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A - MSRA Neuro and Stroke [12] > [9] Cervical Spondylosis > Flashcards

[9] Cervical Spondylosis Flashcards

1
Q

What is cervical spondylosis?

A

A non-specific degenerative process resulting in stenosis of the spinal canal, and /or root canals of the cervical vertebrae

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2
Q

What are the most commonly affected levels in cervical spondylosis?

A
  • C5/6

- C6/7

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3
Q

How common is cervical spondylosis?

A

Very

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4
Q

How does cervical spondylosis progress with age?

A

It gets worse

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5
Q

What percentage of over 60’s are affected by cervical spondylosis?

A

> 85%

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6
Q

What factors are involved in the development of cervical spondylosis

A
  • Dehydration of discs
  • Osteophytes
  • Hypertrophy of lamina, articular facets, ligamentum flavum, and posterior longitudinal ligament
  • Congenitally narrowed canal
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7
Q

Why does dehydration of the intervertebral discs contribute to cervical spondylosis?

A

It allows for more bone-to-bone contact between the vertebrae

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8
Q

What causes spondylosis?

A

Years of constant abnormal pressure placed on the vertebrae and their discs

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9
Q

What can cause the factors causing cervical spondylosis?

A
  • Joint subluxation
  • Stress induced by sports
  • Acute and/or repetitive trauma
  • Poor posture
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10
Q

What does the body do as a result of abnormal pressure on the cervical vertebrae?

A

Produce new bone to compensate for the change in weight distribution

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11
Q

What are the risk factors for cervical spondylosis?

A
  • Age
  • Occupation
  • Previous neck injuries
  • Genetic factors
  • Smoking
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12
Q

What symptoms do most people with cervical spondylosis experience?

A

None

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13
Q

What symptoms present in cervical spondylosis if any?

A
  • Pain

- Stiffness

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14
Q

Where does pain occur in cervical spondylosis?

A
  • Cervical pain
  • Referred pain to occiput, between shoulder blades and upper limbs
  • Retro-orbital or temporal pain*
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15
Q

*When does retro-orbital or temporal pain occur in cervical spondylosis?

A

When there is involvement of C1 and C2

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16
Q

What signs can be seen on examination in cervical spondylosis?

A
  • Limited range of movement
  • Minor neurological changes
  • Poorly localised tenderness
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17
Q

What neck movements can be limited by cervical spondylosis?

A
  • Forward flexion
  • Backward extension
  • Lateral flexion
  • Rotation
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18
Q

What is an example of a minor neurological problem that can be seen in cervical spondylosis?

A

Inverted supinator jerks

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19
Q

What can cervical spondylosis sometimes do to the spinal canal?

A

Cause narrowing

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20
Q

What can happen as a result of the narrowing of the spinal canal sometimes seen in cervical spondylosis?

A

Pinching of the spinal cord or nerve roots

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21
Q

What is it called when there is pinching of the nerve roots or spinal cord due to spinal canal narrowing?

A

Radiculopathy

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22
Q

When should radiculopathy be suspected in cervical spondylosis?

A

When there is unilateral neck, shoulder or arm pain approximating to a dermatome

23
Q

What accompanying symptoms can be seen in radiculopathy?

A
  • Changes in sensation
  • Weakness in related muscles
  • Diminished reflexes at appropriate level
24
Q

What investigations may be used to assess cervical spondylosis?

A
  • X-ray of cervical spine

- MRI

25
Q

What might an x-ray of the cervical spine show in cervical spondylosis?

A

Narrowing of the disc spaces with encroachment of the intervertebral foraminae

26
Q

Is narrowing of the disc spaces with encroachment of the intervertebral foraminae on cervical x-ray diagnostic of cervical spondylosis?

A

No, they can be common in middle aged patients

27
Q

When is an MRI necessary in cervical spondylosis?

A

In a patient with neurological abnormality especially, progressive myelopathy, radiculopathy or intractable pain

28
Q

What are some differentials of cervical spondylosis?

A
  • Non-specific neck pain lesions
  • Malignancy
  • Infections
  • Mechanical lesions
  • Fibromyalgia
  • Psychogenic neck pain
  • Inflammatory disease e.g. RA
  • Metabolic disease
29
Q

What other non-specific neck pain lesions may present like cervical spondylosis?

A
  • Acute neck strain
  • Postural neck ache
  • Whiplash
30
Q

What malignancies are differentials for cervical spondylosis?

A
  • Primary tumour of bone
  • Metastases
  • Myeloma
31
Q

What infections are differentials for cervical spondylosis?

A
  • Osteomyelitis

- Tuberculosis

32
Q

What mechanical lesions may present like cervical spondylosis?

A

Disc prolapse

33
Q

What metabolic diseases are differentials for cervical spondylosis?

A
  • Paget’s disease of bone

- Osteoporosis

34
Q

What red flag symptoms suggest malignancy or infection rather than cervical spondylosis?

A
  • Fever or chills
  • Weight loss
  • Relentless nocturnal pain
  • History of cancer
  • Immunosuppression
35
Q

What symptoms are red flags for myelopathy instead of cervical spondylosis?

A
  • Insidious progression
  • Gait disturbance
  • Loss of sexual, bladder or bowel function
  • Lhermitte’s sign
36
Q

What is Lhermitte’s sign?

A

Neck flexion causes electric shock type sensation radiating down the spine

37
Q

How should symptoms of cervical spondylosis be managed in the first 4 weeks?

A

With reassurance, advice to keep active and avoid use of a cervical collar.

38
Q

What concerns may patients with cervical spondylosis have that should be addressed?

A

Fear of chronic disability

39
Q

What treatment should be considered for prolonged (4-12 weeks) symptoms of cervical spondylosis?

A

Referral to physiotherapy for ‘mechanical’ treatment

40
Q

What treatment should be considered for patients with chronic (>12 weeks) symptoms of cervical spondylosis?

A
  • Referral to pain clinic

- Referral for surgery

41
Q

What mechanical interventions can be performed by physiotherapists for cervical spondylosis?

A

Manipulation of the neck

42
Q

What are the risks of mechanical intervention cervical spondylosis?

A
  • Arterial dissection
  • Myelopathy
  • Vertebral disc extrusion
43
Q

What pharmacological agents can be used to treat symptoms of cervical spondylosis?

A
  • Analgesics
  • Anti-inflammatory agents
  • TCA’s
44
Q

What are the indications for surgery in cervical spondylosis?

A
  • Progressive neurological deficits
  • Documented compression of cervical nerve root, spinal cord, or both
  • Intractable pain
45
Q

What does the surgical option for cervical spondylosis depend upon?

A

The precise pathology

46
Q

How can cervical spondylosis surgery be classified?

A
  • Anterior approach

- Posterior approach

47
Q

When is an anterior approach to cervical spondylosis surgery indicated?

A

When the pathology extends in front of the root and cord

48
Q

What anterior approach surgeries are available for cervical spondylosis?

A
  • Simple discectomy
  • Cloward’s procedure
  • Decompression with plating or synthetic joint insertion
49
Q

What is Cloward’s procedure?

A

Bone grafting into disc space

50
Q

When is a posterior approach to cervical spondylosis surgery used?

A

When there is lateral cord narrowing

51
Q

What are the posterior approach procedures available for cervical spondylosis?

A
  • Foraminectomy

- Laminectomy +/- laminoplasty

52
Q

What are the potential complications of cervical spondylosis surgery?

A
  • Spinal cord injury
  • Nerve root injury
  • Oesophageal perforation
  • Recurrent laryngeal nerve palsy (with anterior approach)
53
Q

What are the potential complications of cervical spondylosis?

A
  • Cervical myelopathy
  • Paraplegia and tetraplegia
  • Recurrent chest infection
  • Pressure sores

A - MSRA Neuro and Stroke [12] (33 decks)

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