VI.

Environmental Living Condition

The patient lives in a nipa hut with a five step ladder outside. The nipa hut has one bedroom and
a bathroom and he lives with his wife. The patient has an 8.4 pack year smoking history consuming four
sticks of cigarettes per day since he was 15 years old. He is an occasional alcohol beverage
drinker,consuming gin and beer. Patient was independent in all aspect of activities of daily living prior to
admission.

X. Impression/ Diagnosis

Hangman’s Fracture (Spondylolisthesis) without neurologic deficit.

XI. Clnical Discission of the Disease

A. Anatomy and Physiology

 The Vertebral Column
 The vertebral column is made of individual bones called vertebrae. The names of the vertebrae
indicate their location along the length of the spinal column. There are 8 cervical vertebrae, 12 thoracic,
5 lumbar, 5 sacral fused into one sacrum, and four to five coccygeal vertebrae fused into one coccyx.

The seven cervical vertebrae are those within the neck. The first vertebra is called the atlas,
which articulates with the occipital bone to support the skull and forms a pivot joint with the odontoid
process of the axis, the second cervical vertebra. This pivot joint allows us to turn our heads from side to
side. The remaining five cervical vertebrae do not have individual names.

The thoracic vertebrae articulate with the ribs on the posterior side of the trunk. The lumbar
vertebrae , are the largest and strongest bones of the spine. The sacrum permits the articulation of the
two hip bones: the sacroiliac joints. The coccyx is the remnant of tail vertebrae, and some muscles of the
perineum are anchored to it.

All of the vertebrae articulate with one another in sequence, connected by ligaments, to form a
flexible backbone that supports the trunk and head. They also form the vertebral canal, a continuous
tunnel (lined with the meninges) within the bones that contains the spinal cord and protects it from
mechanical injury. The spinous and transverse processes are projections for the attachment of the
muscles that bend the vertebral column. The facets of some vertebrae are small flat surfaces for
articulation with other bones, such as the ribs with the facets of the thoracic vertebrae.

The supporting part of a vertebra is its body; the bodies of adjacent vertebrae are seperated by
discs of fibrous cartilage. These disc cushion and absorb shock and permit some movement between
vertebrae(symphysis joints). Since there are so many joints, the backbone as a whole is quite flexible.

 The Spinal Nerves

There 31 pairs of spinal nerves those that emerge from the spinal cord. The nerves are named
according to their respective vertebrae.

The cervical nerves supply the back of the head, neck, shoulders, arms and the diaphragm (the
phrenic nerves). The first thoracic nerve also contributes to the nerves in the arms. The remaining
thoracic nerves supply the trunk of the body. The lumbar and sacral nerves supply the hips, pelvic cavity
and legs. Notice that the lumbar and sacral nerves hang below the end of the spinal cord (in order to
reach their proper openings to exit from the vertebral canal); this is called the the cauda equina, literally
the “horse’s tail”.

Each spinal nerve has two roots, which are neurons entering or leaving the spinal cord. The
dorsal root is made of sensory neurons that carry impulses into the spinal cord. The dorsal root
ganglion is an enlarged part of the dorsal root that contains the cell bodies of the sensory neurons. The
term ganglion means a group of cell bodies outside the CNS. These cell bodies are within the vertebral
canal and are thereby protected from injury.
 The ventral root is the motor root; it is made of the axons of motor neurons carrying impulses
from the spinal cord to muscles or glands. The cell bodies of these motor neurons, as mentioned
previously, are in the gray matter of the spinal cord.

Nerve Spinal Nerve that contribute Distribution

Phrenic C3-C5 Diaphragm
Radial C5-C8,T1 Skin and muscles of posterior
arm, forearm, and hand; thumb
and first two fingers
Median C5-C8,T1 Skin and muscles of anterior
arm,forearm, and hand
Ulnar C8-T1 Skin and muscles of medial arm,
forearm, and hand; little finger
and ring finger
Intercostal T2-T12 Intercostals muscles, abdominal
muscles; skin of trunk
Femoral L2-L4 Skin and muscles of anterior
thigh, medial leg and foot
Sciatic L4-S3 Skin and muscles of posterior
thigh, leg and foot

Pathophysiology

 Book Based Pathophysiology

ETIOLOGY PREDISPOSING FACTORS

 Birth defects  Family history

 Repetitive trauma  Athletes
 Joints problem in the  Older adults
vertebra
 Tumor

One vertebra slips to the next vertebra below

At the Cervical area

 Deformity of spine

Lordotic posture may occur due to stiffening of the back

Inflammation in the site

 Pain in the site of injury, specifically at the neck

Narrowing of spinal canal

Compression of nerve roots in the affected spinal area

 Respiratory Distress may occur if injury extends to the C4

and C5 level
 Muscle spasm and Tingling sensation is felt
 Numbness
 Decreased nerve impulse to the brain due to narrowing of
spinal canal
 Decreased sensation in the distal parts of the body
 Cauda Equina Syndrome may occur
 Decrease range of motion

Narrowing of spinal canal

Waddling gait

Chronic lower back pain

Impaired bowel and bladder function

 Patient Based Pathophysiology

Trauma caused by fall from a height of 10 ft.

Cervical Spine X-
ray showed Displacement occurred in C2 and C3 level causing tolerable neck
anterior pain.
sublaxation of
C2 vertebral
body over C3.

As the injury progresses the patient felt severe and untolerable

neck pain caused by inflammation in the site of injury

Characteristic manifestation is felt

 Numbness
 Tingling sensation
 Muscle spasm
 Body weakness