1. Spinal Cord and Diseases of the Spine Re-written by: Daniel Habashi 1 st Classes by: Dr. Jezewski (Asshole) Seminar by: Dr.

2. Discopathy A combination of 2 systems, the neural system and the muscular system Neural system: ▫Central nervous system ▫Peripheral nervous system Lumbar region 80% have problems  back aches Anulus fibrosus – very well innervated ▫Patients are usually very symptomatic – pain Nucleus palposus -

3. Discopathy – continued T2 – spinal fluid is very intense Discs are very elastic with a lot of fluid Degenerative discs ▫No water ▫Very small Cervical spine A little more dangerous, spinal cord size is that of a pinky finger. Everything is very densely packed and even the slightest compression of the spinal cord can cause very dangerous serious injury. In the lumbar spine you can observe the patient, and treat him through phsyiotherapy because you only have spinal roots which can move only a little bit and they have a lot of space as opposed to those in the cervical region

4. Protrusion of nucleus palposus Goes laterally ▫1. Sensory deficits ▫2. Muscle weakness ▫3. Autonomic deficits Usually there’s compression through the intervertebral foramen?  monoradiculopathy Read about sensory dermatomes  nerve-root- dependent sensory symptoms

5. Spinal Stenosis – Neurogenic Claudication If the problem goes on for 6 months then the patient should be operated because medical treatment will not lead to any more improvement IF the patient is not operated then the degeneration continues ▫The tissues around the spinal canal (yellow ligament, etc) get thicker and enclose the spinal canal and narrow the spinal canal as well.  This leads to a problem where the surgical procedure becomes more difficult and the disc and joint must be removed in order to stabilize the spine since it’s not possible to simply cut through

6. Vascular claudication: stopping and sitting down decreases the pain Spinal Stenosis: the patient has to bend over to increase the size of the spinal canal by 7% and relieve the pain

7. Spine Tumors Symptoms and signs: ▫Radiculopathy ▫Myelopathy ▫Sensory deficits Dorsal LocationExtradural – 55% Ventral LocationExtramedullary Intradural – 40% IntraforaminalIntramedullary – 5% Intraspinal

8. Most common Primary tumors (intramedullary) ▫Astrocytoma and Ependymomas Most common metastatis in males: ▫LUNGS Most common metastasis in Females: ▫BREAST Most common extramedullary tumors: ▫Neurinoma and Meningioma

9. Diagnostic Tests CT NMR Myelography Froin’s Sign ▫Not probably going to encounter the sign. It’s mentioned because it’s a sign from the times when we used to do a lumbar puncture to introduce contrast and examined the CSF at that time as well. ▫When we do lumbar puncture, and measure the protein level it’s always higher below the tumor than higher in the spinal cord because the tumor blocks the circulation of the CSF and that’s why the older CSF (below the tumor) is richer in protein. ▫Also, the pressure of the CSF does not rise below the tumor when we press on the belly Queckenstedt Manouver

10. Meningioma and syringomyelia? Something about that. Need to read about that

11. INJURIES TO THE SPINAL CORD Most important: ▫At the scene of the accident we have to treat the patient as if there’s spinal cord injury by immobilization of the spinal cord ▫Neurological examinations can be false-negative and you must do an x-ray +/- CT to assess spinal fractures / spinal cord trauma

12. Spinal Cord Injury Golden Hour ▫Giving mega doses of steroids can stop such damage (methylprednisolone - 30mg/kg/hour for the 1 st hour and then 5.4 mg/kg/hour for the next 23 hours – is this mg or ml???? Unsure actually…check it out. Spinal shock Bradycardia Hypotension Children – different mechanisms ▫Musculature in the cervical spine region is very delicate and very weak. Even a small drop or intense shake a child can have a very serious injury to the cervical spine. Cervical spine 42% < 9 years of age, 67% non-accidental trauma (shaken baby syndrome) SCIWORA – Spinal Cord Injuries Without Radiological changes?

13. Syringomyelia Tumors Injury Inflammatory diseases ▫Such as meningitis which will later obstruct the canal Congenital malformations ▫Most common: Arnold-Chiari Malformation, typical for patients with myelomeningocele

14. Hydromyelia Different type but symptoms are the same

15. Symptoms Just like intramedullary tumors Spino-thalamic pathway is interrupted Sensory deficits of pain and temperature

16. Inflammatory Diseases Epidural empyema Discitis Compromised host ▫S.Epidermidis, S, Aureus

17. Wady Dysraficzne Przepuklina oponowo-rdzeniowa Arnold chiari Jamistosc Rdzenia Zakotwiczenie stozka

18. Craniosyntosis