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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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