Dr. Lecture: C-spine disorders for the PT

Question 1

ABC’s of the c-spine xray

Answer 1

A-adequacy (all 7 vertebrae, base of skull, top of T1)
-alignment (lines; Basilar line of Wackenheim-relationship of head to c-spine)
B-bone
-base of skull (Clivus line tells if head is on the spine)
C-cartilage (disc spaces)
-contours (should be lordotic)
D-disc spaces
S-soft tissue spaces (3ml in front of 3, 20 in front of 5-7)

Question 2

disc spaces on radiograph

Answer 2

smaller than expected=worn down

larger than expected=trauma

Question 3

uncovertebral joints

Answer 3

• synovial
• can have all the same problems as other joints
• stability
• degenerative changes can effect nerves

Question 4

How does the relationship between vertebrae change as you move down the spine?

Answer 4

becomes more vertical

Question 5

facet joints

Answer 5

• synovial

- can develop bone spurts, etc

Question 6

Ligamentum flavum attachment and why it’s important

Answer 6

• under surface of superior lamina

- bends into SC with degenerative changes to spine

Question 7

facet capsules

Answer 7

• easy to image irritation

- if the bone is OK but the ligament isn’t, ROM and stuff-ligament might not hold up

Question 8

most common segments for radiculopathy

Answer 8

C5-6
C6-7
C4-5

Question 9

When do you have to and not necessarily have to take radiographs of patients with neck complaints?

Answer 9

• don’t have too with people that don’t have a hx of trauma, generic neck pain
• critical for patients with non-mechanical neck pain or a hx of trauma

Question 10

cervical HNP: signs, usual distribution, imaging

Answer 10

• motor weakness, arm pain, neck pain
• classic posture of shoulder abduction (arm on head)
• usually in C6 or 7 distribution (most commonly degenerated)
• MRI better than xray
• -CT/myelogram

Question 11

cervical HNP surgeries

Answer 11

• anterior disectomy
• anterior cervical disectomy and fusion
• posterior foraminotomy

Question 12

cervical spondylotic myelopathy: signs

Answer 12

-SC sx (clumsy, uncoordinated); can have radicular sx; spasticity; may be no clear motor weakness

Question 13

Hofmann’s reflex

Answer 13

• brain lesion

- cervical cord lesion

Question 14

inverted brachial reflex

Answer 14

fingers flexing with biceps relfex

Question 15

CSM: radiographs

Answer 15

• marked degenerative changes
• possible subluxation
• may suggest stenosis

Question 16

CSM surgeries

Answer 16

• cervical laminectomy
• cervical laminectomy with fusion
• laminoplasty

Question 17

imagining for mechanical neck pain

Answer 17

• plain radiographs aren’t helpful
• be careful with MRI report
• CT/myelogram not indicated

Question 18

surgery and mechanical neck pain

Answer 18

• rarely indicated!

- ACDF best results are 70%

Question 19

cervical strain: imaging

Answer 19

• all pts must be evaluated with xray; have to assess for alignment and stability
• acute aggressive PT or manipulation is dangerous
• early immobilization for a while is ok, not for a long time

Question 20

cervical strain: tx

Answer 20

• work on real dx
• education
• ROM and strengthening
• emphasize function, not complete pain recovery

Question 21

don’t manipulate patient who…

Answer 21

• have had trauma
• have clear neurologic signs and symptoms
• have had recent surgery

Question 22

modalities shouldn’t be used on…

Answer 22

recent post-operative patients