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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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PREFERRED PRACTICE PATTERN
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4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1
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PATIENT PRESENTATION
Patient is a 36-year-old construction worker who fell off a ladder and had a burst fracture of the atlas. The physician and patient decided to treat the fracture with immobilization with halo traction and halo vest. Patient achieved a union of his fracture. The patient presents with increased tone bilateral upper trapezius and scalenes with decreased range of motion of the cervical spine.
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Anterior (forward) translation of a vertebra
Fracture of the anterior and posterior arches of the C1 vertebra
Slipping of the vertebra in relationship to the vertebra below
Ataxia
Fracture widens at the pars
Typically a four-part or “burst” fracture
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Essentials of Diagnosis
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Diagnosis made by X-ray, children may require CT scan
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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SIGNS AND SYMPTOMS
Ataxia
Injury to vertebral artery
Cervical, shoulder, arm, and upper-extremity pain; often radiating into lower extremities if central cord involved
Constricted pupil (Horner sign)
Stiffness along spine
Headaches
Pain in the 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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