Spine Flashcards
Cervical spondylosis
Chronci degerneative OA affeting intervertebral joints in cervical spine
Age-realted disc degernation - followed by marginal osteophytosis (osteophyte formation adjacent to end plate of vertebral bodies) and facet joint osteoarthritis
Narrowing of intervertebral foramina can put pressure on the spinal nerves leading to radiculopathy
Cervical spondylosis - symptoms
Symptoms of radiculopathy: dermatome sensory symptoms (paraesthesia, pain)
Myotomal motor weakness
If leads to narrowing of spinal canal, instead put pressure on spinal cord leading to myelopathy
Lesson common than radiculopathy
May manifest as global muscle weakness, gait dysgunction, loss of balance and/or loss of bowel and bladder control
Symptoms arise due to compression and dysfunction of ascendeding and descending tracts within spinal cord
Jeffersons fracture
Fracture of anterior and posterior arches of atlas vertebra (c1)
Mechanism of injury = axial loading e.g. diving into shallow water, impacting the head against the roof of a vehicle, or falling from playground equipment
Causes C1 vertebrae to burst open like a broken polo mint
- ‘Bursting open’ of bone fragments reduce the likelihood of impingement on spinal cord
Causes pain but no neurological signs
May be damage to arteries at base of skull leading to secondary neurological sequelae
E.g. ataxia, stroke, or horner’s syndrome
Horners syndrome
Damage to sympathetic trunk leading to meiosis (decreased pupil size), partial ptosis (dropping eyelid), anhidrosis (decreased sweatin on the affected side of the face) and enopthalmos (sunken appearance of eyeball)
Hangman’s fracture
C2 is fractured thorugh pars interaticularis – region betrween superior and inferior articular processes
Mechnaism of injury: forcible hyperextenison of head on neck – RTCs and hangings
Fracture is unstable and requires treatment Fracture configuration tends to expand the spinal canal, therby reducing risk of an associated spinal cord injury
Peg Fractures
Fracture of odontoid process
Caused: flexion or extension injuries
Most common is an elderly patient with osteoporosis falling towards and impacting their forehead on pavement
Hyperextension injury of cervical spine can result in a fracture of odontoid peg
Can be caused by blow to back of head = hyperflexion injury
I.e. falling against a wall when balance is compromised – such as when intoxicated
On an x ray : ‘open mouth’ AP X ray or a CT of cervical spine – performed either as part of a ‘truama series’ or duing a CT scan of head
Whiplash
Forceful hyperextension-hyperflexion injury of cervical spine
Patients car being struck from rear leading to an accelearation-deceleration injury
At the time of impact, the vehicle suddenly accelerates forward. About 100 ms later, the patient’s trunk and shoulders follow, induced by a similar acceleration of the car seat.
The patient’s head, with no force acting on it, remains static in space. The result is forced extension of the neck, as the shoulders travel anteriorly under the head.
With this extension, the inertia of the head is overcome, and the head then accelerates forward.
The neck then acts as a lever to increase forward acceleration of the head, forcing the neck into flexion.
The hyperflexion followed by hyperextension leads to tearing of cervical muscles and ligaments. Secondary oedema, haemorrhage and inflammation may occur.
The muscles respond to injury by contraction (spasm), with surrounding muscles being recruited in an attempt to splint the injured muscle.
This spasm causes pain and stiffness.
Whiplash syptoms
• Very poor correlation between sverity of RTC and reuslting symtpoms reported by patients
May complain of arm pain and paraesthesia as a reuslt of inury to spinal nerves during whiplash movement of cervical spine
Develop sholder injuries due to holding the steering wheel at time of collision
Lower back pain develops in 40-50% with acute whiplash
Chronic myofascial pain syndrome can sometimes develop as secondary tissue response to disc or facet-joint injury
High prevalence of chronic pain
Secondary gain (e.g. financial compensation) may lead to prolongation of symptoms in a number of patients
Sometimes can result in injury to cervical cord
Cervical pine is highly mobile and ligaments and capsule of joints are weak and loose
Can be sig movement of vertebrae (subluxation/partial dislocation or dislocation) at time of impact, with return to normal anatomical positon afterwards
Soft tissue swelling may only be visible feature on imaging
Protective factor against spinal cord injury = vertebral foramen is relatively large relative to diameter of cord
Cervical intervertebral disc prolapse
it is the exiting nerve root that will be compressed
Assocated compression of nerve roots or spinal cord = 30-50 year olds
Mehcnaism of disc hernitation similar to that seen in lumbar spine
There is little space available for exiting nerves (unlike lumbar spine)
A small cervical disc hernitation may impinge on the nerves and cause sign pain
Cervical intervertebral disc prolapse may be spontanous in origin or may be related to trauma and neck injury
Paracentral proplase
may impinge on a spinal nerve leading to radiculopathy – compression of a psinal nerve)
Canal-filling prolapse
acute spinal cord compression
Cervical myelopathy
a disease of the cervical spine, it may manifest with lower as well as upper limb symptoms due to damage to the long tracts of the spinal cord.
Cause of cervical myelopathy
Degenerative stenosis of spinal canal caused by cervical spondylosis (degenerative OA)
Cervical spondylotic myelopathy (myelopathy secondary to cervical spondylosis) is result of degenerative changes which develop with age (including: ligamentum flavum, hypertrophy or buckling, facet join hypertrophy, disc protrusion and osteophyte formation
congenital stenosis of the spinal canal
cervical disc herniation
spondylolisthesis (anterior slippage of a vertebral body on the vertebra below)
- Trauma - Tumour - RA affecting the cervical spine.
Cervical myelopathy symptoms
Myelopathic - if diameter of spinal canal falls below 12-14mm (norm: 17-18mm)
Range of symptoms (non-specific)
Usually loss of balance with poor coordination decreased dexterity weakness, numbness severe cases paralysis.
Pain is a symptom in many patients but it is important to remember that it may be absent; the absence of pain often leads to a delay in diagnosis.
older patients, manifests with a rapid deterioration of gait and hand function.
Upper cervical lesions tend to cause a loss of manual dexterity with difficulties in writing and nonspecific alteration in arm weakness and sensation.
dysdiadochokinesia - impaired ability to perform rapid alternating movements.
Lower cervical lesions smyptoms
spasticity [increased muscle tone, sometimes with clonus] and loss of proprioception in the legs.
legs ‘feel heavy’
reduced exercise tolerance
gait disturbance
suffer multiple falls.
Normally the signals in the long tracts dampen the spinal reflexes, so a person does not overreact to stimuli. When the long tracts become damaged, however, these protective capabilities are less effective, and the patient may demonstrate an exaggerated response to stimulation, as seen in a positive Hoffman’s or Babinski sign
