Surgical Diseases of the Spinal Cord

Question 1

what is the myotome for C5?

Answer 1

elbow flexor

Question 2

what spinal level is the wrist extensor supplied by?

Answer 2

C6

Question 3

what is the myotome of c7?

Answer 3

elbow extensor

Question 4

what is the myotome of C8?

Answer 4

finger extensors

Question 5

what spinal level nerve is are the intrinsic hand muscle supplied by?

Answer 5

T1

Question 6

what myotome of supplied by L2?

Answer 6

hip flexor

Question 7

what myotome is supplied by L3?

Answer 7

knee extensor

Question 8

what myotome is supplied by L4?

Answer 8

ankle dorsiflexors

Question 9

what myotome is supplied by L5?

Answer 9

long toe extensors

Question 10

what myotome is supplied by S1?

Answer 10

ankle plantar flexors

Question 11

describe upper motor neuron lesion signs

Answer 11

> weakness
increased reflexes
increased tone
Babinski

Question 12

describe lower motor neuron lesion signs

Answer 12

> weakness
> atrophy
> reflexes decreased
> tone decreased
> fasciculations

Question 13

what is myelopathy?

Answer 13

> upper motor neuron problem

> neurological deficit due to compression of the spinal cord

Question 14

describe some signs that may be seen in a myelopathy with a lesion at C6?

Answer 14

> weakness in elbow
increased tone
brisk reflexes
Babinski positive

Question 15

what is radiculopathy?

Answer 15

> lower motor neuron

> compression of the nerve root leading to dermatomal and myotomal deficits

Question 16

what signs could you expect to see in a radiculopathy, L4 nerve root lesion?

Answer 16

> pain down ipsilateral leg
numbness in L4 dermatome
weakness in ankle dorsiflexion
reduced knee jerk

Question 17

what are the core diagnostic tests?

Answer 17

> CT

> MRI

Question 18

what is disc prolapse?

Answer 18

acute herniation of the intervertebral disc causing compression of the spinal roots or spinal cord

Question 19

what would a central cervical disc prolapse cause?

Answer 19

cervical myelopathy

Question 20

what would a lateral cervical disc prolapse cause?

Answer 20

cervical radiculopathy

Question 21

what would a central lumbar disc prolapse cause?

Answer 21

cauda equina syndrome

Question 22

what would a lateral lumbar disc prolapse cause?

Answer 22

lumbar radiculopathy

Question 23

is pain associated with disc prolapse?

Answer 23

yes shooting down the arm/leg

Question 24

what investigation would you carry out for disc prolapse?

Answer 24

MRI

Question 25

how could you manage disc prolapse?

Answer 25

> rehabilitation > nerve root injection > lumbar/cervical discectomy

Question 26

what are the red flags in cauda equine syndrome?

Answer 26

> bilateral sciatica > saddle anaesthesia > urinary dysfunction

Question 27

what investigation does cauda equine syndrome warrant?

Answer 27

an urgent MRI

Question 28

what is the management for cauda equine syndrome?

Answer 28

emergency lumbar discectomy

Question 29

in older patients what degenerative loss of spinal structure can lead to myelopathy and radiculopathy?

Answer 29

> disc prolapse > ligamentum hypertrophy > osteophyte formation

Question 30

what is cervical spondylosis?

Answer 30

umbrella term for degenerative change in cervical spine leading to spine and nerve root compression

Question 31

in cervical spondylosis does the patient present with myelopathy or radiculopathy?

Answer 31

either or both

Question 32

what is the speed of onset of cervical spondylosis?

Answer 32

months to years

Question 33

what is the management for cervical spondylosis?

Answer 33

> conservative if there is no/mild myelopathy | > surgery for progressive moderate/ severe myelopathy

Question 34

what are the signs and symptoms in lumbar spinal stenosis?

Answer 34

spinal claudication (pain down both legs): - worse on walking/standing - relieved by sitting/bending forward

Question 35

what is the management in lumbar spinal stenosis?

Answer 35

lumbar laminectomy

Question 36

is lumbar spinal stenosis an emergency?

Answer 36

no and is usually seen in older patients

Question 37

name some intradural spinal tumours

Answer 37

> meningioma > neurofibroma > lipoma

Question 38

name some intramedullary spinal tumours

Answer 38

> astrocytoma > ependymoma > teratoma > haemagioblastoma

Question 39

what type of spinal tumour is the most common: > extradural > intradural > intramedullary

Answer 39

extradural

Question 40

name some extradural spinal tumours

Answer 40

> metastasis | > primary bone

Question 41

how may a patient with malignant cord compression present?

Answer 41

> pain > weakness > sphincter disturbance

Question 42

someone with known cancer develops back pain what should you do?

Answer 42

get an urgent MRI as there may be malignant cord compression

Question 43

what is the management for malignant cord compression?

Answer 43

surgical decompression and radiotherapy

Question 44

what is osteomyelitis?

Answer 44

infection within the vertebral body

Question 45

what is discitis?

Answer 45

infection of the intervertebral disc

Question 46

what is epidural abscess?

Answer 46

infection in the epidural space

Question 47

what is the triad of signs and symptoms for an epidural abscess?

Answer 47

> back pain > pyrexia > focal neurology

Question 48

what investigation is carried out in a patient with back pain, pyrexia and focal neurology?

Answer 48

in urgent MRI as this could be an epidural abscess

Question 49

what is an epidural abscess?

Answer 49

an extradural collection of pus

Question 50

what are the risk factors for and epidural abscess?

Answer 50

> IV drug abuse > diabetes > chronic renal failure > alcoholism

Question 51

what organisms are involved in an epidural abscess?

Answer 51

> staph aureus > streptococcus > e coli

Question 52

how is an epidural abscess managed?

Answer 52

> urgent surgical decompression | > long term IV antibiotics

Question 53

what are the risk factors for osteomyelitis?

Answer 53

``` > IV drug abuse > diabetes > chronic renal failure > alcoholism > AIDS ```

Question 54

how is osteomyelitis managed?

Answer 54

> antibiotics | > surgery if there is evidence of neurology