NSA Cervical Radiculopathy

8/2/2019 NSA Cervical Radiculopathy

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Options for the treatment of

Cervical Radiculopathy

and recent changes in management

Dr Jonathon BallFRACS BMed BMedSc(Hons)

GradDipBiomedE

www.neurospine.com.au


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Source : http://www.myspinetools.com/education/anatomy_pathology/cervical.html, accessed September 7, 2011 ( Rauschning)

Surgery vs ConservativeAnterior vs Posterior

Anterior fusion vs disc replacement


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Options 3 principles

Adequate nerve decompression With minimal trauma With motion preservation


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Outline Recent literature

NASS evidence based guidelines (2010) Neurosurgery Cervical Spondylosis Supplement (2007)

Novel techniquesAnterior cervical foraminotomy Posterior facet distraction Minimally invasive posterior foraminotomy


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NASS CLINICAL GUIDELINES (2010) Evidence Based Guidelines


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Source : http://www.spine.org/Documents/Cervical_Radiculopathy.pdf, accessed September 8, 2011


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Natural History



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Diagnosis



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Diagnosis



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Treatment



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Treatment



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Treatment



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Treatment - Surgery



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Treatment - Surgery



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NOVEL TECHNIQUES


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MIS FORAMINOTOMYNovel Techniques


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Source : Jonathon Ball


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18 mm Metrx tube

disc

root

cord



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ANTERIOR CERVICAL FORAMINOTOMYNovel Techniques


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Source : Jho, H-D. J Neurosurg. 84:166-160 (1996)


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Source : Jho, H-D. et al. Neurosurgery. 51(S2):46-53 (2002).


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Source : Jho, H-D. J Neurosurg. 84:166-160 (1996)


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POSTERIOR FACET DISTRACTIONNovel Techniques


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Source : Goel, A. & Shah A.J Neurosurg Spine. 14:689-696 (1996)


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Summary Perennial arguments re: cervical radiculopathy

Based on three principles Neural decompression Minimal trauma Motion preservation

Led to novel techniques and approaches Increased focus on evidence led to guideline

development


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Thankyou


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Case 1 77 M several years of left

shoulder weakness new neck and

shoulder pain


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Case 1


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Case 1 Options

Multilevel ACDF Multilevel posterior

foraminotomy laminectomy/rhizolysis +/- fusion

Conservative management Injections Physiotherapy Pain clinic


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Case 1 Multilevel ACDF Increased weakness

Elbow flexion Wrist extension Finger extension

Repeat EMG and CT


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Case 1


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Case 2 53 F several months of left

upper extremity pain


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Case 2