Cervical Disk Herniation Flashcards
Which of the following statements are correct regarding cervical disk syndromes?
● A. C4–C5 herniated cervical disk is only 2%; it causes C5 nerve root compression, diminished deltoid and pectoralis reflexes, motor weakness in deltoid, and paresthesia or hypoesthesia in shoulder
● B. C5–C6 cervical disk herniation is 19%; it causes C6 nerve root compression, diminished biceps and brachioradialis reflex, forearm flexion weakness and paresthesia, and hypesthesia in upper arm, thumb, and radial forearm
● C. C6–C7 cervical disk herniation is 69%; it causes 7 nerve root compression, diminished triceps reflex, motor weakness of forearm extension (wrist drop), and paresthesia hypesthesia in fingers 2 and 3 with all finger tips
● D. C7–T1 cervical disk herniation is 10%; it causes C8 nerve root compression, diminished finger jerk, motor weakness in hand intrinsics, and paresthesia hypesthesia in fingers 4 and 5
● E. All of the above
E. All of the above
Evaluation for radiculopathy includes LMN findings which are weakness in one myotome group with atrophy and fasciculations present, sensory loss in dermatome similar to that of myotomal weakness, and eliciting muscle stretch reflexes and positive mechanical signs with reproduction of radicular
symptoms with mechanical loading of the head. Evidence of cervical cord involvement (myelopathy) is UMN findings in the lower extremity and presence of pathologic reflexes like Hoffmann’s reflex, Babinski sign, and ankle clonus. Following signs
are useful in evaluating cervical radiculopathy except?
● A. Painful limitation of neck movement in almost all herniated cervical disk patients. Neck extension usually aggravates pain when cervical disk disease is present. Some patients find relief in evaluating the arm and cupping the back or the top of the head with the hand (abduction relief sign)
● B. Lhermitte’s sign (electric shock like sensation radiating down the spine)
● C. Spurling’s sign
● D. Axial manual traction of a supine patient with 10 to 15 kg resulting in reduction or disappearance of radicular symptoms is a positive finding
● E. Positive shoulder abduction test in which lifting of hand above head causes reduction or disappearance of radicular signs
● F. Positive Hoffmann’s sign
F. Positive Hoffmann’s sign
Over 90% of patients with acute cervical radiculopathy due to cervical disk herniation can improve without surgery and regression of an extruded cervical disk has been demonstrated
radiographically. Conservative management of cervical disk includes the following except?
● A. Physical therapy which may include intermittent cervical traction (gradually escalating up to 10–15 pounds for 10–15 minutes for two to three times daily)
● B. Use of NSAIDs
● C. Use of short-course tapering steroids
● D. Trigger points injections and facet blocks have no role
● E. Epidural steroid injection (not used as often as in lumbar spine)
D. Trigger points injections and facet blocks have no role
Routine anterior approach for cervical spine surgery is usually able to access levels C3 and C7. While in patients with short thick neck, access may be even more limited. Which of the following are advantages of anterior approach over posterior approach?
● A. Safe removal of anterior osteophytes
● B. Fusion of disk space affords immobility, while there is 10% risk of immobility with extensive approach
● C. The only viable means of directly dealing with centrally herniated disk
● D. All of the above
D. All of the above
For ACDF, a horizontal skin incision in mediolateral direction is made. C5–C6 disk is at the level of which of the following?
● A. Hyoid bone
● B. Thyroid cartilage
● C. Cricoid cartilage
● D. Cricothyroid membrane
● E. None of the above
C. Cricoid cartilage
Choices of graft for anterior cervical fusion includes autologous graft (from iliac crest), nonautologous bone (cadaveric), bone substitutes (hydroxylapatite), or synthetic (PEEK, titanium) filled with osteogenic material. All of the following are benefits of anterior cervical plating except?
● A. It reduces pseudoarthrosis rate and graft problem
● B. It helps to maintain lordosis
● C. It is recommended for improvement of clinical outcome
● D. It is recommended to improve arm pain
C. It is recommended for improvement of clinical outcome
Postoperative check following ACDF includes which of the following?
● A. Checking for evidence of airway obstruction (check for hematoma, respiratory distress, extreme difficulty in swallowing, tracheal deviation)
● B. Weakness of nerve root of the level operated
● C. Long tract signs (Babinski) which may indicate cord compression by spinal epidural hematoma
● D. Hoarseness of voice which may show RLN injury
● E. All of the above
E. All of the above
ACDF complications include the following except?
● A. Exposure injuries (perforation of viscus like pharynx or esophagus or trachea, vocal cord paresis with incidence of 4% permanent and 11% temporary, vertebral artery injury with 0.3% incidence, carotid injury, CSF fistula, Horner syndrome, thoracic duct injury, thrombosis of internal jugular vein)
● B. Spinal cord or nerve root injury
● C. Bone fusion problems like failure of fusion (pseudoarthrosis), anterior kyphotic angulation, graft extrusion
● D. Wound infection, postoperative pneumothorax or hemothorax
● E. All of the above
E. All of the above
Indications for posterior keyhole laminotomy include which of the following?
● A. Monoradiculopathy with posterolateral soft disk sequestration
● B. Radiculopathy in patients who are professional singers or speakers
● C. For lower or upper cervical nerve root compression where anterior approach is more difficult
● D. In patients with herniated disk where it is desired to avoid fusion
● E. All of the above
E. All of the above
Posterior cervical decompression is usually reserved for which of the following cases?
● A. Multiple cervical disks or osteophytes (ACD is usually used to treat only two or three levels without myelopathy)
● B. Where cervical stenosis is more diffuse and more significant as compared to anterior pathology
● C. In professional speakers or singers
● D. All of the above
D. All of the above
A patient presented with weakness of forearm flexion, paresthesias in upper arm and thumb, and diminished biceps reflex. What is the level of herniated cervical disk?
● A. C2–C3
● B. C3–C4
● C. C4–C5
● D. C5–C6
● E. C6–C7
D. C5–C6
Which physical examination test for cervical disk herniation is analogous to straight leg raising test for lumbar disk herniation?
● A. Spurling test
● B. Axial manual spinal traction
● C. Shoulder abduction test
● D. FABER test
● E. Patrick test
A. Spurling test
What is the accuracy of CT myelogram for cervical disk disease?
● A. 70%
● B. 75%
● C. 80%
● D. 90%
● E. 98%
E. 98%
Which of the following is the most frequent radiculopathy mimicking carpal tunnel syndrome?
● A. C2
● B. C4
● C. C5
● D. C6
● E. C7
D. C6
How many patients with acute cervical radiculopathy due to cervical disk herniation can improve without surgery?
● A. 70%
● B. 80%
● C. 85%
● D. 90%
● E. 98
D. 90%
