Adult Spine Trauma
Anatomy & Science
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Neck & Upper Extremity Spine Exam
Lower Extremity Spine & Neuro Exam
Spinal Cord Anatomy
Cervical Spine Anatomy
Thoracic Spine Anatomy
Lumbar Spine Anatomy
Spinal Cord Injuries
Incomplete Spinal Cord Injuries
Syrinx & Syringomyelia
Spinal Cord Tumors
Cauda Equina Syndrome
Cervical Spine Trauma Evaluation
Occipital Condyle FX
Occipitocervical Instability & Dislocation
Atlas Fracture & Transverse Ligament Injuries
Odontoid Fracture (Adult and Pediatric)
Traumatic Spondylolisthesis of Axis (Hangman's Fracture)
Cervical Facet Dislocations & FX
Cervical Lateral Mass Fracture Separation
Subaxial Cervical Vertebral Body FX
Closed Cervical Traction
Halo Orthosis Immobilization
Osteoporotic Vertebral Compression Fracture
Thoracolumbar Burst FX
Chance Fracture (flexion-distraction injury)
Adult Pyogenic Vertebral Osteomyelitis
Spinal Epidural Abscess
Ossification Posterior Longitudinal Ligament
Low Back Pain - Introduction
Discogenic Back Pain
Thoracic Disc Herniation
Lumbar Disc Herniation
Synovial Facet Cyst
Lumbar Spinal Stenosis
Adult Isthmic Spondylolisthesis
Adult Spinal Deformity
Rheumatoid Cervical Spondylitis
DISH (Diffuse Idiopathic Skeletal Hyperostosis)
Pediatric Cervical Spine
Pediatric Cervical Trauma Overview
Pseudosubluxation of the Cervical Spine
Pediatric Spinal Cord Injury
Atlantoaxial Rotatory Displacement (AARD)
Congenital Muscular Torticollis
Adolescent Idiopathic Scoliosis
King Classification of AIS
Lenke Classification of AIS
Juvenile Idiopathic Scoliosis
Infantile Idiopathic Scoliosis
Cerebral Palsy - Spinal Disorders
Pediatric Spondylolisthesis & Spondylolysis
Disk Space Infection - Pediatric
Topic updated on
Cervical spondylosis represents the natural degenerative process of the cervical motion segement (intervertebral disc and facets)
often leads to the clinical conditions of
discogenic neck pain
typically begins at age 40-50
most common levels are
> C6-7 because they are associated with the most flexion and extension in the subaxial spine
more common in men than women
risk factors include
Spondylosis is a natural aging process of the spine
characterized by degeneration of the disc and the four joints of the cervical motion segment which include
two facet joints
two uncovertebral joints of Luschka)
Degenerative cycle includes
disc dessication, loss of disc height, disc bulging, and possible disc hernaition
uncinate spurring and facet arthrosis
ligamentum flavum thickening and infolding secodary to loss of disc height
kyphosis secondary to loss of disc height with resulting transfer of load to the facet and uncovertebral joints, leading to further uncinate spurring and facet arthrosis
Mechanism of Neurologic Compression
Nerve root compression
leads to the clinical condition of radiculopathy
foraminal spondylotic changes
secondary to chondrosseous spurs of facet and uncovertebral joints
posterolateral disc herniation or disc-osteophyte complex
between posterior edge of uncinate and lateral edge of posterior longitudinal ligament (PLL)
affects the exiting nerve root (C6/7 disease will affect the C7 nerve root)
foraminal soft disc herniation
affects the exiting nerve root (C6/7 disease will affect the C7 nerve root)s
Central cord compression (central stenosis)
leads to the clinical condition of myelopathy
occurs with canal diameter is
(normal is 17mm)
worse during neck extension whe central cord is pinched between
common radiographic findings include
degenerative changes of uncovertebral and facet joints
disc space narrowing
decreased sagital diameter (cord compression occurs with canal diameter is < 13mm)
changes often do not correlate with symptoms
70% of patients by 70 yrs of age will have degenerative changes seen on plain xrays
important to look for sagital alignment and size of spinal canal
important to look for foraminal stenosis which often caused by uncovertebral joint arthrosis
flexion and extension views
important to look for angular or translational instability
look for compensatory subluxation above or below the spondylotic/stiff segment
axial imaging is the modality of choice and gives needed information on the status of the soft tissues. It may show
spinal cord changes (myelomalacia)
has high rate of false positive (28% greater than 40 will have findings of HNP or foraminal stenosis)
can give useful information on bony anatomy
most useful when combined with intrathecal injection of contrast (myelography) to see status of neural elements
contrast given via C1-C2 puncture and allowed to diffuse caudally or given via a lumbar puncture and allowed to diffuse proximally by putting patient in trendelenburg position.
paricularly useful in patients that can not have an MRI (pacemaker) or has artifact (local hardware)
controversial and rarely indicated in cervical spondylosis
approach is similar to that used with ACDF
risks include esophageal puncture and disc infection
Nerve conduction studies
high false negative rate
may be useful to distinguish peripheral from central process (ALS)
Presentation and Treatment
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Qbank (1 Questions)
Prospective studies have shown professional athletes in which of the following sports have the highest incidence of degenerative changes in the cervical and lumbar spine?
Horse racers (Jockeys)
Select Answer to see Preferred Response
PREFERRED RESPONSE ▶
Professional horse racers (Jockeys) have the highest incidence of degenerative changes of both the cervical and lumbar spine when compared to age-matched, non-athletes.
There is significant risk of injury when working with horses. The most common acute injuries are extremity fractures from falls off of the horse. Chronic injuries are also well known with a high incidence of degenerative changes of the spine, most commonly in the cervical and lumbar spine.
Tsirikos et al. performed a prospective study analyzing the long-term effects of horse riding on the cervical and lumbar spine in jockeys. A 13-year clinical follow-up of the 32 jockeys revealed the following: 15 (47%) jockeys reported mild to severe limitations of physical activities as a consequence of progressive degenerative changes of the spine. Twenty-four (75%) jockeys had degenerative lesions on the cervical and/or lumbar spine radiographs compared to 6 (18%) in the control group.
Cowley et al. reviewed the workers compensation claims for injuries sustained by horse racing professionals. Of the 358 horse-related injuries sustained by jockeys, 270 (75%) were associated with falls from a horse. They showed that fractures were the most common injury, with the leg and shoulder being the most common sites. There was no comment about long-term chronic injuries.
Illustration A shows a schematic representation of the spinal degenerative process. From left to right there is progressive loss of disc height and osteophyte formation.
Answers 2,3,4,5: None of the sports listed have been shown to have higher rates of degenerative spine problems than jockeys. The sports most commonly cited as having the greatest strain on the spine include: horse-racing, wrestling, rugby, ski-jumping, and gymnastics.
Degenerative spondyloarthropathy of the cervical and lumbar spine in jockeys.
Tsirikos A, Papagelopoulos PJ, Giannakopoulos PN, Boscainos PJ, Zoubos AB, Kasseta M, Nikiforidis PA, Korres DS.
Orthopedics. 2001 Jun;24(6):561-4.
PMID: 11430735 (Link to Pubmed)
Injuries in the Victorian thoroughbred racing industry.
Cowley S, Bowman B, Lawrance M.
Br J Sports Med. 2007 Oct;41(10):639-43; discussion 643. Epub 2007 May 14.
PMID: 17502333 (Link to Pubmed)
Evan Watts MD
Michael Hughes MD
Jan Szatkowski MD
Jeremy Stern MD
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