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  • 738.4 Acquired spondylolisthesis
  • 756.12 Spondylolisthesis congenital
  • 805.01 Closed fracture of first cervical vertebra

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  • M43.10 Spondylolisthesis, site unspecified
  • Q76.2 Congenital spondylolisthesis
  • S12.000A Unspecified displaced fracture of first cervical vertebra, initial encounter for closed fracture
  • S12.001A Unspecified nondisplaced fracture of first cervical vertebra, initial encounter for closed fracture

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Description

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  • Anterior (forward) translation of a vertebra
  • Fracture of the anterior and posterior arches of C1 vertebra
  • Slipping of the vertebra in relationship to the vertebra below
  • Ataxia
  • 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
  • Axial load on top of the head
  • Reports diving into a shallow pool

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General Considerations

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  • Instability
  • Avoid extension positions that increase symptoms

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Demographics

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  • Usually from landing on head, as with diving into a shallow pool

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Signs and Symptoms

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  • Ataxia
  • Injury to vertebral artery
  • Cervical, shoulder, arm, upper-extremity pain; 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

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Functional Implications

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  • Difficulty maintaining standing postures secondary to neck pain
  • Difficulty with movements (reaching overhead) secondary to pain
  • Limited sports participation
  • Can cause quadriplegia or death

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Possible Contributing Causes

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  • Forceful extension from hit under the chin (as in sports)
  • Car accident, hit from rear
  • Hyperextension of the cervical spine
  • Diving into a shallow pool

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Differential Diagnosis

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  • Peripheral nerve impairment
  • Spinal tumor
  • Peripheral neuropathy
  • Paraspinal spasms
  • Degenerative disk disease
  • Hangman’s fracture
    • C2 vertebra anterior translated on C3 with fracture of C2 pedicles

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Imaging

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  • MRI helps to visualize compressed or inflamed nerve root in diagnosis
  • X-ray/plain-film radiograph to see vertebra position
  • CT to show herniation compressing the spinal canal/nerves
  • Electrodiagnostic/nerve conduction testing can help to determine a specific impaired nerve function

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  • Fracture of the anterior and posterior arches of C1 vertebra

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

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  • Restricted mobility of the 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 30 minutes with 0 out of 10 pain rating
    • Stand at work station and perform computer work for 45 minutes with 0 out of 10 pain rating
    • Rotate cervical spine 75 degrees ...

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