1. Causes and Treatments of Neck and Arm Pain Brian T. Ragel, MD Department of Neurosurgery

2. Introduction Anatomy Definitions Cervical spondylosis Herniated disc Dx / Tx Axial neck pain Radiculopathy Myelopathy

8. Cervical Spondylosis degenerative aging process from wear and tear “bone spurs” loss of disc height Osteophytes Mineral deposition in ligaments and discs

10. Degenerative changes that contribute to spinal cord/nerve root compression

12. Axial Neck Pain Sx –Neck pain (poorly understood) –Nerve endings in discs and facets –musculoskeletal Dx –? Tx –NSAID and physical therapy

14. Natural History of Axial Neck Pain Notes: 66% of all adults will have neck pain Rothman, no difference b/w op and non-op Gore, no correlation b/w neck pain and x-ray AuthorReliefPartialNo Relief Depalma21%49%22% Rothman23% Leees45%55%- Gore43%25%32%

15. Cervical Radiculopathy Sx –Sx’s in dermatomal distribution from compressed nerve root Example: C6 radiculopathy will produce pain/numbness in lateral biceps -> lateral forearm -> thumb Dx – sx / exam / MRI Tx –ACDF / disc arthroplasty –Posterior foraminotomy

20. Cervical Myelopathy Sx –Sx’s N/T, clumsy hands, spastic gait, leg weakness due to spinal cord compression Dx – sx / exam / MRI Tx –ACDF (usually > 1 level) –Posterior decompression

21. Natural History of Cervical Myelopathy Lees and Turners –usually stable nonprogressive disability –progressive deterioration exception Symon et al, 67% steady decline Nonrandomized MCT in 2000 –20 surgery with improved function –23 non-op with decline in ADL

25. Summary Cervical spondylosis (degeneration) Dx / Tx Axial neck pain Radiculopathy Myelopathy