3. The Spine - clinical conditions 2 Flashcards Preview

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Flashcards in 3. The Spine - clinical conditions 2 Deck (15)
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what is Jefferson's fracture

fracture of the anterior and posterior arches of atlas (C1)


what causes Jefferson's fracture

increased axial load from vertical fall on extended neck (eg diving into shallow water) - compresses lateral masses of atlas between occipital condyles and axis causing them to radially expand


which structures may be damaged in Jefferson's fracture

- arteries at base of skull (with secondary neurological sequelae, e.g. ataxia, Horner's syndrome)
- typically causes pain but no neurological symptoms due to wide vertebral foramen


what is Hangman's fracture

- fracture of pars interarticularis of axis (C2)
- unstable fracture: forward displacement of C1 and body of C2 on C3


what causes Hangman's fracture

hyperextension of head on neck


what are the clinical consequences of Hangman's fracture

variable severity: no neurological signs if spinal cord not affected, to spinal cord transection (deep unconsciousness, respiratory and cardiac failure)


what can cause fracture of odontoid process of C2

head trauma causing cervical hyperflexion or hyperextension


why does fracture of odontoid process have a long healing time

often unstable fracture at high risk of avascular necrosis due to isolation of distal fragment from blood supply


how is trauma to C1/2 visualised

often difficult to visualise on X-ray so:
- use 'open mouth' AP X-ray ('peg view')
- MRI cervical spine


what is whiplash

neck pain caused by low energy trauma involving hyperextension and hyperflexion


what is cervical spondylosis

- degenerative OA of intervertebral joints in cervical spine
- involves narrowing of space between adjacent vertebrae from age related degeneration of IV discs


describe the X-ray features of cervical spondylosis

1. formation of syndesmophytes (osteophytes) to try and increase surface area
2. thickening of ligamentum flavum
3. signal change in spinal cord


what is the consequence of lateral osteophyte dev. in cervical spondylosis

RADICULOPATHY - pressure on nerve roots:
- dermatomal sensory symptoms (pain, paraesthesia)
- myotomal motor weakness


what is the consequence of anterior osteophyte dev. in cervical spondylosis

MYELOPATHY (less common) - pressure on spinal cord:
- global weakness
- gait dysfunction
- loss of balance
- loss of bladder and bowel control


what are most common causes of thoracic cord compression

fractures (with bony fragments) and tumours