Orthopedics
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| What ligaments hold atlas to axis & keep it stable? | Alar ligaments
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| If one of the two vert columns is intact, then: | the injury is stable
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| If both columns are disrupted, then: | the injury is unstable
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| Radiology: Trauma: | order lateral, AP, & odontoid view; all 7 vertebrae must be seen
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| Tx Jefferson fx: unstable | Cranial traction; halo x 3 months; > 5mm C1-C2 subluxation = C1-C3 fusion
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| Odontoid fx types | type I (rare): avulsion fx of alar ligament; type II & III
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| Burst Jefferson fx stability: determined by: | transverse ligament
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| Burst Jefferson fx stability: neuro effects | Usually neuro intact (fragments burst away; wide breadth of C1 canal)
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| Burst Jefferson fx: 1/3 of fx assoc with: | an axis fx
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| Burst Jefferson fx: 50% chance that: | some other C spine injury is present
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| Odontoid fx MOA | Hyper-flexion or hyper-extension
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| Hangmans Fx = | Traumatic Spondylolisthesis of C2 (bilateral C2 pedicle fx)
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| Hangmans Fx MOA | hyperextension & sudden violent distraction; hyperextension & axial loading; or flexion & compression (usu combination of forces)
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| Hangmans Fx: Types | 4 types (I, II, IIA, III = worst)
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| Hangmans Fx: Immobilization: | rigid cervical orthosis or halo vest system
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| Hangmans Fx: Traction: | used generally for reductions (Gardner-Wells tongs or halo vest system)
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| Acute Cervical Sprain = | Injury to restraining ligaments of cervical spine
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| Acute C- Sprain grade I (mild): | ligaments damaged but not lengthened
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| Acute C- Sprain grade II (mod): | some laxity but not total disrupt
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| Acute C- Sprain grade III (severe): | ligament completely disrupt
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| Acute C- Sprain: if instability present, may need: | 6-12 wks immobilization in rigid orthosis and/or surgery
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| Cervical Stenosis = | narrowing of sagittal diameter of cervical canal
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| C-stenosis: segments most commonly involved | C5 and C6 segments
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| Cervical Stenosis Types | Congenital; Developmental; Acquired
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| C-stenosis: Congenital = | short pedicles, funnel shape of cervical canal
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| C-stenosis: Developmental = | bone size due to stress in weight training
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| C-stenosis: Acquired = | spondylosis, spurs, disc bulge or space narrowing
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| Cervical Spondylosis = | Chronic disc degeneration (arthritis)
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| Cervical Spondylosis: Represents: | nerve root compression
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| Cervical Spondylosis S/S: | neck pain, radicular pain radiating from neck to upper extremity
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| Cervical Spondylosis Rx: | supportive, facet injections, operative decompression
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| Brachial Plexus = | C5, C6, C7, C8, T1
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| Odontoid fx: tx | Reduce fx & hold in halo immobilization (3 months); C1-C2 fusion if severely displaced or non-union; Few advocate acute ORIF dens
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| Hangmans Fx: Stability: | unstable; neuro deficit is surprisingly rare unless C2 - C3 subluxation is severe
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| Hangmans Fx: Tx | will usually stabilize with halo fixation; anterior fusion may be needed due to delayed instability
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| Hangmans Fx: Operative Tx: | occipitocervical fusion; atl-axial fusion; transarticular screw fixation; ant. screw fixation of dens; internal fixation w/ posterior plating of occiput to C2
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| Evaluation of cervical instability (White & Punjabi ) | Vert malalignment; >3.5mm translational displacement; 1.7 mm or greater disk widening
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| C Spine injuries: Tx | Philadelphia collar immobilization (stable); Halo immobilization (stable); Occipito-cervical fusion (unstable)
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| Most common Spinous Process fx found in: | C-spine (Clay Shovelers fx)
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| Axial blow to the head with force transmitted through the occipital condyles; Forces the lateral masses of C1 outward | Jefferson fracture
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| bilateral C2 pedicle fractures (usually due to combo of forces; eg, hyperextension and sudden violent distraction) | Hangman's fracture
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| Back Pain: lifetime prevalence: | 60-80%
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| Disc degeneration MOA: | degeneration overloads facet joints in verts
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| Disc herniation MOA: | herniation impinges nerve roots
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| Pain: Red Flags | > 50 y.o.; kids; Night Pain; Fever, malaise, wt loss; Bladder/ bowel dysfunction; Progressive deficit; Prior ca; Pain > 1 month
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| Bragards test: | Foot dorsiflexion increases back pain
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| FABER test: | Pain in SI joint
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| 70% of LBP is due to: | Lumbar Strain
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| HNP: most common sites | L4-5, L5-S1
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| HNP: MOI: | Flexion & rotation; Tears in annulus
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| Cauda Equina Syn: affects: | L2-L4 nerve roots
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| Cauda Equina Syn: Mechanism: | Compression of nerve roots causes paralysis without spasticity (LMN)
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| Cauda Equina Syn: Etiology: | Central disc herniation, abscess, hematoma
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| Cauda Equina Syn: Sx: | Loss of bladder/ bowel control, bilateral LE weakness & sensory deficits
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| Cauda Equina Syn: Rx: | Emergent Surgical Decompression
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| Spondylolysis = | Pars interarticularis stress fx
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| Spondylolysis: occur most often at: | L5
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| Spondylolysis: x-ray | Scotty dog collar only on oblique xray
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| Spondylolisthesis = | Vertebral sliding (dancers, gymnasts)
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| Spondylolisthesis: PE: | Step-off, may be asymptomatic
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| Spondylolisthesis: Grading | Grade I – V (25 to >100%); Isthmic, degenerative
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| Spondylolisthesis: x-ray | Lateral film shows slip
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| Piriformis Syndrome = | Irritation of sciatic n. (L4,5, S1,2,3) beneath piriformis mx
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| Scoliosis: Xray Cobb angle: | Measure angle from tilted vertebrae above & below apex of curve
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| 50% of pts with solid tumors have: | mets to spine
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| Tumor: Highest prevalence: | BrCa, lung, prostate, colon, thyroid, kidney ca (hematogenous spread)
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| Tumor: Sx: | Night pain, n. root compression
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| 10% of spinal bone tumors are: | primary
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| Spinal bone tumors: in children, 20% are: | malignant
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| Spinal bone tumors: Primary malignant: | Osteosarcoma, Ewing Sarcoma, Chondrosarcoma
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| Facet Syndrome = | n. root compression by loss of disc height & facet hypertrophy
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| Ankylosing Spondylitis: Sx: | Chronic low back pain in young adults; morning stiffness, improves with movement; 20% peripheral joint sx (Enthesopathies common; 25% with anterior uveitis)
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| Ankylosing Spondylitis: PE: | Schobers test (normal is 5 - 7 cm movement)
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| Ankylosing Spondylitis: X-ray: | Erosion & sclerosis on plain films
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| Ankylosing Spondylitis: Rx: | PT, NSAIDs, Sulfasalazine, Infliximab
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| Schobers Test: Less than 5 cm difference suggests: | pathology
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| Ankylosing Spondylitis = | Calcification btw vertebral bodies at edge of discs; gives appearance of bamboo stalk; sclerosis of SI joint
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| Spine Films/ Frontal: Vert body: Crack in owls eye: in = | Chance fx (seat belt fx)
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| LBP: most common site of disk herniation | L5-S1 (also L4-L5)
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