Degenerative diseases of the cervical spine

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Degenerative diseases of the spine, generally[edit | edit source]

  • 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[edit | edit source]

X-ray – degenerative diseases of the cervical 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[edit | edit source]

Diagnosis[edit | edit source]

  • 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[edit | edit source]

  • 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

Links[edit | edit source]

External links[edit | edit source]

Sources[edit | edit source]

Literature used[edit | edit source]

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