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Ortho Spine CT > C-Spine Pathology > Flashcards

C-Spine Pathology Flashcards

1
Q

Canadian C-Spine rule for stable trauma patients

A

Patient 65+
Or paresthesias in extremities
Or dangerous mechanism of injury (fall over 1m/5 stairs;MVA.60mph; rollover or ejection; bike collision; motorized recreational vehicle accident)

If no to the above, and if crash was only simple rear end, the patient can sit in ER, the patient has been ambulatory at any time, the patient had delayed onset of pain, they don’t have midline tenderness, and they can rotate head 45 degrees both ways then NO X-RAY

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2
Q

What are symptoms of cervical instability?

A

Occipital HA
Occipital numbness
Limitations in AROM in all directions
Signs of myelopathy

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3
Q

What are signs of vertebral artery insufficiency?

A

5D’s And 3 N’s
Diziness, Diploplia/changed acuity, dysarthria, dysphagia, drop attacks

Ataxia or anxiety/panic

Nystagmus, numbness, nausea

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4
Q

Signs of systematic inflammatory process

A

High temperature bp >160/95
High HR>100
High RR >25
Fatigue

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5
Q

Signs of myelopathy

A 
Hyperreflexia (incl. Hoffman's sign)
unsteady gait
Bowel and Bladder dysfunction
weakness and sensory change
Sensory disturbance in the hand
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6
Q

Signs of neoplasm

A

Pain at night/with rest
weight loss
history of cancer
age (>50)

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7
Q

Inflammatory arthritis of c-spine: symptoms

A

posterior aching in neck, shoulder, occipital region

symptoms increase with flexion

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8
Q

Structures most commonly involved in inflammatory arthritis of C-spine (e.g. RA)

A

AA facets, transverse ligament, dens

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9
Q

What % of individuals with RA have c-spine involvement?

A

50%

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10
Q

Types of headache

A

Migraine/HA of vascular origin
Organic H/A (can’t reproduce symptoms)
Mechanical/cervicogenic

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11
Q

Which muscles may produce cervicogenic HA?

A

Likely only muscles innervated by C1, C2, C3 (suboccipitals!)

Trigger points in trapezius, SCM, splenius capitus may refer to head, but likely don’t produce true headache

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12
Q

Where can pain be located in cervicogenic HA?

A

Neck and occiput
forehead, orbital region, temple, and ears
Primarily unilateral

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13
Q

Potential sources of pain in cervicogenic HA

A
  • referral via spinal trigeminal nucleus
  • irritation of DRG of C2 or C2 ventral ramus compression
  • WAD
  • Occipital neuralgia (compression of greater occipital nerve–likely overdiagnosed)
  • Psychological factors?
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14
Q

What is the pain-spasm-pain cycle?

A

Process whereby irritation of soft tissues–>tension in the muscle–>ischemia, metabolite buildup, and further irritation–>further tension in muscle–>long-term potential for fibrosis and further disability

may play role in cervicogenic HA

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15
Q

Pt presenting with painful neck splinting, occipatal numbness, and neuro signs may have damage to what structures?

A

C1/C2 vertebrae (fractures)

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16
Q

How much does demand on lower C-spine increase when head is held in forward posture?

A

Every inch forward adds weight of head

e.g. 10 lb head, 1 inch forward would –>20 lbs load; 2 in forward would–>30lbs load

17
Q

What is the source of pain in c-spine OA?

A

LIkely capsular thickening–>decreased motion and pain when stretched

18
Q

What is the order of symptom onset and motion loss with DJD/DDD/OA/spondylosis?

A

1) pain in c-spine and/or arm increases in severity and frequency
2)loss of sidebending
3) loss of extension
4) loss of flexion and rotation (Opening)
Morning stiffness is also key symptom

19
Q

What structure is effected with central stenosis?

A

Disk material and osteophytes impinge upon spinal cord in spinal canal–>cervical myelopathy

20
Q

What structure is impacted with lateral stenosis

A

Nerve roots

21
Q

Spondylosis/OA structures involved

A

begins in IVD, progresses to facet and uncovertebral joints; can–>spondylitic myelopathy

22
Q

Progression of spondylosis

A

Decreased water in nucleus pulposis in 20’s–>increased load on annulus fibrosis–>cracks in AF–>decreased disk height–>changed arthrokinematics–>osteophytes

23
Q

4 “classifications” of cervical spondylosis

A

1) Neck pain
2) Neck pain with proximal referral (e.g trapezius, occiput)
3) radicular pain
3) myelopathy

24
Q

What signs may indicate that changes resulting from spondylosis are encroaching on intervertebral foramen?

A

Nerve root signs (radiating pain, dermatomal sensory changes, diminished reflexes…)

25
Q

What signs may indicate that changes resulting from spondylosis are encroaching on the vertebral canal?

A

Cord signs (drop attacks, hyperreflexia, etc)

26
Q

Joints/levels most commonly effected by spondylosis

A

C5/C6>C6/C7>C3/C4>C7/C8 (C2/C3 possible but rare)

27
Q

What prevents central disk protrusions in the C-Spine?

A

Posterior longitudinal ligament

28
Q

What causes acute cervical spine joint lock/”wry neck”

A

small piece of synovial membrane entrapped in facet joint or uncovertebral joint
AND/OR
Neurophysiological muscle tightness to protect area (manips are effective)

29
Q

Synovial membrane inflammation is called and may lead to

A

Synovitis; persistant inflammation–>cartilage erosion, subchondral bony proliferation, instability of AA joint, muscle aches, fatigue

30
Q

Exam findings: synovitis

A

Joint is painful and feels puffy/boggy during manual exam

31
Q

Whiplash associated disorder classification grades (key differences–see P. 467 course packet for full list)

A

WAD 0=no signs or symptoms
WAD I=Neck pain or stiffness, no physical signs
WAD IIA= WAD I plus motor impairment/decreased ROM and recruitment and local hyperalgesia
WAD IIB= IIA plus psychological impairment
WAD IIC= IIB plus generalized hypersensitivity (central sensitization) and decreased proprioception
WADIII=IIC plus nerve conduction loss
WAD IV=fracture or dislocation

32
Q

Cervicocephalic WAD presents with:

A

neck pain, HA, fatigue, vertigo, decreased concentration/cognitive function, light and noise sensitivity, nervous tissue trauma, barre syndrome

33
Q

Cervicobrachial WAD presents with:

A

neck and UE pain, damaged soft tissue, uncovertebral bruising, joint capsule damage

34
Q

What is the most common cause of disk herniation in the C-Spine

A

Degeneration (fissures in AF): rare before 30, most commonly at 50

35
Q

Pain from IVD herniation in C-spine (location)

A

Broad regions, can be central, unilateral, bilateral

36
Q

Most common nerve root effected by radiculopathy

A

C6 and C7 >C8 > C5

37
Q

Brachial Neuralgia (description)

A

Pain in nerve root distribution as a result of compression; lasts up to 16 weeks

38
Q

CPR for cervical radiculopathy

A

+ULNT 1

Cervical rotation+LR 9.6)

39
Q

Signs and Symptoms of myelopathy

A 
Leg symptoms/incoordination
spasticity
weakness
paresthesias in multiple segments
hyperreflexia
balance disturbance
visual problem
ataxia
bowel and bladder change

Ortho Spine CT (16 decks)

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