Cervical Spine Conditions (Week 1 Module) Flashcards
Cervical spine conditions
Bones (cervical fractures): dens (C2) fracture, hyperflexion teardrop fracture, extension teardrop fracture, vertebral axial load burst fracture, Jefferson axial load burst fracture
Joints: cervical degenerative disk disease (OA), cervical disk herniation
Muscles/tendons: cervical muscle strain, whiplash syndrome
Ligaments: atlantoaxial instability
Nerves/vessels: cervical radiculopathy, cervical spinal stenosis
Dens fracture (C2/axis)
Most common type of upper cervical spine fracture, normally caused by car accidents and falls
Typically at base of dens
Spinal cord injury occurs in 15% of cases
Hyperflexion teardrop fracture
Triangle-shaped fragment of bone is avulsed from anterior vertebral body by pull of anterior longitudinal ligament
Results from severe flexion force (head-on collision in car)
Teardrop fragment remains attached to anterior longitudinal ligament but rest of vertebral body broken off and posterior
Compression of spinal cord and severe neurologic injury (most serious injury of cervical spine)
Unstable fracture with little chance of neurologic improvement
(looks bad, huge piece of spine attached to anterior longitudinal ligament)
Extension teardrop fracture
Caused by blow to forehead or chin; sudden hyper-extension of cervical spine plus tension on anterior inferior margin of vertebral body
Anterior inferior margin of vertebral body avulses and teardrop fragment remains attached to anterior longitudinal ligament
Commonly occurs at C2 (axis) and C3
This kind of fracture is stable and usually not directly responsible for spinal cord injury
(looks not as bad, only small piece of vertebrae attached to anterior longitudinal ligament)
Vertebral axial load burst fracture
Vertebral body compressed both anteriorly and posteriorly
Caused by falls from a height where force of fall extends from buttocks to vertebral body and body bursts/explodes
Pieces of exploding vertebra can displace into surrounding tissue and spinal canal and can injure spinal cord or cauda equina (this is a severe injury!)
Jefferson axial load burst fracture
Vertebral body compressed both anteriorly and posteriorly
Occurs from direct blow to top of head which fractures anterior and posterior neural arches of C1 (atlas)
Usually does not injure spinal cord
Cervical degenerative disk disease (osteoarthritis of the cervical spine)
Pathophysiology: intervertebral disk undergoes normal aging and loses flexibility/shock absorbing function (nucleus pulposus dehydrates bc it loses proteoglycans that bind water, and have more collagen and more pressure on vertebral endplates causes sclerosis and osteophytes and tears in annulus fibrosis); altered alignment of spine causes articular cartilage covering superior/inferior articulating processes to degenerate (osteoarthritis of joints)
Clinical presentation: loss of normal cervical lordosis, local tenderness, X-ray shows narrowed intervertebral disk space, bone sclerosis and osteophytes
Management/prognosis: NSAIDs, opioids, stretch/strengthen, surgical cervical spinal fusion; disease will progress with age/additional trauma
Cervical disk herniation
Pathophysiology: microtears in annulus fibrosis cause inflammation and allows nucleus pulposus to go through the tear (posterolaterally b/c of repeated flexion of cervical spine); herniation directly, or due to inflammation, compresses nerve roots (cervical radiculopathy) or spinal cord (cervical myelopathy)
Clinical presentation: local neck pain w/movement, pain radiating to shoulder/upper extremity, weakness, increased muscle tone, spasticity in legs, tenderness over cervical paraspinal muscles, wasting upper extremity, weakness in myotomal distribution or sensation following dermatomal distribution, reduced reflexes in upper extremity; Spurling’s compression test (if have nerve root compression)
Management/prognosis: NSAIDs, opioids, muscle relaxants, corticosteroid injection into epidural space, relaxation exercises, ice/heat; most will resolve within 6 weeks but complications occur when cervical radiculopathy or cerveical myelopathy
Cervical muscle strain
Pathophysiology: incorrect exertion or overuse of a muscle (in this case, usually posterior cervical paraspinal muscles that compress greater occipital nerve (C2 dorsal ramus))
Clinical presentation: acute onset of sharp pain at upper posterior neck and scalp that worsens with movement, loss of normal cervical lordosis due to muscle spasm, pain reproducible with palpation of affected neck muscles, can cause headaches
Management/prognosis: NSAIDs, ice, temporary neck brace, heat days/weeks after injury, stretching exercises; will resolve within days to weeks
Whiplash syndrome
Pathophysiology: rapid extreme range of motion between hyperextending and hyperflexing can damage facet joints, ligaments and muscles
Clinical presentation: deep aching, sharp, throbbing neck pain from base of skull to cervicothoracic junction of spine or in sternocleidomastoid or trapezius, can get headaches, pain worse w/movement, paraspinal muscle spasm so loss of cervical lordosis, limited ROM due to pain
Management/prognosis: NSAIDs, opioids, muscle relaxants, cervical collar, ice massage for acute; 80% recover after 3 months but 20% continue to have pain due to chronic muscle spasm or ligamentous instability
Alantoaxial instability
Pathophysiology: increased mobility of alantoaxial joint (between anterior arch of C1 (atlas) and dens of C2 (axis)) so dens can move posteriorly and compress spinal cord, abnormality of transverse ligament (congenital (Down’s syndrome) or structural damage (trauma, rheumatoid arthritis))
Clinical presentation: asymptomatic, or cervical myelopathy if spinal cord compressed by dens so can have weakness and sensory impairment on arms or legs or neck, might have pain on palpation if they have reactive muscle spasm, sudden/severe spinal cord compression can cause death, see increased distance in predental space (>3mm)
Management/prognosis: NSAIDs, opioids, surgery; early detection in high risk patients important (Down’s syndrome, RA, hx neck trauma), bc can lead to serious spinal cord injury and death
Cervical radiculopathy
Pathophysiology: results from compression/injury to spinal nerve roots: (1) herniated disk or osteophytes cause compression within neural foramen or within spinal canal, C6 and C7 nerve roots most commonly compressed; (2) inflammatory process of soft tissue near nerve root causes compression (tears in annulus fibrosis); note: sinuvertebral nerves contain nociceptive nerve endings within soft tissues of spine
Clinical presentation: paresthesia along dermatome; change in motor function if ventral motor root injured (see other FC for C5, C6, C7, C8, T1), palpation should NOT reproduce pain, but can have local neck tenderness due to muscle spasm, Spurling’s cervical compression test, EMG
Management/prognosis: NSAIDs, antidepressants and anti-seizure medications for neuropathic pain, temporary reduction of pain via cervical traction, stretching, heat, ice, corticosteroid injection to epidural, can surgically remove herniated disk/osteophyte if severe pain; most symptoms resolve spontaneously
Cervical spine stenosis
Pathophysiology: narrowing of cervical spinal canal (disk herniation, osteophyte, hematoma, tumor, foreign body) can compress and cause radiculopathy and/or cervical myelopathy
Clinical presentation: gradual onset neck pain/stiffness due to muscle spasm, signs of radiculopathy (upper extremity weakness/sensory disturbances, reduced reflexes), signs of cervical myelopathy (stiff legs, bowel/bladder incontinence, increased reflexes in patella and achilles), loss of cervical lordosis, Spurling cervical compression test, EMG, MRI
Management/prognosis: NSAIDs, opioids, oral corticosteroid for acute pain/weakness, injection of corticosteroid, surgical removal of herniated disk or osteophytes in severe cases; most cases improve spontaneously
For cervical radiculopathy, what nerves cause pain/sensation change where?
C5: point of shoulder
C6: thumb
C7: middle finger
C8: little finger
T1: medial forearm
(Nerve root: Pain/Sensation Change)
For cervical radiculopathy, what nerves cause movement deficit where?
(Roots: Movement Deficit)
C5: shoulder abduction
C6: elbow flexion, wrist extension
C7: elbow extension
C8/T1: intrinsic hand muscles
