Cervical And Thoracic Spine Disorders Flashcards
What is cervical spondylosis?
Chronic degenerative osteoarthritis of the intervertebral joints in the cervical spine
Describe the primary pathology of cervical spondylosis
- Age related disc degeneration
- Is followed by marginal osteophytosis (osteophytes forming adjacent to end plates) -and facet joint osteoarthritis
In cervical spondylosis the narrowed intervertebral foramina can put pressure on spinal nerves causing radiculopathy. What are the symptoms of radiculopathy?
- Dermatome sensory symptoms (parathesia and pain)
- Myotome motor weakness
What is a less common outcome of cervical spondylosis, and what are the symptoms?
Myelopathy Symptoms:
- global muscle weakness
- gait dysfunction
- loss of balance
- loss of bowel /+ bladder control
What is a Jefferson’s fracture and how is it commonly caused?
A fracture of the anterior and posterior arches of the atlas vertebra (C1) *like an polo mint always breaks in more than 1 place
Usually caused by diving head first in shallow water or hitting head against the roof of a vehicle
Why are neurological signs not commonly seen in a Jefferson’s fracture?
The bursting of bone fragments reduces the likelihood of the bone impinging on the spinal cord
Will likely just cause pain
What structures could be damaged in a Jefferson’s fracture and what conditions could this lead to?
The arteries in the base of the skull can be damaged
This can lead to secondary neurological sequalae e.g stroke, ataxia or Horner’s syndrome
What is a Hangman’s fracture and what is the most common mechanism of injury to cause one?
When the axis vertebrae (C2) is fractured through the pars interarticularis
Mechanism of injury is usually: HYPEREXTENSION of the head on the neck
How are fractures of the odontoid process caused?
Either by excess flexion or extension
Most commonly caused by elderly, osteoporotic patients falling on their forehead
How would you detect an odontoid process fracture?
By performing an open mouth AP X-Ray Or a CT scan of the cervical spine
What is whiplash injury?
Forceful hyperextension-hyperflexion injury of the cervical spine
What symptoms are commonly seen in whiplash injury?
- arm pain and paraesthesia
- shoulder injury
- lower back pain
- chronic myofascial pain syndrome as a secondary response
Why can you get injury to the spinal cord in whiplash injury, despite no accompanying bony fracture?
The cervical spine is highly mobile as ligaments and capsule are relatively loose.
This means there can be significant movement of the vertebrae at the time of impact that can compress the cord
What is a protective factor against spinal cord injury in whiplash?
Th vertebral foramen has a large diameter
Why might a small cervical disk herniation cause more pain than it would in the lumbar spine?
As the discs in the cervical spine are not very large so there is a little space available for the exiting nerve
What can paracentral prolapse lead to?
Radiculopathy
What might canal filling prolapse lead to?
Acute spinal cord compression
Which nerve root will be compressed in a cervical spine prolapse?
The EXITING nerve
What is cervical myelopathy?
Spinal cord dysfunction due to compression of the cord
Caused by narrowing of spinal canal
What is a common cause of cervical myelopathy?
Degenerative stenosis of the spinal cord by cervical spondylosis
Most commonly in 50-80 year olds
In terms of diameter, when will myelopathic symptoms be experienced?
When the diameter of the spinal canal falls below 12-14mm
What is the common presentation of cervical myelopathy?
- loss of balance and coordination
- decreased dexterity
- weakness
- numbness
- paralysis in severe cases
What can upper cervical lesions lead to?
Loss of manual dexterity
Maybe dysiadokinesia ( unable to do rapid, alternating movements);
What might lower cervical lesions lead to?
Spasticity - loss of muscle tone, loss of proprioception in the legs
What is a Hoffman test?
Test for cervical myelopathy
Dr holds patients middle finger at the middle phalanx and flicks the nail If there is no movement this is normal, if the index finger and thumb move then this is abnormal (positive Hoffman test)
What is the Babinski sign?
The lateral side of the foot is stroked from the heel towards the toes
In a positive Babinski test the hallux dorsiflexes and the toes fan out, suggesting damage to the spinal cord
What is L’Hermitte’s phenomenon
Sensation of intermittent electric shocks in the limbs that is exacerbated by neck flexion- usually associated with cervical myelopathy
What is the most common cause of thoracic cord compression?
Vertebral fractures and tumours in the spinal cord
What are the most common cancers that spread to bone?
- breast
- lung
- thyroid
- kidney
- prostate
Give 3 routes by which pathogens can reach the spinal cord. Which is the most common?
- Haematogenous (most common)
- Direct inoculation during spinal procedure
- Spread from adjacent soft tissue
What is spondylodiscitis, and what group of patients is it most commonly seen in?
Infection of the intervertebral disc
Most commonly seen in immunocompromised patients e.g diabetics, HIV and patients on steroids
The intervertebral disc is avascualar in adults so explain how infection can arise
Organisms initially deposit in the vertebral body causing bony ischemia and infarction
Necrosis then allows direct spread of organisms to the adjacent space
Give some mechanisms of how infection of the spinal canal can lead to neurological damage
- septic thrombosis leading to ischemia
- compression of neural elements by abscess/ inflammatory tissue
- direct invasion of neural elements by inflammatory tissue
- mechanical collapse of bone leading to instability
What are the most common organisms that cause infection of the spinal cord?
- Staphylococcus aureus (50%)
- E. Coli (up to 30%)
- coagulase negative staphylococci (e.g. staph. Epidermidis) following spinal procedure
