At the 11th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference on June 15, Fernando Techy, MD, adult and pediatric spine surgeon of Lutheran General Hospital and a clinical assistant professor at the University of Illinois at Chicago, discussed how spine surgeons should approach cervical myelopathy. 1. Clinical presentation. The initial symptoms of cervical myelopathy in the upper extremities are general clumsiness and the tendency to drop objects. In the lower extremities, cervical myelopathy tends to cause gait instability and loss of balance. "Surprisingly, neck pain and radicular symptoms are not always present," said Dr. Techy. In the late stages of the condition, as compression becomes severe, patients will lose motor strength, exhibit Lhermitte's symptoms and experience bladder and bowel dysfunction.
2. Diagnosis. Initial clinical tests that can indicate cervical myelopathy include proactive cord compression tests, the jaw jerk test, the Barber's Chair test and Hoffman's reflex test. Though these tests can be helpful in diagnosing cervical myelopathy, clinical signs are not sensitive or specific enough to make a definitive diagnosis. Imaging tests are needed to confirm the presence of the condition. "Once the diagnosis of clinically significant cervical myelopathy is made, early treatment should take place before irreversible cord changes and neurological deficit take place," said Dr. Techy.
3. Surgical options. Though many patients may exhibit a lack of signs indicating cervical myelopathy, this should not delay surgical treatment. "There is no doubt that early surgical decompression is the mainstay treatment," said Dr. Techy. Surgical options include laminectomy, anterior cervical decompression and fusion, laminectomy and fusion and laminaplasty.
Laminectomy can cause post-laminectomy kyphosis, instability and recurrent myelopathy. "Laminectomy does not treat neck pain, but can create mechanical and neck pain. It can cause further stenosis and results in revision surgery," said Dr. Techy.
Anterior cervical decompression and fusion has the advantage of direct decompression, kyphosis correction, minimal muscle trauma, a low complication rate and the improvement of neck pain. On the other hand, ACDF can cause adjacent segment degeneration. Studies have shown the procedure to cause hoarseness in 4 percent of patients, dysphagia in 4 percent of patients and vertebral artery injury in 0.5 percent of patients. Dr. Techy explained that he thought anterior cervical discectomy and fusion paired with plating to be the gold standard in the surgical treatment of cervical myelopathy.
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2. Diagnosis. Initial clinical tests that can indicate cervical myelopathy include proactive cord compression tests, the jaw jerk test, the Barber's Chair test and Hoffman's reflex test. Though these tests can be helpful in diagnosing cervical myelopathy, clinical signs are not sensitive or specific enough to make a definitive diagnosis. Imaging tests are needed to confirm the presence of the condition. "Once the diagnosis of clinically significant cervical myelopathy is made, early treatment should take place before irreversible cord changes and neurological deficit take place," said Dr. Techy.
3. Surgical options. Though many patients may exhibit a lack of signs indicating cervical myelopathy, this should not delay surgical treatment. "There is no doubt that early surgical decompression is the mainstay treatment," said Dr. Techy. Surgical options include laminectomy, anterior cervical decompression and fusion, laminectomy and fusion and laminaplasty.
Laminectomy can cause post-laminectomy kyphosis, instability and recurrent myelopathy. "Laminectomy does not treat neck pain, but can create mechanical and neck pain. It can cause further stenosis and results in revision surgery," said Dr. Techy.
Anterior cervical decompression and fusion has the advantage of direct decompression, kyphosis correction, minimal muscle trauma, a low complication rate and the improvement of neck pain. On the other hand, ACDF can cause adjacent segment degeneration. Studies have shown the procedure to cause hoarseness in 4 percent of patients, dysphagia in 4 percent of patients and vertebral artery injury in 0.5 percent of patients. Dr. Techy explained that he thought anterior cervical discectomy and fusion paired with plating to be the gold standard in the surgical treatment of cervical myelopathy.
More Articles on Spine:
How Will the Role of Spine Surgery Evolve? 5 Predictions From Spine Leaders
Dr. Richard Wohns: Comparing Reimbursement for Spine in ASCs vs. Hospitals
6 Business Planning Steps for Spine-Driven Centers