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(LUSUMA) Musculoskeletal System > S6) Cervical and Thoracic Spine > Flashcards

S6) Cervical and Thoracic Spine Flashcards

1
Q

Compare and contrast the cervical and thoracic spine in terms of vertebrae number and mobility

A
  • Cervical spine: 7 vertebrae, mobile
  • Thoracic spine: 12 vertebrae, immobile
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2
Q

Identify 4 characteristics of the cervical vertebrae

A
  • Bifid spinous process (except C7)
  • Transverse foramina
  • Large triangular vertebral foramen
  • Small & broad body
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3
Q

State 2 functions of the foramen transversium in the cervical vertebrae

A
  • Conduit for vertebral artery (except C7)
  • C7 foramen transmits the accessory vertebral vein
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4
Q

Describe the structure of the C1 vertebra (atlas)

A
  • No vertebral body (body is fused with axis to form dens)
  • Widest cervical vertebra
  • Thick vertebral arches
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5
Q

State the superior and inferior articulations of the C1 vertebrae

A
  • Superior: occiput of skull superiorly (atlanto-occipital joint)
  • Inferior: C2 vertebra (atlanto-axial joint)
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6
Q

Describe the structure of the C2 vertebra (axis)

A
  • Odontoid process (/dens)
  • Rugged lateral mass
  • Large spinous process
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7
Q

What is the purpose of the dens and transverse ligament of the axis?

A

Dens and transverse ligament prevent horizontal displacement of atlas as well as the independent movement of C1 on to C2

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8
Q

Describe the structure of the C7 vertebra (vertebra prominens)

A
  • Longest spinous process
  • Non-bifid spinous process
  • Large transverse process is large
  • Small foramen transversarium (accessory vertebral veins)
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9
Q

What is the ligamentum nuchae?

A

The ligament nuchae is a thickening of the supraspinous ligament

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10
Q

What is the ligamentum nuchae attached to?

A
  • External occipital protruberance
  • Spinous processes of all cervical vertebrae
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11
Q

State three functions of the ligamentum nuchae

A
  • Maintains secondary curvature of cervical spine
  • Helps the cervical spine support the head
  • Major site of attachment of neck and trunk muscles e.g. trapezius, rhomboids
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12
Q

Describe the movements of the cervical spine

A
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13
Q

Identify 3 characteristics of the thoracic vertebrae

A
  • Demi-facets on vertebral body (whole facets T9-10)
  • Costal facets on transverse processes (except T11-12)
  • Small circular vertebral foramen
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14
Q

Describe the articulations of the thoracic spine

A
  • Demi facets articulate with respective & inferior head of the rib
  • Costal facets articulate with respective tubercle of rib
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15
Q

Describe the different functions of the anterior and posterior spinal cord

A
  • Anterior cord – pain, temperature, light touch, pressure (sensory & motor)
  • Posterior cord – vibration and proprioception
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16
Q

What is anterior cord syndrome?

A

Anterior cord syndrome is a condition where the anterior spinal cord artery is interrupted due to ischaemia/infarction of the anterior two-thirds of the spinal cord

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17
Q

Describe the effects of anterior cord syndrome

A
  • Sensory problems (temperature, pain, light touch, etc)
  • Motor problems depending on the neural level (part of spine affected)
18
Q

What is central cord syndrome?

A

Central cord syndrome is a common cervical spinal cord injury resulting from neck trauma, leading to major injury to the central grey matter of the spinal cord

19
Q

Describe the effects of central cord syndrome

A
  • More central tracts move the arms and more lateral tracts move the legs
  • Loss of motion and sensation in the arms (inverted paraplegia)
20
Q

What is posterior cord syndrome?

A

Posterior cord syndrome is a rare condition caused by lesion of the posterior portion of the spinal cord or by an interruption to the posterior spinal artery

21
Q

Describe the effects of posterior cord syndrome

A
  • Loss of proprioception
  • Loss of co-ordination
22
Q

What is a neural level?

A

A neural level is the last functioning (sensory & motor) level of a neuron

23
Q

How do nerve roots exit the different regions of the spinal cord?

A
  • Initially, nerve roots in cervical spine exit above their vertebral body until the C7/T1 junction
  • After this junction, nerve roots exit below their vertebral body but above their respective intervertebral disc
24
Q

X-rays are good at observing the bony prominences of the cervical spine.

Identify the bony landmarks observed below:

A
25
Q

MRI’s are better at observing soft tissue of the cervical spine than the bony prominences.

Identify the soft tissue structures observed below:

A
26
Q

What is cervical spondylosis?

A

Cervical spondylosis is a degenerative osteoarthritis of intervertebral joints in cervical spine

27
Q

Describe the symptoms of cervical spondylosis

A
  • Pressure on nerve roots leads to radiculopathy:

I. Dermatomal sensory (paraesthesia, pain)

II. Myotomal motor weakness

  • Pressure on the cord leads to myelopathy:

I. Global weakness

II.Gait dysfunction & loss of balance

28
Q

What are Hangman’s fractures and how do they occur?

A
  • Hangman’s fractures are unstable fractures which occur due to hyperextension of head on neck
  • Axis fractures through the pars interarticularis leading to the forward displacement of C1 & C2 on C3 (spondylisthesis)
29
Q

What are Peg fractures and how do they occur?

A
  • Peg fractures (odontoid fracture) occur due to a fracture through the odontoid process often due to a blow to back of head e.g. falling against a wall when balance is compromised
  • ‘Open mouth’ X-ray = ‘peg view’
30
Q

What are Jefferson’s fractures and how do they occur?

A
  • Jefferson’s fractures are fractures of the anterior and posterior arches of the atlas often due to increased axial load e.g. diving into shallow water
  • Typically causes pain but no neurological signs but may damage arteries at base of skull with secondary neurological sequelae e.g. ataxia, Horner’s syndrome
31
Q

What is whiplash injury?

A

A whiplash injury is a neck injury caused by sudden hyperextension and hyperflexion of the neck (high mobility, low stability)

32
Q

What anatomy changes are associated with a cervical prolapsed intervertebral disc?

A
  • Tear of the annulus fibrosis
  • Migration of nucleus pulposus into the spinal canal
33
Q

Which nerve is affected in a left sided C5/6 prolapsed intervertebral disc?

What will the patient complain of?

A

C6 nerve:

  • Pain – biceps into thumb and index finger
  • Sensory deficit – paraesthesia in thumb and index finger
  • Motor weakness – biceps and wrist extension
34
Q

Which nerve is affected in a left sided C7/T1 prolapsed intervertebral disc?

What will the patient complain of?

A

C8 nerve:

  • Pain — medial two fingers
  • Sensory deficit — paraesthesia in medial two fingers
  • Motor weakness — finger flexion, finger extension
35
Q

What anatomical changes are associated with a cervical myelopathy?

A
  • Osteoarthritis of the cervical spine
  • Osteophytes
  • Thickening ligamentum flavum
36
Q

What will a patient complain of with a cervical myelopathy at C3/4?

A
  • Pain — neck pain
  • Sensory deficit — paraesthesia from shoulder down to feet
  • Motor weakness — shoulder abduction
37
Q

What will a patient complain of with a cervical myelopathy at C5/6?

A
  • Pain – neck pain
  • Sensory deficit – paraesthesia from shoulder down and feet
  • Motor weakness – elbow flexion, wrist and finger movements
38
Q

What is the clinical presentation of cervical myelopathy?

A
  • Clumsiness
  • Loss of fine motor movements
  • Abnormal gait
  • Loss of balance
39
Q

What might a patient complain of in thoracic cord compression (T10 – tumour)?

A
  • Pain – thoracic pain
  • Sensory deficit – paraesthesia from umbilicus down, loss of sphincter control
  • Motor weakness – weakness of all muscles in the legs
40
Q

What might a patient complain of in thoracic cord compression (T5 - tumour)?

A
  • Pain: high thoracic pain
  • Sensory deficit: paraesthesia below the nipples and loss of sphincter control
  • Motor weakness: weakness of all muscles in the legs and intercostals

(LUSUMA) Musculoskeletal System (24 decks)

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