Spine/Back Flashcards
(56 cards)
Where does the spinal cord run to?
L1
What is the name of the structure located at L1?
Conus medullaris
What is the name of the structure following the conus medullaris at L1?
Cauda equina
What is myelopathy?
Injury to the spinal cord due to compression (not the cauda equina)
What is radiculopathy?
Injury affecting the spinal nerves/roots (often due to compression)
Where are spinal nerves located?
Intervertebral Foramen (located between superior and inferior facet joints)
What are the most common general presentations of spinal pathologies?
Numbness
Weakness (function)
Pain
How does a radiculopathy typically present?
Pain radiates to affected spinal level (e.g sciatica)
What is it called when multiple nerve roots are compressed?
Claudication
What are the 2 types of claudication?
Neurogenic
Vascular
How can you differentiate between neurogenic claudication and vascular claudication?
Neurogenic = pain comes on as you walk, relief when flex spine, peripheral pulses normal
Vascular = pain all the time, relief when rest or lie down and hang legs off bed, peripheral pulses often affected and limbs can become cold
Potential skin changes
Why does Flexion in the spine offer pain relief with neurogenic claudication?
Typically caused by spinal stenosis
Flexion of the spine increases the diameter of the spinal canal by stretching the ligamentum flavum and opening larger spaces between the vertebra and intervertebral foramina
What do people typically complain about with claudication?
Dull aching
Jelly legs
Leg heavy
What are the 3 main changes that can occur when there are spinal cord pathologies?
Imbalance
Motor loss/changes
Sensory loss
What are the changes seen with UMN lesions?
Hypertonia
Hyper-reflexia
Atrophy of disuse
Clonus
+ve babinski sign
+ve Hoffmanns sign
What is hoffmans sign?
When you flick the middle fingers nail, the thumb flexes
This is suggestive of an UMN lesion
How do LMN lesions present?
What can it also be called?
Radiculopathy
Hypotonia
Hyporeflexia
Fasiculations
Atrophy of Denervation
Pain
What is spinal stenosis?
Narrowing of the spinal canal or foramina
What are some causes of spinal stenosis?
Herniated intervertebral disc
Tumour
Abcesses
Facet joint osteoarthritis
Ligamentum flavum hypertrophy
Fractures
How may lumbar stenosis present?
Lower back pain
Refered leg or gluteal pain
Neurogenic claudication
Lower limb weakness
What is the gold standard investigation if you believe someone may have a lumbar stenosis?
MRI lumbar sacral spine
What are the steps to managing lumbar stenosis?
Conservatively:
-NSAIDs (like naproxen) with PPI cover
-Physio (core strengthening and mobilisation)
-Weight loss
-Epidural steroids if others fail
Surgical fixation
How can cervical myelopathy (stenosis) present?
Neck pain
Can unilateral or bilateral (both arms or both legs or both arms and legs)
UMN signs
Lhermitte’s sign
Gait disturbance
Paresis (hand clumsiness)
Sensory disturbance
What is Lhermitte’s sign?
When the neck is flexed the patient experiences an electric shock/pain sensation running down their spine
