Ch. 14 - Cervical disc disease and cervical spondylosis Flashcards
predominant sx of cervical spine disorders
neck pain and arm symptoms
cause of cervical spine disorders
degenerative changes in vertebral column = cervical disc disease and cervical spondylosis
most common level of cervical disc herniation
C6/7 > C5/6 (fulcrum of head/spine), otherwise uncommon
direction of disc herniation in cervical spine and implication
posterolaterally because PLL prevents direct posterior herniation ==> nerve root entrapment at the level of the spinal nerve (ie C5/6 prolapse = C6 nerve entrapment)
presentation of cervical disc herniation
“deep achy” neck and arm pain and neurologic manifestations of cervical nerve root compression (radiculopathy)
upper extremity dermatome
C5 - upper arm and forearm
C6 - shooter
C7 - middle finger
C8 - 4th/5th digits
upper extremity myotomes
shoulder: abduction C5, adduction: C6-8
elbow: flexion C5/6, extension: C7/8
Forearm: supinate C6, pronate C7/8
Wrist: flexion C6-8, extension C7/8
Intrinsic hands: C8/T1
Characteristic C6/7 disc prolapse
C7 nerve root compression = weakness with elbow extension, absent triceps jerk, numbness/tingling middle finger
UE reflexes
biceps - C5, brachioradialis - C6, triceps - C7
Characteristics of C5/6 disc prolapse
C6 nerve root compression = absent brachioradialis reflex, numbness/tingling of C6 shooter
Characteristics of C7/T1 disc prolapse
C8 nerve root compression = weakness in long flexors, triceps, finger extensors, intrinsic hand muscles, decreased sensation in 4th/5th digits
ddx disc prolapse
spinal tumor, thoracic outlet syndrome, pancoast’s tumor, peripheral nerve entrapment
disc prolapse management
conservative - bed rest, cervical collar, NSAIDs, muscle relaxants
indications for surgical intervention of disc prolapse
pain > 10 days w/o relief, significant weakness, e/o myelopathy
Dx cervical disc prolapse with…
MRI
surgical interventions for disc prolapse
cervical foraminotomy with excision of prolapsed disc vs anterior cervical discectomy with fusion
disadvantage to anterior cervical discectomy with fusion
adjacent joint disease
cervical spondylosis
degenerative arthritic process of cervical spine
prevalence of cervical spondylosis in people >50
75%