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MI2 > Cervical Spine Pathologies > Flashcards

Cervical Spine Pathologies Flashcards

1
Q

What are the differences between the cervical and thoracic spinous processes?

A

Cervical:

  • Bifurcate (base for muscle attachments)
  • Shorter
  • Pointier, less broad
  • No C1 spinous process
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2
Q

Where are the transverse processes in relation to the spinous processes in the cervical spine?

A

At the same level

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3
Q

Which lateral joints connect consecutive vertebral bodies in the cervical spine?

A
  • Facet joints

- Joints of luschka

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4
Q

What are the functions of the joints of luschka?

A
  • Act as guides for flexion & extension
  • Help the spine move in a coordinated way
  • Open on the contralateral side in lateral flexion
  • Close on the ipsilateral side in lateral flexion & provide stability
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5
Q

What is the difference between the transverse processes of the cervical spine compared to thoracic & lumbar?

A

Much smaller

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6
Q

What is a unique anatomical structure in the cervical spine?

A

Transverse foramen for vertebral arteries

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7
Q

Which statement about the C1-C2 joint is incorrect?

a. Consists of >2 synovial joints
b. Allows more F/E than the atlanto-occipital joint
c. Stabilised by the tectorial & alar ligaments
d. Rotation achieved by suboccipital muscles, SCM & trapezius

A

b. Allows more flexion/extension than the atlanto-occipital joint

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8
Q

What are the synovial joints between C1 & C2?

A
  • Superior/inferior articular surfaces
  • Anterior arch of atlas/dens
  • Tubercle for transverse ligament/dens
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9
Q

What is the orientation of the facet joints in each section of the spine?

A

Lumbar: Vertical
Thoracic: Approx 30 degrees
Cervical: 45 degrees

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10
Q

What is the pathway of the vertebral arteries?

A
  • Originate from subclavian artery (one on each side, left side usually larger)
  • Enters CSp at C6 posterior to transverse process
  • Enters transverse foramen
  • Continues up the neck through each transverse foramen
  • Enters foramen magnum
  • 2 arteries join together to form the basiliar artery
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11
Q

What do the vertebral arteries supply?

A
  • Upper spinal cord
  • Brainstem
  • Cerebellum
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12
Q

What is vertebrobasiliar insufficiency (VBI)? **Red flag

A

Insufficiency of vertebrobasiliar artery system caused by vertebral artery disease or injury (e.g. atherosclerosis, dissection)

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13
Q

What are the symptoms of VBI?

A

5Ds & 3 Ns

  • Dizziness
  • Diplopia (double vision)
  • Dysphagia (difficulty swallowing)
  • Drop attacks (falling without loss of consciousness)
  • Dysarthria (difficulty speaking)
  • Nausea
  • Nystagmus
  • Numbness/p+n of face/tongue
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14
Q

When is a VBI screening test required?

A

When assessment or treatment involves end level sustained extension or rotation or accessory movement testing (all cervical PAIVMs)

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15
Q

What are the potential causes dizziness other than VBI?

A
  1. Postural hypotension (when getting up quickly, usually doesn’t involve rotation)
  2. Vestibular/inner ear
  3. Cervical vertigo (prolonged neck positions/movements)
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16
Q

What is the most common cause of vestibular dizziness?

A

Benign paroxysmal positional vertigo (BPPV)

  • Commonly caused by inner ear infection
  • Aggravated by neck extension & rotation (e.g. rolling over in bed)
  • No symptoms when just moving trunk
17
Q

What should you do if a patient reports significant VBI symptoms in the subjective?

A

Don’t conduct a VBI assessment & refer on

18
Q

When are the risk factors for cervical instability? **Red flag

A
  • RA
  • Down’s syndrome
  • Ehlers-Danlos syndrome (connective tissue disorder)
  • History of major trauma
  • Repetitive throat infections
19
Q

What are the symptoms of cervical instability?

A
  • Head feeling really heavy
  • Intolerance to prolonged static postures
  • Fatigue & inability to hold head up
  • Better with external support
  • Frequent need for self-manipulation
  • Feeling of instability, shaking or lack of control
  • Frequent episodes of acute attacks
  • Sharp pain
  • Neck gets stuck or locks
  • Better in unloaded position (lying down)
  • Catching, clicking, clunking, popping
  • Muscles feel tight or stiff
  • Fear of movement
  • Temporary improvement with clinical manipulation
20
Q

What imaging should be used to diagnose cervical instability?

A
  • Functional MRI

- MRI with someone applying traction to the head

21
Q

What is whiplash?

A
  • Soft tissue injury to the neck following acceleration & deceleration
  • Hyperextension followed by hyperflexion
  • Most commonly in MVAs
  • 40-60% develop chronic pain
22
Q

What should the subjective examination for whiplash include?

A
  • Details of crash (speed, number of vehicles, site of impact)
  • Whether there was any LOC or head injury
  • Results of any investigations or medical clearance
  • Referral of symptoms to arms
  • Altered sensation
23
Q

What are the Canadian C Spine Rules?

A

Guidelines for the cervical spine that indicate the need for imaging after a trauma (equivalent of Ottawa rules)

24
Q

What are the high risk factors in the Canadian C Spine Rules?

A
  • Age 65 or over
  • Dangerous mechanism
  • Paresthesis in extremities
25
Q

What is considered a dangerous mechanism in the Canadian C Spine Rules?

A
  • Fall from elevation of 1m or 5 stairs
  • Axial load to head
  • MVA high speed, rollover or ejection
  • Motorised recreational vehicles
  • Bicycle struck or collision
26
Q

What are the whiplash injury grades?

A

0: No complaint about neck, no physical signs
1: Complaint of neck pain, stiffness, tenderness, no physical signs
2: Neck complaint & musc signs including decreased ROM & point tenderness
3: Neck complaint & neuro signs including absent/decreased tendon reflexes, weakness & sensory deficits
4: Neck complaint & fracture/dislocation

27
Q

What symptoms are predictive of poor recovery in whiplash?

A
  • Higher initial neck pain levels
  • Higher initial disability
  • Self-perceived injury severity
  • Headache
  • Higher number of symptoms
  • Whiplash associated disorders (WAD) grade
  • Back pain
  • Dizziness
28
Q

What psychological & crash related factors are predictive of poor recovery in whiplash?

A

Psychological:

  • Post-traumatic stress symptoms
  • Negative expectation of recovery
  • Somatisation
  • Depression
  • Pain catastrophising
  • Coping strategies

Crash-related:
- Self-related collision severity (not actual collision severity)

29
Q

What are some of the nerve disorders in the cervical spine?

A
  • Spinal cord compression/stenosis
  • Nerve root compression
  • Peripheral nerve sensitivity
30
Q

Is spinal cord compression/stenosis less common in the cervical or lumbar spine?

A

Cervical, as spinal canal is much larger

31
Q

What can cause spinal cord compression/stenosis?

A

Any space-occupying mass e.g. disc herniation, osteophytes, tumour

32
Q

What are the most common cervical spine nerve root compression injuries?

A

Median nerve (carpal tunnel or double crush) & ulnar nerve

33
Q

What is wry neck?

A
  • Acute facet joint injury
  • Unilateral neck pain
  • Often after sleeping in awkward position or after quick, jerky movement
  • Can cause severe movement restriction & muscle spasm
34
Q

What are cervicogenic headaches?

A
  • Due to convergence of sensory input from upper cervical spine into the trigeminal spinal nucleus (generally from C3 and upwards)
  • Mechanical trigger (e.g. occurs when they hold their neck a certain way)
35
Q

What is the international headache society classification?

A
  1. Resistance to or limitations of neck PROM
  2. Changes in neck muscle contour, texture or response to active/passive stretching or contraction
  3. Abnormal tenderness of neck muscles
36
Q

What are migraines and tension headaches?

A
  • Migraines: Pounding sensation, often occur with other symptoms (nausea, vomiting, photophobia, phonophobia)
  • Tension headaches: Pressure sensation around head, bilateral headache, absence of mechanical trigger
37
Q

What are the red flags for headaches which require medical evaluation?

A
  • Headaches getting worse all the time
  • Sudden onset of severe headache
  • Headaches associated with high fever, stiff neck or rash
  • Onset of headache after head injury
  • Problems with vision or profound dizziness
38
Q

What is the treatment for cervical instability?

A
  • Refer on for imaging

- When confirmed, build muscle bulk/control around the area

MI2 (10 decks)

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