Download - Cervical Spondylosis Syndrome
CERVICAL SPONDYLOSIS SYNDROME
PRESENATATION BY DR MISBAHUL FERDOUS MBBS(USTC) FMD (USTC) PGT (CARDIOLOGY) NICVD.DHAKA PUBLICATION- 1 (ORIGINAL ARTICLE) METABOLIC SYNDROME AND ACUTE ST ELEVATION MI IN HOSPITAL
OUTCOME.
PUBLISHED IN B.H.J. JANUARY-2008
MD (CARDIOLOGY), COURSE SHANDONG UNIVERSITY, CHINA.
Definition• Degeneration of cervical IVD and the
secondary degeneration of cervical intervertebral joints, leads to injury of spinal cord, nerve roots and vertebral artery, and shows corresponding symptoms and signs
Causesb u lg e o r e x tru s io n o f IV D
c o m pr e ss ion to sp in a l c o r d ,n e r v e r o o ts,
v e r teb r a l ar te ry
h y p e rp la sia o f v e r teb r a l b o d y,fa c e t jo in ts, l ig a m e n ts
u n stab le of th e sp ine
lig a m e n t lax
N a r ro w e d o f in te r ve r teb r a l sp a ce
d e g e n er a io n o f IV D
• These accumulated changes caused by degeneration can gradually compress one or more of the nerve roots.
• This can lead to increasing pain in the neck and arm, weakness, and changes in sensation.
• In advanced cases, the spinal cord becomes involved. This can affect not just the arms, but the legs as well.
Causes• Injury: acute injury can further injure
originally degenerative cervical vertebra and discs, this can induce cervical spondylosis.
Chronic injury can speed up process of degeneration.
• Congenital deformity: stenosis of the cervical spinal canal.
stenosis of the cervical spinal canal.
Pavlov Ratio: canal (a) / body (b) <0.75
• A previous neck injury (which may have occurred several years prior) can predispose to spondylosis, but the major risk factor is aging.
• By age 60, 70% of women and 85% of men show changes consistent with cervical spondylosis on X-ray.
As you age, the disks of your spine become drier and less elastic.
Classification & clinical findings
• Cervical spondylotic radiculopathy (CSR)
• Cervical spondylotic myelopathy (CSM)
• Vertebral artery type of cervical spondylopathy
Pathology of CSR
• Most common in morbidity (50%-60%)
• Posterolateral protrusion of the cervical disc• Hyperplasia, hypertrophy of the facet joint .
• stimulate or compress nerve roots as they emerge from the cord to pass peripherally through the intervertebral foramen
brachial plexus
pathology
Clinical manifestation• Symptoms– Neck pain: radiating to the ipsilateral upper
extremity– Paresthesia–Muscle weakness in appropriate distribution
pain and paresthesia may be intensified by neck movement, especially by extension or lateral flexion to the side of herniation. May be improved by traction on neck.
• Signs–Stiffness of neck–Tenderness, spasm of paraspinous
muscles–Limitation of active and passive
motion of the neck and affected upper extremity.
Radiographic study
Demonstrate osteophyte formation and narrowing of intervertebral foramen.
CT scan
Pathology-CSM• Midline herniation of nucleus pulposus• Osteophyte of posterior rims of vertebral
body• Hyperplasia of the ligamentum flavum • Calcification of the posterior longitudinal
ligament
Lead to compression of the spinal cord
Clinical manifestation• Symptoms– Weakness– Loss of balance– Cannot handling small objects– Neck pain not obvious
– Numbness– Dysfunction of upper motor neuron
is gradually present from the lower part of body to the upper.
– Spastic paraplegia or quadriplegia-loss of control of the
bladder or bowels
Signs• Marked motor
changes and relatively few sensory changes.– Hypertonic (high
muscular tone)– hyperreflexia– Patellar clonus +– Ankle clonus +
• Pyramidal tract sign– Hoffmann’s sign– Babinski’s sign– Obstacle of fine
motion of the fingers Such as buttons,
write
Calcification of the posterior longitudinal ligament
MRI
Vertebral artery type of CS
• Pathology• Hyperplasia, stenosis of cervical
vertebral transverse foramen, hypertrophy of upper articular process, unstable cervical vertebra
• Directly stimulate, compress or pull vertebral artery
Pathology
• Symptoms–Vertigo is main, induced by rotating
neck–Migraine–Sudden blackout, Diplopia, recovered
in short time–Cataplexy caused by sudden spasm of
artery due to stimulation, come to at once after falling to the ground
• Sign–Positive neck rotation test
Treatment
• The goal of treatment is relief of pain and prevention of permanent spinal cord and nerve root injury.
• In mild cases, no treatment is required. Symptoms from cervical spondylosis usually stabilize or regress with simple, conservative therapy including a neck brace and NSAIDs.
Nonoperative treatment
• Halter traction• Cervical support and collar• Massage• Physical therapy• Analgesics and muscle relaxants• Local block
Halter traction
• Cervical collar
• Analgesics–NSAIDS• VOLTAREN• Tramcontin
• Muscle relaxants
Operative treatment
• Anterior cervical decompression and fusion ( ACDF)
• Artificial disc replacement (ADR)• Laminectomy• Laminoplasty
Artificial disc replacement(ADR)
Posterior approach
• Indications• Multiple level spondylosis and diffuse
spinal canal stenosis.
• MethodsLaminectomy or laminplasty.
Cervical Spondylosis Prevention
• Many cases are not preventable. Prevention of neck injury (such as proper equipment and techniques when playing sports) may reduce risk.
The END!Thank You!
Oh, sorry, not the END, just the beginning!
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