Lecture - Clinical Conditions

Question 1

Cervical spondylosis

Answer 1

Chronic degenerative osteoarthritis affecting the intervertebral joints in the cervical spine

Question 2

Primary pathology of cervical spondylosis

Answer 2

Age related disc degeneration
Followed by marginal osteophytosis
Facet joint osteoarthritis

Question 3

Osteophytosis

Answer 3

Osteophytosis formation adjacent to the end plates of the vertebral bodies

Question 4

Consequences of cervical spondylosis

Answer 4

Narrowing of the intervertebral foramina
Pressure on the spinal nerves
Radiculopathy- dermatome sensory symptoms (paraethesia, pain), myotomal motor weakness

Myelopathy - if narrowing of spinal canal - pressure on spinal cord (less common)

Question 5

Myelopathy

Answer 5

Global muscle weakness and numbness 
Gait + loss of dexterity 
Loss of balance 
Loss of 
Bowel and bladder controls 
Poor coordination 

Due to compression and dysfunction of the ascending and descending tracts within the spinal cord

Spinal canal less that 12-14mm diameter

Narrowing of the spinal canal
- degenerative stenosis (spondylosis)

Most commonly 50 - 80 yr olds

Ligamentum flavum hypertrophy or buckling 
Facet joint hypertrophy 
Disc protrusion - disc hernaitaion 
Osteophyte formation 
Congenital stenosis 
Spondylolisthesis 
Trauma 
Tumour 
Rheumatoid arthritis

Question 6

Jefferson’s fracture

Answer 6

Fracture of the anterior and posterior arches of the atlas

Due to axial loading

Pain but no neurological symptoms
Occasionally - damage to arteries at the base of the skull

Question 7

Damage to arteries at the base of the skull

Answer 7

Secondary neurological sequelae
Ataxia
Stroke
Horners syndrome

Question 8

Horners syndrome

Answer 8

Damage to the sympathetic trunk 
Miosis (decreased pupil size)
Partial ptosis (drooping eyelid) 
Anhidrosis (decreased sweating on affected side of face)
Enophthalmos - sunken eyeball

Question 9

Hangman’s fracture

Answer 9

Axis fracture
Through pars interarticularis - region between the superior and inferior articular processes

Due to :

Forced hyperextension of head

Question 10

Odontoid process fracture (peg fracture)

Answer 10

Caused by
flexion or extension injuries
Blow to back of head - hyperflexion
Hit curb - hyperextension

Detected by open mouth AP X-ray or a CT of cervical spine

Question 11

Whiplash

Answer 11

Forceful hyperextension-hyperflexion injury of the cervical spine

Consequences:
Tearing of muscles and ligaments 
Secondary oedema 
Haemorrhage and inflammation 
Spasm - causes pain and stiffness

Question 12

Cervical intervertebral disc prolapse

Answer 12

Associated compression of nerve roots or spinal cord

Commonly develop in 30-50 yr olds

Tear in annulus pulposus protrudes from disc

Impingement onto an adjacent Exiting nerve root/spinal cord

Sometimes sequestration - extruded segment separates from the main body of disc and enters spinal canal - reabsorbed over weeks

Question 13

Dysdiadochokinesia

Answer 13

Impaired ability to perform rapid alternating movements