Cervical Spine

Question 1

Cervical Spine Triage/Red Flag Signs/ Questions

Answer 1

Spinal fracture Red flags: hx osteoporosis, corticosteroid use, severe trauma/MOI, hx of spinal fracture, hx of cancer, hx of falls, ≥65 y/o, paresthesias in extremities, inability to actively rotate the neck 45 degrees to the left and right (Canadian C-Spine Rule).

Spinal malignancy Red flags: hx of cancer, unexplained weight loss, unexplained significant night sweats, pains worse at night, progressive headaches worse with exertion.

​Spinal infection Red flags: intravenous drug use, poor living conditions, immunosuppression, recent surgery/invasive interventions, history of TB, recent infection, unexplained constitutional symptoms (e.g. fever/chills).

Cervical Myelopathy Red flags: gait disturbances, hand clumsiness, non-dermatomal numbness, weakness or numbness involving lower extremity / bowel / bladder, coordination problems.

Meningitis Red flags: neck stiffness, severe generalized headache that is worse with flexion, neck pain or headache with fever, vomiting or rash, altered mental status, photophobia.

​Vertebral / Carotid Artery Dissection Red flags: severe neck pain and/or headache (described as the worst pain ever), double vision, difficulty initiating swallowing, dizziness, drop attacks, facial numbness, difficulty walking, nausea, nystagmus.

​Intracranial / Brain Lesion Red flags: sudden and intense onset headache (thunderclap headache).

​Neurological disorders (e.g., MS, ALS, neurodegenerative disorders) Red flags: upper/lower motor neuron findings, clonus.

Question 2

Concussion Diagnostic Criteria

Answer 2

History of possible concussion + presence of 3 or more of following:
H/A
Dizziness
Fatigue
Irritability
Insomnia
Concentration Issues
Memory issues
Intolerance to stress, emotion, alcohol

Question 3

Canadian C-Spine Rules (need for imaging post trauma)

Answer 3

1. 65 y/o or older or high energy accident
2. Unable to sit up, midline tenderness, early onset of pain
3. Unable to rotate head 45 degrees

Question 4

Modified Sharp Purser Test

Answer 4

Transverse Ligament
Sl. Flexion, block C2 and push posteriorly. Should NOT feel movement.

Question 5

Alar Lig Stability Test

Answer 5

Alar Lig stabilizes neck during SF and Rot.
Sl. flexion neck, grab C2 laterally and firmly. Rotate or SF head. SHOULD feel movement of C2

Question 6

Cervical Artery Dysfunction

Answer 6

Reduced blood flow to the brain due to the position or damage to arterial structures
No tests completely valid
In sitting take neck to EOR rotation and hold for 10 secs. Count backwards from 100. Look for nystagmus/difficulty counting

Question 7

Myelopathy Clinical Prediction Rule

Answer 7

The five tests:
Gait deviation: abnormally wide-based gait, ataxia, or spastic gait
+ Hoffmann’s sign: reflex contraction of the thumb and index finger when flipping the distal part of the middle finger.
An inverted supinator sign: which is elicited by quick tapping near the styloid process of the radius, the attachment of the brachioradialis tendon. It shows in finger flexion or slight elbow extension.
+ Babinski sign: This sign shows as extension of the big toe and fanning of the other four toes when stroking the lateral aspect of the foot sole from the heal forwards towards the great toe.
Age >45 years old

Question 8

Shoulder screen for neck pain

Answer 8

Neers Test (flex w/ IR), Hawkin’s-Kennedy and ROM with O/P

Question 9

C-Spine Obj Assessment

Answer 9

AROM (upper & lower)
Repeated movts
PROM off end of bed
PAMs (CPA & UPA)
Motor control (post & any structures)
Special Tests:
Flex-rot for cx-genic H/A
Cx rot & lat flex for 1st rib elevation (if arm symptoms)
Cx distraction ? reduction in sx
UTT - Median bias
Spurling’s

Question 10

Clinical Predication Rule for Cx Radiculopathy

Answer 10

+ ULTT
<60 Cx rot
+ Spurling’s
+ Distraction test

Question 11

Common Cervical Pathologies

Answer 11

NON-SPECIFIC MECHANICAL - mvt triggered, most common, not radicular
CX DISC DISORDERS - usually C6/7
CX DEGEN DISORDERS - spondylosis, spondylolysis (usually C5/6 & C6/7)
CX NEUROGENIC DISORDERS: Radiculopathy/myelopathy
H/A’s
WAD

Question 12

CX DISC DISORDERS

Answer 12

Usually C6/7
May get myo/derm/reflex changes
Sharp pain w/ extension
Usually young
Often head held in opposite SF/rot/f
Flattened neck posture
Can have disc pain w/out nerve root irritation

Question 13

CX NEUROGENIC DISORDERS

Answer 13

Stenosis causes:
radiculopathy (most common in 40s/50s)
myelopathy - leg stiffness, hyperreflexia, atrophy of hands

Question 14

Types of Headaches

Answer 14

PRIMARY: not result of another condition (migraine/tension H/A)
SECONDARY: underlying condition e.g neck/sinus infection
CERVICOGENIC H/A: pain r/f from nociceptive source in MSK tissues. Most common = C1-3 (orbital) and C6 (frontal)

Question 15

WAD