Cervical Spine Disorders & Related Conditions

Common Cervical Spine Symptoms

Pain, stiffness, weakness, instability, restricted range of motion, and altered coordination of movement.

Cervical Spine Red Flags

History of major trauma, age > 50 yrs, constant unrelenting pain, fever > 38 °C, anterior neck pain, unexplained weight loss, neurological deficit, arm radicular pain, history of rheumatoid arthritis, or Down syndrome.

Acute Torticollis (Wry Neck)

Sudden-onset SCM spasm causing side-bending with slight flexion/rotation, extreme but transient pain, typically after awkward sleep or sudden movement, with no neurological signs.

Upper Cervical Z-Joint Pain Referral (C0-C3)

Pain referred into the head, jaw, and retro-orbital region.

Mid-Cervical Z-Joint Pain Referral

Pain referred toward the supraspinous fossa or shoulder, often with reduced side-bending/rotation and levator scapulae tenderness.

Lower Cervical Z-Joint Pain Referral

Pain referred to the inter-scapular area with cutaneous pain toward the shoulder or lateral humeral condyle.

Cervicogenic Headache

Headache arising from C0/1, C1/2, or C2/3; history of upper-neck pain, limited movement, trauma; daily or constant unilateral/bilateral pain (occipital, occipito-temporo-maxillary, or supra-orbital).

Cervical Spondylosis

Degenerative change of cervical intervertebral joints (most often C5/6, C6/7); dull aching pain, morning stiffness, grating, worsened by sudden movement, may refer to shoulder, UE, or sub-occipital region.

Spinal Nerve Compression in Spondylosis

Stenosis and osteophytes narrow canal or foramina, compressing C6, C7, or C5 roots and possibly causing vascular compromise or myelopathy.

Cervical Canal Stenosis

Canal narrowing from disc herniation, spondylosis, or space-occupying lesions; may produce cervical myelopathy via cord compression or anterior spinal artery ischemia.

Progressive Cervical Myelopathy

Dynamic cord compression (30-70 yrs) from anterior disc-osteophytes and posterior ligamentum flavum hypertrophy, producing mild lower-cervical cord signs; confirmed by MRI.

Inflammatory Arthritides Affecting Cervical Spine

Rheumatoid arthritis, Reiter’s syndrome, psoriatic arthritis, systemic lupus erythematosus, and ankylosing spondylitis.

Cervical Spondyloarthropathy & HVLA

Absolute contraindication to high-velocity manipulation due to joint erosion and atlanto-odontoid instability.

Common Levels for Cervical Disc Herniation

Most frequent at C5/6, then C6/7, with decreasing incidence at other cervical levels.

Cervical Disc Herniation – Typical Presentation

Severe neck, scapular, and arm pain following dermatomal pattern; worse with coughing/sneezing; neck stiffness, loss of lordosis, paresthesia, and neurological signs in the hand.

Atypical Cervical Disc Herniation Presentations

(1) Upper-limb pain without neck/shoulder pain, (2) neck pain only, or (3) signs of cervical myelopathy.

Whiplash / Whiplash-Associated Disorder (WAD)

Acceleration-deceleration injury damaging muscles, discs, z-joints, capsules, nerve roots, and ligaments; may cause micro-fractures and long-term dysfunction.

WAD Grade 0

No neck pain and no physical signs.

WAD Grade 1

Neck pain, stiffness, or tenderness without physical signs.

WAD Grade 2

Neck pain, stiffness, or tenderness plus physical signs such as decreased ROM.

WAD Grade 3

Neck pain/tenderness plus neurological signs (e.g., weakness, sensory loss).

WAD Grade 4

Neck pain/tenderness with fracture or dislocation.

Ligaments Implicated in Cervical Instability Post-Whiplash

Alar, apical, tectorial membrane (PLL), ligamentum flavum, posterior & anterior atlanto-occipital ligaments, anterior longitudinal ligament, and cruciate (transverse & longitudinal) ligament.

Flexion/Distraction Cervical Fracture

Most common cervical fracture: flexion strain of posterior ligaments leads to middle-column failure, followed by anterior-column failure and end-plate compression.

Brachial Plexus Injury – Pathology Types

Avulsion (root torn from cord, irreparable), rupture (partial/full tear, may be surgically repaired), and neuropraxia/stretch (mild stretch, often self-healing).

Brachial Plexus Injury – Major Aetiology

90 % from motor-vehicle crashes (two-wheelers); also industrial trauma, heavy falls, or iatrogenic injury during neck surgery.

Burner / Stinger

Sudden burning pain and numbness down lateral arm with shoulder weakness after acute side-bend injury; transient upper-trunk BPI from traction or root compression.

Erb-Duchenne Palsy

Avulsion of C5–C6 roots causing loss of shoulder abduction, external rotation, elbow flexion, and forearm supination; sensory loss over lateral arm/forearm and lateral two fingers.

Thoracic Outlet Syndrome (TOS) Categories

Costoclavicular, cervical rib, scalenus anterior, and traumatic (post-fracture) types.

TOS Epidemiology & Aetiology

Females > males, age 20–50; 95 % involve brachial plexus, remainder vascular; caused by mechanical, congenital, or acquired factors.

Neurological Symptoms of TOS

Lower-trunk pattern: paresthesia/numbness in medial forearm, hand weakness, possible wasting of thenar, hypothenar, or interossei muscles.

Vascular Symptoms of TOS

Ischemic pain, peripheral cyanosis, diminished pulses, trophic skin changes, or finger gangrene.

Arterial TOS

Young adults with vigorous arm activity; sudden hand pain, claudication, pallor, cold intolerance, and paresthesia.

Venous TOS

Young men with vigorous arm use; arm heaviness, cyanosis, edema, and finger paresthesia from venous congestion.

Central Cord Syndrome

Hyperextension injury in a degenerated spine; AP compression damages central cord, producing greater motor/sensory loss in upper than lower limbs.

Anterior Cord Syndrome

Hyperflexion or comminuted fracture causing anterior cord ischemia; complete motor, pain, and temperature loss below lesion with preserved deep touch, position, and vibration sense.