Cervical Lecture 1: Epidemiology and Evaluation Framework

Flashcards covering epidemiology, risk factors, red/yellow flag screening, and the evaluation framework for cervical spine conditions based on Dr. Daniel Maddox's lecture and the 2017 JOSPT Clinical Practice Guidelines.

Economic Burden of Neck Pain

It is the 2nd most common musculoskeletal cause of disability and injury claims, and its economic burden is second only to Low Back Pain (LBP) in workers' compensation claims.

Neck Pain Prevalence Rates (Childs 2008)

Point prevalence is approximately $15\%$, annual prevalence is approximately $26\%$, and lifetime prevalence is up to $70\%Configured stats$.

Neck Pain Recurrence (Olson; Carroll 2008)

Approximately $50\%-85\%$ of individuals will experience recurrent or ongoing pain, with recurrence usually occurring within $1-5$ years.

Most Significant Variables for Developing Neck Pain

Female gender and a prior history of neck pain.

Clinical Course Recovery Window

Most significant recovery occurs in the initial $6-12$ weeks, with slow or little recovery observed after $12$ months.

Unfavorable Prognostic Predictors for Neck Pain

High pain intensity, high self-reported disability, high pain catastrophization, post-traumatic stress symptoms (measured by IES in WAD), and pain or sensitivity to cold.

MRI Criteria for Neck Pain

MRI is indicated only if neurological symptoms exist.

Sizer 2007 Category I Red Flags

Factors requiring immediate medical attention, such as blood in sputum, loss of consciousness, altered mental status, or progressive neurological deficits.

Sizer 2007 Category II Red Flags

Factors requiring subjective questioning and precautionary procedures, including age $> 50$, fever, history of cancer, and long-term corticosteroid use.

Sizer 2007 Category III Red Flags

Factors requiring further physical testing and differentiation, such as abnormal reflexes, unexplained weakness, or radiculopathy.

Spinal Metastases Sources

The most common sources are the Breast, Lung, and Prostate.

Meningitis Signs and Symptoms

Fever, (+) Lhermitte’s sign, headache, nausea/vomiting, confusion, seizures, photophobia, or phonophobia.

Myocardial Infarction (MI) Presentation

Angina $>30\,min$ not relieved by rest/antacids, shortness of breath, cold sweat, and high BP; note that $33\%$ of patients (especially women/elderly) may not have chest pain.

Cervical Myelopathy

An Upper Motor Neuron (UMN) lesion resulting from narrowing of the spinal canal, often manifesting with LE weakness, ataxic gait, and hyperreflexia.

Cook 2010 Test Item Cluster (TIC) for Myelopathy

A cluster of 5 findings: 1) Age $>45$, 2) (+) Hoffman’s Sign, 3) (+) Babinski Reflex, 4) Gait Deviation, and 5) (+) Inverted Supinator Sign.

Cook 2010 TIC Psychometrics

If $<1/5$ tests are positive, $Sn = 94\%$ ($-LR = 0.18$); if $>3/5$ tests are positive, $Sp = 99\%$ ($+LR = 31$).

Canadian C-spine Rule (CCR) Purpose

The gold standard for ruling out cervical fracture following trauma ($Sn = 99.4\%$).

CCR High-Risk Factors

Age $\ge 65$ years, dangerous mechanism (e.g., fall $> 1\,metre$ or $5\,stairs$), or paraesthesias in extremities.

CCR Low-Risk Factors for Safe ROM Assessment

Simple rear-end MVC, sitting position in A&E, ambulatory at any time, delayed onset of neck pain, and absence of midline c-spine tenderness.

CCR Rotation Requirement

The patient must be able to actively rotate the neck $45^{\circ}$ left and right to avoid radiography if low-risk factors are met.

Os Odontoideum

A congenital or acquired separation of the dens from the axis ($C2$), serving as a risk factor for Upper Cervical Instability.

Cervical Arterial Dysfunction (CAD) Systems

Includes the Posterior System (vertebrobasilar) and the Anterior System (internal carotids).

CAD 5 D's and 3 N's

Ischaemic signs including Dizziness, Diplopia, Dysarthria, Dysphagia, Drop attacks, Nausea, Numbness (facial), and Nystagmus.

Internal Carotid Artery (ICA) Specific Signs

Non-ischaemic: Horner’s syndrome, pulsatile tinnitus, and CN palsies ($9-12$). Ischaemic: Hemiparesis and speech impairments.

VBI Test Validity

Hutting 2012 found the test has zero value as a screening tool due to low sensitivity ($Sn = 0\%-57\%$).

Yellow Flags in Neck Pain

Psychosocial factors such as fear-avoidance beliefs, catastrophizing, and the belief that pain is harmful or uncontrollable.

Nakashima 2015 Asymptomatic Findings

A study showing that $88\%$ of asymptomatic individuals have significant disc bulges and $95\%$ of men age $60-65$ show degenerative changes.

Neck Disability Index (NDI)

An outcome measure with 10 questions ($0-5$ scale); the maximum score is $50$, which is typically doubled to report a percentage.

Patient Specific Functional Scale (PSFS)

An outcome measure where the patient scores 3 limited activities from $0$ (unable) to $10$ (optimal).

PPIVM and PAIVM

Terms for PROM in the spine; PPIVM stands for Passive Physiological Intervertebral Movements and PAIVM stands for Passive Accessory Intervertebral Movements.

Four Components of 2017 Neck Pain CPG Evaluation

1) Medical Screening, 2) Classification into ICF category, 3) Staging, 4) Determining Intervention Strategies.