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Spinal Surgery 1

Mr Mushtaque A. Ishaque BSc(Hons) BChir(Cantab) DM FRCS FRCS(Ed) FRCS(Orth)

Consultant Orthopaedic Spinal Surgeon and Senior Clinical Academy Teacher Hunterian Professor at The Royal College of Surgeons of England

Teaching Aims

Common Spinal Conditions

Important Spinal Conditions

Safe

Common Spinal Pathologies

Degenerative disc disease Lumbar and cervical disc herniation

Spinal canal stenosis Spondylolysis

Spondylolisthesis

Important Spinal Pathologies

Trauma Tumour Infection

Deformity Inflammatory Cauda Equina

Core Knowledge and Skills

Anatomy, Physiology and Pathology

History and Examination

Draw up a Differential Diagnosis

Anatomy of the Spine

  Central axis of the skeleton

  Supports the Skull

  Attachment to the thoracic cage and hence the pectoral girdle and upper limbs

  Linked via the pelvis to the lower limbs

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Anatomy

Strength of the column is from the size and architecture of the bony elements and the strength of the ligaments and muscles

Protects the neural elements

Anatomy

Cervical Spine Atlas and axis

5 Typical vertebrae

Coccyx

Sacrum 5 segments

Lumbar Spine 5 typical vertebrae

Thoracic Spine 12 Typical vertebrae

Anatomy Anatomy

Anatomy

Annulus fibrosis Nucleus pulposus

Intervertebral Disc

Anatomy

Cord C1 to T12

Conus medullaris T12 to L1

Cauda Equina L2 to sacrum

Long fibre tracts UMN

Nerve roots LMN

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Anatomy Spinal Cord, Primary Rami & Sympathetic Chain

Dorsal Root Ganglion

Medial

Lateral

Posterior 1º Rami

Anatomy

Corticospinal Motor

Syndromes Anterior Central Mixed

Brown-Séquard Dorsal

Spinal Cord Columns and Syndromes

Anatomy

Dermatomal Map

Anatomy

Lower Limb Muscle Groups

Terminology

  Radiculopathy Root injury   Myelopathy Cord injury   Quadriplegia Loss of function in upper

and lower limbs   Paraplegia Loss in function of lower

limbs   Paraparesis Weakness due to cord or

root compression

Implications of Neural Compression

  Above C4 Loss of ventilation   C5 Quadriplegia   C5 to T1 Decreasing arm function   T1 to L1 Paraplegia   L2 to L5 Decreasing leg function   L5 and below Impaired sphincter and

sexual function Foot and ankle weakness

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Cervical & Thoracic Cord Compression

  Spastic paresis/paralysis

  Increased tone and clonus

  Brisk reflexes

  Extensor plantar response

  Retention, overflow and automatic bladder

Cauda Equina & Compression Below L1

  Radicular weakness

  Muscle wasting & fasciculation

  Decreased tone & loss of reflexes

  Autonomous dribbling bladder

  Impotence

Myelopathy

  Weakness of Upper limbs > Lower limbs   Loss of fine motor skills   Broad based shuffling gait   Spasticity   May have Upper limb radiculopathy   Brisk reflexes and extensor plantars   Rarely get urinary symptoms

Radiculopathy

  Radiculitis - Root pain

  Paraesthesia or numbness

  Motor weakness

  Sphincter disturbance

Ready to go !

  Think about putting it all together

  History and examination

  Investigations

  Correlate you findings