C-Spine lecture5 Flashcards
Where in the c-spine do you get the most axial rotation?
C1-2
Where in the c-spine do you get the least axial rotation?
C0-1
Which motion in general does the C-spine have most of
Flexion/Extension (with the exception of rotation at C1-2)
According to Cross, thoracic spine thrust manipulation provides ______ improvement in patients with acute or subacute mechanical neck pain
short-term (decreased pain, increased neck motion, and improved function)
T/F intermittent cervical traction and manip of thoracic can be done in patients with mild cervical compressive myelopathy attributed to herniated disc
T. In fact it seems useful for the reduction of pain and level of disability. Be sure to do a thorough neuro exam though before mechanical treatment of the c spine
T/F quality literature has been published on the benefit of proprioception exercises for the neck and low back
F
Regarding exercise for chronic neck pain patients, O’Riordan suggests
min of 3x per week for 30-60 min at intensity up to 80% of max
T/F no definitive statements to support or refute use of electrotherapy treatment for neck pain
T
T/F the current literature does not support or refute the efficacy or effectiveness of continuous or intermittent traction for pain reduction, improved function or global perceived effect when compared to placebo traction, tablet or heat or other conservative treatments in patients with chronic neck disorders
T
10 red flags for cervical patient
- abnormal sensations (numbness, pins and needles)
- headaches
- night pain
- sustained morning stiffness
- light-headedness
- trauma (MVA, a fall)
- night sweats
- constipation
- easy bruising
- changes in vision
Mobility classification
recent onset of symptoms, no radicular signs/symp.
Manual therapy and exercise
centralization classification
radicular signs/symp. symptoms distal to elbow.
Activities to promote centralization
exercise and conditioning classification
no radicular signs/sx. chronic
Conditioning and strengthening exercises
headaches classification
primary complaint is headache. cervicogenic headache
Man therapy, neck flexor/scapular strengthening
pain control classification
acute onset of symptoms, traumatic mechanism
Gentle ROM and activity
NDI scoring 0-4 (<10%)
no disability (stage 3)
NDI score 5-14
mild disability (stage 2)
NDI score 15-24
moderate disability (stage 2)
NDI score 25-34
severe disability (stage 1)
NDI score 34 or greater
complete disabilty (stage 1)
After staging a patient in stage 1 classification, what categories for treatment do you use?
mobility, centralization, CGH (headache), Exercise/conditioning, pain control
Once a patients progresses to stage 2 classification, what categories for treatment do you use?
Aerobic activity, eliminate impairments, posture, strengthening, flexibility and mobility
Indications for surgery
progressive neurological deterioration, failure of non-surgical treatment, weakness that persists
progressive neurological deterioration
weakness worsening, risk of falling increased, coordination getting worse
Failure of non-surgical treatment
pain persists, tried all other options, cannot function without pain, cannot work/sleep, ADL hampered
weakness that persists
weakness not getting worse but prevents or interferes with work or ADL, likelihood of the problem causing weakness to improve is low
Decompressive laminectomy
remove bone or dist to relieve pressure on nerves or spinal cord
downside of decompressive laminectomy
alter the jt architecture, forces, function
denervation of muscle to some degree
weaken mm attachment to bone
which surgery has the best success rates
microdiscectomy
Factors that determine prognosis for poor surgical results
diagnosis is not clear, expectations not realistic, smoking, depression, anxiety, chronic pain, diabetes, obesity, osteopororsis, worker’s comp, litigation
theoretical pros of minimally invasive surgery
less mm ischemia, less blood loss
cons of minimally invasive surgery
limited visualization, longer operative time, more use of radiation (fluoroscopy), inadequate decompression
Theoretical risks of minimally invasive surgery
higher chance of wrong level surgery, increased pressure on nerves (post-op radic), inadequate decompression or fusion
Spinal cord stimulation
e-stim of the spinal cord replaces the pain sensation with a cool sensation, called paresthesia
clinical objective of spinal cord stim
match the paresthesia to the region(s) of pain by activating a specific population of DORSAL column fibers using a localized e-stim field.
quickly becoming the new standard for stroke care
mechanical thrombectomy for acute stoke
