Spinal Disorders

00:00 - Intro
01:39 - Case
03:13 - Chief complaints in myelopathy
05:46 - Spinal anatomy and lesion localization
08:13 - Complete transverse lesion
09:58 - Hemicord lesion
11:18 - Dorsal, dorsolateral (posterior) lesions
12:09 - Ventral (anterior) lesion
13:01 - Anterior horn lesion
13:23 - Small central cord lesion
14:27 - Large central cord lesion
15:17 - Extramedullary vs intramedullary lesions
18:34 - Back to the case...
21:07 - Pathological differential
22:58 - Immune-mediated pathologies
29:37 - Infectious pathologies
36:40 - Vascular pathologies
43:23 - Structural pathologies
48:15 - Neoplastic pathologies
53:25 - Toxic, metabolic pathologies
58:52 - Hereditary myelopathies
1:00:4 1 - Back to the case...
01:02:48 - Myelopathy work-up
01:09:15 - Treatments
01:13:35 - Management algorithm
Link to Approach to Myelopathy Algorithm featured in this vide:
drive.google.com/file/d/1whAl...
Produced and narrated by:
Igor Rybinnik, M.D.
Department of Neurology
Rutgers Robert Wood Johnson Medical School
Disclaimer: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation when appropriate. Also, the opinions expressed in this talk do not necessarily reflect those of Rutgers Robert Wood Johnson Medical school or Rutgers University as a whole.

[@Ondraha]

I have heard many lectures in my life but this one is by far the best. What a magnificent job summarizing this topic! Thank you.

[@theneurophile]

Thank you. I took over a month to produce. Not an easy topic.

[@wiltonpt1]

I was wondering about the statement that cord compression released by flexion and nerve root relieve by extension. Straight leg raise tenses the dura and arachnoid and that is a kink of flexion. Conversely stenosis which affects roots is relieved by flexion. Any comments??

[@caiyu538]

@@theneurophile we deeply appreciate your great effort and share them for free. Great series.

[@amirjanah9873]

As a 3rd year neurology resident, I can say this is probably the best and most organized lecture about spinal cord disorders!! AMAZING.. Thank you very much for the great effort.

[@samiheikkinen5375]

These are beyond awesome, such high yield learning points, great illustrations and animations and the little videoclips of juxta-relevant entertainment is a combination I have yet to find elsewhere. You do a service to neurology all around the globe, and I would gladly even pay for this quality. P.S. Don't make us pay for this.

[@theneurophile]

Education is always free.

[@bigdee3731]

Amazing work relating movies to the content. makes the content relatable and memorable. thanks

[@58209]

as a patient, this is the best resource i've encountered yet that explains why my doctors ran the tests the did when i presented with demyelinating symptoms. thank you for making this.

[@theneurophile]

I’m sorry to hear that you are suffering with neurological symptoms and I’m glad this talk helped provide some clarity. I hope you feel better.

[@caiyu538]

Great series, KZbin is a nice platform that we can see different excellent tutorials from different teachers from their different perspectives. They piece together to make me understand better. I follow up with your great series. Learning efficiency is much higher. Look forward to your more excellent tutorials.

[@amirabdulkehar4356]

do you know channels on surgury ?recommend me.

[@the-neurosurgeon]

Amazing work . I am a neurosurgery resident. These videos are amazing. Keep up the good work . Please post a video for higher mental functions .

[@theneurophile]

Will do.

[@lyubomirgeorgiev1465]

Same here! This channel is one of the best on youtube, if not THE best. Insane production quality.

[@emperormouse5487]

Best lecture I have ever listened to. Just starting Neuro as an M2 and this video has been invaluable. Thank you!!

[@peaceandserenity2551]

I’m so amazed by your way of presenting Dr. 😍 I hope to become like you someday. 😊

[@Sandsack2311]

I like the speaker. Calm, educating, fun. I learn a lot hearing these talks. Thank you!

[@dr.nikhilbasiltom6294]

Best lecture on spinal cord yet. Wish you would expand outside neurology to other aspects of internal medicine. Looking forward to more lectures sir.

[@youngmedlion8631]

Wow, so happy I came across these videos! Thank you for making these!

[@alcirvogel8672]

Thank you Dr. Igor Rybinnik, M.D. and Rutgers Robert Wood Johnson Medical School!

[@jayanthkrishna1973]

Pediatric neurology consultant here , loved the content , I would love to see some pediatric neurology stuff too ❤️

[@intraoperativeneurophysiol127]

Very nice and comprehensive presentation.

[@amyjrx]

Watched all the videos, amazing lectures and great PPT making!

[@yonelagamnca285]

Super super helpful. Thank you so much

[@user-mn4jg9by2i]

Amazing!!! Thanks for that masterpiece doc!

[@sagorahmed9219]

Great Work Sir....... Need More... 😍

[@caiyu538]

It is worth to revisit several times. Thumb up.

[@Bulbasaur2132]

Thank you Dr Igor 🙂

[@DS-nr9zc]

Dude this channel is a god send

[@pratyushprateek1403]

This lecture series is so educational! Thank you. And best regards! Ps. Hope to see many more in the future. ♥️

[@caiyu538]

Great lecture series.

[@drrafeek5390]

Excellent presentation, awesome. thank u

[@hussinmunzer4303]

Thanks very much for your presentation

[@mustafaahmed4091]

That's Amazing, Thank you Dr !

[@Amber-gc5cv]

Thank you so much! This is brilliant!

[@shayaanp9207]

Awesome, I am learning so much, I am enjoying all your lecture series. You are some, Spinal cord always scared me but I think I am getting hold of the concept

[@salvadorfeliperodbec]

Splendid job. I suggest you to place medical disclaimers on every video as books or the "strong medicine" cannel does in order to avoid conflicts later on. Thank you for your dedication.

[@ashrafshafei7220]

I can't describe my happiness with this awesome lecture; it made my day indeed.... Thanks alot, alot,... I really appreciate your great effort in making this...and really, I am waiting for more and more lectures🙏🙏.....Thanks alot☘☘

[@pnarkurubektasoglu6887]

Excellent!

[@nahommulatu3294]

i extremely love your videos please please more.. if you could approach to paraplegia

[@theneurophile]

Thank you. Please watch the Spinal Disorders video if you want to know about paraplegia.

[@theneurophile]

Paraplegia is more of a localization issue - bilateral medial frontal lobes vs spinal cord (at any level) vs peripheral nerve roots vs peripheral nerves. So neuropathy vs plexopathy vs radiculopathy vs myelopathy vs frontal pathologies. If you can identify the correct localization, pathology and management will follow. I'll make a localization video soon to explain.

[@roseworld2184]

You are amazing.Thank you a lot.😊😊

[@sosa8968]

Best lecture

[@Amit8866797159]

Thank you so much Sir, you are awesome. The way that you have explained this complex topic in such a simplified manner shows your expertise and brilliance. I am really grateful to have attended your lecture. Thank you So Much.

[@lucyoriginales]

You're so awesome!

[@mikhalcohen6095]

Studying for the neurology board exam. I just love your lectures. You’re doing an amazing job! Thank you!

[@engy_20]

Perfect❤

[@sankettajane9854]

Thank you so much ))

[@rubinu2]

I love you! Oh the humor!

[@yashwanthrao98055]

Imagine a spin-off with Sheldon and Shawn Murphy 🙂

[@karankalani4211]

Thank you for this amazing lecture! Is bladder dysfunction due to involvement of the sacral corticospinal fibres or motor autonomic fibres in the lateral horn. You seem to mention both.

[@theneurophile]

Most likely due to sacral parasympathetic fiber involvement.

[@frankrobert9199]

great.

[@sheralishaik4237]

Can u please make a video on neurological exam and Road traffic accident management

[@johnrowland3105]

Still awaiting an 'official' diagnosis after a year of scans and 'terms' expressed in the occasional letters from hospitals and Consultants. Arteriovenus Fistula being the latest and oft used within them. When information is in short supply (to patients) you have to go looking for potential explanations (sadly). Of all the 'research material' i've been looking through, this video was more enlightening (maybe) Thank you.

[@theneurophile]

I'm very sorry to hear that you are having difficulties. I hope you receive a diagnosis and get treatment. I wish you a speedy recovery.

[@hirusandutharumuthumadduma7478]

wow. just WOW!

[@behayluyibe7652]

Am dr behaylu pediatric neurology fellow you present very attractive, entertaining and informative presentation thank you. 2 questions 1. in acte case of compressive transverse myelitis giving 10 mg dexamethasone, couldn't it may worsen if the disease is epidural abscess 2 . how can I get the slide

[@vegapangaribuan6170]

Waiting for your lecture on motor neuron diseases

[@user-lk2gx7wz9b]

Great lecture! Thank you but... what about the eighth cervical vertebra on 19:32?

[@theneurophile]

Oh sorry, that was a "typo." Cervical vertebra end at C7. Thank you for catching that.

[@brainman709]

Hi, could I have the sideways tree diagram in pdf format? Thank you

[@fhibanhes]

Loveeee the lecture. Very impressed with the didactics. Now aren't there 7 cervical vertebrae rather than 8, as the video shows?

[@theneurophile]

Sorry, that was a typo. I'll fix in the update.

[@farahazizi6764]

Thank you very much for such a great explanation but i have one question In minute 4:10 you mentioned flexion decreases size of intervertebral foramina i looked it up it actually increases it or am i missing the point if so please do explain it if possible

[@theneurophile]

Flexion should decrease the size of intravertebral foramina while increasing the size of spinal canal. Hence flexion worsens pain from radiculopathy but makes the pain from spinal stenosis a little better.

[@antonribkin5319]

I’m a bit confused about motor pathways damage and pattern of weakness If say both - anterior horns and corticospinal tracts would be damaged then what pattern of weakness (LMN or UMN) would the patient exhibit? Excuse my imperfect English Thanks in advance

[@theneurophile]

That’s an excellent question. Anterior horns at each spinal level supply the muscles at that dermatome. But motor tracks are continuous. If you acutely damage motor tracks in the cervical cord for example, patients may have quadriplegia. Cervical cord lesions may also damage the cervical anterior horns, but since the arms will already be weak from motor track damage, the signs of anterior horn damage will be masked. So in general, with acute cord injury, motor track damage takes priority clinically. In chronic lesions (like motor neuron disease), you may be able to see lower motor neuron signs associated with anterior horn lesions (fasciculations, wasting, decreased reflexes) and/or upper motor neuron signs with motor tract damage (spasticity, Babinski, hyper-reflexia).

[@user-wr9ks3tf4n]

hello doctor, can I ask whether the term "lower motor neuron lesions/signs" include neuromuscular junction disorder and myopathy? thank you

[@theneurophile]

“Lower motor neuron” only refers to the nerve. Neuromuscular junction and myopathy are technically different conditions.

[@didemkocabiyikoglu4587]

Hi! I thought intervertebral foramina size reduces extension and increase with flexion?

[@theneurophile]

Intervertebral foramina reduces with flexion. One maneuver to bring on the pain of cervical radiculopathy is to tilt the head to the side and press down on the top (Spurling test).

[@fatima-ye5xz]

Can u make video on radiculopathy

[@theneurophile]

Sure.

[@johnnyzhang5333]

Would you be open to making the algorithm as a pdf so we can download it? thanks!

[@theneurophile]

You wish has been granted. Please check the video description for a download link.

[@user-wr9ks3tf4n]

Hi doctor, in 16:33 you said the sensory deficit deficit is in ascending pattern, however most lateral part of posterior column is the innervation of cevical area ; does the proprioception loss happen in descending pattern?

[@theneurophile]

Proprioception deficit with cord compression is really impossible to detect at the bedside, so we focus on pinprick/light touch instead. That is more reliable.

[@user-wr9ks3tf4n]

@@theneurophile very thanks for your reply.

[@user-wr9ks3tf4n]

@@theneurophile Can I ask whether the patient description of pain effectively differentiate pain between dorsal column compression , anterolateral system compression , or dorsal root compression?

[@theneurophile]

@@user-wr9ks3tf4n Description of pain is unfortunately very non-specific as well. Most compressive myelopathy presents with pain, and it's unusual to have cord compression without pain. But that's I can say with any reliability.

[@jillphilips3788]

Please What Is The Spinal Fluids Made Of It’s A Simple Straight Forward Question .

[@theneurophile]

Spinal fluid has proteins and nutrients necessary to protect and sustain the life of nerve cells.

[@Mawbz]

Fantastic lecture, though at 40:08 you've labelled the false lumen of the aortic dissection incorrectly, sorry to be that guy

[@theneurophile]

Yes, you are correct. Thank you for pointing that out. It will get fixed when a revised video gets posted

[@alinstoi]

19:28 wait a minute... you mean that after 5 years and almost 100.000 views nobody noticed that wild C8 vertebra?? 😀

[@theneurophile]

Someone did. Sorry about that. KZbin doesn’t allow corrections. I’ll remake the video when I get some time.

[@neuro-mars]

как скачать это изборажение?

[@theneurophile]

Do you mean the thumbnail?

[@ismaelmohammed1058]

🙏❤️❤️❤️❤️❤️

[@jillphilips3788]

Please You Would Think with Your Knowledge We Would Not Be Having These Issues On Such A Large Scale. Comments

[@jillphilips3788]

My Issues Began after A Shot With Vaccine As I Was In Middle School years. Immediately entered Unconscious to The Hospital. Muscle Wasting every year after that.

[@theneurophile]

I’m very sorry to hear that.

[@peachmelba9333]

I have Cervical-Spinal-Stenosis so after years of being told by family and friends I was a " Pain in the Neck" they were all correct! Just had # 2 of 3 epidural neck shots- We Shall See after #3 if it were worth traveling 50 miles to- 50 miles from because my Community hospital close by doesn't offer this as well as many Other Things! Why do I ever go There? THEY ARE Close? PRETTY POOR EXCUSE! Yeah- should just move back to city where my State LandGrant university and their Very Very good medical college and Hospital are located!

[@theneurophile]

I'm sorry to hear about your troubles. I hope you feel better.

[@peachmelba9333]

@@theneurophile oh I shall- I shall- takes a lot to get this Old Girl down- outlived several of my doctors already!

[@skolastikasavitri4147]

You're interesting

[@hornswing3371]

20:15 C8!!??!!

[@theneurophile]

Yes, I have to fix that in the next video. I apologize for that oversight.

[@hornswing3371]

@@theneurophile thanks for your sharing. I know you work really great in all these tutorial.(♡ ὅ ◡ ὅ )ʃ♡You are making the world better♥(｡￫v￩｡)♥