CERVICAL SPONDYLOSIS & CERVICAL DISC...
Transcript of CERVICAL SPONDYLOSIS & CERVICAL DISC...
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CERVICAL SPONDYLOSIS &CERVICAL SPONDYLOSIS &CERVICAL DISC DISEASECERVICAL DISC DISEASE
Presented By : Dr Anil Presented By : Dr Anil GargGarg
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Cervical Cervical spondylosisspondylosis
•• Cervical Cervical osteophytosisosteophytosis•• Most common progressive disease in the aging Most common progressive disease in the aging
cervical spinecervical spine•• Seen in 95% of the people by 65 yearsSeen in 95% of the people by 65 years
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PathophysiologyPathophysiology
•• DessicationDessication of the disc material and loss of of the disc material and loss of disc heightdisc height
•• Greater stress on the Greater stress on the articulararticular cartilage, cartilage, vertebral end plates and facet jointsvertebral end plates and facet joints
•• Loss of normal cervical Loss of normal cervical lordosislordosis and and Formation of Formation of osteophytesosteophytes
•• Narrowing of neural foramina and spinal canalNarrowing of neural foramina and spinal canal•• Secondary vascular and compressive Secondary vascular and compressive
phenomenonphenomenon
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Mechanical factorsMechanical factors
StaticStatic FactorsFactors•• Congenital spinal canal Congenital spinal canal stenosisstenosis•• Disc Disc herniationherniation•• Vertebral body Vertebral body osteophytesosteophytes•• Hypertrophied Hypertrophied ligamentumligamentum flavumflavum•• Ossified posterior longitudinal ligamentOssified posterior longitudinal ligament
Dynamic FactorsDynamic Factors•• Abnormal stresses over spinal column and cord Abnormal stresses over spinal column and cord
during normal and abnormal movements and during normal and abnormal movements and loadsloads
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Clinical PresentationClinical Presentation
•• Neck painNeck pain•• Cervical Cervical RadiculopathyRadiculopathy•• Cervical Cervical MyelopathyMyelopathy
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Signs and SymptomsSigns and Symptoms
RadiculopathyRadiculopathy•• RadicularRadicular painpain•• Weakness limited to particular Weakness limited to particular myotomemyotome•• Sensory lossSensory loss•• Absent or decreased DTRAbsent or decreased DTR
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Signs and SymptomsSigns and Symptoms
MyelopathyMyelopathy•• Weakness and stiffness of legs, gait Weakness and stiffness of legs, gait
abnormalityabnormality•• Numb or clumsy handNumb or clumsy hand•• Rarely urinary incontinenceRarely urinary incontinence•• Central cord syndromeCentral cord syndrome
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Differential DiagnosisDifferential Diagnosis
•• AmyotropicAmyotropic lateral Sclerosislateral Sclerosis•• Multiple SclerosisMultiple Sclerosis•• SubacuteSubacute combined degeneration of cordcombined degeneration of cord•• TumoursTumours•• SyringomyeliaSyringomyelia•• TabesTabes dorsalisdorsalis
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Radiographic StudiesRadiographic Studies
•• XX-- RayRay•• CT and CT CT and CT myelographymyelography•• MRIMRI•• ElectrophysiologicElectrophysiologic StudiesStudies
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Medical ManagementMedical Management
•• NSAIDNSAID’’ss•• OpoidOpoid AnalgesicsAnalgesics•• Muscle RelaxantsMuscle Relaxants•• AntidepressantsAntidepressants•• AnticonvulsantsAnticonvulsants•• Cervical epidural steroid injectionCervical epidural steroid injection
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NonpharmacologicalNonpharmacologicalNonoperativeNonoperative therapytherapy
•• Cervical collarCervical collar•• Cervical TractionCervical Traction•• Physical TherapyPhysical Therapy
–– Active isometric exercisesActive isometric exercises–– ThermotherpyThermotherpy–– Chiropractic manipulationChiropractic manipulation–– UltrasoundUltrasound–– TENSTENS
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Approach to a patient with neck Approach to a patient with neck painpain
•• NSAIDNSAID’’ss•• Isometric Neck ExercisesIsometric Neck Exercises•• Physical therapyPhysical therapy
•• Surgery Surgery -- FusionFusion
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Approach to a patient with cervical Approach to a patient with cervical radiculopathyradiculopathy
•• Initially conservative managementInitially conservative management•• SurgerySurgery-- ventral or dorsal ventral or dorsal •• VentralVentral-- ACDFACDF•• DorsalDorsal-- LaminoforminotomyLaminoforminotomy
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Approach to a patient with CSMApproach to a patient with CSM
•• NonsurgicalNonsurgical TreatementTreatement--patient is medically frailpatient is medically frailMild Static diseaseMild Static disease
•• Surgical TreatmentSurgical TreatmentProgressive DiseaseProgressive Disease
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Surgical optionsSurgical options
•• Dorsal decompressionDorsal decompression•• LaminectomyLaminectomy•• laminoplastylaminoplasty
•• Ventral decompressionVentral decompression•• ACDFACDF•• CorpectomyCorpectomy and Fixationand Fixation
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Cervical Cervical spondylosisspondylosis: Ventral or : Ventral or Dorsal surgeryDorsal surgery
•• Location of the lesionLocation of the lesion•• Specific disease pathologySpecific disease pathology•• Number of vertebral levels Number of vertebral levels •• Age at surgeryAge at surgery•• Curvature of the spineCurvature of the spine
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Complication of Complication of LaminectomyLaminectomy
•• PostLaminectomyPostLaminectomy KyphosisKyphosis•• InstabilityInstability•• PostlaminectomyPostlaminectomy membranemembrane
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Ventral procedures for Cervical Ventral procedures for Cervical SpondylosisSpondylosis
•• Indications Indications Anterior compression by degenerated disc, Anterior compression by degenerated disc, OPLL, degenerated vertebral bodyOPLL, degenerated vertebral body≤≤3 level disease3 level disease
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ProceduresProcedures
•• ACDF with or without fusionACDF with or without fusion•• ACDF with cervical platingACDF with cervical plating•• CorpectomyCorpectomy with fusionwith fusion
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ACDFACDF
IndicationsIndications•• Degeneration limited to discDegeneration limited to disc•• Cervical Cervical spondylosisspondylosis with with radiculopathyradiculopathy
TechniquesTechniques•• SmithSmith--RobinsonRobinson•• ClowardCloward•• Bloom and RaneyBloom and Raney
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Bryan Cervical Disc ProsthesisBryan Cervical Disc Prosthesis
•• Polyurethane wrapped low friction, water Polyurethane wrapped low friction, water resistant elastic nucleus located between and resistant elastic nucleus located between and articulating with two titanium alloy surfaces.articulating with two titanium alloy surfaces.
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Cervical Cervical corpectomycorpectomy
Aims:Aims:–– Ventral decompressionVentral decompression–– InterbodyInterbody fusionfusion–– Plate Plate osteosynthesisosteosynthesis
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ACDF with Vs without PlatingACDF with Vs without Plating
•• Several Several RCTRCT’’ss demonstrated no improved demonstrated no improved clinical outcome in patient with ACDF with or clinical outcome in patient with ACDF with or without plating in patient with single level without plating in patient with single level diseasedisease
•• In multilevel procedures and unstable spine, In multilevel procedures and unstable spine, there is increased stability and decreased graft there is increased stability and decreased graft migration following instrumentationmigration following instrumentation
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AutograftAutograft vsvs AllograftAllograft
•• Clinical efficacyClinical efficacy•• Graft harvest morbidityGraft harvest morbidity•• Cost and availabilityCost and availability
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Thank youThank you