Cervical & thoracic spine pathologies

Question 1

Describe Jefferson’s fracture (C1)

Answer 1

Fracture of the anterior and posterior arches of the atlas vertebra
Causes: axial loading – diving into shallow water, impacting head against roof of a vehicle
Consequences: pain but no neurological signs, may be damage to the arteries at the base of the skull leading to secondary neurological sequelae

Question 2

Describe Hangman’s fracture (C2)

Answer 2

Axis vertebra is fractured through the pars interarticularis
Causes: forcible hyperextension of the head on the neck – ‘hanging’ & road traffic collisions
Requires treatment & low risk of associated spinal cord injury

Question 3

Describe fracture of the odontoid peg of C2

Answer 3

Caused by either flexion or extension injuries
Most common – elderly patient with osteoporosis falling forwards & impacting their forehead on the pavement
Sometimes caused by a blow to the back of the head resulting in a hyperflexion injury
Detected by an ‘open mouth’ AP x-ray or CT of cervical spine

Question 4

Describe cervical spondylosis

Answer 4

Chronic degenerative osteoarthritis affecting the intervertebral joints in the cervical spine
Causes: age-related
Consequences: radiculopathy (pressure on the spinal nerves), myelopathy (pressure on the spinal canal)
Radiculopathy leads to dermatomal sensory symptoms, myelopathy leads to muscle weakness

Question 5

Describe cervical myelopathy

Answer 5

Spinal cord dysfunction due to compression of the cord

Causes: degenerative stenosis of the spinal canal caused by cervical spondylosis

Question 6

Describe cervical disc prolapse

Answer 6

Causes: may be spontaneous or may be related to trauma and neck injury
Exiting nerve will be compressed
Classical presentation is loss of balance with poor coordination, decreased dexterity, weakness, numbness & in severe cases paralysis

Question 7

Describe thoracic cord compression

Answer 7

Causes: vertebral fractures & tumours in the spinal canal
Pain at the site of lesion, paralysis of all the muscles supplied by the nerve root & paraesthesia in the dermatomes distal to the site of cord compression

Question 8

Describe whiplash injury

Answer 8

Forceful hyperextension-hyperflexion injury

Common cause: patient’s car being struck from the rear leading to an acceleration-deceleration injury

Question 9

List the common infections of the spine

Answer 9

Vertebral osteomyelitis
Discitis
Epidural abscess

Question 10

Describe vertebral osteomyelitis

Answer 10

Bone infection usually caused by bacteria

Rare & most common in young children or elderly

Question 11

Describe discitis

Answer 11

Infection of the intervertebral disc
Most commonly occurs in immunocompromised patients – diabetes, HIV & patients on steroids
Disc is avascular so it is thought the microbes reach through haematogenous spread (segmental artery)

Question 12

Describe epidural abscess

Answer 12

Collection of pus between the vertebrae and the lining membrane of the spinal cord
Main treatment is surgical decompression followed by antibiotic therapy

Question 13

Describe winging of the scapula

Answer 13

Long thoracic nerve damage = serratus anterior paralysed
Medial border of the scapula is no longer held against the chest wall so protrudes posteriorly
Cause: surgical trauma during mastectomy

Question 14

Describe axillary lymphadenopathy

Answer 14

Enlargement of the axillary lymph nodes

Causes: infections of upper limb, pectoral region & breast, metastases from breast cancer & lymphoma