Assessment of the cervical spine in degenerative pathologies
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Transcript of Assessment of the cervical spine in degenerative pathologies
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ASSESSMENT OF THE CERVICAL SPINE
IN DEGENERATIVE PATHOLOGIES
Paul Licina
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EXAMINATION
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LOOK
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deformity wasting swelling
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FEEL
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masses tenderness
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MOVE
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pain stiffness
asymmetry
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NEURO
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power sensation reflexes
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NEURO
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power reflexes
sensation
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SPECIAL
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Spurling’s
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L’hermitte’s
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Hoffman’s
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Adson’s
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DIRECTED
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lower limb neuro
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peripheral neuro
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shoulder
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IMAGING
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plain x-ray CT
MRI nuclear
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RADICULOPATHY
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radiculopathy vs peripheral
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timing of surgery
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fusion vs TDR
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MYELOPATHY
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significance of myelomalacia
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timing of surgery
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Timing of surgery Cervical
myelopathy
surgical
aspects
•surgery indicated if •established myelopathy with symptoms and signs
•aim is to halt progression •hope is to reverse deficit •earlier intervention gives better results •even severe deficit may improve
•early myelopathy with documented progression •? subtle symptoms with no signs and only early MRI changes
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anterior or posterior
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What is the treatment? Cervical
myelopathy
surgical
aspects
anterior discectomy and fusion
anterior corpectomy and fusion
posterior laminectomy
posterior laminectomy and fusion
posterior laminoplasty
DECOMPRESSION
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Anterior surgery Cervical
myelopathy
surgical
aspects
Advantages
• approach pathology directly
• can decompress central and
foraminal stenosis
• can effectively stabilise the
segment in lordosis
• approach is easy and well
tolerated
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Anterior surgery Cervical
myelopathy
surgical
aspects
Disadvantages
• osteophytes difficult to deal with
• multiple levels more difficult
• risks of
• dysphagia / oesophageal injury
• recurrent laryngeal nerve injury
• neurological injury
• vascular injury
• adjacent degeneration may occur
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Posterior surgery Cervical
myelopathy
surgical
aspects
Advantages
• multiple levels easily addressed
• usually reserved for 3 or
more levels
• no risk to vital anterior
structures
• less risk of neurological injury
• can avoid fusion
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Posterior surgery Cervical
myelopathy
surgical
aspects
Disadvantages
• less effective in kyphosis as
relies on posterior cord ‘drift’
• can result in kyphosis (10-50%)
• increased pain from approach
• dura exposed with possible
peridural scar
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Choice of approach Cervical
myelopathy
surgical
aspects
ANTERIOR POSTERIOR one or two levels more than three levels kyphosis lordosis disc prolapse osteophytes