Spine EMQs | Detailed Explanations

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Spinal cord injuries

A. Central cord syndrome

B. Anterior cord syndrome

C. Brown-Séquard syndrome

D. Posterior cord syndrome

E. Cauda equina syndrome

F. Complete cord injury

Scenario 1: A 78-year-old man fell down the stairs sustaining an injury to the neck. He has an

Clinical Rationale: Central cord syndrome.

Scenario 2: A 36-year-old man was stabbed in the right posterior thorax. He has loss of motor

Clinical Rationale: Brown-Séquard syndrome.

Scenario 3: A 14-year-old girl with adolescent idiopathic scoliosis was unable to move her legs

Clinical Rationale: Anterior cord syndrome. Central cord syndrome is the most common incomplete spinal cord injury presenting with greater loss of neurons in the upper extremities than in the lower ones. It has an overall fair prognosis. Brown-Séquard syndrome occurs as a result of penetrating trauma resulting in ipsilateral proprioception loss and motor weakness with loss of contralateral pain and temperature sensation. An anterior cord syndrome is related to vascular insufficiency of the anterior two-thirds ofthe cord resulting in loss of power and pain with preserved proprioception and vibration sense. It carries the worst prognosis among the incomplete spinal cord injuries.

Findings in lumbar disc disease

A. Right paracentral L3/L4 disc herniation

B. Right foraminal L3/L4 disc herniation

C. Right paracentral L4/L5 disc herniation

D. Right far lateral L4/L5 disc herniation

E. Right foraminal L5/S1 disc herniation

Scenario 1: A 32-year-old man presents with sensory loss over the right medial calf with an MRC

Clinical Rationale: Right far lateral L4/L5 disc herniation.

Scenario 2: A 23-year-old lady presents with sensory loss over the lateral aspect of her right

Clinical Rationale: Right paracentral L4/L5 disc

Scenario 3: A 25-year-old builder presents with numbness over the lateral aspect of his right

Clinical Rationale: Right posterolateral L5/S1 disc herniation. Posterolateral or paracentral discs are the most common type occurring in approximately 90–95% of cases. The most common location is L4/L5 followed by L5/S1. Foraminal and far lateral discs occur in 5–10% of the cases. A posterolateral/paracentral disc affects the lower, traversing nerve root (L5 root at the L4/L5 level). A foraminal/far lateral disc affects the upper, exiting root (L5 at the L5/S1 level). A paraspinal approach (Wiltse) is indicated for far lateral disc herniation.

FRCS EMQs: Spine

Key Medical Takeaway

Spinal cord injuries

Findings in lumbar disc disease