Cervical Spine Myelopathy & Radiculopathy скачать в хорошем качестве

Cervical Spine Myelopathy & Radiculopathy

Join this channel to get access to perks:    / @nabilebraheim   Cervical spine myelopathy results from compression of the cervical spinal cord. A hallmark clinical sign is gait disturbance, which is considered a surgical indication. Plain radiographs may demonstrate cervical spondylosis and loss of normal cervical lordosis. MRI is the gold standard and typically reveals spinal cord compression. Some patients may also have concurrent lumbar spinal stenosis and initially present with an MRI of the lumbar spine, reporting gait instability. In such cases, always evaluate the cervical spine with MRI, especially when gait disturbance is present. These patients often have low back pain and imaging confirming lumbar spinal stenosis, but the primary cause of gait dysfunction may actually be cervical myelopathy. Therefore, it is essential to inquire about neck pain and stiffness, as well as sensations of unsteadiness while walking. During physical examination, assess for upper motor neuron (UMN) signs, including spasticity, hyperreflexia, a positive Hoffman’s sign, sustained clonus, and a Babinski reflex—all suggestive of spinal cord compression at the cervical level. Gait disturbance can also occur with thoracic disc herniations, which are more common in males. These patients typically report radicular pain, have a normal upper extremity exam, but exhibit UMN signs in the lower extremities, such as clonus and Babinski reflex. Surgical intervention is usually performed via an anterior approach, particularly in cases with cervical kyphosis exceeding 10 degrees, as this approach allows for deformity correction. Although a posterior approach (laminectomy with posterior fusion) is an option, kyphosis greater than 10 degrees is a contraindication to the posterior-only approach due to risk of further deformity. Posterior surgery is generally used for multilevel decompressions. Postoperative infection is more commonly associated with the posterior approach. Performing a laminectomy alone (without fusion) may result in progressive kyphotic deformity. C5 nerve root palsy is a known complication of both anterior and posterior cervical spine surgeries. The exact mechanism is unclear, but it often resolves gradually over time. Injury to the recurrent laryngeal nerve (RLN) during anterior cervical approaches may lead to unilateral vocal cord paralysis and hoarseness. Damage to the superior laryngeal nerve (SLN), often during upper cervical procedures, affects the ability to produce high-pitched sounds—important for singers—without causing vocal cord paralysis. Approximately 50% of cervical rotation occurs between the C1 and C2 vertebrae. Most flexion and extension occur at the C4-C5 level. Cervical radiculopathy refers to pain and neurological symptoms due to nerve root irritation, often from a herniated disc. Symptoms frequently overlap with those from shoulder pathology. A key diagnostic clue is that pain may be alleviated by shoulder abduction or resting the hand on the head—this is known as the shoulder abduction relief sign. Caution is necessary when interpreting cervical spine MRIs due to the possibility of false positives. Cervical disc herniation usually affects the nerve root at the level below the disc. For example, compression of the C7 nerve root results in numbness of the middle finger, triceps weakness, and diminished triceps reflex. Cervical nerve roots exit in a horizontal orientation, so whether a disc herniation is central or foraminal, the same nerve root is affected. The C7 nerve root passes just above the pedicle of the C7 vertebra. Patients often present with unilateral arm pain that improves with arm elevation. Paresthesia and sensory loss follow distinct dermatomal patterns. On physical exam, perform provocative maneuvers such as Spurling’s test and the shoulder abduction test. Even in the presence of significant disc pathology on MRI, initial treatment should be conservative. Recommend physical therapy and NSAIDs for approximately 3 months. About 75% of patients improve without surgery. Operative treatment is indicated for patients who experience worsening symptoms over 6–12 weeks or develop progressive neurological deficits. Quizzes 1. What is a hallmark clinical sign of cervical myelopathy that often prompts surgical intervention? A) Shoulder pain B) Gait disturbance C) Headaches D) Night sweats Correct Answer: B Explanation: Gait disturbance indicates spinal cord compression and is a key surgical indication in cervical myelopathy. 2. What imaging study best reveals cervical spinal cord compression? A) CT scan B) X-ray C) MRI D) Bone scan Correct Answer: C Explanation: MRI is the gold standard for evaluating spinal cord compression. 3. A patient presents with low back pain, lumbar stenosis on MRI, and gait instability. What should you also evaluate? A) Thoracic spine X-ray B) Cervical spine MRI C) Hip joint D) Sacroiliac joint Correct Answer: B