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373

. Degenerative Disease ,

. . Cervical Spine

. . . Cervical Disc Herniation

. . . . DefinitionProtrusion o the disc into the spinal canal or oramenwith compression o neural structures.

. . . . Aetiology/EpidemiologyDisc degeneration occurs due to mechanical stress to theannulus resulting in small tears. Part(s) o the nucleusmay protrude through these tears causing compression othe nerve root or spinal cord and subsequent neurologi-cal symptoms (radiculopathy or myelopathy).

. . . . SymptomsPain ul limitation o neck motion with pain aggrava-tion on neck extension.Radiating pain occurs according to the involved spinalnerve root sensory distribution.Arm elevation may relieve the pain.Muscle weakness and diminished reexes accordingto the involved segment (see able 4.3.1).C6/7 is the most requently involved segment ollowedby C5/6.

. . . . Diagnostic ProceduresCMRI (Fig. 4.3.1)(Plain x-ray)

. . . . TherapyNon-operative treatment: immobilisation, physicaltherapy, medications. Te vast majority of patients withacute radiculopathy will improve without surgery.Operative treatment. Indications are: Failed non-operative treatment with persisting

radicular complaints, or severe, disabling radicularpain

Spinal cord dys unction (motor weakness, cervicalmyelopathy)

MRI signs o cervical stenosis and increased signalwithin the spinal cord

Operative techniques: Anterior cervical discectomy and usion (Cloward,

Smith Robinson) with or without plating. Te de-cision about which material is inserted into thedisc space depends on the surgeon. Te use oautologous bone is widely replaced by the use onon-autologous bone graf, hydroxyapatite or cagesderived rom various materials in different shapes(titanium, PEEK, etc.) leading to a decrease indonor site morbidity.

Table 4.3.1 Cervical disc syndromes and clinical signs

Cervical segment

C4/C5 C5/C6 C6/C7 C7/T1

Compressed nerve rootand sensory distribution

C5 C6 C7 C8

Refex diminished Biceps Triceps Finger jerk

Index muscle weakness Deltoid Biceps and brachio-radialis

Triceps Intrinsic hand muscles

Testing Arm abduction > 90 Elbow fexion Elbow extensionFinger extension

Abduction little nger

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374 4.3 Degenerative Disease

. . . Cervical Spondylosis

Cervical spondylosis is sometimes synonymously usedwith cervical spinal stenosis, but implies a more wide-spread condition including various combinations oconditions, e.g. congenital spinal stenosis, ocal stenosisrestricted to the disc space (either disc protrusion [sofdisc] or osteophytic bars [hard disc] and ligamentoushypertrophy.

. . . . DefinitionCervical spondylosis re ers to the bony overgrowths, so-called vertebral osteophytosis, associated with degenera-tive changes due to aging o the spine. It is considered themost common progressive disorder o the aging cervicalspine [2].

Lateral anterior cervical sequestrectomy. Posterior oraminotomy and sequestrectomy

(Scooville, Frykholm). Anterior cervical discectomy and arthroplasty us-

ing articial disc prosthesis (various disc prosthe-ses on the market). Tis non- usion technology wasdeveloped to reduce the incidence o adjacent leveldisease.

. . . . PrognosisUsually very good, 8095% o patients are satisedpostoperatively.Immediate postoperative pain relie occurs afer ad-equate root decompression.Risk o symptomatic adjacent level disease afer ante-rior usion is controversial (about 2.9%/year) [1].

Fig. 4.3.1a,b MRI o the cervical spine. 2-weighted axial (a ) and sagittal ( b ) images depicting a lef-sidedcervical disc herniation