Cervical Spine

Question 1

Emergency vs Outpatient protocol for Whiplash

Answer 1

• Emergency Room – get CT if in pain. Immobilize.

* Outpatient – get x rays. Must see T1. C6/7 fractures are commonly missed,

Question 2

Treating whiplash

Answer 2

Rest, ice, NSAIDs, reassurance, PT for high risk, CBT. NOT surgical.

Question 3

Spurling sign

Answer 3

Tests for radiculopathy.

Tilt head to compress nerve on side head is moving toward.

Question 4

3 environmental risk factors for disc herniation

Answer 4

Smoking, vibrating equipment, and repetitive lifting.

Question 5

When should you get an MRI for radiculopathy?

Answer 5

Only if pain last >6 weeks

Question 6

Treating radiculopathy
Less than 2 weeks?
More than 6 weeks?

Answer 6

• Less than 2 weeks: reduce activity, try to keep working, gabapentin for nerve pain, NSAIDs, analgesics (short-term opioids), steroids, PT
• 75% of pxs recover w/o surgery. Disc resorbs over time.
• > 6 weeks: get MRI to confirm diagnosis.
• Indications for surgery: failure to improve, disabling pain, progressive neuro problems, severe weakness / quadriparesis.
• Do discectomy + fusion or replacement

Question 7

C5
Motor weakness
Sensory loss
Decreased reflex

Answer 7

Motor weakness: deltoid, biceps
Sensory loss: shoulder
Decreased reflex: biceps

Question 8

C6
Motor weakness
Sensory loss
Decreased reflex

Answer 8

Motor weakness: biceps, wrist extension, pronation
Sensory loss: thumb, index finger
Decreased reflex: biceps

Question 9

C7
Motor weakness
Sensory loss
Decreased reflex

Answer 9

Motor weakness: triceps
Sensory loss: index, middle finger
Decreased reflex, tripeps

Question 10

C8
Motor weakness
Sensory loss
Decreased reflex

Answer 10

Motor weakness: intrinsics
Sensory loss: ulnar digits
Decreased reflex: none

Question 11

Hoffman’s sign

Answer 11

Tests for cervical myelopathy

Flick index finger and see thumb flex (UMN sign)

Question 12

What diameter is considered spinal stenosis?

Answer 12

Less than 10 mm

Question 13

Treating spinal stenosis: mild vs moderate / severe

Answer 13

• Mild – observe. Surgery is more risky. Do PT, steroid injections.
• Moderate / severe – need surgical decompression. Poor prognosis. Only 80% of pxs improve w/ surgery.

Question 14

When should a C spine be immobilized? (4)

Answer 14

Trauma to head / neck, neuro signs, intoxicated, or distracting injuries such as a fractured pelvis.

Question 15

Who needs neck imaging after trauma? (6)

Answer 15

• Pxs who exibit neuro deficits
• Pxs w/ altered sensorium, head injury, or intoxication
• Pxs w/ neck pain or tenderness
• Pxs w/o neck pain, but w/ significant distracting injury (polytrauma, such as femur fracture)