Cervical and Thoracic Spine COPY

Question 1

1. Where do you most commonly get degeneration in the spine?
2. You also commonly get what here?

Answer 1

1. Uncovertebreal region in which degeneration occurs.
2. This is where you get the osteophytes.

Question 2

What are the lines pointing to?

Answer 2

Question 3

1. Nerve root exits above the pedicle with what number in the cervical spine?
2. C8 root exits above the ____ pedicle?
3. Nerve root exits below the pedicle with what number in the thoracic and lumbar spine?

Answer 3

1. the same
2. T1
3. the same

Question 4

Do we become more kyphotic or lordotic as we age?

Answer 4

Life is a kyphosing event. We lose lordosis.

Question 5

Axial Pain Generator

Pain fibers located where?

5

Answer 5

1. Annulus
2. Joint – uncovertebral, facet
3. Ligaments
4. Periosteum
5. Muscle/Fascia

Question 6

Radicular Pain Generator

1. Nerve root mediated how? 2
2. Quality? 3
3. Associated with what? 2

Answer 6

1.

• Compression
• Chemical/ inflammatory

2.

• Dermatomal sharp pain,
• numbness,
• parasthesia

3.

• weakness,
• hyporeflexia

Question 7

1. What is Referred Pain?
2. Cause?
3. Quality?
4. Associated with?

Answer 7

1. Axial or external pain localized to a site remote from location of nocioceptors
2. Probable activation of contiguous cerebral cortex
3. Dull, achy, nondermatomal pain
4. Associated with axial pain

Question 8

What areas are the following nerve roots associated with:

1. C2-C3?
2. C3-4?
3. C 4-5?
4. C 5-6?
5. C6-7?

Answer 8

Question 9

Pathophysiology/ Normal Aging

1. Normal aging results in a degenerative cascade that may result in a what?
2. what triggers the degenerative cascade?

Answer 9

1. pathologic state
2. Intervertebral disc biologic aging

Question 10

Intervertebral Disc

1. _______ is metabolically active, hydrostatic proteoglycans, shock absorber effect?
2. Nucleus is vascular in childhood via what?
3. Beginning at adolescence nutrition is via _______ only
4. ___________ degenerate, loose H2O content(dehydrate)
5. Alters biomechanical properties of the disc and the motion segment – loss of what?

Answer 10

1. Nucleus
2. annular arteries
3. diffusion
4. Proteoglycans
5. shock absorber

Question 11

1. What happens to the quality of the disc as you age? 2
2. There is also increased strain on the annulus? 3

Answer 11

1.

• Disc dehydration,
• disc narrowing
  2. Increase strain on annulus
• Diffuse bulging annulus
• Annulur tears
• Focal disc herniation

Question 12

Normal Aging

1. Stress transfer to where? 2
2. What does this lead to? 2

Answer 12

1.

• uncovertebral
• facet joints

2.

• Arthrosis (bone spurs), stiffness
• Instability

Question 13

Pathological States

DDx for Axial neck pain? 4

Answer 13

1. Facet , uncovertebral joint arthritis
2. Loss of lordosis resulting in muscular pain
3. Instability
4. Discogenic pain

Question 14

1. What is radiculopathy?
2. Examples? 2
3. What is myelopathy?
4. Examples? 3

Answer 14

1. 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

Question 15

Which nerve roots are involved with the following Disc Space levels:

Answer 15

Question 16

In lumbar spine the nerve part that is injured is which part of the nerve?

Answer 16

transverse portion/nerve that’s getting ready to exit

Question 17

1. For palpation on PE what bones do you want to make sure to palpate for the spine? 4
2. Muscles? 4

Answer 17

1. Bones –
   - occiput,
   - spinous processes,
   - scapula,
   - ribs
2. Muslces-
   - paraspinal,
   - trapezius,
   - scapular elevators,
   - sternocleidomastoid

Question 18

Neurologic Exam

Motor Levels

What do the following do:

C5? 2

C6? 2

C7? 1

C8? 1

T1? 1

Answer 18

C5: deltoid shoulder, external rotators

C6: wrist extension, pronator teres

C7: triceps

C8: finger flexors

T1: interosseous

Question 19

Neuro Exam

Describe the 5 levels of the Motor Scale

Answer 19

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

Question 20

For sensation on the spinal exam what should we test? 4

Answer 20

1. Light touch
2. Pin prick
3. Vibration
4. Temperature

Question 21

DTR

Levels

1. C5?
2. C6?
3. C7?
4. If they are Hyporeflexic think?
5. If they are Hyperreflexic think?

Answer 21

1. biceps
2. brachioradialis
3. triceps
4. – root lesion- radiculopathy
5. – cord lesion- myopathy

Question 22

Describe the C5 motor function, reflex and sensation

Answer 22

Question 23

Describe the C6 motor function, reflex and sensation

Answer 23

Question 24

Describe the C7 motor function, reflex and sensation

Answer 24

Question 25

Describe the C8 motor function, reflex and sensation

Answer 25

Question 26

Describe the T1 motor function, reflex and sensation

Answer 26

Question 27

Physical Exam Long tract signs? 5

Answer 27

1. Hyperreflexia 2. Clonus 3. Spasticity, increase tone 4. Gait, coordination, rectal tone 5. Hoffman(UE), Babinski(LE) Hoffman is an abnormal reflex- may have a myopathy

Question 28

Physical Exam Provacative Tests 3

Answer 28

1. Spurlings – ipsilateral lateral bending + extension 2. Reverse Spurlings – contralateral bending 3. L’Hermitte

Question 29

PE: Associated Systems? 6

Answer 29

1. Vascular 2. Cranial nerves 3. Shoulder and other UE joints 4. Peripheral nerves 5. Lymphatic 6. Pulmonary

Question 30

What does the adson test indicate?

Answer 30

Question 31

Axial DD: 1. Spinal? 3 2. Soft Tissue? 2 3. Tumor/Infection? 2 4. Inflammatory? 1

Answer 31

1. Spinal - Bone: fracture, instability - Disc: degeneration, central HNP - Joint: arthritis, instability 2. Soft tissue: sprain, fibromyalgia 3. Tumor/Infection: primary, metastatic 4. Inflammatory: R.A.

Question 32

Axial Diagnostics Tests: 1. Spinal - bone? 2 - disc? 3 - Joints? 3 2. Soft tissue? 2 3. Tumor infection? 3 4. Inflammatory? 1

Answer 32

1. Spinal - Bone: x-ray, bone scan - Disc: MRI, myelo/CT, discography - Joints: bone scan, F/E x-rays, facet injection 2. Soft Tissues: MRI, diagnosis of exclusion 3. Tumor/Infection: labs, bone scan, MRI 4. Inflammatory: labs

Question 33

Tx Basics: 1. Non-operative? 6 2. Operative?

Answer 33

1. Non - operative - PT, - NSAID, - narcotics, - MR, - education, activity modification, reassurance - Pain management: injection, RFA, 2. Operative Fusion

Question 34

Differential Diagnosis Extremity pain: 1. Nerve Root (radiculopathy)? 6 2. Spinal Cord (myelopathy)? 9 3. Peripheral Nerves? 4 4. Joints? 3

Answer 34

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

Question 35

Dx tests ## Footnote Extremity 1. Nerve root? 4 2. Spinal cord? 3 3. Peripheral nerves? 1 4. Joints? 1

Answer 35

1. Nerve Root: - MRI, - myelo/CT, - EMG, - SNRB 2. Spinal Cord: - MRI, - myelo/CT, - SSEP 3. Peripheral Nerves: - NCV 4. Joints: - orthopedic evaluation

Question 36

Tx Basics ## Footnote Extremity 1. Nonoperative? 6 2. Operative? 1

Answer 36

1. Non - operative - NSAID, - narcotics, - steroid injection, - traction, - collar - Myelopathy: more urgent W/U 2. Operative - Decompression +/- fusion