Cervical spine
The developmental anatomy and biomechanics of the upper cervical spine are unique in children. Congenital osseous anomalies in this region may be associated with an increased risk for subsequent neurological compromise from instability and/or spinal cord encroachment. In a review of the medical records and imaging studies of all children with anomalies of the upper cervical spine seen at his institution between 1988 and 2003, Holsalker found multiple bony and neurologic abnormalities in 79% of the patients. Many of these had been identified as having a named syndrome. The most common findings were spinal stenosis of the bony cervical canal, segmental instability and central nervous system abnormalities. Thorough examination and MRI exam of the cervical spine are recommended in such patients.
The sagittal (front to back) diameter of the cervical spinal canal is of clinical importance in traumatic, degenerative and inflammatory conditions. A small canal diameter has been associated with an increased risk of injury. More than 400 specimens from the Hamann-Todd Collection in the Cleveland Museum of Natural History were examined. From C3 to C7, the average diameter of the canal was 14.1 ± 1.6& mm. Stenosis was defined as
Forward displacement of a proximal vertebra in relation to its adjacent vertebra in association with an intact neural arch, and in the presence of degenerative changes is known as degenerative spondylolisthesis. The term is derived from the Greek word spondylous for vertebra, and olisthesis meaning to slip or slide down a slippery incline. Degenerative spondylolisthesis narrows the spinal canal and symptoms of spinal stenosis are common. Of these, neural claudication is most common. Any forward slipping of one vertebra on another can cause spinal stenosis by narrowing the canal. If this forward slipping narrows the canal sufficiently, and impinges on the contents of the spinal column, it is spinal stenosis by definition. If there are associated symptoms of narrowing, the diagnosis of spinal stenosis is confirmed. With increasing age, the occurrence of degenerative spondylolisthesis becomes more common. The most common spondylolisthesis occurs with slipping of L4 on L5. Frymoyer showed that spondylolisthesis with canal stenosis is more common in diabetic women who have undergone oophorectomy (removal of ovaries). The cause of symptoms in the legs can be difficult to determine. A peripheral neuropathy secondary to diabetes can have the same symptoms as spinal stenosis.
Ankylosing spondylitis
In a retrospective analysis of vertebral fractures in patients with ankylosing spondylitis, it was shown that 74% experienced some form of trauma. Of these, greater than 60% revealed vertebral fractures with some neurologic symptoms. Of these, a significant number went on to develop spinal stenosis. Paravertebral hematomas (blood clots) were accompanied by a higher incidence of other complications. Females were at greater risk of death from the complications.
Adapted from the Wikipedia article Spinal stenosis, under the G. N. U. Free Documentation License. Please also see http://en.wikipedia.org/wiki
