Spine and Spinal Cord Surgery - exam-focused guide
Spine and Spinal Cord Surgery covers degenerative disease, deformity, infection, tumour and syringomyelia. The exam tests red flags, timing of decompression and selection of fusion.
Core rules
- Cauda equina syndrome is an emergency: saddle anesthesia, urinary retention or incontinence, bilateral leg pain/weakness and reduced anal tone. Urgent MRI and decompression are required; delay worsens bladder recovery.
- Radiculopathy follows a dermatomal pattern; myelopathy causes upper motor neuron signs, gait disturbance and sphincter dysfunction. MRI is the imaging of choice.
- Lumbar disc herniation usually improves conservatively; surgery is for progressive deficit, cauda equina or refractory pain. Lumbar stenosis with neurogenic claudication may need decompression.
- Spondylolisthesis is graded by slip; fusion is added when instability is present. Deformity surgery balances coronal and sagittal alignment.
- Spinal infection: discitis/osteomyelitis and epidural abscess cause fever, back pain and neurological deficit. MRI with contrast is sensitive; obtain cultures and start antibiotics; decompress if cord or cauda equina compressed.
- Syringomyelia causes cape-like sensory loss; look for Chiari malformation, trauma or tumour. Treat the cause, not just the syrinx.
Worked example: A 45-year-old has acute back pain, urinary retention, saddle numbness and bilateral leg weakness. MRI shows a large central lumbar disc. This is cauda equina syndrome; urgent surgical decompression is arranged, and the patient is counseled about bladder, sexual and bowel outcomes.
Traps: attributing urinary symptoms to prostate disease and missing cauda equina; relying on plain radiographs for disc herniation; giving antibiotics before cultures in spinal infection; fusing a stable degenerative spine without indication.