CERVICAL SPONDYLOSIS DR T.P MOJA STEVE BIKO ACADEMIC HOSPITAL

Slides:



Advertisements
Similar presentations
Upper Limb Orthopaedic Medicine.
Advertisements

Acute Cervical Injuries In Football
Last week we looked a Thoracic outlet case
Orthopaedic Neurology
Cervical Nerve Root Impingement By: Michael Cox
 Anatomy  History  Observation  Palpation  Neurological exam  Circulatory exam.
Chapter 11 Quiz Questions.
September 5th – 8th 2013 Nottingham Conference Centre, United Kingdom
Sports Medicine Chapter 20
Evaluation and Treatment of the Cervical Spine
= Arthritis of the neck  Degenerative condition  Affects the vertebral bodies, the intervertebral discs,the facet joints and eventually the contents.
Neck Pain Nachii Narasinghan. Introduction F>M Highest prevalence in middle age Types –Non-specific –Whiplash –Cervical spondylosis –Acute torticollis.
Evaluation of back pain and other disorders of the Spine.
September 5 th – 8 th 2013 Nottingham Conference Centre, United Kingdom
Headaches The Migraine headache is unilateral pain (affecting one half of the head) and pulsating in nature, lasting from 4 to 72 hours; symptoms include.
NeuroSurgery Case: Low Back Pain. Salient Features A 45 year old office secretary Sudden snap and pain in the left lumbar area while trying to lift a.
Vivian & slides from ESA mentoring 2013
Neck Pain, Myelopathy and Radiculopathy Clinical Assessment and Management Mr. David Bell London Neurosurgery Partnership.
Orthopedic Injuries- A Legal Perspective Mississippi – Alabama – Tennessee – North Carolina D IANE P RADAT P UMPHREY
By Kyle Hamblen & Austin Icaza. Overall The spine is one of the strongest parts of the body The spine is one of the strongest parts of the body Back pain.
Spondylosis (OA) - Lumbar
Chapter 9 The spine: Objectives
Causes and Treatments of Neck and Arm Pain Brian T. Ragel, MD Department of Neurosurgery.
Neck Pain.
Cervical Spine Injuries. Myotome and Dermatome Testing Nerve Root Level Sensory TestingMotor TestingReflex Testing C1-C2Front of faceNeck flexionN/A C3Lateral.
Degenerative Disease of the Spine
Lumbar Spondylosis.
Lumbar Disc Herniation
Cervical Spine Pathologies and Treatments Physician Name Physician Institution Date.
Mercy Institute of Neuroscience & Mercy Regional Neurosurgery Center
SPINAL STENOSIS Jung U. Yoo, M.D. Professor and Chairman Department of Orthopedics and Rehabiliatation Oregon Health and Science University.
Spine and Orthopaedic Institute St Vincent Medical Group
Common Cervical Spine Disorders -Diagnosis and Treatment
Back pain Back pain is a common problem that affects most people at some point in their life. It usually feels like an ache, tension or stiffness in the.
ATC 222 The Spine Chapter 25 Natasha Tibbetts, ATC.
MedPix Medical Image Database COW - Case of the Week Case Contributor: Michael D Casimir Affiliation: SUNY at Buffalo.
Spinal Disease, Red Flags and What To Lookout For.
SPINAL NERVE ROOT COMPRESSION AND PERIPHERAL NERVE DISORDERS Group A – AHD Dr. Gary Greenberg.
Spine Curvature Disorders
Spine Examination รศ.นพ. สุรชัย แซ่จึง ภาควิชาออร์โธปิดิกส์
Copyright © F.A. Davis Company Part IV: Exercise Interventions by Body Region Chapter 15 The Spine: Management Guidelines.
Cervical Stenosis and Myelopathy
Cervical Spondylosis (Degenerative Disc Disease).
Cervical Radiculopathy. Normal Anatomy Cervical spinal nerves exit via the intervertebral foramen Intervertebral foramen is the gap between the facet.
Neck Pain Frequently Asked Questions … Moe R. Lim, MD UNC Orthopaedics (919-96B-ONES) UNC Spine Center ( )
Whiplash Associated Disorder. Normal Anatomy Vast amount of soft tissue within the cervical spine Facet joints surrounded by a capsule Large amount of.
Chapter 9: The Biomechanics of the Human Spine
Herniated Disc Surgery. Anatomy A herniated disc most often occurs in the lumbar region (low back). This is because the lumbar spine carries most of the.
Degenerative disease of Lumbar spine
Cervical Exam Vitals Appearance. Mood, Orientation Visual Inspection
Radiculopathy and Plexopathy Radiculopathy and Plexopathy Dr Massud Wasel M.D D.O. N.D Registered osteopath P.G.C.A.P Fellow of Higher Education Academy.
LIAO Hui MD Tongji Hospital, HUST
Lumbar Stenosis.
Cervical spine Symptoms:
Lt Col Ibrahim Farooq Pasha
Facet Joint Dysfunction
Spinal Deformity and Degeneration
Cervico-brachial neuralgia Iraj Salehi-Abari MD
Cervico-brachial neuralgia Anatomy Iraj Salehi-Abari MD
Dermatomes & Myotomes.
Spine Surgery WHO NEEDS IT?
Approach to Degenerative Lumbar Spine
Cervical Radiculopathy: Clinical Signs and Treatment
Short Case Presentation
بسم الله Cervical spondylosis By: Abeer Huseein.
Unit Six – Neck & Spine Injuries
بسم الله الرحمن الرحيم وما توفيقي الا بالله عليه توكلت و إليه أنيب
Posterior microscopic tubular cervical foraminotomy (PMTCF)
Presentation transcript:

CERVICAL SPONDYLOSIS DR T.P MOJA STEVE BIKO ACADEMIC HOSPITAL

Pathophysiology Disc degeneration -nucleus pulposus loses water content, fissuring, loss of height and bulging annulus. -acute rupture and herniation may occur Secondary changes due to increased and uneven loading of forces - Vertebral osteophytes - Facet and uncovertebral joint osteoarthritis and hypertrophy - Ligamentum flavum becomes thickened and may ossify - Spine deformity due to segmental instability Degenerative spondylolistheses Degenerative kyphosis or scoliosis Narrowing of the central canal, lateral recesses and foramina with subsequent neural and vascular compression

CERVICAL SPINE XRAY

MRI CERVICAL SPINE

Clinical Presentation Asymptomtic with incidental radiographic findings Symptomatic - in most cases: onset is slow and insidious . However some cases may be acute eg hyperextension injury in minor trauma or acute disc herniation Neck pain Myelopathy Radiculopathy

Neck pain Occurs if there is a disc extrusion Nerve root compression Facet joint arthritis Segmental instability Often poorly localized May radiate to the occipital region, shoulders, interscapular. There may be associated stiffness of the neck from muscle spasm

Myelopathy May be complex and variable Most cases seem to present with a central cord syndrome, rarely brown squard, or complete myelopathy Motor -upper limbs: LMN Weakness Clumsiness of the hands. Muscle wasting. Absent biceps reflex, inverted reflex, Triceps reflex may be brisk. Positive Hoffman reflex -Lower limbs: Spasticity, difficulty walking. No or slight weakness. Sphincters: usually no symptoms. Rarely mild bladder symptoms. ? Prostate

Sensory - No involvement - Patchy sensory loss - Paraesthesia in the hands, sometimes the feet and legs - May be asymmetrical or symmetrical - Different from radiculopathy in that it is not in a specific dermatomes - Lhermittes’s sign

Radiculopathy May be acute if due to a disc protrusion Slow and insidious if due to an osteophyte Most common nerve root is C6 Neck pain and shoulder pain. Pain radiates down the biceps, then the lateral aspect of the forearm then the thumb and index finger. Head may be tilted to the affected side due to muscle spasm. Pain made worse by neck extension, relieved by neck flexion and shoulder abduction. Often numbness, more often hand and fingers

Chronic cases – wasting and fasciculations of biceps and brachioradialis muscle. Weakness of elbow flexion (Thumb-nose), and wrist extension. Absent biceps and brachioradialis reflex

C5 nerve root radiculopathy - Neck pain - Shoulder pain, pain over the lateral aspect of the upper arm. - Numbness or paraesthesia over the lateral aspect of the upper arm. - Weakness of deltoid and biceps muscles, with absent biceps reflex In severe cases, wasting of the deltoid and biceps muscles

Treatment Neck Pain Myelopathy Acute radiculopathy -Conservative -Rarely, surgery Myelopathy -Surgery in most cases -Some may stabilize on conservative Acute radiculopathy -Surgery if indicated Chronic radiculopathy -Most cases, surgery

Conservative treatment Medication: Analgesia NSAIDS Diazepam Baclofen Carbamazepine, Gabapentin, Lyrica Physiotherapy: Range of motion exercises Isometric exercises Heat and massage Traction: Continuous or intermittent halter traction Neck collar Soft neck collar < 1 week Facet and Medial branch block – Cortisone, L.A, Radiofrequency

SURGERY Anterior decompression Posterior decompression Anterior cervical discectomy and fusion Corpectomy and fusion Posterior decompression Laminaplasty Laminectomy