Degenerative spine disease

Question 1

What is spondylosis?

Answer 1

Degenerative, or age-related, changes in the spine

Question 2

What is cervical spondylotic myelopathy?

Answer 2

It is spondylosis where myelopathy has occured. (spinal cord damage)

Question 3

how is cervical spondylotic myelopathy measured and treated?

Answer 3

That is dependent on mJOA score.

Question 4

What 4 entities are measured using mJOA?

Answer 4

• Upper limb motor 5-0
• lower limb motor 7-0
• upper limb sensory 3-0
• Sphincter. 3-0

Question 5

How to interpret the score of mJOA?

Answer 5

low scores are worse.
18p= no problem.
17-15 mild
14-12 moderate
11-0 severe
“every day examples of how the DCM is affecting you.

Question 6

How common is CSM?

Answer 6

An estimated incidence of over 50% in patients over 40yo according to WFNS.

Question 7

What is the evidence for non-operative strategies regarding CSM?

Answer 7

Its poor. Nothing can be recomended.

Question 8

It has been difficult due to poor science, to recomend surgery cut offs. but what are the rec. from 2019 WFNS spine?

Answer 8

Surgical intervention is rec. for pt moderate to severe mJOA score (under 15p)

Question 9

Great risk with laminectomy without fusion in a cervical spondylotic myelopathy?

Answer 9

Swan neck deformity.

Question 10

Perhaps an anterior approach is better for cervical spondylotic myelopathy…..what approaches are possible?

Answer 10

2 level ACDF and plate equals 1 level corpectomy and plate.

Question 11

What are the two late risks after surgery of cervical spondylotic myelopathy?

Answer 11

1. adjacent level disease 25% about 10 years after surgery (most asymptomatic)
2. 20% develop unexplained late deterioration clinically 7-12 years after surgery. (w/o radiological findings)

Question 12

WHat is adjacent segment disease?

Answer 12

Degeneration at the segment below fusion where motions still are.
Very common radiologically but most are thankfully asymptomatic.

Question 13

What is thoracic and lumbar degenerative disc disease?

Answer 13

Same as CSM but different anatomy.
Most common is L4-5, 2nd most common is L3-4

Question 14

What is the differential to neurogenic claudicatio?

Answer 14

Vascular claudicatio - but neurogen is recived while sitting or lying.

Question 15

What is lateral recess syndrome?

Answer 15

Hypertrophy of the superior articular facet compressing the nerve root en passage - L4 and L5 are the most commonly involved facets.

Question 16

In lateral recess stenosis, what descending nerve root would be involved in a L4-L5 subarticular recess stenosis?

Answer 16

The descending L5 nerve root.

Question 17

What might be involved in foraminal stenosis?

Answer 17

• disc protrusion
• spondylolisthesis
• facet hypertrophia
• disc space collapse
• juxtafacet cysts

Question 18

What nerve is causing radiculopthay on a L5-S1 foraminal stenosis?

Answer 18

L5.

Question 19

What nerve is causing radiculopathy in a L4-L5 central stenosis?

Answer 19

L5

Question 20

In spondylolisthesis, what vertebra is subluxed anteriorly?

Answer 20

The upper (usually L5) is anterior to the lower (S1).

Question 21

What groups of pt get spondylolisthesis?

Answer 21

• YOuths with sports causing repetetive extension - rest for months.
• congenital
• acromegaly
• Padgets disease
• Ancylosing spondylisis
• OPLL

Question 22

What are the options of surgery for degeneration in the lumbar region

Answer 22

Option 1:
*Lateral interbody fusion - XLIF, DLIF
or
*ALIF
or
*Interspinous decompression
Option 2:
*Laminectomy
*fusion.

Question 23

When can anterior or lateral surgery be an option?

Answer 23

When there is disc space compression so something can be lifted.
-foraminal stenosis, loss of discspace, facet hypertrophy.

Question 24

When is fusion an option in the lumbar region?

Answer 24

In spondylolisthesis.

Question 25

WHen can stability be considered OK in the lumbar region without fusion?

Answer 25

If more than 50-60% of the facets are intact and disc-space not violated.