Cervical Spondylosis Flashcards
What is cervical spondylosis?
Degeneration of the annulus fibrosis (tough coating of intervertebral discs) combined with osteophyte formation on the adjacent vertebra leads to narrowing of the spinal canal and intervertebral foramina.
As the neck flexes and extends the cord is dragged over protruding body spurs anteriorly and indented by thickened ligamentum flavour posteriorly
What is the PC in CS?
Neck tiffness
Crepitus on moving neck
Stabbling/dull arm pain
Forearm/wrist pain
Limited painful neck movmeent
Neck flsion may produce tingling down the spine (Lhermitte’s sign - also seen in MS)
What is radiculopathy? Features?
Root compression
Pain/electrical sensations in arms or fingers at the level of compression with weakness and easting of muscles innervated by affected root
UMN signs below level of affected root suggests cord compression
What are features of cord compression?
Progressive symptoms (increasing weakness, clumsy hands, gain disturbances)
UMN leg signs (spastic weakness, upgoing plantars)
LMN arm signs (wasting hyporeflexia)
Incontinence
Hesitancy
Urgency
What are the motor and sensory deficits and pain patter in C5 root compression?
Weak deltoid and supraspinatus
Reduced supinator jerks
Numb elbow
Pain in neck/shoulder that radiates down front of arm to elbow.
What are the motor and sensory deficits and pain patter in C6 root compression?
Weak biceps and brachioradialis
Reduced biceps jerks
Numb thumb and index finger
Pain in shoulder radiating down arm below elbow
What are the motor and sensory deficits and pain patter in C7 root compression?
Weak triceps and finger extension
Reduced triceps jerk
Numb middle finger
Pain in upper arm and dorsal forearm
What are the motor and sensory deficits and pain patter in C8 root compression?
Weak finger flexors and small muscles of hand
Numb 5th and ring finger
Pain in upper arm and medial forearm
What are causes of compression? Worrying signs?
MS
Nerve root fibroma
Subacute combined degeneration of the spinal cord
Compression by bone or cord tumours
Weight loss
Night sweats
Fever
What is subacute combined degeneration of the spinal cord?
Vitamin B12 deficiency
Dorsal and lateral columns affected
Joint position and vibration sense lost first then distal paraesthesia
UMN signs typically develop in legs - extensor planters, brisk knee reflexes and absent ankle jerks
If untreated, stiffness and weakness persist
What is management for cervical spondylosis?
MRI and specialist referral for red flag symptoms
Analgesia as per ladder
Encourage gentle activity
If no improvement, then MRI and neurosurgical referral for inter laminal cervical epidural infections, surgical decompression.
