Common%20Spine%20and%20Spinal%20Cord%20Syndromes - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

Common%20Spine%20and%20Spinal%20Cord%20Syndromes

Description:

Low Back Pain. Second most common cause of missed work days ... Low Back Pain. Most episodes of LBP are self limited ... What is worse, the leg or the back pain? ... – PowerPoint PPT presentation

Number of Views:158
Avg rating:3.0/5.0
Slides: 34
Provided by: Gabr99
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Common%20Spine%20and%20Spinal%20Cord%20Syndromes


1
Common Spine and Spinal Cord Syndromes
  • Gabriel C. Tender, MD
  • Assistant Professor of Clinical Neurosurgery,
    Louisiana State University in New Orleans
  • Staff Neurosurgeon, Touro Infirmary

2
Chronic Syndromes
  • Lumbar
  • Cauda equina compression
  • Lumbar radiculopathy
  • Low back pain
  • Cervical
  • Myelopathy (from cord compression)
  • Cervical radiculopathy
  • Axial neck pain

3
Upper vs. Lower Motor Neuron Paralysis(cauda
equina vs. myelopathy)
4
Most Common Problems
  • Disc herniation leads to leg (or arm) pain
  • Disc degeneration leads to low back (or neck)
    pain

5
Disc Herniation Physiology
  • Tears in the annulus
  • Herniation of nucleus pulposus

6
Disc Herniation Physiology
  • Compression of the nerve root in the foramen
    leads to pain

7
Disc Herniation Physiology
  • Leg pain goes down to the toes (L5 or S1)
  • Arm pain can go in the shoulder (C5), thumb (C6),
    middle finger (C7), or little finger (C8)

8
Disc Herniation MRI
9
Lumbar Disc Herniation Treatment
  • Conservative Tx.
  • Moderate bed rest
  • Spinal manipulation
  • Physical therapy
  • Medication
  • NSAIDs
  • Muscle relaxants
  • Rarely narcotics
  • Surgical Tx.
  • Microdiscectomy
  • Less than half of an inch incision
  • Go home the same or next day
  • Good results in up to 90 of cases

10
Lumbar Disc Herniation Surgical Tx.
11
Real Life Case (Lumbar Disc Herniation
Surgical Tx.)
12
Results of Surgical Treatment
  • Good outcome in 80-90 of cases
  • Residual pain may last up to 6 months postop
  • Results are worse if pain was present for over 8
    months before the operation (permanent nerve
    damage?)

13
Low Back Pain
  • Second most common cause of missed work days
  • Leading cause of disability between ages of 19-45
  • Number one impairment in occupational injuries

14
Low Back Pain
  • Most episodes of LBP are self limited
  • These episodes become more frequent with age
  • LBP is usually due to repeated stress on the
    lumbar spine over many years (degeneration),
    although an acute injury may cause the initiation
    of pain

15
Normal Anatomy
16
Disc Degeneration Physiology
  • With age and repeated efforts, the lower lumbar
    discs lose their height and water content (bone
    on bone)
  • Abnormal motion between the bones leads to pain

17
Disc Degeneration MRI
18
Disc Degeneration Treatment
  • Conservative Tx.
  • Moderate bed rest
  • Spinal manipulation
  • Physical therapy
  • Medication
  • NSAIDs
  • Muscle relaxants
  • Rarely narcotics
  • Surgical Tx.
  • Lumbar fusion
  • OR
  • Replacement with artificial disc

19
Lumbar Fusion
  • Decreases pain by stopping abnormal motion at the
    diseased level
  • Minimally invasive lumbar fusion can be done
    through 2 small incisions (less than an inch)

20
Real Life Case (Minimally Invasive)
21
Real Life Case (Open)
22
Replacement with Artificial Disc
  • Decreases pain by reestablishing normal motion at
    the diseased level

23
Fusion vs. Artificial Disc
  • Fusion
  • Has been proven to work
  • The adjacent levels are more stressed and prone
    to degeneration
  • Can be done through a small incision
  • Artificial Disc
  • Has not been proven to work yet
  • The adjacent levels are protected
  • Cannot be done through a small incision

24
Indications for Surgical Treatment
  • Low back pain for at least 2 years
  • Incapacitating
  • Resistant to physical therapy and medication
  • Positive MRI findings (degenerative changes) at
    L4-5 and/or L5-S1
  • For selected cases
  • Concordant pain on discography
  • Psychological evaluation

25
Results of Surgical Treatment
  • Fritzell et al., Spine 2001 Dec 126(23)2521-32
  • Prospective randomized multicentric study (class
    I evidence)
  • In the surgical group, 63 of patients rated
    themselves as much better or better, compared
    to 29 in the nonsurgical group
  • Surgical treatment is superior to nonsurgical
    therapy in a well selected group of patients

26
Osteoporosis and Vertebral Fractures
Depressed endplate(s)
Spine shorter, tilted forward
Wedge- shaped
Normal
Fractured
27
Osteoporosis and Vertebral Fractures
Minimally Invasive Fracture Reduction
28
Real Life Case
29
Key Questions
  • What is worse, the leg or the back pain? (both
    is not acceptable ask if you had to chose,
    which one would you like me to cure?)
  • Whats the intensity on a scale of 1 to 10?
  • On the average
  • At its worst
  • Is the pain interfering with your normal
    activities? Is it incapacitating?
  • What makes it better? (position, medication,
    leaning forward) or worse?
  • Did you try physical therapy for at least 3
    months?
  • Are you involved in Workmans comp or litigation?

30
Neck and/or Arm Pain Conservative Tx.
  • Rarely bed rest
  • Home cervical traction
  • Physical therapy (if no weakness / myelopathy)
  • Medication
  • NSAIDs
  • Muscle relaxants
  • Rarely narcotics

31
Neck and/or Arm Pain Surgical Tx.
  • Anterior Approach
  • Anterior cervical discectomy and fusion
  • Small skin incision (about one inch)
  • The disc and bony spurs are removed
  • A small piece of bone is inserted in the disc
    space to achieve fusion
  • Alternatively, an artificial disc can be inserted

32
Neck and/or Arm Pain Surgical Tx.
  • Posterior Approach
  • If there is an eccentric (lateral) disc
    herniation, the free fragment can be removed and
    the nerve root decompressed (the entire disc
    cannot be removed)
  • If there is canal stenosis at multiple levels, a
    decompressive laminectomy followed by a fusion
    can be performed

33
THANK YOU!
About PowerShow.com