1. CERVICAL SPONDYLOSIS SYNDROME

2. PRESENATATION BY
DR MISBAHUL FERDOUS
MBBS(USTC)
FMD (USTC)
PGT (CARDIOLOGY) NICVD.DHAKA
PUBLICATION- 1 (ORIGINAL ARTICLE)
METABOLIC SYNDROME AND ACUTE ST ELEVATION MI IN HOSPITAL
OUTCOME.
PUBLISHED IN B.H.J. JANUARY-2008
MD (CARDIOLOGY), COURSE
SHANDONG UNIVERSITY, CHINA.

3. Definition
• Degeneration of cervical IVD and the
secondary degeneration of cervical
intervertebral joints, leads to injury of
spinal cord, nerve roots and vertebral
artery, and shows corresponding
symptoms and signs

4. Causes
d e g e n er a io n o f IV D
b u l g e o r e x tr u s i o n o f I V D
N a r r o w e d o f i n te r ve r te b r a l s p a c e
l i g a m e n t l ax
u n s tab l e of th e s p i n e
h y p e r p l a si a o f v e r te b r a l b o d y,
fa c e t jo i n ts, l i g a m e n ts
c o m p r e s s i on to sp i n a l c o r d ,
n e r v e r o o ts,
v e r te b r a l ar te r y

5. • These accumulated changes caused by
degeneration can gradually compress
one or more of the nerve roots.
• This can lead to increasing pain in the
neck and arm, weakness, and changes in
sensation.
• In advanced cases, the spinal cord
becomes involved. This can affect not
just the arms, but the legs as well.

6. Causes
• Injury:
acute injury can further injure
originally degenerative cervical vertebra
and discs, this can induce cervical
spondylosis.
Chronic injury can speed up process of
degeneration.
• Congenital deformity:
stenosis of the cervical spinal canal.

7. stenosis of the
cervical spinal
canal.
Pavlov Ratio:
canal (a) /
body (b) <0.75

10. • A previous neck injury (which may have
occurred several years prior) can
predispose to spondylosis, but the
major risk factor is aging.
• By age 60, 70% of women and 85% of
men show changes consistent with
cervical spondylosis on X-ray.

11. As you age, the disks of your spine
become drier and less elastic.

12. Classification & clinical findings
• Cervical spondylotic radiculopathy (CSR)
• Cervical spondylotic myelopathy (CSM)
• Vertebral artery type of cervical
spondylopathy

13. Pathology of CSR
• Most common in morbidity (50%-60%)
• Posterolateral protrusion of the cervical
disc
• Hyperplasia, hypertrophy of the facet joint .
• stimulate or compress nerve roots as they
emerge from the cord to pass peripherally
through the intervertebral foramen

15. brachial plexus

16. pathology

17. Clinical manifestation
• Symptoms
– Neck pain: radiating to the ipsilateral upper
extremity
– Paresthesia
– Muscle weakness in appropriate distribution
pain and paresthesia may be intensified by neck
movement, especially by extension or lateral
flexion to the side of herniation. May be
improved by traction on neck.

18. • Signs
–Stiffness of neck
–Tenderness, spasm of paraspinous
muscles
–Limitation of active and passive
motion of the neck and affected
upper extremity.

19. Radiographic study
Demonstrate
osteophyte
formation and
narrowing of
intervertebral
foramen.

20. CT
scan

21. Pathology-CSM
• Midline herniation of nucleus pulposus
• Osteophyte of posterior rims of vertebral
body
• Hyperplasia of the ligamentum flavum
• Calcification of the posterior longitudinal
ligament
Lead to compression of the spinal cord

22. Clinical manifestation
• Symptoms – Numbness
– Weakness – Dysfunction of
– Loss of balance upper motor neuron
– Cannot handling small is gradually present
objects from the lower part
– Neck pain not obvious of body to the upper.
– Spastic paraplegia
or quadriplegia
-loss of control of the
bladder or bowels

23. Signs
• Marked motor • Pyramidal tract sign
changes and – Hoffmann’s sign
relatively few – Babinski’s sign
sensory changes. – Obstacle of fine
– Hypertonic (high motion of the fingers
muscular tone) Such as buttons,
– hyperreflexia write
– Patellar clonus +
– Ankle clonus +

24. Calcification of the posterior
longitudinal ligament

25. MRI

26. Vertebral artery type of CS
• Pathology
• Hyperplasia, stenosis of cervical
vertebral transverse foramen,
hypertrophy of upper articular process,
unstable cervical vertebra
• Directly stimulate, compress or pull
vertebral artery

27. Pathology

28. • Symptoms
–Vertigo is main, induced by rotating
neck
–Migraine
–Sudden blackout, Diplopia, recovered
in short time
–Cataplexy caused by sudden spasm of
artery due to stimulation, come to at
once after falling to the ground
• Sign
–Positive neck rotation test

29. Treatment

30. • The goal of treatment is relief of pain
and prevention of permanent spinal
cord and nerve root injury.
• In mild cases, no treatment is required.
Symptoms from cervical spondylosis
usually stabilize or regress with simple,
conservative therapy including a neck
brace and NSAIDs.

31. Nonoperative treatment
• Halter traction
• Cervical support and collar
• Massage
• Physical therapy
• Analgesics and muscle relaxants
• Local block

32. Halter traction

34. • Cervical collar

37. • Analgesics
– NSAIDS
• VOLTAREN
• Tramcontin
• Muscle relaxants

38. Operative treatment
• Anterior cervical decompression and
fusion ( ACDF)
• Artificial disc replacement (ADR)
• Laminectomy
• Laminoplasty

39. Artificial disc replacement
(ADR)

42. Posterior approach
• Indications
• Multiple level spondylosis and diffuse
spinal canal stenosis.
• Methods
Laminectomy or laminplasty.

44. Cervical Spondylosis Prevention
• Many cases are not preventable.
Prevention of neck injury (such as
proper equipment and techniques when
playing sports) may reduce risk.

46. The END!
Thank You!
!
Oh, sorry, not the END, just the beginning
Email: misbahul_ferdous@yahoo.com
house no: 26. house name:TAKHDIR.
SUGANDHA. R/A ,CHITTAGONG
BANGLADESH 46