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Condition/Disorder Synonym

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  • Cervical spondylolisthesis

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ICD-9-CM Codes

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  • 738.4 Acquired spondylolisthesis

  • 756.12 Spondylolisthesis congenital

  • 805.02 Closed fracture of second cervical vertebra

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ICD-10-CM Codes

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  • M43.10 Spondylolisthesis, site unspecified

  • Q76.2 Congenital spondylolisthesis

  • S12.100A Unspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture

  • S12.101A Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture

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Preferred Practice Pattern

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Key Features

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Description

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  • Anterior (forward) translation of a vertebra

  • C2 vertebra anterior translated on C3 with fracture of C2 pedicles

  • Fracture of the pedicles on C2 vertebra

  • Slipping of vertebra in relationship to the vertebra below

  • Neurogenic claudication

  • Fracture widens at the pars

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Essentials of Diagnosis

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  • Diagnosis made by x-ray

  • Clinical examination may find step deformity

  • Dermatome/myotome pattern

  • Stability of cervical spine is critical

  • Spondylolysis: fracture without displacement

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General Considerations

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  • Instability

  • Individual may not know they have a fracture immediately following an accident

  • Avoid extension positions that increase symptoms

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Demographics

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  • After trauma

  • Suicidal hanging

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Clinical Findings

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Signs and Symptoms

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  • Cervical, shoulder, arm, upper-extremity pain and paresthesia, often radiating into lower extremities if central cord involved

  • Constricted pupil (Horner's sign)

  • Stiffness along spine

  • Headaches

  • Pain in cervical spine worsens with extension

  • Diminished sensation, motor control, reflexes in the distribution of involved nerve

  • Neurogenic claudication

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Functional Implications

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  • May cause death

  • Difficulty maintaining standing posture secondary to neck and arm pain

  • Inability to sleep flat on back without a pillow

  • Weakness with lifting

  • Loss of movement or feeling in the upper extremity

  • Difficulty with movements (reaching overhead) secondary to pain

  • Limited sports participation

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Possible Contributing Causes

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  • Forceful extension from hit under the chin (as in sports)

  • Congenital

  • Car accident, hit from rear

  • Hyperextension of the cervical spine

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Differential Diagnosis

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  • Peripheral-nerve impairment

  • Spinal tumor

  • Peripheral neuropathy

  • Paraspinal spasms

  • Degenerative disk disease

  • Stenosis

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Means of Confirmation or Diagnosis

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Imaging

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  • MRI helps visualize compressed or inflamed nerve root in diagnosis

  • X-ray/plain-film radiograph to see vertebral position

  • CT to show herniation compressing the spinal canal/nerves

  • Electrodiagnostic/nerve conduction testing can help determine a specific impaired nerve function

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Findings and Interpretation

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  • C2 vertebra anterior translated on C3 with fracture of C2 pedicles

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Referrals/Admittance

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  • To hospital for imaging

  • To surgeon for surgical consult if myelopathy suspected

    • Fusion

  • To physician for corticosteroid injection

  • To physician for anti-inflammatory medication

  • To orthopedist for halo ...

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