Cervical Spine

Question 1

How is stability defined in the context of cervical spine injury?

Answer 1

the ability of the spine to maintain function without development of neurologic sx, chronic pain or deformity

Question 2

Describe the symptoms of whiplash associated disorder.

Answer 2

hyperextension mechanism causes the following symptoms

muscle strains of strap muscles and SCM
damage to the sympathetic trunk (autonomic dysfunction)
facet joint impaction (cartilage can be sheared off and appear normal on imaging)
disc disruption

Question 3

How do you assess someone with suspected WAD?

Answer 3

palpate for tenderness
test ROM, starting with rotation then flexion
look for horner’s syndrome autonomic dysfunction

Question 4

What is the prognosis of someone with WAD?

Answer 4

95% improve without treatment
10-20% have chronic pain and 2-5% have disabling pain

poorer prognosis with high pain at initial contact (consider emotional response) and those unable to cope with pain (social network, drug use, etc)

Question 5

What is the treatment for WAD?

Answer 5

little proven effective

short rest period, ICE, NSAIDs, reassurance, high risk should receive PT early on +/- early behavioral cognitive therapy

Question 6

What is the treatment for WAD?

Answer 6

little proven effective

short rest period, ICE, NSAIDs, reassurance, high risk should receive PT early on +/- early behavioral cognitive therapy

Question 7

Describe factors/conditions that put someone in danger of cervical radiculopathy.

Answer 7

disc deformity- either nucleus leaking into epidural/foramenal space or defect in disk annulus

cervical spondylosis: foramen stenosis, osteophytes on the uncinate process

70% is genetic (related to collagen deformities?)

history of smoking, vibrating equipment and repetitive lift

Question 8

When is imaging standard of treatment for radicular pain?

Answer 8

after 6 weeks pain, many people will recover without further treatment

those requiring imaging and likely surgery sooner include those who fail to improve, have disabling pain, have progressive neurologic deficits and those with severe weakness (ie. quadriparesis

Question 9

Describe the pathophysiology of radiculopathy regarding nerve compression and chemical mediated inflammation.

Answer 9

when nerve is compressed it impairs axon potentials and causes hypersensitivity at synapses

chemical mediated inflammation includes cytokine release (IL-1, 6, TNFa and PGE3); WBC and macrophage response, proteolytic enzymes as part of response can lead to tissue degradation

Question 10

What is the treatment for radicular pain?

Answer 10

reduce activity that causes pain while staying active as possible

pain can be addressed with gabapentin (best), NSAIDs; short term opioids and steroids show little response

Question 11

What is the treatment for radicular pain?

Answer 11

reduce activity that causes pain while staying active as possible

pain can be addressed with gabapentin (best), NSAIDs; short term opioids and steroids show little response

Question 12

Compare anterior and posterior surgical approaches to cervical radiculopathy.

Answer 12

anterior diseconomy requires fusion and disc replacement
posterior includes diseconomy and avoids fusion but can only be use to address lateral disc abnormalities

90-95% satisfaction rate, no difference by approach, 10% re-operation rate

Question 13

Describe the typical presentation of cervical myelopathy.

Answer 13

typically not as painful as radiculopathy and the overwhelming symptom is loss of sensation or motor abilities; will have UMN signs and possible changes to gait and coordination

use UMN and LMN signs to differentiate

Question 14

What conditions are known to cause cervical myelopathy?

Answer 14

narrowing int eh spinal column due to: 
congenital formation 
degenerative spondylosis (most common)
disc herniation
instability/ subluxation
deformity (kyphosis)
inflammatory pannus (RA)
ossification of the posterior longitudinal ligament (Asia)

Question 15

What conditions are known to cause cervical myelopathy?

Answer 15

narrowing int eh spinal column due to: 
congenital formation 
degenerative spondylosis (most common)
disc herniation
instability/ subluxation
deformity (kyphosis)
inflammatory pannus (RA)
ossification of the posterior longitudinal ligament (Asia)

Question 16

Describe the process by which damage occurs to the spinal cord in myopathy.

Answer 16

ischemia and loss of auto regulation
loss of myelin sheath, necrosis of glia and neurons
edema (on MRI)
spinal cord infarct/atrophy

Question 17

Do all those with mylopathy require surgery?

Answer 17

most that are asymptomatic or mild do not need surgery (only 10-20%), for these risk of surgery is greater than the risk of observation

for those with moderate to severe myopathy there is no effective non-operative treatment, improvement in 80% after surgery, rarely a complete recovery