Ch. 14 - Cervical disc disease and cervical spondylosis

Question 1

predominant sx of cervical spine disorders

Answer 1

neck pain and arm symptoms

Question 2

cause of cervical spine disorders

Answer 2

degenerative changes in vertebral column = cervical disc disease and cervical spondylosis

Question 3

most common level of cervical disc herniation

Answer 3

C6/7 > C5/6 (fulcrum of head/spine), otherwise uncommon

Question 4

direction of disc herniation in cervical spine and implication

Answer 4

posterolaterally because PLL prevents direct posterior herniation ==> nerve root entrapment at the level of the spinal nerve (ie C5/6 prolapse = C6 nerve entrapment)

Question 5

presentation of cervical disc herniation

Answer 5

“deep achy” neck and arm pain and neurologic manifestations of cervical nerve root compression (radiculopathy)

Question 6

upper extremity dermatome

Answer 6

C5 - upper arm and forearm
C6 - shooter
C7 - middle finger
C8 - 4th/5th digits

Question 7

upper extremity myotomes

Answer 7

shoulder: abduction C5, adduction: C6-8
elbow: flexion C5/6, extension: C7/8
Forearm: supinate C6, pronate C7/8
Wrist: flexion C6-8, extension C7/8
Intrinsic hands: C8/T1

Question 8

Characteristic C6/7 disc prolapse

Answer 8

C7 nerve root compression = weakness with elbow extension, absent triceps jerk, numbness/tingling middle finger

Question 9

UE reflexes

Answer 9

biceps - C5, brachioradialis - C6, triceps - C7

Question 10

Characteristics of C5/6 disc prolapse

Answer 10

C6 nerve root compression = absent brachioradialis reflex, numbness/tingling of C6 shooter

Question 11

Characteristics of C7/T1 disc prolapse

Answer 11

C8 nerve root compression = weakness in long flexors, triceps, finger extensors, intrinsic hand muscles, decreased sensation in 4th/5th digits

Question 12

ddx disc prolapse

Answer 12

spinal tumor, thoracic outlet syndrome, pancoast’s tumor, peripheral nerve entrapment

Question 13

disc prolapse management

Answer 13

conservative - bed rest, cervical collar, NSAIDs, muscle relaxants

Question 14

indications for surgical intervention of disc prolapse

Answer 14

pain > 10 days w/o relief, significant weakness, e/o myelopathy

Question 15

Dx cervical disc prolapse with…

Answer 15

MRI

Question 16

surgical interventions for disc prolapse

Answer 16

cervical foraminotomy with excision of prolapsed disc vs anterior cervical discectomy with fusion

Question 17

disadvantage to anterior cervical discectomy with fusion

Answer 17

adjacent joint disease

Question 18

cervical spondylosis

Answer 18

degenerative arthritic process of cervical spine

Question 19

prevalence of cervical spondylosis in people >50

Answer 19

75%