CERVICAL DISC DISEASE Cervical spondylosis Cervical osteophytosis Most common progressive disease in the aging cervical spine Seen in 95 of the people by 65 years Pathophysiology Dessication of the disc material and loss of disc height ID: 1042625
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1. CERVICAL SPONDYLOSIS &CERVICAL DISC DISEASE
2. Cervical spondylosisCervical osteophytosisMost common progressive disease in the aging cervical spineSeen in 95% of the people by 65 years
3. PathophysiologyDessication of the disc material and loss of disc heightGreater stress on the articular cartilage, vertebral end plates and facet jointsLoss of normal cervical lordosis and Formation of osteophytesNarrowing of neural foramina and spinal canalSecondary vascular and compressive phenomenon
4. Mechanical factorsStatic FactorsCongenital spinal canal stenosisDisc herniationVertebral body osteophytesHypertrophied ligamentum flavumOssified posterior longitudinal ligamentDynamic FactorsAbnormal stresses over spinal column and cord during normal and abnormal movements and loads
5. Clinical PresentationNeck painCervical RadiculopathyCervical Myelopathy
6. Signs and SymptomsRadiculopathyRadicular painWeakness limited to particular myotomeSensory lossAbsent or decreased DTR
7. Signs and SymptomsMyelopathyWeakness and stiffness of legs, gait abnormalityNumb or clumsy handRarely urinary incontinenceCentral cord syndrome
8. Differential DiagnosisAmyotropic lateral SclerosisMultiple SclerosisSubacute combined degeneration of cordTumoursSyringomyeliaTabes dorsalis
9. Radiographic StudiesX- RayCT and CT myelographyMRIElectrophysiologic Studies
10. Medical ManagementNSAID’sOpoid AnalgesicsMuscle RelaxantsAntidepressantsAnticonvulsantsCervical epidural steroid injection
11. Nonpharmacological Nonoperative therapyCervical collarCervical TractionPhysical TherapyActive isometric exercisesThermotherpyChiropractic manipulationUltrasoundTENS
12. Approach to a patient with neck painNSAID’sIsometric Neck ExercisesPhysical therapySurgery - Fusion
13. Approach to a patient with cervical radiculopathyInitially conservative managementSurgery- ventral or dorsal Ventral- ACDFDorsal- Laminoforminotomy
14. Approach to a patient with CSMNonsurgical Treatement- Patient is medically frail Mild Static diseaseSurgical Treatment Progressive Disease
15. Surgical optionsDorsal decompressionLaminectomyLaminoplastyVentral decompressionACDFCorpectomy and Fixation
16. Cervical spondylosis: Ventral or Dorsal surgeryLocation of the lesionSpecific disease pathologyNumber of vertebral levels Age at surgeryCurvature of the spine
17. Laminectomy: Operative technique
18. Complication of LaminectomyPost Laminectomy KyphosisInstabilityPost laminectomy membrane
19. Laminoplasty: operative technique
20. Ventral procedures for Cervical SpondylosisIndications Anterior compression by degenerated disc, OPLL, degenerated vertebral body ≤3 level disease
21. ProceduresACDF with or without fusionACDF with cervical platingCorpectomy with fusion
22. ACDFIndicationsDegeneration limited to discCervical spondylosis with radiculopathyTechniquesSmith-RobinsonClowardBloom and Raney
23. Bryan Cervical Disc ProsthesisPolyurethane wrapped low friction, water resistant elastic nucleus located between and articulating with two titanium alloy surfaces.
24. Cervical corpectomyAims:Ventral decompressionInterbody fusionPlate osteosynthesis
25. ACDF with Vs without PlatingSeveral RCT’s demonstrated no improved clinical outcome in patient with ACDF with or without plating in patient with single level diseaseIn multilevel procedures and unstable spine, there is increased stability and decreased graft migration following instrumentation
26. Autograft vs AllograftClinical efficacyGraft harvest morbidityCost and availability
27. Thank you