CERVICAL + THORACIC SPINE DISORDERS

Question 1

What is Cervical spondylosis?

Answer 1

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

Question 2

Causes of Cervical spondylosis

Answer 2

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

Question 3

What is radiculopathy?

Answer 3

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

Question 4

Symptoms of radiculopathy?

Answer 4

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

Question 5

What is Myelopathy?

Answer 5

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

Question 6

Symptoms of Myelopathy?

Answer 6

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

Question 7

What is a jefferson’s fracture

Answer 7

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

Question 8

Jeffersons fracture MOI?

Answer 8

-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.

Question 9

Presentation of Jeffersons fracture?

Answer 9

-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.

Question 10

What are examples of secondary neurological sequelae?

Answer 10

-Ataxia
-Stroke
-Horner’s syndrome

Question 11

What is Hangman’s fracture?

Answer 11

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

Question 12

What is the MOI of Hangman’s fracture

Answer 12

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

Question 13

Presentation of Hangman’s fracture?

Answer 13

-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

Question 14

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

Answer 14

-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.

Question 15

How can you detect odontoid process fractures?

Answer 15

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

Question 16

What is whiplash injury?

Answer 16

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

Question 17

What is the classical MOI of whiplash injury?

Answer 17

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

Question 18

What are areas of pain in Whiplash injury?

Answer 18

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

Question 19

What is cervical intervertebral disc prolapse?

Answer 19

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

Question 20

What is the MOI in intervertebral disc prolapse?

Answer 20

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

Question 21

Causes of intervertebral disc prolapse?

Answer 21

-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.

Question 22

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

Answer 22

-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)

Question 23

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

Answer 23

-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

Question 24

What is Cervical myelopathy?

Answer 24

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

Question 25

Causes of cervical myelopathy

Answer 25

-most common is degenerative stenosis of the spinal cord caused by cervical spondylosis.
-Other stenosis:
>Congenital stenosis
>cervical disc herniation
>Trauma
>Tumour
>RA

Question 26

Describe the anatomy changes in cervical myelopathy

Answer 26

-Thickening ligamentum flavum
-Osteophytes
-Can lead to spinal cord signal change
-Treated by surgical decompression

Question 27

Symptoms of Cervical myelopathy

Answer 27

-Loss of balance with poor coordination
-Decreased dexertity
-Numbness
-Rapid deterioration of gait + hand function

Question 28

What will a patient with a C4 myelopahty complain of?

Answer 28

-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’

Question 29

What is thoracic cord compression?

Answer 29

-Most common causes of thoracic cord compression are vertebral fractures and tumours in the spinal canal.

Question 30

Importance of lower thoracic spine in compression?

Answer 30

-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.

Question 31

Symptoms of thoracic cord compression?

Answer 31

-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

Question 32

What will a
patient present
with if they have
thoracic cord
compression at
T10?

Answer 32

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)

Question 33

What will a
patient present
with if they have
thoracic cord
compression at
T5?

Answer 33

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

Question 34

How can pathogens reach the bones and tissues?

Answer 34

-Pathogens can reach the bones and tissues of the spine by 3 routes
-Haematogenous
-Spread from adjacent soft tissue infection
-During invasive spinal procedures

Question 35

What is spondylodiscitis/discitis?

Answer 35

Infection of the intervertebral disc, occurs most commonly in immunocompromised patietns e.g. dibaetics , HIV,

Question 36

How do organisms reach intervertrbral disc in adults (spondylodiscitis/discitis)?

Answer 36

-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.

Question 37

What is the most common causative organisms of spondylodiscitis/discitis?

Answer 37

-Staphylococcus aureus (50%)
-Gram negative bacilli e.g. E. Coli (30%)
-In invasive spinal procedure: Staph epidermidis.
-Injecting drug users: Candida may be seen