![Page 1: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/1.jpg)
Common Spine Disorders -Diagnosis and Treatment
Wayne Cheng, MDAssistant Professor, Dept. of Orthopaedic Surgery
Loma Linda University Medical Center
![Page 2: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/2.jpg)
Outline
Urgent Vs. Elective. ( 緊急狀態對非緊急狀態 )
Diagnosis of four common spine disorders– Spinal Stenosis 脊髓狹窄– Disk degeneration 脊椎圓盤退化– Herniated Disc 圓盤推出擠壓– Arthritis (spondylosis) 關節炎
Treatment of common spine disorders– Nonsurgical Vs. Surgical 沒有手術對手術
![Page 3: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/3.jpg)
緊急狀態對非緊急狀態緊急狀態
– 傳染– 瘤– 骨頭破裂– 不能控制排尿
非緊急狀態– 一切其他 .
![Page 4: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/4.jpg)
1. 脊髓狹窄
Anatomy
• Central Stenosis– Neurogenic claudication
• Lateral Stenosis– Radiculopathy
![Page 5: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/5.jpg)
脊髓狹窄 + 滑動 Derivation from Greek
– Spondylos: “vertebra”– Olisthein: “to slip”
Myerding Grading System– Grade 1 25%– Grade 2 50%– Grade 3 75%– Grade 4 100%
![Page 6: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/6.jpg)
Stenosis with 脊柱側凸
Lateral instability
![Page 7: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/7.jpg)
Clinical Presentation – Neurogenic Claudication
![Page 8: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/8.jpg)
MRI - 脊髓狹窄
![Page 9: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/9.jpg)
Decompressive Laminectomy
![Page 10: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/10.jpg)
Surgical Decompression
Unilateral/bilateral laminotomy with foraminotomy – Focal lateral stenosis
Up to 50% of facet joint usually may be removed w/ low risk of post-op instability
![Page 11: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/11.jpg)
Surgical Treatment-Fusion 融 合 Instability
– Spondylolisthesis
– Scoliosis
– Severe disc degeneration
![Page 12: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/12.jpg)
Surgical Treatment-Fusion( 融 合 )
![Page 13: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/13.jpg)
![Page 14: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/14.jpg)
新技術 - 小創傷
![Page 15: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/15.jpg)
新技術 - 小創傷
![Page 16: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/16.jpg)
新技術 - 小創傷
![Page 17: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/17.jpg)
Decompression
![Page 18: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/18.jpg)
新技術 - 小創傷
![Page 19: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/19.jpg)
新技術 - 小創傷
![Page 20: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/20.jpg)
脖子手術
![Page 21: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/21.jpg)
脖子手術
![Page 22: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/22.jpg)
MRI - 狹窄
![Page 23: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/23.jpg)
脖子手術為狹窄
![Page 24: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/24.jpg)
Discogenic pain 脊椎圓盤退化
![Page 25: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/25.jpg)
脊椎圓盤退化
![Page 26: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/26.jpg)
脊椎圓盤退化 - MRI
Black disc
![Page 27: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/27.jpg)
脊椎圓盤退化 -DISCOGRAM
Discogram
![Page 28: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/28.jpg)
脊椎圓盤退化 Disk degeneration Require 50%
preservation of disc height
60-70% improvement May take up to eight
months to be “effective”
![Page 29: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/29.jpg)
總圓盤替換
![Page 30: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/30.jpg)
Total disc replacement 總圓盤替換
![Page 31: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/31.jpg)
融 合
![Page 32: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/32.jpg)
3. Herniated Disc 圓盤推出擠壓
![Page 33: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/33.jpg)
Herniated disc 圓盤推出擠壓
![Page 34: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/34.jpg)
Normal MRI
![Page 35: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/35.jpg)
MRI-HNP 圓盤推出擠壓
![Page 36: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/36.jpg)
新技術 - 小創傷
![Page 37: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/37.jpg)
Treat patient not x-ray ! 67Asymptomatic
volunteers:– MRI + Herniated disc
• <60 yo = 20%
• >60 yo = 36%
• >80 yo = 90%
(Boden JBJS 1990)
98 Asymptomatic vol.– 36% had normal disc at all
levels
(Jensen NEJM 1994)
![Page 38: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/38.jpg)
4. Arthritis of the Spine 關節炎
![Page 39: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/39.jpg)
Inferior articular process 關節炎-Located posterior and
medially
-Forms lateral wall of spinal canal
-Osteophytes cause central canal narrowing
![Page 40: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/40.jpg)
Superior articular process 關節炎-Located laterally and
anteriorly
-Osteophytes cause narrowing of :
-lateral recess
-neural foramen
![Page 41: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/41.jpg)
Clinical Presentation of Facets Arthropathy 關節炎
•Morning Stiffness.
•Lower back Pain without radiculopathy
•Pain improves with activities during the day, returns in the evening.
•More pain with extension than flexion
•Aggravated by weather or humidity change
![Page 42: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/42.jpg)
關節炎 – CT SCAN
![Page 43: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/43.jpg)
關節炎
![Page 44: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/44.jpg)
Non-Surgical Treatment沒有手術治療
(80-90% of patient) Bed rest (1-2 days) Traction(at least 25% of body weight) Acupuncture/trigger point injection TENS Corset/Braces Manipulation Medication
– NSAID
– Muscle relaxant
![Page 45: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/45.jpg)
Physical Therapy 物理療法 Aerobic (LA firefighter-higher fitness, lower risk of
subsequent back pain)
Stretching (YMCA-80% improvement/6wks)
Williams isometric flexion program (stenosis, arthritis)
McKenzie extension program (Discogenic)
![Page 46: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/46.jpg)
Epidural Steroid Injections(ESI) 脊椎射入 May be helpful in acute flare-ups with
significant radicular complaints and/or mild/moderate stenosis
Useful in older pt population with many co morbidities (poor surgical candidates) after failing medical Rx and PT
Complications - meningitis, nerve injury, epidural hematoma, arachnoiditis
![Page 47: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/47.jpg)
Epidural Steroid Injections(ESI) 脊椎射入 Prospective, randomized, double-blind
study in pts with radicular Sx (~ 50% had Dx of lumbar stenosis)
No significant difference in symptomatic improvement between steroid and placebo injections at 24-hr and 1-year f/u– Cuckler JM et al, JBJS Am 1985; 67:63-66
![Page 48: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/48.jpg)
Stimulator & pain pump
![Page 49: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/49.jpg)
Surgical Treatment
Is a Quality of Life Issue!
![Page 50: Common Spine Disorders - Diagnosis and Treatment Wayne Cheng, MD Assistant Professor, Dept. of Orthopaedic Surgery Loma Linda University Medical Center](https://reader035.vdocuments.net/reader035/viewer/2022081515/56649de75503460f94ae010c/html5/thumbnails/50.jpg)
Thank You