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Key Features

Essentials of Diagnosis

  • Neck pain, sometimes radiating to one or both arms

  • Restricted neck movements

  • Motor, sensory, or reflex changes in one or both arms with root involvement

  • Neurologic deficit in legs, gait disorder, or sphincter disturbance with cord involvement

General Considerations

ACUTE CERVICAL DISK PROTRUSION

  • Acute cervical disk protrusion leads to pain in the neck and radicular pain in the arm, exacerbated by head movement

CERVICAL SPONDYLOSIS

  • Results from

    • Chronic cervical disk degeneration, with herniation of disk material

    • Secondary calcification

    • Associated osteophytic outgrowths

  • One or more of the cervical nerve roots may be compressed, stretched, or angulated

  • Myelopathy may also develop as a result of

    • Compression

    • Vascular insufficiency

    • Recurrent minor trauma to the cord

Clinical Findings

Symptoms and Signs

ACUTE CERVICAL DISK PROTRUSION

  • With lateral disk herniation, motor, sensory, or reflex changes are in a radicular (usually C6 or C7) distribution on the affected side (Figure 24–2)

  • With more centrally directed herniations, the spinal cord may also be involved, leading to spastic paraparesis and sensory disturbances in the legs, sometimes accompanied by impaired sphincter function

Figure 24–2.

Cutaneous innervation. The segmental or radicular (root) distribution is shown on the left side of the body and the peripheral nerve distribution on the right side. Segmental maps show differences depending on how they were constructed (single root stimulation or section; local anesthetic ­injection into single dorsal root ganglia). (Adapted, with permission, from Aminoff MJ, Greenberg DA, Simon RP. ­Clinical Neurology, 9th ed. McGraw-Hill Education, 2015.)

CERVICAL SPONDYLOSIS

  • Neck pain and restricted head movement, occipital headaches, radicular pain and other sensory disturbances in the arms, weakness of the arms or legs, or some combination of these symptoms

  • Examination generally reveals that lateral flexion and rotation of the neck are limited

  • A segmental pattern of weakness or dermatomal sensory loss (or both) may be found unilaterally or bilaterally in the upper limbs, and tendon reflexes mediated by the affected root or roots are depressed

  • The C5 and C6 nerve roots are most commonly involved; then, examination frequently reveals

    • Weakness of muscles supplied by these roots (eg, deltoids, supraspinatus and infraspinatus, biceps, brachioradialis)

    • Pain or sensory loss about the shoulder and outer border of the arm and forearm

    • Depressed biceps and brachioradialis reflexes

  • Spastic paraparesis may also be present if there is an associated myelopathy, sometimes accompanied by posterior column or spinothalamic sensory deficits in the legs, urinary urgency, or incontinence

Differential Diagnosis

  • Congenital abnormalities may involve the cervical spine and lead to ...

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