Spine and Spinal Cord Surgery
Core concepts
Know the anatomy and biomechanics of the spine, including the three-column concept and the indications for stabilization. Understand degenerative disease: disc herniation, stenosis, spondylolisthesis, and the surgical options (discectomy, laminectomy, fusion). Cover spinal cord compression from tumor, infection, and trauma, and the timing of decompression. Learn the principles of spinal instrumentation, the risks of adjacent segment disease, and the assessment of instability. Also know the presentation and management of syringomyelia, Chiari malformation, and spinal vascular malformations.
Traps
- Assuming all back pain needs surgery; most degenerative disease is managed conservatively.
- Missing cauda equina syndrome (saddle anesthesia, urinary retention, bilateral leg weakness), which is a surgical emergency.
- Confusing radiculopathy (dermatomal, single root) with myelopathy (cord signs, hyperreflexia, gait disturbance).
- Forgetting that spinal epidural abscess requires urgent decompression and antibiotics.
Worked example / rule of thumb
A patient with sudden urinary retention, saddle anesthesia, and bilateral leg weakness has cauda equina syndrome and needs emergent MRI and decompression. Rule of thumb: radiculopathy follows a dermatome, myelopathy produces upper motor neuron signs below the lesion, and cauda equina produces lower motor neuron signs with sphincter dysfunction.