Cervical and Thoracic Spine (Ch 8)

Osteoarthritis

A degeneration of one or many joints. In the spine, changes may include bony sclerosis, degeneration of cartilage, and formation of osteophytes or bony growths

Scheuermann's disease

A relatively common disease of unknown origin that generally begins during adolescence. Results in the abnormal spinal curvature of kyphosis and scoliosis. Is more common in boys than girls. Most cases are mild and continue for several years, after which symptoms disappear but some spinal curvature remains.

Scoliosis

An abnormal or exaggerated lateral curvature of the spine. Is most common in children between the ages 10-14 and is more common in girls. If severe enough, may complicate cardiac and respiratory functions. This deformity is more obvious if it occurs in the lower vertebral column, where it may create tilting of the pelvis with a resultant effect on the lower limbs, producing a limp, or uneven walk.

Osteoporosis

Condition is characterized by loss of bone mass. Bone loss increases with age, immobilization, long-term steroid therapy, and menopause. Predisposes individuals to vertebral and hip fractures.

Compression fracture

Frequently associated with osteoporosis, it involves collapse of a vertebral body, which results from flexion or axial loading, most often in thoracic or lumbar regions. It also can result from severe kyphosis caused by other diseases. The anterior edge collapses, changing the shape of the vertebral body into a wedge instead of a block. This increases kyphosis and may compromise respiratory and cardiac function; it also frequently results in injury to the spinal cord. These fractures are best demonstrated on a lateral projection of the affected region of the spine.

Herniated nucleus pulposus (HNP)

If the sole inner part of an intervertebral disk protrudes through the fibrous cartilage outer layer into the spinal canal, it may press on the spinal cord or spinal nerves, causing severe pain and possible numbness that radiate into the extremities. This condition is sometimes called slipped disk. Frequently involves L4 through L5

Spondylitis

Inflammation of the vertebrae.

Kyphosis

Is an abnormal or exaggerated convey curvature of the thoracic spine that results in stooped posture and reduced height. May be caused by compression fractures of the anterior edges of the vertebral bodies in osteoporotic patients, posture, rickets, or other diseases involving the spine. A lateral projection of the spine will best demonstrate the extent of this condition.

Teardrop burst fracture

The mechanism of injury is compression with hyperflexion in the cervical region. The vertebral body is comminuted, with triangular fragments avulsed from the anteroinferior border and fragments from the posterior vertebral body displaced into the spinal canal. Neurologic damage (usually quadriplegia) is a high probability. Based on the extent of the fracture and possible spinal cord involvement, CT scanning usually is indicated once a baseline lateral and AP projections of the cervical spine have been taken.

Odontoid fracture

The odontoid fracture involves the dens and can extend into the lateral masses or arches of C1. An AP open mouth projection will demonstrate any disruption of the arches of C1.

Jefferson fracture

This comminuted fracture (splintered or crushed at site of impact) occurs as a result of axial loading, such as that produced by landing on one's head or abruptly on one's feet. The anterior and posterior arches of C1 are fractured as the skull slams onto the ring. The AP open mouth projection and lateral cervical spine projections will demonstrate this fracture.

Hangman's fracture

This fracture extends through the pedicles of C2, with or with our subluxation of C2 on C3. This fracture occurs when the neck is subjected to extreme hyperextension. If alive, the patient is not stable because the intact dens is pressed posteriorly against the brainstem. A lateral projection of the cervical spine will demonstrate the anterior displacement of C2.

Clay shoveler's fracture

This fracture, which results from hyper-flexion of the neck, results in avulsion fractures on the spinous processes of C6 through T1. The fracture is best demonstrated on a lateral cervical spine radiograph.

Facets-unilateral subluxation and bilateral locks

Zygapophyseal joints in the cervical region can be disrupted during trauma. If the patient's injury involves flexion, distraction, and rotation, only one zygapophyseal going may be out of alignment, with a unilateral subluxation. Radiographically, the vertebral body will be rotated on its axis, creating a bowtie artifact on the lateral cervical spine image. If the patient's injury involves extreme flexion and distraction, both right and left zygapophyseal joints on the same level can be disrupted, creating a bilateral locked facets. Radiographically, the vertebral body will appear to have jumped over the vertebral body immediately inferior to it. AP and lateral cervical projections will demonstrate injury.