Lumbar and cervical spondylosis Flashcards
What is spondylosis?
Broad term for degeneration in spine (discs, joints, vertebral bodies)
Osteoarthritis “wear and tear” to spine
Discs and joints degenerate
-Bone spurs grow on vertebra
- Impair movement
- Affect spinal nerves
How does cervical spondylosis present?
axial neck pain
referred pain - mimic headache
reduced motion of cervical spine
paraspinal muscle spasm
tingling, numbness weakness in arms hands legs or feet
What are complications of cervical spondylosis?
Radiculopathy (nerve root damage where leaves spine “pinched nerve”)
myelopathy (injury to spinal cord due to compression)
Indication for MR in cervical spondylosis?
What would you find?
cervical MRI (if persistent pain 4-6 weeks, suspect myelopathy or infection, hx of malignancy)
will see bone destruction, spinal cord or nerve compression
What would you see on cervical Xray in cervical spondylosis?
Degenerative joint disease
malalignment
spinal canal stenosis
fracture
instability
bone spurs
for ppl with severe/chronic neck pain, hx of trauma or neck surgery
Treatment for cervical spondylosis?
- Analgesia NSAIDS e.g. naproxen / diclofenac
Physio and traction
Corticosteroids
- cervical nerve root block / epidural anaesthesia
- surgical nerve decompression
What would you do in a physical exam of a pt with cervical spondylosis?
Range of motion of neck
Test reflexes / muscle strength (is there compression or spinal nerves / spinal cord)
Gait - spinal compression affecting?
-flaccid upper limb paresis (due to radiculopathy), variable sensory changes (sometimes including the Lhermitte phenomenon)
-spastic paraparesis (with variable involvement of the upper limbs depending on the site of the lesion, and degree of radiculopathy).
Flaccid paralysis is a neurological condition characterized by weakness or paralysis and reduced muscle tone without other obvious cause
What is a CT myelography and why used in cervical spondylosis?
Type pf CT where dye injected in spinal canal
used for detailed view of spinal cord, canal and nerve roots.
What could you do to investigate nerve function in a pt with cervical cervical spondylosis?
Electromyography - check electrical activity in nerves as they transmit to muscle when contracting and at rest
Nerve conduction study - electrode attached to skin above nerve - small shock passed through the nerve. strength and speed of nerve signal measured
Symptoms of lumbar spondylosis?
lower back pain
stiffness
restriction e.g. hard to arch back
pain referred to buttocks leg
Risk factors for spondylosis?
FHX
obesity
sedentary
Hx of spinal trauma /surgery
smoking
occupation (heavy lifting)
psoriatic arthritis
Complications of spondylosis?
chronic pain
nerve compression - neurological dysfunction
spinal stenosis
cauda equina
