Abdulwahed Barnawi MD P SMMC Riyadh SA History Vesalius describes the disc 450 years ago Then Stookey in 1928 describe it again It consider as inflammatory process or infection in origin by many author in early 19 century ID: 913898
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Slide1
Cervical spondylosis
By Abdulwahed Barnawi MD PSMMC Riyadh SA
Slide2History
Vesalius describes the disc 450 years ago Then Stookey in 1928 , describe it again It consider as inflammatory process or infection in origin by many author in early 19 century Until 1952 Brain identified this as degenerative process of aging and the term cervical spondylosis came out Victor Horsley provided the first description of an operation a C 6 laminectomy for a patient with quadripasis
Slide3Introduction
Cervical spondylosis is degenerative changes affecting the aging spine and may cause pain or neural impairment You find it in 10 % of people by age 25And 95 % by age 65
Slide4How it forms ?
It all start at the intervertebral disc space By loosing the disc height and it is integrity and elasticity As the disc is weaken , the surrounding structure are required to bear a greater burden of weight bearing load and dynamic stresses This lead the surrounding structure to undergo reactive changes (end plate ,uncovertebral joint and facet joint start to form osteophyte )And due to dynamic stress the ligamentum flavum and the PLL undergo hypertrophy
Slide5Slide6The spondylosis effects happen either
In static conditionDynamic condition Vascular insult Commonest level affected C5-C6 & C6-C7 level
Slide7Symptoms and Signs
Neck pain The source is the muscle , ligament and the facet joint 2. Cervical Radiculopathy Due to exiting nerve root compression Often caused by the uncovertebral and facet joint osteophyte It cause pain and numbness in the affected dermatome or weakness in the corresponding myotome
Slide8Slide9Positive
spurling signThe abduction relief signLower motor neuron signs ( hyporeflexia )Differential diagnosis for Radiculopathy
Shoulder pathology Carpel tunnel syndrome Pan coast tumour
Ulnar
neuropathy at elbow
Brachial
plexitis
Slide103.Cervical
Spondolitic MyelopathyHappen due to cord compression Present with spastic gait , clumsiness of the hand And sphincter disturbance Signs :Lhermits sign Finger escape sign
Hoffman sign Babinski sign Upper motor neuron signs ( hyper reflexia , clonus , hypertonia )
Slide11Slide12Differential diagnosis for
myelopathy Multiple sclerosis Syringomelia transverse myelitis Spinal cord tumour Amyotrophic lateral sclerosis
Spinal AVM Subacute combined degeneration
Chiari malformation
Epidural abscess
Hydrocephalus
Slide13Myelopathy scales
Slide14Slide15Slide16Treatment
Non surgical Neck pain Radiculopathy without deficit Radiculopathy controlled with medicine Myelopathy ?Surgical
Radiculopathy with deficit or failed medical management Myelopathy
Slide17Approaches :
- Anterior ( ACDF VS Corpectomy )
Slide18Slide1942 years old lady work as teacher with cervical pain and left radiculopathy at C 6 dermatome
Slide20Slide2153 year male driver with
hx of LB and inability to walkon exam : +ve upper motor neuron signs
Slide22Slide23Slide24-
Posterior ( Laminectomy with or without fixation , laminoplasty , foraminotomy )
Slide25C. Seng et al
( the Spine journal 13 (2013) 723-731)
Anterior group
Post group
P value
Length of operation (min)
186±38
123±28
˂ 0.01
Length of stay (
d)
3.7±1.5
5.4±1.4
< 0.01
Slide26M.
Hussain et al. / The Spine Journal 12 (2012) 401–408 Stability of the multilevel discectomy construct was higher than that of the corpectomy constructBiomechanical studies comparing different multilevel fusion reconstructivetechniques show that the multilevel
discectomies and combined corpectomy-discectomy are significantly more rigid than multilevel corpectomies
Slide27Scott L. Parker et al (
The Spine Journal Volume 14, Issue 11, P S45, November 1, 2014 )anterior approach for cervical surgery was associated with significantly lower length of stay, surgical morbidity and return to their activities within 30 days as compared to posterior approach. For patients who can be effectively treated by either anterior or posterior approach, giving preference to anterior approach may offer the opportunity for quality improvement and greater patient safety.
Slide28Thank you