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MSK- Clinical correlates > Disorders of the cervical and thoracic spine > Flashcards

Disorders of the cervical and thoracic spine Flashcards

1
Q

Fracture of the C1 atlas is called

A

a Jefferson fracture

  • fracture of anterior and posterior arch
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2
Q

jefferson fracturew

A

A ‘Jefferson’s fracture’ is a fracture of the atlas (C1 vertebra)

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3
Q

cause of Jefferson fracture

A

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).

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4
Q

presentation of jefferson fracute

A

It presents with upper neck pain but no neurological symptoms.

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5
Q

diagnosis of jefferson fracture

A

Diagnosis is confirmed with an X-ray or sometimes a CT scan.

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6
Q

treatment of jefferson fracture

A

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).

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7
Q

fracture of C2 axis

A

hangmans fracture

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8
Q

hangmans fracture

A
  • Fracture through the pars interarticularis
  • Unstable fracture
  • Forward displace of C1 and C2 on C3
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9
Q

clear X-ray of hangmans fracture

A
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10
Q

cause of hangmans fracture (C2)

A

usually caused by forcible hyperextension of the neck, classically caused through hanging, giving it its unusual lay name.

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11
Q

Why does is a hangmans fracture very unlikely to damage the spinal cord

A

because the fracture itself expands the spinal canal, so it typically presents with neck pain alone.

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12
Q

diagnosis of hangmans fracture

A

Diagnosis is confirmed with an X-ray or sometimes a CT scan.

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13
Q

treatment of hangmans fracture

A

Treatment can range from a neck brace to neck immobilisation (a form of skeletal traction) to surgical intervention

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14
Q

another fracture caused by hyperextension

A

Odontoid peg fracture

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15
Q

Odontoid peg fracture

A

C2

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16
Q

diagnsosis of odontoid peg fracture

A
  • Open mouth AP X-ray = peg view
  • CT scan- difficult to visualise
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17
Q

cervical spondylosis

A

osteoarthitics of the cervical vertebra

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18
Q

presentation of cervical spondylolysis

A
  • Triad:
    • Loss of disc height
    • Osteophytes
    • Facet joint OA
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19
Q

cervical spondylolysis can lead to

A

radiculopathy and myelopathy

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20
Q

Cervical radiculopathy

A

Compression of the nerve roots

  • Osteophytes in the foramen due to cervical spondylolysis
21
Q

symptoms of radiculopathy

A
  • Sensory- dermatomal- paraesthesia/ numbness, pain
  • Motor- myotome- weakness
22
Q

difference between cervical myelopathy and cervical radiculopathy

A

cervical radiculopathy= compression of spinal roots

cervical myelopathy= compression of cord

23
Q

where are the osteophytes found in cervical myelopathy

A
  • Osteophytes in the vertebral canal
24
Q

who does cervical myelopathy affect

A
25
Q

anatomy change in cevrical myelopathy

A
  • Thickening of ligamentum flavum
  • Osteophyte
  • Can lead to spinal cord signal change
26
Q

symptoms of cervical myelopathy

A
  • Progressive disorder
  • Clumsiness
  • Loss of motor movement
  • Loss of balance
27
Q

cervical prolapsed intervertbral disc

A
28
Q

Cervical prolapsed intervertebral disc is a cause of

A
  • Cause of radiculopathy (compression of spin al roots )
  • In 30 to 50 year olds
29
Q

how is cervical prolapsed intervertebral disc different to lumbar herniation

A
  • Just wake up with stiff neck
  • Unlike prolapsed discs in the lumbar spine where pts report carrying something heavy before etc
30
Q

mechanism of action of a prolapsed intervertebral disc

A
  • Tear of the annulus fibrosis
  • Nucleus pulposus migrates through into the spinal canal
31
Q

Thoracic Cord Compression cause

A

Thoracic cord compression is commonly caused by vertebral fractures and tumours.

32
Q

thorarci cord compression symptoms

A

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.

33
Q

diagnosis of thoracic cord compression

A

Diagnostic tests may involve spinal X-ray, CT or MRI scans.

34
Q

treatment of throacic cord compression

A

Treatment can include NSAIDS, steroidal injection, physical therapy and/or surgery to relieve pressure on the spinal cord.

35
Q

why is throacic cord compression likely to give neurology

A

as the vertebral foramen is smallest (however joints are also the most stable)

36
Q

Metastasis (tumours)

A
  • 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
37
Q

spondylodiscitis

A

Infection of the spin

  • Bacteria enters spin via vertebral nutrient artery
  • Lodges at end plate
  • Extends towards disc
38
Q

if Spondylodiscitis is untreated

A
  • Untreated develops an epidural abscess and vertebral osteomyelitis
39
Q

1) What will a patient complain of with a left- sided C5/6 prolapsed disc?

A

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

40
Q

2) What nerve is affected with a cervical disc prolapse at C7/T1?

A

- 8

41
Q

3) What will a patient complain of with a left- sided C7/T1 prolapsed disc?

A

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

42
Q

4) What will a patient with a C4 Myelopathy complain of ?

A

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

43
Q

5) What will a patient present with if they have thoracic cord compression at T10?

A

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

44
Q

6) What will a patient present with if they have thoracic cord compression at T5?

A

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

45
Q

whiplash

A

Whiplash is a forceful hyper-extension, hyper-flexion injury of the cervical spine with associated ligament damage.

46
Q

cause of whiplash

A

It is commonly caused by a rapid deceleration for example in a car crash.

47
Q

presentation of whiplash

A

It presents with neck pain and can cause spinal cord injury, shoulder pain and lower back pain additionally.

48
Q

prognosis of whiplash

A

MSK- Clinical correlates (13 decks)

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