Presented by: Dr Paul Licina — Spine Surgeon Event: Bone School Presentation - 2014

1. ASSESSMENT OF THE
CERVICAL SPINE
IN DEGENERATIVE
PATHOLOGIES
Paul Licina

2. EXAMINATION

3. LOOK

4. deformity
wasting
swelling

7. FEEL

8. masses
tenderness

9. MOVE

10. pain
stiffness
asymmetry

12. NEURO

13. power
sensation
reflexes

14. NEURO

15. power
reflexes
sensation

17. SPECIAL

18. Spurling’s

20. L’hermitte’s

22. Hoffman’s

24. Adson’s

26. DIRECTED

27. lower limb
neuro

28. peripheral
neuro

29. shoulder

30. IMAGING

31. plain x-ray
CT
MRI
nuclear

32. RADICULOPATHY

33. radiculopathy
vs peripheral

36. timing of
surgery

37. fusion
vs TDR

38. MYELOPATHY

39. significance of
myelomalacia

42. timing of
surgery

43. Timing of surgery
Cervical
myelopathy
surgical
aspects
•surgery indicated if
•established myelopathy with symptoms and signs
•aim is to halt progression
•hope is to reverse deficit
•earlier intervention gives better results
•even severe deficit may improve
•early myelopathy with documented progression
•? subtle symptoms with no signs and only early MRI changes

44. anterior or
posterior

45. What is the treatment?
Cervical
myelopathy
surgical
aspects
anterior discectomy
and fusion
anterior corpectomy
and fusion
posterior laminectomy
posterior laminectomy
and fusion
posterior laminoplasty
D
E
C
O
M
P
R
E
S
SI
O
N

46. Anterior surgery
Cervical
myelopathy
surgical
aspects
Advantages
• approach pathology directly
• can decompress central and
foraminal stenosis
• can effectively stabilise the
segment in lordosis
• approach is easy and well
tolerated

47. Anterior surgery
Cervical
myelopathy
surgical
aspects
Disadvantages
• osteophytes difficult to deal with
• multiple levels more difficult
• risks of
• dysphagia / oesophageal injury
• recurrent laryngeal nerve injury
• neurological injury
• vascular injury
• adjacent degeneration may occur

48. Posterior surgery
Cervical
myelopathy
surgical
aspects
Advantages
• multiple levels easily addressed
• usually reserved for 3 or
more levels
• no risk to vital anterior
structures
• less risk of neurological injury
• can avoid fusion

49. Posterior surgery
Cervical
myelopathy
surgical
aspects
Disadvantages
• less effective in kyphosis as
relies on posterior cord ‘drift’
• can result in kyphosis (10-50%)
• increased pain from approach
• dura exposed with possible
peridural scar

50. Choice of approach
Cervical
myelopathy
surgical
aspects
ANTERIOR POSTERIOR
one or two levels more than three levels
kyphosis lordosis
disc prolapse osteophytes