[article]
Titre : |
Anatomical specificities of the degenerated cervical spine: a narrative review of clinical implications, with special focus on targeted spinal injections |
Type de document : |
texte imprimé |
Auteurs : |
Christelle Nguyen, Auteur ; Katherine Sanchez, Auteur ; Alexandra Roren, Auteur |
Année de publication : |
2016 |
Article en page(s) : |
p. 276-281 |
Langues : |
Anglais (eng) Français (fre) |
Mots-clés : |
Cou Disque intervertébral Arthrose Cervical spine,Uncarthrosis,Degenerative disc disease,Spondylosis,Spinal injections |
Résumé : |
Background: Cervical radiculopathy is most often related to foraminal stenosis due to osteoarthritic changes of the uncovertebral joints anteriorly or zygapophyseal joints posteriorly, rather than disc herniation.
Objectives: To describe anatomical specificities of the degenerated cervical spine.
Methods: A critical narrative review was conducted. Articles were non-systematically selected and based on authors’ expertise, self-knowledge, and reflective practice.
Results: Vertebral bodies of the lower cervical spine are characterized by 2 lateral prismatic bony protuberances, the uncinate processes, located on C3 to C7 superior vertebral endplates, that are involved in the stabilization of the cervical spine. Degenerative changes at the lower cervical spine can affect different anatomical structures: the intervertebral disc, uncovertebral joints, and facet joints. The incidence and severity of changes increase with age. Furthermore, uncovertebral osteoarthritis is characterized by the presence of transverse fissures in the annulus fibrosus.
Discussion: These specific anatomical features of the cervical spine may have clinical implications, including more targeted spinal injections for managing disabling persistent or recurrent symptoms related to cervical spine degenerative changes such as cervical radicular pain. |
Permalink : |
./index.php?lvl=notice_display&id=45205 |
in Annals of physical and rehabilitation medicine > Vol. 59, n° 4 (September 2016) . - p. 276-281
[article] Anatomical specificities of the degenerated cervical spine: a narrative review of clinical implications, with special focus on targeted spinal injections [texte imprimé] / Christelle Nguyen, Auteur ; Katherine Sanchez, Auteur ; Alexandra Roren, Auteur . - 2016 . - p. 276-281. Langues : Anglais ( eng) Français ( fre) in Annals of physical and rehabilitation medicine > Vol. 59, n° 4 (September 2016) . - p. 276-281
Mots-clés : |
Cou Disque intervertébral Arthrose Cervical spine,Uncarthrosis,Degenerative disc disease,Spondylosis,Spinal injections |
Résumé : |
Background: Cervical radiculopathy is most often related to foraminal stenosis due to osteoarthritic changes of the uncovertebral joints anteriorly or zygapophyseal joints posteriorly, rather than disc herniation.
Objectives: To describe anatomical specificities of the degenerated cervical spine.
Methods: A critical narrative review was conducted. Articles were non-systematically selected and based on authors’ expertise, self-knowledge, and reflective practice.
Results: Vertebral bodies of the lower cervical spine are characterized by 2 lateral prismatic bony protuberances, the uncinate processes, located on C3 to C7 superior vertebral endplates, that are involved in the stabilization of the cervical spine. Degenerative changes at the lower cervical spine can affect different anatomical structures: the intervertebral disc, uncovertebral joints, and facet joints. The incidence and severity of changes increase with age. Furthermore, uncovertebral osteoarthritis is characterized by the presence of transverse fissures in the annulus fibrosus.
Discussion: These specific anatomical features of the cervical spine may have clinical implications, including more targeted spinal injections for managing disabling persistent or recurrent symptoms related to cervical spine degenerative changes such as cervical radicular pain. |
Permalink : |
./index.php?lvl=notice_display&id=45205 |
| ![Anatomical specificities of the degenerated cervical spine: a narrative review of clinical implications, with special focus on targeted spinal injections 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) 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