1. Spinal Deformity and Degeneration
Shay Bess, MD
Assistant Professor of Orthopaedic Surgery
University of Utah School of Medicine

2. Spine Surgery Overview
Trauma
Tumor
Infection
Degenerative
Radiculopathy
Myelopathy
Deformity
Scoliosis
Kyphosis

3. Goals Peripheral Nerve Anatomy Identify and Differentiate
Cervical
Lumbar
Identify and Differentiate
Radiculopathy
Myelopathy
Differentiate and Measure
Coronal imbalance
Sagittal imbalance

4. Degenerative Conditions
Radiculopathy & Myelopathy

5. General Anatomy

6. Regional Anatomy

7. Radiculopathy Nerve Root Compression Cervical Thoracic Lumbar
Spinal Nerve Anatomy

8. Radiculopathy Etiology Mechanical Compression Disc Herniation (HNP)
Foraminal Stenosis

9. Radiculopathy Spinal Nerve Exiting Anatomy Correlate Pathoanatomy
L4-5 Disc Herniation
Symptoms?
C4-5 Disc Herniation

10. Radiculopathy Symptoms Anatomic distribution Lower motor neuron
Weakness
Sensory deficit
Diminished reflexes

11. Cervical Radiculopathy

12. Cervical Radiculopathy

13. Lumbar Radiculopathy

14. Radiculopathy Spinal Nerve Exiting Anatomy Correlate Pathoanatomy
L4-5 Disc Herniation
Symptoms?
C4-5 Disc Herniation

15. Cervical Radiculopathy
Treatment
Nonoperative
Physical Therapy
NASIDs
Selective Root Injection
ACDF
Anterior Cervical Discectomy & Fusion
Posterior Foramenotomy and Discectomy
Courtesy of Dan Riew, MD

16. Lumbar Radiculopathy Treatment Nonoperative Physical Therapy NASIDS
Selective Root Injection
Discectomy

17. Myelopathy Spinal Cord Compression Location Cervical? Thoracic?
Lumbar?
Why?

18. Myelopathy Symptoms Upper Motor Neuron Unsteady gait
Poor manual dexterity
Loss proprioception
Normal strength
Normal sensation

19. Myelopathy Symptoms Upper Motor Neuron Hyperreflexia
Pathologic reflexes
Babinski
Hoffman
Inverted brachioradialis
Grading Reflexes
0 = Absent
1+= Diminished
2+ = Normal
3+ = Increased
4+ = Increased with associated clonus

20. Myelopathy Etiology Cord Compression Disc Degenerative Instability
Soft disc herniation (HNP)
Hard Disc
Degenerative Instability
Disc incompetence
Facet incompetence
OPLL
Tumor
Infection
Courtesy of Henry Bohlman, MD

21. Anterior Cervical Corpectomy
Myelopathy
Treatment
Surgery
Decompress Offending Agent
Anterior Procedures
Posterior Procedures
Anterior Cervical Corpectomy
Courtesy of Dan Riew, MD

22. Myelopathy
Posterior Cervical Laminaplasty
Courtesy of Dan Riew, MD

23. Spinal Defomity
Scoliosis & Kyphosis 4

24. Spinal Deformity Definition of Terms Coronal plane Scoliosis
Sagittal plane
Lordosis
Kyphosis
Normal Spinal Alignment

25. Scoliosis Coronal Deformity Evaluation Cobb Angle Measurement
Top of the top
Bottom of the bottom
Perpendiculars

26. Kyphosis Sagittal Deformity Cobb Angle Measurement Thoracic Kyphosis
40 degrees
Lumbar Lordosis
T12-S1
60 degrees
20-40 degrees > thoracic kyphosis
Regional Deformity

27. Spinal Deformity Treatment Risk of progression Etiology Curve size
Remaining growth
menarche
age
Appearance
Symptoms
Nonoperative
Observation
Bracing

28. Spinal Deformity Operative Treatment High Risk Progression Cosmesis
Etiology
Large deformity
Remaining growth
Cosmesis
Disability

29. Spinal Deformity Treatment

30. Spinal Deformity Treatment

31. Spinal Deformity Treatment

32. Summary Diagnose, Differentiate, Pathoanatomy Radiculopathy Myelopathy
Identify and Measure Spinal Deformity
Coronal imbalance= scoliosis
Sagittal imbalance= kyphosis
Effective Treatment algorithms

33. Thank You