orthopedics 5th year, 2nd lecture (dr. hamid)
DESCRIPTION
The lecture has been given on May 8th, 2011 by Dr. Hamid.TRANSCRIPT
CERVICAL SPONDYLOSIS
CERVICAL SPONDYLOSISbull 1048729 Commonest cause of - neck pain- Radiculopathy- Myelopathy- both- Decreased ROM
Cervical Sponylosisbull Chronic degenerative lesions of single ormultiple intevertebral discs and consequentosteophytosis of related vertebral bodiesbull Cervical spondylosis is a leading cause of
musculo- skeletal disabilitybull There is no inflammation being not
synovialbull natural process of ageing
Cervical spondylosis is a general term encompassing a number of degenerative conditions
Degenerative disc disease (DDD)Spinal stenosisWith or without degenerative facet jointsWith or without the formation of osteophytesWith or without a herniated disc
One single component as a diagnosis is rare
Path--Degeneration-Change in osmotic properties- Decrease in water content - Loss of disc heightampability to expand- Irregularities of end plate- Sclerosis in disc interspace-Formation of spures and osteophytes
CLpbull pressure on (pss)ampdsleeve-bull = == == = root-bull = = = = = = =cord-bull = = = = = = =both-
historybull A Pain in the neck- Dull boring difficult to
localize bull Morning stiffnessbull Headaches in some ndash from neck to back of head bull B Radicular pain- C5- Deltoid C6 - Thumb amp
index finger +- weakness of afected myotoms bull CInstability ndash difficulty in walking difficulty inclimbing stairsbull DBladder and Bowel dysfunction
Exambull -Gait -Look feel move - neurological
exam -special testbull Neck ndash loss of lordosis tender areasbull - restricted amp painful neck movementsbull Radiculopathy -Reflex changesbull wasting of small amp big musclesbull Myelopathy - Brisk jerks in lower extbull Tendency for clonusbull Spasticity
radiculopathy
Aetiologybull 1048729 Aging processbull 1048729 Mechanical load applied to the spinebull 1048729 Mechanical instabilitybull 1048729 Abnormal movementsbull 1048729 Genetic abnormalities of cartilage
protein(type IX collagen
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
CERVICAL SPONDYLOSISbull 1048729 Commonest cause of - neck pain- Radiculopathy- Myelopathy- both- Decreased ROM
Cervical Sponylosisbull Chronic degenerative lesions of single ormultiple intevertebral discs and consequentosteophytosis of related vertebral bodiesbull Cervical spondylosis is a leading cause of
musculo- skeletal disabilitybull There is no inflammation being not
synovialbull natural process of ageing
Cervical spondylosis is a general term encompassing a number of degenerative conditions
Degenerative disc disease (DDD)Spinal stenosisWith or without degenerative facet jointsWith or without the formation of osteophytesWith or without a herniated disc
One single component as a diagnosis is rare
Path--Degeneration-Change in osmotic properties- Decrease in water content - Loss of disc heightampability to expand- Irregularities of end plate- Sclerosis in disc interspace-Formation of spures and osteophytes
CLpbull pressure on (pss)ampdsleeve-bull = == == = root-bull = = = = = = =cord-bull = = = = = = =both-
historybull A Pain in the neck- Dull boring difficult to
localize bull Morning stiffnessbull Headaches in some ndash from neck to back of head bull B Radicular pain- C5- Deltoid C6 - Thumb amp
index finger +- weakness of afected myotoms bull CInstability ndash difficulty in walking difficulty inclimbing stairsbull DBladder and Bowel dysfunction
Exambull -Gait -Look feel move - neurological
exam -special testbull Neck ndash loss of lordosis tender areasbull - restricted amp painful neck movementsbull Radiculopathy -Reflex changesbull wasting of small amp big musclesbull Myelopathy - Brisk jerks in lower extbull Tendency for clonusbull Spasticity
radiculopathy
Aetiologybull 1048729 Aging processbull 1048729 Mechanical load applied to the spinebull 1048729 Mechanical instabilitybull 1048729 Abnormal movementsbull 1048729 Genetic abnormalities of cartilage
protein(type IX collagen
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Cervical Sponylosisbull Chronic degenerative lesions of single ormultiple intevertebral discs and consequentosteophytosis of related vertebral bodiesbull Cervical spondylosis is a leading cause of
musculo- skeletal disabilitybull There is no inflammation being not
synovialbull natural process of ageing
Cervical spondylosis is a general term encompassing a number of degenerative conditions
Degenerative disc disease (DDD)Spinal stenosisWith or without degenerative facet jointsWith or without the formation of osteophytesWith or without a herniated disc
One single component as a diagnosis is rare
Path--Degeneration-Change in osmotic properties- Decrease in water content - Loss of disc heightampability to expand- Irregularities of end plate- Sclerosis in disc interspace-Formation of spures and osteophytes
CLpbull pressure on (pss)ampdsleeve-bull = == == = root-bull = = = = = = =cord-bull = = = = = = =both-
historybull A Pain in the neck- Dull boring difficult to
localize bull Morning stiffnessbull Headaches in some ndash from neck to back of head bull B Radicular pain- C5- Deltoid C6 - Thumb amp
index finger +- weakness of afected myotoms bull CInstability ndash difficulty in walking difficulty inclimbing stairsbull DBladder and Bowel dysfunction
Exambull -Gait -Look feel move - neurological
exam -special testbull Neck ndash loss of lordosis tender areasbull - restricted amp painful neck movementsbull Radiculopathy -Reflex changesbull wasting of small amp big musclesbull Myelopathy - Brisk jerks in lower extbull Tendency for clonusbull Spasticity
radiculopathy
Aetiologybull 1048729 Aging processbull 1048729 Mechanical load applied to the spinebull 1048729 Mechanical instabilitybull 1048729 Abnormal movementsbull 1048729 Genetic abnormalities of cartilage
protein(type IX collagen
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Cervical spondylosis is a general term encompassing a number of degenerative conditions
Degenerative disc disease (DDD)Spinal stenosisWith or without degenerative facet jointsWith or without the formation of osteophytesWith or without a herniated disc
One single component as a diagnosis is rare
Path--Degeneration-Change in osmotic properties- Decrease in water content - Loss of disc heightampability to expand- Irregularities of end plate- Sclerosis in disc interspace-Formation of spures and osteophytes
CLpbull pressure on (pss)ampdsleeve-bull = == == = root-bull = = = = = = =cord-bull = = = = = = =both-
historybull A Pain in the neck- Dull boring difficult to
localize bull Morning stiffnessbull Headaches in some ndash from neck to back of head bull B Radicular pain- C5- Deltoid C6 - Thumb amp
index finger +- weakness of afected myotoms bull CInstability ndash difficulty in walking difficulty inclimbing stairsbull DBladder and Bowel dysfunction
Exambull -Gait -Look feel move - neurological
exam -special testbull Neck ndash loss of lordosis tender areasbull - restricted amp painful neck movementsbull Radiculopathy -Reflex changesbull wasting of small amp big musclesbull Myelopathy - Brisk jerks in lower extbull Tendency for clonusbull Spasticity
radiculopathy
Aetiologybull 1048729 Aging processbull 1048729 Mechanical load applied to the spinebull 1048729 Mechanical instabilitybull 1048729 Abnormal movementsbull 1048729 Genetic abnormalities of cartilage
protein(type IX collagen
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Path--Degeneration-Change in osmotic properties- Decrease in water content - Loss of disc heightampability to expand- Irregularities of end plate- Sclerosis in disc interspace-Formation of spures and osteophytes
CLpbull pressure on (pss)ampdsleeve-bull = == == = root-bull = = = = = = =cord-bull = = = = = = =both-
historybull A Pain in the neck- Dull boring difficult to
localize bull Morning stiffnessbull Headaches in some ndash from neck to back of head bull B Radicular pain- C5- Deltoid C6 - Thumb amp
index finger +- weakness of afected myotoms bull CInstability ndash difficulty in walking difficulty inclimbing stairsbull DBladder and Bowel dysfunction
Exambull -Gait -Look feel move - neurological
exam -special testbull Neck ndash loss of lordosis tender areasbull - restricted amp painful neck movementsbull Radiculopathy -Reflex changesbull wasting of small amp big musclesbull Myelopathy - Brisk jerks in lower extbull Tendency for clonusbull Spasticity
radiculopathy
Aetiologybull 1048729 Aging processbull 1048729 Mechanical load applied to the spinebull 1048729 Mechanical instabilitybull 1048729 Abnormal movementsbull 1048729 Genetic abnormalities of cartilage
protein(type IX collagen
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
CLpbull pressure on (pss)ampdsleeve-bull = == == = root-bull = = = = = = =cord-bull = = = = = = =both-
historybull A Pain in the neck- Dull boring difficult to
localize bull Morning stiffnessbull Headaches in some ndash from neck to back of head bull B Radicular pain- C5- Deltoid C6 - Thumb amp
index finger +- weakness of afected myotoms bull CInstability ndash difficulty in walking difficulty inclimbing stairsbull DBladder and Bowel dysfunction
Exambull -Gait -Look feel move - neurological
exam -special testbull Neck ndash loss of lordosis tender areasbull - restricted amp painful neck movementsbull Radiculopathy -Reflex changesbull wasting of small amp big musclesbull Myelopathy - Brisk jerks in lower extbull Tendency for clonusbull Spasticity
radiculopathy
Aetiologybull 1048729 Aging processbull 1048729 Mechanical load applied to the spinebull 1048729 Mechanical instabilitybull 1048729 Abnormal movementsbull 1048729 Genetic abnormalities of cartilage
protein(type IX collagen
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
historybull A Pain in the neck- Dull boring difficult to
localize bull Morning stiffnessbull Headaches in some ndash from neck to back of head bull B Radicular pain- C5- Deltoid C6 - Thumb amp
index finger +- weakness of afected myotoms bull CInstability ndash difficulty in walking difficulty inclimbing stairsbull DBladder and Bowel dysfunction
Exambull -Gait -Look feel move - neurological
exam -special testbull Neck ndash loss of lordosis tender areasbull - restricted amp painful neck movementsbull Radiculopathy -Reflex changesbull wasting of small amp big musclesbull Myelopathy - Brisk jerks in lower extbull Tendency for clonusbull Spasticity
radiculopathy
Aetiologybull 1048729 Aging processbull 1048729 Mechanical load applied to the spinebull 1048729 Mechanical instabilitybull 1048729 Abnormal movementsbull 1048729 Genetic abnormalities of cartilage
protein(type IX collagen
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Exambull -Gait -Look feel move - neurological
exam -special testbull Neck ndash loss of lordosis tender areasbull - restricted amp painful neck movementsbull Radiculopathy -Reflex changesbull wasting of small amp big musclesbull Myelopathy - Brisk jerks in lower extbull Tendency for clonusbull Spasticity
radiculopathy
Aetiologybull 1048729 Aging processbull 1048729 Mechanical load applied to the spinebull 1048729 Mechanical instabilitybull 1048729 Abnormal movementsbull 1048729 Genetic abnormalities of cartilage
protein(type IX collagen
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
radiculopathy
Aetiologybull 1048729 Aging processbull 1048729 Mechanical load applied to the spinebull 1048729 Mechanical instabilitybull 1048729 Abnormal movementsbull 1048729 Genetic abnormalities of cartilage
protein(type IX collagen
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Aetiologybull 1048729 Aging processbull 1048729 Mechanical load applied to the spinebull 1048729 Mechanical instabilitybull 1048729 Abnormal movementsbull 1048729 Genetic abnormalities of cartilage
protein(type IX collagen
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Pridisposing factorsbull Abnormalities of glucose metabolismbull HLA related genotype aberrationbull Diabetesbull High blood pressurebull Smoking
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Osteophite amp Spurebull Disc bulge - peripheral tear within annulusbull elevates ALLampPLL from bony rimbull Produces Tension which stimulates growthamp Proliferation of fibroblasts in outer annulusand metaplasia into chondrocytes leads to
cartilage osteophite and spur formation
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
IMAGINGbull X-raybull CTbull MRI
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Differential Diagnosisbull Nerve entrapment Syndromesbull Rotator Cuff lesionsbull Cervical tumersbull TOS
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Treatment
bullConservative
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
bull Surgery-1-progressive Cmylopathy on conservativR2-moderate to sever mylopathy3-clinical and radiological evidence of
radiculopathy with progressive N defficit4--single level with signif pain and stiffness5-diffinit foraminal narrowing with nroot
compression
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
bull The type of surgical procedure performed will depend upon
bull Extent of the compression bull Number of vertebral levels involved bull Location Anterior Vs Posterior compression bull Instability+ve or -vebull Alignment of the cervical spinekL
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Two main approaches
PosteriorLaminectomyLaminectomyLaminoplastyLaminoplasty
AnteriorWhy not like disc surgery-neucleolysispercutaneous
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Anterior cervical decompression
bull The goal bull To expand the spinal canal bull To secure spinal stability
bull To preserve the protective function of the spine bull Indication
bull Herniated disc and ostephite removal bull Vertebral fusion bull Access C2 - C7 Multilevel cord compression
bull Morbidities bull complexitybull of multilevel anteriorbull Recurrent laryngeal nerve Rt bull Sympathetic nervebull Carotid artery
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Anterior Cervical Discectomy and Fusion (ACDF)bull High success rate gt90 for 1 level
bull Multilevelsbull Disc removaldecompressionbull Use of microscopebull Bone graft or other material for fusionbull Usually with plating
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Cervical MyelopathyCervical MyelopathyDefinition
Pathological process that affect primary the spine and cause spinal cord impairment
- It is usually chronic and slowly progressive- The main cause is spondyloticspondylotic compression-It is quite common in advanced spinal stenosis-Transverse myelitis-Transverse myelitis ( when acute)
multiple sclerosis infectious myelitis haemorrhage
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Causes1 Compromise of the spinal cord
bull Cervical spondylosisbull Acute disc herniation bull Inflammatory arthritisbull Spinal stenosis
2 Trauma 3 Congenital and developmental
defects bull Syringomyelia bull Neural tube formation
defects 4 Spinal neoplasms 5 Physical agents
bull Decompression sickness bull Electrical injury bull Radiation
6 Toxins bull Nitrous oxide
7 Metabolic and nutritional disorders bull Pernicious anemia bull Chronic liver disease
8 Remote effect of cancer 9 Arachnoiditis 10 Post infectious autoimmune
disorders bull Acute transverse myelitis bull Connective tissue disease
11 Multiple sclerosis 12 Epidural infections 13 Primary infections (human
immunodeficiency virus [HIV]) 14 Vascular causes
bull Epidural hematoma bull Atherosclerotic abdominal
aneurysm bull Malformation
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Introduction
Cervical MyelopathyCervical Myelopathy cervical cord compression
bull Cervical spondylosis 50 bull hypertrophy of facet joint and osteophyte formation
bull Hypertrophy of the ligamenta flava
bull Bulging (or prolapse) of a cervical disc bull Spinal stenosis bull Congenital narrowing
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Pathophysiology Direct pressure on the spinal cord
( Mechanical Factors ) bull Static
bull Dynamic
Ischemia of the cord bull compression and obstruction of small vessels
within the cord bull Compression of the feeding radicular arteries
within the the intervertebral foramen
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Phathophysiology
The morphological changes within the cord include
bull Degeneration and loss of nerve cellsbull Cavitations and proliferation of glia within the grey
matter bull Demyelination of the lateral and posterior columns bull Wallerian degeneration in ascending tracts above and
descending tracts below the compression bull Proliferation of small blood vessels with thickening of
the vessel walls
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Clinical syndromesFive Clinical syndromes of Spondylotic Myelopathy
1 Posterior syndrome2 Anterior cord syndrome3 Central cord syndrome4 Brown-sequard syndrome
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Diagnosis Clinical History And exam Neurologic findings Accurate radiologic imaging studies
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Age 30 ndash 50 Duration of symptoms range from several months to several years bull Hand sensory complaints ( numbness and paresthesia) bull Gait dysfunctions bull Impairment of hand Fine movements bull Less frequent symptomes
bull Sphincter and sexual dysfunction are relatively infrequent ( advance myelopathy)
bull pain bull Bladder dysfunction
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
History and Physical
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Neurological Examination
Sign bull Muscle weakness (the hand intrinsic and triceps muscles) bull Lower extremity weakness (primarily affecting the iliopsoas) bull Spasticity (cause of gait dysfunction ) bull Hyperreflexia bull + ve Hoffman reflex bull Muscel wasting relatively uncommonbull Gripampreleaseinverted radial reflex finger escape
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
bull Sometimes clinical signs do not improve after decompression
bull Sometimes myelopathy progress in spite of decompression
bull Neurological findings do not always correlate with radiological level of compression
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Myelopathy in elderlybull Wasting of small muscles in handsbull Weakness of deltoid is characteristicbull Extension contractures of finger MP jointsbull Numbness amp paraesthesiae in handsbull Difficult to use spoon button shirt
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Radiological investigationsbull Plain X-ray ( essential firs step )
bull AP lateral and Oblique narrow vertebral canal ( 13 mm lower limit)
bull Canal diameter to body diameter should be greater than 08bull flexion-extension mobility of the cervical spine
bull CT bull Osteophytes calcified discs dimensions bull Inadequate assessment of cord amp roots
bull MRI bull To confirm the nature and extent of the cord compression ( anterior
vs posterior compression)bull The severity of the diseasebull T2 hyperintensity reflects myelomalacia demyelination or microcavitiesbull Intense signal probably inflammation or edema
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Natural history bull Slowly progressivebull Periods of relative stability or accelerated functional
decline bull Spontaneous improvement is rarebull Motor symptoms much more progressive and less likely
to improve than sensory abnormalities
Cervical MyelopathyCervical MyelopathySpine Round Friday October 14 Spine Round Friday October 14 20052005
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
Surgery
bullSurgery
Spine Round Friday October 14 Spine Round Friday October 14 20052005
Cervical MyelopathyCervical Myelopathy
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
-
THANK YOU
- PowerPoint Presentation
- CERVICAL SPONDYLOSIS
- Cervical Sponylosis
- Slide 4
- Path--Degeneration
- CLp
- history
- Exam
- radiculopathy
- Aetiology
- Pridisposing factors
- Osteophite amp Spure
- IMAGING
- Slide 14
- Differential Diagnosis
- Treatment
- Slide 17
- Slide 18
- Slide 19
- Anterior cervical decompression
- Anterior Cervical Discectomy and Fusion (ACDF)
- Slide 22
- Cervical Myelopathy
- Causes
- Introduction
- Slide 26
- Pathophysiology
- Phathophysiology
- Clinical syndromes
- Diagnosis
- History and Physical
- Neurological Examination
- Slide 33
- Myelopathy in elderly
- Radiological investigations
- Slide 36
- Natural history
- Surgery
- THANK YOU
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