CERVICAL + THORACIC SPINE DISORDERS Flashcards

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1
Q

What is Cervical spondylosis?

A

-Chronic degenerative osteoarthritis affecting intervertebral joints of the cervical spine.

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2
Q

Causes of Cervical spondylosis

A

-Age-related disc degeneration
-Marginal osteophytosis
-Facet joint OA
-Leads to radiculopathy or myelopathy

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3
Q

What is radiculopathy?

A

-Narrowing of the intervertebral foramina putting pressure on the spinal nerves.

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4
Q

Symptoms of radiculopathy?

A

-Dermatomal sensory symptoms
-Paraesthesia + Pain
-Myotomal motor weakness

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5
Q

What is Myelopathy?

A

Narrowing of the spinal canal may put pressure on the spinal cord.

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6
Q

Symptoms of Myelopathy?

A

-Global muscle weakness
-Gait dysfunction
-Loss of balance
-Loss of bladder/bowel control

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7
Q

What is a jefferson’s fracture

A

-Fracture of the anterior and posterior arches of the atlas (C1).

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8
Q

Jeffersons fracture MOI?

A

-Axial loading e.g. diving into shallow water, impacting head against the roof of a vehicle, falling off playground equipment.

-Fractures causes C1 to burst open like a broken polo mint.

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9
Q

Presentation of Jeffersons fracture?

A

-Bursting open of bone fragments reduces chance of impingment on the spinal cord
-Fracture typically causes pain but no neurological signs.
-Possible damage to arteries at the base of the skull => leads to secondary neurological sequelae.

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10
Q

What are examples of secondary neurological sequelae?

A

-Ataxia
-Stroke
-Horner’s syndrome

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11
Q

What is Hangman’s fracture?

A

an axis vertebrae (C2) fracture through the pars interarticularis (region between the superior and inferior artiucular processes).

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12
Q

What is the MOI of Hangman’s fracture

A

-Forcible hyperextension of the head on the neck
-‘Hanging’
-Road traffic collisions

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13
Q

Presentation of Hangman’s fracture?

A

-Fracture is unstbale also requires treatment
-Fracture configuration tends to expand the spinal canal reducing risk of associated spinal cord injury.
-Forward displacement of C1 + C2 on C3

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14
Q

What are fractures of the odontoid process (C2) (peg fractures)?

A

-Caused flexion or extension injuries
-most commonly in elderly patients with osteoporosis falling forwards and impacting their forehead on pavement.
-This hyperextension injury= fracture of odontoid peg.

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15
Q

How can you detect odontoid process fractures?

A

-‘Open mouth’ AP X-ray= ‘peg view’
-CT scan= difficult to visualise

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16
Q

What is whiplash injury?

A

-Forcible hyperextension/flexion injury of the cervical spine leading to tearing of the cervical muscles + ligaments.
-Cervical spine has high mobility + low stability.

17
Q

What is the classical MOI of whiplash injury?

A

Patients car being struck from the rear leading to an acceleration-deceleration injury.

18
Q

What are areas of pain in Whiplash injury?

A

-Arm pain + paraesthesia due to injury of the spinal nerves
-Shoulder pain due to holding steering wheel
-Lower back pain
-Chronic myofascial pain syndrome

19
Q

What is cervical intervertebral disc prolapse?

A

-Cervical disc prolapse with associated with compression of nerve roots or spinal cord.m
-Most commonly develops in the 30-50yrs.

20
Q

What is the MOI in intervertebral disc prolapse?

A

Disc herniation, in the cervical spine the exiting root will be compressed (nerve exiting above the respective vertebrae)
e.g. in C5/6 exiting nerve= C6

21
Q

Causes of intervertebral disc prolapse?

A

-Spontaneous in origin or mabye related to trauma and neck injury
-Paracentral prolapse may impinge on a spinal nerve= radiculopathy
-Canal filling prolapse may lead to acute spinal cord compression.

22
Q

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

A

-C6 (exiting nerve)
-C6: elbow flexion / wrist extension
/supination / (motor weakness)
-Pain: Neck down anterior arm,lateral forearm into thumb and index finger.
-Numbness/ ‘pins and needles’ in lateral
forearm, thumb and index finger (sensory)

23
Q

What will a
patient complain
of with a leftsided C7/T1
prolapsed disc?

A

-C8 (exiting nerve)
-Motor weakness: Long finger flexors and extensors
-Pain: Neck and anterior arm and forearm pain into little and ring fingers
-Sensory: Numbness/ ‘pins and needles’ in little and ring fingers, ulnar border of hand

24
Q

What is Cervical myelopathy?

A

-Spinal cord dysfunction due to compression of the cord caused by narrowing of the spinal canal.

25
Causes of cervical myelopathy
-most common is degenerative stenosis of the spinal cord caused by cervical spondylosis. -Other stenosis: >Congenital stenosis >cervical disc herniation >Trauma >Tumour >RA
26
Describe the anatomy changes in cervical myelopathy
-Thickening ligamentum flavum -Osteophytes -Can lead to spinal cord signal change -Treated by surgical decompression
27
Symptoms of Cervical myelopathy
-Loss of balance with poor coordination -Decreased dexertity -Numbness -Rapid deterioration of gait + hand function
28
What will a patient with a C4 myelopahty complain of?
-Neck Pain -Shoulder Abduction (C5) + other myotomes distally, including trunk and lower limbs. -Numbness/ ‘pins and needles’ from shoulder distally, trunk and lower limbs e.g. ‘numbness of feet’
29
What is thoracic cord compression?
-Most common causes of thoracic cord compression are vertebral fractures and tumours in the spinal canal.
30
Importance of lower thoracic spine in compression?
-In the lower thoracic spine + lumbar spine the neural segments do not line up with their respective vertebral segments as the spinal cord is shorter than vertebral column.
31
Symptoms of thoracic cord compression?
-Pain at the sight of lesion -Spastic paralysis of all muscles in the legs -Paraesthesia in the dermatomes distal to the site of cord compression -Loss of sphincter control
32
What will a patient present with if they have thoracic cord compression at T10?
Pain: Lower thoracic pain Motor weakness: Weakness of all muscles in the legs Sensory: Loss of Sphincter Control -‘pins and needles’ from just below umbilicus inferiorly (T10 vertebrae is aligned with T11-12 segments of the cord)
33
What will a patient present with if they have thoracic cord compression at T5?
Pain: High thoracic pain Motor weakness: Weakness of all muscles in the legs and INTERCOSTALS Sensory: ‘pins and needles’ from just below the nipples inferiorly. Loss of Sphincter Control
34
How can pathogens reach the bones and tissues?
-Pathogens can reach the bones and tissues of the spine by 3 routes -Haematogenous -Spread from adjacent soft tissue infection -During invasive spinal procedures
35
What is spondylodiscitis/discitis?
Infection of the intervertebral disc, occurs most commonly in immunocompromised patietns e.g. dibaetics , HIV,
36
How do organisms reach intervertrbral disc in adults (spondylodiscitis/discitis)?
-Intervertebral disc is avascular organisms are initially deopsited in the vertebral body via the segmental artery. -this leads to bony ischaemia and infarction -necrosis of bone allows direct spread of organisms to adjacent disc space, epidural space, and adjacent vertebral bodies.
37
What is the most common causative organisms of spondylodiscitis/discitis?
-Staphylococcus aureus (50%) -Gram negative bacilli e.g. E. Coli (30%) -In invasive spinal procedure: Staph epidermidis. -Injecting drug users: Candida may be seen