Cervical spine

Question 1

What are the components of the functional spinal unit?

Answer 1

three joint complex of intervertebral disc and paired facet joint articulations

Question 2

Describe the contents and function of the anterior and posterior spinal columns

Answer 2

Anterior: consists of vertebral bodies and intervertebral discs, functions to transmit loads and is themweight bearing column.

Posterior: a tension band that controls motion and is important to prevent excessive movements.

Question 3

What components are present in the nucleus of an intervertebral disc?

Answer 3

water, proteoglycans, type 2 collagen

Question 4

In what ways is the environment within an intervertebral disc hostile to cellular activity?

Answer 4

low oxygen, low pH, high pressure

Question 5

Describe age related changes in disc space that are seen on radiographs

Answer 5

disc space narrowing
end plate scerlosis
osteophyte formation
subluxation
loss of hydration

Question 6

What muscles can be strained in whiplash associated disorder?

Answer 6

anterior musculature including strap muscle, sternocleidomastoid and longis coli

Question 7

Injury to the ______ can cause autonomic and visceral symptoms in WAD

Answer 7

sympathetic plexus

- Horner’s syndrome

Question 8

What treatments are used for WAD?

Answer 8

short period of rest, ice, NSAIDs, PT and CBT if high risk

NOT surgical

Question 9

_____ will present with dermatomal distribution to pain, + Spurlings test, and possibly weakness

Answer 9

cervical radiculopathy

Question 10

__________ is an autoimmune induced inflammation of the brachial plexus

Answer 10

Parsonage Turner syndrome

Question 11

Describe causes of disc herniation that cause cervical radiculopathy

Answer 11

nucleus leaking into foramen
defect in annulus
genetics- collagen mutations
environmental- smoking, repetitive lifting, operating vibrating equipment

Question 12

What is on the differential diagnosis for cervical radiculopathy?

Answer 12

herniated disc
foramenal stenosis
peripheral nerve entrapment- carpal tunnel etc
tumor
infection
inflammatory disease

Question 13

Imaging is not used to work up cervical radiculopathy unless:

Answer 13

• greater than 6 weeks with no improvement

Question 14

Describe the pathophysiology of radiculopathy

Answer 14

• nerve compression: impaired axon potentials, hypersensitivity
• inflammation: cytokines, MMPs, leukocytes

Question 15

Describe treatments of cervical radiculopathy

Answer 15

• moderate activity, gabapentin, NSAIDs, very short term opioids, PT??
• surgery only if > 6 weeks or progressive neurologic defects- anterior or posterior discectomy

Question 16

Describe the presentation of cervical myelopathy

Answer 16

upper motor neuron signs- gait, clumsiness, neuro exam abnormalities, hyper-reflexia

Question 17

Describe the pathophysiology of cervical myelopathy

Answer 17

• narrowing of spinal canal due to disc herniation, degenerative spondylosis, subluxation, etc
• spinal cord compression leading to ischemia of the spinal cord

Question 18

What is the treatment for cervical myelopathy?

Answer 18

usually need surgery, but recovery is rarely complete

Question 19

What is the treatment for cervical myelopathy?

Answer 19

usually need surgery, but recovery is rarely complete

surgery: laminectomy, anterior decompression