Transcript cervical spondylosis dr tp moja steve biko academic hospital

CERVICAL
SPONDYLOSIS
DR T.P MOJA
STEVE BIKO ACADEMIC HOSPITAL
Pathophysiology
Disc degeneration
-nucleus pulposus loses water content, fissuring, loss of height and bulging annulus.
-acute rupture and herniation may occur
Secondary changes due to increased and uneven loading of forces
- Vertebral osteophytes
- Facet and uncovertebral joint osteoarthritis and hypertrophy
- Ligamentum flavum becomes thickened and may ossify
- Spine deformity due to segmental instability
Degenerative spondylolistheses
Degenerative kyphosis or scoliosis
•
Narrowing of the central canal, lateral recesses and foramina with subsequent
neural and vascular compression
CERVICAL SPINE XRAY
MRI CERVICAL SPINE
Clinical Presentation
Asymptomtic with incidental radiographic findings
Symptomatic - in most cases: onset is slow and insidious
. However some cases may be acute eg hyperextension
injury in minor trauma or acute disc herniation
Neck pain
Myelopathy
Radiculopathy
Neck pain
• Occurs if there is a disc extrusion
• Nerve root compression
• Facet joint arthritis
• Segmental instability
• Often poorly localized
• May radiate to the occipital region, shoulders,
interscapular.
• There may be associated stiffness of the neck
from muscle spasm
Myelopathy
• May be complex and variable
• Most cases seem to present with a central cord syndrome, rarely brown squard,
or complete myelopathy
• Motor
• -upper limbs: LMN Weakness
•Clumsiness of the hands. Muscle wasting. Absent biceps
reflex, inverted reflex, Triceps reflex may be brisk. Positive
Hoffman reflex
• -Lower limbs: Spasticity, difficulty walking. No or slight weakness.
• Sphincters: usually no symptoms. Rarely mild bladder symptoms. ? Prostate
• Sensory
- No involvement
- Patchy sensory loss
- Paraesthesia in the hands, sometimes the feet
and legs
- May be asymmetrical or symmetrical
- Different from radiculopathy in that it is not in a
specific dermatomes
- Lhermittes’s sign
Radiculopathy
• May be acute if due to a disc protrusion
• Slow and insidious if due to an osteophyte
• Most common nerve root is C6
• Neck pain and shoulder pain. Pain radiates down the
biceps, then the lateral aspect of the forearm then the
thumb and index finger.
• Head may be tilted to the affected side due to muscle
spasm. Pain made worse by neck extension, relieved by
neck flexion and shoulder abduction.
• Often numbness, more often hand and fingers
• Chronic cases – wasting and
fasciculations of biceps and
brachioradialis muscle.
• Weakness of elbow flexion (Thumbnose), and wrist extension.
• Absent biceps and brachioradialis reflex
C5 nerve root radiculopathy
• - Neck pain
• - Shoulder pain, pain over the lateral aspect of
the upper arm.
• - Numbness or paraesthesia over the lateral
aspect of the upper arm.
• - Weakness of deltoid and biceps muscles,
with absent biceps reflex
•In severe cases, wasting of the deltoid and
biceps muscles
Treatment
Neck Pain
-Conservative
-Rarely, surgery
Myelopathy
-Surgery in most cases
-Some may stabilize on conservative
Acute radiculopathy
-Conservative
-Surgery if indicated
Chronic radiculopathy
-Most cases, surgery
Conservative treatment
• Medication: Analgesia
NSAIDS
Diazepam
Baclofen
Carbamazepine, Gabapentin, Lyrica
• Physiotherapy: Range of motion exercises
Isometric exercises
Heat and massage
• Traction:
• Neck collar
Continuous or intermittent halter traction
Soft neck collar < 1 week
• Facet and Medial branch block – Cortisone, L.A, Radiofrequency
SURGERY
• Anterior decompression
– Anterior cervical discectomy and fusion
– Corpectomy and fusion
• Posterior decompression
– Laminaplasty
– Laminectomy