Table 18.1 Nomenclature of bone tumors
Vertebral column, left lateral view
• Myelopathy possibly resulting in gait disturbance, weakness, and even spasticity
• Sensory examination usually not helpful
ETIOLOGY
Unknown
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
• Rotator cuff tendinitis
• Carpal tunnel syndrome
• Thoracic outlet syndrome
• Brachial neuritis
WORKUP
In most cases, the diagnosis can be established on a clinical basis alone.
IMAGING STUDIES
• Plain roentgenograms within the first few weeks
1. Usually normal in soft disk herniation
2. With chronic degenerative disk disease, usually loss of height of the disk space, anterior and posterior osteophyte formation, and encroachment on the intervertebral foramen by osteophytes.
• Myelography, CT scanning, and MRI indicated in patients whose symptoms do not resolve or when other spinal pathology suspected
• Electrodiagnostic studies to confirm the diagnosis or rule out peripheral nerve disorders
TREATMENT
NONPHARMACOLOGIC THERAPY
• Rest and cervical collar if needed
• Local modalities such as heat
• Physical therapy
ACUTE GENERAL Rx
• NSAIDs
• “Muscle relaxants” for their sedative effect
• Analgesics as needed
• Epidural steroid injection for radicular pain
DISPOSITION
• Usually improve with time
• Surgical intervention in <5-10%
REFERRAL
Orthopedic or neurosurgical consultation for intractable pain or neurologic deficit
PEARLS & CONSIDERATIONS
COMMENTS
• Pain relief with physical therapy seems anecdotal and short-lived; any overall improvement usually parallels what would have probably occurred naturally.
• Sometimes carpal tunnel syndrome and cervical radiculopathy occur together; this is termed the double-crush syndrome and results from nerve compression at two separate levels. Proximal compression may decrease the ability of the nerve to tolerate a second, more distal compression.
• Surgical intervention is indicated primarily for relief of radicular pain caused by nerve root compression or for the treatment of myelopathy; it is generally not helpful when chief complaint is neck pain alone.
• In many cases of cervical spondylosis with myelopathy, the lowerextremity symptoms are much more disabling than the neck symptoms, a situation that can cause some difficulty in determining their etiology.
• Sensory examination usually not helpful
ETIOLOGY
Unknown
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
• Rotator cuff tendinitis
• Carpal tunnel syndrome
• Thoracic outlet syndrome
• Brachial neuritis
WORKUP
In most cases, the diagnosis can be established on a clinical basis alone.
IMAGING STUDIES
• Plain roentgenograms within the first few weeks
1. Usually normal in soft disk herniation
2. With chronic degenerative disk disease, usually loss of height of the disk space, anterior and posterior osteophyte formation, and encroachment on the intervertebral foramen by osteophytes.
• Myelography, CT scanning, and MRI indicated in patients whose symptoms do not resolve or when other spinal pathology suspected
• Electrodiagnostic studies to confirm the diagnosis or rule out peripheral nerve disorders
TREATMENT
NONPHARMACOLOGIC THERAPY
• Rest and cervical collar if needed
• Local modalities such as heat
• Physical therapy
ACUTE GENERAL Rx
• NSAIDs
• “Muscle relaxants” for their sedative effect
• Analgesics as needed
• Epidural steroid injection for radicular pain
DISPOSITION
• Usually improve with time
• Surgical intervention in <5-10%
REFERRAL
Orthopedic or neurosurgical consultation for intractable pain or neurologic deficit
PEARLS & CONSIDERATIONS
COMMENTS
• Pain relief with physical therapy seems anecdotal and short-lived; any overall improvement usually parallels what would have probably occurred naturally.
• Sometimes carpal tunnel syndrome and cervical radiculopathy occur together; this is termed the double-crush syndrome and results from nerve compression at two separate levels. Proximal compression may decrease the ability of the nerve to tolerate a second, more distal compression.
• Surgical intervention is indicated primarily for relief of radicular pain caused by nerve root compression or for the treatment of myelopathy; it is generally not helpful when chief complaint is neck pain alone.
• In many cases of cervical spondylosis with myelopathy, the lowerextremity symptoms are much more disabling than the neck symptoms, a situation that can cause some difficulty in determining their etiology.
Cervical Disc Degeneration
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Cervical disk syndrome
BASIC INFORMATION
DEFINITION
Cervical disk syndromes refer to diseases of the cervical spine resulting from disk disorder, either herniation or degenerative change (spondylosis). When posterior osteophytes compress the anterior spinal cord, lower extremity symptoms may result, a condition termed cervical spondylotic myelopathy.
EPIDEMIOLOGY & DEMOGRAPHICS
PREVALENCE: 12% of general adult population (symptoms in 55% of population at some time in their life)
PREDOMINANT SEX: Male = female
PREDOMINANT AGE: 30 to 60 years
PHYSICAL FINDINGS & CLINICAL PRESENTATION
• Neck pain, radicular symptoms, or myelopathy, either alone or in combination
• Limited neck movement
• Pain with neck motion, especially extension
• Referred unilateral interscapular pain, resulting in a local trigger point
• Radicular arm pain (usually unilateral), numbness, and tingling possible, most commonly involving the C6 (C5-C6 disk) or C7 (C6-C7 disk) nerve root
• Weakness and reflex changes (C6-biceps, C7-triceps)