Clinical Correlations

Question 1

Scoliosis

Answer 1

Most common back deformity in the world (highest in prepubescent females)

• hemivertebra
• shorter leg

muscle imbalance causes elongation of the pedicle on one side and shortens it on the other,
Changes the shape of SPs
changes shape of vertebral foramen
May cause compression of the lung and moves the heart to the other side

Question 2

Compression fx

Answer 2

think diving into shallow water
blow out body of the vertebrae
can cause impingement of spinal cord

tx: vertebroplasty

made worse if IV disc is damaged

Question 3

Pathological fractures: Osteoporosis

Answer 3

weakening of trabeculated spongy bone can lead to wedge vertebrae and fractures

Question 4

Pathological fractures: cancers

Answer 4

Breast, prostate, Hodgkin’s

disseminate into the vertebrae via the vertebral venous plexus (Battson’s plexus)

Question 5

Cervical dislocation/locked facets

Answer 5

most often occurs in C6
causes a sliding of vertebral body anteriorally until it becomes locked onto superior articulating facet of vertebrae below

can compress the spinal cord (may lead to death)

Question 6

Jefferson fx of CV1

Answer 6

downward compression of skull can burst the delicate atlas

> causes severing of the anterior and posterior arch

Question 7

Hangman’s fx

Answer 7

spondylolysis/spondylolethisis of CV2/CV3 due to forced hyperextension

Question 8

Fx of the dens

Answer 8

dens alone or dens+part of the body can snap off CV2
if the transverse ligament remains attached it will stay associated with CV1 for a while if the transverse ligament is left intact and can be asymptomatic
—>same deal with dislocation

Question 9

Rupture of alar ligament

Answer 9

occurs when the head is in flexion and forced rotation occurs
increases ROM by 30 deg

Question 10

Spondylosis

Answer 10

family of osteoarthritic degenerations between the vertebrae and discs (degeneration of articular cartilage leads to inflammation and osteophyte formation)
>causes spinal stenosis (narrowing of vertebral canal–> impingement on spinal cord)
or the narrowing of the intervertebral foramen which would impinge on spinal nerves

Question 11

Pt with increased reflexes

Answer 11

indicates that there is a spinal cord impingement

caused by spondylosis

Question 12

Pt with decreased reflexes and muscle wasting

Answer 12

Indicates that there is a spinal nerve impingement (caused by spondylosis)

Question 13

Spinal stenosis

Answer 13

Osteophytic vertebral cause radiculopathy of spinal nerves due to decreased size of vertebral canal and/or intervertebral foramen

Tx= laminectomy to relieve pressure 
Tx= foraminotomy to clean out intervertebral 

acute pain= from inflammation
chronic pain= from pinching of nerve roots

Question 14

Wiplash

Answer 14

can cause a tear of anterior longitudinal ligament due to rapid hyperextension
can fx the body of the vertebrae
made worse if the IV disc is torn

> post-injury muscle spasms pull vertebrae out of line

Question 15

Ankylosing Spondylitis

Answer 15

Fused vertebrae due to inflammation of synovial joints and ligaments

Bamboo spine
loss of dynamic shape

HLA-B27

Question 16

Intervertebral disc diseases

Answer 16

Herniations etc

occur most in areas of high mobility (LV4/LV5 L5/S1 or cervical)

Acute pain= from tearing posterior longitudinal ligament

chronic pain= from mechanically stimulating spinal nerve or spinal cord

look for pain in affected dermatome/myotomes

Question 17

Ishemia of the spinal cord

Answer 17

can occur after the repair of the abdominal aorta if the segmental medullary arteries are not properly repaired.

Most vulnerable areas are T1-T4 and L1

leads to paralysis