Lecture 2: Cervical Spine Functional Anatomy Part 2

Question 1

Where is the first IVD of the spine?

Answer 1

C2-3

Question 2

What are two main components of the IVD?

Answer 2

1. nucleus pulposus

2. annulus fibrosis

Question 3

What is the NP?

Answer 3

center of disc buffer to compresion

Question 4

What is the AF?

Answer 4

outside rings designed in criss cross manner that is a buffer to increases tension

Question 5

What part of AF is lacking?

Answer 5

posterior portion in the cervical spine

Question 6

What is purpose of ventrebal end plate of the IVD?

Answer 6

layer of hyaline and fibrocartilage which separates IVD from vert body

nutrition to disc comes through endplate and better supply is fueled by movement

Question 7

What happens to disc during flexion, extension, SB?

Answer 7

flex- posteriorly
ext- anteriorly
SB- contralateral side

Question 8

Where does the IVD receive its innervation?

Answer 8

sensory nerve fibers found throughout AF via sinuvertebral nerve

Question 9

At what age does normal degeneration of disc occur?

Answer 9

50’s, disc begins to dry out, loses height and ability to absorb force

Question 10

What is a disc herniation?

Answer 10

NP of IVD leaks into SC causing pain and inflammation

Question 11

What is difference between degeneration and degradation?

Answer 11

degen- normal part of aging

degrad- more aggressive and likely due to unequal load distribution

Question 12

What muscles in c spine act like the TA in l spine?

Answer 12

longus colli and capitis, rectus capitis anterior and lateralis

Question 13

How many cervical spinal nerves are there and where do they exit?

Answer 13

8, exit above the vertebrae of same number

Question 14

How can you assess integrity of spinal nerves?

Answer 14

myotomes, DTR, dermatomes, sclerotome (bone or fascia)

Question 15

What is cervical radiculopathy?

Answer 15

dz of the cervical spinal root, often from compressive or inflammatory pathology (disc herniation)

Question 16

What are sx of cervical radiculopathy?

Answer 16

pain in neck or arm, distal parathesia, hypoesthesia or anesthesia with increased pressure, motor weakness, decreased or absent DTR

Question 17

What is myelopathy?

Answer 17

any pathological condition of the spinal cord

narrowing of SC from degenerative changes

ex: spinal stenosis

Question 18

What are common sx from myelopathy?

Answer 18

multi level weakness or sensory changes, muscle wasting, spasticity, hyperreflexia, gait disturbances, sudden change in bowel/bladder function

Question 19

What is referred pain?

Answer 19

pain felt in a part of the body that is usually considerable distance from the issues that have caused it

Question 20

What is important to remember about refereed pain?

Answer 20

ALWAYS find cause of it, even if it is not of MS origin

Question 21

What are two important arteries of the cervical spine?

Answer 21

1. internal carotid- supplies 80% of brain

2. Vertebral arteries- blow flow to brainstem, medulla, pons, cerebellum and vestibular

Question 22

What are 4 parts of VA?

Answer 22

1. proximal- by longus colli and scalene
2. transverse- can be compressed by osteophytes
3. suboccipital- located at very mobile part of spine (c1-2)
4. intracranial

Question 23

What key motions are likely to cause VBI?

Answer 23

end range rotation, extension and traction

Question 24

What are risk factors for VBI?

Answer 24

VA asymmetry, HTN, OA, lig laxity, DM, HLF, hx of TIA or CVA

Question 25

What are sx of VBI?

Answer 25

5D 3N 1A

dizziness, diplopia, dysarthria, dysphagia, drop attacks

nausea, nystagmus, numbness of face

ataxic gait

Question 26

How do you screen for VBI?

Answer 26

use subjective info as well as AROM if negative performed sustained rotation in sitting or supine

Question 27

How is VBI test performed?

Answer 27

passively rotate pts head and hold for 10 seconds

positive results in sx production, refer out

Question 28

What is contraindicated if pt has VBI?

Answer 28

cervical manipulation/mobilization, end range rotation, exacerbating positions

Question 29

What are 3 common C spine radiograph views?

Answer 29

1. lateral- must include at 7 c spine vert as well as c7-T1 junction
2. Anteroposterior
3. open mouth odontoid

Question 30

What is shown on an AP view?

Answer 30

SP, TP and alignment

Question 31

What is shown on lateral view?

Answer 31

disc height, shape of vert, osteophytes, ADI