![]() ![]() An increased loss of balance is interpreted as a positive Romberg’s test and is indicative of dysfunction involving the dorsal columns of the spinal cord. In the latter, the patient stands with eyes closed, and arms held forward. The clinician can evaluate the patient’s gait and balance with a toe-to-heel walk test and Romberg’s test. A more specific sign for CSM is Hoffman’s sign, which is elicited by flicking the patient’s distal phalanx of the middle finger and observing reflexive flexion of the thumb and/or index finger.Īll physical exams should include a meticulous evaluation of bilateral extremities for muscle strength, sensation, and deep tendon reflexes in order to look for weakness in a myotomal distribution, sensory deficits in a dermatomal pattern, and reflex changes, respectively all of which can help to identify the compromised nerve root(s) and/or myelopathy. In some cases, manual neck distraction may alleviate radicular pain.Įlectric shock-like sensations radiating down the spine and into the extremities with cervical flexion is a positive Lhermitte's sign, which is concerning for cervical spondylotic myelopathy (CSM). In a 2011 study by Shabat et al., the Spurling test was found to be 95% sensitive and 94% specific for diagnosing nerve root pathology in 257 patients as confirmed by cervical spine CT and/or MRI. If there is radiating pain down the upper limb with head extension and ipsilateral head rotation to the affected side, then it is considered a positive Spurling test for cervical radiculopathy. Tender “trigger” points are frequently present within the superior trapezius muscles, cervical paraspinal muscles, and/or periscapular muscles. On the first appearance, the patient may appear immobile and stiff at the head and neck due to increasing axial neck pain with cervical spine movement. Urinary symptoms (i.e., incontinence) are rare and typically appear late in disease progression However, spondylotic discs were observed to have thicker bony endplates with a more diffuse expression of TNF-alpha and MMP-3 in the inner layer of the annulus fibrosus. However, herniated discs demonstrated more profound inflammatory reactions involving CD68-positive macrophage infiltration into the outer layer of the annulus fibrosus. Chondrocytes taken from both groups were abundant in CD68-positive macrophages, tumor necrosis factor-alpha (TNF)-alpha, matrix metalloproteinase (MMP)-3, basic fibroblast factor (bFGF), and vascular endothelial growth factor (VEGF). In a 2008 study by Kokubo et al, a total of 500 cervical intervertebral discs excised from 198 patients with disc herniation and 166 patients with spondylosis were examined en bloc samples via histological analysis and immunohistochemical staining. While both spondylotic discs and herniated discs undergo similar degenerative changes (e.g., macrophage infiltration, upregulation of growth factors, and cytokines), there exist immunohistological distinctions between the two disease processes. ĭisc herniation can be an early precursor to the development of spondylosis. These degenerative changes lead to loss of cervical lordosis and movement, as well as a reduction in the spinal canal diameter. Furthermore, disruption in the load balance along the spinal column generates greater axial loads onto the uncovertebral and facet joints which triggers hypertrophy or enlargement of the joints and accelerates bony spur formation into the surrounding neural foramen. ![]() These bone spurs or osteophytes can form along the ventral or dorsal margins of the cervical spine, which can then project into the spinal canal and intervertebral foramina. Progression of the kyphosis causes the annular and Sharpey’s fibers to peel off from the vertebral body edges, resulting in reactive bone formation. The result is a reversal of the normal cervical lordosis. With further disc desiccation, the annular fibers become more mechanically compromised under compressive loads, producing significant alterations in the load distribution along the cervical spine. As the nucleus pulposus loses its ability to maintain weight-bearing loads effectively, it begins to herniate through the fibers of the annulus fibrosus and contributes to the loss of disc height, ligamentous laxity, and buckling, and compression of the cervical spine. Desiccation of the disc causes the nucleus pulposus to lose its elasticity as it shrinks and becomes more fibrous. An increase in the keratin-chondroitin ratio prompts changes to the proteoglycan matrix resulting in loss of water, protein, and mucopolysaccharides within the intervertebral disc. The pathogenesis of cervical spondylosis involves a degenerative cascade that produces biomechanical changes in the cervical spine, manifesting as secondary compression of neural and vascular structures. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |