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

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)

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

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

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

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

all radiculopathies and myelopathies
based on the severity of clinical findingd and from the proof of compressing structures

for disc herniations, dorsal or lateral osteophytes
bone grafts are placed in the areas around the plates (in order to prevent kyphotization), osteosynthesis

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

ZEMAN, Miroslav. Speciální chirurgie. 2. edition. Praha : Galén, 2004. pp. 575. ISBN 80-7262-260-9.