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32 Cards in this Set
- Front
- Back
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Etiology of Cervical (or thoracic) myelopathy.
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Narrowing of central canal of cervical (or thoracic) spine causing compression of spinal cord.
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What type of neurons are affected in cervical (or thoracic) myelopathy?
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UMN
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Why are symptoms of cervical (or thoracic) myelopathy difficult to assess sometimes?
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They are subtle and usually attributed to old age
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What are the possible symptoms of cervical (or thoracic) myelopathy? x6
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1. Global hand numbness
2. Decrease in dexterity 3. Dysgraphia 4. Gait disturbance (due to spasticity) 5. Neck pain 6. Associated radiculopathy |
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List the positive physical exams starting from the most likeliest earliest finding. x5
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1. Sobriety test
(loss of tandem gait is earliest) 2. Heel/shin test 3. Hoffman's test 4. Hyperreflexia 5. Clonus |
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What are the treatments for cervical (or thoracic) myelopathy?
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Surgery:
ACDF Laminectomy Laminoplasty |
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What will be different symptomatically between Cervical myelopathy and Thoracic myelopathy?
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Thoracic myelopathy will have same symptoms and cervical myelopathy, except it won't have upper extremity problems.
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What is the usual outcome for cervical (or thoracic) myelopathy patients after surgery? x3
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Gait is immediate to improve
UE takes time to resolve Some conditions will never resolve due to permanent injury on the spinal cord. |
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Etiology of Neurogenic Claudication.
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Narrowing of central lumbar canal (stenosis) causing decrease in venous outflow from nerve roots.
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Symptoms of Neurogenic claudication.
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Vague, but severe and persistent PAIN in the low back, buttocks, and/or thighs.
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When are the symptoms of Neurogenic Claudication most extreme?
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When standing b/c central canal gets narrower when standing.
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Neurogenic claudication has symptoms very similar to what fatal disease?
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Leriche syndrome
(aortoiliac insufficiency) |
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What disease would you expect if patients have stools in front of sink or in showers, where they can SIT FOREVER.
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Neurogenic Claudication
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What would the physical exam reveal for neurogenic claudication and what test MUST you do and why?
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Usually normal except for typical signs of degenerative disease.
Must test distal pulses to rule out aortoiliac insufficiency. |
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What tests must you run for neurogenic claudication and what would you expect.
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1. MRI - Necessary to r/o Leriche
(expect no fluid signal @ 2-3 levels) 2. EMG/NCS - normal 3. X-ray (Disc space narrowing) |
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What is the short term treatment for neurogenic claudication?
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Epidural steroids
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What is the long term treatment for neurogenic claudication?
Prognosis? |
Surgery WITHOUT FUSION
Excellent |
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What is segmental instability?
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Measurable increase in motion between segments.
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What are the specific measurements of Segmental instability?
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C-spine: > 3.5 mm
L-spine: > 4.5 mm > 11 degrees more motion between adjacent segments |
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What condition is frequently associated with segmental instability?
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Associated radiculopathy
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What are the two components of treatment for segmental instability?
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Surgery:
Decompression Fusion |
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What can be said about the prognosis of treatment for segmental instability?
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Results proportional to indications.
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What disease is associated with "Scotty dog" on X-ray?
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Segmental instability
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What are the risk factors for Neoplasm? x8
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Hx of CA
Bowel/Bladder problems Age ( >50 or <18 ) Neurologic deficit Pregnancy IV drug use Steroid use Systemic symptoms |
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What are the symptoms of Neoplasms? x3
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Night pain > Day pain
Isolated / Thoracic pain Constant pain Unrelieved by anything |
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What is a good test for detecting neoplasms and why?
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MRI, b/c tumors are very vascular.
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What should you be careful with when dealing with Myelomas?
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Bone scan can be false negative
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Back pain syndromes
- Pain location and intensity |
Back pain > leg/buttock pain
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Back pain syndromes
- prognosis |
>90% resolve within 6 weeks
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If back pain unresolved after 6 weeks, beware of what? x2
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Chronic pain behavior (Waddell signs)
Narcotic seekers |
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What term should you beware of when your referral spinal surgeon uses it preceding any type of surgery? and why?
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Discogenic pain
You will be stuck with a pain management problem |
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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. |
