C-Spine Disorders Lecture Powerpoint

Question 1

C1 (lacks vertebral body and spinous process) is also known as the ___, C2 as the ___ which features the ___

Answer 1

Atlas, axis, dens/odontoid process

Question 2

Anterior longitudinal ligament vs posterior longitudinal ligament vs ligamentum flavum vs interspinous ligaments vs nuchal ligament

Answer 2

Anterior is in the front of the vertebral body, posterior is on the back of the body but in front of the spinal cord (the floor of the spinal column), the ligamentum flavum connects the lamina of each adjacent vertebrae on the roof of the spinal column, interspinous connects the spinous processes off the back of that, while the nuchal connects the spinous processes to the rhomboid and trapezius muscles (ending at the 7th cervical vertebra)

Question 3

What does the vertebral arteries supply?

Answer 3

The brainstem, the cerebellum, and spinal cord

Question 4

Most prominant spinous process of the cervical vertebrae

Answer 4

C7

Question 5

Superior and inferior articular facets function

Answer 5

Allow the vertebral bodies to improve range of motion with one another by assisting in articulation

Question 6

Red flags in patients with neck pain (5)

Answer 6

• Recent major neck trauma
• neurologic symptoms
• lhermitte’s phenomenon
• fever or chills
• Unexplained weight loss

Question 7

Stable spine injury

Answer 7

Only impacts the anterior column (anterior longitudinal ligament, anterior half of vertebral body, disc and annulus)

Question 8

Unstable spine injury

Answer 8

Affects anterior and posterior column (posterior longitudinal ligament and all posterior aspects of vertebral body)

Question 9

Cervical sprain

Answer 9

Acute whiplash associated disorder ligamentous injury with delayed onset of a few hours and increasing neck stiffness as well as generalized and diffuse pain, diagnosed typically from history and physical and tender on palpation - don’t need films if no midline tenderness, focal neuro deficit, normal alertness, rest and conservative management best option (nsaids, ice, PT)

Question 10

Cervical strain

Answer 10

Neck and upper dorsal pain/stiffness due to musculotendinous injury due to previous injury, overuse, improper posture, etc, localized tenderness with unremarkable xrays and neurlogics intact, conservative management best option for treatment

Question 11

Discitis

Answer 11

Inflammation of vertebraldisc space usually a coinfection with vertebral osteomyelitis from infection spreading from other sites, presents with neck pain and stiffness, evaluated with MRI**, treated with antibiotics or support if viral and immobilized, limited course

Question 12

Spondylolysis/spondyloisthesis

Answer 12

Defect in pars interarticularis causing low back pain either nondisplaced as a stress fracture or collapsed, overuse in nature from hyperextension, insidious onset, positive stork test, treated with nsaids or bracing

Question 13

Stork test

Answer 13

Stand on one leg, hyperextend and rotate spine, elicits pain in positive case indicating spondylolysis/spondyloisthesis

Question 14

C spine sublaxation

Answer 14

Partial dislocation of vertebrae, flexion injury that represents significant ligamentous injury, although stable needs orthopedic consult to prevent facet dislocation

Question 15

Bilateral facet dislocation

Answer 15

Severe form of c spine sublaxation and ligamentous injury, very unstable, disruption of both anterior longitudinal lig and posterior, complete anterior dislocation of vertebral body and high risk for spinal cord injury, needs surgical management

Question 16

Compression fractures

Answer 16

Common in osteoporosis*** as well as malinancy from axial force, one of the vertebral bodies collapses into another, type 1 (wedge fracture) is stable and heals on its own in 8-10 weeks with cervical collar, type iii less stable and need surgery, type IV and V poor prognosis

Question 17

Flexion teardrop fracture

Answer 17

Most unstable and dangerous c spine injury, variant of burst compression fracture, common from diving head first, displacement of anterior inferior edge of vertebral body displacing posterior inferior corner frragments into spinal cord, acute and severe neurologic deficits, diagnosed via lateral c spine view, needs life support measures

Question 18

Hangman’s fracture

Answer 18

C2 fracture, traumatic spondylolisthesis, bilateral fracture of pars interarticularis, anterior displacement of vertebra, usually result of hyperextension and axial compression with MVA being most comon cause, usually neurologically intact but see pain, need rigid collar or surgery

Question 19

Jefferson fracture

Answer 19

C1 burst fracture, diving and MVA cause, immobilization and skeletal traction help manage