Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Cervical Spine Disorders 297

Cervical Spine Disorders...............................

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Neck pain, sometimes radiating to arm or head

■Weakness, numbness or paresthesias occur in arms w/ radicular

involvement

■Leg weakness, gait disorder or sphincter dysfunction occurs w/ cord

compression

■May be history of trauma or other precipitating cause (eg, coagulopa-

thy, osteoporosis, malignant disease, predisposition to infection)

■Spasm of cervical paraspinal muscles

■Restriction of neck movements, esp. lateral flexion

■Focal tenderness over spinous process (esp. w/ tumor or infection)

■May be segmental motor, sensory or reflex deficit in arms

■Spurling’s sign may be positive

■With cord compression, may be spastic paraparesis & sensory dis-

turbances in legs, w/ brisk reflexes & extensor plantar responses

tests

■If fracture suspected, neck must be immobilized immediately & then

imaged

■MRI detects structural abnormalities of spine & suggests their nature

& severity

■EMG may indicate whether MRI abnormalities are of clinical rele-

vance

differential diagnosis

■MRI distinguishes btwn different spinal disorders–eg, disc protru-

sion, cervical spondylosis, metastatic deposits, osteoporosis, epidu-

ral infection

management

■Analgesics or NSAIDs for pain

■Use of soft collar sometimes helpful

specific therapy

■Treat underlying cause

■Spinal stenosis, cervical spondylosis or prolapsed disc may require

surgery

■Metastatic disease may require irradiation