CERVICAL SPONDYLOSIS SYNDROME

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.

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

Causesb u lg e o r e x tru s io n o f IV D

c o m pr e ss ion to sp in a l c o r d ,n e r v e r o o ts,

v e r teb r a l ar te ry

h y p e rp la sia o f v e r teb r a l b o d y,fa c e t jo in ts, l ig a m e n ts

u n stab le of th e sp ine

lig a m e n t lax

N a r ro w e d o f in te r ve r teb r a l sp a ce

d e g e n er a io n o f IV D

• 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.

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.

stenosis of the cervical spinal canal.

Pavlov Ratio: canal (a) / body (b) <0.75

• 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.

As you age, the disks of your spine become drier and less elastic.

Classification & clinical findings

• Cervical spondylotic radiculopathy (CSR)

• Cervical spondylotic myelopathy (CSM)

• Vertebral artery type of cervical spondylopathy

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

brachial plexus

pathology

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.

• Signs–Stiffness of neck–Tenderness, spasm of paraspinous

muscles–Limitation of active and passive

motion of the neck and affected upper extremity.

Radiographic study

Demonstrate osteophyte formation and narrowing of intervertebral foramen.

CT scan

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

Clinical manifestation• Symptoms– Weakness– Loss of balance– Cannot handling small objects– Neck pain not obvious

– Numbness– Dysfunction of upper motor neuron

is gradually present from the lower part of body to the upper.

– Spastic paraplegia or quadriplegia-loss of control of the

bladder or bowels

Signs• Marked motor

changes and relatively few sensory changes.– Hypertonic (high

muscular tone)– hyperreflexia– Patellar clonus +– Ankle clonus +

• Pyramidal tract sign– Hoffmann’s sign– Babinski’s sign– Obstacle of fine

motion of the fingers Such as buttons,

write

Calcification of the posterior longitudinal ligament

MRI

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

Pathology

• 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

Treatment

• 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.

Nonoperative treatment

• Halter traction• Cervical support and collar• Massage• Physical therapy• Analgesics and muscle relaxants• Local block

Halter traction

• Cervical collar

• Analgesics–NSAIDS• VOLTAREN• Tramcontin

• Muscle relaxants

Operative treatment

• Anterior cervical decompression and fusion ( ACDF)

• Artificial disc replacement (ADR)• Laminectomy• Laminoplasty

Artificial disc replacement(ADR)

Posterior approach

• Indications• Multiple level spondylosis and diffuse

spinal canal stenosis.

• MethodsLaminectomy or laminplasty.

Cervical Spondylosis Prevention

• Many cases are not preventable. Prevention of neck injury (such as proper equipment and techniques when playing sports) may reduce risk.

The END!Thank You!

Oh, sorry, not the END, just the beginning!

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Email: misbahul_ferdous@yahoo.com house no: 26. house name:TAKHDIR.SUGANDHA. R/A ,CHITTAGONG BANGLADESH