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Cervical Spondylosis (Degenerative Disc Disease)

TENSEGRITY FRYTTE S LAW ANATOMY OUTER annulus and longitudinal ligaments are innervated No N. supply for cartilagenous end plate and nucleus pulposus, no nociceptors in lig. Flavum Capsule of facet joints are innervated by dorsal rami

Sections of the Cervical Spine Due to its morphology, biomechanics, and the presence or absence of intervertebral disks, the cervical spine is divided anatomically and functionally into (Fig. 12.4): • Upper cervical spine: – anatomically: atlas and axis; – functionally: C0/C1 and C1/C2 segments; also called the segments without intervertebral disks. • Lower cervical spine: – anatomically: C3–C7; – functionally: C2/C3 to T3/T4 segments; also called the segments with intervertebral disks

Normal Anatomy Intervertebral disc Annulus fibrosus Nucleus pulposus Gel type substance Shock absorber

Flexion , extension and minimal side bending atlanto occipital joint Rotation in atlanto axial joint Joint of lushka 20 percent of axial loading Atlanto occipital axial loading C6-t4 axial loading

Pathophysiology Disc degenerates (normal process) Water loss Changes height of IVD Changes orientation of joints Leads to instability or increase shear stress Increase shear stress irritates facet joints leading to OA Increased stress and strain on soft tissue

Pathophysiology Osteophytes form to in response to increase facet apposition and instability Pain is not caused by the degeneration itself Soft tissue and joint irritation source of nociceptive input

Radiculopathy Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve. Radiculopathy can occur in any part of the spine, but it is most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy). It is less commonly found in the middle portion of the spine (thoracic radiculopathy).

Radiculopathy is caused by compression or irritation of a nerve as it exits the spinal column. Symptoms of radiculopathy include pain, numbness, tingling, or weakness in the arms or legs. Most patients with radiculopathy respond well to conservative treatment including medications, physical therapy, or chiropractic treatment. Often radiculopathy can resolve within 6 weeks to 3 months

What are the risk factors for radiculopathy? Risk factors for radiculopathy are activities that place an excessive or repetitive load on the spine. Patients involved in heavy labor or contact sports are more prone to develop radiculopathy than those with a more sedentary lifestyle. A family history of radiculopathy or other spine disorders also increases the risk of developing radiculopathy.

Symptoms of radiculopathy depend on which nerves are affected Symptoms of radiculopathy depend on which nerves are affected. The nerves exiting from the neck (cervical spine) control the muscles of the neck and arms and supply sensation there. The nerves from the middle portion of the back (thoracic spine) control the muscles of the chest and abdomen and supply sensation there. The nerves from the lower back (lumbar spine) control the muscles of the buttocks and legs and supply sensation there

The human body has 31 nerve root pairs: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. Each nerve root has two components: a somatic portion, which innervates the skeletal muscles and provides sensory input from the skin, fascia, muscles, and joints, and a visceral component, which is part of the autonomic nervous system. The autonomic system supplies the blood vessels, dura mater, periosteum, ligaments, and intervertebral discs, among many other structures. The sensory distribution of each nerve root is called the dermatome. A dermatome is defined as the area of skin supplied by a single nerve root.

Myotomes are defined as groups of muscles supplied by a single nerve root. A lesion of a single nerve root is usually associated with paresis (incomplete paralysis) of the myotome (muscles) supplied by that nerve root. A sclerotome is an area of bone or fascia supplied by a single nerve root Radicular or radiating pain, a form of referred pain, is a sharp, shooting pain felt in a dermatome, myotome, or sclerotome because of direct involvement of or damage to a spinal nerve or nerve root. A radiculopathy refers to radiating paresthesia, numbness or weakness but not pain.

Dermatomes vs myotomes Dermatome of cervical: C5 Lateral aspect of arm. C6 Lateral aspect of forearm and thumb. C7 Middle aspect of forearm and middle three fingers. C8 Medial aspect of forearm and little finger. T1 Medial aspect of arm. Myotome of cervical: C5  deltoid (shoulder abduction), supraspinatous. C6  flexion elbow + wrist extension C7  elbow extension + wrist flexion + fingers extension C8  fingers flexion T1  fingers abduction and adduction

Associated Pathologies Osteoarthritis Stenosis Disc Herniation Radiculopathy

spondylosis It is general progressive degeneration of the IVD specially freely mobile as they are more subjected to wear and tear

Cervical disc prolapse Herniation: a general term used when there is any change in the shape of the annulus that causes it to bulge beyond its normal perimeter Protrusion: nuclear material is contained by the outer layers of the annulus and supporting ligamentous structures. ■ Prolapse: frank rupture of the nuclear material into the vertebral canal. ■ Extrusion: extension of nuclear material beyond the confines of the posterior longitudinal ligament or above and below the disc space, as detected on magnetic resonance imaging (MRI), but still in contact with the disc. ■ Free sequestration: the extruded nucleus has separated from the disc and moved away from the prolapsed area.

Disc breakdown, showing (A) breakdown and compression of fibrous layers of the annulus and displacement of disc material; (B) radial fissures/tears with nuclear material bulging against the outer annulus; (C) extrusion of nuclear material through the outer annulus but still in contact with the disc; (D) sequestration of nuclear material beyond the annulus;

Causes Spontanous and traumatic Manifestations Onset: sudden severe neck pain Local manifestations Muscle spasm, neck is fixed referred pain to the affected dermatome and myotome causing muscle weakness

treatment Soft tissue problems Junctional approaches (mobilization) Decompression (1-2 weeks) Correction of curvature abnormalities Reduction (retracted extension) stabilization ex

Suboccipital release Can help tension headache Neck pain Shoulder pain Upper back pain How??? Soften fascia and muscles in suboccipital area

Diaphragmatic release neuro dynamics

Solving the puzzle Cervical pain may be due to: Soft tissue facet joint Joint of louchka Miniscoid impingement Disc curvature abnormalies