cervical herniated disc: symptoms and diagnosis
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CERVICAL HERNIATED DISC:
SYMPTOMS AND DIAGNOSIS ___________________________________
GIOSUE’ GARGIULO
S.S.C.V.D. CHIRURGIA VERTEBRALE
U.O. ORTOPEDIA
CERVICAL HERNIATED
DISC _____________________________
MAN 6.5/ 100.000
FEMALE 4.6/ 100.000
_____________________________
AGE 40-54 Y.
_____________________________
LEVEL :
- C5-C6 30%
- C6-C7 55%
- OTHERS 15%
CERVICAL HERNIATED DISC
__________________________
- CENTRAL
- POSTERO-LATERAL
- LATERAL
___________________________
- DEGENERATIVE CHANGES
- TRAUMA
CLINICAL
PRESENTATION ____________________
- ACUTE
- CERVICAL PAIN
- RADICULAR PAIN
- MIELOPATHY
PHYSICAL EXAMINATION
______________________
- Lhermitte sign
- Spurling sign
- Axial compression
CERVICAL NERVE ROOT
INVOLVEMENT
_________________________ -PERIPHERICAL RADUCULAR
OVERLAP
-MOTOR PREVALENCE : - C5-C6 DELTOID + BICEPS
- C7 TRICEPS
- C8 FINGHER EXTENSOR
- C8-T1 HAND INTRINSIC MUSCLES
SYMPTOMS
_______________________________ - ARM PAIN 99 %
- NECK PAIN 80%
- SCAPULAR PAIN 52%
- ANT. CHEST PAIN 18%
- HEADACHE 9%
- CERVICAL ANGINA 3%
_____________________________________
- PAIN DERMATOMAL PATT. 55%
- PAIN NON DERMATOMAL PATT. 45%
_____________________________________
- ONE LEVEL RESP. 87%
- TWO LEVELS RESP. 13%
_____________________________________
- PAIN CORRISPONDENCE C5 - C8
- MOTOR CORRISPONDENCE C5 - C8
_____________________________________
- SURGICAL SITE PREDICTED 71%
IMAGING
ANGLED SAGITTAL MRI
SHIM J.H. et al.
Eur. Spine J. , 2009 aug, , 18(8) : 1109-16
E.M.G. _____________________________________
- RADICULAR PERIPHERAL OVERLAP
- D.D. POLINEUROPATHY
- D.D. FOCAL PERIPHERAL NEUROPATHY
- NEGATIVE EMG DOES NOT ESCLUDE
RADICOLOPATHY
P.E.M. _______________________
- CORD COMPRESSION
DIFFERENTIAL DIAGNOSIS : - NECK PAIN
- ARM PAIN _______________________________________
- CERVICAL SPINE DISEASE
- NEUROLOGICAL PATHOLOGY
( CORD – ROOTS )
D.D. CERVICAL PATHOLOGY ___________________________________
- DEGENERATIVE
- TRAUMA
- NEOPLASM
- INFECTION
- REUMATHOID
- POSTURAL
- PSYCHOLOGIC
- VISCERAL PATHOLOGY OF THE NECK
SPONDYLOGENIC CONDITIONS
___________________________
- DISC DEGENERATION
- FACETS DEGENERATION
CERVICAL TUMORS
_________________________
- PRIMARY
- SECONDARY
METASTASIS
D.D. BONE
________________ SHOULDER V.S.
C5 RADICULOPATHY
D.D. INTRINSIC NERVE CONDITIONS
_________________________________
- NEOPLASM
- INFLAMMATORY ( HERPES ZOSTER)
- DEMYELINATING CONDITIONS
- SYRINGOMYELIA
CERVICO-THORACIC-BRACHIAL TUNNEL
D.D. EXTRINSIC NERVE CONDITIONS
CERVICAL COST
Angio
Base Iperabduction superior arm
SUPERIOR THORACIC SYNDROME
PANCOAST TUMOR
PERISCAPULAR TUMOR
SUPERIOR ARM
NERVE ENTRAPMENT SYNDROME
______________________________
- DOUBLE CRUSH SYNDROME
- PHYSICAL EXAMINATION
- ELECTRODIAGNOSTIC TESTS
CONCLUSION
________________________ -NATURAL HISTORY
-CLINICAL FINDINGS
-IMAGING
-DIFFERENTIAL DIAGNOSIS
NEUROLOGICAL DAMAGE
_______________________
-VASCULAR SUPPLY
- AXOPLASMATIC FLOW
CERVICAL PAIN
_______________
-SINUVERTEBRAL
NERVE
PATHOGENESIS
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