Common Cervical Pathologies

Question 1

What is Cervical spondylosis?

Answer 1

It is a degenerative disc disorder affecting the inter body joint and predominantly affects the lower cervical spine

Question 2

What are the pathological changes when you develop cervical spondylosis?

Answer 2

Loss of disc height due to disc dehydration and degeneration
Increased pressure on facet joints
Possible nerve root entrapment and spinal cord compression due to degenerative changes.

Question 3

What are the signs and symptoms of cervical spondylosis?

Answer 3

Symptoms -
Bilateral or unilateral neck pain
Neck stiffness
Signs- decreased cervical Rom
Pain on PAIVM of involved levels
Altered posture
Dermatomal changes if nerve root involved

Question 4

What is cervical disc herniation?

Answer 4

It is caused by the degenerative weakening of annulus- nucleus prolapses through
It affects individuals in 30’s
C6-7 and c5-6 are the most common levels
Risk factors include age/smoking/lifting heavy objects and driving
However it is uncommon much less common than a disc prolapse in the lumbar spine

Question 5

What ways can a CDS occur?

Answer 5

The disc can prolapse centrally, posterolaterally and bulge. The source of pain is caused by a tear of the outer annulus and is also an inflammatory process

Question 6

What are the signs and symptoms of a cervical disc herniation?

Answer 6

Symptoms include acute and rapidly worsening neck pain - central or unilateral
Referred scapula pain
Pain worse on extension and prolonged flexion activities like cough inflammation and sneezing
Antalgic posture- head held in flexion
Postero-lateral prolapse and spinal nerve is involved if produces radicular referred pain into the arm and hand, par aesthetics or anaesthesia
If prolapse is posterior and central spinal cord is involved = myelopathy - signs and symptoms of cord compression

Question 7

What is facet joint osteoarthritis?

Answer 7

Degenerative disorder affecting the synovial joints
Pathology includes synovitis (joint lining inflammation) disintegration of cartilage, osteophyte formation and joint space narrowing. (Osteophytes are bony lumps that grow on the bones of the spine) they cause pain and stiffness

Question 8

What are the signs and symptoms of facet osteoarthritis

Answer 8

Symptoms
Local and often unilateral neck pain
Somatic pain referral into shoulder/ scapula region depending on the levels affected
Stiff neck
Signs
Decreased ROM into facet closed packed position - Extension and ipsilateral side flexion and ipsilateral rotation
Pain is reproduced on PAIVM of the affected levels

Question 9

What is cervical radiculopathy

Answer 9

There are 8 cervical nerve roots and lateral canal stenosis is narrowing of the iv foramina which causes nerve root compression and irritation and neurological changes
Irritation of the cervical nerve root in the iv foramina in the medial half is caused by inflammation, posterior-lateral disc prolapse, degenerative changes of facet joints. It most commonly affects C6, 7 and 5 levels

Question 10

What are the signs and symptoms of cervical radiculopathy

Answer 10

Severe arm pain in dermatomal distribution
Altered sensation in dermatomal distribution
Myotomal/ reflex changes
Significant night pin
Antalgic postures
Arm pain worsened on movements or postures closing down iv foramina eg ipsilateral rotation and extension

Question 11

What is cervical myelopathy

Answer 11

Compression of the spinal cord by severe central degenerative changes eg osteophytes
Large central disc prolapse

Question 12

What are the signs and symptoms of a cervical myelopathy

Answer 12

Chronic neck pain, less severe than lateral canal stenosis
Mild gait disturbances and numb clumsy hands
May have other cord signs like bladder dysfunction
Symptoms are aggravated with movements or posture that decrease the size of the spinal canal such as extension
It is usually a medical emergency

Question 13

What is whiplash

Answer 13

An acceleration- deceleration mechanism which results from rear end or side impact MVA and may result in bony or soft tissue injuries with a variety of clinical manifestations
Hyper extension affects anterior cervical structures
Hyper flexion phase is limited by chin, chest or forehead

Question 14

What are the possible lesions in whiplash

Answer 14

Muscle strain,
Facet joint capsule sprain,
Spraining ligaments and tears,
IVD- prolapse, annular tears, clefts in endplate
Spinal cord and nerve root traction injuries,
Concussion,
Thoracic outlet syndrome 
TMJ dysfunction

Question 15

What are the most affected areas of whiplash?

Answer 15

Rim lesions
Endplate avulsions
Ligament tear
Articulate process 
Tears of the anterior longitudinal ligament

Question 16

What are the symptoms of whiplash and prognosis?

Answer 16

Duration of symptoms- 6wk to 1yr
10% develop chronic pain
Biological symptoms include pain stiffness headaches nausea dizzy referred pain.
Pyschosocial symptoms include depression anxiety anger loss of job and income mental, and family disruption and ptsd

Question 17

What is postural dysfunction?

Answer 17

Pain is a result of tissue over stress and strain. There is no tissue damage or underlying pathology

Question 18

What are the signs and symptoms of postural dysfunction

Answer 18

Symptoms- widespread neck pain radiating into shoulders and head
This is worsened by prolonged postures such as sitting at a computer/ driving
Often easier in morning and worse at end of day

Signs- poor upper quadrant posture
FHP
TRigger points
May have full AROM and a sense of joint signs

Question 19

Where can be affected by a cervicogenic headache?

Answer 19

Areas of pain at upper back and neck, base of head, ears, above ears, has and above eyes
Dysfunction in upper cervical spine can present as headaches, face/eye/ TMJ/ Ear pain and pain in suboccipital region
Mechanism is thought to be the convergence

Question 20

What is the definition of a cervicogenic headache

Answer 20

A dysfunction in an upper cervical spine structure which refers pain into the head

Question 21

What are the signs and symptoms of a cervicogenic headache?

Answer 21

Signs 
Forward head posture
Decreased upper cervical AROM
Top of C0-C3 segments
Weakness in deep neck flexors
Symptoms 
Classically unilateral
Side consistency 
Pain starts in neck and spreads to head 
Aggravated by neck movements of sustained head or neck podture

Question 22

What are the red flags in the cervical spine

Answer 22

Cerebral artery dysfunction
Tuberculosis
Infection
Inflammatory conditions such as osteoarthritis, fractures and trauma