L14 C Spine Pathology 2

Question 1

jefferson fracture

Answer 1

burst fracture of C1 vertebrae

Question 2

MOI jefferson fracture

Answer 2

axial load
compression with flexion or extension
diving or fall

Question 3

diagnosing jefferson fracture

Answer 3

difficult due to lack of neuro deficit
CT scan

Question 4

associated injuries with jefferson fracture

Answer 4

vertebral artery injury
atlantoaxial, atlanto occipital instability

Question 5

hangman’s fracture

Answer 5

BL fracture of pars interarticularis at C2

Question 6

MOI of hangman’s fracture

Answer 6

distraction with hyperextension (forceful) centered on chin
diving, contact sports, falling
also C spine hyperflexion

Question 7

diagnose hangman’s fracture

Answer 7

xray and CT scans

Question 8

dens fracture type I

Answer 8

avulsion fracture
a piece breaks off the dens but ligaments are not completely disrupted

Question 9

dens fracture type II

Answer 9

fracture through the base of the dens

Question 10

MOI of dens fracture type II

Answer 10

excessive extension or hyperflexion

Question 11

dens fracture type III

Answer 11

fracture through body of C2 involving a portion of C1/2 facets

Question 12

which dens fracture types are unstable

Answer 12

Ii and III

Question 13

halo device is used for:

Answer 13

unstable cervical and upper thoracic fractures down to T3
greatest amount of motion restriction
best stability when extending down to iliac crest, often goes to umbilicus

Question 14

indications for a halo

Answer 14

dens fracture any type
C2 fractures
C1 fractures
transverse ligament rupture
AA instability
single column cervical fractures
post op tumor resection in unstable spine
SCI

Question 15

halo motion restriction

Answer 15

90-96% limited flexion/extension
92-96% SB
98-99% rotation

Question 16

complications of halo

Answer 16

neck pain/stiffness
pin loosening
pin site infection
scarring
pain at pins
pressure sores
redislocation
restricted ventilation
dysphagia
nerve injury
dural puncture
neuro deterioration

Question 17

what can you expect to see in a patient after a halo has been removed?

Answer 17

cervical pain and muscle weakness
need to assess neuro function as not all achieve stable spine

Question 18

contraindications to halo

Answer 18

psycho: claustrophobia
severe skin irritation or breakdown

Question 19

PT interventions after halo

Answer 19

mobility for unaffected joints
shoulder ROM and strengthening
C spine mobility when allowed
core strength
balance training

Question 20

philadelphia collar (HCO) indications

Answer 20

immobilization after surgery
cervical sprain/strain
post traumatic immobilization, especially uncx patients
serious stretching ligament injury
anterior cervical fusion
after halo removal
dens type I fracture
anterior discectomy
teardrop fracture

Question 21

PT interventions after HCO

Answer 21

posture correction
ROM once allowed
scap and neck strengthening
cervical and thoracic stretching

Question 22

how much does HCO/philadelphia limit motion?

Answer 22

flex/ext: 65-70% of normal
SB: 30-35% of normal
Rotation: 50% of normal

Question 23

cervical thoracic orthoses indications

Answer 23

minimally unstable fractures
better motion restriction to lower cervical spine
limits CT junction

Question 24

cervical soft collar indications

Answer 24

mild cervical sprain/strain
post traumatic cervical pain
recovery from non surgical interventions
can lead to atrophy if worn long term

Question 25

cervical soft collar ROM limitations

Answer 25

flex/ext: 50% of normal SB: 60% of normal rotation: 50-60% of normal

Question 26

drawbacks to cervical collars

Answer 26

only limited force can be applied through them due to soft tissue structures around the neck high cervical mobility means these are not effective at limiting motion no control over head or thorax

Question 27

soft collar

Answer 27

light weight velcro strap comfortable but needs to be cleaned often

Question 28

indications for soft cervical collar

Answer 28

warmth psych comfort head support with acute neck pain relief from minor muscle spasm or cervical strain

Question 29

motion limitations of soft cervical collar

Answer 29

flex/ext: 5-15% SB: 5-10% rotation: 10-17%

Question 30

hard cervical collar

Answer 30

plastic ring collar with padding and adjustable height more durable

Question 31

indications for hard cervical collar

Answer 31

support for acute neck pain relief with minor spasm from spondylosis psych comfort stability and protection during halo application

Question 32

motion restrictions from hard cervical collar

Answer 32

flex/ext: 20-25% less effective in limited rotation and SB

Question 33

anterior cervical discectomy and fusion indications

Answer 33

disc herniation causing radiculopathy or myelopathy

Question 34

anterior cervical discectomy and fusion activity limitations

Answer 34

risk of segment degeneration 4-6 weeks: avoid sitting> 30-45 min no lifting>20# avoid end range motion no OH activity gentle c/s motion until 12 weeks can increase weight by 5# every other week return to baseline at 6 months

Question 35

PT interventions for anterior cervical discectomy and fusion

Answer 35

posture correction scap strength ROM in c/s t/s strengthening DNF, extensors functional training

Question 36

cervicak disc arthroplasty indications

Answer 36

DDD symptomatic radiculopathy/myelopathy in single level

Question 37

cervical disc arthroplasty contraindications

Answer 37

multilevel cervical disease poor bone quality significant facet joint arthritis

Question 38

PT Interventions for cervical disc arthroplasty

Answer 38

focus on dynamic motion and strengthening functional cervical mobility proprioception and joint position

Question 39

indications for posterior cervical laminoformainotomy

Answer 39

foraminal stenosis or radiculopathy w nerve root compression

Question 40

PT interventions for posterior cervical laminoforaminotomy

Answer 40

neck stretch nerve glide strengthen cervical and upper back muscles posture training avoidance of activities worsening symptoms

Question 41

posterior cervical fusion indications

Answer 41

degenerative cervical spine w instability

Question 42

PT interventions for posterior cervical fusion

Answer 42

stretch and mobilize c/s and t/s scap strengthening core strengthening functional activity