Taking a Look at Cervical Spondylodiscitis

This assignment will present a reflective analysis of the examination, diagnosis, treatment and referral plan based on a simulated patient presenting with a minor injury. Potential diagnoses related to the mechanism of injury will discussed aligning the patient presentation with the literature to produce the most likely diagnosis. When this is established, a suggested treatment plan will be created in line with current guidance.

In elderly patients and high risk patients, physicians may consider a more conservative treatment option using splints/casts rather than surgery

Cervical lymphadenopathy is the enlargement or swelling of the cervical lymph nodes. Cervical lymph nodes are the lymph nodes located at the anterior and posterior aspect of the neck and under the jaw. A thorough knowledge of the anatomy of the neck is essential to formulate a differential diagnosis. Cervical lymphadenopathy is not uncommon, especially in children and therefore differential diagnoses are broad (Lang, & Kansy, 2014). The causes of cervical lymphadenopathy can be infections, autoimmune disorders, or malignancy.

Hudson,S.R.(2011.) points out that MVA trauma has been the leading cause of young adults death, the appropriate imaging protocols for this patient are essential for the diagnosis of chest and pelvic injuries during initial clinical assessment. When MVA trauma patient arriving the Emergency Department, the first stage is that three significant x-rays are taken right on the stretch (chest, C-spine and pelvis) before going for an operation. For

The detection of injury during initial CT scanning was able to establish anatomic relationships and avoided unnecessary additional plain radiographs or CT scans, which may require longer patient transfer time and increase chances of inadequate patient monitoring (Schenart et al, 2001). Daffner (2000), in a study of 127 high-speed motor vehicle trauma patients, found the length of time necessary to obtain standard six-view radiographs of the cervical vertebral column in trauma patients (average time, 22 min) was twice of the time for a full helical CT examination of cervical region in a group of patients who were concurrently undergoing cranial CT (because many of those scans are done on patients who are already on the table for cranial

are present. Turvey identifies petechial hemorrhages traumatic injuries from an offending force to the neck that cause an increase in venous pressure and an increase in capillary pressure that then causes damage to the inner walls of those capillaries. This damage produces minute points of bleeding which can be visible as pinpoint hemorrhages in the softer tissues (Turvey, 1996). It appears there is a lower line of bruising near the base of the neck that may have been cause by the initial tightening of the ligature, which then rolled up the neck.

The NEXUS criteria can assist in determining whether a cervical collar is indicated for immobilisation. According to this criteria a patient who has been involved in a motor vehicle accident would require a cervical collar to be applied if they report any midline cervical tenderness on palpation or if the patient has a neurological deficit for example paraesthesia, central cord syndrome or radiculopathy. If the patient was intoxicated from any substance, a collar to immobilise the neck would also be indicated, as this may impair their ability to recognise pain and injury. If the patient has an altered mental status being GCS less than 15 or less than normal baseline if known otherwise. If the patient has a painful distracting injury a cervical

The lateral neck is divided into 3 zones; this system is useful in the evaluation and treatment of penetrating neck injuries. Zone 1 extends from the clavicle to the cricoid cartilage and includes the thoracic inlet. This region contains the major vascular structures of the subclavian artery and vein, jugular vein, and common carotid artery, as well as the esophagus, thyroid, and trachea. Only subclavian artery and vein—which are inferior to the clavicle and ascend slightly superior to the clavicle—are relevant to this injury, as the rest are superior and medial to the stab wound. The other structures that were injured include the epidermis surrounding the entry of the stab, the apex of the lung, which is deep to the lateral of the clavicle,

Trauma to the Neck and Thoracic regions presents the highest rates of mortality in trauma patients. Mortality from PNT originates from exsanguinating hemorrhage and 24 hours delay in the diagnosis of visceral injuries being the esophageal injuries the most lethal of all (1).

Most commonly presented symptoms are unilateral headaches, facial or neck pain ipsilateral to the dissection, as was the case for this patient, but they could also experience mild cranial nerve dysfunction or a complete ischemic event (Stapf et al., 2000). Ischemic events frequently occur with about 50% of patients reporting ischemic symptoms preceding a stroke (Schievink, 2001). There is a higher risk of a stroke within the first month of the onset of a dissection, thus, early diagnosis is important to initiate management and prevention of stroke (Adkins et al.,

Lymphadenopathy can be due to many causes, but the 2 major ones are either infection of malignancy (Goolsby & Grubbs, 2015). If the cervical lymphadenopathy accompanies with a history of upper respiratory infection and with symptoms such as fever, sore throat, runny nose, cough, and malaise, it is most likely caused by an infection. On the other hand, if the patient presents with fatigue, malaise, weakness, anorexia, weight loss, fever, night sweats, or easily bruising, a suspicion of malignancy should be ruled out.

Method of minimally invasive posterior cervical “key-hole” laminoforaminotomy decompression for cervical spondylotic radiculopathy is to build a working channel by expanding the tubular retractor to open the surrounding soft tissue, the system does not need specific endoscope equipment and steep learning curve of operating under the endoscope. The surgeons accomplish the vertebral plate excision, spinal canal decompression, removal of nucleus pulposus, and retain the kinetic segments of cervical vertebra using the working channel. There were some advantages for the approach, such as the safety was fine, slight trauma, being liable to master for beginner, satisfactory curative effect and so on. The approach obtained the satisfactory clinical effects in short periods, but the persistent follow-up observations are needed for the long term

A middle aged patient with chronic neck pain (>3 months history of neck pain and NDI score of 5014 points) presents. The patient is cleared of having a bone fracture, high blood pressure, surgery, scoliosis, stenosis in the lumbar spine, and spondyloarthritis.

Involvement of the carotid and vertebral arteries leads to neurologic and ophthalmologic symptoms, including dizziness, tinnitus, headaches, syncope, stroke, and visual disturbances. Atrophy of facial muscles and jaw claudication are mostly late manifestations. Occlusions of the brachiocephalic and subclavian arteries impair blood flow to the upper extremities, presenting as arm claudication, pulselessness, and discrepant blood pressures. The detection of bruits can be helpful in making the diagnosis 6.

The median basilic, at the inner edge of the arm, may have tendency to roll and is near a main artery and nerve. This part of the arm is very tender. The cephalic vein also has a tendency to roll and the skin over it is often tough. Using the index or middle finger, palpate the arm, feeling for the best vein. If a vein cannot be found try the following suggestions. Gently pat the site to enlarge the veins, massage the arm, wrap the arm in a warm towel, check both arms, always select the most suitable vein for puncture. When selecting a vein, seek another site for puncture if any of the following conditions exist: edema, burn, hematoma, I.V. If another site is not available, consult the supervisor.