Cervical Spine

Question 1

What is cervical spondylosis?

Answer 1

Degeneration of the cervical intervertebral discs

Question 2

Spondylosis of the cervical spine predisposed to which condition?

Answer 2

OA of the cervical spine

Question 3

How do patients with spondylosis of the cervical spine present?

Answer 3

1. Slow onset stiffness
2. Pain in the neck
3. Radiation of pain to the occiput and shoulder

Question 4

What is the mainstay of treatment for cervical spine spondylosis?

Answer 4

Physio and analgesia

Question 5

Osteophytes may impinge on nerve roots in the cervical spine which may result in what?

Answer 5

Radiculopathy involving the upper limb dermatomes and myotomes

Question 6

Impinging osteophytes in the cervical spine may require what treatment?

Answer 6

Decompression (for severe symptoms)

Question 7

If patients have nerve root compression secondary to cervical disc prolapse, what do they complain of?

Answer 7

Shooting neuralgic pain down a dermatomal distribution

(there may be weakness and loss of reflexes)

Question 8

Typically, in cervical disc prolapse, the ________ nerve root is involved

Answer 8

Lower

(C7/C8)

Question 9

A large central disc prolapse in the cervical spine may lead to what?

Answer 9

Myelopathy with upper motor neurone symptoms and signs

Question 10

What are signs and symptoms of upper motor neurone disruption?

Answer 10

1. Wide based gait
2. Weakness
3. Increased tone
4. Upgoing plantar response

Question 11

Atraumatic cervical spine instability can occur in which two conditions mainly?

Answer 11

1. Down syndrome
2. RA

Question 12

Children with down syndrome are at risk of developing which type of cervical instability and subluxation?

Answer 12

Atlanto-axial (C1/C2)

(this may also lead to spinal cord compression)

Question 13

How can children with down syndrome be screened to check for abnormal motion in the cervical region?

Answer 13

Flexion/extension X-rays

Question 14

What is the recommendation for children with

a) Minor degrees of cervical instability
b) Severe degrees of cervical instability

Answer 14

a) Avoidance of high impact sport
b) Surgical stabilisation (especially if there is abnormal neurology)

Question 15

Why does atlanto-axial subluxation occur in patients with RA?

Answer 15

There is destruction of the connecting synovial joint

(and potentially also rupture of the transverse ligament)

Question 16

Spinal cord compression due to atalnto-axial subluxation in RA can be _______

Answer 16

Fatal

Question 17

How are patients with atlanto-axial subluxation treated?

Answer 17

1. Wearing a collar (to prevent flexion)
2. More severe cases mandate surgical fusion

Question 18

Lower cervical subluxation are due to what?

Answer 18

1. Destruction of the synovial facet joints
2. Destruction of the synovial uncovertebral joints

Question 19

Lower cervical subluxations can also present with _______ _________ __________ signs

Answer 19

Upper motor neurone