Case Study: Cervical Spondylosis C5,C6,C7

Herniated Nucleus Pulposus

Neha Bhasin
Demographic Details
Name : Mrs. Rajeshwari Tomar
Age: 44 years
Sex: Female
Address: L 161 Shastri Nagar Meerut
Occupation: Teacher
Chief complaints: She complains of neck pain
and pain going down in both arms.
History
History of Present illness:
Pain in neck and pain going down in both the arms.The most recent

episode started two months ago when she started experiencing pain in
her left shoulder going down her left arm and in her lateral 3 fingers.
She has had neck pain for the past two years but she says her pain is

getting worse over the past two months. She has had two previous
laminectomy/decompression surgeries at C5-C6 which did temporarily
relieve her pain.
Recently, she started having pain along her right upper extremity along

with some numbness and tingling.

She says that she has been dropping stuff from her hand because of

weakness and numbness.

She denies any walking difficulties or lower extremity weakness. She

denies any changes in her handwriting. She also denies any bowel or
bladder complaints and any weakness in the legs.
Post Surgical History
 She has had 2 previous cervical
laminotomies/decompression surgeries for
the spondylosis and stenosis.
 Medical History: Tylenol plus codeine, muscle

relaxants, albuterol p.r.n., Lisinopril for mild

HTN,daily aspirin, Lipitor QD
Physical examination :
 B.P. : 120 /85mmHg
 Pulse rate: 72/min
 Respiratory rate: 16/min
 Body Built : Moderately Overweight
 Head Ear Eyes Nose Throat(HEENT) :

Normocephalic ,atraumatic head. The pupils

are round, equal and reactive to light and
accommodation. Extraocular motions intact.
 Gait: Normal, she can heel and toe walk

without difficulty.
 Swelling : Present
 Deformities : None

Cranial Nerve Examination:

 Optic Group- II,III,IV,VI
 Brachiomotor - V,VII,IX,X,XI,XII NORMAL
 Special sensory- I,VII,VIII

Sensory Examination:
 Sensation is intact in L2 through S2 bilaterally
 Sensation is intact in C4-T1 bilaterally
Reflex examination:
Deep tendon reflexes

Jerk + ++ +++ ++++

Biceps 4+

Triceps 4+
Knee 2+
Ankle 2+
Superficial Reflexes
 Abdominal Reflexes: Normal
 Plantar Reflexes: Normal
MOTOR EXAMINATION
Muscle tone:

+ ++ +++ ++++
Arm 4+
Forearm 4+
Wrist 4+
Thigh 4+
Ankle 4+
No limb length discripancies.
Coordination and balance are good.
Functional assessment: NAD
INVESTIGATIONS:
 X-ray Findings: show extensive degenerative disk disease
with disc space narrowing and prominent anterior
osteophytes at the C5/C6 and C6/C7 levels.
 M R I Findings: Evaluation of MRI done in shows presence
of C5-6 and C6-7 prolapsed inter-vertebral disks with
narrowing of the foramina and cord compression.
SPECIAL TESTS AND DIFFERENTIAL DIAGNOSIS:

 Slump test is positive. Patient complains of

backache in forward bending and in
extension.
 Spurling test is positive.
 Apley’s Scratch test is positive.
DDx:

1.Muscle strain or spasm

2.Facet joint disruption or degeneration
3.Intervertebral disc degeneration or herniation
4.Vertebral compression fracture
5.Vertebral end-plate microfractures
6.Spondylolisthesis
7.Spinal stenosis
8.Scheuermann's disease (vertebral epiphyseal aseptic
necrosis) Infection
Treatment
Medical Treatment:
 Analgesics
 Tylenol plus codeine, muscle relaxants,

albuterol, Lisinopril for mild HTN,

 daily aspirin

Home Advice:
 Take Hot fomentation.
 Avoid Carrying/Lifting Heavy Objects.
 Avoid standing for a longer duration.
Physiotherapy treatment
Goals:
 To Reduce Pain and swelling.
 To achieve more a active life style.
 Improve postural habits.
Treatment:
 Postural correction
 Full rom exercises for the shoulder joint.
 Maximum use of upper extrimity.
 Scapular protraction-retraction and

other shoulder exercise.

 Deep breathing and cycling without

straining the neck.

 Isometerics to cervical neck muscleswith
mild tension.
 Checking and training in application of

cervical collar.
 Relaxing thermotherapy modality
 Stronger but painfree isometeric exercises
 Intermittent cervical traction
 Relaxed passive mobilisation of neck.
 Gradually increasiing rom exercises.
 Postural Guidance avoid excessive Flexion
attitudes.
 Regular Back Extension Exercises should be
performed.
 Knee to chest position should be tried.
 Practise of Yoga regularly in order to stay active
and to relieve pain.
 Regular Stretching of muscles is required too.
THANK YOU!