Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Cervical spondylolisthesis ++ 738.4 Acquired spondylolisthesis756.12 Spondylolisthesis congenital805.02 Closed fracture of second cervical vertebra ++ M43.10 Spondylolisthesis, site unspecifiedQ76.2 Congenital spondylolisthesisS12.100A 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 ++ 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1 +++ Description ++ Anterior (forward) translation of a vertebraC2 vertebra anterior translated on C3 with fracture of C2 pediclesFracture of the pedicles on C2 vertebraSlipping of vertebra in relationship to the vertebra belowNeurogenic claudicationFracture widens at the pars +++ Essentials of Diagnosis ++ Diagnosis made by x-rayClinical examination may find step deformityDermatome/myotome patternStability of cervical spine is criticalSpondylolysis: fracture without displacement +++ General Considerations ++ InstabilityIndividual may not know they have a fracture immediately following an accidentAvoid extension positions that increase symptoms +++ Demographics ++ After traumaSuicidal hanging +++ Signs and Symptoms ++ Cervical, shoulder, arm, upper-extremity pain and paresthesia, often radiating into lower extremities if central cord involvedConstricted pupil (Horner’s sign)Stiffness along spineHeadachesPain in cervical spine worsens with extensionDiminished sensation, motor control, reflexes in the distribution of involved nerveNeurogenic claudication +++ Functional Implications ++ May cause deathDifficulty maintaining standing posture secondary to neck and arm painInability to sleep flat on back without a pillowWeakness with liftingLoss of movement or feeling in the upper extremityDifficulty with movements (reaching overhead) secondary to painLimited sports participation +++ Possible Contributing Causes ++ Forceful extension from hit under the chin (as in sports)CongenitalCar accident, hit from rearHyperextension of the cervical spine +++ Differential Diagnosis ++ Peripheral-nerve impairmentSpinal tumorPeripheral neuropathyParaspinal spasmsDegenerative disk diseaseStenosis +++ Imaging ++ MRI helps visualize compressed or inflamed nerve root in diagnosisX-ray/plain-film radiograph to see vertebral positionCT to show herniation compressing the spinal canal/nervesElectrodiagnostic/nerve conduction testing can help determine a specific impaired nerve function ++ C2 vertebra anterior translated on C3 with fracture of C2 pedicles ++ To hospital for imagingTo surgeon for surgical consult if myelopathy suspectedFusionTo physician for corticosteroid injectionTo physician for anti-inflammatory medicationTo orthopedist for halo vest traction device, cervical bracing ++ Restricted mobility of upper cervical spineHypermobilityNoted weakness of neck musculature ++ RestBracingAddress painElectrical stimulationHeat/iceAddress hypertonicitySoft tissue massageHeatAddress muscle weaknessStability exercises ++ Patient will be able ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.