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Neck Injuries

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