Spinal Cord and Root Dysfunction

Question 1

How does spinal cord and root dysfunction present?

Answer 1

• Pain.
• Sensory disturbance.
• Weakness.
• Sphincter dysfunction.
• Sexual dysfunction.

Question 2

How does spinal cord and root dysfunction at a cervical level present?

Answer 2

• Arm involvement.

- UMN features if central.

Question 3

How does spinal cord and root dysfunction at a thoracic level present?

Answer 3

• No/ minimal arm involvement.

- UMN features if central.

Question 4

How does spinal cord and root dysfunction at a lumbar level present?

Answer 4

• Only leg involvement.

- No UMN features.

Question 5

In UMN pathology, what happens to tone?

Answer 5

Tone is increased.

Question 6

In LMN pathology, what happens to tone?

Answer 6

Tone is decreased.

Question 7

Does atrophy occur in UMN or LMN pathology?

Answer 7

• UMN: no atrophy/late.

- LMN: atrophy present.

Question 8

Do fasciculations occur in UMN or LMN pathology?

Answer 8

LMN pathology.

Question 9

Describe reflexes indicative of UMN pathology.

Answer 9

Brisk reflexes in UMN pathology.

Question 10

Describe reflexes indicative of LMN pathology.

Answer 10

Decreased/absent reflexes in LMN pathology.

Question 11

Describe plantars action indicative of UMN pathology.

Answer 11

Upgoing plantars.

Question 12

Describe plantars action indicative of LMN pathology.

Answer 12

Downgoing plantars.

Question 13

Clonus is indicative of which MN pathology, upper or lower?

Answer 13

Clonus indicates UMN pathology.

Question 14

Describe examination findings indicative of a cervical disc prolapse.

Answer 14

• Arm pain.
• Dermatomes affected.
• Myotomes affected.
• LMN pathology.

Question 15

Describe examination findings indicative of a thoracic disc prolapse.

Answer 15

Rare.

• Thoracic pain.
• Dermatomes dermatomes affected.
• Usually central causing myelopathy.

Question 16

Describe examination findings indicative of a lumbar disc prolapse.

Answer 16

• Leg pain.
• Dermatomes affected.
• Myotomes affected.
• LMN pathology.

Question 17

Patient presents with intermittent pain that is worse on mobilising, eases at rest and on bending forwards.

The pain is often felt at the back of the thighs and calves where there is also altered sensation. Heaviness/ weakness is also experienced.

What is your diagnosis?

Answer 17

Spinal claudication.

Question 18

What is the principle concern of Cauda Equina syndrome?

Answer 18

Urinary function.

Question 19

What sensory symptoms would suggest cauda equina syndrome?

Answer 19

• Perianal sensory loss to pinprick sensation.

- Genital numbness.

Question 20

Painless urinary retention with urinary incontinence (overflow) in cauda equina syndrome suggests involvement of which nerve roots?

Answer 20

S2-S4.

Question 21

What signs/ symptoms suggest cervical myelopathy?

Answer 21

• “Numb, clumsy hands”.
• Usually bilateral, one side may be more affected.
• Fingertip paraesthesia.
• Difficulty with fine motor tasks.
• Dropping objects.
• Reduced mobility.
• Hoffman’s and Lhermitte’s sign.

Question 22

What is Hoffman’s sign?

Answer 22

Flick the nail of the middle finger.

-Positive: flexion of ipsilateral thumb and/or index finger.

Question 23

What does positive Hoffman’s sign indicate?

Answer 23

• Corticospinal tract pathology e.g. cervical myelopathy.
• Brain tumour.
• MS.
• Hyperreflexia.
• Hyperthyroidism, anxiety, use of nervous system stimulants etc.

Question 24

What is Lhermitte’s sign?

Answer 24

Sensation similar to an electric shock passing down the back of the neck and into the spine. May then radiate out into the arms and legs.

Usually triggered by bending your head forwards towards your chest.

Question 25

Lhermitte's sign is suggestive of?

Answer 25

Lesion or compression of upper cervical spinal cord or lower brainstem e.g. cervical myelopathy. Often considered classical of MS.

Question 26

Should surgery or conservative management be utilised in cervical myelopathy?

Answer 26

Most do not need surgery. Early surgery vs conservative treatment shows no difference at 1 year. Surgery however has a faster rate of PERCEIVED recovery, but risks.

Question 27

What is failed back syndrome?

Answer 27

- Recurrence of/ residual compression following surgery. - Nerve injury, altered joint mobility and instability. - Fibrosis, arachnoidities. - Infection. - Depression anxiety.

Question 28

What increases likelihood of Failed Back Syndrome?

Answer 28

- Diabetes. - Smoking. - High BMI.

Question 29

Is surgery indicated in back/ neck pain?

Answer 29

- No significant benefit with surgery, which may in fact worsen the pain.

Question 30

How should back/ neck pain be managed?

Answer 30

Conservative management: - Physiotherapy and analgesia. - Chronic pain teams.

Question 31

Present Babinski sign may indicate?

Answer 31

- UMN lesion. - CNS pathology: most likely pyramidal tract. - Corticospinal dysfunction.

Question 32

What is the Babinski sign?

Answer 32

Stroking the sole of the foot produces extension of the big toe.