Académique Documents
Professionnel Documents
Culture Documents
Neurological and
Spinal Conditions
Cerebral conditions
Spinal conditions
Cervical spine
Thoracic and lumbar spine
Pelvic and sacral conditions
Peripheral nerve lesions
Spinal Conditions
Cervical spine
Congenital abnormalities
Klippel–Feil syndrome
Sprengel’s shoulder
Cervical rib
Torticollis
Spina bifida
Congenital webbing
Neoplasia
Benign - soft tissue
cartilaginous
bony
Malignant - primary - soft tissue
cartilagenous
bony
secondary
Trauma
Soft tissue injuries - t e n d o n s /
ligaments
Subluxation and dislocation
Fractures
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Infection
Discitis
Osteomyelitis
Tuberculosis
Arthritis
Autoimmune - rheumatoid arthritis
ankylosing spondylitis
Degenerative -cervical spondylosis
Paralysis
Poliomyelitis
Syringomyelia
Thoracic and lumbar spine
Congenital abnormalities
Spina bifida and meningomyelocele
Lumbarisation and sacralisation of
vertebrae
Spondylolysis and spondylolisthesis
Spinal stenosis
Diastematomyelia
Hemivertebrae
Neoplasia
Benign - meningioma
neurofibroma
haemangioma
eosinophilic granuloma
Malignant - primary
secondary
Trauma
Soft tissue injuries- t e n d o n s /
ligaments
Subluxation
Dislocation
Fractures
Neurological and Spinal Conditions 379
Infection
Discitis
Osteomyelitis
Tuberculosis
Arthritis
Rheumatoid arthritis
Ankylosing spondylitis
Spinal paralysis
Trauma
Thrombosis and embolus of the cord
Neurofibromatosis
Transverse myelitis
Syringomyelia
Scoliosis
Congenital abnormalities
Idiopathic causes
Paralysis
Compensatory
Kyphosis and lordosis
Congenital abnormalities
Neoplasia
Trauma
Infection
Osteoporosis
Paget’s disease
Scheuermann’s disease
Back pain
Congenital abnormalities
Neoplasia
Trauma
1. Peripheral
neuritis
2. Poliomyelitis
3. Brachial plexus
4. Axillary nerve
3 5. Radial nerve
4 6. Ulnar nerve
7. Median nerve
8. Digital nerve
11 9. Sudek’s
10 atrophy
5 10. Nerve
7 9 entrapment
6
11. Cauda equina
1,8 10 12. Sciatic nerve
13. C o m m o n
2 12 peroneal nerve
14. Tibial nerve
14
13
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CT appearance of a
Cerebral palsy cerebral neoplasm
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X-ray appearance of
Tendon transfer
an osteotomy
Neurological and Spinal Conditions 389
Stroke and head injuries
A stroke is defined as an upper-motor neurone lesion
which is often acquired in later life. Stroke is usually
caused by a cerebrovascular incident which includes
haemorrhage, thrombosis or embolus. It may also fol-
low a head injury, and less commonly various neuro-
logical disorders such as disseminated sclerosis and
cerebral tumours. A stroke usually affects the arm and
leg on the side opposite to the cerebral lesion. As with
cerebral palsy, however, it may affect only one limb,
or all four limbs and the trunk.
The clinical picture is very similar to that of cere-
bral palsy with all gradations of physical and mental
impairment. Left-sided cerebral lesions in right-hand-
ed people and in a majority of left-handed people,
cause dysphasia due to involvement of the speech cen-
tres.
The treatment is very similar to cerebral palsy with
the emphasis being on mobilisation and rehabilitation.
Simple subcutaneous elongation of the tendo Achillis
alone to correct an equinus deformity will often also
reflexly improve a spastic flexion deformity of the hip
and knee on the side affected. Similarly, open elonga-
tion of the biceps tendon alone will often reflexly im-
prove a palmar flexion and pronation deformity of the
wrist and forearm.
Cerebral neoplasms
The possibility of a secondary tumour, a meningioma,
a glioma or other cerebral neoplasm must always be
considered in all patients with a history of increasing
weakness, sensory loss, ataxia or mental impairment.
Referral to a neurologist plus EEG, CT or MRI scans
may be indicated as well as other investigations.
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Stroke and Head Injuries
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CT appearance of CT appearance
an extradural of a subdural
haemorrhage haemorrhage
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X-ray appearance
Torticollis
of a cervical rib
Neurological and Spinal Conditions 393
Neoplasia
Secondary deposits in the vertebrae are the
most common cause of neurological compres-
sion. These affect one or more vertebral
bodies and less commonly the laminae and
pedicles with possible subluxation or dis-
location leading to quadriplegia. The disc
spaces are usually intact, with secondary
deposits, providing a useful radiological
means of distinguishing them from infections
which almost always involve the disc. Neu-
rofibromata and meningiomata are rare caus-
es of paralysis.
Trauma
A dislocation or fracture dislocation is a
common cause of nerve root or even spinal
cord compression. A flexion rotation force
is the usual mechanism.
Infection
Pyogenic infection usually involves one disc
space alone initially with the adjacent
vertebrae. There may also be an abscess which
can cause cord compression.
Tuberculous infection is much more insidious
and often causes destruction of more than
one vertebra and the disc between.
Arthritis
Autoimmune (rheumatoid arthritis)
Rheumatoid arthritis causes softening of the
ligaments, particularly in the upper cervical
region with subluxation or dislocation of
the odontoid peg and possible quadriplegia
due to cord compression.
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Cervical Spine Conditions
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Neck traction
Supportive collar with rotation and
flexion to side
of lesion
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Oblique X-ray
Oblique X-ray spondylolisthesis
spondylolysis with forward
displacement
Neurological and Spinal Conditions 401
cauda equina compression. Back pain is com-
mon, but neurological signs are uncommon.
The most common cause of a mild spondy-
lolisthesis occurring in any part of the
lumbar spine is degeneration of the facet
joints and the intervertebral disc secondary
to osteoarthritis. Again neurological signs
are uncommon, but back pain may be severe.
Clinically, apart from muscle spasm and
tenderness of the lower lumbar spine, a step
may be felt at the site of a slip as one
vertebra and its spinous process subluxes
forward on the vertebra below. A defect in
the pars interarticularis seen on oblique
X-rays has been compared to the head, eyes
and ears of a Scottish terrier dog. A collar
at its neck signifies a spondylolysis. A
forward slip of its head (represented by the
transverse process and upper pedicle) on
the body and front legs (represented by the
lower pedicle and spinous processes)
signifies a spondylolisthesis. Investigations
should include not only X-ray views of the
area, but also CT scans of the individual
vertebrae and occasionally an MRI scan in
addition.
The treatment of back pain in spondy-
lolisthesis is usually back exercises, rest
and a supporting corset. In severe cases,
decompression of the nerves or postero-lat-
eral arthrodesis of the affected part of the
lumbar spine alone may be necessary.
Spinal stenosis
Spinal stenosis may be due to congenital
narrowing of the spinal canal in conditions
such as achondroplasia or it may develop
following encroachment of osteophytes upon
the vertebral canal as occurs in osteoar-
thritis of the facet joints. Alternatively
spinal stenosis may be secondary to a previ-
ous fracture of the vertebral bodies. As a
result the vertebral canal is narrowed and
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Trauma
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Kyphosis Kyphos
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Kyphoscoliosis
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X-ray appearance of
Kyphos a kyphos-secondary
to metastatic
deposit
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Back exercises
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Trauma
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Paget’s disease
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Diminished
knee jerk
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Weakness
of plantarflexion
Diminished ankle
Weakness jerk
indorsi-
flexion
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L5 dermatome S1 dermatome
(L4/5 disc) (L5/S1 disc)
2
5
10
3
4
7
1 8
10
6
9
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1. Secondary deposits
2. Low back strain
3. Prolapsed disc
4. Ankylosing spondylitis
5. Trauma
6. Coccydynia
7. Vascular
8. Pelvic tumour
9. Gynaecological
10. Osteoarthritis
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Physiotherapy Heat
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Local anaesthetic
spray and extension Fracture boards
exercises
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Spinal exercises
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Carcinoma involving
bladder and rectum
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Retroflexed uterus
5
10
3 2
4
1 7
8
6 10
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1. Secondary deposits
2. Low back strain
3. Prolapsed disc
4. Ankylosing spondylitis
5. Trauma
6. Coccydynia
7. Vascular
8. Pelvic tumour
9. Gynaecological
10. Osteoarthritis
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Poliomyelitis
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Polio patient in
a wheelchair
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Diagnosis
1. Altered nerve
response to electrical
stimulation
2. Absent or diminished
sensation and
sweating
3. Flail or weak arm
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Sensory deficit
Treatment
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Dorsum Palm
Sensory deficit
Treatment
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Dorsum Palm
Sensory deficit
Treatment
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Nerve entrapment
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