David Ferguson

Aims & Objectives

Spine Anatomy Signs & Symptoms Diagnosis Treatment

AnatomyCauda Equina

Dorsal Root Ganglion

Dura Mater

Intervertebral disc

S1 nerve root

Filum Terminale

Lumbar IV disc

Lateral part of sacrum

Pedicle L5 vertebra

L5 nerve roots

S2 vertebra

Sup. Art. Process L3

Thecal Sac

30 Yr Old Woman with lower back pain 1. History?

2. Examination?3. Diagnosis?

Large disc bulge L4/5

Cauda Equina

Syndrome

Cauda Equina Diagnosed

Questions

The dural sac ends at which vertebral level?L1L2S1S2The Coccyx

Correct!

Questions

In infants, the spinal cord may extend as far as:L3L4S2The Coccyx

Correct!

Acute (on chronic) back pain Severe pain 10/10 Constant pain Changing neurology Bladder dysfunction is a bad late sign

Symptoms

Causes

Prolapsed disc Tumour Blood clot Infection Vascular Trauma Congenital canal stenosis Developmental (Syrinx/ Chiari)

Cauda Equina (Dura opened)

Red Flag Symptoms Bilateral sciatica Saddle anaesthesia Sphincter disturbance

Urinary retention Bowel & Bladder Incontinence Reduced Anal Tone

Bilateral loss of ankle jerk

Treatment

Urgent decompression for acute cauda equina

CES treated within 24hrs are much more likely to recover bladder function

Remember Spinal TB: abscess needs to be drained.

Spinal TB

48 year old female with microcytic anaemia and low back ache

Diagnosis

Plain MRI T2 weighted shows if there is lack of

CSF around cauda equina CT Myelography

Treatment options

Depend on causesSpinal decompression & stabilisationRadiotherapyAntibiotics