Cervical Spine Pathologies Flashcards
What are the differences between the cervical and thoracic spinous processes?
Cervical:
- Bifurcate (base for muscle attachments)
- Shorter
- Pointier, less broad
- No C1 spinous process
Where are the transverse processes in relation to the spinous processes in the cervical spine?
At the same level
Which lateral joints connect consecutive vertebral bodies in the cervical spine?
- Facet joints
- Joints of luschka
What are the functions of the joints of luschka?
- 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
What is the difference between the transverse processes of the cervical spine compared to thoracic & lumbar?
Much smaller
What is a unique anatomical structure in the cervical spine?
Transverse foramen for vertebral arteries
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
b. Allows more flexion/extension than the atlanto-occipital joint
What are the synovial joints between C1 & C2?
- Superior/inferior articular surfaces
- Anterior arch of atlas/dens
- Tubercle for transverse ligament/dens
What is the orientation of the facet joints in each section of the spine?
Lumbar: Vertical
Thoracic: Approx 30 degrees
Cervical: 45 degrees
What is the pathway of the vertebral arteries?
- 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
What do the vertebral arteries supply?
- Upper spinal cord
- Brainstem
- Cerebellum
What is vertebrobasiliar insufficiency (VBI)? **Red flag
Insufficiency of vertebrobasiliar artery system caused by vertebral artery disease or injury (e.g. atherosclerosis, dissection)
What are the symptoms of VBI?
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
When is a VBI screening test required?
When assessment or treatment involves end level sustained extension or rotation or accessory movement testing (all cervical PAIVMs)
What are the potential causes dizziness other than VBI?
- Postural hypotension (when getting up quickly, usually doesn’t involve rotation)
- Vestibular/inner ear
- Cervical vertigo (prolonged neck positions/movements)
What is the most common cause of vestibular dizziness?
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
What should you do if a patient reports significant VBI symptoms in the subjective?
Don’t conduct a VBI assessment & refer on
When are the risk factors for cervical instability? **Red flag
- RA
- Down’s syndrome
- Ehlers-Danlos syndrome (connective tissue disorder)
- History of major trauma
- Repetitive throat infections
What are the symptoms of cervical instability?
- 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
What imaging should be used to diagnose cervical instability?
- Functional MRI
- MRI with someone applying traction to the head
What is whiplash?
- Soft tissue injury to the neck following acceleration & deceleration
- Hyperextension followed by hyperflexion
- Most commonly in MVAs
- 40-60% develop chronic pain
What should the subjective examination for whiplash include?
- 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
What are the Canadian C Spine Rules?
Guidelines for the cervical spine that indicate the need for imaging after a trauma (equivalent of Ottawa rules)
What are the high risk factors in the Canadian C Spine Rules?
- Age 65 or over
- Dangerous mechanism
- Paresthesis in extremities
What is considered a dangerous mechanism in the Canadian C Spine Rules?
- 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
What are the whiplash injury grades?
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
What symptoms are predictive of poor recovery in whiplash?
- 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
What psychological & crash related factors are predictive of poor recovery in whiplash?
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)
What are some of the nerve disorders in the cervical spine?
- Spinal cord compression/stenosis
- Nerve root compression
- Peripheral nerve sensitivity
Is spinal cord compression/stenosis less common in the cervical or lumbar spine?
Cervical, as spinal canal is much larger
What can cause spinal cord compression/stenosis?
Any space-occupying mass e.g. disc herniation, osteophytes, tumour
What are the most common cervical spine nerve root compression injuries?
Median nerve (carpal tunnel or double crush) & ulnar nerve
What is wry neck?
- 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
What are cervicogenic headaches?
- 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)
What is the international headache society classification?
- Resistance to or limitations of neck PROM
- Changes in neck muscle contour, texture or response to active/passive stretching or contraction
- Abnormal tenderness of neck muscles
What are migraines and tension headaches?
- Migraines: Pounding sensation, often occur with other symptoms (nausea, vomiting, photophobia, phonophobia)
- Tension headaches: Pressure sensation around head, bilateral headache, absence of mechanical trigger
What are the red flags for headaches which require medical evaluation?
- 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
What is the treatment for cervical instability?
- Refer on for imaging
- When confirmed, build muscle bulk/control around the area
