated or relieved by?

Answer 37

Precipitated by standing or back extension | Relieved by sitting, lumbar flexion or walking uphill (as opening up foramina)

Question 38

What is the difference in distribution between neurogenic and vascular claudication?

Answer 38

Neurogenic- dermatomal | Vascular- Sclerotomal

Question 39

What is the difference in the type of pain between neurogenic and vascular claudication?

Answer 39

Neurogenic is burning pain | Vascular is cramping pain

Question 40

What is the treatment for spinal stenosis?

Answer 40

Initially- whilst symptoms tolerable physiotherapy and analgesia As symptoms worsen and intolerable- surgery offered

Question 41

which levels is cervical spondylosis most common at?

Answer 41

C5/C6 | C6/7

Question 42

In what condition are hands affected first resulting in "numb clumsy hands", Finger tip paraestoesia, difficulty with fine motor tasks and dropping objects

Answer 42

Degenerative cervical myelopathy

Question 43

Hoffman's and Lhermitte's sign are present in which type of lesion?

Answer 43

UMN

Question 44

Cervical Myelopathy can be cured with decompression spinal surgery TRUE/FALSE

Answer 44

FALSE This is the treatment of choice however any surgery is just to stop the symptoms getting worse. It does not improve symptoms

Question 45

What is the commonest cause of spinal cord compression?

Answer 45

Tumours

Question 46

If there is a complete cord resection then there will initially be a flaccid areflexic paralysis which is followed by...

Answer 46

UMN signs

Question 47

Anterior cord syndrome produces....

Answer 47

Paralysis, loss of pain and temperature below the level of injury

Question 48

Brown-Sequard causes...

Answer 48

Paralysis/Loss of proprioception on the same side as the lesions Loss of pain/temperature on opposite side (beginning 1-2 segments below)

Question 49

What is syringomyelia?

Answer 49

Cysts within spinal cord

Question 50

Why is a lesion in the central cord more likely to damage to upper limb fibres?

Answer 50

As the fibres supplying the upper limbs in the lateral corticospinal tracts are more medial than the fibres supplying the lower limbs

Question 51

Failed back syndrome occurs after what?

Answer 51

Recurrent, residual compression