Cervical and thoracic spine and neural anatomy Flashcards
What is spondylosis? What is the difference between this and spondylolysis and spondylothesis?
spondylosis is the degenerative osteoarthiritis of intervertebral joints in the cervical spine.
- spondylolysis is a break in the pars interarticularis
- spondylothesis is the forwards slippage of a vertebral body due to a spondylolysis
describe the mobility of thoracic and cervical spine
cervical- mobile
thoracic- immobile
Which cervical vertebrae have a bifid spinous process?
C2,3,4,5,6
What is the role of the transverse foramen (foramen transversarium)?
The vertebral artery and vein will enter at C6 and travel up the foramen into the skull
What is the names for the articulating surfaces of the cervical foramen?
superior articulating facet and inferior articulating facet
What is the name for C1? What movements does is superior and inferior joints permit?
the atlas
superior: atlanto-occipital joint= flexion and extension
inferior: atlanto- axial joint= rotation (shaking head)
What is the name for the structure of the axis (C2) that prevents horizontal displacement of the atlas?
the dens (odontoid process) and the transverse ligament
What is the name for the ligament that attaches to the occipital protruberance and spinous process of C2,3,4,5,6 and 7?
the ligamentum nuchae
What is the role of the ligamentum nuchae?
- maintains secondary curvature of the cervical spine
- helps cervical spine support head
- attachment site for many muscles (trapezium, rhomboids)
What is the name of the ligaments which run down the front and the back (within the vertebral foramen) of the vertebral bodies?
the posterior and anterior longitudinal ligaments
What is the name of the ligaments that connect the lamina and spinous processes of the vertebrae?
lamina: ligamentum flavum
spinous processes: interspinatous ligament between spines and supraspinatus ligament runs down the very back
What 4 articulating surfaces are found on thoracic vertebra?
superior and inferior articulating facet (faces back), inferior articulating facet (faces front of body)
transverse costal facet (on transverse process, facing sides)
costal facet (facing to sides/ up, on vertrbral body/ pedicle)
Where is the L3 dermatome ?
knee, inner theigh
What is a neural level?
the last functioning level of motor and sensory control
What should a young health intervertebral disc look like on an MRI?
white and bright- as lots of water
What is the result of cervical spondylosis?
- pressure on nerve roots leading to radiculopathy (parasthesia and pain in that dermatome and loss myotomal muscle weakness)
- pressure on bones= pain and stiffness
- sometimes pressure put on cord leads to myelopathy (global weakness, gait dysfunction, loss of balance, bladder and bowel control
What is a hangmans fracture?
2 fractures of the axis (C2) between the superior and inferior articulating facet (across the pars interarticularis). it sometimes comes with neural injury but not always
How does a hangmans fracture occur?
hyperextension of head on neck (road traffic accidents, hanging)
How can hangmans fracture be seen on xray?
C1 and the body of C2 (but not spinous process) will be displaced forwards- the actual fracture can be hard to see
What is a peg fracture and how can it occur?
a fracture of the dens of the axis. occurs due to hyperextension or blows to back of head
How can peg fracture be seen?
CT scan is easiest to see it on
What is a jeffersons fracture and how does it occur?
It is a fracture to the anterior and posterior arches of the atlas due to axial loading (dive into shallow pool, impact from roof of vehicle, falls from playground equiptment it may also lead to artery damage at base of skull
Why is there rarely neurological symptoms in a jeffersons fracture?
the vertral foramen is large in the atlas meaning the spinal cord is able to move.
What is whiplash?
pain following a low injury injury where there was hyperflexion and then hyperextension of the neck. It is thought to be muscular but no specific pathology has every been found.
What will a patient with a prolapsed disc at C5/6 complain of?
nerve root of C6 affected
- pain, numbness and parasthesia in lateral forarm, thumb an index finger
- motor weakness in biceps and wrist extension
What is a cervical myelopathy?
osteoarthiritis in cervial spine (spondylosis) leading to osteophytes which compress the spinal cord
How will a cervial myelopathy affect the pt if it is at C3/4?
- neck pain (from arthiritis)
- loss of shoulder adbuction (C4 myotome function lost)
- weakness in all movement below shoulders (cord impinged)
- numbness and parasthesia from shoulders, down arms and typically in feet
- loss of proproiception= clumsiness
- loss of fine motor control
- gait/ balance disturbance
What is the most common cause of thoracic cord compression?
- tumours and fractures
- sometimes arthiritis
Whats the difference between reticulopathy and myelopathy?
myelopathy is compression of the spinal cord- last neural level is upper segment (if C4/5 compression, C4 is last neural level)
reticulopathy is compression of a specific nerve root- so sensory and motor loss in that myotome/ dermatome only
