Cervical Spine Myelopathy & Radiculopathy -

cervical spine myopathy and radiculopathy we will start with cervical myopathy you will have gate disturbance gate disturbance means myopathy once you have gate disturbance this is an indication for surgery you also will have upper motor neuron signs upper extremity weakness the hands are clumsy you got myopathy of the hand the X-ray will show spongiosis and loss of lordosis MRI will show compression of the cervical spinal cord some of these patient will have a lumbar spinal stenosis and they come to you with an MRI but they have gate disturbance check the C spine get an MRI of the C spine the exam may be confusing because they will come with low back pain and positive MRI for lumber stenosis ask them about neck pain and stiffness and if they feel unstable when they walk then examine them for upper motor neuron signs for spicity for hyperlexia for hman sign the presence of this reflex indicates some upper motor neuron lesion due to cervical spinal cord compression for clonus and for biny test gate disturbance can occur in thusc disk which occurs in males you will have pain with radicular symptoms with normal upper extremity exam and you'll have upper motor neuron findings in the lower extremity such as clonus and bonki if you're going to do surgery on cervical myopathy which approach would use you will do anterior approach of the cervical spine when there is a kyotic spinal segment you'll go anterior especially if there is cervical kosis more than 10° because you can correct that anteriorly the airway compromise occurs when the surgery takes more than 5 hours in the upper C spine and more than three levels and more than 300 mL of blood loss you can go posteriorly laminectomy and posterior Fusion but kosis more than 10° is counter indication to going posteriorly you will do this operation for multi-level compression complication from poster approach you can get infection if you do laminectomy alone you will have Progressive kosis C5 nerve root pulsy can occur from anterior or posterior approach nobody knows why it happens the nerve recovers but it takes long time to recover about laminoplasty is not used when there is fixed cervical kosis how about the suat sensory evoke potential it is one of the spinal cord monitor in technique it is positive if 50% decrease in amplitude or 10% increase in latency how about the recurrent Lan nerve vocal code Paralysis on one side will give you horseness the superior Lan nerve will affect the high note phation it can affect singers will be no vocal cord paralysis and usually occur when you deal with upper sepine approaches where the rotation of the C spine mostly occur C1 and C2 about 50% occurs in C1 and C2 how about flexion extension of the c-spine where mostly occurs C4 C5 now let's go to cervical radiculopathy we know that the cervical spine and shoulder problems overlap you know that the condition is of cervical ethology if relief of the pain occurs with shoulder abduction by placing the hand over the head in cervical dis problems be aware of false positive MRIs it usually involve the lower numbered root so if you have C 6 C7 you will get C7 nerve root you will get the middle finger numbness you will get the triceps weakness and triceps reflex will be affected there is an easy way to remember the dermatomes and the muscle function but let's understand the arrangement of these nerve Roots You Got seven vertebrae but eight nerve Roots so what happened the Serv nerve route is horizontal in orientation so it doesn't matter if the desk is Central or the desk is foraminal it will get the same nerve root for example if this is at the level of C6 C7 is going to get C7 nerve root and this nerve root runs above the pedicle so C7 nerve rout runs above C7 pedicle C come to C8 nerve root and this one runs above T1 paricle and then T1 nerve root runs below T1 pedicle so let's start with C7 C7 you'll have the wrist flexion it looks like C7 and you can see that the wrist is flexed and the finger is extended it is the shape of seven that will help you to remember that if the rest flexion is C7 then the rest extension is C6 the finger flexion is C8 abduction is T1 the inter oi is T1 you can add shoulder abduction C5 and elbow flexion will be C6 elbow extension will be C7 and triceps reflex is C7 you can see the dermatomes here C6 is present at the letter six C7 at the middle finger and the fifth finger will be C8 so the patient will come to you with unilateral arm pain relieved by arm elevation and the numbness and the paresthesia will be in a specific dermatomes when you examine the patient you will do the provocative test such as the spilling and the shoulder abduction test even if the show you a bad cervical spine disc on an MRI you will treat it conservatively for about 3 months you give the patient therapy and nonsteroidal anti-inflammatory medication 75% of the patient will improve with nonoperative treatment when do you do the surgery when you have persistent pain for 6 to 12 weeks and Progressive neurological deficit thank you very much I hope that was helpful

Channel: nabil ebraheim

Views: 11,106

Keywords: cervical spine, myelopathy, radiculopathy, injury, spinal cord, compression, signs, symptoms, diagnosis, managment

Id: aSXZCtoQNB0

Length: 9min 50sec (590 seconds)

Published: Mon Oct 09 2023