Week 4: Cervical Spine Stenosis Flashcards

1
Q

What is cervical spinal stenosis?

A
  • Narrowing of the spinal canal

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where can a cervical spinal stenosis be found?

A
  • Central

- Lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is cervical spinal stenosis associated with?

A

Spondylosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How old are patients with cervical spinal stenosis?

A

Usually in patients over 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Classes of cervical spinal stenosis

A
  • Degenerative
  • Congenital
  • Traumatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Degenerative cervical spinal stenosis

A

Osteophyte formation, degenerative disc, hypertrophy of ligamentum flavum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Congenital cervical spinal stenosis

A

Present due to spinal development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Traumatic cervical spinal stenosis

A

Single incident

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Bony structures implicated in cervical spinal stenosis

A
  • Osteophytes on vertebral bodies (posterior or posterolateral)
  • Facet joint ostephytes
  • Uncovertebral joint osteophytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Soft tissue structures implicated in cervical spinal stenosis

A
  • Disc protrusion or calcification
  • Ossified posterior longitudinal ligament
  • Ligamentum flavum hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Characteristics of cervical spinal stenosis

A
  • Chronic and slowly progressive
  • Usually episodes of worsening symptoms
  • May have focal radicular symptoms
  • May present w/ cervical spondylotic myelopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Spinal canal mechanics

A
  • Flexion –> widening of canal by 31%
  • Extension –> narrowing of canal by 20%
  • Rotation –> Ipsilateral narrowing, contralateral widening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Spondylosis

A

Degeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Symptoms complexes associated w/ symptomatic spondylosis

A
  • Axial spine pain
  • Radicular pain
  • Myelopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Axial spine pain

A

Most common in middle ages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Radicular pain

A

Herniated disc, neuroforaminal stenosis, or both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Myelopathy

A

Central stenosis leading to cord compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is cervical myelopathy?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Major mechanisms of cervical myelopathy

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Risk factors for cervical myelopathy

A
  • In 90% of people over 70
  • Most spinal cord dysfunction is in people over 55
  • Males > females
  • Asian descent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Prognosis for cervical myelopathy

A

Variable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Signs and symptoms for cervical myelopahty

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Syndromes associated with CSM

A
  • Transverse syndrome
  • Motor system syndrome
  • Mixed radicular and long tract syndrome
  • Partial Brown-Squard syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Transverse syndrome

A

Corticospinal, spinothalamic, and dorsal column

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Motor system syndrome
Corticospinal and anterior horn
26
Mixed radicular and long tract syndrome
-
27
Partial Brown-Sequard syndrome
-
28
Spinal tracts involved in cervical myelopathy
- Corticospinal - Posterior columns - Anterior foraminal - Lateral thalamic
29
Corticospinal info conveyed
Ipsilateral motor
30
Posterior columns info conveyed
Ipsilateral vibration/proprioception
31
Anterior foraminal info conveyed
Ipsilateral motor
32
Lateral thalamic info conveyed
Contralateral pain, temp, and touch
33
Corticospinal symptoms from compression
LE weakness
34
Posterior columns symptoms from compression
Ataxia
35
Anterior foraminal symptoms from compression
UMN signs
36
Lateral thalamic symptoms from compression
Sensory changes
37
Stages of myelopathy
- Mild - Moderate - Severe
38
Mild myelopathy
Involves hand and arm symptoms, but not prevent normal ADLs
39
Moderate myelopathy
Considerable difficulty using arms and legs, affects ADLs
40
Severe myelopathy
Requires ambulatory aids, often confined to bed, chair, or home
41
Clinical cluster signs for cervical myelopathy
- Gait deviation - Hoffmann's test - Inverted supinator sign - Babinski test - >45 years - 3 or more
42
Imaging to use for diagnosis
- X-ray - CT scan - MRI
43
-
-
44
-
-
45
-
-
46
-
-
47
-
-
48
-
-
49
-
-
50
-
-
51
-
-
52
-
-
53
-
-
54
-
-
55
-
-
56
-
-
57
-
-
58
-
-
59
-
-
60
-
-
61
-
-
62
-
-
63
Possible treatment categories for cervical myelopathy
-
64
-
-
65
-
-
66
-
-
67
-
-
68
-
-
69
-
-
70
-
-
71
-
-
72
-
-
73
-
-
74
-
-
75
-
-
76
Surgical risk, complications
-
77
-
-
78
-
-
79
-
-
80
-
-
81
-
-
82
-
-
83
-
--
84
-
-
85
-
-
86
-
-
87
-
-
88
Post operative PT for surgery
-