Spinal Cord Compression

Question 1

What % of the UK economy will have back pain in their adult life?

1 - 0.6%
2 - 6%
3 - 36%
4 - 60%

Answer 1

4 - 60%

• lifetime prevalence is between 49 - 70%

Question 2

What age does lower back pain generally pean in the UK?

1 - 21-30 y/o
2 - 30-40 y/o
3 - 41-50 y/o
4 - >55 y/o

Answer 2

3 - 41-50 y/o

Question 3

Which of the following is NOT a red flag for back pain?

1 - weight gain
2 - fever
3 - persistent pain, even without movement
4 - night pain
5 - history of malignancy
6 - progressive bowel/ neurology dysfunction (saddle anaesthesia. bowel bladder issues)

Answer 3

1 - weight gain

• typically patients lose weight in things that may cause red flags

Question 4

Where does the spinal cord end and form the conus medularis?

1 - T10
2 - T12
3 - L1
4 - L3

Answer 4

3 - L1

Question 5

The cauda equina is what the nerves below the end of the spinal cord form. These nerves are important and carry innervation for all of the following EXCEPT:

1 - nerves of GIT
2 - genitals
3 - internal and external anal sphincter
4 - detrusor vesicae
5 - muscles of the leg
6 - reflexes of the knee and ankle
7 - skin sensations of the legs and pelvis

Answer 5

1 - nerves of GIT

Question 6

Cauda equina is a medical emergancy and can be caused by compression, trauma or damage to the nerves of the cauda equina. All of the following can cause cauda equina, but what is the most common cause of cauda equina?

1 - spinal stenosis
2 - disc herniation
3 - ankylosing spondylitis
4 - spondylolisthesis
5 - trauma
6 - malignancy

Answer 6

2 - disc herniation

• ankylosing spondylitis = disc degeneration and inflammation
• spondylolisthesis = protrusion of vertebral disc

Question 7

In cauda equina patients can present with all of the following EXCEPT which one?

1 - saddle anesthesia
2 - bladder incontenance
3 - bowel incontenance
4 - increased erectile function

Answer 7

4 - increased sexual function

• generally causes reduced erectile function

Question 8

When comparing cauda equina and conus medularis, which typically presents with more pain?

Answer 8

• cauda equina

Question 9

When comparing cauda equina and conus medularis, which typically has radicular pain?

Answer 9

• cauda equina

Question 10

When comparing cauda equina and conus medularis, which presents with a sudden and bilateral onset?

Answer 10

• conus medularis
• cauda equina is gradual and unilateral

Question 11

When comparing cauda equina and conus medularis, which presents with flaccid paralysis at the level of the level of the lumbar root?

Answer 11

• cauda equina
• conus medularis has normal motor function, unless S1-S2 are damaged

Question 12

When comparing cauda equina and conus medularis, which can present with loss of ankle and knee reflexes?

Answer 12

• cauda equina
• conus medularis typically loses just ankle reflex

Question 13

Dissociation of sensation is when there is loss of sensation in a selective manner. When comparing cauda equina and conus medularis, does dissociation occur in both?

Answer 13

• generally occurs in conus medularis

Question 14

What is the major difference between cauda equina and conus medularis when comparing them with lesions that occur higher up the spinal cord?

Answer 14

• cauda equina and conus medularis = flaccitiy and areflexic resembling LMN lesions
• higher lesions = spasticity and hyperflexic resembling UMN lesions

Question 15

In patients with back pain we need to do a FBC and biochemistry. What are we looking for mainly in the FBC?

1 - WBC
2 - RBC
3 - haematocrit
4 - pH

Answer 15

1 - WBC

• raised WBC may suggest infection causing problem

Question 16

In patients with back pain we need to do a FBC and biochemistry. Which 2 of the following markers are signs of malignancy?

1 - anaemia
2 - Ca2+
3 - Na+
4 - neutrophils

Answer 16

1 - anaemia
2 - Ca2+

Question 17

X-rays are generally performed on patients with suspected trauma of the spine. But which imaging technique would be classed as the gold standard for looking at the spine?

1 - ultrasound
2 - MRI
3 - CT

Answer 17

2 - MRI

• often identifies significant findings in asymptomatic patients requiring treatment

Question 18

In back pain should bed rest be encouraged?

Answer 18

• no
• unless spine is fractured

Question 19

All of the following are causes of spinal cord compression:

• trauma
• spinal tumours )benign or malignant)
• prolapsed intervertebral disc
• epidural or subdural haematoma
• spinal infection:
• vertebral osteomyelitis,
• cervical spondylitic myelopathy
• spinal manipulation

Question 20

Spinal cord compression is most commonly causes by disc herniation. Which 2 of the following are the most common site of disc herniation?

1 - L4-L5
2 - L5-S1
3 - L2-L3
4 - S1-S2

Answer 20

1 - L4-L5
2 - L5-S1

Question 21

The principle features of a chronic and subacute cord compression are all of the following EXCEPT what?

1 - tetraparaesis
2 - paraparaesis
3 - radicular pain at point of compression
4 - hemianopia
5 - sensory loss below the compression

Answer 21

4 - hemianopia

• tetraparaesis = all 4 limbs
• paraparaesis = lower limbs
  BOTH ARE REDUCED SENSATIONS AND WEAKNESS

Question 22

What is radicular pain?

1 - no pain
2 - nerve root pain
3 - colicky pain
4 - radiating pain

Answer 22

2 - nerve root pain

Question 23

Which infection can lead to cord compression in countries where the infection is common?

1 - tuberculosis
2 - clostridium difficile
3 - varicella-zoster virus
4 - neisseria gonorrhoeae

Answer 23

1 - tuberculosis

• infection leads to vertebral and spinal space destruction
• leads to paraparesis and eventually paralysis

Question 24

Is cord compression dangerous?

Answer 24

• yes
• medical emergency

Question 25

What is the main imaging of choice if you suspect a patient has spinal cord compression? 1 - X-ray 2 - CT 3 - MRI 4 - ultrasound

Answer 25

3 - MRI

Question 26

If a patient has a confirmed spinal cord compression, which of the following management options is most suitable? 1 - analgesia and bed rest 2 - back support 3 - steroid injections 4 - surgery

Answer 26

4 - surgery - medical emergency - delays can lead to permanent cord damage

Question 27

If there is a cord malignancy that is inoperable, how can the patient be treated? 1 - palliative care 2 - chemotherapy 3 - radiotherapy

Answer 27

3 - radiotherapy

Question 28

Malignancy is a potential cause of spinal cord compression. All of the following are causes of metastasis in bone, which can lead to spinal cord compression, EXCEPT: 1 - breast 2 - prostate 3 - colon 4 - lung

Answer 28

3 - colon

Question 29

In spinal cord compression, if a patient experiences bilateral leg weakness, and sometimes arm weakness, where is the compression most likely to be? 1 - cervical 2 - thoracic 3 - lumbar 4 - sacral

Answer 29

1 - cervical

Question 30

When trying to identify if there is a spinal cord compression, we need to identify if it is a upper motor neuron (UMN) or lower motor neuron (LMN) problem. When looking at muscle contractions, do UMN or LMN have more contractions?

Answer 30

- UMN = more muscle contractions - LMN = less muscle contractions

Question 31

When trying to identify if there is a spinal cord compression, we need to identify if it is a upper motor neuron (UMN) or lower motor neuron (LMN) problem. When looking at muscle tone, do UMN or LMN have more muscle tone?

Answer 31

- UMN = more muscle tone (hypertonic) - LMN = less muscle tone (hypotonic)

Question 32

When trying to identify if there is a spinal cord compression, we need to identify if it is a upper motor neuron (UMN) or lower motor neuron (LMN) problem. When looking at reflexes, do UMN or LMN have more reflexes?

Answer 32

- UMN = hyperreflexia - LMN = hyporeflexia

Question 33

When trying to identify if there is a spinal cord compression, we need to identify if it is a upper motor neuron (UMN) or lower motor neuron (LMN) problem. Do patients with UMN or LMN have a negative Babinski sign?

Answer 33

- UMN = positive test, indicating UMN lesion - LMN - negative test

Question 34

When trying to identify if there is a spinal cord compression, we need to identify if it is a upper motor neuron (UMN) or lower motor neuron (LMN) problem. Both UMN and LMN have atrophy, but which is disuse and which is due to disuse innervation?

Answer 34

- UMN = disuse atrophy - LMN = reduced innervation