common spine disorders diagnosis and treatment
TRANSCRIPT
![Page 1: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/1.jpg)
Common Cervical Spine Disorders -
Diagnosis and Treatment
Wayne Cheng, MDHead of Spine Service
Bones and Spine
![Page 2: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/2.jpg)
Cervical
Radiculopathy Vs. Myelopathy
![Page 3: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/3.jpg)
Clinical Presentation
Radiculopathy
– Shooting pain down
the arm with
numbness, tangling
– +/- weakness
– +/- interscapula pain
– Better with arm
abducted
Myelopathy– Gait changes/falling
– Bowel(18%) or bladder(15%)dysfunction
– Change hand writing
– Diffuse hyperreflexia/spastic
– 20% no neck or arm pain
– Electric shock with
movement of neck
![Page 4: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/4.jpg)
![Page 5: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/5.jpg)
![Page 6: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/6.jpg)
Physical ExamC5 Radiculopathy
C4-5 level
– 3rd most common
Weak deltoid, shoulder external rotators
– perhaps biceps
Biceps reflex
Pain & Sensory loss
– lateral shoulder
– lateral brachium
![Page 7: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/7.jpg)
Physical ExamC6 Radiculopathy
C5-6 level
Weak biceps & wrist extension
Brachioradialis reflex
Pain & sensory loss
– radial hand
– lateral brachium
![Page 8: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/8.jpg)
Physical ExamC7 Radiculopathy
C6-7 level
Weak triceps, wrist flexion, finger ext
Triceps reflex
Pain & sensory loss
– middle finger
– posterolateral arm
![Page 9: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/9.jpg)
Physical ExamSpurling Test
Extending the neck
Rotating head
Downward pressure on head
Positive if pain radiates to side patient’s head is pointed– Positive Spurling in 71%
football players c recent burner (Levitz et al AM J Sp
Med 1997)
![Page 10: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/10.jpg)
Physical ExamManual Cervical Distraction
Supine patient
Gentle manual axial
distraction
– Up to ~30lbs
Positive response
reduction neck and
limb symptoms
![Page 11: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/11.jpg)
Hoffman’s ReflexMyelopathy
Suddenly extend middle finger DIP
Reflex finger flexion
When asymmetric indicative spinal cord impingement
![Page 12: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/12.jpg)
Physical ExamL’hermitte’s Sign - myelopathy
Neck flexion
Electric-like sensation radiating down spine and/or extremities
– Cervical spondylosis
– Multiple sclerosis
– Tumor
![Page 13: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/13.jpg)
Non-Operative Treatment
NSAID
Oral steroid
Soft cervical collar
Cervical traction
Epidural steroid
injection
![Page 14: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/14.jpg)
ANT. CORPECTOMY &
POST FORAMINOTOMY
59 yo businessman
with severe R. arm
pain.
![Page 15: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/15.jpg)
Cervical artificial disc
![Page 16: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/16.jpg)
2 Level cervical artificial disc
![Page 17: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/17.jpg)
Cervical Laminoplasty
81 year old with
quadriparesis, loss of
function of all 4,
worse with BUE than
BLE.
![Page 18: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/18.jpg)
Cervical laminaplasty
![Page 19: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/19.jpg)
Conclusion
Patient selection and Making the correct
diagnosis is the key to success.
![Page 20: Common Spine Disorders Diagnosis and Treatment](https://reader033.vdocuments.site/reader033/viewer/2022061614/62a0a72d447585199206b1c8/html5/thumbnails/20.jpg)
Thank You