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32 Cards in this Set

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Etiology of Cervical (or thoracic) myelopathy.
Narrowing of central canal of cervical (or thoracic) spine causing compression of spinal cord.
What type of neurons are affected in cervical (or thoracic) myelopathy?
UMN
Why are symptoms of cervical (or thoracic) myelopathy difficult to assess sometimes?
They are subtle and usually attributed to old age
What are the possible symptoms of cervical (or thoracic) myelopathy? x6
1. Global hand numbness
2. Decrease in dexterity
3. Dysgraphia
4. Gait disturbance (due to spasticity)
5. Neck pain
6. Associated radiculopathy
List the positive physical exams starting from the most likeliest earliest finding. x5
1. Sobriety test
(loss of tandem gait is earliest)
2. Heel/shin test
3. Hoffman's test
4. Hyperreflexia
5. Clonus
What are the treatments for cervical (or thoracic) myelopathy?
Surgery:

ACDF
Laminectomy
Laminoplasty
What will be different symptomatically between Cervical myelopathy and Thoracic myelopathy?
Thoracic myelopathy will have same symptoms and cervical myelopathy, except it won't have upper extremity problems.
What is the usual outcome for cervical (or thoracic) myelopathy patients after surgery? x3
Gait is immediate to improve

UE takes time to resolve

Some conditions will never resolve due to permanent injury on the spinal cord.
Etiology of Neurogenic Claudication.
Narrowing of central lumbar canal (stenosis) causing decrease in venous outflow from nerve roots.
Symptoms of Neurogenic claudication.
Vague, but severe and persistent PAIN in the low back, buttocks, and/or thighs.
When are the symptoms of Neurogenic Claudication most extreme?
When standing b/c central canal gets narrower when standing.
Neurogenic claudication has symptoms very similar to what fatal disease?
Leriche syndrome
(aortoiliac insufficiency)
What disease would you expect if patients have stools in front of sink or in showers, where they can SIT FOREVER.
Neurogenic Claudication
What would the physical exam reveal for neurogenic claudication and what test MUST you do and why?
Usually normal except for typical signs of degenerative disease.

Must test distal pulses to rule out aortoiliac insufficiency.
What tests must you run for neurogenic claudication and what would you expect.
1. MRI - Necessary to r/o Leriche
(expect no fluid signal @ 2-3 levels)

2. EMG/NCS - normal

3. X-ray
(Disc space narrowing)
What is the short term treatment for neurogenic claudication?
Epidural steroids
What is the long term treatment for neurogenic claudication?

Prognosis?
Surgery WITHOUT FUSION

Excellent
What is segmental instability?
Measurable increase in motion between segments.
What are the specific measurements of Segmental instability?
C-spine: > 3.5 mm
L-spine: > 4.5 mm

> 11 degrees more motion between adjacent segments
What condition is frequently associated with segmental instability?
Associated radiculopathy
What are the two components of treatment for segmental instability?
Surgery:

Decompression
Fusion
What can be said about the prognosis of treatment for segmental instability?
Results proportional to indications.
What disease is associated with "Scotty dog" on X-ray?
Segmental instability
What are the risk factors for Neoplasm? x8
Hx of CA

Bowel/Bladder problems
Age ( >50 or <18 )
Neurologic deficit

Pregnancy
IV drug use
Steroid use
Systemic symptoms
What are the symptoms of Neoplasms? x3
Night pain > Day pain

Isolated / Thoracic pain

Constant pain
Unrelieved by anything
What is a good test for detecting neoplasms and why?
MRI, b/c tumors are very vascular.
What should you be careful with when dealing with Myelomas?
Bone scan can be false negative
Back pain syndromes

- Pain location and intensity
Back pain > leg/buttock pain
Back pain syndromes

- prognosis
>90% resolve within 6 weeks
If back pain unresolved after 6 weeks, beware of what? x2
Chronic pain behavior (Waddell signs)

Narcotic seekers
What term should you beware of when your referral spinal surgeon uses it preceding any type of surgery? and why?
Discogenic pain

You will be stuck with a pain management problem
If fusion doesn't relieve pain, would a disc replacement work?

Why or why not?
No

Anterior placement is dangerous, more so with age.

Severe complications.