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Options for the treatment of
Cervical Radiculopathy
and recent changes in management
Dr Jonathon BallFRACS BMed BMedSc(Hons)
GradDipBiomedE
www.neurospine.com.au
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Source : http://www.myspinetools.com/education/anatomy_pathology/cervical.html, accessed September 7, 2011 ( Rauschning)
Surgery vs ConservativeAnterior vs Posterior
Anterior fusion vs disc replacement
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Options 3 principles
Adequate nerve decompression With minimal trauma With motion preservation
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Outline Recent literature
NASS evidence based guidelines (2010) Neurosurgery Cervical Spondylosis Supplement (2007)
Novel techniquesAnterior cervical foraminotomy Posterior facet distraction Minimally invasive posterior foraminotomy
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NASS CLINICAL GUIDELINES (2010) Evidence Based Guidelines
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Source : http://www.spine.org/Documents/Cervical_Radiculopathy.pdf, accessed September 8, 2011
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Natural History
Source : http://www.spine.org/Documents/Cervical_Radiculopathy.pdf, accessed September 8, 2011
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Diagnosis
Source : http://www.spine.org/Documents/Cervical_Radiculopathy.pdf, accessed September 8, 2011
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Diagnosis
Source : http://www.spine.org/Documents/Cervical_Radiculopathy.pdf, accessed September 8, 2011
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Treatment
Source : http://www.spine.org/Documents/Cervical_Radiculopathy.pdf, accessed September 8, 2011
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Treatment
Source : http://www.spine.org/Documents/Cervical_Radiculopathy.pdf, accessed September 8, 2011
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Treatment
Source : http://www.spine.org/Documents/Cervical_Radiculopathy.pdf, accessed September 8, 2011
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Treatment - Surgery
Source : http://www.spine.org/Documents/Cervical_Radiculopathy.pdf, accessed September 8, 2011
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Treatment - Surgery
Source : http://www.spine.org/Documents/Cervical_Radiculopathy.pdf, accessed September 8, 2011
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NOVEL TECHNIQUES
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MIS FORAMINOTOMYNovel Techniques
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Source : Jonathon Ball
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18 mm Metrx tube
disc
root
cord
Source : Jonathon Ball
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Source : Jonathon Ball
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ANTERIOR CERVICAL FORAMINOTOMYNovel Techniques
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Source : Jho, H-D. J Neurosurg. 84:166-160 (1996)
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Source : Jho, H-D. et al. Neurosurgery. 51(S2):46-53 (2002).
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Source : Jho, H-D. J Neurosurg. 84:166-160 (1996)
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POSTERIOR FACET DISTRACTIONNovel Techniques
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Source : Goel, A. & Shah A.J Neurosurg Spine. 14:689-696 (1996)
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Summary Perennial arguments re: cervical radiculopathy
Based on three principles Neural decompression Minimal trauma Motion preservation
Led to novel techniques and approaches Increased focus on evidence led to guideline
development
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Thankyou
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Case 1 77 M several years of left
shoulder weakness new neck and
shoulder pain
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Case 1
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Case 1 Options
Multilevel ACDF Multilevel posterior
foraminotomy laminectomy/rhizolysis +/- fusion
Conservative management Injections Physiotherapy Pain clinic
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Case 1 Multilevel ACDF Increased weakness
Elbow flexion Wrist extension Finger extension
Repeat EMG and CT
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Case 1
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Case 2 53 F several months of left
upper extremity pain
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Case 2
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