C Spine Pathologies

Question 1

how may common variants (vertebral fusion) present?
what is it potentially due to?
what can it lead to?

Answer 1

may present as asymptomatic - no treatment or with decreased range of movement
anomalous embryonic development
scoliosis

Question 2

what is the treatment for a vertebral fusion?

what may vertebrae present with and which vertebrae?

Answer 2

meds & physical therapy to ease symptoms

2nd/7th vertebrae may present with bifid spinous process

Question 3

what is os odointoideum?

Answer 3

a congenital failure of fusion of dens to the remainder of the axis

Question 4

what are the general symptoms of os odointoideum?

what is a less frequent symptom and would this occur?

Answer 4

may be asymptomatic or present with local mechanical pain, torticollis, headache, neuromuscular symptoms, sensory changes
neurovascular symptoms from vertebral artery compression as a result of atlanto-axial instabiltity

Question 5

what is the treatment for os odointoideum? - 3 points

Answer 5

clinical and radiological surveillance

may need an operational stabilisation if there is spinal instability/neurological involvement/severe pain

if a pt is asymptomatic, they’re at risk of acute spinal cord injury after minor traumatic injury so fixation & fusion should be undertaken to avoid development of these injuries

Question 6

What is a Jefferson #?

Answer 6

it is a burst # of the atlas due to direct compression force applied directly over the vertex in the caudal direction

Question 7

how does a jefferson # occur?

what does it cause to happen?

Answer 7

axial compression force (e.g. driving injury) along axis of c spine
causes occipital condyles to be driven into the lateral masses of C1

Question 8

how may a jefferson # result in a spinal cord injury?

what other parts is a jefferson # associated with?

Answer 8

due to retropulsed # fragment

other # of cervical region, head injury, vertebral artery injury & extra-cranial cranial nerve injury

Question 9

how is a jefferson # shown on a diagnostic image?

how is it treated?

Answer 9

radiographs show asymmetry in odontoid peg with displacement of lateral masses - a distance greater than 6mm suggests ligamentous injury

treated using hard collar immobilisation as long as there is no ligament damage
if there is ligament damage, it is considered unstable and halo immobilisation device used with lateral mass internal fixation

Question 10

what is the prognosis of a Jefferson # if wearing a halo immobilisation device?
why does upper cervical instability need to be carefully managed?
what is the expected outcome after treating jeffersons #?

Answer 10

weaned from the halo whilst neck is gradually rehabilitated in terms of intrinsic muscle stability & range of motion
upper cervical instability needs to be carefully managed as neurological damage can can leave the pt dependent on a ventilator
pt’s are expected to heal and have excellent prognosis for resumption of activity in the absence of associated injuries

Question 11

What is a Burst # usually due to?
how is a burst # characterised?
what is a burst #often accompanied by?
is it a stable or an unstable #?

Answer 11

usually due to compression forces
by anterior wedging of vertebral body
by retro-pulsion of posterior margin of vertebral body into spinal canal
stable or unstable

Question 12

what is the mechanism of injury for a burst #?

Answer 12

result of compressive high energy injury (like Jeff#) - caused by fall from significant height
where the intervertebral disc is driven into the vertebral body below

Question 13

what is the preferred diagnostic method for a burst #?
what are the radiographic features of a Burst #?
what is the treatment for a burst #?

Answer 13

CT
loss os posterior vertebral height on lateral views, retro-pulsed fragments in spinal canal
if there is no retro-pulsed fragment then the injury is considered stable and is treated by immobilisation & pain relief
if a # fragment is evident then there is a possible cause of neurological damage and possibly surgery

Question 14

how does a hangman’s #occur?

what is a hangman’s #?

Answer 14

involves hyperextension of the neck in the sagittal plane, caused usually by hyperextension injury 
# of the neural arch of C2 (axis)

Question 15

the bilateral lamina & pedicle # at C2 (occurring to hangman’s #) is associated with …

Answer 15

antero-listhesis of C2 on C3

Question 16

what is the treatment for hangman’s #? - 3 points
what is there a more aggressive type of treatment for?
what are major complications of non-operative treatment?

Answer 16

can be hard collar immobilisation for 6-8 weeks
halo traction
more typical internal fixation

for more aggressive stabilisation against the likelihood of # fragment dislodgement & subsequent spinal cord injury

Nonunion and Malunion but fortunately these are rare occurrences

Question 17

what is the mechanism of injury for a teardrop #?

Answer 17

hyperflexion and compression - e.g. diving head first

Question 18

what are the radiographic features of a teardrop #? - 6 points

Answer 18

of anterior-inferior vertebral body (teardrop sign), loss of anterior height of vertebral body, cervical kyphosis, posterior cervical displacement above level of injury, widening of spinous processes, intervertebral disc narrowing anterior dislocation of facet joints

Question 19

why would further imaging be required to investigate in a teardrop #?
what else can cause a teardrop #?

Answer 19

to investigate possible cord injuries

hyperextension but it’s not as severe as hyperflexion as the vertebral body isn’t displaced

Question 20

what is the treatment for a teardrop #?

Answer 20

immobilisation in neck collar, pain relief and restricted activities during healing

Question 21

what is a Clay Shoveller’s #?

what is the mechanism of injury for a Clay Shoveller’s #?

Answer 21

# of spinous process of lower cervical vertebrae and is usually a stress #
associated with MVAs, sudden muscle contraction and direct blows to the spine

Question 22

what are the radiographic features of a Clay Shoveller’s #?

Answer 22

seen as oblique lucency through the spinous process

Question 23

what is the mechanism of injury for an Odontoid #?

Answer 23

caused by falls in elderly pt’s, caused by blunt trauma to the head in younger pt’s causing the head to either hyperextend/hyperflex

Question 24

Give the 3 types of Odontoid #s

Answer 24

Type I - through the upper part of the odontoid peg (rare & potentially unstable)
Type II - through the base of the odontoid peg (unstable
& high risk of non-union)
Type III - through odontoid & into lateral masses of C2 (best prognosis for healing because larger s.a. of #)

Question 25

what is an anterior displacement due to odontoid # associated with?
what is a posterior displacement caused by?

Answer 25

transverse ligament failure

hyperextension of the neck where arch of atlas impacts odontoid

Question 26

what is the mechanism of injury for an atlanto-occipital dislocation?
what is this associated with?
why can this be fatal?

Answer 26

RTA/pedestrian collision

associated with nerve damage as a result (e.g. quaddraparesis - muscle weakness in all 4 limbs)

can be fatal due to the disruption to the medulla oblongata

Question 27

what is the cause of a # dislocation?

Answer 27

RTA/blunt trauma & sporting injuries (e.g. skiing)

Question 28

what may the neck suffer as a result of a # dislocation?
why is malalignment a cause for concern?
why can checking signs and symptoms be different?

Answer 28

neck can suffer major bony ligaments damage and only have symptoms of pain while minor bony damage can cause severe neurological damage

due to disruption of associated nerves/blood supply/airways therefore realignment is a priority

associated swelling will cause its own symptoms

Question 29

what is the treatment for a # dislocation? - 4 points

Answer 29

meds to reduce swelling followed by surgery, removal of disc fragments, reduction of dislocation, surgical stability with anterior reconstruction of vertebrae

Question 30

what is a cause for the loss of lordosis? - 3 points

Answer 30

neglecting to maintain good posture, OP, obesity

Question 31

what is the treatment for loss of lordosis?

what is a disadvantage?

Answer 31

traction therapy & physio to assist with regaining proper posture, sometimes spinal fusion needed to address abnormal curvature by fusing the cervical vertebrae so that they can’t drift out of place

a disadvantage to this is that the spine then loses some of its flexibility and elasticity

Question 32

what happens to muscles after a traumatic injury?
what is this a characteristic of?
what can infection cause?
what are other infections?

Answer 32

the muscles go into spasm resulting in twisting of the head
characteristic of torticollis
infection causes gland & lymph nodes within the neck to swell and muscles overlying these glands can go into spasm
other infections of sinuses/ear/nose/throat = torticollis

Question 33

what is the treatment for torticollis?

when is the prognosis good?

Answer 33

meds, physical therapy, stretching exercises and sometimes surgery
prognosis is good with symptoms relieved within a few days to few weeks

Question 34

what is spondylosis?

Answer 34

degenerative changes in the spine - can be degenerative discs or growth of bony spurs

Question 35

what are the typical appearances of spondylosis? - 4 points

Answer 35

1. osteophytic lipping
2. sub-chondral sclerosis
3. reduced disc space height
4. reduced joint space

Question 36

what is the treatment for spondylosis?

Answer 36

meds and physical therapy to ease symptoms, no cure because it is degenerative

Question 37

what is ankylosing spondylitis? - 4 points

who is most likely to be diagnosed?

Answer 37

chronic inflammatory disease of axial skeleton involving peripheral joints - can eventually cause complete fusion and rigidity of spine, “Bamboo Spine” - develops when outer fibres of fibrous ring of disc ossify and results in formation of osteophytes between adjoining vertebrae

onset most likely between 15-25 years

Question 38

what is the treatment for ankylosing spondylitis? - 4 points

Answer 38

meds - analgesia, anti-inflammatory drugs, disease modifying meds (e.g. sulfsalazine) & physical therapy to ease symptoms, no cure because degenerative, surgery but only in severe low risk cases
cause = linked to genetics
can lead to complete rigidity of spine

Question 39

what is spondylolisis?

what does this defect predispose to and why?

Answer 39

incomplete development and formation of connecting part of vertebrae (pars interarticularis)

spondylolisthesis because of the spinal instability

Question 40

what is spondylolisthesis?
what are the causes? - 4 points
what are the symptoms? - 2 points

Answer 40

forward or backward displacement of body of one of the lower vertebrae on the vertebrae below it

congenital, degenerative - exhibits later in life, traumatic, pathologic (weakens neural arch)

low back pain to incapacitating pain - restricted spinal motion

Question 41

what is the treatment for spondylolisthesis? - 6 points

Answer 41

change of lifestyle to manage decreased mobility, bed rest if necessary, analgesics, anti-inflamamtory drugs, bracing physic, in severe cases = possible surgical fixation