Cervical Spine
Disorders
Compiled from: Management of common MSK
Disorders, Darlene,
4th Edition.
Prepared By: Dr. Ambreen Asghar Sajjad (PT)
Assistant Professor
Learning Objectives
O At the end of this lecture the student
will have the knowledge about
different disorders of cervical spine
and its management.
Trauma and Whiplash-
Associated Disorders
O Most common is acceleration-
deceleration injury.
O The typical mechanism involves rear-
end collision with neck
hyperextension.
O Rear end collision hyper-extension
mechanism is more likely to result in
chronic soft tissue symptoms than
flexion and lateral flexion injuries.
O Injuries include disruptions of the
anterior longitudinal ligament, disk,
or articular facet capsule, muscular
strains, retropharyngeal hematoma,
intraesophageal hemorrhage, and
cervical sympathetic chain reaction.
O Hyperflexion (head-on-collision) injuries is
similar. Injuries include tears of the
posterior cervical musculature, sprains of
the ligamentum nuchae and posterior
longitudinal ligament, articular facet joint
disruption, and posterior intervertebral
disk injury with nerve root hemorrhage.
Flexion at the atlantoaxial joint will stress
the alar ligament complex as the atlas
and head attempt to rotate anteriorly
over the axis.
O Lateral flexion of the cervical spine
between C2 and C7 is strictly
coupled to rotation of the cervical
disks. If an external forces laterally
flex the neck, the structures at risk
of injury will be determined by the
extent to which coupling occurs. If
the force simply reproduces
physiologic movements, the articular
joint capsules on both sides and
intervertebral disks will be most at
risk from axial torque. If there is little
coupling, lateral flexion will
compress the ipsilateral articular
facet joint and distract the
contralateral joint.
O 80% of patients reporting symptoms
following a motor vehicle accident
will be better within 3 to 4 weeks.
Clinical Considerations-
Rear End Collisions
O One of the predictors of poor
prognosis are roentgenographic
evidence of degenerative joint
disease and neurological signs soon
after the accident.
O Acute Phase: Begins at the moment
of accident and may last as long as 2
to 3 weeks. The most severe is from
a rear impact.
O Evaluation
O Treatment
O Sub-Acute Phase: Usually lasts 2 to
10 weeks.
O Evaluation
O Treatment
O Chronic Phase: Begins when the
acute healing process is over.
O It begins when the large muscle
groups will have completely healed
but they may be shortened and
fibrotic.
O Evaluation
O Treatment
Acute Locking Of The
Cervical Spine
O Clinically, acute locking is an unguarded
movement of the neck, with instant pain
over the articular pillar and an antalgic
posture of lateral flexion to the opposite
side and slight flexion which the patient
is unable to correct.
O Most common at C2-C3 and in children
and young adults.
O Evaluation
O Treatment
Cervical Zygapophyseal
Joint Pain
Joints b/w C3-C7 can refer pain to the
supra spinous process and into the
arm.
Evaluation: pain is typically unilateral
and described as dull ache.
Limited range of cervical motion owing
to soft tissue dysfunction can be
found.
Treatment
Cervical Disk
Dysfunction
O Common in 35-55 yrs range and
cervical levels of C5-C6, C6-C7, and
C4-C5.
O Evaluation
O Treatment
Degenerative Joint Disease/
Cervical Spondylosis
O It is a chronic and commonly
progressive degeneration of the
cervical articular facet joints and/or
the intervertebral disk.
O Commonly affects C5-C7 vertebra
and affects the disk and the facet
joints.
O Lateral canal stenosis, which is
frequently referred to as cervical
spondylosis, is the second most
common cause of cervical
radiculopathy and may cause
symptoms of neck pain, shoulder
pain, radiating pain in the arm,
numbness in the extremity, or
muscle weakness.
O Evaluation
O Treatment
Cervical Instability
O Stability is necessary for proper
function of the kinematics of the
spine.
O Three main integrated components
for spinal stability, conceptualized by
Panjabi are:
O 1) Passive subsystem
O 2) Active subsystem
O 3 Neural Control
O Evaluation
O Treatment
Cervical Headaches
O Cervical headache refers to
headache arising from dysfunction or
inflammation of the musculoskeletal
structures of the upper cervical
spine.
O Most common cause is degenerative
joint disease or trauma that is either
sudden or gradual.
CAUSES:
Trigeminocervical nucleus
Greater Occipital Nerve
Compression of Dura at any cervical
level (extrasegmental headache)
Evaluation
Treatment
O Thank You!
