Disorders of the cervical and thoracic spine Flashcards
Fracture of the C1 atlas is called
a Jefferson fracture
- fracture of anterior and posterior arch
jefferson fracturew
A ‘Jefferson’s fracture’ is a fracture of the atlas (C1 vertebra)
cause of Jefferson fracture
caused by axial loading e.g. diving into a shallow pool.
It presents with upper neck pain but no neurological symptoms. Diagnosis is confirmed with an X-ray or sometimes a CT scan. Treatment can range from a neck brace to neck immobilisation (a form of skeletal traction) to surgical intervention (especially if the transverse ligament is damaged).
presentation of jefferson fracute
It presents with upper neck pain but no neurological symptoms.
diagnosis of jefferson fracture
Diagnosis is confirmed with an X-ray or sometimes a CT scan.
treatment of jefferson fracture
Treatment can range from a neck brace to neck immobilisation (a form of skeletal traction) to surgical intervention (especially if the transverse ligament is damaged).
fracture of C2 axis
hangmans fracture
hangmans fracture
- Fracture through the pars interarticularis
- Unstable fracture
- Forward displace of C1 and C2 on C3
clear X-ray of hangmans fracture
cause of hangmans fracture (C2)
usually caused by forcible hyperextension of the neck, classically caused through hanging, giving it its unusual lay name.
Why does is a hangmans fracture very unlikely to damage the spinal cord
because the fracture itself expands the spinal canal, so it typically presents with neck pain alone.
diagnosis of hangmans fracture
Diagnosis is confirmed with an X-ray or sometimes a CT scan.
treatment of hangmans fracture
Treatment can range from a neck brace to neck immobilisation (a form of skeletal traction) to surgical intervention
another fracture caused by hyperextension
Odontoid peg fracture
Odontoid peg fracture
C2
diagnsosis of odontoid peg fracture
- Open mouth AP X-ray = peg view
- CT scan- difficult to visualise
cervical spondylosis
osteoarthitics of the cervical vertebra
presentation of cervical spondylolysis
- Triad:
- Loss of disc height
- Osteophytes
- Facet joint OA
cervical spondylolysis can lead to
radiculopathy and myelopathy
Cervical radiculopathy
Compression of the nerve roots
- Osteophytes in the foramen due to cervical spondylolysis
symptoms of radiculopathy
- Sensory- dermatomal- paraesthesia/ numbness, pain
- Motor- myotome- weakness
difference between cervical myelopathy and cervical radiculopathy
cervical radiculopathy= compression of spinal roots
cervical myelopathy= compression of cord
where are the osteophytes found in cervical myelopathy
- Osteophytes in the vertebral canal
who does cervical myelopathy affect
anatomy change in cevrical myelopathy
- Thickening of ligamentum flavum
- Osteophyte
- Can lead to spinal cord signal change
symptoms of cervical myelopathy
- Progressive disorder
- Clumsiness
- Loss of motor movement
- Loss of balance
cervical prolapsed intervertbral disc
Cervical prolapsed intervertebral disc is a cause of
- Cause of radiculopathy (compression of spin al roots )
- In 30 to 50 year olds
how is cervical prolapsed intervertebral disc different to lumbar herniation
- Just wake up with stiff neck
- Unlike prolapsed discs in the lumbar spine where pts report carrying something heavy before etc
mechanism of action of a prolapsed intervertebral disc
- Tear of the annulus fibrosis
- Nucleus pulposus migrates through into the spinal canal
Thoracic Cord Compression cause
Thoracic cord compression is commonly caused by vertebral fractures and tumours.
thorarci cord compression symptoms
It presents with pain in the thoracic spine, spastic paralysis of the lower limb muscles, paraesthesia of dermatomes distal to the site of compression and loss of sphincter control. If the compression is around T5, there may also be reduced chest expansion on inspiration.
diagnosis of thoracic cord compression
Diagnostic tests may involve spinal X-ray, CT or MRI scans.
treatment of throacic cord compression
Treatment can include NSAIDS, steroidal injection, physical therapy and/or surgery to relieve pressure on the spinal cord.
why is throacic cord compression likely to give neurology
as the vertebral foramen is smallest (however joints are also the most stable)
Metastasis (tumours)
- Incidence of cancer in lifetime is 1 in 2
- 50-60% of patients with cancer will have skeletal metastases at dearth
- Spine is second commonest site for skeletal metastases
spondylodiscitis
Infection of the spin
- Bacteria enters spin via vertebral nutrient artery
- Lodges at end plate
- Extends towards disc
if Spondylodiscitis is untreated
- Untreated develops an epidural abscess and vertebral osteomyelitis
1) What will a patient complain of with a left- sided C5/6 prolapsed disc?
Location of pain: neck down anterior arm, lateral forearm into thumb and index finger
Motor weakness: elbow flexion, wrist extension, supination
Sensory: Numbness/ pins and needles in lateral forearm, thumb and index finger
2) What nerve is affected with a cervical disc prolapse at C7/T1?
- 8
3) What will a patient complain of with a left- sided C7/T1 prolapsed disc?
Location of pain: Neck and anterior arm and forearm pain into little ring fingers
Motor weakness: long finger flexors and extensors
Sensory: Numbness/ pins and needles’ in little and ring fingers, ulnar, border of hand
4) What will a patient with a C4 Myelopathy complain of ?
Location of pain: neck pain
Motor weakness: shoulder abduction (C5and other myotomes distally, including trunk and lower limbs
Sensory: Numbness/ pins and needles’ from the shoulder distally, trunk and lower limbs e.g. numbness of feet
5) What will a patient present with if they have thoracic cord compression at T10?
Location of pain: Lower thoracic pain
Motor weakness: weakness of all muscles in the legs
Sensory: Loss of sphincter control. Numbness/ pins and needles from just below umbilicus inferiorly
6) What will a patient present with if they have thoracic cord compression at T5?
Location of pain: High thoracic pain
Motor weakness: weakness of all muscles in the legs and intercostals
Sensory: Loss of sphincter control. Numbness/ pins and needles from just below nipples inferiorly
whiplash
Whiplash is a forceful hyper-extension, hyper-flexion injury of the cervical spine with associated ligament damage.
cause of whiplash
It is commonly caused by a rapid deceleration for example in a car crash.
presentation of whiplash
It presents with neck pain and can cause spinal cord injury, shoulder pain and lower back pain additionally.
prognosis of whiplash
