C-Spine Common Presentations Flashcards
what is a positive Kernig’s sign?
hip flexion to 90deg and unable to straighten knee (positive for meningitis)
what types of cancer commonly metastasize to the vertebrae? (Hint: PB KTL)
Prostate
Breast
Kidney
Thyroid
Lung
40% of kidney neoplasms metastasize where? (Hint: PVP)
Pelvis
Vertebrae
Proximal femur
metastases of the ____ affect women 3x > men
thyroid
what age is someone likely to develop RA?
prior to 50
20-80% of pts with RA develop instability where in the c-spine?
AA instability (C1-C2)
what is basilar invagination?
when the dens drifts superior d/t ligamentous laxity and it can contact brain structures
ankylosing spondylitis = ossification of ligaments of what 3 structures?
Spine
IV discs/endplates
Facet structures
risk of SCI is how many times greater in pts with ankylosing spondylitis?
11.4x
pts with ankylosing spondylitis have a greater risk of ____ hematoma
epidural
low-impact trauma is most common at what c-spine vertebrae in pts with ankylosing spondylitis?
C5-C7
what gender and age is at greater risk of developing ankylosing spondylitis?
Men (10x > women)
20s - 30s
fusion of what c-spine vertebrae is most common in Klippel Feil syndrome?
C2 and C3 (vertebrae never separated during development)
what are the consequences of VBI/CAD?
Retinal or brain ischemia
Compression or stretching = local symptoms (see CN S/S)
SAH or ICH
what is the mean age for VBI/CAD?
39 - 45
what is one of the biggest risk factors for VBI/CAD?
HTN
what are 5 other big risk factors for VBI/CAD?
Hx of migraine-type HA
DM
Blood clotting disorders/alterations in blood properties
Hx of smoking
Immediately postpartum
what are the 5 D’s and 3 N’s?
Dizziness
Dysarthria (poor muscle coordination when talking)
Dysphagia
Diplopia
Drop attacks (beginning of LOC, legs give out, suddenly feel like you’re going to fall)
Nystagmus
Nausea
Numbness (dysesthesia of face / lips / extremities)
ossification of what ligament is common with c-spine myelopathy? (reason unknown)
PLL
what 5 things are included in the CPR for c-spine myelopathy?
- Gait deviation
- Hoffman’s
- Inverted Supinator
- Babinski
- Patient age > 45
what is the pars interarticularis?
stretch of vertebra btw sup/inf articular processes, like the “neck” of the spinous process
what is a Jefferson fx and how does it happen?
4-part burst fx of C1 that happens from compression (ex: diving, something falling on the head)
spondylolisthesis = vertebral body displaces in what direction?
anteriorly
degenerative spondylolisthesis is most common at what parts of the c-spine?
C3-C5
describe the 4 grades of spondylolisthesis
Graded by % vertebral body slips
I → 0-25%
II → 25-50%
III → 50-75%
IV → > 75%
does z-joint arthropathy typically have UL or BL symptoms?
UL (remember this differs from disc pain referral patterns!)
what 4 things are included in Wainner’s Cluster for cervical radiculopathy?
Ipsi c-spine rotation AROM < 60deg
Positive Spurling’s Test
Positive Cervical Distraction
Positive ULTT (median n. bias)
what can be fractured with Whiplash Associated Disorders (WAD)? (Hint: LOAD)
Laminae of C2
Occipital condyles (upper c-spine)
Articular pillars/subchondral plates
Dens
where do the referred and radicular pain come from in WAD?
Referred pain = from z-joints and other structures
Radicular pain = from inflammation or injury to spinal n.
are symptoms usually UL or BL with WAD?
BL
cervicogenic HA: where does trigeminal nerve refer pain to?
frontal, orbital, parietal
cervicogenic HA: where does C1-C3 refer pain to?
occipital and auricular
