cervical presentations Flashcards
Types of cancer that commonly metastasize to the vertebrae (75%)
Lead Kettle (PB KTL)
Prostate, breast, kidney , thyroid, lung
Types of cancer that commonly metastasize to the vertebrae (75%)
Lead Kettle (PB KTL)
Prostate, breast, kidney , thyroid, lung
rheumatoid arthritis prevalence and cervical spine complications
women>men, prior to 50s
-increased risk for AA instability, basilar invagination
ankylosing spondylitis definition and sequelae
(chronic inflammatory spondyloarthropathy)
def: ~vertebral fusion of spine, IV discs/end-plates, facet structures)
*high risk of SC injury, epidural hematoma,low-impact trauma, and osteoporosis
men>women
ankylosing spondylitis presentation (complaints)
back pain (worse @ night in morning and improves w/ exercise)-SI>thoracic>cervical
decreased chest wall expansion
back stiffness
ankylosing spondylitis examination
obs: “chin on chest”- flat lumbar+ kyphosis
ROM: multidirectional lim (AROM/PROM)
imaging: radiographic sacroilitis
klippel feil syndrome def and complications
persistent fusion of 2 or more vertebrae (2 and 3 most common)
-instability, spinal stenosis
klippel feil syndrome presentation
50% short neck, lower posterior hairline, lim C-spine ROM
50% scoliosis
cervical arterial dysfunction def and pathogenesis
internal tear w/in blood vessel wall wherein blood starts to fill in or clot (occluding or dissecting aneurysm)
-predisposition via underlying abnormality in arteries ( vertebral and internal carotid are common)
-trigger of infection (ex: dental abscess) or trauma
MOST significant risk factor of cervical artery dysfunction
HYPERTENSION +connective tissue disease (see also, high cholesterol, steroids, pregnancy, trx/infection, CVD, DM,etc)
cervical artery dysfunction presentation
severe head, neck and FACE pain
bilateral extremity dysesthesia, motor dysfn, pain
pulsatile tinnitus
horner’s syndrome
CN palsies
5 Ds and 3Ns
cervical artery dysfunction complications/sequelae
retinal or brain ischemia, local symptoms from stretch/compression, subarachnoid or intracerebral hemorrhage (pretty rare, mostly 39-45y/o)
what are the 5 Ds and 3 Ns and what do they relate to
cervical artery dysfunction
-dizziness,dysarthria, dysphagia,diplopia, drop attacks
-nystagmus,nausea, numbness (face, lip extremity)
what are the components of horner’s syndrome?
ptosis (droopy eyelid)
miosis (constricted pupil)
enophthalmos (sinking orbit)
anhidrosis (dry eyes)
cervical artery dysfunction exam
hx,interview neurologic testing, BP and thennn positional tests
positional:end range rotation, pre-manip positioning, modified sphinx, VBI
pathophysiology of myelopathy
SC compression from impinging structures; related but not synonymous with stenosis
epidemiology and symptoms of myelopathy
present in 90% of ppl by 60 y/o, often PLL is ossified
Imbalance/fall hx, neck pain/stiffness, UE (dysesthesia), may involve LEs first (gait,weakness)
general cervical spine myelopathy examination
s/s: gait impairment, spasticity, pathologic reflexes, hyperreflexia, incoordination, radicular signs that can be sensory and or weakness (unilat/bilat) , balance impairment
cervical myelopathy CPR (3/5=99%)
gait deviation, Hoffmann’s sign, Inverted supinator, Babinksi’s, >45 y/o
what are the 2 main contributors to upper cervical instability?
ligamentous deficit(concomitant connective tissue dx, trauma) and fracture (fatigue, trauma)
Pathogenesis of cervical ligament instability
trauma/surgery, and congenital collagenous dx, throat infection, inflammation
upper cervical instability symptomatology
neck pain, occipital HA/numbness, limited activities @ end range ROM, radicular OR myelopathic s/s, positional intolerance
cervical instability examination (minus special tests)
ROM: multidirectional lim, w/ potential guarding
potential radicular or myelopathic signs
common tests for upper cervical instability (may not even need to perform all of them)
Modified Sharp/purser (transverse lig) , alar ligament stability test, lateral shear, tectorial membrane, Posterior A-O
jefferson fracture
4 part burst of atlas bone (most commonly due to compression), screen other c-spine injuries too!
define spondylolysis
defect of pars interarticularis (area between sup and inf processes)
define spondylolisthesis.What is the most common location?
forward/backward translation of one vertebra on another (anterior is most common esp @ c3/4 and c4/5); can be graded I-V
what are the Canadian C-spine rules and what do they help us to decide?
they help us screen for if we need radiography
High risk? (>65y/o, dangerous MOA, extremity paresthesia)
Low risk? (simple rear-end collision, sitting in ER, ambulation, delayed pain, absent tenderness)
AROM? (at least 45* bilat)
what is the NEXUS low risk rule and who uses it?
typically immediate post-trauma (think ER and urgent care)
-no midline cervical tenderness
-no focal neurologic deficit (radicular/myelopathic )
-no intoxication
-no painful/distracting injury
-normal alertness
define spondylosis
when osteophyte complexes form around vertebrae body margins,hence it also affects discs
what are the 2 types of degenerative arthropathies?
spondylosis and osteoarthritis (typically @ AA and facet joints)
what are the 2 types of degenerative spinal stenosis?
lateral and central canal
describe complications related to central canal stenosis.
myelopathy, z-joint hypertrophy, bulging disc, thickening/ossification of ligament, spondylolysthesis
describe complications related to lateral canal stenosis.
loss ofo disc height, facet and uncovertebral joint hypertrophy, spondylolisthesis, and potential radicular pain or radiculopathy (check sensory AND motor)
what is the common MOI for acute z-joint arthropathy? What should we include in an examination for it?
Extension MOI
-pain w/ compression ROM (think lat flex, rotation,ext)
-pain w/ segmental provocation (P-As, U-Ps)
-potentially positive cervical compression & Spurling (IF RADICULAR)sd
define somatic referred pain
relatively localized pain perceived by one anatomic location that is innervated by nerves other than that of the true source (convergenge of 2 CNS regions)
define radicular pain
pain related to nerve root irritation perceived in dermatome distribution often when closing on foramen, w/ or without radiculopathy, can aso be inflmmed (radiculitis)
define radiculopathy
conduction block> motor weakness,hyporeflexia, and dysesthesia;
what c-spine region is most commonly impacted by radiculopathy?
C6 and C7 > spondylosis w/ foraminal encroachment in most cases; can be traumatic or gegenerative
what s/s might be present in a pt with cervical radiculopathy?
Bakody’s sign, pain/lim ROM w/ compressed foramen or stretched nerve root, positive valsalva, wainner’s cluster
what is wainner’s cluster?
ipsilateral c-spine rotation<60 deg, + Spurling’s, +Cervical distraction, ULTT
describe the 3 main components of the mechanics behind whiplash associated dx
trunk thrust upward, lower c-spine rotation, a distracted annulus w/ impaction on facet
what are some s/s that might cue you into a whiplash associated dx?
HISTORY!, post-concussive sx (ex. tinnitus, visual deficits, dizziness), myotomal weakness, radicular or referred sx, glove like paresthesia, neck or UE pain and limited ROM,
what nucleus do cervicogenic headaches originate from?
trigeminocervical (frontal, orbital and parietal referral meet C1-C3), over half follow whiplash occurrence.
criteria of dx cervicogenic headache
1+5:possible
>/=3: probable
1.unilateral HA that doesn’t switch
2. s/s neck involvement
3.fluctuating episodes
4.mod, non-excruciating throb
5. pain from neck»oculo, frontal, temporal
6. anaesthetic bock works
7. ANS s/s + sensory changes (vision, sound)
what other dx may need to be tested before confirming a cervicogenic dx?
migraine, dissecting aneurysm, posterior cranial fossa lesion, greater occipital neuralgia, neck-tongue syndrome, C2 neuralgia
what are the 3 proposed pathophysiologic mechanisms of cervicogenic dizziness
ischemic process impacting vertebrobasilar system, irritation of cervical SNS>vasomotor changes, altered proprio from upper c-spine
