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  • 738.4 Acquired spondylolisthesis
  • 756.12 Spondylolisthesis congenital
  • 805.02 Closed fracture of second cervical vertebra

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

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  • To hospital for imaging
  • To surgeon for surgical consult if myelopathy suspected
  • To physician for corticosteroid injection
  • To physician for anti-inflammatory medication
  • To orthopedist for halo vest traction device, cervical bracing

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  • Restricted mobility of upper cervical spine
  • Hypermobility
  • Noted weakness of neck musculature

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  • Rest
  • Bracing
  • Address pain
    • Electrical stimulation
    • Heat/ice
  • Address hypertonicity
    • Soft tissue massage
    • Heat
  • Address muscle weakness
    • Stability exercises

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  • Patient will be able to
    • Sit with neutral cervical-spine posture for greater than ...

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