1) The document discusses various causes of compressive myelopathy including spondylosis, herniated discs, spinal stenosis, and tuberculosis. It describes the clinical features and treatments for different levels of involvement in the cervical and lumbar spine.
2) Imaging techniques like MRI, CT myelogram, and X-rays are used to identify compression of the spinal cord or nerve roots from conditions like herniations, osteophytes, and tuberculosis lesions.
3) Surgical intervention may be indicated for moderate to severe myelopathy, progressive neurological deficits, or failure of conservative treatment. The goal is to decompress the spinal cord and relieve compression.
47. BasillarinvaginationMcRae’s LINE Joins anterior and posterior edges of foramen magnum: sagittal diameter of foramen magnum. (Avg – 35mm);dense below the line foramen stenosis MCGREGOR’S LINE (Basal line)- Joins hard palate to lowest point of occipital bone Tip of dens should not exceed 5 mm above this line FISHGOLD’S DIGASTRIC LINE – paramedian abnormality HEIGHT INDEX OF KLAUS – dense to tuberculam line < 30 basillarinvagination
48. Spinolamellar line – atlas not intersected in ant fusion of atlas atlanto axial dislocation CLIVUS CANAL LINE – basillarinvagination
49.
50. Failure of normal segmentation of the cervical vertebrae/somite between 3rd and 8th weeks of fetal development (rather than a secondary fusion)
52. Autosomal dominant inheritance – C2-C3 fusion. Autosomal recessive – C5- C6 fusionFEIL’S TRIAD : Low posterior hair line(<L4) Short neck Limitation of head and neck movements / decreased range of motion in cervical spine
53.
54. Rotational loss and lateral bending is usually more pronounced than loss of flexion and extension
62. Cervical spine routine x-ray followed by flexion/extension lateral X-rays. - flattening and widening of vertebrae, hemivertebrae or block vertebrae, instability.
63.
64. Arnold-Chiari Malformation 1) Extension of a tongue of cerebellar tissue, posterior to the medulla and spinal cord, into the cervical canal 2) displacement of the medulla into the cervical canal, along with the inferior part of the fourth ventricle 1) Increased ICTheadache, 2) progressive cerebellar ataxia, 3) progressive spastic quadriparesis, 4) downbeatingnystagmus 5) cervical syringomyelia 6)lower cranial nerves palsies hydrocephalus, Type I – Cerbellartonsilarherniation – adult onset,syrinx Type II-Part of Vermis, Medulla & 4th Ventricle herniatingupto mid cervical region – early ages;ass with mengiomyelocele Rx to do nothing Pregessivesymptomaticupper cervical laminectomy and enlargement of the foramen magnum
70. Disease depends on1.cross sectional extent 2.longitu extent.Classic elements: a) segmental weakness and atrophy of the hands and arms b) loss of some or all tendon reflexes in the arms c)segmental anesthesia of a dissociated type (loss of pain and thermal preservation of touch)over the neck,shoulders,and arms(cape sensation) Pyramidal tract: UL : Reflexes preserved or brisk amyotrophy of shoulders and hands spastic LL: Spastic type Post column,spinothalamic tract involvement later Horner syndrome can occur Usually have tropic ulcers; vague pain may be presenting feature
71. BARNETT`s Classification Syringobulbia: affect the brainstem(medulla ,pons) 1. Vestibular nuclei Vertigo & nystagmus 2. Nucleus ambiguusdysphagia & hoarseness of voice 3. Spinal trigeminal nucleus Analgesia & thermal anesthesia on ipsilateral face (Onion skin pattern ) 4. hypoglossal nucleus Weakness of lingual muscles & dysarthria
72. Patho: Gardnershydrodyanamic theory Inves: MRI with contrast – slow filling cavity ; look other skeleatl manifestations CT Myelogram; X ray of cervical spine and skull DD for Dissociated sensory loss: Pseudosyringomyelia-small fib polyneu; DM,amyloia,heriditarysensory,fabrys ant Spinal arte thrombosis PICA Rx Type I-surgical decompression of foramen magnum and upper cervical canal(relieve headache, pain,mildy improve motor sym;ataxia&nystagmus persist Syringostomy or Shunting by T tube by syringotomy in Type I and some II Other types – surgery not useful
78. Bacterial culture pods <25%Rx: Decompressivelaminectomy /drainage + long term parentral(6-8wk) antibiotic weakness several days – not improve with surgery Caudaequina – antibiotics is enough mostly Empiric Abx: Nafcillin plus metronidazole plus either cefotaxime or ceftazidime Vancomycin (1 g every 12 hours) can be substituted for nafcillin
87. Pathophysiology: xtraspinal source of infection osteomyelitis and arthritis (anterior aspect of the vertebral body adjacent to the subchondral plate) spread to adjacent intervertebral disks Child may de direct invasion bone destruction vertebral collapse and kyphosis(throcic>lumbar>cervical) Kyphotic deformity abscesses, granulation tissue, or direct dural invasion Paravertebral abscess anterior longitudinal lig Healing by fibrous tissue spinal cord compression and neurologic deficits bony ankylosis vertebrae. Groin abscess Thoracic abscess
93. X Ray appearances Lytic destruction of anterior portion of vertebral body anterior wedging Collapse of vertebral body Reactive sclerosis Intervertebral disks shrunk or destroyed Vertebral bodies may show destruction Enlarged psoas shadow with or without calcification Fusiformparavertebral shadows MRI
94. Tb spine with PARAPLEGIA INCIDENCE 10-30% Dorsal spine (MC) Motor functions affected before /greater than sensory Sense of position & vibration last to disappear Patho of Tuberculoses Paraplegia Inflammatory Edema –vascular stasis,toxin Extradural Mass – Tuberculousostetis,abscess Bony Disorder – Sequestra, Internal Gibbus Meningeal changes – ‘dura as rule not involved’ Extradural granulation –contractcicatrizationperidural fibrosis paraplegia Infarction of spinal cord - Ant spinal artery Endarteritis, Periarteritis, Thrombosis Changes in Spinal cord- Myelomalacic,Syringomyelic change
95. Seddon’s Classification: GROUP A_-Early onset - in active stage of the disease within first 2 years (active disease - Caseous material, debris, sequestrated disc or bone, internal gibbus, stenosis and deformity can cause compression) GROUP B -Late onset- Usually after 2 years of onset of the disease (Healed disease - Usually internal gibbus and acute kyphotic deformity) Kumar’s classification(paraplegia) 1 Negligible :Unaware of neural deficit, Plantar extensor/ Ankle clonus 2 Mild :Walk with support 3 Moderate :Nonambulatory, Paralysis in extention,sensory loss <50% 4 Severe :3+ paralysis in flexion/sensory loss>50%/ Sphinters involved MANAGEMENT: ATT – prolonged pack and surgery
96. Surgical indications: 1. No sign of Neurological recovery after trial of 3-4 weeks therapy 2. Neurological complication during treatment 3. Neuro deficit becoming worse 4. Recurrence of neuro complication 5. Prevertebral cervical abscesses,neurological signs 6. Advanced cases- Sphincter involvement, flaccid paralysis, Severe flexor spasms 7.severe neurodeficcit Surgical techniques: 1. Decompression -Failed response 2 .Debridement+/- Failed response after 3-6 fusion months, 3 .Debridement +/- Recrudescence of disease DECOMP+/- fusion 4 Debridement+/- Prevent severe Kyphosis fusion 5 .Anterior Severe Kyphosis +neural deficit- Transposition 6 .LaminectomySTS,secondarystenosis, posterior disease 7. Costotransversectomy– in tense paravertebral abscess
97. VASCULAR – Compressive myelopathy Epidural Haematoma: predisposing factors: Anticoagulation therapy,Trauma,Bleedingdisorder,tumor Acute focal &/ radicular Pain Acute Spastic paraparesis or conusmedularis syndrome Surgical decompression Haematomyelia: Haemorrhage into the substances of spinal cord Trauma,parenchymal vascular malformations,vasculitis,tumors ACUTE PAINFUL TRANSVERSE MYELOPATHY – INTRAMEDULLARY subarachnoid hgecan occur MRI; Spinal Angiography Conservative management only surgery if AVM is the cause
100. at or below the midthoracic levelClinical features: middle-aged man progressive myelopathy that worsens slowly or intermittently with periodic remissions incomplete sensory, motor, and bladder disturbances mixture of upper and restricted lower motor neuron signs Pain over the dorsal spine, dysesthesias, or radicular pain symptoms that change with posture, exertion such as singing, menses Foix-Alajouanine syndrome - progressive thoracic myelopathy with paraparesis Investigation:MRIcontrast;CTmyelogram;Selective spinal angiography Management: Endovascular embolization of feeding vessels surgical if ruptured
105. old age pt Vertebral pain with acute onset of neurological deficit
106. MRI – hypodense in T1;doesnot cross the adjacent disc space
107. Bone scan may be useful to detect the all other metastasis
108.
109. Primary tumors of spinal cord common in cervical Intradural : Benign and slow growing ; progressive compression signs Meningioma,Neurofibroma,chordoma,lipoma dermoid,sarcoma MENINGIOMA: benign throcic cord level or near foramen magnum from arachonoid cells forms Psommama bodies Radiation therapy- Gammma Knife, proton beam treatment external beam NEUROFIBROMA: from schwwan cells arises near posterior root begins with radicular symptoms asymetric progressive spinal cord syndrome need surgical treatment INTRAMEDULLARY: uncommon cervical commonly central cord syndrome or hemicord syndrome Ependymoma,Haemangioblastoma,secondaries astrocytoma(lowgrade) Microsurgical debulking can be tried RT is not useful
