Degenerative disc disease of the cervical spine:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia
Hanley & Belfus
2000
|
| Series: | Spine
14,3 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XI S., S. 521 - 676 S. Ill., graph. Darst. |
| ISBN: | 156053334X |
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| adam_text | SPINE: State of the Art Reviews
Vol. 14, No. 3, 2000
Degenerative Disc Disease of the Cervical Spine
Yizhar Flomcin, MD, Stephen T. Onesti, MD, and Ely Ashkenazi, MD
Editors
CONTENTS
Preface xi
Yizhar Floman, Stephen T. Onesti, and Ely Ashkenazi
Cervical Spine Anatomy 521
Michael A. Milligram and Nahshon Rand
The cervical spine serves as a supporting column for the cranium and as a con¬
strained flexible conduit for passage of the neural elements. The classic division
into the axial and the subaxial spine has been replaced by a four part division ac¬
commodating new surgical concepts: (1) the occipitocervical region; (2) the at
lantoaxial region; (3) the subaxial region; and (4) the cervicothoracic junction. A
quantitative approach to cervical spine anatomy was developed in parallel to sur¬
gical reconstructive techniques. Attention to detail and proper selection of the sur¬
gical solution in each case can allow for a good outcome with minimal morbidity.
New microanatomic research helps us better understand patients signs and symp¬
toms with the hope of future intervention to alleviate suffering and promote
convalescence.
Pathogenesis of Degenerative Disc Disease of the Cervical Spine 533
Masaki Oishi, Stephen T. Onesti, and Howard D. Dorfman
The clinical manifestations of cervical spine disease as observed by the spine sur¬
geon are many and span a wide spectrum of signs and symptoms. These may be as
varied as uncomplicated neck pain and radicular pain in the mildest of cases, or
present as quadriplegia with respiratory compromise and spinal shock in its most
severe form. Such symptoms are largely determined by the degree of involvement
of the tissues that comprise the cervical spine, such as bone and connective tissues,
and that of adjacent structures, including nerve roots and spinal cord. The various
individual disease processes that involve the cervical spine may produce similar
symptoms, depending on the stage of progression for each disease. Recognition
and identification of specific pathologic processes by the clinician is of great im¬
portance, as it may determine the course of treatment and prognosis of the patient
with cervical spine disease.
Imaging of the Degenerative Cervical Disease 545
Allan J. Schwartz
The ability to image cervical spondylosis has grown dramatically. Today we find
ourselves in an era of instantaneous image acquisition with a plethora of available
iii
iv Contents
radiographic options. The clinician is now faced with the challenge of how to best
obtain the information needed and how to respond to the information received. To
make that decision, besides an understanding of anatomy and pathology, the clini¬
cian is also required to understand the differences between the radiologic choices.
Each option gives specific information and has its own advantages and disadvan¬
tages, which are reviewed in this article. The understanding and proper use of these
options will assist the clinician in this challenging task.
Symptomatology and Nonoperative Management of Degenerative
Disc Disease of the Cervical Spine 571
Efraim D. Leibner, Michael A. Millgram, and Nahshon Rand
Degenerative disc disease of the cervical spine occurs as a normal part of the aging
process. Although the emphasis is on disc disease, the degenerative process is not
isolated to the disc. It is conceivable that at least in part of the cases disc degener¬
ation is the primary factor, with the abnormal stresses, strain, and motion patterns
resulting from defective disc function affecting the other components of the five
joint complex. As is expected with a degenerative process, the incidence rises with
age. Various factors are associated with a higher incidence and earlier degenera¬
tion. Fortunately, despite the widespread incidence of degenerative disc changes
and the large potential for symptoms arising from the degenerative process in the
other articulations, most individuals are asymptomatic or have only intermittent
symptoms, with a minority having neurologically significant or unremitting symp¬
toms. The degenerative process may manifest itself clinically, in imaging studies,
or in both. The clinical signs are referred to as compressive or mechanical in
nature.
Degenerative Disc Disease of the Cervical Spine:
Indications for Operative Management 587
Yizhar Floman
The most important information in clinical decision making is a clear and thorough
knowledge of the natural history of a given condition. The decision whether to use
operative management in degenerative disc diseases of the cervical spine accompa¬
nied by radiculopathy or myeloradiculopathy is no exception to this rule. Surgery
should be considered only if it will alter the natural history of myeloradiculopathy
due to degenerative cervical disc disease. A small subset of patients with radicu¬
lopathy are candidates for surgery, while nonoperative management should suffice
for the rest. A small subset of patients with mild CSM may be observed and man¬
aged nonoperatively, while the majority of patients with moderate to severe
myelopathy will require surgical treatment.
Bimechanical Considerations in Cervical Spine Implants 593
Joseph Y. Margulies, Thomas Steffen, and Max Aebi
The mechanical goal of implant use in the cervical spine is the same as in other
areas of the spine: internal fixation until bony fusion consolidates. However, the
anatomic features of the cervical spine and its complex mechanical role in posture
and motion necessitate the solutions that are stable enough to allow healing and
consolidation, yet flexible enough to maintain motion in the adjacent segments and,
most importantly, preserve them. The main problem in achieving this goal is the
small size of the bones that allows only a limited bone implant interface area, com¬
bined with the large range of motion that exists in the normal spine. In a situation
of such a small area of bone implant interface, it is a mechanical challenge to con¬
trol the forces, stability, and motion of the cervical spine.
Contents v
Anterior Cervical Discectomy without Fusion 605
Masaki Oishi, Stephen T. Onesti, and Robert N. N. Holtzman
Since the pioneering work of Cloward and of Smith and Robinson, anterior cervi¬
cal discectomy with concomitant fusion has been a well established and accepted
operation in the neurosurgical armamentarium. However, the precise indications
for fusion in the setting of anterior discectomy are controversial. There is still con¬
siderable disagreement among practicing surgeons about when fusion is indicated.
This article reviews the literature concerning discectomy with or without fusion,
and presents a guide to the absolute and relative indications for fusion. The role of
fusion in single level anterior discectomy is reviewed in detail. In addition, partial
discectomy and anterior transforaminal discectomy are reviewed.
Surgical Treatment of Multilevel Cervical Spondylosis 611
Douglas M. Ehrler, Alan S. Hilibrand, and Todd J. Albert
We generally prefer to address multilevel cervical spondylosis through an anterior
approach. For patients with two levels of symptomatic spondylosis without con¬
genital spinal stenosis or spinal cord compression we will perform a two level dis¬
cectomy and autogenous interbody grafting with supplemental anterior cervical
plating. For patients with three level disease who do not have spinal cord compres¬
sion at all three levels we recommend a combined corpectomy discectomy de¬
compression with autogenous iliac crest bone grafting. For three level spondylotic
disease involving stenosis and spinal cord compression at all three levels we advo¬
cate two level corpectomy with placement of an autogenous iliac crest or fibula
strut graft. We reserve posterior cervical procedures for elderly patients with
spondylosis at four or more levels and predominant symptoms of myelopathy
rather than radiculopathy. Ultimately, the decision of the best treatment of multi¬
level cervical spondylosis lies with the operating surgeon, who must consider the
clinical diagnosis, radiographic findings, wishes of the patient, and the surgeon s
own surgical expertise.
Cervical Interbody Fusion with BAK C Cages in the Management
of Cervical Spondylotic Myeloradiculopathy 625
Ely Ashkenazi, Eyal Yitchayek, and Yizhar Floman
In recent years several new surgical techniques using interbody spacers or cages
have been developed that can be combined with local bone or allograft, thus elimi¬
nating donor site morbidity. One of these devices is the Bagby and Kuslich (BAK)
device modified from the Bagby basket. Although the BAK cage was designed for
posterior lumbar interbody fusion, it was later modified for anterior use in the cer¬
vical spine (BAK C). We present our experience with the use of the BAK C inter¬
body fusion cage. We elected to use this device in order to achieve proper interbody
distraction, immediate mechanical stability, high fusion rates, and to avoid the use
of allograft, relying instead on locally harvested autologous bone.
Expansive Open Door Laminoplasty in the Management
of Multilevel Cervical Myelopathy 635
Yizhar Floman and Ely Ashkenazi
Laminoplasty is now a well recognized and useful procedure for decompression of
multilevel cervical spondylotic myelopathy and myelopathic OPLL. It is both an
effective and safe procedure that results in arrest of the myelopathic process with
neurologic improvement in a significant percentage of the cases. This procedure
maintains the mechanical stability of the cervical spine and is rarely complicated
vi Contents
by late postsurgical deformities. Additional advantages of laminoplasty are the
ability to perform decompression over many levels, even spanning the entire subax
ial cervical spine (C3 T1). Following laminoplasty, the spinal cord shifts posteri¬
orly away from the anterior compressing structures, resulting in decompression and
expansion of the surface area of the cord.
Revision Surgery for Degenerative Disc Disease of the Cervical Spine 643
Stephen T. Onesti and Masaki Oishi
Revision surgery of the surgical spine presents many challenging aspects to the
spine surgeon. Difficult dissection of scar tissue through abnormal surgical
anatomy, along with problems of iatrogenic instability, have given revision surgery
of the surgical spine somewhat of a bad reputation in the spine community. This ar¬
ticle reviews the indications and problems associated with revision surgery for de¬
generative disc disease of the cervical spine. The authors emphasize the basic
principles behind any revision cervical surgery and discuss several specific com¬
monly encountered clinical examples.
Cervicothoracic Junction Problems 651
ToddJ. Albert, Dan A. Zlotolow, and Alan S. Hilibrand
The cervicothoracic junction is an anatomically, biomechanically, and surgically
complex area of the spine. In this segment, the spine abruptly changes from the pli¬
able, lordotic cervical spine, to the stiff and kyphotic thoracic spine. Significant
stresses are therefore placed upon the junctional segments during trauma, predis¬
posing this area to injury. Moreover, the junction is susceptible to both primary and
metastatic tumors and spinal infections. Yet, because of the presence of bony ob¬
structions, diagnosis of pathology is frequently missed on standard plain radi¬
ographs. Anatomically, the morphology of the vertebral components shifts
dramatically from C6 to T2, making posterior instrumentation more difficult and
less likely to be adaptable to standardized screw insertion protocols. There is also
an absence of vertebral arteries in the foramen transversarium of C7 in the majority
of patients, making pedicle screw fixation preferable to other techniques often ad¬
vocated for the remainder of the lower cervical spine. In addition, the proximity of
the cervicothoracic junction to the ribs, clavicle, sternum, lungs, and major vessels
precludes a simple anterior exposure technique.
Cervical Spinal Surgery Complications 661
Michael A. Millgram, Nahshon Rand, and Ely Ashkenazi
Cervical spine surgery is undertaken to address a myriad of pathologies—degener¬
ative, infectious, tumor, deformity, inflammatory, and traumatic. The approach can
be anterior or posterior and complications can be either approach related or proce¬
dure related. Appreciation of the possible complications can help avoid and prop¬
erly treat them if they arise. The overall complication risk in cervical spine surgery
has been reported to be 5 6.7%. Minor transient problems may develop in as many
as 89% of surgeries. Proper preoperative planning, meticulous surgical technique,
and thorough postoperative care can help avoid many of the difficulties.
Index 671
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| spelling | Degenerative disc disease of the cervical spine ed.: Yizhar Floman ... Philadelphia Hanley & Belfus 2000 XI S., S. 521 - 676 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Spine 14,3 Cervical Vertebrae Spinal Diseases Spinal Osteophytosis Bandscheibenkrankheit (DE-588)4069120-2 gnd rswk-swf Halswirbelsäule (DE-588)4023095-8 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Halswirbelsäule (DE-588)4023095-8 s Bandscheibenkrankheit (DE-588)4069120-2 s DE-604 Floman, Yizhar Sonstige oth Spine 14,3 (DE-604)BV000700970 14,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009122005&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Degenerative disc disease of the cervical spine Spine Cervical Vertebrae Spinal Diseases Spinal Osteophytosis Bandscheibenkrankheit (DE-588)4069120-2 gnd Halswirbelsäule (DE-588)4023095-8 gnd |
| subject_GND | (DE-588)4069120-2 (DE-588)4023095-8 (DE-588)4143413-4 |
| title | Degenerative disc disease of the cervical spine |
| title_auth | Degenerative disc disease of the cervical spine |
| title_exact_search | Degenerative disc disease of the cervical spine |
| title_full | Degenerative disc disease of the cervical spine ed.: Yizhar Floman ... |
| title_fullStr | Degenerative disc disease of the cervical spine ed.: Yizhar Floman ... |
| title_full_unstemmed | Degenerative disc disease of the cervical spine ed.: Yizhar Floman ... |
| title_short | Degenerative disc disease of the cervical spine |
| title_sort | degenerative disc disease of the cervical spine |
| topic | Cervical Vertebrae Spinal Diseases Spinal Osteophytosis Bandscheibenkrankheit (DE-588)4069120-2 gnd Halswirbelsäule (DE-588)4023095-8 gnd |
| topic_facet | Cervical Vertebrae Spinal Diseases Spinal Osteophytosis Bandscheibenkrankheit Halswirbelsäule Aufsatzsammlung |
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