Session 7 clinical conditions

Question 1

What is cervical spondylosis

Answer 1

Chronic degenerative osteoarthritis

affecting intervertebral joints in cervical spine

Question 2

Primary pathology of cervical spondylosis

Answer 2

Age related disc degeneration, marginal osteophytosis, facet joint osteoarthritis

Question 3

What is the consequence of resultant narrowing of intervertebral foramina in cervical spondylosis

Answer 3

Puts pressure on spinal nerves leading to radiculopathy (dermatomal sensory symptoms and myotomal motor weakness)

Question 4

Consequence of narrowing of spinal canal in spondylosis

Answer 4

Myelopathy (pressure on spinal cord)
Less common
Global muscle weakness, gait dysfunction, loss of balance, incontinence

Question 5

What is Jefferson’s fracture

Answer 5

Fracture of anterior and posterior arches of atlas C1
Axial loading
Typically pain but no neurological signs

Question 6

Occasional complication of Jeffersons fracture

Answer 6

damage to arteries at base of skull

secondary neurological sequelae (ataxia, stroke, Horner’s syndrome)

Question 7

What is Hangman’s fracture

Answer 7

Axis C2 is fractured through pars interarticularis (between superior and inferior articular processes)
Forcible hyperextension of neck
Unstable- needs treatment

Question 8

Cause of fractures of the odontoid process and detection

Answer 8

Flexion or extension

open mouth X ray or CT

Question 9

What is whiplash

Answer 9

forceful hyperextension/hyperflexion injury of cervical spine
tearing of cervical muscles and ligaments

Question 10

Consequence of whiplash

Answer 10

secondary oedema
haemorrhage
inflammation
Spasm

Sometimes injury to cervical cord

Question 11

What is myofascial pain syndrome

Answer 11

secondary issue in response to a disc or facet joint injury

Such as whiplash

Question 12

Protective mechanism against spinal cord injury in whiplash

Answer 12

vertebral foramen is large relative to diameter of cord in cervical region

Question 13

How can sequestration be resolved

Answer 13

extruded segment of nucleus pulposus is resorbed in spinal canal

Question 14

Problem with cervical nerves

Answer 14

little space for exiting nerves

Question 15

Symptoms in C5/C6 left prolapse

Answer 15

parenthesia in radial border of left forearm, thumb and index finger on left
Weakness in left elbow flexion, supination and wrist extension
Pain in neck radiating down left arm over biceps and to skin supplied by C6

Question 16

What is cervical myelopathy

Answer 16

Spinal cord dysfunction due to compression of cord by narrowing of vertebral canal

Question 17

Commonest cause of cervical myelopathy

Answer 17

cervical spondylosis
e.g. ligamentum flavum hypertrophy or buckling, facet joint hypertrophy, disc protrusion and osteophyte formation
Reduction in canal diameter resulting in cord compression

Question 18

Other causes of cervical myelopathy

Answer 18

congenital stenosis of spinal canal 
Cervical disc herniation 
Spondylolisthesis 
trauma 
tumour 
RA

Question 19

When do myelopathic symptoms start

Answer 19

<12-14mm spinal canal

Question 20

Classic cervical myelopathy presentation

Answer 20

loss of balance with poor coordination 
decreased dexterity 
weakness 
numbness or paralysis 
pain or not 
rapid deterioration of gait and hand function in elderly

Question 21

Classic upper and lower cervical lesions presentation

Answer 21

Upper- loss of manual dexterity, Dysdiadochonkonesia (impaired ability to perform rapid alternating movements)
Lower- spasticity, loss of proprioception in legs, legs feel heavy, reduced exercise tolerance, gait disturbance, multiple falls

Question 22

What do hoffmans and Babinski tests test for

Answer 22

Exaggerated response to stimulation (Hoffmans or Babinski sign)

Question 23

Hoffmans test

Answer 23

flick fingernail of middle phalanx

if the index finger and thumb move- patient has a positive sign

Question 24

Babinski sign

Answer 24

lateral side of sole of foot stroked with a blunt instrument from heel to toe
Normal = flexor response (2-3+)
Babinski sign = hallux dorsiflexes and toes fan out

Question 25

What is Lhermitte’s phenomenon

Answer 25

sensation of intermittent electric shocks in the limbs
Exacerbated by neck flexion
Classically associated with cervical myelopathy

Symptoms may progress to sphincter dysfunction and quadriplegia if surgical decompression is not performed

Question 26

Symptoms of myelopathy of cervical spine at C5

Answer 26

neck pain
weakness of shoulder abduction and external rotation
weakness of all myotomes distally
paraesthesia from the shoulder distally

Question 27

Commonest causes of thoracic cord compression

Answer 27

vertebral fractures with bony fragments in spinal canal or tumours in spinal canal

Question 28

Common sites for metastasis

Answer 28

1st = pelvis 
2nd = spine

Question 29

Most common cancers that arise from solid organs and spread to bone are

Answer 29

breast, lung, thyroid, kidney and prostate

Question 30

Metastasis in T12 vertebra would compress

Answer 30

L4-5 segments of sinal cord

Question 31

Symptoms of spinal cord compression from a metastasis at T10

Answer 31

pain in thoracic spine, spastic paralysis of all muscles in legs, parawsthesia in dermatomes distal to site of cord compression, loss of sphincter control

Question 32

T5 metastasis presentation

Answer 32

weakness of intercostal muscles from 5th intercostal space, reduced chest expansion on inspiration diaphragmatic breathing
Paraethesia from below nipples distally
Weakness of leg muscles and loss of sphincter control

Question 33

3 routes for pathogens reaching bones and tissues of spine

Answer 33

Haematogenous (most common)
Direct inoculation during invasive spinal procedure
Spread from adjacent soft tissue infection

Question 34

Infection of intervertebral disc is called

Answer 34

spondylodiscitis or discitis

Question 35

Spondylodiscitis is most common in

Answer 35

immunocompromised patients (diabetes, HIV, patients on steroids)

Question 36

Where are organisms initially deposited

Answer 36

Vertebral body, via segmental artery, leading to bony ischaemia and infarction

Necrosis allows direct spread into disc space epidural space and adjacent vertebral bodies

Question 37

Spread of infection into spinal canal can lead to neurological damage via

Answer 37

Septic thrombosis leading to ischaemia
Compression of neural elements by abcess/inflammatory tissue
Direct invasion of neural elements by inflammatory tissue
Mechanical collapse of bone leading to instability, particularly in chronic infections

Question 38

Most common organisms for spread of infection to spinal canal

Answer 38

Staph aureus, gram neg bacillus such as E coli,

Following surgery = coagulase negative staph

Drug users IV = pseudomonas, candida