Case 11

2018 ◽  
Author(s):  
Bashar Katirji
Keyword(s):  
Cervical Spine ◽  
Clinical Practice ◽  
Neck Pain ◽  
Cervical Radiculopathy ◽  
Radicular Pain ◽  
Nerve Conduction Studies ◽  
Accurate Diagnosis ◽  
Motor Weakness ◽  
Needle Electromyography ◽  
Cervical Root

Cervical radiculopathy and neck pain are among the most common neurological presentations seen in clinical practice. Cervical radiculopathy results in radicular pain, sensory manifestations, motor weakness and reflex changes, that are dependent on the specific compressed cervical root. The accurate diagnosis of cervical radiculopathy depends on a detailed neurological examination supplemented by electrodiagnostic studies and imaging of the cervical spine. This case highlights the anatomy, pathophysiology, and findings of the various cervical radiculopathies and distinguishes them from brachial plexopathies and other upper limb mononeuropathies. The benefits, pitfalls, and challenges of electrodiagnostic studies, including nerve conduction studies and needle electromyography, are also discussed.

Cervical pneumatocyst

2011 ◽  
Vol 15 (3) ◽  
pp. 332-335 ◽  
Author(s):  
Jason M. Hoover ◽  
Doris E. Wenger ◽  
Laurence J. Eckel ◽  
William E. Krauss
Keyword(s):  
Cervical Spine ◽  
Carpal Tunnel Syndrome ◽  
Neck Pain ◽  
Carpal Tunnel ◽  
Chronic Neck Pain ◽  
Cervical Radiculopathy ◽  
Disc Disease ◽  
Left Hand ◽  
Tunnel Syndrome ◽  
Multilevel Fusion

The authors present the case of a 56-year-old right hand–dominant woman who was referred for chronic neck pain and a second opinion regarding a cervical lesion. The patient's pain was localized to the subaxial spine in the midline. She reported a subjective sense of intermittent left arm weakness manifesting as difficulty manipulating small objects with her hands and fingers. She also reported paresthesias and numbness in the left hand. Physical and neurological examinations demonstrated no abnormal findings except for a positive Tinel sign over the left median nerve at the wrist. Electromyography demonstrated bilateral carpal tunnel syndrome with no cervical radiculopathy. Cervical spine imaging demonstrated multilevel degenerative disc disease and a pneumatocyst of the C-5 vertebral body. The alignment of the cervical spine was normal. A review of the patient's cervical imaging studies obtained in 1995, 2007, 2008, and 2010 demonstrated that the pneumatocyst was not present in 1995 but was present in 2007. The lesion had not changed in appearance since 2007. At an outside institution, multilevel fusion of the cervical spine was recommended to treat the pneumatocyst prior to evaluation at the authors' institution. The authors, however, did not think that the pneumatocyst was the cause of the patient's neck pain, and cervical pneumatocysts typically have a benign course. As such, the authors recommended conservative management and repeated MR imaging in 6 months. Splinting was used to treat the patient's carpal tunnel syndrome.

Cervical spine disorders

2011 ◽  
Author(s):  
Howard An
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Exercise Program ◽  
Cervical Radiculopathy ◽  
Radicular Pain ◽  
Narcotic Analgesics ◽  
Advantages And Disadvantages ◽  
Degenerative Cervical Spine ◽  
Spine Disorders

♦ Degenerative cervical spine disorders may manifest clinically with axial neck pain, radiculopathy, myelopathy, or a combination of these clinical symptoms♦ The findings on radiographs and MRI are pertinent if they correlate with the clinical symptoms♦ The initial treatment for patients with degenerative cervical spine disorders is conservative, including non-narcotic analgesics, anti-inflammatory medications, exercise program, physiotherapy, and occasional injections♦ Surgical indications include significant radicular pain despite conservative treatment, profound neurologic deficits, and presence of significant myelopathy♦ Surgical treatment for cervical radiculopathy includes lamino-foraminotomy, anterior cervical discectomy and fusion (ACDF), and artificial disk replacement, and surgical treatment for myelopathy includes anterior discectomy and/or corpectomy with fusion, posterior laminoplasty, and posterior laminectomy and fusion. The surgeon should be familiar with the specific indications as well as advantages and disadvantages of each procedure.

scholarly journals The Biomechanics of Cervical Spondylosis

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Lisa A. Ferrara
Keyword(s):  
Risk Factor ◽  
Cervical Spine ◽  
Neck Pain ◽  
Load Balance ◽  
Cervical Spondylosis ◽  
Cervical Radiculopathy ◽  
Height Loss ◽  
Ventral Margin ◽  
Vascular Structures ◽  
Eventual Loss

Aging is the major risk factor that contributes to the onset of cervical spondylosis. Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss along the ventral margin of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. The altered posture of the cervical spine will progress into kyphosis and continue if the load balance and lordosis is not restored. The content of this paper will address the physiological and biomechanical pathways leading to cervical spondylosis and the biomechanical principles related to the surgical correction and treatment of kyphotic progression.

scholarly journals Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group

2021 ◽  
pp. rapm-2021-103031
Author(s):  
Robert W Hurley ◽  
Meredith C B Adams ◽  
Meredith Barad ◽  
Arun Bhaskar ◽  
Anuj Bhatia ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Clinical Practice ◽  
Radiofrequency Ablation ◽  
Neck Pain ◽  
Working Group ◽  
Selection Criteria ◽  
Medial Branch ◽  
Pain Medicine ◽  
En Bloc ◽  
Joint Injections

BackgroundThe past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial.MethodsIn August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4–5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement.ResultsTwenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation.ConclusionsCervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.

scholarly journals A Review on Diagnosis and Management of Cervical Spondylosis

2021 ◽  
pp. 668-674
Author(s):  
Ahmed Abdulaziz G. Ibrahim ◽  
Ali Mohammed A. Alahmari ◽  
Abdullah Hassan F. Alsuayri ◽  
Abdullah Misfer M. Algomshah ◽  
Saeed Ghanem S. Almlfi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Cervical Spondylosis ◽  
Natural Aging ◽  
Posterior Longitudinal Ligament ◽  
Cervical Radiculopathy ◽  
Intervertebral Discs ◽  
Degenerative Changes ◽  
Facet Joints ◽  
Wide Range

Cervical spondylosis is a term that encompasses a wide range of progressive degenerative changes that affect all components of the cervical spine (i.e., intervertebral discs, facet joints, Luschka joints, flava ligaments, and laminae). It is a natural aging process and occurs in most people after the age of five. Most people with radiographic spondylotic changes in the cervical spine  remain asymptomatic, and 25% of those under  40, 50% of those over  40, and 85% of those over  60 show some evidence of degenerative changes , including changes in  the environment. Uncovertebral joints, facet joints, posterior longitudinal ligament (PLL) and yellow ligament lead to  narrowing of the spinal canal and intervertebral foramina. As a result, the spinal cord, spinal vasculature, and nerve roots can become compressed, leading to the three clinical syndromes that occur with cervical spondylosis: axial neck pain, cervical myelopathy, and cervical radiculopathy. Cervical spondylosis is usually diagnosed for clinical reasons only, but imaging is also required. Treatment for cervical spondylosis can be medical or surgical, depending on whether the patient has symptoms of myelopathy, radicular pain, or neck pain.

Cervical Radiculopathy

2018 ◽  
pp. 101-108
Author(s):  
Michael Karsy ◽  
Ilyas Eli ◽  
Andrew Dailey
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Cervical Spondylosis ◽  
Cervical Radiculopathy ◽  
Surgical Approaches ◽  
Anatomical Landmarks ◽  
Cervical Fusion ◽  
Spine Mobility ◽  
Posterior Cervical Fusion ◽  
Spine Disease

Degenerative cervical spondylosis resulting in cervical radiculopathy or myelopathy can be a significant source of morbidity for patients. Traditional surgical approaches have involved anterior or posterior cervical fusion with decompression; however, these techniques may result in higher cost compared with noninstrumented cases, reduction of spine mobility, and adjacent level disease. Anterior microforaminotomy, first described by Jho in 1996, involves a microdiscectomy and decompression of the cervical spine without arthrodesis. Posterior approaches to the foramina can also be an option. In this chapter, the authors describe the use of lateral disc foraminotomies in the treatment of cervical spine disease. These techniques are mainly for the treatment of cervical radiculopathy without instability or mechanical neck pain. Techniques for both anterior and posterior approaches, including pitfalls and key anatomical landmarks, are described.

scholarly journals Complementary and Alternative Medicine for the Management of Cervical Radiculopathy: An Overview of Systematic Reviews

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Xu Wei ◽  
Shangquan Wang ◽  
Jinxue Li ◽  
Jinghua Gao ◽  
Jie Yu ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Neck Pain ◽  
Alternative Medicine ◽  
Complementary And Alternative Medicine ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Cervical Radiculopathy ◽  
Overview Of Systematic Reviews ◽  
Cervical Spine Manipulation ◽  
Complementary And Alternative

Background. Complementary and alternative medicine (CAM) is widely applied in the clinical practice of neck pain owing to cervical radiculopathy (CR). While many systematic reviews exist in CAM to improve CR, research is distributed across population, intervention, comparison, and setting.Objective. This overview aims to summarize the characteristics and evaluate critically the evidence from systematic reviews.Methods. A comprehensive literature search was performed in the six databases without language restrictions on February 24, 2015. We had identified relevant systematic reviews that examined the subjects with neck pain due to cervical radiculopathy undergoing CAM. Two authors independently appraised the methodological quality using the revised assessment of multiple systematic reviews instrument.Results. We had included eight systematic reviews. The effectiveness and safety of acupotomy, acupuncture, Jingfukang granule, manual therapies, and cervical spine manipulation were investigated. Based on available evidence, the systematic reviews supported various forms of CAM for CR. Nevertheless, the methodological quality for most of systematic reviews was low or moderate. In addition, adverse reactions of primary studies were infrequent.Conclusions. Current systematic reviews showed potential advantages to CAM for CR. Due to the frequently poor methodological quality of primary studies, the conclusions should be treated with caution for clinical practice.

Cervical spine clearance in the traumatically injured patient: is multidetector CT scanning sufficient alone?

2013 ◽  
Vol 19 (5) ◽  
pp. 576-581 ◽  
Author(s):  
Brandon G. Chew ◽  
Christopher Swartz ◽  
Matthew R. Quigley ◽  
Daniel T. Altman ◽  
Richard H. Daffner ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Neck Pain ◽  
Multidetector Ct ◽  
Altered Mental Status ◽  
Radicular Pain ◽  
Resonance Imaging ◽  
Ligamentous Injury

Object Clearance of the cervical spine in patients who have sustained trauma remains a contentious issue. Clinical examination alone is sufficient in neurologically intact patients without neck pain. Patients with neck pain or those with altered mental status or a depressed level of consciousness require further radiographic evaluation. However, no consensus exists as to the appropriate imaging modality. Some advocate multidetector CT (MDCT) scanning alone, but this has been criticized because MDCT is not sensitive in detecting ligamentous injuries that can often only be identified on MRI. Methods Patients were identified retrospectively from a prospectively maintained database at a Level I trauma center. All patients admitted between January 2004 and June 2011 who had a cervical MDCT scan interpreted by a board-certified radiologist as being without evidence of acute traumatic injury and who also had a cervical MRI study obtained during the same hospital admission were included. Data collected included patient demographics, mechanism of injury, Glasgow Coma Scale score at the time of MRI, the indication for and findings on MRI, and the number, type, and indication for cervical spine procedures. Results A total of 1004 patients were reviewed, of whom 614 were male, with an overall mean age of 47 years. The indication for MRI was neck pain in 662 patients, altered mental status in 467, and neurological signs or symptoms in 157. The MRI studies were interpreted as normal in 645 patients, evidencing ligamentous injury alone in 125, and showing nonspecific degenerative changes in the remaining patients. Of the 125 patients with ligamentous injuries, 66 (52.8%) had documentation of clearance (29 clinical, 37 with flexion-extension radiographs). Another 32 patients were presumed to be self-cleared, bringing the follow-up rate to 82% (98 of 119). Five patients died prior to clearance, and 1 patient was transferred to another facility prior to clearance. Based on these data, the 95% confidence interval for the assertion that clinically irrelevant ligamentous injury in the face of normal MDCT is 97%–100%. No patient with ligamentous injury on MRI was documented to require a surgical procedure or halo orthosis for instability. Thirty-nine patients ultimately underwent cervical surgical procedures (29 anterior and 10 posterior; 5 delayed) for central cord syndrome (21), quadriparesis (9), or discogenic radicular pain (9). None had an unstable spine. Conclusions In this study population, MRI did not add any additional information beyond MDCT in identifying unstable cervical spine injuries. Magnetic resonance imaging frequently detected ligamentous injuries, none of which were found to be unstable at the time of detection, during the course of admission, or on follow-up. Magnetic resonance imaging provided beneficial clinical information and guided surgical procedures in patients with neurological deficits or radicular pain. An MDCT study with sagittal and coronal reconstructions negative for acute injury in patients without an abnormal motor examination may be sufficient alone for clearance.

scholarly journals Cervicovestibular rehabilitation in adult with mild traumatic brain injury: a randomised controlled trial protocol

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Pierre Langevin ◽  
Philippe Fait ◽  
Pierre Frémont ◽  
Jean-Sébastien Roy
Keyword(s):  
Traumatic Brain Injury ◽  
Cervical Spine ◽  
Brain Injury ◽  
Neck Pain ◽  
Mild Traumatic Brain Injury ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Conventional Approach ◽  
Persistent Symptoms ◽  
Link Type

Abstract Background Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25% of adult with mTBI present persistent symptoms. Headache, dizziness, nausea and neck pain are the most commonly reported symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2017 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headache and dizziness is, however, recommended based only on limited scientific evidence. The benefit of such intervention should therefore be further investigated. Objective To compare the addition of a 6-week individualized cervicovestibular rehabilitation program to a conventional approach of gradual sub-threshold physical activation (SPA) alone in adults with persistent headache, neck pain and/or dizziness-related following a mTBI on the severity of symptoms and on other indicators of clinical recovery. We hypothesize that such a program will improve all outcomes faster than a conventional approach (between-group differences at 6-week and 12-week). Methods In this single-blind, parallel-group randomized controlled trial, 46 adults with subacute (3 to12 weeks post-injury) persistent mTBI symptoms will be randomly assigned to: 1) a 6-week SPA program or 2) SPA combined with a cervicovestibular rehabilitation program. The cervicovestibular rehabilitation program will include education, cervical spine manual therapy and exercises, vestibular rehabilitation and home exercises. All participants will take part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome will be the Post-Concussion Symptoms Scale. The secondary outcomes will be time to clearance to return to function, number of recurrent episodes, Global Rating of Change, Numerical Pain Rating Scale, Neck Disability Index, Headache Disability Inventory and Dizziness Handicap Inventory. A 2-way ANOVA and an intention-to-treat analysis will be used. Discussion Controlled trials are needed to determine the best rehabilitation approach for mTBI with persistent symptoms such as neck pain, headache and dizziness. This RCT will be crucial to guide future clinical management recommendations. Trial registration ClinicalTrials.gov Identifier - NCT03677661, Registered on September, 15th 2018.

Sign in / Sign up

Export Citation Format

Share Document