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Sem 2 - MSK > Cervical And Thoracic Spine Associated Disorders > Flashcards

Cervical And Thoracic Spine Associated Disorders Flashcards

1
Q

How many vertebra are in the cervical and throacic spine? What is the difference?

A

7 cervical and 12 throacic vertebra

Cervical are more mobile than thoracic as thoracic has ribs attached whereas cervical does not.

Also, different locations of facet joints. Means more injuries associated with cervical than thoracic vertebra.

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2
Q

What are some characteristics of cervical vertebra?

A
  • Smallest vertebral body (as less weight baring) and broad from side to side.
  • Also has a bifid spinous process (except C7)
  • Transverse foramen in transverse process.
    • Transmits the vertebral artery
    • C7 foramen transmits the acessory vertebral vein.
    • Large triangular vertebral foramen.
  • Transverse process is a bit shorter.
  • Transverse foramen that contains vertebral arteries - Only in cervical vertebrae.
  • Superior articular facet faces upwards and backwards.
  • Inferior articular facet faces downwards and forwards.
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3
Q

Why is C1 atypical?

A

Atlas.

No vertebral body - vertebral body is fused with axis to form dens or odontoid process.

No spinous process

Widest cervical process - Largest vertebral foramen.

This means it rarely gives neurology as there is lots of room for the spinal cord to move.

Vertebral arches are thick and strong to form a powerful lateral mass.

Articulates with:

  • Occiput of skull superiorly (atlanto-occipital joint - 50% of total flexion and extension “nodding” - Other 50% is ALL other joints.
  • Axis (C2) inferiorly. Rotation. (Atlanto-axial joint is 50% of total rotation - shaking of the head
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4
Q

Why is C2 atypical?

A

It is called Axis

The odontoid process

Characterised by:

  • Rugged lateral mass
  • Largest spinous process of Cervical Vertebra.

Transverse ligament sits behind Odontoid peg.

This prevents the displacement of atlas.

If it breaks then means C1 and C2 will move independently.

This means you can get compression of the spinal cord and can get neurological problems.

It also leads to Atlantoaxial instability.

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5
Q

Why is C7 atypical?

A

Longest spinous process

Called vertebra prominens

Spinous process is not bifid

The transverse foramen is smaller than at other areas of the cervical spine.

The transverse process is large but the Foramen Transversarium is small and only transmits the accessory vertebral veins.

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6
Q

How do nerve roots change as you get older?

A

As a baby, the nerve roots exit at Same level.

But, as older, bones grown faster than spinal cord.

The nerve roots exit more horizontally than in the lumbar spine.

Nerve roots in cervical spine exit above their vertebral body until C7/T1 junction.

C7 exit above C7 vertebra and C8 exits below C7. This means that all the other nerve roots exit below their vertebra.

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7
Q

What is the ligamentum nuchae?

A

Nuchal ligament.

Thickening of the supraspinous ligament.

Attached to:

  • External occipital protuberance
  • Spinous processes of all cervical vertebra
  • Spinous process of C7
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8
Q

What is the role of the Ligamentum Nuchae?

A

Gives neck and trunk muscles (eg Trapezium and Rhmboids) extra attachment so they do not have to work as hard to support the head.

It maintains the secondary curvature of the cervical spine.

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9
Q

What are ligaments of the vertebral body and what are their roles?

A

Ligaments provide stability ​

  • Anterior Longitudinal Ligament (Stronger)
  • Posterior longitudinal Ligament
  • Supraspinous ligament
  • Ligament flavum
  • Interspinous ligament
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10
Q

What movement can the cervical spine conduct?

A

Flexion - 80°

Extension - 70°

Rotation - 80° each way

Lateral flexion - 40° each way

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11
Q

What are the characteristics of the Thoracic Vertebrae?

A

Typical vertebrae

Except:

  • Heart shaped body (Not kidney shapes)
  • Longer transverse processes.
  • Demi-facets on side of the body for articulation with head of the rib (T2-T8). Whereas whole facets on T9 and T10.
  • Costal facets on transverse processes for articulation with tubercle of rib (except T11 and T 12)
  • Vertebral Foramen is small and circular.
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12
Q

What is the orientation of the thoracic vertebrae?

A

Not much moment because rib cage.

Also orientation of Thoracic joints - They are side to side so they do not flex.

Means predominant movement is rotation.

Superior articular processes face posterolaterally.

Inferior articular processes face anteromedially.

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13
Q

What is a PA view?

A

This is an x-ray view from the back to the front. Must show the whole of the neck. Jaw clouds C1 and 2

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14
Q

What is a lateral view?

A

This is an x-ray from the side. Get more information from this than a PA view. This is useful to check alignment of the vertebrae - Look at the line.

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15
Q

What is cervical Spondylosis?

A

This is an age related changes of the cervical spine.

Triad:

  • Loss of disc height
  • Osteophytes
  • Facet Joint Osteoarthritis

Pressure on nerve roots leads to Radiculopathy:

  • Dermatomal sensory symptoms: parathesia and pain
  • Myotome motor weakness.

Pressure on the cord leads to Myelopathy (less common) -

  • Global Weakness
  • Gait dysfunction
  • Loss of bladder and bowel control.
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16
Q

What are Hangman’s Fractures?

A

These are fractures of axis (C1).

This results in:

  • Hyperextension of the head on neck
  • Axis fractures through the pars interarticularis
  • Unstable fracture
  • Forward displacement of C2 and body of C2 on C3.
  • You get sheering of spinal cord that leads to instant death.
  • Knot should be at the front rather than at the back as seen in films.
17
Q

What is an Odontoid Peg fracture?

A

This is a fracture of the axis (C2)

Odontoid Fracture:

Hyperextension Injury (or hyperflexion)

Don’t put hands out so land face first - Elderly patients with osteoporosis falling forward and banging head on pavement is the most common presentation. But, can be seen when patients get a blow to the back of the head resulting in a hyperflexion injury.

‘Open mouth’ AP X-ray = peg view

CT scan - Trauma series with head CT scan.

18
Q

What is a Jefferson’s Fracture?

A

This is like a polo - has to be broken in two places.

Fracture of anterior and posterior arches of atlas.

Classic mechanism is falling onto the top of your head - No neurology as vertebral foramen is big but causes pain.

Axial load e.g. diving into shallow water, impact against the roof of the vehicle, falls from playground equipment.

May damage vertebral arteries with secondary neurological sequelae e.g. Ataxia, Stroke.

19
Q

What is a Whiplash Injury?

A

Weight of the head is 7-10% of the Total Body Weight.

High mobility Low stability

Prone to ‘Whiplash injury’ - Hyperextension and hyper flexion.

They have never discovered a particular structure that is damaged during a whiplash injury. This is because the vertebrae can move signficantly during injury but return to normal after. This would result on onyl seeing soft tissue injury.

20
Q

What is a cervical disc prolapse?

A

They typically occur in 30-50 year olds.

They wake up with pain.

Anatomy change:

  • Tear of the annulus fibrosis
  • Nucleus Pulposus - migrates through into the spinal canal.
21
Q

What will a patient complain of with a left sided C5/C6 prolapsed disc?

A

Affect the C6 nerve root.

Pain: Neck at C5/C6, down anterior arm and later forearm into thumb and index finger.

Motor weakness: Weak elbow flexion, Wrist extension and supination

Sensory: Numbness / ‘pins and needles’ in lateral forearm, thumb and index finger.

22
Q

What would a patient complain of if they had a C7/T1 disc prolapse?

A

C8 is affected.

Pain: At C8 level of spine, down anterior arm and forearm to little and ring finger.

Motor weakness: Finger flexion and finger extension

Sensory: Numbness / pins and needles in little and ring fingers, ulnar border of hand.

23
Q

What is cervical Myelopathy?

A

Affects 50 - 80 year olds.

Cord gets compressed on all sided as a result of age related changes (Spondylosis).

Anatomical changes:

  • Thickening of ligamentum flavum,
  • Osteoarthritis of the cervical spine,
  • Osteophytes,
  • Signal changes in the spinal cord.
24
Q

What would a patient complain of with a cervical myelopathy at C3/C4?

A

Neck pain

Motor weakness: Shoulder abduction (C5) and other myotomes distally, inculding trunk and lower limbs e.g. ‘numbness of feet’.

25
Q

What would a patient complain of with a cervical myelopathy at C5/C6?

A

Neck pain

Motor Weakness: Elbow flexion and wrist extension (C6), Elbow extension and wrist flexion (C7) and finger movements (C8 and T1); also motor weakness in the trunk and lower limbs.

Sensory: Numbness / ‘Pins and needles’ from elbows distally, trunk and lower limbs e.g. ‘numbness in feet’.

26
Q

What are some characteristics of cervical myelopathy?

A
  • Progressive disorder
  • Clumsiness
  • Loss of fine motor movements
  • Gait / Balance disturbance
  • Positive Hoffmanns and Babinski reflex
  • Clonus
  • Dysdiadhokokinesis (impared ability to perform rapid alternating movements)
27
Q

What is thoracic cord compression?

A

Anatomy changes:

  • Fracture of the vertebrae giving bony fragments in the canal or
  • Tumour developing in the canal compressing the spinal cord.
  • Commonest surgical causes of Thoracic Cord Compression are fractures and tumours.

Symptoms include:

  • Pain at the site of the lesion
  • Spastic paralysis of all the muscles in the legs
  • Parasthesia in the dermatomes distal to the site of cord compression
  • Loss of sphincter control
28
Q

What would a patient complain of is they has thoracic cord compression at T10?

A

Thoracic pain

Weakness of all muscles in the legs (Paraplesia)

Numbness / Pins and needles from umbilicus inferiorly

Loss of Sphincter control.

29
Q

How would a patient present if they has a tumour at T5?

A

High thoracic pain

Weakness of all muscles in the legs and INTERCOSTALS (problems breathing)

Numbness / pins and needles from just below the nipples inferiorly

Loss of Sphincter control

30
Q

Who would get infections of the spine?

A

Occurs in he immunocomprimised.

  • Diabetes Mellitus
  • Steroids
  • HIV

Staph Aureus is most common (50%).

31
Q

How does Spondylodiscitis occur?

A

Bacteria enters spine via vertebral body

Lodges at end plate

Extend towards the disc

Untreated develops an epidural abscess - if burst out posteriorly.

Treat with a minimum of 6 weeks. Antibiotics. This is because disc doesn’t have its own blood supply.

Sem 2 - MSK (22 decks)

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