cervical & lumbar spine conditions

  1. Spinal compression fracture
    • collapsing of bone secondary to osteoporosis
    • thoracic level or thoracolumbar jx
    • usually in postmenopausal women, elderly men, long-term corticosteriods, trauma
  2. Spondylolysis
    • fracture of pars interarticularis (L5/S1) - scottie dog w/collar
    • 5% of pop, athletes who hyperextend their spines
    • spondylolisthesis (vertebal body slip) occurs secondary to this in younger adults - can be stable or unstable
    • in older adults, spondylolisthesis occurs secondary to degenerative disk disease
  3. Spondylolysis symptoms
    • pain causes antalgic gait, reactive muscle spasm
    • ROM: limited back extension
    • pain over L5 on palpation
    • usually does not require surgical intervention
  4. Lumbar degenerative disk disease: pathophysiology
    • decline in concentration of proteoglycans, increase in collagen in nucleus pulposus
    • excessive pressure on vertebral endplate
    • tears form in annulus fibrosis
    • articular cartilage degenerates -> osteoarthritis of joints, bridging osteophytes
  5. Lumbar degenerative disk disease: clinical presentation and treatment
    • loss of lumbar lordosis (due to paraspinal muscle spasm)
    • normal/limited ROM, pain worse w/extension
    • pain is not reproducible, except in the spasmed paraspinal muscles
    • weight loss can help stress on spine, strengthening of paraspinal muscles, possible surgical fusion
  6. lumbar disk herniation pathophysiology
    • tears in annulus fibrosis
    • inflammatory response affecting surrounding soft tissues
    • nucleus pulposus protudes posteriorly b/c the posterior longitudinal ligament is thinner in the lumbar spine
  7. lumbar disk herniation clinical presentation
    • local low back pain, paraspinal muscles, worse w/movement
    • nerve root compression - radiculopathy, sharp shooting, tingling, numbness, aching
    • thecal sac compression - bowel, bladder incontinence, weakness, leg symptoms
  8. Dens (C2) Fracture
    • Most common upper spine fracture, car accidents, falls
    • posterior displacement of dens toward spinal cord
    • spinal cord injury in 15% cases
  9. Hyperflexion Teardrop Fracture
    • Hyperflexion Teardrop Fracture
    • Anterior longitudinal ligament pulls on anterior vert. body, while the rest of the vet. body is distracted posteriorly
    • Most serious cervical spine injury
    • Fracture is unstable with little change of neurological improvement
  10. Extension Teardrop Fracture
    • Osteoporosis
    • Avulsion fracture. Same as hyperflexion fracture but not from severe flexion force
    • Fracture tends to be stable and doesn’t usually cause spinal cord injury
  11. Vertebral Axial Load Burst
    • VB compressed both anteriorly and posterioly. Often caused by fall from height
    • Pieces of vertebra displace into surrounding tissues and can go into the spinal cord , on CT.
  12. Jefferson Axial Load Burst
    • VB compressed both anteriorly and posterioly
    • Involves C1 vet (atlas) at the weakest points in C1 –where lateral masses connect to the ant/post lateral arches
    • Same as Vertebral Axial load burst except that it occurs in the atlas (C1)
  13. Cervical DDD (OA)
    • Normal aging process, losing flexibility and shock absorbing function
    • Nucleus pulposus loses [proteoglycans] that bind water and it deteriotes. Also increase [Collagen], so it becomes white and firm. Shortening of disk height and changes alignemnet -> lots of pressure on vertebral endpates. Vetebral endplates form osteophytes. Tears in annulus fibrosis. Facet joints disarticulate/don’t fit right
    • Inspection: loss of normal cervical lordosis bc of paraspinal muscle spasm in response to pain
    • Range of motion: normal to limited
    • Treatment: NSAIDs, opiods
    • Strengthen paraspinals, stretching
    • If severe, surgical cervical spinal fusion
  14. Cervical Disk Herniation
    • Normal aging as int. vet. Disk degenerates
    • Microtears in annulus fibrosis allows nucleus pulposus to leak out and get inflammation
    • Typical posterolateral pathway –nucleus pulposus pushes posteriorly bc of flexion.
    • -can compress nerve roots (cervical radiculopathy) -directly compress spinal cord (cervical mypoathy)
    • Spurling’s Test + for nerve root compression
    • Prog: most resolve w/in 6 weeks. More complicatons if radicu or myopathy
  15. Cervical Muscle Strain
    • Injury of muscle from incorrect exertion or overuse. Most common reason for neck pain
    • Injury of muscle from incorrect exertion or overuse. Most common reason for neck pain

    • loss of cervical lordosis bc of muscle spasm
    • -ROM limited bc of pain/stiffness
    • Palpation-reproducible w/ palpation of affected neck muscle,
    • -Acute onset sharp aching throbbing pain locatlized to posterior neck,
    • -Worse w/ neck movement
    • -can migrate to head-> headaches
    • -no CR needed
  16. Whiplash Syndrome
    • Too much and too fast hyperflexion/hyperext, injures facet joints, ligaments, muscles
    • Deep aching, sharp, throbbing neck pain, from base of skull to CT junc of spine
    • sometimes pain in trapezius, SCM, or headaches
    • Pain worse w/ movement and can get paraspinal muscle spasm
    • Loss of normal lordosis, ROM limited cuz of pain
    • Tender in paraspinals on spinous process
    • CR in flexion/ext to rule out vertebral fractures and spinal instability
    • 80% full recover 3 mo, 20% have pain cuz of chronic muscle spasm or ligamentous instability
  17. Atlantoaxial Instability
    • Dens moves posteriorly and might compress spinal cord
    • C1/C2 instability, abnormalities of transverse ligament (congenital laxity) –Down syndrome, RA (structural damage)
    • CR –increased distance in predental space, normal 3mm
    • Symptom: (asymptomatic or) subluxaton of dens, spinal cord compress, cervical myelopathy –weakness/sensory impairement in legs, can last mo-yrs, sometimes increase intensity over time, sudden spinal cord compression => death
    • ROM limited to pain,
    • Midline deep pain bc of paraspinals spsasm
    • -Weakness, increased tone, hyperreflexia, ,sensation probs
    • Treat w/ surgical fixation
  18. Cervical Radiculopathy
    • C6 and C7 most commonly affected-inflammation usually bc of annulus fibrosis tears
    • parasthesia in dermatome pattern
    • motor deficit from nerve root
    • cervical parapsinal muscle spasm, ROM limited as extension might cause more compression of nerve roots
    • local tenderness over paraspinals but not in the extremity (pain not reproducible)
    • Spurlings
    • EMG-CR not always, but to rule out, MRI someimtes helpful
  19. Cervical Spine Stenosis
    • Narrowing of the cervical spinal canal
    • disk herniation, osteophyte on vertebral end plates, hematoma, tumor, foreign body
    • Cervcial muscle spasms, loss of normal lordosis, abnormal gait if spinal cord compressed
    • ROM limited bc of neck pain , neck extension painful- must avoid neck ext if this is suspected
    • Spurlings, EMG
    • Sensory/motor reflex testing-MRI
    • NSAIDs, opiods, oral corticostroid for acute pain/weakness
    • corticosteroid injection,
    • excision of osteophytes/ herniated disk Prog:herniation good, others need treatment (aimed to prevent progression, not reverse deficits)
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cervical & lumbar spine conditions
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