4. Spinal tracts
Corticospinal = Motor control to
ipsilateral muscles
Dorsal colums = Fine touch,
vibration &
proprioception
Spinothalamic = Crude touch, pain &
temperature
5. Arterial supply
Anterior spinal artery
• Supplies 2/3
• Spinothalamic & corticospinal tracts
Posterior spinal artery
• Dorsal columns
Anterior cord syndrome, most commonly
due to insufficiencies in the aorta
(aneurysm/dissection/trauma), leads to
disturbance of spinothalamic & corticospinal
tracts.
Very poor prognosis
6. Cervical Spine – Radiograph lines
Important for describing alignments on
radiographs.
Anterior vertebral line
Posterior vertebral line
Spinolaminar line
Posterior spinous line
7. • Predominantly lower back / leg
pain
• Progression from disc protrusion –
annulus fibrosus intact
• Tear in annulus fibrosus (outer)
allows nucleus pulposus through
• Usually due to age related
degeneration
• More rarely due to trauma
• Usually resolve within a few weeks
without discectomy
Disc herniation
8. • Neurosurgical emergency
• Based on incidence &
catchment around 5 would be
expected yearly at WMH
• Most due to large central
lumbar disc herniation at L4/5
or L5/S1
• Three Classic patterns of
presentation
1. Acutely as first symptom of
disc herniation
2. Endpoint of long history of
back pain due to herniating
disc
3. Insidious progression to
numbness & symptoms
Cauda Equina Syndrome (CES)
9. • Red Flag symptoms:
• Severe lower back pain
• Sciatica type pain
• Saddle +/- genital sensory loss
• Bladder, bowel or sexual
dysfunction
• Defined as:
1. Incomplete Cauda Equina
syndrome
2. Cauda Equina syndrome with
urinary retention
• Patients with urinary retention
have worse prognosis
Cauda Equina Syndrome (CES)
10. • History including time frame &
bladder / bowel / sexual
dysfunction
• Examination:
• Full lower limb neuro including
reflexes
• Perianal sensation & anal tone
• Catheter tug sensation
• Clinical diagnosis even by
neurosurgeons has 43% false
positive rate so urgent MRI
recommended
• If clinical features & MRI
suggest reversible cause of
pressure then need transfer to
spinal centre for surgical
decompression
CES - Management
11. • Some debate regarding urgency of
surgery
• Most recent evidence shows that early
(<24hrs) decompression does lead to
better outcomes in incomplete CES
• Retrospective study noted that 87%
recovered normal bladder function if
<24hrs, compared to 43% if >24hrs.
• Inconclusive evidence regarding benefit
of surgery & its timing in CES with
retention
CES - Outcomes
12. Other differentials to consider from history:
Tumour – either primary bone or metastatic cord
compression
Epidural / subdural haematoma
Infective pathology
13. Complete cord injury
Due to major trauma
Neither motor nor sensory below injury level
Minimal chance of functional recovery
Anterior cord syndrome
Due to disruption / thrombosis of flow in
anterior spinal artery
Motor, pain & temperature loss bilaterally
Poor prognosis
Other spinal cord injury patterns
14. Brown-Séquard syndrome
Hemi-transection or unilateral compression
Ipsilateral motor (corticospinal), proprioception &
vibration (dorsal columns) loss
Contralateral pain & temperature (spinothalamic)
loss
Central cord syndrome
Commoner following hyperextension in patient with
cervical spondylosis
Greater motor weakness in upper than lower limbs
Burning sensation in upper extremities common
Other spinal cord injury patterns
15. Recap on spinal anatomy and radiographic description
Disc herniation key facts
Cauda Equina syndrome presentation & management
Other spinal cord injury patterns
Thank you,
Any questions?
Learning objectives
