Cervical And Thoracic Spine Clinical Conditions

Question 1

What is Spondylosis

What is the usual cause, what 2 things follow

Answer 1

Chronic degenerative osteoarthritis affecting the intervertebral joints

Age-related disc degeneration (So reduced disc height)

-> Marginal osteophytosis, facet joint arthritis

Question 2

Explain the symptoms of Cervical Spondylosis

Answer 2

1. Compression of nerve roots leads to Radiculopathy
   - Pain, Parasthesia
   - Muscle weakness
2. Compression of spinal cord leads to Myelopathy
   - Global muscle weakness
   - Gait dysfunction, loss balance
   - Possible loss of bowel and bladder control

Question 3

What is a Jefferson’s fracture, and what is the mechanism of injury

Explain the primary symptom

Explain the secondary symptom

Answer 3

Fracture of anterior and posterior arches of C1, by increased axial loading.

1: Bone fragments are ‘bust open’ so it is unlikely that the spinal cord will be compressed-> Pain, but no neurological signs
2: Damaged arteries at base of skull-> Neurological signs (Ataxia, stroke)

Question 4

What is a Hangman’s fracture, what is its mechanism of injury

Answer 4

Fracture of C2 though the Pars Interarticularis (Region between superior and inferior articular facets)

Forced hyperextension of head

Question 5

What are 2 causes of Peg Fractures.

What’s the most common mechanism of injury

Answer 5

HyperFlexion (Block to back of head) OR Hyperextension

Elderly patient falling and impacting forehead on ground (Hyperextension)

Question 6

What is a Whiplash injury

Name 1 aspect of cervical spine that increases the likelihood of this, and 1 aspect that decreases it.

Answer 6

Forceful hyperextension-hyperflexion injury of cervical spine (Leads to tearing of cervical muscles and ligaments)

Increases: Low stability due to high mobility
Decreases: Large vertebral foramen (relative to cord diameter)

Question 7

How can Cervical Myelopathy present normally

6 signs

Answer 7

Loss of balance 
Poor co-ordination 
Weakness
Numbness
Decreased dexterity 
Paralysis/ pain

Question 8

Describe Hoffman’ test

Answer 8

Hold middle phalanx of middle finger and flick finger nail

No movement in index finger/ thumb= -ve Hoffman’s sign (Normal)

Question 9

Describe the Babinski sign

Answer 9

Lateral sole of foot is stroked from heel to toe with a blunt object.

Toes flex= Negative Babinski sign (Normal)

Hallux dorsiflexion + Toes fan out= Positive Babinski sign

Question 10

What is L’Hermitte’s phenomenon

What is it associated with

Answer 10

Sensation of intermittent electric shocks in limbs, exacerbated by neck flexion

Cervical myelopathy

Question 11

What are the 2 most common causes of Thoracic Cord compression

Answer 11

1. Vertebral fractures (With bony fragments in spinal canal)

2. Tumours in spin canal

Question 12

What are the 5 most common cancers that arise from solid organs and spread to bone

Answer 12

Breast
Lung 
Thyroid 
Kidney 
Prostate

Question 13

Name 3 ways pathogens can reach bones and tissue of spine

Answer 13

• Haematogenous (Originating in or carried by blood)
• Direct inoculation during invasive spinal procedure
• Spread from adjacent soft tissue infection

Question 14

What is Spondylodiscitis/ Discitis?

In which 2 patient groups is it most common

Answer 14

Infection of the intervertebral disc

• Immunocompromised
• On steroids

Question 15

In 3 steps, outline how organisms invade the AVASCULAR intervertebral disc

Answer 15

1. Organisms deposit in vertebral body via segmental artery
2. Bony ischaemia and infarction-> Necrosis
3. Organisms spread into adjacent disc space, epidural space and adjacent vertebral bodies

Question 16

What are the 2 most common organisms causing Discitis

Answer 16

Staph aureus (50%), Gram -ve bacilli (30%)