Cervical and Thoracic Spine Flashcards
- Where do you most commonly get degeneration in the spine?
- You also commonly get what here?
- Uncovertebreal region in which degeneration occurs.
- This is where you get the osteophytes.
What are the lines pointing to?


- Nerve root exits above the pedicle with what number in the cervical spine?
- C8 root exits above the ____ pedicle?
- Nerve root exits below the pedicle with what number in the thoracic and lumbar spine?
- the same
- T1
- the same
Do we become more kyphotic or lordotic as we age?
Life is a kyphosing event. We lose lordosis.
Axial Pain Generator
Pain fibers located where?
5
- Annulus
- Joint – uncovertebral, facet
- Ligaments
- Periosteum
- Muscle/Fascia
Radicular Pain Generator
- Nerve root mediated how? 2
- Quality? 3
- Associated with what? 2
1.
- Compression
- Chemical/ inflammatory
2.
- Dermatomal sharp pain,
- numbness,
- parasthesia
3.
- weakness,
- hyporeflexia
- What is Referred Pain?
- Cause?
- Quality?
- Associated with?
- Axial or external pain localized to a site remote from location of nocioceptors
- Probable activation of contiguous cerebral cortex
- Dull, achy, nondermatomal pain
- Associated with axial pain
What areas are the following nerve roots associated with:
- C2-C3?
- C3-4?
- C 4-5?
- C 5-6?
- C6-7?

Pathophysiology/ Normal Aging
- Normal aging results in a degenerative cascade that may result in a what?
- what triggers the degenerative cascade?
- pathologic state
- Intervertebral disc biologic aging
Intervertebral Disc
- _______ is metabolically active, hydrostatic proteoglycans, shock absorber effect?
- Nucleus is vascular in childhood via what?
- Beginning at adolescence nutrition is via _______ only
- ___________ degenerate, loose H2O content(dehydrate)
- Alters biomechanical properties of the disc and the motion segment – loss of what?
- Nucleus
- annular arteries
- diffusion
- Proteoglycans
- shock absorber
- What happens to the quality of the disc as you age? 2
- There is also increased strain on the annulus? 3
1.
- Disc dehydration,
- disc narrowing
2. Increase strain on annulus - Diffuse bulging annulus
- Annulur tears
- Focal disc herniation
Normal Aging
- Stress transfer to where? 2
- What does this lead to? 2
1.
- uncovertebral
- facet joints
2.
- Arthrosis (bone spurs), stiffness
- Instability
Pathological States
DDx for Axial neck pain? 4
- Facet , uncovertebral joint arthritis
- Loss of lordosis resulting in muscular pain
- Instability
- Discogenic pain
- What is radiculopathy?
- Examples? 2
- What is myelopathy?
- Examples? 3
- Radiculopathy – pressure related nerve root disfunction (peripheral nerves)
2.
- Disc herniation
- Uncovertebral, facet joint spurs
3. Myelopathy – pressure related spinal cord disfunction (cord)
4.
- Large disc herniation
- Spurs
- Congenitally narrow canal
Which nerve roots are involved with the following Disc Space levels:


In lumbar spine the nerve part that is injured is which part of the nerve?
transverse portion/nerve that’s getting ready to exit
- For palpation on PE what bones do you want to make sure to palpate for the spine? 4
- Muscles? 4
- Bones –
- occiput,
- spinous processes,
- scapula,
- ribs - Muslces-
- paraspinal,
- trapezius,
- scapular elevators,
- sternocleidomastoid
Neurologic Exam
Motor Levels
What do the following do:
C5? 2
C6? 2
C7? 1
C8? 1
T1? 1
C5: deltoid shoulder, external rotators
C6: wrist extension, pronator teres
C7: triceps
C8: finger flexors
T1: interosseous
Neuro Exam
Describe the 5 levels of the Motor Scale
Motor Scale
5/5 normal
4/5 weak
3/5 > gravity- can bring arm up against gravity
2/5 less than gravity- can move side ways but not up and down
1/5 trace- twicth
0/5 absent
Some people may lose a lot more strength without noticing. Weakness of the phyiscal exam
For sensation on the spinal exam what should we test? 4
- Light touch
- Pin prick
- Vibration
- Temperature
DTR
Levels
- C5?
- C6?
- C7?
- If they are Hyporeflexic think?
- If they are Hyperreflexic think?
- biceps
- brachioradialis
- triceps
- – root lesion- radiculopathy
- – cord lesion- myopathy
Describe the C5 motor function, reflex and sensation

Describe the C6 motor function, reflex and sensation

Describe the C7 motor function, reflex and sensation

Describe the C8 motor function, reflex and sensation

Describe the T1 motor function, reflex and sensation

Physical Exam
Long tract signs? 5
- Hyperreflexia
- Clonus
- Spasticity, increase tone
- Gait, coordination, rectal tone
- Hoffman(UE), Babinski(LE)
Hoffman is an abnormal reflex- may have a myopathy
Physical Exam
Provacative Tests
3
- Spurlings – ipsilateral lateral bending + extension
- Reverse Spurlings – contralateral bending
- L’Hermitte
PE: Associated Systems? 6
- Vascular
- Cranial nerves
- Shoulder and other UE joints
- Peripheral nerves
- Lymphatic
- Pulmonary
What does the adson test indicate?

Axial DD:
- Spinal? 3
- Soft Tissue? 2
- Tumor/Infection? 2
- Inflammatory? 1
- Spinal
- Bone: fracture, instability
- Disc: degeneration, central HNP
- Joint: arthritis, instability - Soft tissue: sprain, fibromyalgia
- Tumor/Infection: primary, metastatic
- Inflammatory: R.A.
Axial Diagnostics Tests:
- Spinal
- bone? 2
- disc? 3
- Joints? 3 - Soft tissue? 2
- Tumor infection? 3
- Inflammatory? 1
- Spinal
- Bone: x-ray, bone scan
- Disc: MRI, myelo/CT, discography
- Joints: bone scan, F/E x-rays, facet injection - Soft Tissues: MRI, diagnosis of exclusion
- Tumor/Infection: labs, bone scan, MRI
- Inflammatory: labs
Tx Basics:
- Non-operative? 6
- Operative?
- Non - operative
- PT,
- NSAID,
- narcotics,
- MR,
- education, activity modification, reassurance
- Pain management: injection, RFA, - Operative
Fusion
Differential Diagnosis
Extremity pain:
- Nerve Root (radiculopathy)? 6
- Spinal Cord (myelopathy)? 9
- Peripheral Nerves? 4
- Joints? 3
1.
- HNP,
- spondylosis,
- instability,
- tumor,
- infection,
- fracture
2.
- HNP,
- stenosis,
- instability,
- cord lesions,
- medical,
- trauma,
- tumor,
- syrinx,
- CNS
3.
- entrapment,
- neuropathy,
- plexopathy,
- RSD
4.
- rotator cuff,
- tennis
- elbow
Dx tests
Extremity
- Nerve root? 4
- Spinal cord? 3
- Peripheral nerves? 1
- Joints? 1
- Nerve Root:
- MRI,
- myelo/CT,
- EMG,
- SNRB - Spinal Cord:
- MRI,
- myelo/CT,
- SSEP - Peripheral Nerves:
- NCV - Joints:
- orthopedic evaluation
Tx Basics
Extremity
- Nonoperative? 6
- Operative? 1
- Non - operative
- NSAID,
- narcotics,
- steroid injection,
- traction,
- collar
- Myelopathy: more urgent W/U - Operative
- Decompression +/- fusion