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Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
Cervical Laminoplasty by Pablo Pazmino MD
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Cervical Laminoplasty by Pablo Pazmino MD

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This video explains Cervical Stenosis and Cervical Spondylosis/Arthritis. When stenosis begins to affect the spinal cord this is called Cervical Spondylotic Myelopathy. This video highlights the …

This video explains Cervical Stenosis and Cervical Spondylosis/Arthritis. When stenosis begins to affect the spinal cord this is called Cervical Spondylotic Myelopathy. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Cervical Stenosis/Arthritis for a Laminoplasty feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1

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  • 1. Pablo Pazmi ño, MD
  • 2. Orthopaedic Surgery American Academy of Orthopaedic Surgeons Clinical Faculty Olympia Medical Center Cedars Sinai Medical Center Century City Doctors Hospital
    • Education
      • The University of California, Los Angeles
      • The University of Michigan, Ann Arbor
  • 3.
    • The beauty of the laminoplasty is that it increases the space available for the spinal cord
    • It does this without fusing the spine whatsoever
  • 4.
    • Cervical Spondylotic Myelopathy: Natural History
    • Pathophysiology
    • Diagnosis
      • Symptoms
      • Exam Findings
    • Studies
    • Surgical Laminoplasty
    • Cases
  • 5.  
  • 6.
    • Cervical Spondylosis
    • This is a Progressive degenerative changes that develop slowly over time , this alters the spinal biomechanics from the loss of shock absorption properties of intervertebral discs.
    • This leads to other changes in surrounding structures.
  • 7.
    • Dysfunction  Instability  Stabilization (Marginal Osteophytes)
    • Initially you develop a dysfuntion in your neck
    • The neck then becomes unstable as a result
    • Arthritis is your bodies attempt to stabilize this naturally by growing bone spurs and stiffening an unstable area. This is why you may develop stiffness.
  • 8.
    • Patients develop Stepwise degeneration with periods of stability between exacerbations.
    • 45% of patients with non myelopathic symptoms have good resolution after onset, the remaining 55% continue to have moderate long term morbidity
        • Lees Turner BMJ 63:2:1607 (44pts/ CSM 3-40yrs)
            • Do well for awhile
            • Then Get Worse
  • 9.
    • In the Front  disc degeneration and osteophytes ,PLL
    • Anterolaterally  Uncovertebral joint, and facet hypertrophy
    • In the Back  Ligamentum flavum thickens and buckles
    • Parke WW. Spine 1988
    • Bernhardt et al JBJS 1993
    Progressive cervical spondylotic changes result in circumferential narrowing of the cervical canal
  • 10.
    • Anteriorly  disc degeneration and osteophytes ,PLL
    • Anterolaterally  uncovertebral joint, and facet hypertrophy
    • Posteriorly  Ligamentum flavum buckling
    • Parke WW. Spine 1988
    • Bernhardt et al JBJS 1993
    Circumferential Process= It occurs from all sides
  • 11. Three distinct clinical syndromes can result: Type I: Cervical Radiculopathy: Cmprsn +Inflammation of Spinal Nerve with symptoms that correspond to the level involved Type II: Cervical Myelopathy: Cord involvement Type III: Axial Joint Pain (Mechanical neck pain, “discogenic pain”, facet syndrome, painful instability
  • 12.
    • Radiculopathy is not a specific condition, but rather a description of a problem in which one or more nerves are affected and do not work properly
    • The emphasis is on the nerve root (“Radix" = "root“ ).
    • This can result in radicular pain, weakness, numbness, or difficulty controlling specific muscles.
  • 13.
    • Sex: Radiographic changes are more severe in men than in women.
    • Cervical Spondylosis present in 50% of population at 50 years of age. Kellgren Ann Rheum Dz 1958
    • Irvine et al defined the prevalence of Spondylosis using radiographic evidence. Lancet 1965
      • ♂ prevalence was 13% in the third decade  100% by age 70 years.
      • ♀ prevalence ranged from 5% in the fourth  96% > 70 years.
      • In 1992, Rahim and Stambough noted that spondylotic changes are most common in those older than 40 years. Eventually, more than 70% of men and women are affected Orthop Clin North Am 1992
      • By age 60-65 95% of nonsymptomatic men and 70% of asymptomatic women develop at least one degenerative change on Xray Gore Spine 1986
    • Moore and Blumhardt series, 23.6% of patients presenting with nontraumatic myelopathic symptoms had CSM. Spinal Cord 1997
    • CSM is the most common cause of nontraumatic spastic paraparesis and quadriparesis.
  • 14.
    • No patient ever returned to normal state
    • 75% Had episodic worsening/progression
    • 20% Slow steady progression
    • 5% Rapid onset followed by lengthy disability
    • Motor changes tended to persist and progress with time
    • Sensory/bladder changes were transient
    • Soft collar improved gait and Nroot syx for 50% pts
        • Clark E, Robinson PK Cervical Myelopathy: a complication of cervical spondylosis Brain 56:79:483-70 (120 patients)
    • Stepwise degeneration with periods of stability between exacerbations.
    • 45% of patients with nonmyelopathic symptoms have good resolution after onset, the remaining 55% continue to have moderate long term morbidity
        • Lees Turner BMJ 63:2:1607 (44pts/ CSM 3-40yrs)
  • 15.
    • Cervical Spine Research Society
    • Multicenter, Nonrandomized study
    • Poor outcome of Nonsurgical Mgmt of CSM
    • 43pts
    • 23 Medical treatment: Decrease in ability to perform ADLs, worsening of Neurologic symptoms
    • 20 Surgical treatment: Decreased neurologic symptoms,overall pain, and improved functional status
    • Sampath P et al Spine 2000: 25:670
  • 16.
    • T he Cervical discs themselves have been shown to account for consistent patterns of neck pain
    • Grubb Spine 25: 1382-1389, 2000
  • 17.
    • The facet joints themselves can account for significant neck pain.
    • The facet joint capsules have free nerve endings which send referred pain into these specific distributions.
    • This is why many of the patients we see every day have neck/ shoulder/scapular pains.
    Dwyer Spine 15: 453-7, 1990.
  • 18.
    • With my background as a Third grade teacher I always make it a point to build a foundation concept before moving on to complex ideas.
    • As a Spine surgeon I want the most vantage points on an object, this gives me a frame of reference and helps to construct the anatomy in my mind.
  • 19. Here is what I mean by a foundation concept. You will see side view images and top down images throughout this presentation and on your MRIs. This can be hard to grasp unless we stop and point a few things out initially The Sagittal view is also called the lateral view and this is pictured here it displays the spine as viewed from the SIDE. The Axial view is a top down view of the spine. This image repsents a slice obtained as if an Axe were to chop you, therefore the name Axial view.
  • 20.
    • Next we will review some basic anatomy
    • Some images will be in the Sagittal plane
  • 21.
    • Others will be in the Axial Plane
  • 22.
    • There are seven bones which make up the cervical spine. Each vertebral body ( these look like blocks) are separated by intervertebral discs which function as shock absorbers.
    1 2 3 4 5 6 7
  • 23.  
  • 24.
    • A Herniated disc A herniated disc (sometimes called a slipped disc) is the most common cause of sciatica. Discs are the cushions between the bones in the back. They act like "shock absorbers" when we move, bend, and lift.
  • 25.
      • There is a tough ring around the outside called the Annulus Fibrosus , and a thick almost crabmeat like center inside called the Nucleus pulposus.
  • 26.
      • If the outer edge of the disc ruptures, the center can push through and put pressure on the exiting nerve, leading to the pain of sciatica (referred to as a Herniated nucleus pulposus or disc herniation).
  • 27.
    • Are located posteriorly, these are the joints of the spine and are essential for control of normal motion and based on their orientation
    • Compromised facets will alter the distribution of mechanical forces throughout the spine
  • 28. Joint Facet Nucleus Pulposus Right Nerve Root Left Nerve Root As you can see here on MRI and CT scans the Facet joints end up looking like the buns of a hamburger. Its just the way the happen to look when they are sliced in this plane. We will show you this on some examples later Annulus Fibrosus Axial View of the Disc and Neural elements Spinal Cord
  • 29. Joint Facet Disc Right Nerve Root Left Nerve Root Axial View
  • 30.
    • Radiographs
    • CT: Computed Tomography
    • MRI: Magnetic Resonance Imgaing
  • 31. Joint Facet Disc Right Nerve Root Left Nerve Root Next I will show you some MRIs You will see this is a patient with a left sided herniation pinching off her exiting left nerve root Spinal Cord
  • 32. Joint Facet Disc Right Nerve Root Left Nerve Root Axial Scans: Spinal Cord
  • 33. Cervical 7 Spinous Process Nerves 2-3 Disc 3-4 Disc 4-5 Disc 5-6 Disc 6-7 Disc
  • 34.
    • Early stages intermittent symptoms (neural inflammation)
    • Activity modification
    • Staying in shape physically/aerobically
    • Bedrest 2-3 days: Avoid longterm bedrest
    • Avoid certain activities : bending,twisting, lifting, unnecessary walking…..Usually eases pain
    • PTherapy: stretching and isometrically strengthening atrophied muscles
    • Modalities: heat, U/S, Whirlpool, massage
  • 35.
    • Avoid Narcotic medications and muscle relaxants (depression/sedation)
    • Anti-inflammatory meds
    • Bracing
    • Epidural steroids and oral steroid ‘dose packs’ relieve pain and inflammation and allow aerobic conditioning and incr fcn
    • All temporary not a cure for stenosis, and gives indication of severity
  • 36.
    • Surgery should be a last resort, when conservatives measures fail.
    • In some cases surgery needs to be done sooner than later, or even urgently, depending on the physical exam, history, neural deficits, and size of the herniation.
  • 37.
    • All the procedure does is increase the space available for the spinal cord
    • Again it does this without fusing the spine whatsoever
  • 38. Joint Facet Disc Right Nerve Root Left Nerve Root This is an Axial view of a normal space around the spinal cord. Notice how much room the Cord has Spinal Cord
  • 39. Joint Facet Disc Right Nerve Root Left Nerve Root This is an Axial view of a normal space around the spinal cord. Notice how much room the Cord has
  • 40. Joint Facet Disc Right Nerve Root Left Nerve Root This is an Axial view of the decreased space around the spinal cord with CSM. Notice how it is now triangular in shape
  • 41. Joint Facet Disc Right Nerve Root Left Nerve Root This is an Axial view of the decreased space around the spinal cord with CSM. Notice how it is now triangular in shape and the Spinal cord looks like a bean
  • 42. Joint Facet Disc Right Nerve Root Left Nerve Root The Laminoplasty seeks to increase the area around the spinal cord here and give the nerves an environment to heal
  • 43. Joint Facet Disc Right Nerve Root Left Nerve Root The way Dr Pazmino performs this is by literally “hinging open “ the bone in the back of the neck called the Lamina Hinge open Here
  • 44. Joint Facet Disc Right Nerve Root Left Nerve Root The way Dr Pazmino performs this is by literally “hinging open “ the bone in the back of the neck called the Lamina Hinge open Here
  • 45. Joint Facet Disc Right Nerve Root Left Nerve Root To keep this hinge open a plate and a piece of bone is placed inside the Hinge to keep this open. This is a Laminoplasty Keep the Hinge open Bone
  • 46. Joint Facet Disc Right Nerve Root Left Nerve Root Small screws are placed into the Lamina and the Lateral masses to keep the Hinge open. This is a Laminoplasty Keep the Hinge open Bone
  • 47. Joint Facet Disc Right Nerve Root Left Nerve Root Now the SPINAL CORD has an environment where it can heal Bone
  • 48. Joint Facet Disc Right Nerve Root Left Nerve Root Now the SPINAL CORD has an environment where it can heal Bone
  • 49.
    • Team approach
    • All procedures are done by two Spinal Surgeons
  • 50.
    • All our procedures are peformed
    • in a minimally invasive manner.
    • All discectomies are performed as a microdiscectomy as opposed to the traditional open discectomy.
    • All patients receive a plastics closure and are followed closely afterwards
  • 51.
    • Thank you for your time.
    • If you know someone who could benefit from a consultation for Laminoplasty please refer them to our online website or call toll free to schedule an appointment
    • 1-8SPINECAL-1
    • www.beverlyspine.com
    • www.santamonicaspine.com

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