Spine diseases/syndromes of the spine

Question 1

degenerative causes of sensory symptoms in the cervical spine?

Answer 1

• stenosis
• disc herniation
• cynovial cyst

Question 2

extradural neoplasms in the cervical back?

Answer 2

• metastases
• primary bone-tumours

Question 3

intramedullary neoplasms in the cervical spine?

Answer 3

• Ependymoma
• Astrocytoma
• Hemangioblastoma

Question 4

Characteristics of ependymoma on MRI?

Answer 4

Hypointensities correlating to hemosiderin above and below the tumor on T2W images.

Question 5

Characteristics of intramedullary Astrocytomas?

Answer 5

• longer than 6 vertebras
• Cysts within the lesion
  *rarely hemorrhage at the margins
• May have mixed enhancement pattern
  + Younger patients

Question 6

Intradural, extramedullary neoplasms in the cervical spine

Answer 6

• Meningioma
• Schwannoma
• Neurofibroma
• Ganglioneuroma

Question 7

most common cause of anterior cord syndrome

Answer 7

infarction/compression of the anterior spinal artery.

Question 8

Presentation of anterior cord syndrome?

Answer 8

• Paraplegia. (If above C7 = Quadriplegia)
• Loss of pain and temperature sensation (spinothalamic tract)
• • Preserved 2 point discrimination, joint position sense, deep pressure sensation
    (posterior column functions)

Question 9

When is it reasonable to consider surgery in anterior cord syndrome?

Answer 9

• in cord compressions
• In instability

Question 10

What are signs of central cord syndrome?

Answer 10

• Disproportionate greater motor deficits in the upper compared to the lower extremities.

Question 11

WHat is burning hand syndrome?

Question 12

Cause of central cord syndrome?

Answer 12

This is a watershed area and therefore sensistive. Usually due to hyperextension injuries in the presence of osteophytic spurs.

Question 13

When is surgery applied for central cord syndromes?

Answer 13

• In ongoing compression, usually in a non-emergency basis.

Question 14

What are the entities running in the spinothalamic tract?

Answer 14

pain and temperature sense.

Question 15

What is Brown Sequard syndrome?

Answer 15

?

Question 16

What usually causes Brown Sequard syndrome?

Answer 16

• penetrating trauma
• radiating myelopathy
• Cord compression (eg epidural HT)
• cervical disc herniation
  (tumors, AVMs, cervical spondylosis, herniation)

Question 17

Clinical findings of Brown Sequard Syndrome

Answer 17

1. Ipsilateral:
   *Motor paresis below lesion
   *Loss of posterior column function
2. Contralateral:
   * Loss of pain and temperature sensation - 1-2 segments below injury

preserved light (crude) touch.

Question 18

What is “posterior cord syndrome”

Answer 18

?

Question 19

Clinical findings of “posterior cord syndrome”

Answer 19

mild paresis in UE and
PAIN and PARESTHESIA (often burning) in neck, upper arms and torso.

Question 20

How common is Brown Sequard syndrome?

Answer 20

?

Question 21

How common is central cord syndrome?

Answer 21

?

Question 22

How common is posterior cord syndrome?

Answer 22

?

Question 23

Which of the cord-syndromes may be surpassing?

Answer 23

• central cord syndrome
  ? more?

Question 24

What is different from central/posterolateral disc herniation in Foraminal and extraforaminal lumbar disc herniations?

Answer 24

• less common
• compression of exiting nerve root at the index level
• typically manifest with radiopathy and focal sensorimotor deficits.

Question 25

What structure might be compressed in foraminal/extraforaminal lumbar disc herniation?

Answer 25

Dorsal root ganglion

Question 26

Due to compression of the dorsal root ganglion, how might the pain appear ?

Answer 26

burning, dysthetic.

Question 27

What is spondylolisthesis?

Question 28

What three types of disc herniations are there?

Answer 28

* protrusion * extrusion (a line of anulus = contained or uncontained= no anulus seen around the protrusion anymore) * sequestration

Question 29

Which are the most common locations of lumbar disc herniation?

Answer 29

Central and posteriolateral.

Question 30

What are the symptoms from central lumbar disc herniation?

Answer 30

* cauda equina * nerve root compression: 'radiculopathy *sensorimotor deficits * bowel/bladder issues * neurogenic claudicatio * lower back pain.

Question 31

Other names for posterolateral disc herniatin?

Answer 31

* paracentral * subarticular * lateral recess herniation

Question 32

What nerve is usually affected in a posterolateral disc herniation?

Answer 32

The traversing nerve root at that level. Ex. herniation at L4-L5 often affect the L5 nerveroot that traverse the L4-L5 level and exits at the L5 level.

Question 33

If a posterolateral disc herniation is very large/wide, it might also compress another nerve. which?

Answer 33

The exiting nerve root in the foraminal zone.

Question 34

When should surgical resection be considered for a lumbar disc herniation?

Answer 34

* significant neurological symtoms * Failed nonoperative treatment

Question 35

foraminal/extraforaminal/faar lateral L4-L5 herniation would cause a nerve compression...on what level?

Answer 35

L4 compression