Degenerative Cervical Myelopathy and Radiculopathy: Treatment Approaches and Options

Description

Degenerative disorders of the cervical spine are among the more common reasons why patients seek medical attention or consult with a spine specialist. These conditions can lead to neck pain and/or neurological deficit that can significantly compromise an individual’s quality of life. Despite the regularity of these conditions, there remains both uncertainty and controversy regarding optimal management. No standard of care exists, however there are nuances related to a patients history, clinical presentation, and imaging that may make one approach more conducive to clinical success. This text is intended to serve as a comprehensive, up-to-date resource for clinicians involved in the management of patients with cervical degenerative disease. The text is divided into sections, organized in a clinically strategic manner. The initial chapters address the basics of cervical spine anatomy and biomechanics as well as the pathophysiology leading to various cervical degenerative disorders and the possible neurological sequelae. Subsequent chapters outline characteristics of the clinical presentation and the various diagnostic modalities to evaluate these patients. Key elements involved in the surgical-decision making process are covered, providing the necessary elements to establish a solid foundation for treatment planning. The final sections discusses specific procedures; including traditional approaches as well as more recent developments such as motion preservation surgery and minimally invasive techniques. The last section focuses on challenging clinical scenarios that require advanced surgical consideration. Individual chapters are organized with an introductory outline containing key chapter elements. Chapters focusing on specific pathological entities include discussions regarding pathophysiology, genetics, and risk factors. Those describing surgical procedures include a discussion on indications/contraindications, pre-operative planning, surgical technique, post-operative care, and complication avoidance. Chapter authors present their personal experience enhancing the information from current, evidence-based, referenced material. When appropriate, case presentations are added to provide a practical application of chapter’s key points. This text, based on relevant, up-to-date clinical information and the cumulative experience of current spine experts, offers physicians the necessary tools involved in the decision-making process to formulate the optimal treatment plan for an individual patient. In addition, identification of knowledge gaps will hopefully stimulate future research and the evolution of cervical spondylotic treatments. Front Matter ....Pages i-xiii Front Matter ....Pages 1-1 Functional Anatomy of the Spinal Cord (Mario Ganau, Rahel Zewude, Michael G. Fehlings)....Pages 3-12 Cervical Spine Biomechanics (Bryan S. Lee, Edward C. Benzel)....Pages 13-28 Cervical Alignment and Sagittal Balance (Alexander Tuchman, Dominque M. O. Higgins)....Pages 29-36 Degenerative Cervical Myelopathy: A Spectrum of Degenerative Spondylopathies (Aria Nouri, Jean-Christophe Murray, Michael G. Fehlings)....Pages 37-51 Pathobiology of Cervical Radiculopathy and Myelopathy (Cory J. Hartman, Daniel J. Hoh)....Pages 53-65 Natural History of Cervical Degenerative Disorders (John E. O’Toole, Joseph E. Molenda)....Pages 67-74 Front Matter ....Pages 75-75 Fundamentals of Cervical Neurological Exam (Meena Thatikunta, Maxwell Boakye)....Pages 77-87 Clinical Assessment Tools (Jian Guan, Zoher Ghogawala)....Pages 89-95 Radiographic Modalities (Ha Son Nguyen, Shekar N. Kurpad)....Pages 97-107 Alternative Diagnostic Tools (Kurt M. Eichholz)....Pages 109-119 Front Matter ....Pages 121-121 Failure of Nonoperative Management (Hamadi Murphy, Scott C. Wagner, Alex Vaccaro, Stephen Silva)....Pages 123-127 Timing of Operative Intervention (Alexander M. Tucker, Tianyi Niu, Daniel T. Nagasawa, Langston T. Holly)....Pages 129-138 Surgical Approach Decision-Making (Mena G. Kerolus, Vincent C. Traynelis)....Pages 139-152 Utility of Intraoperative Neuromonitoring (Randy S. D’Amico, Peter D. Angevine)....Pages 153-165 Factors Predictive of Operative Outcome (Jerry Ku, Jefferson R. Wilson)....Pages 167-176 The Cost-Effectiveness of Various Surgical Procedures in the Cervical Spine (Blake N. Staub, Todd J. Albert)....Pages 177-183 An Overview of Various Surgical Approaches (Matthew J. Tormenti, Mark R. McLaughlin)....Pages 185-194 Front Matter ....Pages 195-195 Posterior Laminoforaminotomy for Radiculopathy (James S. Harrop, John L. Gillick)....Pages 197-206 Cervical Laminoplasty (Lionel N. Metz, Grigoriy Arutyunyan, Deeptee Jain, Lee A. Tan, K. Daniel Riew)....Pages 207-220 Cervical Disc Arthroplasty (Jau-Ching Wu, Praveen V. Mummaneni, Regis W. Haid)....Pages 221-233 MIS Approaches for Cervical Spondylotic Disease (Mena G. Kerolus, Richard G. Fessler)....Pages 235-246 Front Matter ....Pages 247-247 Anterior Cervical Discectomy and Fusion (Luis M. Tumialán)....Pages 249-270 Anterior Cervical Corpectomy (Anthony C. Lau, Allan D. Levi)....Pages 271-285 Multilevel ACDF Versus Corpectomy (Hani R. Malone, Michael G. Kaiser)....Pages 287-307 Options for Interbody Grafting (Azam Basheer, Mohammed Macki, Frank La Marca)....Pages 309-318 Anterior Fixation Plating (Harel Deutsch, Mena G. Kerolus)....Pages 319-327 Cervical Laminectomy and Fusion (Jacob Januszewski, Juan S. Uribe)....Pages 329-339 Biological Enhancers of Fusion (Matthew F. Gary, Scott D. Boden)....Pages 341-348 Front Matter ....Pages 349-349 Occipitocervical Stabilization (Robert F. Heary, Nitin Agarwal)....Pages 351-360 Alternative Means of Posterior Cervical Stabilization (Hsuan-Kan Chang, David McCarthy, Michael Y. Wang)....Pages 361-372 Atlantoaxial Stabilization (Avery L. Buchholz, John C. Quinn, Christopher I. Shaffrey, Justin S. Smith)....Pages 373-384 Reconstructive Procedures in the Osteoporotic Patient (Jacob Januszewski, Juan S. Uribe)....Pages 385-394 The Cervicothoracic Junction (Anthony M. DiGiorgio, Michael S. Virk, Ming-Hsiao Hu, Mohanad Alazzeh, Santan Thottempudi, Praveen V. Mummaneni)....Pages 395-407 Osteotomy for Cervical Kyphosis (Joseph A. Osorio, Justin K. Scheer, Derek G. Southwell, Christopher P. Ames)....Pages 409-420 Back Matter ....Pages 421-431