Cervical Spondylosis

MANAGEMENT (contd) Indications for operation

1. Progressive neurological deficit - myelopathy or radiculopathy.

2. Intractable pain, when this fails to respond to conservative measures. This is rarely the sole indication for operation and usually applies to acute disc protrusions (see below) rather than chronic radiculopathy.

, Bone and disc drilled away.

Osteophytes removed with curettes. □

, Bone and disc drilled away.

Osteophytes removed with curettes. □

Operative techniques

1. Anterior decompression and fusion A core of bone and disc is drilled out allowing removal of the osteophytic projection. Although not essential, most combine this with fusion using a dowel from the iliac crest.

Suitable for root or cord compression from an anterior protrusion at one level, although two and even three levels may be decompressed by this method.

■ Bone graft fuses bodies

2. Posterior approach

— (a) Laminectomy: a wide decompression, usually from C3-C7, is carried out. Only suitable for multilevel cord compression especially when superimposed on a congenitally narrow s spinal canal.

(b) Foraminotomy: the nerve root at one or more levels may be decompressed by drilling away overlying bone.

Results

Operative results vary widely in different series and probably Some improvement occurs in 50-80% of patients. Operation preventing progression rather than curing all symptoms.

CERVICAL DISC PROLAPSE

In contrast to cervical spondylosis, cervical 'soft disc' protrusion is uncommon. This tends to occur acutely in younger patients and may be related to a specific incident such as a sudden twist or injury to the neck. The protrusion usually occurs posterolateral^ at the C5/C6 or C6/C7 level causing a radiculopathy rather than a myelopathy. SAGITTAL T1 weighted MRI or CT scan with intrethecal contrast clearly outline the disc protrusion.

Operative removal through an anterior approach may be required for intractable pain or neurological deficit and gives depend on patient selection, should be aimed at

T2 weighted axial MRI showing disc protrusion (note poorer definition than CT/myelogram)

good results.

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