DISCUSSION
Several article reviews have been published regarding the approaches either be it anterior or posterior for the treatment of CSM. Due to advancement in medical practice, many new surgical technique have been applied and many new biomaterial have appeared. Even though many options are available, Selection of surgical approaches for better clinical outcome for the treatment of CSM remains controversial. CSM often involves from C2-C7 vertebrae. It can cause cervical instability, hyperostosis of ligaments as well as cervical vertebrae, compression of nerve root and spinal cord. Thus, our main aim of treatment is to decompress the nerve. So, any adequate method of decompression, no matter either its anterior or posterior approach, should decompress it properly, maintain physiological curvature of cervical spine and restore the stability of cervical spine.
The surgical strategy depend upon the cause of compression, the primary site of compression, the number of segment involved, the sagittal alignment of the spine. Other factors are patient age, general
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All sorts of pros and cons of laminoplasty versus anterior corpectomy and strut grafting should be kept in mind. Anterior decompression and fusion is a more direct decompression technique that confesses correction of deformity and stabilization with fusion. It is a mechanically demanding procedure in multi segment cases, and it will have lots of complications. Rigid postoperative bracing is necessary in this approach. The posterior approach is an indirect decompression and depends on the spinal cord which is able to shift posteriorly in an increased canal. That is why, kyphotic patient are not good candidates for a posterior approach and anterior impingement on the cord will remain. Instability and subluxation may also worsen with a posterior approach if fusion is not carried
Per procedure reports, the patient is status post therapeutic bilateral sacroiliac intra-articular injection on 02/18/16, diagnostic bilateral sacroiliac intra-articular injection on 02/05/16, confirmatory bilateral L3-5 medial branch nerve block on 01/25/16, diagnostic bilateral L3-5 medial branch nerve block on 01/11/16, bilateral L5-S1 transforaminal epidural injection on 04/06/15, bilateral L5 dorsal ramus
QEP Scripts for Two Recordings – Audio for Musculoskeletal System; “OK, Team! We have a new patient in Room 3B who is being admitted with a progressive (gradual, advancing) decrease in mobility (movement) of his back and legs, and increase in pain located in the lumbosacral (lower back above the tailbone of the spine) area. The patient’s Primary Care Provider has sent along Computed Tomography scans (CT, a rotating x-ray emitter, detailed internal scanner) showing spinal stenosis (narrowing of the spine causing pressure on the nerves and spinal cord causing lower back pain.) and decrease of the normal lordosis (abnormal curvature lower spine, excessive inward curvature of the spine) in the thoracic vertebrae (upper and middle back). Lumbosacral
DOI: 5/19/2010. Patient is a 57-year-old male electrician who sustained injury when he was struck in the back by a car in a parking lot. He underwent a L5 laminectomy and decompression of the neutral elements 2011. Per the progress report dated 5/18/16, the patient complained of low back and left leg pain.
Dr. Kristen Radcliff - Spinal Surgeon with the Rothman Institute An experienced physician who holds certification through the American Board of Orthopaedic Surgery, Dr. Kristen Radcliff holds a cum laude BS in biology from Harvard University and an MD from the Duke University School of Medicine. She completed a residency through the Department of Orthopedic Surgery at the Baylor College of Medicine and a spinal cord injury and spine surgery fellowship through Thomas Jefferson University. In addition to her fellowship at Thomas Jefferson, Kristen Radcliff, MD, served appointments at the University as both an associate professor of orthopedic surgery and an associate professor of neurological surgery. Since 2020, Dr. Kristen Radcliff has treated
The patient has completed physical therapy, time, rest, medications, chiropractic care, and acupuncture with no alleviation of the pain. Significant pathology on the MRI is noted with degenerative disk disease, neural foraminal stenosis and a nerve root impingement in the cervical spine. Treatment plan includes epidural at the bilateral C5-C6 level, continuation with home exercise program and medications and follow up in 2 weeks.
The SAP block primarily the thoracic intercostal nerves and to provide anterior hemithorax as arising from the anterior axillary line to the sternum, the posterior hemithorax as being from the posterior axillary line to the spinous processes of the vertebra, and the lateral hemithorax as the area in between the other two. Here we describe the use of ultrasound (US)-guided SAP block to treat acute, severe zoster-associated
While this may seem like a small difference in performance, there are still many controversy among the medical professionals about which technique is the best. The risks, complications, and other factors, associated
Obviously, there is a significant amount of psychological overlay in these patients. Patient has dynamic instability. He has radiculopathy. He has failed conservative treatment. He has attempted to lose weight and warrants a straightforward surgical
It was noted that since the last evaluation, the IW notes subjective worsening of his neck, middle-back and low back pain and he demonstrates a 15 degree deterioration in cervical flexion, 10 degree deterioration in cervical extension, 10 degree deterioration in cervical rotation bilaterally, 15 degree deterioration in lumbar flexion, and 5 degree deterioration in lumbar extension. With resumption of a regular physical therapy program, short term goals include subjective decrease in his neck pain, middle-back pain, and low back pain as well as objective improvement in cervical and lumbar range of motion of 5-10 degrees, as well as improvement in his ability to perform his functional activities. Long term goals include a return to his prior level of function as well as safely perform all activities of daily living. Assessments include multiple cervical spine disc bulges and disc herniations, multiple lumbar spine disc bulges and disc herniation and thoracic spine
Techniques adopted and preferred techniques: Everyone is not comfortable with the same techniques, hence you need to be clear as to which technique you are comfortable with. Some patients prefer Orthospinology or Blair. Some of them are comfortable with the NUCCA upper cervical
In lateral canal stenosis as there is involvement of the nerve it results in severe radiculopathy, with muscle weakness, pain and immobility. This results from a series of changes in the components of the central and lateral canal such as ligamentum flavum inflammation, bony spurs, epidural fat deposition and facetal hypertrophy.(1) Management of spinal stenosis includes conservative or surgical treatment. Conservative approach comprises of rest, analgesics, anti inflammatory medications, physical exercises, and weight loss. Surgery is done in patients who have severe pain, disability, neuropathy or malignancy.
The lumbar drain was inserted as a method of reducing cerebral spinal fluid leakage. She was successfully managed conservatively without decompressive surgery. In the report the underlying pathophysiology, clinical presentation, diagnosis, and management of tension pneumocephalus will be
Haut et al conducted a study comparing the mortality rate of patients who underwent immobilization (43%) and those who were not. Overall this study found that there was ant 8.1% mortality rate overall, immobilized patients were more likely to have had a case of complete severance of the spinal cord with a required SCI repair surgery afterwards. In addition, both authors also stated that spinal immobilization may increase prehospital time, leading to a delay before patients receive treatment from
A total of 52 patients were enrolled, 25 in Group 1 and 27 in Group 2 (Table 1). The mean postoperative follow-up period was 18 months in Group 1 (range, 12–24 mo) and 18.2 months in Group 2 (range, 14–24 mo). In Group 1 (OD), there were 10 men and 15 women, with a mean age of 58 + 12.4 years. The vertebral level affected was L4–L5 in 14 patients (57.9%), L5–S1 in eight patients (42.1%) and double level in 3 patients. All patients in Group 1 presented with preoperative neurologenic claudication; 0% had motor deficits, 72% had sensory deficits (18 out of 25), and 40% had impaired or absent reflexes (10 out of 25).
There are a numerous devices available in the market which can be used to decompress your cervical spine at home. Some of these are: Traction Device – Very useful device that improves blood circulation and releases pressure from the spine. Inversion Table – Very good device for decompression of spine. It uses your force of gravity coupled with the body weight to release the pressure on the spine. Foam Roller – Not a very scientific device but reasonably useful, especially in case of sciatica problem.