L14 C Spine Pathology 2 Flashcards
jefferson fracture
burst fracture of C1 vertebrae
MOI jefferson fracture
axial load
compression with flexion or extension
diving or fall
diagnosing jefferson fracture
difficult due to lack of neuro deficit
CT scan
associated injuries with jefferson fracture
vertebral artery injury
atlantoaxial, atlanto occipital instability
hangman’s fracture
BL fracture of pars interarticularis at C2
MOI of hangman’s fracture
distraction with hyperextension (forceful) centered on chin
diving, contact sports, falling
also C spine hyperflexion
diagnose hangman’s fracture
xray and CT scans
dens fracture type I
avulsion fracture
a piece breaks off the dens but ligaments are not completely disrupted
dens fracture type II
fracture through the base of the dens
MOI of dens fracture type II
excessive extension or hyperflexion
dens fracture type III
fracture through body of C2 involving a portion of C1/2 facets
which dens fracture types are unstable
Ii and III
halo device is used for:
unstable cervical and upper thoracic fractures down to T3
greatest amount of motion restriction
best stability when extending down to iliac crest, often goes to umbilicus
indications for a halo
dens fracture any type
C2 fractures
C1 fractures
transverse ligament rupture
AA instability
single column cervical fractures
post op tumor resection in unstable spine
SCI
halo motion restriction
90-96% limited flexion/extension
92-96% SB
98-99% rotation
complications of halo
neck pain/stiffness
pin loosening
pin site infection
scarring
pain at pins
pressure sores
redislocation
restricted ventilation
dysphagia
nerve injury
dural puncture
neuro deterioration
what can you expect to see in a patient after a halo has been removed?
cervical pain and muscle weakness
need to assess neuro function as not all achieve stable spine
contraindications to halo
psycho: claustrophobia
severe skin irritation or breakdown
PT interventions after halo
mobility for unaffected joints
shoulder ROM and strengthening
C spine mobility when allowed
core strength
balance training
philadelphia collar (HCO) indications
immobilization after surgery
cervical sprain/strain
post traumatic immobilization, especially uncx patients
serious stretching ligament injury
anterior cervical fusion
after halo removal
dens type I fracture
anterior discectomy
teardrop fracture
PT interventions after HCO
posture correction
ROM once allowed
scap and neck strengthening
cervical and thoracic stretching
how much does HCO/philadelphia limit motion?
flex/ext: 65-70% of normal
SB: 30-35% of normal
Rotation: 50% of normal
cervical thoracic orthoses indications
minimally unstable fractures
better motion restriction to lower cervical spine
limits CT junction
cervical soft collar indications
mild cervical sprain/strain
post traumatic cervical pain
recovery from non surgical interventions
can lead to atrophy if worn long term
cervical soft collar ROM limitations
flex/ext: 50% of normal
SB: 60% of normal
rotation: 50-60% of normal
drawbacks to cervical collars
only limited force can be applied through them due to soft tissue structures around the neck
high cervical mobility means these are not effective at limiting motion
no control over head or thorax
soft collar
light weight velcro strap
comfortable but needs to be cleaned often
indications for soft cervical collar
warmth
psych comfort
head support with acute neck pain
relief from minor muscle spasm
or cervical strain
motion limitations of soft cervical collar
flex/ext: 5-15%
SB: 5-10%
rotation: 10-17%
hard cervical collar
plastic ring collar with padding and adjustable height
more durable
indications for hard cervical collar
support for acute neck pain
relief with minor spasm from spondylosis
psych comfort
stability and protection during halo application
motion restrictions from hard cervical collar
flex/ext: 20-25%
less effective in limited rotation and SB
anterior cervical discectomy and fusion indications
disc herniation causing radiculopathy or myelopathy
anterior cervical discectomy and fusion activity limitations
risk of segment degeneration
4-6 weeks:
avoid sitting> 30-45 min
no lifting>20#
avoid end range motion
no OH activity
gentle c/s motion until 12 weeks
can increase weight by 5# every other week
return to baseline at 6 months
PT interventions for anterior cervical discectomy and fusion
posture correction
scap strength
ROM in c/s t/s
strengthening DNF, extensors
functional training
cervicak disc arthroplasty indications
DDD
symptomatic radiculopathy/myelopathy in single level
cervical disc arthroplasty contraindications
multilevel cervical disease
poor bone quality
significant facet joint arthritis
PT Interventions for cervical disc arthroplasty
focus on dynamic motion and strengthening
functional cervical mobility
proprioception and joint position
indications for posterior cervical laminoformainotomy
foraminal stenosis or radiculopathy w nerve root compression
PT interventions for posterior cervical laminoforaminotomy
neck stretch
nerve glide
strengthen cervical and upper back muscles
posture training
avoidance of activities worsening symptoms
posterior cervical fusion indications
degenerative cervical spine w instability
PT interventions for posterior cervical fusion
stretch and mobilize c/s and t/s
scap strengthening
core strengthening
functional activity
