Eval and Tx of Cervical Pain

Question 1

What 7 serious conditions are you screening for with a c-spine evaluation?

Answer 1

Fx
instability
vascular insufficiency
Neoplasm or CA
CNS degenerative disease
CVA
Cord compression/ Myelopathy

Question 2

You have a patient come in who suffered a blow to the head and was knocked out for a few seconds. What are you most concerned about at this point?

Answer 2

A fracture causing instability.

Question 3

When looking at the Canadian C-Spine Rules when do you stop and order an x-ray?

Answer 3

At any point that they present with one of the risks
OR
When you are genuinely concerned that they have one even if the C-Spine rules say no

Question 4

Give the first portion of the Canadian C-Spine Rules in order.

Answer 4

1) Age: >65 OR
2) Dangerous mechanism (fall >1 m or 5 stairs, MVA >100km/hr {62 m/hr}, rollover ejection, bike accident) OR
3) Paraesthesia’s in the extremities.

Question 5

What is the second portion of the Canadian C-Spine Rules?

Answer 5

Is there a low risk factor that will prevent safe ROM assessment?

1) Not a simple rear-end MVA
2) Unable to sit in ER
3) Not ambulatory since accident
4) Immediate onset of pain (day after is NORMAL)
5) Presence of midline pain (palpate spinous processes for this)

Question 6

When looking at a “simple rear-end MVA” what types of incidents would be excluded from that category?

Answer 6

Being pushed into traffic, rollover, high speed impact, or being hit by a bus or truck

Question 7

The third portion of the Canadian C-Spine rules states that “Is the patient able to rotate the neck ?? bilaterally?”

Answer 7

They should be able to rotate at least 45 degrees both ways.

Question 8

Give the two types of fractures typically associated with a C1 Atlas Fx.

Answer 8

Neural Arch Fractures and Burst Fractures

Question 9

Which type of fracture is characterized by hyperextension where the posterior ring of C1 is jammed between C2 and the occiput?

Answer 9

The Neural Arch Fx.

Question 10

T/F: There is usually no neural involvement with a neural arch fx.

Answer 10

True

Question 11

What percentage of the burst fractures are associated with a C2 fracture?

Answer 11

About 33%

Question 12

What is the mechanism of injury for a burst fracture?

Answer 12

Axial compression (ex. is diving into shallow water)

Question 13

If C2 is not damaged then the likelihood of neural damage with a burst fractures is higher or lower?

Answer 13

Without C2 involvement a burst fracture does not typically have neural damage.

Question 14

A burst fracture is typically treated with a _____, but with C2 fractures it is treated with _____ and _______.

Answer 14

Cervical collar; Collar and halo.

Question 15

What is the mechanism and risk of fatality with a odontoid fracture?

Answer 15

Uncertain mechanism - Likely excessive rotation

Highly fatal

Question 16

What are the 3 types of C3-C7 fractures?

Answer 16

Flexion-Compression
Hyperextension
Flexion

Question 17

Give the type of injuries associated with flexion compression and how you would treat it.

Answer 17

1) Anterior wedge fractures: treat with collar

2) Burst Fx: no treatment given

Question 18

What is the mechanism of injury for a burst fracture?

Answer 18

Posterior fragment may be displaced into the SC, causing cord injury.

Question 19

What is a predisposition for a flexion compression injury?

Answer 19

Certain contact sports.

Question 20

What will you see/find with a hyperextension fracture and how would you treat it?

Answer 20

Tear of the anterior ligament, avulsion fracture, facet compression
An extension x-ray will show a gap
Treatment with collar

Question 21

What is another name for flexion injuries at C3-C7?

Answer 21

Flexion distraction injury

Question 22

With a dislocation without a fracture what will be torn and how would you treat it?

Answer 22

Posterior ligament is torn (can be unilateral or bilateral facet dislocation)
Treated with a fusion

Question 23

A fracture dislocation is usually associated with damage to where?

Answer 23

Cord Damage

Question 24

A flexion injury is sufficient enough to cause what other types of damage in the C3-C7 area?

Answer 24

A burst fracture and tearing of the posterior ligaments.

Question 25

A patient comes in to your clinic with severe neck pain and spasms. What is your biggest concern after hearing they have recently suffered a trauma?

Answer 25

A vertebral fracture

Question 26

After deciding this patient needs to see a MD you refer them out but they are back 2 days later. They tell you the doctor put them on muscle relaxers but their pain is worse than before. Is this a good thing or a bad thing?

Answer 26

This is bad; muscle relaxers will help if the injury is just spasms. If the patient has an undetected fracture then muscle relaxers will make their pain worse.

Question 27

Upper cervical instability is usually the result of what?

Answer 27

Pathological changes to the ligamentous restraints

Question 28

What increases the ADI and what is considered too high?

Answer 28

Pathological changes to the ligamentous restraints; >2-3 mm is too high

Question 29

What are you looking for with the Atlanto-dens interval (ADI)?

Answer 29

Looking for a gapping between atlas and dens and you are looking for the ring to slide. If C1 moves too much then you have a higher ADI.

Question 30

What are 3 types of arthritis that can cause non traumatic instability according to the notes?

Answer 30

Rheumatoid, psoariatic, or ankylosing spndylitis

Question 31

If a patient with arthritis has a cord compression what can be the end result?

Answer 31

Common cause of sudden death for that patient

Question 32

Describe characteristics of Marfans syndrome.

Answer 32

1) Genetic soft tissue disorder with a variable presentation
2) Arm span is longer than height
3) Wrist sign: can overlap thumb and little finger at wrist
4) Thumb Sign: thumb in palm extends beyond 5th digit
5) Pectis excavatum: hollowed chest
6) Prone to Aortic aneurysms

Question 33

How would someone present if they were suffering from Grisel’s Syndrome?

Answer 33

1) Age: 6-12 years old
2) Upper respiratory tract infections or chronic sore throats
3) Hx: infection, post-op tonsillitis, fever, headaches, neck stiffness
4) Spontaneous torticollis
5) Shared retropharyngeal system
6) Tests and measures show a SB and rotated neck (cock robin posture)

Question 34

How would you treat Grisel’s Syndrome if it was caught early? What if it was caught later?

Answer 34

Early: Antibiotics, collar, and rest
Late: Spinal fusion

Question 35

Children with Downs Syndrome has a 22% chance of having what?

Answer 35

Odontoid hypoplasia