Cervical radiculopathy is pain caused by compression or irritation of cervical nerve roots. It commonly affects the C7 and C6 nerve roots and symptoms include pain and sensory or motor changes in the upper extremities. While most cases resolve within 3 months with conservative treatment like NSAIDs, oral steroids, or gabapentin, surgery may be considered for worsening symptoms. Minimally invasive posterior cervical foraminotomy has been shown to effectively treat radiculopathy with low complication rates and reduced need for further surgery compared to other options like anterior cervical discectomy and fusion.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
This ppt describes various movement disorders found commonly in elderly persons. It also describes hyper and hypokinetic disorder categorization with cause and pathophysiology of movement disorders.
This presentation looks at the role of Pregabalin in refractory trigeminal neuralgia and chemotherapy induced peripheral neuropathy through illustrative case studies.
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. DEFINITION
Pain in a radicular pattern in one or both
upper extremities related to compression
and/or irritation of one or more cervical
nerve roots.
Frequent signs and symptoms - sensory,
motor and reflex changes as well as
dysesthesias and paresthesias related to
nerve root(s) without evidence of spinal
cord dysfunction (myelopathy).
(North America Spine Society Working Group) 2
3. EPIDEMIOLOGY
• Incidence: 85 per 100,000
• Peak incidence 5th decade
• C7 nerve root (60%)
• C6 nerve root(25%)
Risk factors
• Manual labor involving heavy lifting, driving, or operation of vibrating
equipment, golf, chronic smoking.
3
4. PATHOPHYSIOLOGY
• Key pathophysiologic feature is inflammation
• Cytokine-mediated response leads to a decrease in the number
of large-diameter myelinated axons.
• Acute radiculopathy ----predominant motor findings.
• Chronic radiculopathy ------predominantly sensory findings
and is more commonly seen in older patients.
4
5. PATHOPHYSIOLOGY
• From a pathologic perspective, chronic radiculopathy
often has
• disk pathology
• facet arthropathy and,
• uncovertebral osteophytes.
5
6. SIGNS AND SYMPTOMS
Pain or paresthesia in a
• dermatomal pattern 54%,
• diffuse or non dermatomal pattern 46%
Clinical findings related to the fingers are
the most accurate for localizing a disc to a
single level
A single level disc may produce signs and
symptoms that correspond to overlapping
dermatomal levels.
Henderson CM, Hennessy RG, Shuey HM, Jr., Shackelford EG. Posterior-lateral foraminotomy as an exclusive operative technique
for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. Nov1983;13(5):504-512.
6
7. PROVOCATIVE TESTS
Spurling test (foraminal compression test)
• Probably the best test for confirming the diagnosis of cervical radiculopathy.
• Neck extended head rotated and applying downward pressure on the head
• Specificity (93%), Sensitivity (30%)
• Not a good screening test, but it clinically useful in helping to confirm
• Shoulder Abduction test(relief)
• Axial Manual distraction test
• Upper limb manual traction test( similar to SLRT in Lower
limbs)
• Valsalva maneuver 7
8. RADICULOPATHY MIMICKERS
• Carpel Tunnel Syndrome: positive NCS, thenar muscle wasting, positive
phalen’s sign
• PIN(Posterior Interosseus Nerve ) syndrome vs C7 radiculopathy:
sensory intact, normal triceps and wrist flexors in PIN
• Cubital tunnel syndrome vs C8 radiculopathy: intact adductor pollicis in
C8
• Brachial plexus neuritis(Parsonage turner): pain followed by weakness
esp C5/6 after few days as pain subsides in neuronitis vs together in
radiculopathy
8
10. MISSED DERMATOMES
• It is important to consider C3 and C4 radiculopathy as a potential cause of
trapezoidal and posterior scapular pain because it can be overlooked and
grouped into chronic axial neck pain.
• Suprascapular: C5 and C6
• Infra and interscapular: C7 and C8
10
11. IMAGING
• Xray: AP/Oblique views
• CT:
• MRI:
MRI is considered the imaging method of choice for the
evaluation of cervical radiculopathy.
< 40 years : 10% have disc herniations;
>40 years, 20% have evidence of foraminal stenosis and 8%
had disc protrusion or herniation.
11
14. ELECTRODIAGNOSIS
• Positive sharp waves and fibrillation potentials : 18-21 days
after the onset of a radiculopathy
• EMG is to confirm nerve root dysfunction when the
diagnosis is uncertain / when the physical examination
findings are unclear.
• Normal EMG results in a patient with signs and symptoms
does not exclude the diagnosis of cervical radiculopathy.
14
15. TREATMENT
• There is no clear evidence that surgical treatment of cervical radiculopathy
provides better long-term outcomes than nonoperative measures.
Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders
• Over 85% of acute cervical radiculopathy resolves without any
specific treatments within 8-12 weeks
• NSAIDs for 1 to 2 weeks
• Oral steroids
• Tricyclic antidepressants
• Gabapentin/Pregabalin can be useful adjuncts in the treatment of cervical
radiculopathy
• Methylcobalamin (??)
15
16. TREATMENT
• Over 85% of acute cervical radiculopathy resolves without
any specific treatments within 8-12 weeks
• NSAIDs for 1 to 2 weeks
• Oral steroids
• Tricyclic antidepressants
• Gabapentin/Pregabalin can be useful adjuncts in the
treatment of cervical radiculopathy
• Methyl cobalamin (vitamin B12): ??
16
17. ORAL STEROIDS
• Randomized, double-blinded, placebo-controlled trial
• 50mg/day for 5 days and tapered over 5 days
• Decrease in NDI and VRS more in prednisolone group
Ghasemi M, Masaeli A, Rezvani M, Shaygannejad V, Golabchi K, Norouzi R. Oral prednisolone in
the treatment of cervical radiculopathy: a randomized placebo controlled trial. J Res Med Sci
2013;18:S43-6.
17
18. TRANSLAMINAR/TRANSFORAMINAL
STEROIDS
• Relief from a single treatment can be significant and long-
lasting.
• Half of the patients : relief of at least 50% for weeks following
injection
• Complication rates - 0% and 16.8%
• Complications can be devastating; brainstem or spinal cord
sequelae
Carragee EJ, Hurwitz EL, Cheng I, Carroll LJ, Nordin M, Guzman J, Peloso P, Holm LW, Côté P, Hogg-Johnson S, van der Velde G, Cassidy JD,
Haldeman S; Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Treatment of neck pain: injections and
surgical interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa
1976). 2008 Feb 15;33(4 Suppl):S153-69.
18
19. COLLAR?
• A cervical collar and rest for three to six weeks or
physiotherapy accompanied by home exercises for
six weeks reduced neck and arm pain substantially
compared with a wait and see policy in the early phase
of cervical radiculopathy
• Cervical collar - only for a few days to avoid deconditioning and
atrophy, converting a potentially self-limited process to a more
chronic condition
Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical
radiculopathy: randomised trial. BMJ 2009;339:b3883
19
20. TRACTION
• Commonly used - efficacy not been proved.
• The current literature does not support or refute the
efficacy or effectiveness of continuous or intermittent
traction for pain reduction, improved function or global
perceived effect
Graham N, Gross A, Goldsmith C, et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database
Syst Rev 2008;(3):CD006408
20
21. TENS
• Transcutaneous electrical nerve stimulation (TENS)
has also had mixed reviews.
• Studies have been inconsistent and conclusions
regarding its use in acute pain have not been
reached.
21
22. SURGERY
• Surgery: for worsening neurology/pain not controlled by conservative
means
• Meta-analysis of RCTs
• ACDF/ cervical disc replacement(CDR) /minimally invasive PCF: all
effective
• CDR - lowest rate of secondary surgical procedures (P=.0178)
• Minimally invasive posterior cervical foraminotomy - lowest percentage of
adverse events (P< .0001),
• No single technique proved to be the most effective.
Gutman G, Rosenzweig DH, Golan JD. Surgical Treatment of Cervical Radiculopathy: Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa
1976). 2018 Mar 15;43(6):E365-E372
22
25. PCF(POSTERIOR CERVICAL
LAMINOFORAMINOTOMY)
Cost effective
• A low rate (∼1%) of need for future index-level surgery and a
• < 1% rate of development of symptomatic adjacent-level disease : mean 32-
month follow-up.
Limitations :
• prohibitive risk for addressing more ventral disease,
• failure to address cervical kyphosis
• difficulty with addressing bilateral disease.
• Skovrlj B, Gologorsky Y, Haque R, et al. Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J. 2014;14:2405–
2411.
25
26. TAKE HOME MESSAGE
26
• Most of cervical radiculopathy is managed by non surgical means
• Comprehensive team care in association with physiotherapists and pain
physicians will improve outcome
• Minimal Invasive Posterior cervical foraminotomy can have good results
without need for implants and possible adjacent level degeneration
Disc herniation is responsible for only 21.9% of cervical radiculopathy cases
less commonly caused by tumors, trauma, synovial cysts, meningeal cysts, dural arteriovenous fistulae or tortuous vertebral arteries