Flashcards in Spine Deck (59)
Identify the anatomic structures of the entire vertebral column. (Concave vs convex; number of vertebrae; label vertebrae in coronal and lateral views)
slipping of one vertebra on another
pars interarticularis defect
degenerative change, osteophytes, disc space changes
Identify which carcinomas are known to metastasize to the spine
Multiple myeloma: Lung 31%, Breast 24%, GI 9%, Prostate 8%
aka Whiplash, Result of sudden hyperextension followed by hyperflexion of the neck.
Clinical Presentation of Cervical Strains
Most common cause is from rear-end collisions, sports trauma, repetitive C-spine stretching beyond their physiologic capacity, generating inflammation within the local soft tissues.
Symptoms and Exam of a patient with a Cervical Strain
Neck pain, trapezial pain, back pain, muscle spasm, heacache, and limited ROM. (*bogginess of post neck musculature, c-tissue edema (not pitting!), and limited ROM secondary to m. spasm). Often begin ACUTELY, hours after the injury (usually the sx occur the next day). Very minimal long-term sequelae.
Diagnosis of Cervical Strains
CLINICAL! Based on H and P and simple tests. Use Xray to help exclude more severe injuries.
NLC- Low Risk Criteria and CCR- Canadian C-Spine Rule. Both the CCR and NLC are proven effective with excellent negative predictive values. Helical CT is faster with better sensitivity (but $$). MRI-used for soft tissues, spinal cord, and ligament.
Physical Exam of Cervical Strains
PE- ALWAYS assume DANGEROUS underlying patho and consider c-spine strain ONLY as dx of exclusion. Many times, pt will present w/ C-collar.
First- assess pt for: sobriety, cooperatively, and presence or absence of distracting injury. Check neck for skin integrity, edema, eccyhymosis, and asymmetry. Next, perform detailed neuro exam in UE and LE and then test Cervical ROM.
Treatment for Cervical Strains
Clinical course is benign. Most pts will be able to return to normal function in 1-2 weeks. Heat and Ice packs are beneficial (altering 2 for 15-20 minutes per session). C-collar and time off from work are not recommended for C-strain. NSAIDS and analgesia (pain control), Encourage normal use as tolerated, PT.
When to refer
Persistent pain over several weeks, abnormal neuro exam or abnormal radiologic findings.
Cervical Disc Degeneration
Common cause of neck pain in the elderly, showing decreased ROM, and stiffness. It’s MUCH LESS COMMON than a disc degeneration of lumbar spine (because it’s subjected to much less force). It’s caused from Wear and Tear over time!
Clinical Presentation of Cervical Disc Degeneration
Low-grade neck pain, stiffness, and instability. Can present with numbness, tingling, weakness in the neck, arm, or shoulders→ from nerves being irritated/pinched.
Imaging for Cervical Disc Degeneration
X-ray to help define problem more clearly. They show a decrease in intervetebral disc space, osteophyte formation, and loss of normal cervical lordosis. Get flexion, extension, AP (for tumor, fractures), and lateral view (anterior osteophytes and disc space narrowing). Use MRI for pts with neuro symptoms.
Physical Exam of Cervical Disc Degeneration
Ask the pt to perform flexion, extension, and rotational movements (report if pain decreases/increases). Can become so severe that surrounding osteophytes may encroach spinal canal, leading to spinal stenosis, and myelopathy. Symptoms include stumbled gait, difficult w/ fine motor skills in hands/arms, and shock-type feelings down legs to toes→ NEEDS REFERRAL!
Treatment of Cervical Disc Degeneration
Nonsurgical: NSAIDS, PT (freestyle swimming w/ snorkeling gear), Epidural steroids (if needed),
Restoring flexibility helps further repetitive microtrauma, Intermittent C-traction.
Surgical: Only when conservative treatment has failed- Surgery= disc removal, placement of intervetebral bone graft, and fusion. Plate fixation is usually for multiple levels of involvement.
Cervical Disc Herniation
Very common cause of neck and arm pain in young adults. Usually caused by traumatic events but can also occur spontaneously
Clinical Presentation ofCervical Disc Herniation
Frequent headaches, Pain originating around paraspinal muscle that radiates down one extremity. Finger numbness and/or tingling. Can cause spinal cord compression - disc material pushes directly on spinal cord (more serious- with awkward stumbling gait, tingling, and shock-type feelings down the torso or legs).
Special Tests for the Diagnosis of Cervical Disc Herniation
Spurling maneuver→ the head is placed into an extended position, and the patient's chin is rotated toward the affected side. A compressive force is then placed onto the patient's head, and symptoms of nerve impingement are reproduced. On the flip side, patients typically get relief of symptoms when asked to place their hands on top of their heads (abduction relief sign)
Physical Exam for Cervical Disc Herniation
Perform careful exam of shoulder and wrist to r/o shoulder/wrist pathology. Numbness, tingling, begins in shoulder and extends down into the fingers. ROM is usually limited secondary to pain. Presents with biceps weakness and pain/numbness in index and thumb. Pain can often be reproduced by spurling maneuver.
Imaging for Cervical Disc Herniation
Dx studies → X-rays and MRI. MRI is imaging of choice.
Treatment of Cervical Disc Herniation
Nonsurgical: NSAIDS, Cervical epidural steroids, Surgical discetomy and fusion.
Surgical: Only when nonsurgical tx has not worked. Removal of disc through and anterior approach or autograft (bone graft taken from the pt’s iliac crest) can be used.
Cervical Spinal Stenosis
The NARROWING of spinal cord-may lead to neural compression and radiculopathy or myelopathy. Some of later sx are bowel/bladder incontinence in a rapid progression.
***Note: it’s very important to recognize possible cervical cord compression early to prevent IRREVERSIBLE damage to cord.
Etiology of Cervical Spinal Stenosis
Stenosis=narrowing of the spinal canal and may lead to neural compression, subsequent radiculopathy or myelopathy
Radiculopathy- root compression and symptoms follow dermatomal pattern
Myelopathy – cord compression and symptoms are more diffuse
Special Tests for Cervical Spinal Stenosis
Positive Lhermitte sign→ Electric Shock like sensation radiates down spine or extremities w/ certain movements of neck esp flexion/extension.
Physical Exam for a patient with Cervical Spinal Stenosis
Neck and arm pain, Numbness and tingling, Clumsiness, loss of fine motor skills, and sensory complaints in UEs. Difficulty walking and imbalance in Les Weakness, bowel and bladder incontinence, and proprioceptive dysfunctions=advanced disease.
+ Lhermitte sign, Cord compression-upper motor lesion-hyperreflexia and upper and lower extremities and ankle clonus (Babinski), Hoffman Spurling.
Jaw jerk test-differentiates cervical myelopathy from lesions in the brain
Diagnosis of Cervical Spinal Stenosis
MRI-diagnositc TEST OF CHOICE/CT scan with myelocram is next best if MRI not available
Treatment for Cervical Spinal Stenosis
NSAIDs and PT, Epidural steroid injection, Surgical evaluation with abnormal neurologic exam