Cervical spine pathologies

Question 1

what is cervical spondylosis

Answer 1

degenerative disc disorder affecting interbody joint, lower cervical spine most affected (C5-6, C6-7, C4-5), age groups 45+, onset= insidious or traumatic. Disc space narrowing, anterior osteophyte formation, lipping & irregularity of vertebral bodies

Question 2

cervical spondylosis- patho-anatomical changes

Answer 2

loss of disc height due to disc dehydration and degermation, vertebrae approximate, formation of marginal osteophytes, increased WB on facet joints, possible nerve root entrapment and spinal cord compression due to degenerative changes

Question 3

cervical spondylosis- symptoms and signs

Answer 3

symptoms- bilateral/unilateral neck pain, referred pain into shoulder/arm/head, this can be somatic referred pain or radicular referred if degenerative irritate a spinal nerve, neck stiffness
signs- decreased cervical ROM (rotation and SF most affected), pain on PAIVM on affected level, altered posture, dermatomal changes if nerve root involved, degenerative changes on X-rays

Question 4

cervical disc herniation

Answer 4

caused by degenerative weakening of annulus- nucleus propulsus goes through, affects individuals in 30’s, C6-7 and C5-6 most common affected. Uncommon- IVD in Cx supported posteriorly by PLL and laterally by uncovertebral joints, nucleus pulposus is Cx is largely fibrocartilaginous

Question 5

cervical disc herniation- risk factors

Answer 5

age, smoking, lifting heavy objects, diving

Question 6

cervical disc herniation- source of pain and disc prolapse

Answer 6

source= tear of outer annulus, inflammatory process, can be bilateral issue with all 4 limb (affect gait)
disc prolapse- centrally, posterolateral, bulge

Question 7

cervical disc herniation- symptoms

Answer 7

S&S depended on size and location, acute and rapidly worsening neck pain (central or unilateral), referred pain to scapula, pain worse on ext and prolonged flex activities (cough and sneeze), antalgic posture- head held in flex

Question 8

cervical disc herniation- different positions symptoms

Answer 8

posterolateral and spinal nerve will produce- radicular referred pain into arm and hand (lateral canal stenosis), paraesthesia and or anaesthesia into UL
if prolapse is posterior and central spinal cord may be involved= myelopathy, may get signs of cord compression (central canal stenosis)

Question 9

Facet OA

Answer 9

degenerative disorder affecting synovial joints, most common in >65 y/o

pathology- synovitis, disintegration of articular cartilage, osteophyte formation, joint space narrowing

Question 10

Facet OA- symptoms and signs

Answer 10

symptoms- local- often unilateral pain, somatic pain referral into shoulder/scap region depending on levels affected, stiff neck
signs- decreased ROM into facet closed pack position- ext and ipsilateral SF/ rotation
pain reproduced on PAIVM affected levels

Question 11

Facet OA- position of affected levels

Answer 11

C2-C3= posterior to ear on left side, C3-C4= pain on neck on right side, C4-5= pain on neck lower than C3, C5-C6= pain over right shoulder, C6-7= pain over scapula

Question 12

Facet OA- X ray changes

Answer 12

cartilage destruction of facet joints, loss of joint space, osteophyte formation around joint margin, IVD and vertebral bodies normal

Question 13

Cervical radiculopathy

Answer 13

links to disc prolapse= nerve irritated, 9 cervical nerve roots, emerge above corresponding vertebrae but below IVD

Question 14

Cervical radiculopathy- lateral canal stenosis

Answer 14

narrowing of I-V formation, causes nerve root compression and irritation, neurological changes

Question 15

Cervical radiculopathy- nerve roots as source of pain

Answer 15

irritation of cervical nerve root in the IV foraminal usually in the medial half by: inflammation, posterolateral disc prolapse, degenerative changes of facet joints, most common affects C5/6/7

Question 16

Cervical radiculopathy- signs and symptoms

Answer 16

acute severe arm pain in dermatomal distribution, altered sensation in dermatomal distribution, myotomal/reflex change, may have neck pain, arm pain worsened on movements or postures closing down IV foramina (e.g. ipsilateral rotation), significant night pain, antalgic posture, overhead arm positions may relieve

Question 17

Cervical myelopathy

Answer 17

compression of SC by- severe central degenerative changes (osteophytes) and large central disc prolapse
S and S- chronic neck pain, less severe than lateral canal stenosis, associated symptoms= mild gait disturbances and numb clumsy hand, may have other cord signs= bladder dysfunction/ gait disturbances, LL dysfunction

Question 18

cervical myelopathy- aggravated by

Answer 18

aggravated with movements or postures that decrease size of spinal canal (e.g. ext), usually medical emergency

Question 19

what is whiplash

Answer 19

whiplash is an acceleration-deccerlation mechanism- may result from rear end or side impact, may result in bony or soft tissue injuries
rear end collision mechanism: hyperextension (affects anterior cervical structures) occurs first followed by hyperflexion (limited by chin on chest)

Question 20

possible lesions in whiplash

Answer 20

muscle strain (SCM and scalenes), facet joint (capsule strain), ligament sprains/tears- ALL/PLL/IVL, IVD- prolapse and annular tears, SC and nerve root traction injuries, vertebral artery, concussion, Thoracic outlet syndrome

Question 21

Whiplash- clinical picture

Answer 21

whiplash is a multi-level/tissue/pathology disorder, be aware of potential for instability and cervical artery trauma, often involves BOS component (PTSD)

Question 22

Whiplash- duration and biological symptoms

Answer 22

duration= 6 weeks - 1 year
biological= pain, stiffness, headaches, nausea, dizziness, referred pain, paraesthesia, blurred vision, difficulties swallowing

Question 23

Whiplash association disorder (WAD) classification

Answer 23

WAD 1- neck pain only and no physical signs, WAD 2a- neck pain with alterations in movement and muscle recruitment and local mechanical hyperalgesia, WAD 2b- above plus psychological impairment, WAD 2c- above plus generalised hyperalgesia, WAD 3- above plus neuro sign, WAD 4- fracture/dislocation

Question 24

postural dysfunction

Answer 24

no tissue damage/ pathology, pain is a result of tissue overstress/ strain

Question 25

postural dysfunction S and S

Answer 25

symptoms= widespread neck pain radiating into shoulders and head, worsened by prolonged postures, often easier in morning and worse at end of day
signs- poor upper quadrant posture= trigger points, may have fall AROM and absence of joint signs, find postures that work better

Question 26

cervicogenic headache

Answer 26

down to irritation of nucelli in top of cervical spine (trans general nucleus- TGN) or cranial nerves. Onset- often pain related to trauma, postural strain and degenerative disease, precipitating factor- sustained neck postures or movements

Question 27

cervicogenic headache- S and S

Answer 27

dysfunction in upper Cx can present at- headaches, face/eye/TMJ/ear pain pain in suboccipital region
nausea, dizziness, SQ- headaches (5D’s) and 2 N’s

Question 28

5 D’s and 2 N’s

Answer 28

dizziness, drop attacks (faiting), dysarthria ( loss of speech), dysphagia (loss of ability to swallow), diplopia (blurred vision)
Nause, numbness and nystagmus

Question 28

Convergence theory

Answer 28

pathomechanics- referred pain from upper cervical spine structures

Question 29

somatic referred pain from upper Cx spine

Answer 29

front of head- C0/1= pain above eyebrows, C1/2- pain at eyebrows= C1/2, C2/3= pain at the eyes
back of head- C0/C1= pain is in head, C1/2= pain at occiput and upper neck, C2/3= pain in the head and into neck

Question 30

cervicogenic headaches- symptoms

Answer 30

classically unilateral, side consistency, associated with suboccipital or neck pain, pain starts in neck and spreads to head, variable severity, rarely has other symptoms, no pattern, aggravated by neck movements or sustained head or neck posture

Question 31

cervicogenic headaches- signs

Answer 31

forward head posture, positive upper cervical joint findings- decreased upper cervical AROM, decreased upper cervical accessory ROM, weakness in deep neck flexors, trigger points in muscles supplied by C1-C3- nerves