CERVICAL + THORACIC SPINE DISORDERS Flashcards
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What is Cervical spondylosis?
-Chronic degenerative osteoarthritis affecting intervertebral joints of the cervical spine.
Causes of Cervical spondylosis
-Age-related disc degeneration
-Marginal osteophytosis
-Facet joint OA
-Leads to radiculopathy or myelopathy
What is radiculopathy?
-Narrowing of the intervertebral foramina putting pressure on the spinal nerves.
Symptoms of radiculopathy?
-Dermatomal sensory symptoms
-Paraesthesia + Pain
-Myotomal motor weakness
What is Myelopathy?
Narrowing of the spinal canal may put pressure on the spinal cord.
Symptoms of Myelopathy?
-Global muscle weakness
-Gait dysfunction
-Loss of balance
-Loss of bladder/bowel control
What is a jefferson’s fracture
-Fracture of the anterior and posterior arches of the atlas (C1).
Jeffersons fracture MOI?
-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.
Presentation of Jeffersons fracture?
-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.
What are examples of secondary neurological sequelae?
-Ataxia
-Stroke
-Horner’s syndrome
What is Hangman’s fracture?
an axis vertebrae (C2) fracture through the pars interarticularis (region between the superior and inferior artiucular processes).
What is the MOI of Hangman’s fracture
-Forcible hyperextension of the head on the neck
-‘Hanging’
-Road traffic collisions
Presentation of Hangman’s fracture?
-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
What are fractures of the odontoid process (C2) (peg fractures)?
-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.
How can you detect odontoid process fractures?
-‘Open mouth’ AP X-ray= ‘peg view’
-CT scan= difficult to visualise
What is whiplash injury?
-Forcible hyperextension/flexion injury of the cervical spine leading to tearing of the cervical muscles + ligaments.
-Cervical spine has high mobility + low stability.
What is the classical MOI of whiplash injury?
Patients car being struck from the rear leading to an acceleration-deceleration injury.
What are areas of pain in Whiplash injury?
-Arm pain + paraesthesia due to injury of the spinal nerves
-Shoulder pain due to holding steering wheel
-Lower back pain
-Chronic myofascial pain syndrome
What is cervical intervertebral disc prolapse?
-Cervical disc prolapse with associated with compression of nerve roots or spinal cord.m
-Most commonly develops in the 30-50yrs.
What is the MOI in intervertebral disc prolapse?
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
Causes of intervertebral disc prolapse?
-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.
What will a
patient complain
of with a leftsided C5/6
prolapsed disc?
-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)
What will a
patient complain
of with a leftsided C7/T1
prolapsed disc?
-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
What is Cervical myelopathy?
-Spinal cord dysfunction due to compression of the cord caused by narrowing of the spinal canal.
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
Describe the anatomy changes in cervical myelopathy
-Thickening ligamentum flavum
-Osteophytes
-Can lead to spinal cord signal change
-Treated by surgical decompression
Symptoms of Cervical myelopathy
-Loss of balance with poor coordination
-Decreased dexertity
-Numbness
-Rapid deterioration of gait + hand function
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’
What is thoracic cord compression?
-Most common causes of thoracic cord compression are vertebral fractures and tumours in the spinal canal.
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.
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
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)
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
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
What is spondylodiscitis/discitis?
Infection of the intervertebral disc, occurs most commonly in immunocompromised patietns e.g. dibaetics , HIV,
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.
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
