Week 4: Cervical Spine Stenosis

Question 1

What is cervical spinal stenosis?

Answer 1

• Narrowing of the spinal canal

- Most common cause of spinal cord disorders in patients over 55

Question 2

Where can a cervical spinal stenosis be found?

Answer 2

• Central

- Lateral

Question 3

What is cervical spinal stenosis associated with?

Answer 3

Spondylosis

Question 4

How old are patients with cervical spinal stenosis?

Answer 4

Usually in patients over 50

Question 5

Classes of cervical spinal stenosis

Answer 5

• Degenerative
• Congenital
• Traumatic

Question 6

Degenerative cervical spinal stenosis

Answer 6

Osteophyte formation, degenerative disc, hypertrophy of ligamentum flavum

Question 7

Congenital cervical spinal stenosis

Answer 7

Present due to spinal development

Question 8

Traumatic cervical spinal stenosis

Answer 8

Single incident

Question 9

Bony structures implicated in cervical spinal stenosis

Answer 9

• Osteophytes on vertebral bodies (posterior or posterolateral)
• Facet joint ostephytes
• Uncovertebral joint osteophytes

Question 10

Soft tissue structures implicated in cervical spinal stenosis

Answer 10

• Disc protrusion or calcification
• Ossified posterior longitudinal ligament
• Ligamentum flavum hypertrophy

Question 11

Characteristics of cervical spinal stenosis

Answer 11

• Chronic and slowly progressive
• Usually episodes of worsening symptoms
• May have focal radicular symptoms
• May present w/ cervical spondylotic myelopathy

Question 12

Spinal canal mechanics

Answer 12

• Flexion –> widening of canal by 31%
• Extension –> narrowing of canal by 20%
• Rotation –> Ipsilateral narrowing, contralateral widening

Question 13

Spondylosis

Answer 13

Degeneration

Question 14

Symptoms complexes associated w/ symptomatic spondylosis

Answer 14

• Axial spine pain
• Radicular pain
• Myelopathy

Question 15

Axial spine pain

Answer 15

Most common in middle ages

Question 16

Radicular pain

Answer 16

Herniated disc, neuroforaminal stenosis, or both

Question 17

Myelopathy

Answer 17

Central stenosis leading to cord compression

Question 18

What is cervical myelopathy?

Answer 18

A disorder in the cervical region that disrupts or interrupts the normal transmission of the neural signals

Question 19

Major mechanisms of cervical myelopathy

Answer 19

• Direct compression of the spinal cord
• Ischemia caused by compromise of the vascular supply to the cord
• Repeated trauma secondary to normal flexion and extension of the neck

Question 20

Risk factors for cervical myelopathy

Answer 20

• In 90% of people over 70
• Most spinal cord dysfunction is in people over 55
• Males > females
• Asian descent

Question 21

Prognosis for cervical myelopathy

Answer 21

Variable

Question 22

Signs and symptoms for cervical myelopahty

Answer 22

• Neck and UE pain
• Weakness and sensory impairments
• LMN signs at level of lesion
• UMN signs below level of lesion
• Parasthesia w/ weakness and wasting of the hands
• Gait disorders
• Bowel and bladder dysfunction
• Loss of deep touch, vibration, and joint position sense
• Lhermitte’s sign

Question 23

Syndromes associated with CSM

Answer 23

• Transverse syndrome
• Motor system syndrome
• Mixed radicular and long tract syndrome
• Partial Brown-Squard syndrome

Question 24

Transverse syndrome

Answer 24

Corticospinal, spinothalamic, and dorsal column

Question 25

Motor system syndrome

Answer 25

Corticospinal and anterior horn

Question 26

Mixed radicular and long tract syndrome

Answer 26

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Question 27

Partial Brown-Sequard syndrome

Answer 27

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Question 28

Spinal tracts involved in cervical myelopathy

Answer 28

• Corticospinal
• Posterior columns
• Anterior foraminal
• Lateral thalamic

Question 29

Corticospinal info conveyed

Answer 29

Ipsilateral motor

Question 30

Posterior columns info conveyed

Answer 30

Ipsilateral vibration/proprioception

Question 31

Anterior foraminal info conveyed

Answer 31

Ipsilateral motor

Question 32

Lateral thalamic info conveyed

Answer 32

Contralateral pain, temp, and touch

Question 33

Corticospinal symptoms from compression

Answer 33

LE weakness

Question 34

Posterior columns symptoms from compression

Answer 34

Ataxia

Question 35

Anterior foraminal symptoms from compression

Answer 35

UMN signs

Question 36

Lateral thalamic symptoms from compression

Answer 36

Sensory changes

Question 37

Stages of myelopathy

Answer 37

• Mild
• Moderate
• Severe

Question 38

Mild myelopathy

Answer 38

Involves hand and arm symptoms, but not prevent normal ADLs

Question 39

Moderate myelopathy

Answer 39

Considerable difficulty using arms and legs, affects ADLs

Question 40

Severe myelopathy

Answer 40

Requires ambulatory aids, often confined to bed, chair, or home

Question 41

Clinical cluster signs for cervical myelopathy

Answer 41

• Gait deviation
• Hoffmann’s test
• Inverted supinator sign
• Babinski test
• > 45 years
• 3 or more

Question 42

Imaging to use for diagnosis

Answer 42

• X-ray
• CT scan
• MRI

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Possible treatment categories for cervical myelopathy

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Surgical risk, complications

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Post operative PT for surgery

Answer 88

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