Degenerative spine disease Flashcards
What is spondylosis?
Degenerative, or age-related, changes in the spine
What is cervical spondylotic myelopathy?
It is spondylosis where myelopathy has occured. (spinal cord damage)
how is cervical spondylotic myelopathy measured and treated?
That is dependent on mJOA score.
What 4 entities are measured using mJOA?
- Upper limb motor 5-0
- lower limb motor 7-0
- upper limb sensory 3-0
- Sphincter. 3-0
How to interpret the score of mJOA?
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.
How common is CSM?
An estimated incidence of over 50% in patients over 40yo according to WFNS.
What is the evidence for non-operative strategies regarding CSM?
Its poor. Nothing can be recomended.
It has been difficult due to poor science, to recomend surgery cut offs. but what are the rec. from 2019 WFNS spine?
Surgical intervention is rec. for pt moderate to severe mJOA score (under 15p)
Great risk with laminectomy without fusion in a cervical spondylotic myelopathy?
Swan neck deformity.
Perhaps an anterior approach is better for cervical spondylotic myelopathy…..what approaches are possible?
2 level ACDF and plate equals 1 level corpectomy and plate.
What are the two late risks after surgery of cervical spondylotic myelopathy?
- adjacent level disease 25% about 10 years after surgery (most asymptomatic)
- 20% develop unexplained late deterioration clinically 7-12 years after surgery. (w/o radiological findings)
WHat is adjacent segment disease?
Degeneration at the segment below fusion where motions still are.
Very common radiologically but most are thankfully asymptomatic.
What is thoracic and lumbar degenerative disc disease?
Same as CSM but different anatomy.
Most common is L4-5, 2nd most common is L3-4
What is the differential to neurogenic claudicatio?
Vascular claudicatio - but neurogen is recived while sitting or lying.
What is lateral recess syndrome?
Hypertrophy of the superior articular facet compressing the nerve root en passage - L4 and L5 are the most commonly involved facets.
In lateral recess stenosis, what descending nerve root would be involved in a L4-L5 subarticular recess stenosis?
The descending L5 nerve root.
What might be involved in foraminal stenosis?
- disc protrusion
- spondylolisthesis
- facet hypertrophia
- disc space collapse
- juxtafacet cysts
What nerve is causing radiculopthay on a L5-S1 foraminal stenosis?
L5.
What nerve is causing radiculopathy in a L4-L5 central stenosis?
L5
In spondylolisthesis, what vertebra is subluxed anteriorly?
The upper (usually L5) is anterior to the lower (S1).
What groups of pt get spondylolisthesis?
- YOuths with sports causing repetetive extension - rest for months.
- congenital
- acromegaly
- Padgets disease
- Ancylosing spondylisis
- OPLL
What are the options of surgery for degeneration in the lumbar region
Option 1:
*Lateral interbody fusion - XLIF, DLIF
or
*ALIF
or
*Interspinous decompression
Option 2:
*Laminectomy
*fusion.
When can anterior or lateral surgery be an option?
When there is disc space compression so something can be lifted.
-foraminal stenosis, loss of discspace, facet hypertrophy.
When is fusion an option in the lumbar region?
In spondylolisthesis.
WHen can stability be considered OK in the lumbar region without fusion?
If more than 50-60% of the facets are intact and disc-space not violated.
