Normal Variants

Question 1

congenital anomalies of cervical spine are common or uncommon

Answer 1

uncommon

Question 2

majority of affected individuals (cervical anomalies) are ___

if symptoms develop, they are due to what

Answer 2

asymptomatic

due to instability or degenerative OA

Question 3

patients with upper cervical anomalies have a tendency to develop what

secondary to what

Answer 3

early instability and neurological problems

secondary to minor traumatic events

Question 4

if symptoms occur in the lower cervical spine they usually occur when

due to what

Answer 4

in adult life

due to degenerative arthritis in the HYPERMOBILE articulations adjacent to areas of synostosis

Question 5

the good prognosis of cervical lesions are overshadowed by what

Answer 5

hidden or unrecognized anomalies

Question 6

what anomalies are considered to occur in high incidences

Answer 6

scoliosis 
sprengels deformity 
renal anomalies 
deafness 
neurological malformation

Question 7

early recognition and treatment is essential why

Answer 7

it spares the patient from further deformity or serious illness

Question 8

if you have a altered nerve root function then what do you rule out

Answer 8

herniated disc
nerve tumor
syrinx

Question 9

what image modality do you use to see a syrinx

Answer 9

MRI

Question 10

is thyroid calcification normal

what should you not confuse this with

Answer 10

yes its normal

vertebral artery calcification

Question 11

supracondylar process may causes compression of what

Answer 11

compression of median nerve (neuropathy) especially following trauma

compression of brachial artery may occur as well

Question 12

what are the symptoms of someone with a supracondylar process

what is associated with this process

Answer 12

patient complains of paresthesias in the hand - carpal tunnel like symptoms

ligament of struthers - connects medial epicondyle of the humerus

Question 13

ligament of struthers is a __ anomaly that compresses the median nerve, brachial artery, or both

Answer 13

congenital anomaly

Question 14

what is eagles syndrome

symptoms

Answer 14

stylohyoid ligament calcification (elongated)

foreign body sensation in the throat, dysphagia, and intermittent facial pain

others - headache, pain on neck rotation, pain on extension of the tongue, change in voice, and sensation of hyper salivation

Question 15

how do you diagnose eagles syndrome

Answer 15

radiologically

confirm by palpation of tonsillar fossa

Question 16

sprengels deformity is usually unilateral or bilateral

Answer 16

unilateral

Question 17

20-25% of sprengel deformities occur with what syndrome

Answer 17

klippel feil syndrome

Question 18

what bone is seen in 30-40% of sprengels deformity cases

Answer 18

omovertebral bone

Question 19

downs syndrome causes what congenital anomaly in the spine

Answer 19

laxity of the transverse atlas ligament

Question 20

what are downs syndrome signs and symptoms due to

Answer 20

mechanical compression of the cervical nerve roots or spinal cord and vertebral arteries may be distorted

gait deterioation, weakness, loss of muscle tone in legs, increased deep tendon reflexes in arms and legs

Question 21

should you manipulate a person with a downs syndrome

Answer 21

no, its always dangerous adjusting the cervical spine due to laxity of the transverse atlas ligament

Question 22

what subluxation usually occurs in downs patients

Answer 22

anterior subluxation of atlas

7-8 mm between anterior arch of C1 and odontoid process of C2

Question 23

how should down syndrome patients be screened to rule out atlantoaxial instability

Answer 23

screened with flexed and extended lateral views

Question 24

down syndrome patients should restrict contact sports if the ADI is what

Answer 24

> 4.5 mm

Question 25

adults with down syndrome are prone to developing what

Answer 25

cervical myelopathy secondary to cervical spondylosis

Question 26

higher incidence of disc herniation occurs in what congenital anomaly

where does it occur

age

Answer 26

spina bifida occulta at S1

L5-S1 disc herniation

> 41 years

Question 27

what occurs due to a congenital block vertebrae

Answer 27

myelopathy secondary to degeneration and spondylosis

Question 28

what imaging is helpful to evaluate secondary soft complication of disc disease, stenosis, and other neurovascular problems

Answer 28

MRI

Question 29

what occurs when complete or partial ossification of the oblique portion of the atlantooccipital membrane

Answer 29

posterior ponticle at C1

Question 30

what should one worry about when adjusting a posterior ponticle at C1

what adjust are we worried about

Answer 30

vertebrobasilar insufficiency

rotatory adjustments

Question 31

os vesalianum should not be confused with what

Answer 31

old fracture of 5th metatarsal bone

Question 32

where is os fabella located

Answer 32

lateral head of gastroc

dislocation of the lateral head of gastroc may cause shifting of fragment producing pain

Question 33

lunate triquetrum coalition occurs when

Answer 33

scapholunate ligament tear due to distal radius fracture

creates widening of scapholunate joint space due to tear of SL ligament