CERVICAL SPONDYLOSIS SYNDROME

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CERVICAL SPONDYLOSIS SYNDROME
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• 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.

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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

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Causes
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• 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.

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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.

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stenosis of the cervical spinal canal.
Pavlov Ratio canal (a) / body (b) lt0.75
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• 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.

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

• Cervical spondylotic radiculopathy (CSR)
• Cervical spondylotic myelopathy (CSM)
• Vertebral artery type of cervical spondylopathy

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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

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brachial plexus
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pathology
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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.

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• Signs
• Stiffness of neck
• Tenderness, spasm of paraspinous muscles
• Limitation of active and passive motion of the
  neck and affected upper extremity.

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Radiographic study
Demonstrate osteophyte formation and narrowing of
intervertebral foramen.
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CT scan
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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

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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

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Signs

• Marked motor changes and relatively few sensory
  changes.
• Hypertonic (high muscular tone)
• hyperreflexia
• Patellar clonus
• Ankle clonus

• Pyramidal tract sign
• Hoffmanns sign
• Babinskis sign
• Obstacle of fine motion of the fingers
• Such as buttons, write

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Calcification of the posterior longitudinal
ligament
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MRI
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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

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Pathology
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• 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

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Treatment
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• 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.

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Nonoperative treatment

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

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Halter traction
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• Cervical collar

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• Analgesics
• NSAIDS
• VOLTAREN
• Tramcontin
• Muscle relaxants

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Operative treatment

• Anterior cervical decompression and fusion (
  ACDF)
• Artificial disc replacement (ADR)
• Laminectomy
• Laminoplasty

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Artificial disc replacement(ADR)
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Posterior approach

• Indications
• Multiple level spondylosis and diffuse spinal
  canal stenosis.
• Methods
• Laminectomy or laminplasty.

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Cervical Spondylosis Prevention

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

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The END!Thank You!

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