Cervical Spine Pathophysiology

Question 1

What is the incidence and prevalence of cervical spine issues?

Answer 1

Affects 90% of individuals within their lifetime
Prevalence of neck pain increases w/age (common in your 50’s)
25% pts in PT for neck pain
Actual origin is often undefinable
~80% of cases involving back & neck pain have an underlying path that can’t be determined

Question 2

What does it mean if someone has impaired posture?

Answer 2

Center of gravity anterior to OA joint

Question 3

What can lead to a impaired posture?

Answer 3

Excessive & prolonged forward head pathology

Question 4

What is postural syndrome?

Answer 4

Symptoms that are developed from sustained loading, relieved by change in position

Question 5

What is the clinical examination for impaired posture?

Answer 5

Postural Exam
A/PROM→ Flexibility
Strength & Endurance
Accessory Motion Testing/ Joint Play
Ergonomics

Question 6

What is the intervention for impaired posture?

Answer 6

PT primarily

Question 7

What is the MOI for acute traumatic injuries?

Answer 7

Violent flexion (C4/5, C5/6)
Impaction
Lateral stretch injuries (brachial plexus)
Extension
Extension followed by flexion (whiplash)

Question 8

What tissues are hurt due to trauma?

Answer 8

Ligament
Musculotendinous units
Bone
Disk
Articular cartilage
Nerves/Spinal Cord

Question 9

Acute injuries diagnostics?

Answer 9

X-ray, CT, MRI

Question 10

What are some interventions for acute injuries?

Answer 10

Short term immobilization
Soft collar or shell based collar
NSAIDs
PT
May need surgery to correct fracture

Question 11

When should a clinician be suspicious of serious injury in presence of vague clinical signs?

Answer 11

Following a MVA (40MPH) or fall from a height (5 ft) or down 5 stairs

Question 12

What indications are there to a negative Canadian Cervical Spine Rule?

Answer 12

No high risk factors
Safe Assessment of ROM
Patient is able to actively rotate 45° both

Question 13

Spondolosis

Answer 13

degeneration

Question 14

What is the prevalence of disc herniation?

Answer 14

Male or female
25-55 yrs old

Question 15

What is the area of complaint for disc herniation?

Answer 15

Neck or scapular pain
May complain of vague whole upper extremity or hand aching
Pain at medial border of scapula

Question 16

What is stenosis?

Answer 16

narrowing of spaces within spine

Question 17

What can cause cervical stenosis?

Answer 17

disc herniation

Question 18

What is lateral stenosis?

Answer 18

Narrowing of intervertebral foramen

Question 19

What is central stenosis?

Answer 19

Narrowing of spinal canal

Question 20

What are symptoms of lateral stenosis radiculopathy?

Answer 20

Male or female
Pt will most likely report neck & arm symptoms
Pain referred (Scapula & UE)
Paresthesia follows dermatome
Neuro screen will reveal weakness in particular myotome & abnormal MSR/DTR

Question 21

What are symptoms of central stenosis myelopathy?

Answer 21

Male or female
22-55 yrs old
More subtle particularly in early stage
Neck pain
Unsteadiness in gait or clumsiness
Multidermatomal distribution of paresthesia
Hoffman and Babinski signs are significant
Childs table 1 for more risk factors/key findings

Question 22

What will Hoffman & Babinski indicate clinically?

Answer 22

Generally indicate cord involvement in cervical spine or intracranial pathology

Question 23

What diagnostic modalities are needed for cervical stenosis?

Answer 23

EMG/NCS, MRI

Question 24

What are the 4 criteria for Wainner’s CPR for cervical radiculopathy?

Answer 24

Cervical spine rotation <60°
+ spurlings test
+ distraction test
+ upper limb nerve tension test (Elvy’s test)

Question 25

What is the management approach for cervical radiculopathy?

Answer 25

Radiculopathy
Consertive care primarily PT (centralization category → cervical traction, RMT etc), epidural injections

Question 26

What is the management approach for cervical myelopathy?

Answer 26

Surgical, especially if progressive & disabling in nature

Question 27

What are the characteristics of degenerative joint disease?

Answer 27

Male>Female
45+ years old
Symptoms usually Bilat & often do not cross midline
When bad is can radiate to SSF +/- mid-scapula #ouch
Deep ache
Rarely functionally limiting, but wears patient down

Question 28

What are the characteristics of DJD in older adults?

Answer 28

Proliferation of calcific deposits in & around the periphery of the joint (Osteophytes)
Wearing away of hyaline cartilage
Thickening of synovial lining & joint capsule
Thickening of subchondral bone
AKA spondylosis