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 feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1

1. Pablo Pazmi ño, MD

5. 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

11. October 24,1892 20 YO “builder who under the influence of alcohol, fell off his van on to the road striking his right shoulder.” Over 2month this man gradually lost control of legs and sphincters Dr Horsley performed the First Laminectomy of 6 th Cervical Vertebra. Oct 1892 During surgery he saw the Spinal cord was compressed by a ridge projecting backwards from the body of the vertebra. After surgery the patient had a Complete recovery by September of that year

15. Mechanical Factors Static Canal Stenosis Severity Cmprsn Dynamic Changes Flexion Changes Extension Role of Ischemia Pathological Evidence Central gray and medial white most severely affected Relative sparing of anterior columns Progression with severity Lateral CSpinal Tracts most vulnerable Ant Horn Cells less infarction Extensive Infarct Gray and White with AP Cmpr<20% Cellular and molecular mechanisms Free radical mediated cell injury Cation-mediated cell injury (Na + /Ca ++ ) Glutamatergic toxicity/cell injury Apoptosis

19. Cord compression ratio remains<0.4 Smallest AP Diam/Largest Trans Fujiwara JBJS BR ‘89

26. Dynamic Stenosis Pincer Effect Euler’s Theorum Shear /Stretch Principle (Out of Plane Loading Poisson’s Effect Dentate Tension Theory

56. Grip-and-release test. Normal adults can perform rapid complete grip and release to full finger extension 20 times in 10 seconds. This not only becomes slower but, in advanced cases, exaggerated wrist flexion occurs with attempted finger extension and exaggerated wrist extension occurs with finger flexion.

58. It suggests compression in the upper cervical spine (C2-C4). Concept that compression of the spinal cord above the level of the innervating roots of the reflex should prevent the normal descending inhibition of the spinal reflexes, resulting in hyperreflexia. It does not exclude coexisting compression at lower levels

84. Axial C5-6 2 3 4 5 6

88. 2 4-5 4 5 6 5-6

92. 4

104. Hoffmans + Gait Weakness Prox Neck Pain Hyper reflexic Myelo Hand Babinski