C-Spine lecture5

Question 1

Where in the c-spine do you get the most axial rotation?

Answer 1

C1-2

Question 2

Where in the c-spine do you get the least axial rotation?

Answer 2

C0-1

Question 3

Which motion in general does the C-spine have most of

Answer 3

Flexion/Extension (with the exception of rotation at C1-2)

Question 4

According to Cross, thoracic spine thrust manipulation provides ______ improvement in patients with acute or subacute mechanical neck pain

Answer 4

short-term (decreased pain, increased neck motion, and improved function)

Question 5

T/F intermittent cervical traction and manip of thoracic can be done in patients with mild cervical compressive myelopathy attributed to herniated disc

Answer 5

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

Question 6

T/F quality literature has been published on the benefit of proprioception exercises for the neck and low back

Answer 6

F

Question 7

Regarding exercise for chronic neck pain patients, O’Riordan suggests

Answer 7

min of 3x per week for 30-60 min at intensity up to 80% of max

Question 8

T/F no definitive statements to support or refute use of electrotherapy treatment for neck pain

Answer 8

T

Question 9

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

Answer 9

T

Question 10

10 red flags for cervical patient

Answer 10

1. abnormal sensations (numbness, pins and needles)
2. headaches
3. night pain
4. sustained morning stiffness
5. light-headedness
6. trauma (MVA, a fall)
7. night sweats
8. constipation
9. easy bruising
10. changes in vision

Question 11

Mobility classification

Answer 11

recent onset of symptoms, no radicular signs/symp.

Manual therapy and exercise

Question 12

centralization classification

Answer 12

radicular signs/symp. symptoms distal to elbow.

Activities to promote centralization

Question 13

exercise and conditioning classification

Answer 13

no radicular signs/sx. chronic

Conditioning and strengthening exercises

Question 14

headaches classification

Answer 14

primary complaint is headache. cervicogenic headache

Man therapy, neck flexor/scapular strengthening

Question 15

pain control classification

Answer 15

acute onset of symptoms, traumatic mechanism

Gentle ROM and activity

Question 16

NDI scoring 0-4 (<10%)

Answer 16

no disability (stage 3)

Question 17

NDI score 5-14

Answer 17

mild disability (stage 2)

Question 18

NDI score 15-24

Answer 18

moderate disability (stage 2)

Question 19

NDI score 25-34

Answer 19

severe disability (stage 1)

Question 20

NDI score 34 or greater

Answer 20

complete disabilty (stage 1)

Question 21

After staging a patient in stage 1 classification, what categories for treatment do you use?

Answer 21

mobility, centralization, CGH (headache), Exercise/conditioning, pain control

Question 22

Once a patients progresses to stage 2 classification, what categories for treatment do you use?

Answer 22

Aerobic activity, eliminate impairments, posture, strengthening, flexibility and mobility

Question 23

Indications for surgery

Answer 23

progressive neurological deterioration, failure of non-surgical treatment, weakness that persists

Question 24

progressive neurological deterioration

Answer 24

weakness worsening, risk of falling increased, coordination getting worse

Question 25

Failure of non-surgical treatment

Answer 25

pain persists, tried all other options, cannot function without pain, cannot work/sleep, ADL hampered

Question 26

weakness that persists

Answer 26

weakness not getting worse but prevents or interferes with work or ADL, likelihood of the problem causing weakness to improve is low

Question 27

Decompressive laminectomy

Answer 27

remove bone or dist to relieve pressure on nerves or spinal cord

Question 28

downside of decompressive laminectomy

Answer 28

alter the jt architecture, forces, function
denervation of muscle to some degree
weaken mm attachment to bone

Question 29

which surgery has the best success rates

Answer 29

microdiscectomy

Question 30

Factors that determine prognosis for poor surgical results

Answer 30

diagnosis is not clear, expectations not realistic, smoking, depression, anxiety, chronic pain, diabetes, obesity, osteopororsis, worker’s comp, litigation

Question 31

theoretical pros of minimally invasive surgery

Answer 31

less mm ischemia, less blood loss

Question 32

cons of minimally invasive surgery

Answer 32

limited visualization, longer operative time, more use of radiation (fluoroscopy), inadequate decompression

Question 33

Theoretical risks of minimally invasive surgery

Answer 33

higher chance of wrong level surgery, increased pressure on nerves (post-op radic), inadequate decompression or fusion

Question 34

Spinal cord stimulation

Answer 34

e-stim of the spinal cord replaces the pain sensation with a cool sensation, called paresthesia

Question 35

clinical objective of spinal cord stim

Answer 35

match the paresthesia to the region(s) of pain by activating a specific population of DORSAL column fibers using a localized e-stim field.

Question 36

quickly becoming the new standard for stroke care

Answer 36

mechanical thrombectomy for acute stoke