Dodge, MD
Clinical Evaluation
Proper Immobilization
trauma
3 to 25% of spinal cord injuries occur after
injuries.
Absence of pain
Normal mental status complete radiographic evaluation
cervicothoracic junction
Plain x-ray will miss 15 to 17% of injuries
oversensitive
iatrogenic injury
Combination of CAT and plain x-ray
probably standard.
Types of Orthrosis
Halo- the best, especially at upper cervical
Soft collars little immobilization Semi rigid- ( Miami J, Philadelphia, Aspen)
Occipitocervical Dissocation
Atlas Fractures
Axial load
Stability requires healing of transverse
ligament MRI
Halo- reasonable treatment C1-C2 fusion if transverse ligament disrupted
Axis Fractures
Odontoid fractures are most common
Type I Avulsion
Type Odontoid
Type Odontoid
Controversial treatment
C2 fusion
Fusion needed if reduction not achieved or
maintained
Type Odontoid
High healing rate with halo vest
rebound flexion
Most treated in halo
retropulsion
Spinal cord injury rate is high Most require surgery anterior or anterior
and posterior
Facet Dislocations
Timely reduction required
Subluxation of 25% suggests unilateral, 50%
suggests bilateral
MRI needed to assess for HNP Failure of closed reduction mandates open
reduction
Pathophysiology
Disk loses water and proteoglycan content
lordosis
Osteocartilaginous overgrowth occurs in
Cervical Roots exhibit a higher degree of overlap than seen in the thoracolumbar spine, therefore symptom patterns may fail to localize.
Hyporeflexia
Biceps
Brachioradialis C- 6
Triceps C- 7
more susceptible
Myelopathy
Most commonly presents as clumsiness, ataxia, loss of fine motor skills.
Cervical Spondylosis
May cause radicular pain from nerve root
origin
May cause referred sclerotomal pain
Treatment
75% of radiculopathy improve with P.T. ,
Imaging Studies
Plain x-ray alignment, spondylosis
Flexion extension for instability MRI CAT defines bone anatomy Diskography
Electrodiagnostic Studies
Paresthesias cannot be localized
picture
Nonsurgical Care
P.T. emphasize isometric exercise
Surgical Indications
Success for axial pain is 60 %
ACDF
Allograft versus autograft
Plate fixation
Accelerates degeneration at adjacent levels
Posterior Decompression
Foraminotomy for bony foraminal stenosis
adding fusion
Thank you
We will now move into the exam part of the lecture.