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Spinal cord disorders (Spinal cord
lesions (Anterior horn plus
pyramidal…
Spinal cord disorders
Spinal cord
lesions
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Central cord
Clinical presentation
Early pain and temperature loss in cape distribution
Anterior extension - pyramidal weakness
Lateral extension - ipsilateral Horner's
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Anterior cord
Clinical presentation
LMN weakness (flaccid, areflexic, wasting, fasiculations)
Sphincter disturbance
Loss of pain and temperature sensation bilaterally
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Pathophysiology
Loss of spinothalamic tracts, preservation of dorsal columns
so loss of pain and temperature but preserved sensation
Loss of pyramidal tracts (weakness)
Anterior horn cell
Pathophysiology
Anterior horn cell only, so only LMN weakness
Clinical presentation
LMN weakness (flaccid, areflexic, wasting, fasiculations)
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Posterolateral cord
Pathophysiology
Loss of dorsal columns and lateral motor tracts,
thus loss of touch, proprioception and UMN weakness
Clinical presentation
Loos of touch and proprioception (level)
UMN weakness (spastic, hyperreflexic)
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Complete section
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Clinical presentation
Loss of sensory, motor, autonomic
at and below level of lesion
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Cauda equina
Clinical presentation
LMN lower limb weakness (flaccid, areflexic)
Saddle anaesthesia
Sphincter disturbance
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Posterior cord
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Pathophysiology
Loss of dorsal columns, thus touch and prorioception
Spinal cord
injury
Management
Acute
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Immobilise neck,
log roll for assessment
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Types of fracture
Thoracolumbar
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Diagnosis
Plain films
HR-CT, MRI spine
Management
Rehabilitation
Decompression, internal/
external fixation, fusion
Cervical
Axial (C1/C2)
Types
C1 fracture
Often no neuro deficit (canal is wide)
Open mouth view and lateral X-rays
Halo immobilise (3m)
C2 fracture
Odontoid peg fracture
Neuro deficit in some but not all
HR-CT and MRI cord
Halo immobilisation, may need surgical fixation
Hangman's fracture
Neck pain and head feels unstable,
often neurologically intact
Lateral c-spine X-ray, MRI spine
Halo or immobiliser brace,
may need surgical fixation
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Pathophysiology
Ring structures, so typically
fracture in two places
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Definition
Spinal instability: loss of ability of the spine
to maintain normal anatomical alignment
under normal physiological loads,
so increased likelihood of further damage
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Aetiology
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Neoplastic
Mets (lung, breast, prostate, thyroid, kidney)
Intrinsic cord tumour
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Diagnosis
Examination
UMN below level,
LMN signs at level
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Bladder/bowel
(hesitancy, urgency,
frequency, retention)
Investigations
Bloods
FBC, CRP/ESR (inflammation),
U+E, LFTs, blood cultures, B12/folate
Immunology (ANA, ANCA)
Microbiology (syphilis)\
Genetics (SMA
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