Cervical & thoracic spine injury Flashcards
Cervical spondylosis
What is it?
What is the pathology ?
How does radiculopathy arise?
What are the symptoms of radiculopathy?
How does myelopathy arise?
What are the symptoms of myelopathy?
- Chronic degenerative oeteoarthritis affecting intervertebral joints in cercial spine
- disc degeneration > marginal osteophytosis > facet joint OA
- narrowing of the intervertebral foramina > pressure on spinal nerve > radiculopathy
- parathesia @ affected dermatome, myotomal motor weakness
- if spinal canal is narrowed > pressure on spinal cord
- global muscle weakness, gait dysfunction, loss of balance, loss of bowel & bladder control
Jefferson’s fracture
What is it?
What causes it?
How would patient present?
What is the advantage of the bursting open of bone fragments?
What are the complications?
- Fracture of a & p arches of atlas vertebra
- axial loading (diving into shallow water)
- support head with their hands
- reduce impingement on spinal cord
- ataxia, stroke, horner’s syndrome
Hangman’s fracture
What is it?
What causes it?
- fracture through pars intercularis of C2 (region between s & i articular processes)
- hyperextension of head on neck
Peg fractures
What is it?
What causes it?
How is this fracture detected?
- Fractures of odontoid process
- Hyperflexion or hyperextension of head on neck
- open mouth AP X-ray
Whiplash injury
Why is the cervical spine prone of whiplash injury?
Describe the mechanism causing it.
What are the complications?
- High mobility and low stability
- Forceful hyperextension-hyperflexion injury on cervical spine > tearing of cervical muscles and ligaments > srrounding muscles contract > spasm, pain and stiffness
- Secondary oedema, haemorrhage, inflammation, chronic myofacial pain syndrome, cervical cord injury
Cervical intervertebral disc prolapse
Which nerve root will be compressed and why?
What will a patient complain of in left sided C5/6 prolapse? Why?
- Exiting nerve root. Disc in cervical spine not very large, little space available for exiting nerves
- Paresthesia in left C6 dermatome, weakness in C6 myotome
- cervical nerves exit above their vertebrae, no traversing root present. so affected nerve will be C6
Cervical myelopathy
What is it?
What causes it?
What are the symptoms?
How does it often manifest in old people?
- spinal cord dysfunction caused by compression of spinal cord due to narrowing of spinal canal
- cervical spondylosis, ligamentum flavum hypertrophy, disc protrusion, osteophyte formation, RA, tumour
- poor coordination, dec. dexterity, weakness, numbness, paralysis
- rapid deterioration of hand and gait
Cervical Myelopathy
What is caused by upper cervical lesion?
What do lower cervical lesion do?
What is a hoffman’s test?
What is a babinski’s test?
- loss of manual dexterity, dysdiadochokinesia(dec. ability to perform rapid alternating movements)
- spasticity, loss of proprioception in legs, gait dysfunction
- doctor holds patient’s middle phalanx > flicks finger nail > if no movement by index & finger = (-) hoffman’s sign = normal
- lat side of sole of foot stroke with blunt intrument from heel to toes > toes flex downwards = normal, hallux dorsiflex and toes fan out = abnormal
L’Hermitte’s phenomenon
What is it?
What is it associated with?
What are the complictaions?
- sensation of intermittent electric shocks in the limb, exacerbated by neck flexion
- Cervical myelopathy
- sphincter dysfunction, quadraplegia
Thoracic cord compression
What causes it?
What common cancers would spread to bone?
Where else would a metastasis at T12 impinge and why?
What are the symptoms?
What are the additional symptoms if tumour at T5?
- vertebral fractures, tumours in spinal canal
- breast, lung, thyroid, prostate
- L4-5 - neural segments do not line up with their respective segments in the lower thoracic spine and in the lymbr spine - spinal cord shorter than vertebral column
- spastic paralysis of all muscles in legs, paresthesia in dermatomes distal to site of cord compression
- weakness of intercostal muscles from 5th intercostal space distally > dec. chest expansion on inspiraiton
Vertebral osteomyelitis, discitis, epidural abcess
What are the 3 routes for pathogen spread to bones?
How does spread occurs haemarogenously?
What is infection of intervertebral disc called?
What patients are most at risked of spine infection?
What are the common causative organism?
What are the different spread of infection to spinal canal which leads to neurologicla problems?
Adult intervertebral disc is avascular. What does it lead to if infection is present?
- Haematogenous, direct innoculation, spread from adjacent soft tissue infection
- arterial supply to vertebral body, retrograde venous flow
- spondylodiscitis
- diabetic, HIV, immunocompromised, steroid use
- Staph aureus, E.coli, staph epidermidis
- septic thrombosis > ischaemia, compression of neural elements by abcess, invasion of neural elements by inflammatory tissue, mechanical collapse of bone
- bony ischaemia > infarction > direct spread of organism into adjacent disc sapce, epidural space, adjacent vertebral body
