Cervical , Thoracic Spine Conditions

Question 1

cervical spondylitis what is it?

its cause?

how it presents?

Answer 1

• chronic denegerative OA affecting the intervertebra; joints in the cervical spine
• pathology related to disc degeneration followed by marginal osteophytosis (ostephytes formation adjascent to end plates) and facet joint OA
• this results in presure being put on the spinal nerves leaving the foramen c radiculopathy (dermatomal sensory symptoms like paraesthesia and mytomal motor weakness)
• it can also cause narrowing of spinal canal putting pressure on the spinal cord causing myelopathy (tissue of spinal cord compression)
• less common outcome fo radiculopathy is gait dysfunction, global muscle weakness, balance loss and loss of bladder control - these symtpoms arise because of the compression of the ascending adn descending tracts within the spinal cord)

Question 2

fractures of atlas

Answer 2

• atlas fracure = jefferson’s fracture
• C1 fracture - cant be seen on xray so do CT
• injury is due to axial loading (top weight) like diving inot shallow water, head against roof impact, or flaling from playground equipment
• patients present by supporting the head in their hands,
• bursts open like a polo mint, thsi bursting open of the fracture means theres no compression of nerves , so no neurological symptoms but theres pain
• but sometimes the artieries at the base of the skill can get damaged leading to secondary neurological sequelae. e.g ataxia, stroke, or Horner’s syndrome (miosis - pupil constriction d damage to sympathetic nerves of the face, ptosis- drooping of the upper eyelid)

Question 3

fracture of C2

Answer 3

axis fracture also known as hangman fracture

the fracture passes throught he pars interarticualris (space between inferior and superior articualr process)

injury is due forced hyperextension ec histrollicaly is due to hanging, but now collisionaccidents

this fracture is unstable and requires treatment , but fortunaelty like jefferson fracture they expand and theres no compression of spinal cord

Question 4

fracture of the odonid peg (dens)

Answer 4

caused by hyperflexion or hyperextension injuries

most commonly seen with elderly patients with osteoporosis (when osteoblasts dont fill properly when undergoing bone remodelling so weaker bones), they fall forward and impact their forehead on the pavement ,

hyperflexion can also cause this fracture , i.e when theres a blow to the back of the head, like when falling against a wall when baalnce is compromisedi.e when intoxicated)

the fracture is detected on a ‘open mouth’ AP X-ray or a Ct scan of the cervival spine

Question 5

whiplash injury

why is the head prone to it?

what is it? describe the mechanism

Answer 5

• 7-10% of the total body weight is the head, it is balanced on the cervical spine wc had high motility and low stability
• whiplash = forcefully hyperextension-hyperflexion injury of the cervical spine
• main mechanism of injury is rear ended by car,
  
  • upon impact vehicle acceraltes forward, 100ms later the patient’s trunk and shoulders follow induced by similar accelertion of the car seat
  • patietns head has no froce acting on it adn so is static in space. so th results are forced extension of the neck as the shoudler travel anteriorly tothe head,
  • this extension c the inertia of the head to be ovrecome, and the head accelerates forwards
  • neck acts a lever to increase forward accelerationof the ehad, forcing neck into flexion
  • hyperextension followed by hyperflexion leads to tearing of the cervicalmuscles and ligaements
  • c secondary oedema, haeemorhage adn inflammation to occur
  • muscles respond by contracting (spasm), surroundign muscles are recruited to attempt to splint the injured muscles, this spasm causes pain and stiffnes
    
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Question 6

whats the prognosis of whiplash injury

Answer 6

patients may report arm pain/paraestheisia as a result of the injury to spinal nerves when the cervical spine was moving. or shoulder pains due to them holding the steering whell

lower back pain develops acutely in40-50% of patients wit whiplsh injury

chronic myofascial pain syndrome may dvelop as the secondary tissue response to disc or facet-joint injury

sometimes injury to cervical cord, despite no bone fracture due to the high mobility of the cervical spine theres significant movement of the vertebrae (subluxation or dislocation) at tiem of impact wc returns to the normal anatomical position afterwards. soft tissue swelling may be the only visible featre on imaging

the protective factor against spinal cord injury is that the cervicla spine is very large relative to diameter of cord, the cord is 10mm the vertebral foraemn is 17-18mm

Question 7

whats the protective factor against spinal cord injury

Answer 7

cervical vertebral foramen being very large compared to the spinal cord

10mm to 17-18mm vertebral foraemn

Question 8

what does traversing root mean and exitign root

Answer 8

traversing root is the spinal nerve that exits below the vertebrae adn since the roots exit above in cervical theres no traverssing nerve root

exiting root is the spinal nerve that exists laterally at that level

Question 9

cerebral intervertebral disc prolapse

Answer 9

• associated compression of nerve roots / spinal nerve
• most commonly 30-50 yrolds
• disc herniation (disc degeneration, prolapse, extrusion, sequestration)
• cervical vertebral foraemen alrge but small spce for exiting nerve root unlike lumbar
• c can also be trauma
  
  • symptoms depend on the direction of the disc prolapse ;paracentrally = radiculopathy, or canal filling where prolapse may lead to acute spinal cord compression

Question 10

cervical myelopathy

Answer 10

• spinal cord dysfunction due to compressio of the spinal cord
• this is due to the narrowing of the spinal canal
• common cause is degenerative stenosis caused by spondylitis.
• cervical spondylotic myelopathy is due to degenerative changes wc develop with age, inclusing ligamentum flavum hypertrophy or buckling, facet joint hypertrophy, disc protrusion and osteophyte formation
• trauma, congenital stenosis of the spinal cord, spondylolithesis (anterior slipage of the cervical vertebrae), tumour , RA can also causeit
• sympotms are poor coridnation, decreased dextrity, weakness, numbness, and severe cases paralysis and in elderly gait and deteroiated hand function
• lower cervical lesion patienes usually present with spaticity (increased muscle tone, sometimes with clonus) adn loss of proprioception in the legs, they feel like their legs are heavy and experiencereduced exercise tolerance. they have gait and multiple falls
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