Lecture 2: Cervical Spine Functional Anatomy Part 2 Flashcards
Where is the first IVD of the spine?
C2-3
What are two main components of the IVD?
- nucleus pulposus
2. annulus fibrosis
What is the NP?
center of disc buffer to compresion
What is the AF?
outside rings designed in criss cross manner that is a buffer to increases tension
What part of AF is lacking?
posterior portion in the cervical spine
What is purpose of ventrebal end plate of the IVD?
layer of hyaline and fibrocartilage which separates IVD from vert body
nutrition to disc comes through endplate and better supply is fueled by movement
What happens to disc during flexion, extension, SB?
flex- posteriorly
ext- anteriorly
SB- contralateral side
Where does the IVD receive its innervation?
sensory nerve fibers found throughout AF via sinuvertebral nerve
At what age does normal degeneration of disc occur?
50’s, disc begins to dry out, loses height and ability to absorb force
What is a disc herniation?
NP of IVD leaks into SC causing pain and inflammation
What is difference between degeneration and degradation?
degen- normal part of aging
degrad- more aggressive and likely due to unequal load distribution
What muscles in c spine act like the TA in l spine?
longus colli and capitis, rectus capitis anterior and lateralis
How many cervical spinal nerves are there and where do they exit?
8, exit above the vertebrae of same number
How can you assess integrity of spinal nerves?
myotomes, DTR, dermatomes, sclerotome (bone or fascia)
What is cervical radiculopathy?
dz of the cervical spinal root, often from compressive or inflammatory pathology (disc herniation)
What are sx of cervical radiculopathy?
pain in neck or arm, distal parathesia, hypoesthesia or anesthesia with increased pressure, motor weakness, decreased or absent DTR
What is myelopathy?
any pathological condition of the spinal cord
narrowing of SC from degenerative changes
ex: spinal stenosis
What are common sx from myelopathy?
multi level weakness or sensory changes, muscle wasting, spasticity, hyperreflexia, gait disturbances, sudden change in bowel/bladder function
What is referred pain?
pain felt in a part of the body that is usually considerable distance from the issues that have caused it
What is important to remember about refereed pain?
ALWAYS find cause of it, even if it is not of MS origin
What are two important arteries of the cervical spine?
- internal carotid- supplies 80% of brain
2. Vertebral arteries- blow flow to brainstem, medulla, pons, cerebellum and vestibular
What are 4 parts of VA?
- proximal- by longus colli and scalene
- transverse- can be compressed by osteophytes
- suboccipital- located at very mobile part of spine (c1-2)
- intracranial
What key motions are likely to cause VBI?
end range rotation, extension and traction
What are risk factors for VBI?
VA asymmetry, HTN, OA, lig laxity, DM, HLF, hx of TIA or CVA
What are sx of VBI?
5D 3N 1A
dizziness, diplopia, dysarthria, dysphagia, drop attacks
nausea, nystagmus, numbness of face
ataxic gait
How do you screen for VBI?
use subjective info as well as AROM if negative performed sustained rotation in sitting or supine
How is VBI test performed?
passively rotate pts head and hold for 10 seconds
positive results in sx production, refer out
What is contraindicated if pt has VBI?
cervical manipulation/mobilization, end range rotation, exacerbating positions
What are 3 common C spine radiograph views?
- lateral- must include at 7 c spine vert as well as c7-T1 junction
- Anteroposterior
- open mouth odontoid
What is shown on an AP view?
SP, TP and alignment
What is shown on lateral view?
disc height, shape of vert, osteophytes, ADI
