spine

Cervical spine

Symptoms: pain, stiffness, deformity , numbness, headache. Signs: look, feel, movement, neurological examination, tests for arterial compression. Imaging: x-ray, CT, MRI, Mylography

Vertebral anomalies

Klippel-feil syndrome. Odontoid anomalies. Basilar impression. Other anomalies


Deformities of the neck Torticollis-- Infantile ( congenital) Torticollis -Secondary Torticollis

Infantile ( congenital) Torticollis:

Acute intervertebral disc prolapse
Clinical features. Imaging Differential diagnosis Treatment: Rest, reduce , removal

Acute intervertebral disc prolapsed:

It is less common than lumbar spine. It cause pain in neck and stiffness, and neurological symptoms in upper limb or cord compression. C5-6 , C6-7 are the common site of prolapse. There may be a history of trauma or sudden movement. The disc protrude posteriorly or postero-laterally and irritate or compress the nerve roots or spinal cord. Acute intervertebral disc prolapsed clinical features is variable and depend on severity and site of prolapse. Neck pain and stiffness , root compression or even cord compression may found. Imaging study of cervical spine involve X-ray, MRI, and CT. Differential diagnosis: prolapse intervertebral disc of cervical spine to be differentiated from all causes of neck pain , and upper limb pain.


CERVICAL SPONDYLOSIS

CERVICAL SPONDYLOSIS:

It is Common especially over 50 years. It start as degeneration in intervertebral disc and posterior facet joints. Pain, stiffness and referred pain to upper limbs are the common symptoms. X-ray shows narrowing of disc space and osteophytes especially in C5-6 , C6-7. Treatment: most symptoms disappear in short duration, Analgesia, Rest in collar, physiotherapy may used sometimes. Rarely surgical treatment used when there is cord and roots compression ( cervical spinal stenosis and myelopathy).

Cervical spinal stenosis and mylopathy

Infection : pyogenic & tuberculosis

Rhumatoid arthritis

Rheumatoid arthritis of cervical spines :
Cervical spine commonly affected by RA. May cause destruction and subluxation of vertebra. May need support by suitable plastic collar. Some cases may need surgical treatment by intervertebral fusion.

Cervical rib

Congenital overdevelopment, bony or fibrous of the costal process of the 7th cervical vertebra. It is often cause no symptoms in young. In adult with gradual dropping of shoulder may lead to neurological and vascular disturbances in upper limbs. Compression of lower trunk of C8 - T1 and subclavian vessels between first rib and clavicle may occur. ( between first rib and attachments of scalenus anterior and scalenus medius.


Clinical features: patients usually older than 30 years presented with neurological symptoms and vascular symptoms. Diagnosis: x-ray shows the cervical rib and long transverse process, arteriography may be useful to assess vascular compression, electrical studies used to assess nerve compression. Treatment: Conservative treatment by exercises and postural training used in mild and moderate symptoms, and surgical treatment used for severe symptoms or persistent neurovascular compression.