T&O spine conditions 2

Question 1

what is cervical spondylosis

Answer 1

triad: loss of disc height, osteophytes and facet joint OA
osteophytes in the foramen irritates the nerve roots which can cause compression / radiculopathy. can also cause inflammation of the spinal cord

Question 2

presentation of cervical spondylosis

Answer 2

progressive neck pain and stiffness
Headaches in the back of your head
signs of radiculopathy-
sensory; paraesthesia, numbness and pain
motor: weakness, lack of coordination

Question 3

how will cervical prolapsed intervertebral disc present

Answer 3

waking up with a stiff neck with no recall of injury
progressive symptoms

Question 4

how do you manage cervical spondylosis

Answer 4

NSAIDs, physio, neck brace, heat packs
decompression or laminectomy

Question 5

what is a Jefferson’s fracture

Answer 5

C1#
occurs due to high energy axial loading causing outward spread of the lateral masses
unlikely to damage spinal cord due to this ‘ bursting action’, higher risk if transverse ligament is ruptured
Gehweiler classification

Question 6

what is the management for a Jefferson’s fracture

Answer 6

conservative: analgesia and immobilisation
if unstable may require surgical intervention
occipito-cervical or posterior C1-C2 fusion, resulting in a significant loss of range of cervical neck movement

Question 7

what is cervical myelopathy

Answer 7

compression of the cervical spinal cord
thickening of the ligamentum flavus, osteophytes and spinal cord changes
can be due to degeneration or spondylosis
progressive disorder

Question 8

presentation of cervical myelopathy

Answer 8

clumsiness
loss of fine movement and balance
neck pain
sensory/motor loss

Question 9

management of cervical myelopathy

Answer 9

early stages/ mild disease: analgesia/ NSAIDs, steroid injections.
neck brace / cervical collar
if conservative management is ineffective then surgery for decompression is likely needed

Question 10

what is a hangmans fracture

Answer 10

fracture through par interarticularis or between the lamina and pedicle
due to hyperextension of the neck
if unstable theres forwards displacement of C1 and 2 which transects the spinal cord

Question 11

presentation of hangmans fracture

Answer 11

if unstable or a higher grade will often be fatal
if stable can present with non-specific complaints of suboccipital pain.
Sometimes there is a clear spasm of the neck muscles.
Patients may manifest neurological deficits

Question 12

management of hangman’s fractures

Answer 12

if stable: conservative, analgesia, brace, and rest.
surgery if unstable or risk of becoming unstable in the future - surgical fixation/ fusion

Question 13

how do odontoid peg fractures occur

Answer 13

hyperextension injury
especially in older people if they have fell and are unable to break the fall with their hands so there is direct impact with the floor

Question 14

presentation of odontoid peg fracture

Answer 14

neck pain worse with motion
dysphagia
neurological deficits are very rare due to the larger size of the spinal canal at the C-spine

Question 15

management of odontoid peg fracture

Answer 15

XR - AP mouth open to get odontoid view
immobilisation, analgesia, physio
surgery: C1-C2 fusion, anterior odontoid screw, odontoidectomy