Spinal cord, radiculopathy, and neurorehabilitation
Spinal cord, radiculopathy, and neurorehabilitation
The exam tests cord localization, red flags, radicular pain, and rehabilitation principles. Cervical myelopathy causes hand clumsiness, gait disturbance, hyperreflexia, and sphincter change. Cauda equina syndrome causes saddle anesthesia, urinary retention, and bilateral leg weakness; urgent MRI is required. Radiculopathy follows a dermatomal pattern with positive straight-leg raise in lumbar disease. Cord syndromes include anterior cord syndrome from anterior spinal artery infarction, dorsal column loss in B12 deficiency, and Brown-Sequard hemisection. Rehabilitation focuses on function, spasticity, bladder care, and pressure injury prevention.
Worked example
A 45-year-old has severe back pain, urinary retention, and saddle numbness. Reasoning: cauda equina syndrome. Obtain emergency MRI and surgical consultation; do not wait for weakness to develop.
Traps
Do not miss red flags such as fever, cancer history, trauma, or bowel/bladder dysfunction; do not treat radiculopathy with opioids alone; do not overlook cervical myelopathy in elderly patients with falls; do not delay decompression in cauda equina syndrome; do not ignore spasticity and bladder rehabilitation.