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UM - Axial > Cervical Spine Pathology & Radiology > Flashcards

Cervical Spine Pathology & Radiology Flashcards

1
Q

What are the Canadian C-Spine Rules

A

Get a radiograph if:
- Age >/= 65 yo
- Dangerous mechanism (fall from elevation, axial load to head, MVA)
- Paresthesia in extremities
- Low Risk Factor where Pt unable to actively rotate neck > 45 degrees

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2
Q

What do you look for in an AP View of the neck?

A
  • alignment of the cervical vertebra
  • SP midline
  • Pedicles are equidistant on either side of midline
  • space b/t vertebrae
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3
Q

What do you look for in a Lateral View of the neck?

A
  • 3 parallel lines: Facets, Vertebrae, SP
  • Disc Space
  • Prevertebral soft tissue (< 7mm at C2, < 22mm at C6)
  • Alantodens Interval (ADI): < 3mm in adult & < 5mm in peds
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4
Q

What is widening of the prevertebral soft tissue indicative of?

A

A cervical spine injury

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5
Q

What is the Atlantodens Interval (ADI) important for?

A

If you suspect cervical instability

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6
Q

What do you look for in an Oblique View of the neck?

A
  • Intervertebral fOramina (as OVALS)
  • Pedicles
  • SP
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7
Q

What do you look for in an open mouth View of the neck?

A
  • Position of dens b/t 2 columns of C1 vertebra
  • position of the vertebra & C2 vertebra
  • Bil. jt spaces should be equal
  • TP of C1
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8
Q

What is a Lateral Flexion/Extension stress view of the neck

A
  • Dynamic Motion Studies that help to elicit less than obvious instability of the C-spine
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9
Q

What do you see in a Swimmer’s View of the neck?

A

Helps demonstrate cervico-thoracic junction

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10
Q

What is a Jefferson Fracture?

A

A burst Fx of C1 caused by vertical forces compressing the lateral masses of C1 b/t the occiput and the axis

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11
Q

What are the 4 types of Jefferson Fx?

A

I - anterior arch
II - posterior arch
III - anterior & posterior arch double fx
IV - Lateral mass fx

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12
Q

Where in the cervical spine is there the greatest amount of flexion/extension?
Why is this important?

A

C5-6 = more likely to see degeneration

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13
Q

What is the resting position of the cervical spine?

A

Mid-way b/t flexion and extension

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14
Q

What is the closed packed position of the cervical spine

A

Bil: Full extension

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15
Q

What is the capsular pattern of the cervical spine?

A

Side flexion & rotation = limited, extension

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16
Q

What levels are the Upper Cervical Spine?

A

C0-C2

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17
Q

What levels are the Lower Cervical Spine?

A

C2-C7

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18
Q

What motions occur at the OA joint?

A

Primarily flexion/extension (24-30 deg) w/small amount of rot/SB

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19
Q

What are the arthrokinematics for flexion of the OA joint?

A

Bilateral condyles roll forward, glide posterior

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20
Q

What are the arthrokinematics for extension of the OA joint?

A

Bilateral condyles roll backward, glide anterior

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21
Q

What are the motions of the AA joint?

A
  • Primarily Rotation, up to 40-45 deg
  • some flexion, extension, & SB
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22
Q

What are the arthrokinematics for rotation of the AA joint?

A
  • IPSI posterior glide
  • CL anterior glide
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23
Q

Which motion segment places the most stress on the vertebral artery?

A

AA joint

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24
Q

Which motion segment may give a false test result on the alar ligament test?

A

C2-C3 if there is a motion restriction there

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25
Q

What angle are the superior facets of the lower cervical spine at?

A

45 degree angle upward, bkwd, and medially

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26
Q

In the lower cervical spine, what are the arthrokinematics of flexion?

A

Bilateral anterior-superior/ventral-cranial

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27
Q

In the lower cervical spine, what are the arthrokinematics of extension?

A

Bilateral posterior-inferior/dorsal-caudal

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28
Q

In the lower cervical spine, what are the arthrokinematics of SB/Rot?

A

IPSI dorsal-caudal, CL ventral-cranial

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29
Q

What is the a/b in the upper cervical spine?
A. Coupled movement
B. Non-coupled movement

A

A: opposite
B: Same

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30
Q

What is the a/b in the lower cervical spine?
A. Coupled movement
B. Non-coupled movement

A

A: same
B: opposite

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31
Q

Which levels do the nerves travel ABOVE their corresponding vertebra & which are BELOW?

A

C1-C7 ABOVE
C8 ABOVE T1
T1 & down is BELOW

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32
Q

What are uncovertebral joints

A

Present from C3-C7 they are a superior projection from the lateral aspect of the vertebral bodies that can reinforce the disc and provide protection from herniation

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33
Q

What % does the upper thoracic spine assist cervical motion?

A

Up to 25%

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34
Q

What is the common MOI for whiplash?

A

Flexion often combined with some rotation, followed by rapid extension or vice versa

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35
Q

What are some of the other factors you may want to consider about the MOI of whiplash?

A
  • Position of head at impact
  • awareness of impending impact
  • condition of the neck tissues
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36
Q

Which direction of impact will cause the greatest whiplash disability?

A

Rear impact

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37
Q

What is a grade 0 whiplash

A

No neck symptoms of physical signs

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38
Q

What is a grade 1 whiplash

A

No physical signs except for pain, stiffness and tenderness only

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39
Q

What is a grade 2 whiplash

A

Neck symptoms and musculoskeletal signs (dec ROM, point tenderness)

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40
Q

What is a grade 3 whiplash

A

Neck symptoms w/neurological signs (dec or absent DTR, weakness, and sensory deficits)

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41
Q

What is a grade 4 whiplash

A

Neck symptoms and fx or dislocation

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42
Q

What is whiplash-associated disorders (WAD)

A

Whiplash that leads to a variety of clinical manifestations:
- Aching/stiffness of the neck
- difficulty swallowing
- H/A
- Pain into scapula, chest, and/or shoulders
- Concussion

43
Q

T or F: WAD symptoms occur immediately

A

They can be immediate OR delayed

44
Q

What are factors that can cause delayed recovery from whiplash?

A
  • dec. cervical spine mobility post injury
  • pre-existing neck trauma
  • female
  • older age
  • psychosocial factors
  • pending litigation
45
Q

What is congenital torticollis?

A
  • SCM unilateral contraction that primarily effects females ages 6 mo to 3 years
  • due to: Intrauterine injury or living situations
46
Q

What is the presentation of acquired/acute torticollis?

A
  • > = 20 yo
  • unilateral pain, dec ROM, severe pain @ end ROM, strong but uncomfortable isometric strength testing
47
Q

T or F: Acquired Tort is always the SCM

A

False, it can be SCM, splenius capitius, semispinalis capitus, or anterior scalene

48
Q

What are possible causes of acute/acquired tort?

A
  • Trauma/mm strain
  • URTI
  • Viral infection
  • poor posture
  • hearing problems
49
Q

Treatment for acquired tort?

A
  • 1st 24 hrs: rest, heat, ice
  • after: STM, modailites, joint mobs, NSAIDs
50
Q

What is cervical spondylosis?

A

Normal aging process (40+) with the loss of integrity of disc causing instability of affected segment

51
Q

What % of radiographs for cervical spondylosis are asymptomatic?

A
  • 50% by age 50
  • 90% at age 65
52
Q

Life of a disc

A
  1. Disc degenerates
  2. Loss of disc height = overriding zygoapophyseal joints = damage articular cartilage
  3. Translational instability & dec/loss arthrokin control
  4. Formation of protective osteophytes
  5. OA –> hypomobility
53
Q

What conditions can lead to cervical hypermobility?

A
  • whiplash
  • OA/RA
  • segmental degeneration
  • trauma
  • genetic predisposition
54
Q

What are the main signs/symptoms of cervical hypermobility

A
  • history of trauma
  • catching/locking/giving way
  • poor muscle control
  • excessive EF
  • signs of hypermob on x-ray
55
Q

What clinical findings would you expect w/cervical instability

A
  • neck pain & HA w/sustained WB (sitting)
  • Catching or locking of neck
  • weakness
  • altered ROM (aberrant)
  • hypermobility and soft end feel w/PPIVMs and PAVIMs
56
Q

What is internal decapitation?

A

The transverse ligament breaks and a full force motion cuts the SC

57
Q

What are the cause of upper cervical instability

A
  • Trauma
  • RA
  • Down’s syndrome
  • prolonged corticosteroid use
58
Q

What are the s/s of upper cervical instability

A
  • feels like head is falling off
  • feels like lump in throat
  • torticollis (cock robin position = cardinal sign of early phase)
  • neurological signs/symptoms
59
Q

What are the major concerns w/upper cervical instability?

A

Paralysis or death

60
Q

What are the treatment options for upper cervical instability?

A
  • Sx
61
Q

What may indicate a facet joint pathology?

A
  • A capsular pattern
  • possible referred pain in head/shoulders
62
Q

What is the progression for a disc herniation?

A
  1. degeneration
  2. prolapse
  3. extrusion
  4. sequestration
63
Q

What is thoracic outlet syndrome?

A

Compression of neuroVASCULAR structures as they course from the cervical region to anterior chest/shoulder

64
Q

What are some symptoms that would indicate thoracic outlet syndrome?

A
  • vague shoulder pain/achiness
  • sense of heaviness in the shoulder
  • neurogenic signs (numbness, tingling, weak grip, loss of dexterity)
  • Vascular signs & tests that reproduce symptoms w/diminished pulse
65
Q

What are some common sites of compression for thoracic outlet?

A
  • anterior/middle scales & first rib
  • costoclavicular space
  • pec minor/coracoid
  • presence of cervical rib (rare)
66
Q

What is cervical myelopathy?

A

Spinal cord compromise (compression & ischemia) from stenosis/spondylosis that disrupts normal neural transmission

67
Q

What should you do if you suspect cervical myelopathy?

A

Refer for medical assessment so they can have a sx (ACDF)

68
Q

What is the cervical myelopathy cluster?

A

3/5 must be positive to RULE in:
- gait deviation
- + Hoffman’s sign
- Inverted supinator sign
- Positive Babinski test
- Age > 45 yo

69
Q

What is the inverted supinator sign

A

Reflex test of brachioradialis causes finger flexor hyperactive response

70
Q

What is the common area for the vertebral artery to get kinked?

A
  • C2 entering the skull
71
Q

What is the presentation for a non-ischemic VA Dissection

A

Ipsilateral posterior neck pain
Occipital HA

72
Q

What is the presentation for an ischemic VA Dissection

A
  • Hindbrain TIA (Dizziness, diplopia, dysarthria, dysphagia, drop attacks, nausea, nystagmus, facial numbness, ataxia, vomiting)
  • Hindbrain Stroke (Wallenberg’s syndrome or locked-in syndrome)
  • CN Palsies
73
Q

What is the presentation for a non-ischemic Internal Carotid Art. Dissection

A
  • Head/neck pain
  • Horners syndrome (drooping of eyes)
  • Pulsatile tinnitus
  • CN palsies
74
Q

What is the presentation for an ischemic Internal Carotid Art. Dissection

A
  • TIA
  • Ischemic stroke of MCA
  • Retinal infarction
75
Q

What is a common source of cervicogenic HA?

A

C2-3 pain referral

76
Q

What are the classic findings w/Cervicogenic H/A

A
  • Unilateral symptoms usual after strain/mvmt to c. spine
  • pain in neck/suboccipitals that radiates to frontotemporal & orbital regions (throbbing)
  • Presents w/limited ROM
  • Relieved w/lying down or blockage to cervical jts/nerves
77
Q

Migraine S/S

A
  • unilateral H/A
  • throbbing
  • Autonomic systems
  • changes w/food/light/stress
  • Response to medication
  • NOT related by neck movement & NO ROM changes or blockage of cervical jts/nerves
78
Q

Tension-Type HA S/S

A
  • bilateral
  • Pressure/tightening
  • Presence of Trigger points
  • NOT autonomic
  • NOT changed by mvmt, routine activity, NO ROM changes
79
Q

What is the most painful type of headache that can last from weeks to months?

A

Clusters headache

80
Q

What are the s/s of a cluster headache

A
  • tearing
  • redness in eye
  • stuffy/runny nose
  • sweating
  • drooping eyelid
81
Q

When would a cervical sx be indicated for…
Radiculopathy

A
  • Persistent/recurrent arm pain > 3mo
  • neuro deficits that interfere w/function
  • failed conservative treatments
82
Q

When would a cervical sx be indicated for…
Myelopathy

A
  • Mod–>Severe sympt altering QOL
  • Unsteady gait
  • hand dysfun
  • neurogenic bowel/bladder
  • spinal stenosis
83
Q

What are the 3 primary cervical surgeries

A

Anterior cervical discectomy and fusion
athroplasty
framinotomy

84
Q

What is the purpose of an ACDF Sx?

A
  • Halt further osteophyte formation
  • lead to regression & remodeling of existing osetophytes
  • distract the disc space to reduce bulking of the ligamentum flavum & enlarge the neuroforamen
85
Q

How is an ACDF done?

A

Anterior approach w/removal of disc and endplate cartilage to the uncovertebral jt and to PLL w/graft taken from iliac cret

86
Q

What do they need to be cautious of when doing an ACDF?

A

overdistraction as it can lead to collapse

87
Q

How much of the facet jt should be preserved to prevent segmental instability during a posterior laminectomy?

A
  • 50-75%
88
Q

Why might a disc arthroplasty be the best procedure?

A

Maintains cervical motion at the segment and is friendlier to the neighbouring segments by doing so

89
Q

ICF: Neck pain w/mobility deficits

What are the ICD Dx?

A

Cervicalgia
Pain in T spine

90
Q

ICF: Neck pain w/mobility deficits

Clinical findings for classification?

A
  • Younger < 50
  • acute neck pain duration
  • symptoms isolated to neck w/UE symptoms only caused by provocation of involved cervical/thoracic segment
  • restricted cervical ROM
  • neck pain @ end range
91
Q

ICF: Neck pain w/mobility deficits

Interventions

A
  • Cervical & thoracic mobs/manips
  • Stretching & mobility exercises
  • coordination, strength & endurance exercises
92
Q

ICF: Neck pain w/H/As

ICD Dx?

A
  • H/A
  • Cervicocranial syndrome
93
Q

ICF: Neck pain w/H/As

Clinical findings?

A
  • Unilateral H/A aggravated by neck mvmts
  • HA produced w/provocation of IPSI posterior cervical myofascia and jts
  • Restricted cerv ROM
  • Upper cervical (C1-2) segmental mobility defecits w/flexion rotation test
  • Restricted cervical segmental mobility
  • abnormal performance on cranial cervical flexion test
94
Q

ICF: Neck pain w/H/As

Interventions

A
  • Cervical/thoracic mobs/manips
  • strength endurance and coordination exercises for neck and postural mm
  • postural education
95
Q

ICF: Neck pain w/Mvmt Coordination Impairments

ICD Dx?

A

Sprain and strain of the cervical spine (hypermobile)

96
Q

ICF: Neck pain w/Mvmt Coordination Impairments

Clinical Findings?

A
  • Longstanding neck pain
  • abnormal performance on cranial cerv flexion test and deep flexor endurance tests
  • coord, strength & endurance deficits of neck/UQ mm
  • flexibility deficits of UQ mm
  • ergonomic inefficiencies w/repetitive activities
  • Hypermobility & loose end feels
  • Aberrant AROM w/greater AROM in supine
97
Q

ICF: Neck pain w/Mvmt Coordination Impairments

Interventions

A
  • coord, strength & endurance
  • stretching
  • mobs/manips above & below hypermobilities
  • ergonomic corrections
98
Q

Acute Pain symptoms

A
  • high pain and disability scores
  • recent hx of trauma
  • referred sympt into UE
  • limitied cervical AROM
  • poor tolerance to manual exam
99
Q

Acute pain includes what dx?

A

WAD

100
Q

Acute pain interventions

A
  • gentle AROM w/in Pt tolerance
  • activity mod to control pain
  • relative rest
  • physical modalities
  • intermittent use of C. collar
  • gentle manual & exercises
101
Q

ICF: Neck pain w/radiating pain

ICD Dx?

A

Spondylosis w/radiculopathy
Cervical disorder w/radiculopathy

102
Q

ICF: Neck pain w/radiating pain

Clinical findings

A
  • UE symptoms produced w/the TIC
  • Dec. cerv rot.
  • signs of nn root compression (sensory, strength, reflex deficits)
103
Q

ICF: Neck pain w/radiating pain

Interventions

A
  • UQ and nerve mobs
  • traction
  • craniocervical flexion exercises
  • postural exercise
  • thoracic mobs/manips

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