Cervical and thoracic clinical conditions

Question 1

What causes cervical spondylosis (osteoarthritis)? (hint: triad)

Answer 1

Age-related changes:

• loss of disc height
• osteophytes
• facet joint osteoarthritis

Question 2

What can cervical spondylosis lead to?

Answer 2

1) Radiculopathy (compression of a nerve root) = osteophyte on the foramen
2) Myelopathy (compression of the spinal cord) = osteophyte in the vertebral canal

Question 3

What is the main cause of radiculopathy in the 30-50 age group?

Answer 3

Cervical prolapsed intervertebral disc

Question 4

What happens in the cervical prolapsed intervertebral disc?

Answer 4

• tear of annulus fibrosis

- nucleus pulposus migrates through into spinal canal

Question 5

What are anatomical changes in cervical myelopathy?

Answer 5

• Thickening of the ligamentum flavum
• Osteophyte
• Spinal cord signal change

Question 6

How do patients with cervical myelopathy present?

Answer 6

• Loss of fine movements
• Loss of balance
• Clumsiness

Question 7

What is a Jefferson fracture?

Answer 7

• Burst fracture of the atlas (C1)
• Fracture of the anterior and posterior arches of the atlas
• From axial load e.g. diving in shallow waters

Question 8

What is a Hangman’s fracture?

Answer 8

• Unstable fracture through the pars interartucularis
• forward displacemnt of C1 and C2 on C3
• Hyperextension of head on neck

Question 9

What is an Odontoid peg fracture?

Answer 9

-Hyperextension or hyperflexion injury of the Atlas (specifically the odontoid peg)

Question 10

What are the two most common causes of a thoracic cord compression?

Answer 10

Fractures and tumours

Question 11

What is spondylodiscitis?

Answer 11

Infection of the intervertebral discs

• bacteria enters spine via vertebral body nutrient artery
• direct inoculation (e.g. lumbar pucture)
• spread from adjacent tissue

Question 12

What is a whiplash injury?

Answer 12

a forceful hyperextension-hyperflexion injury of the cervical spine
-usual mechanism: car crash

Question 13

Why are we prone to whiplash injury?

Answer 13

The cervical spine is highly mobile and the ligaments and capsule of the joints are weak and loose

Question 14

What is protective factor against spinal cord injuries?

Answer 14

The vertebral foramen is large relative to the diameter of the cord

Question 15

What is the Hoffman’s test? (cervical myelopathy)

Answer 15

Holding the patient’s middle finger at middle phalanx and flicking the finger nail (Positive result = index finger or thumb move)
-for cervical myelopathy

Question 16

What is the Babinski sign?

Answer 16

Lateral side of the sole of the foot is stroked (positive result = hallux dorsiflexes and the toes fan out)
-for cervical myelopathy

Question 17

What is the L’Hermitte’s phenomenon?

Answer 17

Sensation of intermittent electric shocks in the limbs exacerbated by neck flexion
-associated with cervical myelopathy