Clinical Conditions Of The Cervical + Thoracic Spine Flashcards
What is cervical spondylosis?
Osteoarthritis of IV joints
What is the typical triad presentation of cervical spondylosis?
Loss of disc height
Osteophytes
Facet joint space osteoarthritis
What is a spinal radiculopathy?
Pressure on the spinal nerve due to narrowing of IV foramen
Osteophytes in foramen
Symptoms of spinal radiculopathy
Paraesthesia - in dermatome
Pain - radiates from root to dermatome e
Myotomal motor weakness
What is spinal myelopathy?
Pressure on spinal cord due to stenosis of spinal canal
Oesteophytes in vertebral canal
Symptoms of spinal myelopathy
Global muscle weakness
Gait dysfunction
Loss of balance
Loss of bowel + bladder control
Effect of myelopathy in upper cervical lesions
Decreased dexterity
Dysdiadocokinesia - impaired ability to perform rapid alternating movements
Effect of myelopathy in lower cervical lesions
- Spacsticity - increase muscle tone
- Loss of proprioception of legs - loss of awareness of position + movement of body (legs feel heavy)
What is a Jefferson’s fracture?
Fracture of the anterior + posterior arches of the C1 vertebra
Mechanism of Jefferson’s fracture
Examples
Axial loading
e.g. diving into shallow water, impacting head from hall or crash
Why does a Jefferson’s fracture present with pain but no neurological signs?
Fracture bursts open
Decreased likelihood of impingement of spinal cord
What is a Hangman’s fracture?
Fracture of C2 vertebra through pars interarticularis
Mechanism of hangman’s fracture
Example
Hyperextension of head on neck
e.g. RTC
Mechanism of fracture of odontoid process
Examples
Hyperflexion e.g. blow to back of head
Hyperextension e.g. falling + impact on forehead
Outline a whiplash injury
Forceful hyperextension + hyperflexion of injury to cervical spine»_space; tearing of cervical muscles and ligaments
Muscles contract to splint injured muscles > spasm > pain and stiffness
What nerve is compressed in cervical IV disc prolapse?
Exiting root
Causes of thoracic cord compression
Vertebral fracture > fragments in spinal cord
Tumours in spinal canal
What are the routes that pathogens can reach bones and tissues of the spine?
- Haematogenous
- spread from adjacent soft tissue infection
- direct inoculation during invasive spinal procedure
e.g. lumbar puncture, epidural
What is spondylodiscitis/discitis?
Infection of IV disc
How does spondylodiscitis occur?
IV disc is avascular so not via blood
Enters due to necrosis of bone due to ischaemia > direct spread of organisms
