C Spine Pathologies Flashcards
how may common variants (vertebral fusion) present?
what is it potentially due to?
what can it lead to?
may present as asymptomatic - no treatment or with decreased range of movement
anomalous embryonic development
scoliosis
what is the treatment for a vertebral fusion?
what may vertebrae present with and which vertebrae?
meds & physical therapy to ease symptoms
2nd/7th vertebrae may present with bifid spinous process
what is os odointoideum?
a congenital failure of fusion of dens to the remainder of the axis
what are the general symptoms of os odointoideum?
what is a less frequent symptom and would this occur?
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
what is the treatment for os odointoideum? - 3 points
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
What is a Jefferson #?
it is a burst # of the atlas due to direct compression force applied directly over the vertex in the caudal direction
how does a jefferson # occur?
what does it cause to happen?
axial compression force (e.g. driving injury) along axis of c spine
causes occipital condyles to be driven into the lateral masses of C1
how may a jefferson # result in a spinal cord injury?
what other parts is a jefferson # associated with?
due to retropulsed # fragment
other # of cervical region, head injury, vertebral artery injury & extra-cranial cranial nerve injury
how is a jefferson # shown on a diagnostic image?
how is it treated?
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
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 #?
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
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 #?
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
what is the mechanism of injury for a burst #?
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
what is the preferred diagnostic method for a burst #?
what are the radiographic features of a Burst #?
what is the treatment for a burst #?
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
how does a hangman’s #occur?
what is a hangman’s #?
involves hyperextension of the neck in the sagittal plane, caused usually by hyperextension injury # of the neural arch of C2 (axis)
the bilateral lamina & pedicle # at C2 (occurring to hangman’s #) is associated with …
antero-listhesis of C2 on C3
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?
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