2 results
Chapter 107 - Treatment of the herniated disc
- from Section 22 - Neurologic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 686-692
-
- Chapter
- Export citation
-
Summary
Herniated discs usually occur in the cervical and lumbar spine. The thoracic spine is relatively non-mobile due to the attached rib cage and therefore is less commonly affected by disc herniations. Herniated discs typically occur in younger patients between ages 30 and 50 years and present primarily with appendicular pain (radicular pain of arm, leg) as well as axial pain (mechanical pain of neck, back). Cervical and thoracic discs may present with myelopathy due to spinal cord compression or radiculopathy from nerve root compression. Sometimes, a combination of myelopathic and radiculopathic symptoms is present. The majority of patients with a disc herniation obtain relief with conservative treatment. Herniated discs are the initial manifestations of the continuum of degenerative disc disease that is later manifested by dehydration of disc material, loss of disc space height, associated facet joint arthropathy, and the development of osteophytes.
Cervical level
Patients with cervical disc herniation typically present with arm and periscapular pain, and often with weakness, numbness, or paresthesias in a nerve root distribution. The majority of patients improve with non-surgical therapeutic options such as cervical collar immobilization rest, non-steroidal anti-inflammatory or corticosteroid medications, traction, and physical therapy. Sometimes epidural steroid injections or foraminal steroid injections are helpful. Typically, patients with troublesome symptoms that do not resolve with these non-surgical measures and that persist beyond 6 weeks–3 months are considered to be candidates for surgery. Patients with significant weakness or sensory loss may opt for surgery sooner.
Chapter 123 - Cervical spine surgery
- from Section 24 - Orthopedic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
-
- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 736-739
-
- Chapter
- Export citation
-
Summary
Cervical spine disorders that require surgical intervention can include degenerative disorders causing radiculopathy or myelopathy, trauma, tumors, and infections. Radiculopathy can present as parasthesias or weakness in a specific root level(s). Myelopathy is a condition caused by spinal cord compression; once manifest clinically, the only treatment for this process is surgery to prevent further neurologic decline. Tumors or infections can present in the cervical spine as radiculopathy, myelopathy, or pain due to instability or pathologic fracture.
The cervical spine can be accessed via anterior or posterior approaches; a combined anterior–posterior approach (360° approach) may be utilized when necessary. The choice of approach is largely dependent upon location of the pathology, history of previous surgery, body habitus, and patient comorbidities. The anterior approach allows exposure of the spine by mobilization of the trachea and esophagus to exploit the interval between these structures and the carotid sheath. The anterior approach allows performance of anterior cervical discectomy and fusion (ACDF) as well as vertebral corpectomy.
Anterior cervical discectomy and fusion involves removing the pathologic disc material and then replacing this void with a spacer fashioned from autograft bone, allograft bone, or synthetic devices. This procedure is employed primarily in treating radiculopathy and multilevel (< 3 levels) cervical spondylitic myelopathy. Anterior cervical discectomy and fusion can also be used in the treatment of certain fractures (e.g., unstable facet fractures or floating lateral mass fractures) and for infections.