3. The Spine - clinical conditions 2

Question 1

what is Jefferson’s fracture

Answer 1

fracture of the anterior and posterior arches of atlas (C1)

Question 2

what causes Jefferson’s fracture

Answer 2

increased axial load from vertical fall on extended neck (eg diving into shallow water) - compresses lateral masses of atlas between occipital condyles and axis causing them to radially expand

Question 3

which structures may be damaged in Jefferson’s fracture

Answer 3

• arteries at base of skull (with secondary neurological sequelae, e.g. ataxia, Horner’s syndrome)
• typically causes pain but no neurological symptoms due to wide vertebral foramen

Question 4

what is Hangman’s fracture

Answer 4

• fracture of pars interarticularis of axis (C2)

- unstable fracture: forward displacement of C1 and body of C2 on C3

Question 5

what causes Hangman’s fracture

Answer 5

hyperextension of head on neck

Question 6

what are the clinical consequences of Hangman’s fracture

Answer 6

variable severity: no neurological signs if spinal cord not affected, to spinal cord transection (deep unconsciousness, respiratory and cardiac failure)

Question 7

what can cause fracture of odontoid process of C2

Answer 7

head trauma causing cervical hyperflexion or hyperextension

Question 8

why does fracture of odontoid process have a long healing time

Answer 8

often unstable fracture at high risk of avascular necrosis due to isolation of distal fragment from blood supply

Question 9

how is trauma to C1/2 visualised

Answer 9

often difficult to visualise on X-ray so:

• use ‘open mouth’ AP X-ray (‘peg view’)
• MRI cervical spine

Question 10

what is whiplash

Answer 10

neck pain caused by low energy trauma involving hyperextension and hyperflexion

Question 11

what is cervical spondylosis

Answer 11

• degenerative OA of intervertebral joints in cervical spine

- involves narrowing of space between adjacent vertebrae from age related degeneration of IV discs

Question 12

describe the X-ray features of cervical spondylosis

Answer 12

1. formation of syndesmophytes (osteophytes) to try and increase surface area
2. thickening of ligamentum flavum
3. signal change in spinal cord

Question 13

what is the consequence of lateral osteophyte dev. in cervical spondylosis

Answer 13

RADICULOPATHY - pressure on nerve roots:

• dermatomal sensory symptoms (pain, paraesthesia)
• myotomal motor weakness

Question 14

what is the consequence of anterior osteophyte dev. in cervical spondylosis

Answer 14

MYELOPATHY (less common) - pressure on spinal cord:

• global weakness
• gait dysfunction
• loss of balance
• loss of bladder and bowel control

Question 15

what are most common causes of thoracic cord compression

Answer 15

fractures (with bony fragments) and tumours