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Upper Cervical Injury – Rupture of Transverse Ligament

January 31, 2010 By Leave a Comment

This is a pure ligamentous injury of upper cervical spine and behaves differently from other injuries of C1-C2 region.

Most common cause of this injury is blow on the back of the head following a fall.

How Does Transverse ligament Rupture?

The ligament may either be avulsed with a bony fragment from the lateral mass on either side or it may rupture in its substance.

Diagnosis

The presentation would be like other injuries of upper cervical spine. The xrays may reveal anterior subluxation of ring of C1 on lateral views in flexion.

The instability can be reduced on extension.

These flexion and extension views should be made under supervision of a physician.

Presence of retropharyngeal hematoma suggests an acute injury.

A small fleck of the bone may suggest avulsion of the ligament.

Anterior widening of atlanto-dens interval of more than 5 mm in lateral view in flexion suggests that transverse ligament is incompetent.

Treatment

Rupture of the transverse liagment is a ligamentous injury and non operative treatment is not effective in this type of injury.

Therefore surgery is almost always needed.

Initial treatment of this injuryis by stablization of the spine using traction.

Definitive treatment involves fusion of C1-C2 vertebrae.

Popularity: 2% [?]

Filed Under: Cervical Spine, Spine Injuries Tagged With: ,

Posterior Ramus Syndrome – Thoracolumbar Junction Syndrome

January 30, 2010 By 4 Comments

This also called Maigne Syndrome or Dorsal Ramus Syndrome. It is caused by the unexplained activation of the primary division of a posterior ramus of a spinal nerve.

In absence of any radiological signs, the  diagnosis is made clinically.

The thoracolumbar junction (TLJ) is comprised of the T10-11, T11-12 and T12-L1 motion segments. This transitional area, interposed between the thoracic and lumbar spine, is often the source of a characteristic pain syndrome characterized by a referral of the pain in the related dermatomes (T10 to L1). [Read more...]

Popularity: 5% [?]

Filed Under: Back Pain, Spine Tagged With: , , , , , , ,

What Is Spinal Fusion

January 29, 2010 By 1 Comment

Fusing means two bones are permanently placed together so there is no longer movement between them. The term is technically similar to arthrodesis. Spinal fusion is usually done along with other surgical procedures of the spine.

other terms for spinal fusion are spondylodesis or spondylosyndesis.

Spinal fusion is a surgery done to fuse two or more vertebrae. Supplementary bone tissue like autograft or allograft is used to aid in fusion. In  conjunction with the body’s natural osteoblastic processes [New bone formation],  this graft helps in creating a bony bridge across the vertebrae. [Read more...]

Popularity: 1% [?]

Filed Under: Spine Tagged With: , , , ,

Stretch Test For Cervical Spine Instability

January 27, 2010 By Leave a Comment

Stretch test is a useful test to determine clinical instability of the lower cervical spine. The test involves stretching of the cervical spine with the traction and determining the changes on xrays.

This test is contraindicated in an unstable injury.

What Is measured?

This test measures the displacement patterns of spine and identifies anterior and posterior disruption of ligaments.

The stretch test is always done under supervision of a physician. [Read more...]

Popularity: 2% [?]

Filed Under: Cervical Spine Tagged With: , , ,

Cervical Spine Instability

January 26, 2010 By 2 Comments

Cervical spine instability is defined as the loss of ability of cervical spine under physiological loads to maintain relationships between vertebrae in such a way, that spinal cord or nerve roots are not damaged or irritated and deformity or pain does not develop.

While most of definition is explanatory, the key term to remember is physiological l0ad.

The instability may be caused by trauma, malignancy or infection,

Instability can be of two types [Read more...]

Popularity: 9% [?]

Filed Under: Cervical Spine Tagged With: ,

Alar Ligament

January 25, 2010 By 7 Comments

The alar ligaments connect the sides of the dens on the axis, or the second cervical vertebra to tubercles on the medial side of the occipital condyle.

They are short, tough, fibrous cords and function to check side-to-side movements of the head when it is turned.

The alar ligament is also known as the check ligament of the odontoid.

The fibers within each alar ligament are arranged in a multiplanar fashion, rostrally originating from the medial surfaces of the occipital condyles and converging in a V-shaped fashion on either side of the tip of the odontoid process. This complex composition allows the alar ligaments to serve a variety of functions.

Popularity: 6% [?]

Filed Under: A-D, Definitions Tagged With: ,

An Overview of Atlantoaxial Injuries

January 25, 2010 By Leave a Comment

In normal conditions, the articulation of the odontoid process of C2 (axis) with the anterior arch of C1 (atlas) allows for 50% of cervical lateral rotation.

The liagments responsible for stability are transverse and alar ligaments. They  maintain joint integrity and limit posterior motion of the odontoid process relative to the C1 anterior arch.

An acute injury to this area can cause cord compression and could be fatal.

Acute trauma, usually cervical hyperflexion, hyperextension, or a direct axial load on the head or cervical spine causes atlanto axial injuries. Certain conditions  congenital odontoid anomalies, such as odontoid aplasia, odontoid hypoplasia, and a separate odontoid process or  os odontoideum and inflammatory processes predispose an individual to these injuries.

Most of these injuries are the result of significant trauma to the head, although they may occur in older patients with a simple fall and striking of the occiput.

The individuals suffering from these injuries present with general symptoms of neck pain, limited range of motion, and torticollis. However, worsening of  symptoms like headache, fatigue, transient upper-extremity paresthesias could be an indicator of this injury. [Read more...]

Popularity: 1% [?]

Filed Under: Spine Injuries Tagged With: , , , , ,

Dynamic Radiography of Cervical Spine – Flexion Extension Xrays

January 24, 2010 By Leave a Comment

Dynamic motion studies of the neck are helpful in eliciting less than obvious instability of the cervical spine and assessing the healing results of the cervical spine following trauma and other pathologies.

What Is Dynamic Radiography?

In this xrays are taken in different positions of neck for example flexion and extension. The xrays are then studied for relations of vertebral bodies and the preservation or loss of anatomical alignment which may be indicated by

  • Development of deformity in particular position
  • Inability to maintain normal relationships of vertebrae on change of position.
  • More than desired motion of a vertebral segment on movement.

Any of the above indicates an imbalance of ligamentous structure. [Read more...]

Popularity: 9% [?]

Filed Under: Cervical Spine, Spine, Spine Injuries Tagged With: , , , , , ,

Motion Segment

January 23, 2010 By 4 Comments

A motion segment consists of two adjacent vertebrae, including the intervertebral disk between them, and the ligaments that bind them together.

Concept of motion segment is important in planning the fusion of the vertebrae.

Popularity: 1% [?]

Filed Under: Definitions, I-M, Spine Tagged With: , ,

What Is Anastomosis?

January 23, 2010 By Leave a Comment

An anastomosis is defined as  a network of streams that both branch out and reconnect. In human body the blood vessels frequently anastomoe at the places where requirement is high.

Simply put anastomosis is the connection of two structures. [A look at the picture below would explain it in detail].

When it occurs between blood vessels it is called circulatory anastomosis. The circulatory anastomosis is further divided into arterial and venous anastomosis. Arterial anastomosisis common around elbow [picture below], palmar arch in the hand,  plantar arch in the foot and anastomosis around the knee among others. [Read more...]

Popularity: 7% [?]

Filed Under: Musculoskeletal Anatomy Tagged With: , , ,
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