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CERVICAL SPONDYLOSIS

Basic clinical description of cervical spondylosis

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CERVICAL SPONDYLOSIS

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  1. CERVICAL SPONDYLOSISEXAMINATION & CLINICAL CORRELATION ALIYU IBRAHIM YAKUB

  2. SYNOPSIS • BASIC ANATOMY • INTRODUCTION • EPIDEMIOLOGY • ETIOLOGY/RISK FACTORS • CLINICAL MANIFESTATION • EXAMINATION • CLINICAL CORRELATION

  3. ANATOMY • The cervical spine is made up of two anatomically and functionally different segments.  These two segments work together to produce rotation, lateral flexion, flexion and extension of the head and neck. • It is made up of 7 vertebrae. The first 2, C1 and C2, are highly specialized and are given unique names: atlas and axis, respectively. C3-C7 are more classic vertebrae, having a body, pedicles, laminae, spinous processes, and facet joints.

  4. Typical Cervical Vertebra (C3-C7)

  5. Uncovertebral joint

  6. Atypical Cervical Vertebra (C1&C2)

  7. Uniqueness • Age related changes starts first in lower cervical spine ( approx 25yrs) ?? • 600 times/hr • Uncovertebral joint

  8. INTRODUCTION • Cervical spondylosis is a term that encompasses a wide range of progressive degenerative changes “wear and tear” that affect all the components of the cervical spine (Physiopedia) •  It is a natural process of aging and presents in the majority of people after the fifth decade of life. • Usually in pts with cervical spondylosis there, there is history of faulty posture, prolonged immobilisation after injury or severe repetitive trauma

  9. The most common evidence of degeneration is found at C5-6 followed by C6-7 and C4-5. • 3 distinct clinical syndromes: • Type I Cervical radiculopathy • Type II Cervical myelopathy • Type III Axial joint pain (Neck pain) • Spondylosis is a term applied to changes noted in the spine of radiologically significant: • Narrowing of the disc height • Presence of the osteophytes • Osteoarthritic changes in the posterior zygapophyseal joint

  10. EPIDEMIOLOGY • Account for 2% of all hospital admission • Starts earlier in men than women • Symptoms may appear in person’s <30 yrs but most commonly in individuals of 40-60 yrs. • The course may be slow or prolong, and patients may remain asymptomatic or have mild cervical pain. • Morbidity ranges from chronic neck pain, radicular pain, reduced ROM, headache and myelopathy.

  11. ETIOLOGY/RISK FACTORS • Causes includes: • Often develops as a result of changes in the neck joints as advances > 25 yrs • Old injury to the neck • Poor posture • Overload activities that requires heavy lifting, a lot of bending or twisting • Spine surgery, slipped disc or osteoporosis • Risk factors: • Age > 40 yrs • Head or neck trauma • Previous cervical spine surgery • Previous cervical myofacial strain • Genetic Predisposition

  12. CLINICAL MANIFESTATION • Though many pts with radiographic cervical spondylosis show no symptoms. Symptoms cluster into 3 clinical syndromes: • Axial neck pain • Cervical spondyloticradiculopathy (CSR) • Cervical spondyloticmyelopathy (CSM)

  13. EXAMINATION • Subjective ( PC, Aggravating and relieving factors, 24 hr pattern, radiating/localised, movements/activities etc) • Observation • Postural examination • Front, behind & sides

  14. Observation con’t • Sleeping • Sitting posture • Activity posture • Gait pattern

  15. RANGE OF MOTION (ROM) • AROM • PROM

  16. Activities posture

  17. SPECIAL TESTS • Spurling test • Strength testing

  18. CLINICAL CORRELATION

  19. REFERENCES • Bernabéu-Sanz Á, Mollá-Torró JV, López-Celada S, Moreno López P, Fernández-Jover E. MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression. EurRadiol. 2020 Jan;30(1):357-369. [PubMed] • Ferrara LA. The biomechanics of cervical spondylosis. Adv Orthop. 2012;2012:493605. [PMC free article] [PubMed] • Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res ClinRheumatol. 2010 Dec;24(6):783-92. [PubMed] • Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018 Sep;27(Suppl 6):796-801. [PubMed] • Kelly JC, Groarke PJ, Butler JS, Poynton AR, O'Byrne JM. The natural history and clinical syndromes of degenerative cervical spondylosis. Adv Orthop. 2012;2012:393642. [PMC free article] [PubMed] • Kokubo Y, Uchida K, Kobayashi S, Yayama T, Sato R, Nakajima H, Takamura T, Mwaka E, Orwotho N, Bangirana A, Baba H. Herniated and spondyloticintervertebral discs of the human cervical spine: histological and immunohistological findings in 500 en bloc surgical samples. Laboratory investigation. J Neurosurg Spine. 2008 Sep;9(3):285-95. • Lu X, Tian Y, Wang SJ, Zhai JL, Zhuang QY, Cai SY, Qian J. Relationship between the small cervical vertebral body and the morbidity of cervical spondylosis. Medicine (Baltimore). 2017 Aug;96(31):e7557. [PMC free article] [PubMed] • ShedidD, Benzel EC. Cervical spondylosis anatomy: pathophysiology and biomechanics. Neurosurgery. 2007 Jan;60(1 Supp1 1):S7-13. [PubMed]

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