Disorders of the cervical and thoracic spine

Question 1

Fracture of the C1 atlas is called

Answer 1

a Jefferson fracture

• fracture of anterior and posterior arch

Question 2

jefferson fracturew

Answer 2

A ‘Jefferson’s fracture’ is a fracture of the atlas (C1 vertebra)

Question 3

cause of Jefferson fracture

Answer 3

caused by axial loading e.g. diving into a shallow pool.

It presents with upper neck pain but no neurological symptoms. Diagnosis is confirmed with an X-ray or sometimes a CT scan. Treatment can range from a neck brace to neck immobilisation (a form of skeletal traction) to surgical intervention (especially if the transverse ligament is damaged).

Question 4

presentation of jefferson fracute

Answer 4

It presents with upper neck pain but no neurological symptoms.

Question 5

diagnosis of jefferson fracture

Answer 5

Diagnosis is confirmed with an X-ray or sometimes a CT scan.

Question 6

treatment of jefferson fracture

Answer 6

Treatment can range from a neck brace to neck immobilisation (a form of skeletal traction) to surgical intervention (especially if the transverse ligament is damaged).

Question 7

fracture of C2 axis

Answer 7

hangmans fracture

Question 8

hangmans fracture

Answer 8

• Fracture through the pars interarticularis
• Unstable fracture
• Forward displace of C1 and C2 on C3

Question 9

clear X-ray of hangmans fracture

Question 10

cause of hangmans fracture (C2)

Answer 10

usually caused by forcible hyperextension of the neck, classically caused through hanging, giving it its unusual lay name.

Question 11

Why does is a hangmans fracture very unlikely to damage the spinal cord

Answer 11

because the fracture itself expands the spinal canal, so it typically presents with neck pain alone.

Question 12

diagnosis of hangmans fracture

Answer 12

Diagnosis is confirmed with an X-ray or sometimes a CT scan.

Question 13

treatment of hangmans fracture

Answer 13

Treatment can range from a neck brace to neck immobilisation (a form of skeletal traction) to surgical intervention

Question 14

another fracture caused by hyperextension

Answer 14

Odontoid peg fracture

Question 15

Odontoid peg fracture

Answer 15

C2

Question 16

diagnsosis of odontoid peg fracture

Answer 16

• Open mouth AP X-ray = peg view
• CT scan- difficult to visualise

Question 17

cervical spondylosis

Answer 17

osteoarthitics of the cervical vertebra

Question 18

presentation of cervical spondylolysis

Answer 18

• Triad:
  
  • Loss of disc height
  • Osteophytes
  • Facet joint OA

Question 19

cervical spondylolysis can lead to

Answer 19

radiculopathy and myelopathy

Question 20

Cervical radiculopathy

Answer 20

Compression of the nerve roots

• Osteophytes in the foramen due to cervical spondylolysis

Question 21

symptoms of radiculopathy

Answer 21

• Sensory- dermatomal- paraesthesia/ numbness, pain
• Motor- myotome- weakness

Question 22

difference between cervical myelopathy and cervical radiculopathy

Answer 22

cervical radiculopathy= compression of spinal roots

cervical myelopathy= compression of cord

Question 23

where are the osteophytes found in cervical myelopathy

Answer 23

• Osteophytes in the vertebral canal

Question 24

who does cervical myelopathy affect

Question 25

anatomy change in cevrical myelopathy

Answer 25

* Thickening of ligamentum flavum * Osteophyte * Can lead to spinal cord signal change

Question 26

symptoms of cervical myelopathy

Answer 26

* Progressive disorder * Clumsiness * Loss of motor movement * Loss of balance

Question 27

cervical prolapsed intervertbral disc

Answer 27

Question 28

**Cervical prolapsed intervertebral disc is a cause of**

Answer 28

* Cause of radiculopathy (compression of spin al roots ) * In 30 to 50 year olds

Question 29

how is cervical prolapsed intervertebral disc different to lumbar herniation

Answer 29

* Just wake up with stiff neck * Unlike prolapsed discs in the lumbar spine where pts report carrying something heavy before etc

Question 30

mechanism of action of a prolapsed intervertebral disc

Answer 30

* Tear of the annulus fibrosis * Nucleus pulposus migrates through into the spinal canal

Question 31

Thoracic Cord Compression cause

Answer 31

Thoracic cord compression is commonly caused by vertebral fractures and tumours.

Question 32

thorarci cord compression symptoms

Answer 32

It presents with pain in the thoracic spine, spastic paralysis of the lower limb muscles, paraesthesia of dermatomes distal to the site of compression and loss of sphincter control. If the compression is around T5, there may also be reduced chest expansion on inspiration.

Question 33

diagnosis of thoracic cord compression

Answer 33

Diagnostic tests may involve spinal X-ray, CT or MRI scans.

Question 34

treatment of throacic cord compression

Answer 34

Treatment can include NSAIDS, steroidal injection, physical therapy and/or surgery to relieve pressure on the spinal cord.

Question 35

why is throacic cord compression likely to give neurology

Answer 35

as the vertebral foramen is smallest (however joints are also the most stable)

Question 36

**Metastasis (tumours)**

Answer 36

* Incidence of cancer in lifetime is 1 in 2 * 50-60% of patients with cancer will have skeletal metastases at dearth * Spine is second commonest site for skeletal metastases

Question 37

spondylodiscitis

Answer 37

Infection of the spin * Bacteria enters spin via vertebral nutrient artery * Lodges at end plate * Extends towards disc

Question 38

if **Spondylodiscitis** is untreated

Answer 38

* Untreated develops an epidural abscess and vertebral osteomyelitis

Question 39

**1) What will a patient complain of with a left- sided C5/6 prolapsed disc?**

Answer 39

**Location of pain:** neck down anterior arm, lateral forearm into thumb and index finger **Motor weakness:** elbow flexion, wrist extension, supination **Sensory:** Numbness/ pins and needles in lateral forearm, thumb and index finger

Question 40

**2)** **What nerve is affected with a cervical disc prolapse at C7/T1?**

Answer 40

**-** 8

Question 41

**3) What will a patient complain of with a left- sided C7/T1 prolapsed disc?**

Answer 41

**Location of pain:** Neck and anterior arm and forearm pain into little ring fingers **Motor weakness:** long finger flexors and extensors **Sensory:** Numbness/ pins and needles’ in little and ring fingers, ulnar, border of hand

Question 42

**4)** **What will a patient with a C4 Myelopathy complain of ?**

Answer 42

**Location of pain:** neck pain **Motor weakness:** shoulder abduction (C5and other myotomes distally, including trunk and lower limbs **Sensory:** Numbness/ pins and needles’ from the shoulder distally, trunk and lower limbs e.g. numbness of feet

Question 43

**5) What will a patient present with if they have thoracic cord compression at T10?**

Answer 43

**Location of pain:** Lower thoracic pain **Motor weakness:** weakness of all muscles in the legs **Sensory:** Loss of sphincter control. Numbness/ pins and needles from just below umbilicus inferiorly

Question 44

**6) What will a patient present with if they have thoracic cord compression at T5?**

Answer 44

**Location of pain:** High thoracic pain **Motor weakness:** weakness of all muscles in the legs and intercostals **Sensory:** Loss of sphincter control. Numbness/ pins and needles from just below nipples inferiorly

Question 45

whiplash

Answer 45

Whiplash is a **forceful hyper-extension, hyper-flexio**n injury of the cervical spine with associated ligament damage.

Question 46

cause of whiplash

Answer 46

It is commonly caused by a rapid deceleration for example in a car crash.

Question 47

presentation of whiplash

Answer 47

It presents with neck pain and can cause spinal cord injury, shoulder pain and lower back pain additionally.

Question 48

prognosis of whiplash