Cervical disc signs and cervical spondylosis

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  1. minimal canal AP diamter is 14 mm at C5; must have at least 11 mm or else cord compression occurs
    1. bone spurs of cervical spondylosis are accompanied by dural-arachnoid adhesions and entrapment of the cervical root; motion of the cord with movement of the neck exaggerates the effect of entrapment
    2. radicular arteries within the dural sleeves tolerate compression and repetitive minor trauma poorly
    3. loss of disc height due to loss of water within the disc may exacerbate the symptoms
    4. disc space narrowing in the aging cervical spine occurs in the ventral aspect of the vertebral disc first
  2. pain in the neck and arm in a radicular distribution is the hallmark of acute soft disc rupture; paresthesias may accompany pain but are usually more distal in the extremity; pain is exaggerated by extension or rotation of the neck; wasting and fasciculations are unusual as are long track signs
  3. Lhermitte’s sign: electrical shock-like sensation down back of neck with neck flexion
  4. Spurling’s sign: radicular pain reproduced when the examiner exerts downward pressure on vertex while tilting head towards symptomatic side
  5. muscle innervation
    1. C5 – infraspinatus – rotate arm out
    2. C5 – supinator – forearm supination
    3. C5 – deltoid
    4. C6 - biceps
    5. C6 – extensor carpi radialis – radial hand extension
    6. C7 – extensor digitorum – extension of hand and phalanges of fingers 2-5
    7. C7 – triceps
    8. C6-7 – pronator teres
    9. C8 – flexor digitorum profundus – flex distal phalanx of fingers 2-3
    10. C8 – flexor pollicis longus – flex distal phalanx of thumb
    11. C8 – abductor pollicis longus – abduction thumb, metacarpal and radial hand extension
    12. T1 – opponens pollicis
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