1. Spinal Disease, Red Flags and What To Lookout For.
Mr James Akinwunmi
Consultant Neurosurgeon.
Hurstwood Park Neurological Centre.
Spire Gatwick Park Hospital.

2. FUNCTIONS OF THE SPINE. Protection. Muscular attachment. Mobility.
Support (stability).

3. Common spinal problems
Disc prolapse.
Spinal stenosis
Radiculopathy
Myelopathy
Radiculomyelopathy.
Instability.
Tumours.
Trauma.

4. COMMON RED FLAG SYMPTOMS & SIGNS
Urinary incontinence.
Altered bowel habits.
Impotence.
Spastic Gait.
Muscular weakness.
- foot drop.

5. Urgent referral. Change in urinary/bowel/erectile function.
Perianal numbness/incontinence.
Constant unremitting backpain- ? tumour.
Muscle weakness/wasting.

6. Radiculopathy. Nerve pain – radiation down the limb. Numbness.
Paraesthesia.
+ve nerve stretch test.
Reduce/absent tendon reflex.
Muscle wasting/weakness.

9. Cervical Spine- Arm pain
Radiculopathy.
Neckpain.
Numbness.
Paraesthesia.
Headaches.

10. Cervical Radiculopathy – causes.
Anterior cervical disc prolapse.
Stenosis – degenerative changes.

11. Cervical Radiculopathy –Red Flags
Muscle wasting.
Muscle weakness.

12. How to test for arm weakness?

13. C5 red flags Wasting of deltoid muscle.
Difficulty abducting the shoulder.
Poor resistance to adduction the shoulder.

14. C6 Biceps wasting. Weakness of elbow flexion.
Inability to lift objects up.

16. C7
Triceps wasting.
Weakness in elbow extension/wrist extension.

17. C8

18. Sciatica.
Leg pain.
Paraesthesia.
Numbness.
Muscle fasciculation.

22. Lumber spine – Red Flags.
Muscular wasting.
Weakness.
Changes in bladder/bowel habits.

23. L2/3 weakness

24. Testing/looking for L4 root red flags.
Wasting of quadriceps.
Difficulty in climbing stairs.

28. Test for L5 weakness.
Can the patient stand and walk on their heels.

29. Testing/looking for S1root weakness
Can the patient stand and walk on tip-toes.
Is there calf wasting.

32. Spinal Tumours.

33. Silent tumours – red flags
Neurological deficits.
Unremitting pain -chronic.
Worsening on coughing.
Nocturnal pain.
Sensory level.
Radicular Pain.

39. Developed back pain, which did not resolve with conservative measure.
Case study
Mr AB
Aged 18
Playing cricket
Developed back pain, which did not resolve with conservative measure.
Patient also had nocturnal pain.
When to GP – advised conservative management.
Patient presented to the A/E (x3) with tingling in his feet.
Patient developed difficulty in walking and latter developed paralysis.

40. Trauma.

45. Case study
Mrs DA
RTA 8/52
? Cervical #
She had continues pain.
Cervical muscular spasm.
Could not tolerate, being without a collar.
Patient sent for physiotherapy.
Physiotherapist not happy so therefore sent for a Neurosurgical consultation.

48. THANK YOU