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NYCC Bone & Joint > C3-C7 Anomalies > Flashcards

C3-C7 Anomalies Flashcards

1
Q

What are other names for congenital fusion?

A
  • congenital block vertebra
  • congenital synostosis
  • non-segmentation defect
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2
Q

What is the technically correct term for congenital fusion?

A

Non-segmentation defect
(bc it occurs in utero; never had 2 segments bc 2 somites never separated)

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3
Q

Vertebral bodies arise from what embryonic structure?

A

Notochord

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4
Q

Congenital fusion occurs due to failure of ____

A

Somite segmentation

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5
Q

Congenital fusion most commonly affects how many segments?

A

2

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6
Q

What spinal levels are most commonly affected by Congenital fusion?

A

C5/6
C2/3
T12/L1

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7
Q

When a Congenital fusion involves 2 or more segments, what should you consider?

A

Klippel Feil syndrome

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8
Q

What are the radiographic findings of a Congenital fusion?

A
  • hypoplastic disc
  • wasp waist deformity
  • 50% of cases involve fusion of facets (but all cases have fusion of bodies)
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9
Q

What spinal level cannot have a Congenital fusion?

A

C1-C2 (no disc here)

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10
Q

What is the clinical significance of a Congenital fusion?

A

Concern for biomechanical instability immediately above or below the fusion

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11
Q

What is your next step if you find a Congenital fusion?

A

Need flexion/extension radiographs to check for instability
(May have step-off deformity above or below fusion)

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12
Q

What is the diagnosis? How can you tell?

A

Surgical fusion:
- no loss of A-P dimension (wasp waist)
- no hypoplastic disc (usually scooped out & packed with bone chips)

(Other possibilities, not visualized)
- may involve C1-C2
- may involve posterior elements ONLY
- may have surgical hardware

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13
Q

What is the most common method of surgical fusion?

A

ACDF (anterior c-spine discectomy & fusion)
= scoop out disc, pack spacers with bone chips, hold in place with titanium

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14
Q

If you find out a patient has a surgical fusion, what are your next steps?

A

Flexion/extension radiographs to check for instability above & below the fusion

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15
Q

In a patient with a surgical fusion, what are your 2 concerns?

A
  • instability above/below
  • did the fusion take?
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16
Q

What is the diagnostic criteria for Klippel Feil syndrome?

A

Multiple Congenital block vertebrae in the cervical spine

17
Q

In a patient with Klippel Feil syndrome, what are your concerns?

A
  • hypermobility/instability issues
  • neurologic concerns
  • associated cardiac & renal anomalies
18
Q

What are your next steps for a patient who has Klippel Feil syndrome?

A
  • flexion/extension radiographs
  • thorough neuro exam
  • refer to cardiology & urology
19
Q

What other diagnoses are frequently associated with Klippel Feil syndrome?

A
  • Omovertebral bone
  • Sprengel deformity
20
Q

What is an omovertebral bone?

A

Bone connecting scapula to spine

(Black arrow)
21
Q

What is a Sprengel deformity?

A

Failure of scapula to descend during development, resulting in short, webbed neck and decreased ROM

(White arrow)
22
Q

Give 2 findings seen at C5/C6.

A
  • wasp waist deformity
  • hypoplastic disc
    (Congenital fusion)
23
Q

Give 2 findings seen at C5/C6.

A
  • wasp waist deformity
  • hypoplastic disc
    (Congenital fusion)
24
Q

What is the diagnosis?

A

Surgical fusion

25
Q

What is the diagnosis?

A

Klippel Feil syndrome

26
Q

Name 2 additional diagnoses

A
  • Sprengel deformity
  • omovertebral bone
27
Q

What is a cervical spondylolisthesis?

A

Antero/retrolisthesis of cervical vertebrae relative to the segment below

28
Q

What is the most common location of a cervical rib?

A

C7

29
Q

What are the types/forms of cervical ribs?

A

partial or complete
(may be unilateral or bilateral)

30
Q

What is the clinical presentation of cervical ribs?

A
  • mostly asymptomatic
  • may cause TOS (40s-50s pt)
31
Q

What orthopedic test(s) should be performed if a patient is complaining of upper extremity numbness/pain/weakness?

A
  • Adson’s
  • ROOS
  • Cervical compression
    (for TOS DDx)
32
Q

How can you tell a cervical rib from a thoracic TP radiographically?

A

cervical ribs point down, thoracic TPs point up

33
Q

What is the clinical significance of an elongated TP? What are your next steps for this patient?

A
  • soft tissue implications:
    may change path of scalenes/brachial plexus
  • If symptomatic, brachial plexus MRI. Otherwise myofascial release of scalenes, adjust CT & ribs
34
Q

How is a cervical rib differentiated from an elongated TP radiographically?

A

No extra bone/joint seen with elongated TP, continuous with vertebra

35
Q

What is the diagnosis?

A

Cervical rib

36
Q

What is the diagnosis?

A

Elongated cervical TP

NYCC Bone & Joint (20 decks)

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