Cervical Spine DDx 1 Flashcards
Possible causes for cervical instability
- trauma
- RA
- corticosteroid use
- OP
- congenital
- developmental
- postural changes
cervical instability: type of trauma most likely to cause
hyper-flexion injuries
cervical instability: What does prolonged exposure to corticosteroids cause?
- softening of the dens and transverse ligament
- promotes osteoporosis
cervical instability: congenital
Down’s syndrome
cervical instability: developmental
C1-2 of young children naturally unstable
cervical instability: posture
Cadaver studies have indicated that people with marked FHP in life have had anatomic changes in these
dens
transverse ligament
Sn of Canadian C-spine rule
.994
Sp of Canadian C-spine rule
.451
% of cervical fractures that concern the odontoid
15%
odontoid fractures: MOI
- hyperextension
- forceful hyperflexion
- blunt trauma
odontoid fractures: typical presentation
- neck pain
- rarely have neuro symptoms
Most common type
Type II
Type II odontoid fractures are the most common and are (stable/unstable)
unstable
Burst fx of C1 is called
Jefferson fracture
Jefferson fx: typical MOI
axial load
Jefferson fx: % of all spinal fractures
2%
Jefferson fx: Why might neuro symptoms not be present?
due to expansion of the ring
Jefferson fx: imaging used to detect Jefferson and Odontoid fx’s
- open mouth radiographs
- CT
The vertebral artery provides (%) of blood flow to the brain
11%
How is VBI tested?
Vertebral artery test
placing neck in a position that can limit blood flow through arteries
Vertebral artery test: reduction in blood flow may lead to a
TIA
% of vertebral artery cases that presented with neck and head pain
92%
% of vertebral artery cases that reported sudden onset of pain
25%
vertebral artery: sudden onset of pain suggestive of
dissection in progress
Any CPR for vertebrobasilar ischemia?
no CPR or reliable criteria that can accurately ID which pts are at risk
Vertebrobasilar ischemia:
1 in how many will have a serious complication from cervical manipulation with mechanical neck pain
1 in 20,000-10,000,000
% of pts who have non-serious side effects from cervical manipulation
1-2%
non-serious side effects of cervical manipulation
- local discomfort
- headache
- fatigue
- radiating discomfort
*rarely noticed the day after manipulation
Pts with neck pain, headaches, and/or disability have better outcomes with (mobs/manips/exercises OR mobs/manips only)
mobs/manips/exercises
