Serious Cervical Spine Conditions
Original Editor - Rachael Lowe
Top Contributors - Rachael Lowe, Kim Jackson, Simisola Ajeyalemi, Lucinda hampton and Jess Bell
Introduction[edit | edit source]
Clinicians must be aware of the key signs and symptoms associated with serious pathological neck conditions (red flags), continually screen for the presence of these conditions, and initiate referral to the appropriate medical practitioner when a potentially serious medical condition is suspected.
Red Flags[edit | edit source]
Clinicians must be able to identify red flags in patients with neck pain that suggest the presence serious pathology and the need for medical (infection, cancer, and cardiac involvement) or surgical consultation (cervical stenosis and myelopathy). Clinicians should also screen patients with neck pain for suspected arterial insufficiency, upper cervical ligamentous instability, and fracture[1].
If red flags are identified in the spine, the therapist should first consider if onward referral is appropriate[2]. If serious enough, the therapist may refer onto Accident and Emergency, such as in the case of fractures[3]. Otherwise further specialist medical opinions can be gained from a specialist medical practitioner or in a specialist spinal clinic[4].
Cervical Stenosis and Myelopathy[edit | edit source]
Cervical Arterial Dysfunction[edit | edit source]
AD is an umbrella term covering a broad spectrum of potential pathologies. These range from pre-existing underlying anatomical anomalies, vasospasm, atherosclerosis, through to giant cell arteritis (i.e. temporal arteritis) or arterial dissection. All of these may lead to potential cranio-cerebral ischaemia which may originate and manifest in a variety of ways. Presentations range from pain, through to cranial nerve dysfunctions, sympathetic nerve dysfunction (e.g. Horner’s Syndrome), blindness, stroke, or at worst, death.
Cervical Instability[edit | edit source]
Cervical Fractures[edit | edit source]
When a patient with neck pain reports a history of trauma, the therapist needs to be particularly alert for spinal fracture and the potential for cervical instability and/or spinal cord or brain stem injury. The Canadian C-Spine Rule can be used to determine when to refer for radiography in individuals following trauma where fracture of the cervical spine is a concern.
Serious Pathology[edit | edit source]
Cancer, Infection, and Visceral Disorders
References[edit | edit source]
- ↑ Knew WW. Neck Pain Guidelines: Revision 2017. J Orthop Sports Phys Ther. 2017;47(7):511-2.
- ↑ Moffett, J. K., McLean, S. and Roberts, L. Red flags need more evalutation: reply. Rheumatology. 45, pp: 922. 2006
- ↑ Chau, A. M. T., Xu, L. L., Pelzer, N. R. and Gragnaniello, C. (2013). Timing of surgical intervention in cauda equine syndrome – a systematic critical review. World Neurosurgery. 12
- ↑ Carvalho, A. Red Alert: How useful are flags for identifying the origins of pain and barriers to rehabilitation? Frontline. 13 (17). 2007
