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45 Cards in this Set

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Physical signs of complete cord syndrome
1. no motor or sensory function
2. reflex loss at the level of lesion
3. hyper-reflexia below lesion
Name 4 types of incomplete cord syndrome
1. anterior spinal cord lesion
2. central spinal cord lesion
3. posterior spinal cord lesion
4. hemi-spinal cord lesion (Brown-Sequard)
Physical signs of conus medullaris syndrome
1. symmetrial sensory loss
2. early sphincter involvement
3. not marked motor weakness
Physical signs of cauda equina syndrome
1. asymmetrical sensory loss
2. radicular pain
3. LMN sign
4. late sphincter involvement
Mechanical pain
1. related to spinal instability
2. local pain or referred pain (somatic sensation)
3. improve with rest
Inflammatory pain
1. related to arthritis
2. loca or referred pain
3. relief with anti-inflammatory /steroid
Neuropathic pain
1. injury or compression of CNS or PNS
2. burning, shooting
3.
What is the mechanism of neuropathic pain?
1. sensitization
2. loss of central inhibition
3. re-organization of central A-beta fibre
4. ectopic dishcarge
The most common site of spinal injury is? followed by?
Most common: cervical
2nd : thoracolumbar
Give 3 easy signs / symptoms of spinal injury
1. severe pain
2. movement limitation
3. muscle spasm
In spinal injury radiology, wt's the aim?
1. check spinal stability
2. check any cord compression
Give 3 reversible compression in spinal injury
1. extraduarl haematoma
2. bone fragement
3. herniated disc
What are the radiological investigation in spinal injury?
Inital : Plain XR
Localizing neurological sign: CT
Neurologic deficit: MRI
Under what condition will Wedge fracture easily occur?
Loss of height (LOH) > 50%
or angle > 30
Give 6 forms of cervical spinal injury
1. Jefferson fracture
2. C1 rotary subluxation
3. Odontoid fracture
4. Hangman's fracture
5. Anterior column fracture
6. Posterior column fracture
Jefferson fracture
1. C1 lamina fracture
2. axial load
3. no cord injury but unstable
4. associated with C2 fracture
C1 rotary subluxation
1. RTA
2. neck pain, spasm and torticollis deformity
3. open-mouth odontoid view
Odontoid fracture
1. high velocity or fall
2. 3 types
Hangman's fracture
1. C2 pedicle fracture
2. hyperextension + distraction
What do anterior column fracture include?
1. compression fracture
2. burst fracture
3. tear drop fracture
What do posterior column fracture include
1. spinous process avulsion
2. facet fracture and dislocation
Mx of Jefferson fracture
Collar or Traction
Mx of C1 rotary subluxation
Traction + cast immobilization
Surgery for delayed case
Mx of odontoid fracture
Halo immobilization or surgery
Hangman's fracture
Collar immobilization x 3 mths
The first step in acute Mx of spinal cord injury is......
immobilization
In prolonged immobilization case...
Cervical fracture use_____ and ______
Thoracolumbar fracture use _____, ____and _____
1. halojacket brace, internal fixation

1. bed rest, external brace , internal fixation
Fixation VS Fusion
Fixation : implant
Fusion: induction of healing, use bone graft
3 phases of spinal degeneration
1. dysfunctional
2. instability
3. restabilization
Fast Food Question
DDx of spinal cord compression
1. osteophyte
2. spinal stenosis
3. ossified posterior longitudinal ligament
Fast Food Question
DDx of spinal nerve compression
1. Prolapsed inter-vertebral disc
2. Facet joint hypertrophy
Fast Food Question
DDx of pain
1. spinal instability
2. facet arthritis
3. neuropathic pain
Differentiate between cervica spinal stenosis and lumbar spinal stenosis
Cervical spinal stenosis:
1. Pain or weakness in shoulders, arms
2. hand clumsiness
3. gait and balance disturbance

Lumbar spinal stenosis
1. pain or weakness in lower limbs
2. symtom decreases when sit or lie
The 3 commonest intramedullary spinal tumour
1. ependymoma
2. astrocytoma
3. hemangioblastoma
The 3 commonest extramedullary spinal tumour
1. nerve sheath tumour
2. meningioma
3. filum ependymoma
In children, wt the commonest intramedullary, intradural extramedullary, and extradural tumour?
Intramedullary: astrocytoma
Intradural extramedullary: ependymoma
Extradural: neuroblastoma
Tx of extramedullary spinal tumour
Surgical excision
Adjuvant therapy for aggressive

( Most extramedullar tumour is benign)
Tx of intramedullary spinal tumour
Surgical excision for benign
Midline myelotomy for malignant
Post-op radiotherapy for selected malignant or recurren tutmour
Prognosis of spinal tumour in surgery
For benign tumour
1. Pre-op neurological function
2. Location of lesion
3. Surgical technique

For malignant,
1. susceptibility to adjuvant therapy
Where is the region most commonly affect by arterio-venous malformation in spinal cord?
Thoracolumbar region
Clinical feature of spinal AVM
Hemorrhage
MRI of spinal AVM
Enlarged vessel

Two of the folowing may happen too:
1. haematoma
2. cord atrophy
What is the definite diagnosis of spinal AVM ?
Spinal angiography
Give 4 complication of spine infection
1. spondylitis
2. discitis
3. epidural abscess
4. cord abscess
Pattern of spine infection in children and adult
Children: disk space first, then vertebrae

Adult: subchondral vetebrae first, then disc space