Cervical and Lumbar

pain

Neck pain and back

pain
History and physical
examination
Neurological manifestations and
symptoms of systemic illness

NO
Conservativ
e
managemen
t
Symptoms
resolve
Symptoms
persist

Yes
Additional
evaluation by
imaging &
laboratory
studies

History
Pain

: onset , character , location ,

radiation , aggravating and relieving

factors and its intensity to
differentiate between mechanical and
inflammatory pain

Mechanical
Pain

Inflammatory
Pain
in

at night
morning
activity
rest
MS < 30
MS > 30
min
min

Cervical Myelopathy
2ry to compression of the spinal cord due
to degenerative disc disease.
Symptoms of weakness of upper and lower
limbs.
Urinary or rectal incontinence .
UMN signs on examination below the
affected level and LMN signs at the same
level.
Some patients improve with conservative
therapy , but in progressive myelopathy ;
surgery is the choice.

Cervical Myelopathy

Cervical Spondylosis
Neck pain is diffuse and may radiate
to shoulders , occiput or
interscapular area.
On examination : midline tenderness
and pain on extension and lateral
flexion.
Plain x rays : intervertebral
narrowing , osteophytes and facet
joint sclerosis.
TTT: patient education , NSAIDs ,

Cervical Spondylosis

Cervical Strain
Pain in middle or lower portions of
the posterior aspect of the neck.
On examination : local tenderness of
the paraspinal muscles , ROM and
loss of cervical lordosis.
TTT: NSAIDs , muscle relaxants, local
injections and neck exercises (ROM
and strenghthening exercises).

Normal

Loss of
cervical curvatur

Cervical hyperextension injuries

(whiplash)
Acceleration-deceleration injury to the soft
tissue structures of the neck.
Stretched or torn paracervical muscles ,
injured intervertebral discs or damage to
sympathetic ganglia.
On physical examination : severe neck
tenderness , ROM and paraspinal muscle
contraction.
TTT: NSAIDs , muscle relaxants, cervical
collar.

Cervical Radiculopathy
Pain radiating from shoulder to forearm and hand .
2ry to herniated cervical disc , osteophytes ,
inflammation of the involved root.
Neck pain is minimal or absent.
Physical examination (Spurling sign): extension ,
lateral flexion and compression of the cervical
spine cause radicular pain.
Neurologic examination : sensory abnormality ,
asymmetric reflexes, motor weakness corresponds
to the affected root.

Cervical Radiculopathy

Cervical Radiculopathy

Cervical Radiculopathy

2
3
4
5
6
7

Physical Examination of
Neck Pain
Inspection for active ROM , skin , masses.
Palpation
Tenderness of the midline structures
(( intrinsic spinal disorders)) , but tenderness
off the midline suggests soft tissue pathology).
Passive ROM
Neurological evaluation
Special tests.

Spurling maneuver
Extending the neck and rotating the head to
one side then compress and then to the
other side .
+ve result

Radicular pain.

Useful in confirming the presence of cervical

radiculopathy.

Spurling maneuver

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Lumbar Spondylosis
The most commonly identified cause of

LBP.
Facet syndrome : pain may radiate

into posterior thigh on bending

ipsilateral to the involved facet joint.

Lumbar Spondylosis

Disc Herniation
The nucleus pulposus in a degenerated
disc may prolapse and push out the
weakened annulus fibrosus , usually
posterolateraly.
It results in nerve root impingement
syndrome.
95% occurs at L4/5 and L5/S1.
Rarely a massive midline disc herniation
compresses the cauda equina ending in
cauda equina syndrome.

Disc Herniation

Spondylolithesis
It is the anterior displacement of a
vertebra on the one beneath it.
Degenerative spondylolithesis ;
2ry to degenerative changes in the
disc and facet joints .
Isthmic spondylolithesis ; 2ry to
developmental defect in the pars
interarticularis of the vertebral arch.

Spondylolithesis

Spondylolithesis

Spinal Stenosis
Narrowing of the spinal canal.
Due to hypertrophied ligamentum flavum
into posterior part of the canal, also
herniated disc narrows the anterior part of
the canal.
Pseudoclaudication (neurogenic
claudication): pain and discomfort
together with parathesia and weakness in
the buttocks , thighs and legs.
by standing or walking and sitting or
flexing forward.

Spinal Stenosis

Thickened ligamnetum
flavum

Physical Examination of
Back Pain
Inspection for ROM , skin , masses and
scoliosis .
Palpation
Tenderness of the midline structures
(( intrinsic spinal disorders)) , but tenderness
off the midline suggests soft tissue pathology).
Passive ROM
Neurological evaluation
Special tests.

Scoliosis

Straight Leg Raising test

In patients with sciatica.
It places tension on the sciatic nerve roots
( L4, 5 and S1,2 and 3).
+ve when there is radicular pain when
the leg is raised <60 , while the knee is
extended.
Neurological examination .
MRI ( herniated disc).

Straight Leg Raising test

Neurological Examination

Th a n k
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