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Condition/Disorder Synonyms

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  • Herniated intervertebral disk
  • Prolapsed intervertebral disk
  • Slipped disk
  • Ruptured disk
  • Herniated nucleus pulposus

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ICD-9-CM Code

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  • 721.1 Cervical spondylosis with myelopathy
  • 719.48 Pain in joint involving other specified sites
  • 722.0 Displacement of cervical intervertebral disc without myelopathy
  • 722.4 Degeneration of cervical intervertebral disc
  • 722.71 Intervertebral disc disorder with myelopathy cervical region

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ICD-10-CM Code

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  • M47.12 Other spondylosis with myelopathy, cervical region
  • M50.00 Cervical disc disorder with myelopathy, unspecified cervical region
  • M50.30 Other cervical disc degeneration, unspecified cervical region

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Preferred Practice Pattern

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Key Features

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Description

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  • Any disorder that affects the spinal nerve roots
  • Lateral cervical spine nerve root compression
  • Gradual or acute onset secondary to intervertebral disc or osteophyte formation in the intervertebral foramen1

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Essentials of Diagnosis

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  • Diagnosis made by clinical examination
  • Dermatome or myotome pattern
  • Reproduction of symptoms

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General Considerations

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  • Herniated disk is one cause
  • Avoid positions that increase symptoms

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Demographics

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  • Women at greater risk than men, middle-aged to geriatric

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Clinical Findings

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Signs and Symptoms

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  • Neck, shoulder, upper extremity pain and parasthesia often radiating to hand1
  • Pain in cervical spine worsens with cervical extension, side bending, and rotation to the involved side1
  • Diminished sensation, motor control and reflexes in the distribution of the involved nerve1

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Functional Implications

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  • Difficulty sustaining sitting postures secondary to neck and arm pain
  • Inability to sleep
  • Weakness with upper-extremity lifting
  • Loss of movement or feeling in upper extremity
  • Difficulty with neck movements, as with driving, secondary to pain

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Possible Contributing Causes

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  • Forward-head or rounded-shoulder posture due to tight pectoralis, weak periscapular, deep neck flexor muscles.
  • Prolonged extension or position of cervical side-bending towards impaired nerve
  • Facet hypertrophy
  • Size of spinal canal; can be congenital

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Differential Diagnosis

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Means of Confirmation or Diagnosis

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Imaging

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  • MRI helps to visualize compressed or inflamed nerve root in diagnosis
  • X-ray/plain-film radiograph helpful if osteophyte located in intervertebral foramen
  • CT scan to show herniation compressing the spinal canal/nerves

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Diagnostic Procedures

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Findings and Interpretation

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  • Physical exam cluster to rule in cervical radiculopathy2
    • Spurling’s test
    • Rotation limited ...

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