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  • Cervical spondylolisthesis

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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
  • Fracture of the pedicles on the vertebra below
  • Slipping of the vertebra in relationship to the vertebra below
  • Neurogenic claudication
  • Fracture widens at the pars
  • Hangman’s fracture
    • C2 vertebra anterior translated on C3 with fracture of C2 pedicles

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Essentials of Diagnosis

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General Considerations

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Demographics

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  • May be congenital or acquired

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Signs and Symptoms

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  • Cervical, shoulder, arm, upper extremity pain and parasthesia, often radiating into the lower extremities if central cord involvement
  • Constricted pupil (Horner’s sign)
  • Stiffness along spine
  • Headaches
  • Pain in cervical spine worsens with extension
  • Diminished sensation, motor control, and reflexes in the distribution of the involved nerve
  • Neurogenic claudication

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Functional Implications

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  • Difficulty sustaining standing postures secondary to neck and arm pain
  • Inability to sleep flat on the back without a pillow
  • Weakness with lifting
  • Loss of movement or feeling in the upper extremity
  • Difficulty with movements secondary to pain, especially reaching overhead
  • Limited sports participation

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Possible Contributing Causes

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  • Forceful extension from hit under the chin (sports)
  • Congenital
  • Car accident, hit from rear
  • Hyperextension of the cervical spine
  • Suicidal hanging
  • Increased cervical lordosis posture

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Differential Diagnosis

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  • Peripheral nerve impairment
  • Spinal tumor
  • Infection
  • Peripheral neuropathy
  • Paraspinal spasms
  • Degenerative disk disease
  • Stenosis

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Imaging

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

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  • Cervical vertebra anterior translated on the lower cervical vertebrae with fracture of pedicles

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  • Restricted mobility of the upper cervical spine
  • Hypermobility
  • Weakness of neck musculature
  • ...

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