1
Fifth stage
Surgery-Ortho
Lec-8
.د
مثنى
1/1/2014
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:
The head is tilted and rotated by contracture of the sternomastoid muscle of one side, (
ischemia of muscle as birth injury lead to fibrosis of muscle presented early in infancy
as a sternomastoid tumor ), presented at late infancy as head tilted and the
sternomastoid muscle felt like cord. The ear of affected side be near to shoulder and
lately the face be asymmetric. In early stage treatment is physiotherapy , if persist
surgical release indicated followed by physiotherapy.
Secondary torticollis: torticollis may follow ocular disorders or inflammatory lesions in
neck or even psychogenic (hysterical).
2
Acute intervertebral disc prolapse
Clinical features.
Imaging
Differential diagnosis
Treatment:
Rest, reduce , removal
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:
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
3
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.