Degenerative diseases of the cervical spine

Degenerative diseases of the spine, generally

 * one of the most common causes of incapability to work, often leading to disability
 * these changes are only solved by a neurosurgeon if they cause compression of nerve structures
 * it manifests with irritant or extinct neurologic symptomatology
 * the only thing that will be achieved through surgery is the decompression of structures, restoration of functions will occur only when the spinal cord is not yet irreversibly damaged
 * pathogenesis – degeneration occurs on all structures of the vertebrae – intervertebral disc – breakdown of collagen fibers, decrease in water, decrease in elastic fibers, cracks and tears form, breakdown into sequesters, osteophytes form on bones, …
 * in addition to disc herniation (this is most frequent), bone  apposition is also involved in compression

Cervical part of the spine

 * disc herniation occurs, productive changes,… and subsequently canal stenosis or foramin compression
 * prolapse is manifested by a rather sudden, rapidly progressing symptomatology, productive changes usually have chronic symptoms
 * vertebral syndrome – restriction of cervical spine mobility, blockages, contractures, pain
 * characteristic symptom of disc herniation – so called decharge electrique (Lhermitt's symptom) – when the head is tilted forward an electric shock is felt along the spine
 * compression is mainfested by spinal root syndrome (radiculopathy) and spinal cord compression (myelopathy)


 * cervical root syndromes – cervicobrachial syndromes
 * irritant radicular symptoms - painful radiation to the appropriate dermatome in the upper extremities
 * extinction symptoms, motoric and sensitive


 * myelopathy – compression is from the front (either by a disc or osteophytes) – therefore motorics are mainly affected
 * sensation is only affected by an extensive compression
 * under the site of compression – clinical image of central paresis – hyperreflexia, spasticity, pyramidal irritations

Differential diagnosis

 * some primary spinal cord diseases may have a similar picture (MS, amyotrofic lateral sclerosis)

Diagnosis

 * X-ray shows osteophytes, dynamic images show instability (when bend forward and backword, …)
 * CT – size of osteophytes and channel narrowing, yield improves with intrathecal contrast (CT–PMG)
 * MRI – for detection of disc herniation

Treamtent

 * indications
 * absolute
 * acute, sudden onset or rapidly progressing compression syndrome
 * causes – medial disc herniation
 * immediate surgery, irreversible changes occur very quickly, metylprednizon should be administered as soon as possible
 * relative
 * all radiculopathies and myelopathies
 * based on the severity of clinical findingd and from the proof of compressing structures


 * types of surgeries
 * anterior approach
 * for disc herniations, dorsal or lateral osteophytes
 * bone grafts are placed in the areas around the plates (in order to prevent kyphotization), osteosynthesis
 * posterior approach
 * reserved for multi-storey stenoses, where in addition to osteophytes, there also is a congenital narrowing of the canal
 * decompression of laminectomies, durotomies and release of the dentate ligament
 * rarely performed today