This session will cover cervical spine problems in 5 categories:
Acute neck pain
Whiplash
Chronic neck pain
Cervical radiculopathy
Cervical myelopathy
For each syndrome or condition, several areas will be reviewed:
Condition will be defined
Symptoms will be outlined
Profile of patient will be reviewed
Radiographics findings will be discussed
Cervical myelopathy
Radiographics findings will be discussed
Management will be discussed and surgical interventions, if indicated, will be reviewed
Acute neck pain
Definition: Acute onset mechanical neck pain of less than three months duration neck injuries whip lash. Typically occurs in adults during productive years (20 to 50 years). Frequently no major precipitating trauma.
Clinical features
Axial neck pain aggravated by activity
Muscle spasm
pain may radiate up into the occipital region of the head or to the interscapular region
Aching in the muscles toward the shoulders
Radicular pain radiating into extremities usually not be present
Pathophysiology
Usually represents a muscle sprain or strain injury
Subtle tears in discs or damage/inflammation to facet joint may play a role
Has a
Whiplash
Definition: Syndrome typically caused by a rear-end motor vehicle accident with oscillation of the head and neck. Weight of the head typically imparts a flexion and then extension moment on the cervical spine.
Pathophysiology
Experimental studies reveal
Anterior neck muscle tears and hematomas
Elongation of anterior cervical structures with hyperextension
Anterior longitudinal ligament rupture
Avulsion of the disc from adjacent vertebra
Sympathetic nerve stretching
Facet joint injury
Hemorrhage around the spinal cord
Clinical features
Neck pain and spasm - increased with motion of the neck
Associated occipital headaches and interscapular pain
May have radicular pain and paresthesias
Frank neurologic deficits are uncommon
Subtle mental status changes are common
Patient profile
30 to 50 years
Female preponderance
High proportion of
Management
Analgesics and anti-inflammatory medications
Immobilization (collar) of the neck in acute stage
Physical therapy involving muscle strengthening and range of motion activities (ACTIVE)
No proven benefit of epidural injections
Little evidence that surgery has a role
Chronic neck pain
Definition: Neck pain present for more than three months
Mechanical, axial neck pain
Neck pain greater than extremity pain
Aggravated by activity
Relieved by rest
Neck pain may be associated with radicular features (neural compression)
Categories
Discogenic pain
Extension preference
Facet syndrome
Flexion preference
Musculo-ligamentous pain
Discogenic pain
Discs undergo degeneration with alterations win structural integrity and biochemistry
Degeneration is
Cervical Radiculopathy
Definition: Compression of one or more cervical roots. Nerve root compression result of herniated disc or secondary to bony spur.
Clinical Presentation
Neck pain with pain radiating into the upper extremity
Arm pain, increased with neck extension and relieved with neck flexion
Positive Spurling's sign (neck extension, lat. rotation with axial compression)
Nerve deficit in
Cervical myelopathy
Definition: Results from spinal cord compression caused by bony and/or disc protrusions. Often an element of congenital canal stenosis. Most spinal cord compression in anterior; thus loss of function of the anterior and central columns occur. Posterior column function is usually preserved.
Clinical presentation
Mixed upper and lower motor neuron signs
Vague sensation of unsteadiness with gait an early sign
Difficulties with manual dexterity involving the upper extremities
Diffuse weakness and sensory changes in upper extremity, with evidence of myelopathy in the lower extremities in classic
myelopathy evidenced by positive Babinski sign, hyperreflexia, and clonus
Posterior column function is usually preserved in these patients
Natural history
Poorly documented
Better clinical outcome with surgical versus non-operative treatments
Patients treated non-operatively seldom show improvement in neurologic picture