Cervical Pathology

Question 1

Whiplash

Answer 1

primarily muscle and/or ligamentous strain
can be associated with bony/joint injuries/dysfunction
MOI - acc/dec involving rapid and uncontrolled ext/flex
potential for vertebral artery injury
often associated with dizziness and headache in addition to spasm

Question 2

Whiplash Management

Answer 2

AVOID - forceful use of muscle, traction, aggressive massage (esp along length of muscle), joint mob
may need support - soft collar for short period of time
restore normal pain-free active mobility and muscle balance (CON, ECC, endurance)

Question 3

Spondylosis

Answer 3

potential for lateral or central stenosis
decreased IVF space (lateral) or cord space (central)
disc space narrowing
osteophytes

Question 4

Spondylosis Signs and Symptoms

Answer 4

cervical radiculopathy
headaches that radiate to back of head
cervical myelopathy - cord compression - more diffuse UE symptoms/clumsiess, may have LE UMN symptoms

Question 5

Spondylosis Surgical Management

Answer 5

laminectomy
laminoplasty - open hinge to decompress cord and nerve roots
- supportive collar post-op for several weeks, gradual mobility and strengthening afterwards

Question 6

Disc-Related Disorders

Answer 6

most common - C4-5, C5-6
cervical roots exit ABOVE corresponding vertebra (C5 exits between C4-5 segment, C8 below C7)
often associated with UE radiculopathy
bulge/herniation may be ant or post

Question 7

ACDF Management

Answer 7

anterior cervical discectomy and fusion

post-op brace until bone heals (graft usually from iliac crest)
no - lifting overhead and no lifting beyond 10 lb, driving, repetitive bending
take small bites and chew well

Question 8

Jefferson Fx (C1)

Answer 8

burst fx of ring structure of C1 = combined fx of ant and post arches
moderately unstable
MOI - axial compression often from fall on head
may have associated head injuries

Question 9

Jefferson Fx Treatment

Answer 9

nondisplaced - philly or four poster type brace
displaced - halo traction
bone healing - 8-16 weeks

Question 10

Odontoid Fx (C2) MOI, Treatment and Management

Answer 10

MOI - combo of flex/rot and ex
I - fx of tip; soft collar
II - fx at base or neck; halo or operation and then halo vest
III - fx extends body of atlas; usualy halo traction, then halo vest, immobilized 12-16 weeks

Question 11

Hangman’s Fx (C2)

Answer 11

Fx of neutral arch of C2 = separation of body from post elements
MOI - forceful ext of already ext neck, mostly MVA

Question 12

Hangman’s Fx (C2) Treatment and Management

Answer 12

I - philly collar or four poster
II - closed reduction with axial traction, immobilized in halo vest brace
III - ORIF with post fusion of C2-C3 then halo vest
All types immobilized 8-12 weeks

Question 13

Whiplash Classification

Answer 13

0 - no symptom of neck pain or physical signs
1 - neck symptom (pain, stiffness, or tenderness only), no physical signs
2 - neck symptom, musculoskeletal symptoms (decreased ROM, point tenderness)
3 - neck symptom, musculoskeletal signs, neruological signs (decreased/absent DTRs, muscle weakness, sensory deficits)
4 - neck symptoms and fx/dislocation

Question 14

WAD II

Answer 14

A - neck pain, motor impairment (dereased ROM, altered muscle recruitment patterns), sensory impairment (local cervical mechanical hyperalgia)
B - neck pain, motor and sensory impairment, psychological impairment (elevated psychological distress)
C
- neck, pain
- motor impairment (all and increased joint positioning errors)
- sensory impairment (all and generalized sensory hypersensitivity [mechanical, thermal, B ULTT 1 limitation], some may show SNS disturbances)
- psychological impairment - all and elevated levelso f acute posttraumatic stress