MSK-14 · Spine: Anatomy, Disc Herniation, and Radiculopathy

Spine: Anatomy, Disc Herniation, and Radiculopathy. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: That single articulation between the skull and C1 provides about 50% of all cervical flexion and extension. It is our primary nod joint. — Correct: The atlanto-occipital joint is the primary nod joint, but it does not supply half of the cervical flexion-extension arc. Measured in-vivo contributions cluster around 15 to 20 percent of the whole-neck arc, and the joint is strongly extension-biased, contributing several times more extension than flexion. The paired claim in the same passage, that the atlantoaxial joint supplies about 50% of cervical rotation, is correct and stands. (2) In the audio: Why is threading the needle directly into the foramen, the transforaminal approach, favored over the interlaminar approach when you have a single, specifically identified, hot nerve root? — Correct: That preference holds for the lumbar spine. For a cervical radiculopathy the interlaminar approach (typically C7-T1) is the usual first choice, because cervical transforaminal injection has caused brainstem and spinal cord infarcts when particulate steroid entered the vertebral or radicular arteries. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-14.