Cervical and thoracic spine and neural anatomy

Question 1

What is spondylosis? What is the difference between this and spondylolysis and spondylothesis?

Answer 1

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

Question 2

describe the mobility of thoracic and cervical spine

Answer 2

cervical- mobile

thoracic- immobile

Question 3

Which cervical vertebrae have a bifid spinous process?

Answer 3

C2,3,4,5,6

Question 4

What is the role of the transverse foramen (foramen transversarium)?

Answer 4

The vertebral artery and vein will enter at C6 and travel up the foramen into the skull

Question 5

What is the names for the articulating surfaces of the cervical foramen?

Answer 5

superior articulating facet and inferior articulating facet

Question 6

What is the name for C1? What movements does is superior and inferior joints permit?

Answer 6

the atlas

superior: atlanto-occipital joint= flexion and extension
inferior: atlanto- axial joint= rotation (shaking head)

Question 7

What is the name for the structure of the axis (C2) that prevents horizontal displacement of the atlas?

Answer 7

the dens (odontoid process) and the transverse ligament

Question 8

What is the name for the ligament that attaches to the occipital protruberance and spinous process of C2,3,4,5,6 and 7?

Answer 8

the ligamentum nuchae

Question 9

What is the role of the ligamentum nuchae?

Answer 9

• maintains secondary curvature of the cervical spine
• helps cervical spine support head
• attachment site for many muscles (trapezium, rhomboids)

Question 10

What is the name of the ligaments which run down the front and the back (within the vertebral foramen) of the vertebral bodies?

Answer 10

the posterior and anterior longitudinal ligaments

Question 11

What is the name of the ligaments that connect the lamina and spinous processes of the vertebrae?

Answer 11

lamina: ligamentum flavum

spinous processes: interspinatous ligament between spines and supraspinatus ligament runs down the very back

Question 12

What 4 articulating surfaces are found on thoracic vertebra?

Answer 12

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)

Question 13

Where is the L3 dermatome ?

Answer 13

knee, inner theigh

Question 14

What is a neural level?

Answer 14

the last functioning level of motor and sensory control

Question 15

What should a young health intervertebral disc look like on an MRI?

Answer 15

white and bright- as lots of water

Question 16

What is the result of cervical spondylosis?

Answer 16

• 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

Question 17

What is a hangmans fracture?

Answer 17

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

Question 18

How does a hangmans fracture occur?

Answer 18

hyperextension of head on neck (road traffic accidents, hanging)

Question 19

How can hangmans fracture be seen on xray?

Answer 19

C1 and the body of C2 (but not spinous process) will be displaced forwards- the actual fracture can be hard to see

Question 20

What is a peg fracture and how can it occur?

Answer 20

a fracture of the dens of the axis. occurs due to hyperextension or blows to back of head

Question 21

How can peg fracture be seen?

Answer 21

CT scan is easiest to see it on

Question 22

What is a jeffersons fracture and how does it occur?

Answer 22

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

Question 23

Why is there rarely neurological symptoms in a jeffersons fracture?

Answer 23

the vertral foramen is large in the atlas meaning the spinal cord is able to move.

Question 24

What is whiplash?

Answer 24

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.

Question 25

What will a patient with a prolapsed disc at C5/6 complain of?

Answer 25

nerve root of C6 affected

• pain, numbness and parasthesia in lateral forarm, thumb an index finger
• motor weakness in biceps and wrist extension

Question 26

What is a cervical myelopathy?

Answer 26

osteoarthiritis in cervial spine (spondylosis) leading to osteophytes which compress the spinal cord

Question 27

How will a cervial myelopathy affect the pt if it is at C3/4?

Answer 27

• 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

Question 28

What is the most common cause of thoracic cord compression?

Answer 28

• tumours and fractures

- sometimes arthiritis

Question 29

Whats the difference between reticulopathy and myelopathy?

Answer 29

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