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  • Cervical spondylolysis

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  • 738.4 Acquired spondylolisthesis

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  • M43.00 Spondylolysis, site unspecified

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Description

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  • Stress fracture of the pedicles on the vertebra below
  • Tightness or pain in the neck region
  • Often no symptoms
  • Weakness in the pars

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Essentials of Diagnosis

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  • Diagnosis made by X-ray
  • Can be acquired or congenital
  • Neck pain

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General Considerations

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  • Instability
  • Avoid extension positions that increase symptoms
  • Thin vertebral bone: pars

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Demographics

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  • Teenagers with high risk activities are more at risk
  • Runs in families

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Signs and Symptoms

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  • Pain in cervical spine, shoulder, arm, upper extremity
  • Stiffness along spine
  • Headaches
  • Pain in cervical spine worsens with extension

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Functional Implications

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  • Difficulty sustaining standing postures secondary to neck and arm pain
  • Inability to sleep flat on the back without a pillow
  • Difficulty with movements (reaching overhead) secondary to pain
  • Limit sports participation

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Possible Contributing Causes

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  • Forceful extension from hit under the chin (sports)
  • Congenital
  • Car accident, hit from rear
  • Hyperextension of the cervical spine
  • Increased cervical lordosis posture

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Differential Diagnosis

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  • Peripheral nerve impairment
  • Spinal tumor
  • Peripheral neuropathy
  • Paraspinal spasms
  • Degenerative disk disease
  • Stenosis

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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 to see vertebra position
  • CT scan to show herniation compressing the spinal canal/nerves
  • Electrodiagnostic/nerve conduction testing can help to determine a specific impaired nerve function

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  • Stress fracture of the pars

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  • Restricted mobility of the upper cervical spine
  • Hypermobility
  • Weakness noted of neck musculature

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  • Rest
  • Bracing
  • Address Pain
    • Electrical stimulation
    • Heat/ice
  • Address hypertonicity
    • Soft-tissue massage
    • Heat
  • Address muscle weakness
    • Stability exercises

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  • Patient will be able to
    • Sit with neutral cervical spine posture for greater than 30 minutes with 0 out of 10 pain rating
    • Stand at work station and perform computer work for 45 minutes with 0 out of 10 pain rating
    • Rotate cervical spine 75 degrees so as to look over the shoulder while driving the car with 0 out of 10 pain rating

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  • Fair to good depending on severity of vertebral translation, amount of nerve-root compression, and upper/lower-extremity impairments

1. The American Physical Therapy Association. Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation. Interactive Guide to Physical Therapist Practice 2003. DOI: 10.2522/ptguide.978-1-931369-64-0. Online February 28, 2012. Accessed March 1, ...

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