Cervical Spondylosis Syndrome

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Cervical Spondylosis Syndrome

  1. 1. CERVICAL SPONDYLOSIS SYNDROME
  2. 2. 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.
  3. 3. 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
  4. 4. Causes d e g e n er a io n o f IV D b u l g e o r e x tr u s i o n o f I V D N a r r o w e d o f i n te r ve r te b r a l s p a c e l i g a m e n t l ax u n s tab l e of th e s p i n e h y p e r p l a si a o f v e r te b r a l b o d y, fa c e t jo i n ts, l i g a m e n ts c o m p r e s s i on to sp i n a l c o r d , n e r v e r o o ts, v e r te b r a l ar te r y
  5. 5. • 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.
  6. 6. 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.
  7. 7. stenosis of the cervical spinal canal. Pavlov Ratio: canal (a) / body (b) <0.75
  8. 8. • 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.
  9. 9. As you age, the disks of your spine become drier and less elastic.
  10. 10. Classification & clinical findings • Cervical spondylotic radiculopathy (CSR) • Cervical spondylotic myelopathy (CSM) • Vertebral artery type of cervical spondylopathy
  11. 11. 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
  12. 12. brachial plexus
  13. 13. pathology
  14. 14. 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.
  15. 15. • Signs –Stiffness of neck –Tenderness, spasm of paraspinous muscles –Limitation of active and passive motion of the neck and affected upper extremity.
  16. 16. Radiographic study Demonstrate osteophyte formation and narrowing of intervertebral foramen.
  17. 17. CT scan
  18. 18. 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
  19. 19. Clinical manifestation • Symptoms – Numbness – Weakness – Dysfunction of – Loss of balance upper motor neuron – Cannot handling small is gradually present objects from the lower part – Neck pain not obvious of body to the upper. – Spastic paraplegia or quadriplegia -loss of control of the bladder or bowels
  20. 20. Signs • Marked motor • Pyramidal tract sign changes and – Hoffmann’s sign relatively few – Babinski’s sign sensory changes. – Obstacle of fine – Hypertonic (high motion of the fingers muscular tone) Such as buttons, – hyperreflexia write – Patellar clonus + – Ankle clonus +
  21. 21. Calcification of the posterior longitudinal ligament
  22. 22. MRI
  23. 23. 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
  24. 24. Pathology
  25. 25. • 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
  26. 26. Treatment
  27. 27. • 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.
  28. 28. Nonoperative treatment • Halter traction • Cervical support and collar • Massage • Physical therapy • Analgesics and muscle relaxants • Local block
  29. 29. Halter traction
  30. 30. • Cervical collar
  31. 31. • Analgesics – NSAIDS • VOLTAREN • Tramcontin • Muscle relaxants
  32. 32. Operative treatment • Anterior cervical decompression and fusion ( ACDF) • Artificial disc replacement (ADR) • Laminectomy • Laminoplasty
  33. 33. Artificial disc replacement (ADR)
  34. 34. Posterior approach • Indications • Multiple level spondylosis and diffuse spinal canal stenosis. • Methods Laminectomy or laminplasty.
  35. 35. Cervical Spondylosis Prevention • Many cases are not preventable. Prevention of neck injury (such as proper equipment and techniques when playing sports) may reduce risk.
  36. 36. The END! Thank You! ! Oh, sorry, not the END, just the beginning Email: misbahul_ferdous@yahoo.com house no: 26. house name:TAKHDIR. SUGANDHA. R/A ,CHITTAGONG BANGLADESH 46

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