Cervical Spine

Question 1

Signs of Vertebrobasilar Artery(VBA) Dissection

Answer 1

Unsteadiness/ataxia 67%
Dysphagia/dysarthria/aphasia 44%
Lower limb weakness 41%
Upper limb weakness 33%
Nausea/vomiting 26%
Facial palsy 22%
Dizziness/loss of equilibrium 20%
Loss of consciousness 15%

Question 2

Signs of Internal Carotid Artery (ICA) Dissection

Answer 2

Ptosis 60-80%
Upper limb weakness 65%
Facial palsy 60%
Lower limb weakness 50%
Dysphagia/dysarthira/aphasia 45%
Unsteadiness/ataxia 40%
Nausea/vomiting 30%
Loss of consciousness 20%

Question 3

NDI outcome measure MDC?

Answer 3

5/50 for uncomplicated neck pain;
up to 10/50 for cervical radiculopathy

Question 4

NDI outcome measure CID(clinically important difference)

Answer 4

varies from 5/50 to 19/50 across studies

Question 5

Canadian C-Spine Rule

Answer 5

Pt should get X-ray if
1) Any high risk factor MOI=yes
2) Low risk factor MOI=no
3) Able to actively rotate 45* R and L=no

not applicable in certain populations, injury type, presentation

Question 6

Nexus Criteria for C-spine Imaging

Answer 6

Imaging indicated if any of the following present:
1) focal neuro deficit
2) midline spine tenderness
3) altered LOC present
4) intoxication present
5) distracting injury present

Question 7

Predictors for moderate/severe disability at 12 months after WAD

Answer 7

age 35+, NDI 40%+, hyperarousal symptoms 6+ on subscale of PTSD scale

Question 8

predictors for full recovery after WAD

Answer 8

age <35, NDI scores <=32%
-majority of recovery takes place in first 3 months

Question 9

Cook et al cluster to diagnose cervical myelopathy

Answer 9

-age >45
-positive babinski sign
-positive supinator sign

Question 10

Referred pain location liver/gallbladder

Answer 10

R shoulder

R sided lower scapula and back pain

RUQ for gallbladder

Question 11

Referred pain location heart

Answer 11

chest, L arm mimicking cervical radiating pain C8/T1 dermatome

Question 12

Referred pain location lungs/diaphragm

Answer 12

clavicular and neck region

Question 13

Referred pain location stomach

Answer 13

middle/upper portion of anterior or posterior abdomen/back

Question 14

referred pain location colon

Answer 14

anterior lower abdomen and pelvis

Question 15

referred pain location urinary bladder

Answer 15

sacral region

Question 16

referred pain ovaries

Answer 16

similar anatomical location abdomen

Question 17

referred pain location kidneys

Answer 17

flank pain wrapping around lower back

Question 18

referred pain location appendix

Answer 18

RLQ

Question 19

referred pain location pancreas

Answer 19

upper back or abdomen

Question 20

Cervical manipulation CPR for positive outcome

Answer 20

-symptoms duration < 38 days
-positive expectation manipulation will help
-difference of >10 ROM rotation side to side
-pain w/ PA spring testing of midcervical spine

Question 21

Cervical traction & exercise CPR

Answer 21

-peripheralization w/ C4-7 mobility testing
-positive shoulder abduction relief sign
-age >=55
-positive ULTT A(median nerve)
-positive cervical distraction test

Question 22

Cervical radiculopathy CPR

Answer 22

-positive ULTT A(median nerve)
-cervical rotation <60* towards invlved side
-positive cervical distraction test
-positive Spurling’s A test

3 positives = 65% probability
4 positive = 90% probability

Question 23

C spine imaging signs

Answer 23

hamburger sign
-NORMAL on CT/MRI
-shows superior/inferior facets are normally aligned

reverse hamburger sign
-indicates dislocated or locked facet
-“hamburger buns are inverted”

naked facet sign
-only 1 facet is visible
-indicates dislocated or locked facet
-severe ligamentous disruption/spinal instability