Cervical Spine

Question 1

Cervical Anatomy

Answer 1

7 vertebrae
C1- atlas. In shape of a washer. Skull rests on it
C2- axis. Has Odontoid process.
C1 and C2 provide great mobility to skull
Thinnest and most delicate
Role= supporting head, protection of spinal cord and providing mobility to head and neck
C3-C7 are more classic. They have a body, pedicels, laminae, spinous processes and facet joints

Question 2

Cervical muscles

Answer 2

Sternocleidmastoid
Lavator scapulae
Trapezius
Splenius cervicis 
Splenius capitis 
Scalenes anterior 
Scalenes posterior 
Erector spinae

Question 3

Cervical pathology-initial testing

Answer 3

What movements are painful?
What are the general patterns? 
What is the V a S?
Are they on any medication?
Are they presenting any red flags?

Question 4

Cervical Pathologies

Answer 4

Degenerative or postural

Question 5

Initial assessment

Answer 5

Take out the initial assessment in setting.
– Look at posture. Do they have normal curves? Lordosis, kyphosis, lordosis is normal.
– Ears should roughly be in line with shoulders
– Active range of movement. Flexion/extension, rotation, Side flexion, retraction and pro traction. Looking for pain, quality, resistance, range, spasm
– Then carry out these movements passively. OVERPRESSURES

Question 6

What comes after initial assessment?

Answer 6

Palpation– Begin by sweeping the skin
-Warmth/sweating may indicate inflammation or inflammatory disorder
– Dry skin may denote autonomic changes
– Palpate the spine looking for the position of the vertebrae. Is there any undue prominence?
-PQRRS
-P –> tender? Painful? Normal? Stiff? Spasm?
-R –> normal? Hypomobile? Hyper mobile? Stiff?
– Are there any abnormalities? Prominent or depressed segments
-PAIVMS

Question 7

Neurological testing…

Answer 7

Dematomes= area of skin supplied by a single nerve. Gently brush skin on both sides.

Myotomes= muscle blocks along either side of the vertebrae. Remember the dance.

Reflexes= automatic response to stimulus

Question 14

Lumbar muscles

Answer 14

Erector Spinae
Quadratus Lumborum 
Lattissimus Dorsi 
Multifidus 
Internal Abdominal Oblique 
External Abdominal Oblique 
Rectus Abdomanis 
Transversus Abdominis

Question 15

Lumbar Anatomy

Answer 15

5 vertebrae
Provide stability, control of movement and protection of intervertebral discs.
Incredibly strong
Two articulating surfaces: superior articular facets and inferior articular facets
Articular surfaces facilitate flexion, extension and prevent rotation

Question 16

Spondylosis

Answer 16

The first thing to degenerate is the disc (becomes thinner and spongy)

Water content decreases- annular fibrosis is weakened

Decrease in water content means that some height will be lost

Loss of a shock absorption, vertebrae will move closer together

This increases the risk of a disc prolapse

This increases the pressure on the facet joints causing postural changes, increasing ligament laxity meaning that the overall joints are less stable.

This can cause irritation and inflammation of the spinal root nerves

Hypermobility occurs in the facet joints causing osteophytes to form (bony projection)

Osteophytes developed to increase surface area in vertebral bodies to stabilise the joint and reduce hypermobility.

Question 17

Risk factors of spondylosis

Answer 17

Previous injuries 
Carrying heavy items 
Sports that require persistent hyperextension of lumbar spine 
40+ 
Any region of spine

Question 18

Clinical presentation of spondylosis

Answer 18

– Spinal stenosis
– Disc herniation
– Spondylolysis

Question 19

Signs and symptoms of pathologies

Answer 19

ADD LATER

Question 20

Postural dysfunction

Answer 20

Posture
– Kyphosis= excessive outward curvature – hunchback
– Lordosis= excessive inward curvature
- scoliosis= abnormal lateral curvature of spine

Effects 
– Inefficient sitting or standing
– Sedentary lifestyle, obesity, diabetes
– Slumped position, bad habits 
– Neck and back pain

Anatomical and physiological effects of poor posture
– Spinal ligaments elongate
– Muscular imbalances occur.some muscles are in constant contraction while opposing muscles are weak and overstretched leading to pain
– Abdominal muscles – a hunch position will cause abdominal muscles to shorten, encouraging a further hunched position
– Potential constriction of blood vessels and nerves
– Poor circulation increases the pressure of gases and fluids moving through the body
– Potential vertebral subluxation
– Nerve construction – movements of subluxations can put pressure on the surroundings spinal nerves

Question 21

Red flags

Answer 21

Signs

• altered bowel habits
• unexplained weight loss
• night sweats/night pain
• constant relentless pain
• saddle anaesthesia
• altered gait pattern
• bi-lateral symptoms
• dysphasia, dysarthria, dizziness, diplopia, drop attacks
• nausea, nystagmus, numbness

Cervical= UCI, CAD 
Lumbar= Cauda Equina

Question 22

CAD

Coronary Artery Dysfunction

Answer 22

Blockage of one or more of the arteries supplying blood to the heart
Subclavian artery enters spine at C6/7
Vertebral artery is close to uncovertebral joint and facet joints meaning that any osteophytic changes could impair movement of artery

Risks
– Extreme rotation – could cause vertebral artery injury. C1 and C2 are the most vulnerable
-Contralateral side is more likely to be damaged during rotation
– Vertebral artery can go into spasm during manipulative techniques

Signs

• 5D’s and 3N’s
• nausea, vomiting, ataxic gait, weakness, tingling or numbness of face, hearing disturbances, headache, past history of trauma

Question 23

Cauda Equina

Answer 23

Affecting bundle of nerve roots at the lower end of the spinal cord
CE provides innervation to lower limbs, sphincter, bladder retention/overflow, sensation to skin around bottom and back passage
Most common cause is a prolapsed lumbar disc
Spinal cord ends at L1, with the caudal roots starting below

Symptoms
- lower back pain, saddle anaesthesia, bowel and bladder disturbances, reduced or absent lower reflexes, sciatica

Clinical presentation
-bilateral neurogenic sciatica, reduced perineal sensation, altered bladder function, loss of anal tone, sexual dysfunction

Question 24

UCI

Upper Cervical Instability

Answer 24

Instability of the craniovertebral ligaments can compromise the vascular and neurological structures in upper cervical region
Loss of Osteo-ligamentous integrity between occiput, C1 and C2 can cause impingement on spinal cord

Signs and symptoms
- facial paraesthesia, drop attacks, nystagmus, nausea, motor defects

Question 25

Myotomes Cervical

Answer 25

1- neck Flexion 
2-neck extension 
3- head tilt 
4- shoulder elevation 
5- shoulder abduction 
6- elbow flexion/wrist extension 
7- elbow extension/ wrist flexion/ thumb

Question 26

Reflexes for cervical

Answer 26

5= biceps tendon 
6= thumb 
7= arm

Question 27

Cervical sensory

Answer 27

1- front of face 
2- front of face 
3- lateral face
4- supra scapula 
 5-lateral shoulder and upper arm
6-lateral lower arm and hand (thumb and index) 
7- palmar aspect of hand (middle 3)

Question 28

Lumbar Myotome Testing

Answer 28

1+2= hip flexors
3- knee extensors
4- ankle dorsiflexor
5- long toe extensor

Question 29

Dermatome Testing Lumbar

Answer 29

1- inguinal area 
2- anterior superior thigh 
3- anterior middle thigh 
4- anterior knee suprapatellar 
5- 1st and 2nd web space

Question 30

Lumbar reflexes

Answer 30

Both L3 and L4 reflexes are the patellar

Question 31

Herniated disc

Answer 31

Symptoms 
-most common in lumbar but do occur in cervical 
-arm and leg pain 
Numbness or tingling 
Weakness 

Risk factors

• overweight
• occupation
• genetics

Causes

• wear and tear
• decrease in water content causes discs to be less flexible and more prone to tearing or rupturing