Cervical Spine Myelopathy & Radiculopathy - Everything You Need To Know - Dr. Nabil Ebraheim
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- เผยแพร่เมื่อ 9 ก.ย. 2020
- Dr. Ebraheim’s educational animated video describes the condition of cervical spine myelopathy and radiculopathy.
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Cervical Spine Myelopathy & Radiculopathy
Cervical spine myelopathy can occur due to compression of the cervical spinal cord. Patient with cervical spine myelopathy will have gait disturbance. Gait disturbance is an indication for surgery. X-ray will show spondylosis and loss of lordosis. MRI will show compression of the cervical spinal cord. Some of these patients will have lumbar spinal stenosis, and they come to the doctor with an MRI, and they have gait disturbance. Check the cervical spine. Get an MRI of the cervical spine. The patient examination may be confusing, because they will come to the doctor with low back pain and a positive MRI for lumbar spinal stenosis. Ask about neck pain and stiffness, and also if the patient feels unstable when walking. Then examine the patient for upper motor neuron signs: spasticity, hyperreflexia, Hoffman’s sign, Clonus, or Babinski reflex. The presence of this reflex indicates an upper motor neuron lesion due to cervical spinal cord compression. Gait disturbances can also occur with thoracic disc problems, which occur more in males. There will be pain with radicular symptoms, with normal upper extremity exam, and there will be upper motor neuron findings in the lower extremity such as clonus and Babinski reflex. Usually you will do anterior approach of the cervical spine especially when there is a kyphotic spinal segment. Go anterior, especially if there is cervical spine kyphosis more than 10 degrees, because this can be corrected anteriorly. You may go posteriorly, (laminectomy and posterior fusion), but kyphosis more than 10 degrees is contraindication to going posteriorly. Usually this operation is done for multilevel decompression. Infection is a complication of the posterior approach. If you do laminectomy alone, you will have progressive kyphosis. C5 nerve root palsy may occur due to the anterior and posterior approach (unknown why it occurs, the nerve recovers but takes a long time to recover). The recurrent laryngeal nerve (RLN) can cause vocal cord paralysis on one side will give hoarseness. The superior laryngeal nerve (SLN) will affect the high note phonation, it can affect singers, there will be no vocal cord paralysis. This usually occurs when dealing with upper cervical spine surgical approaches. 50% of neck rotation is between C1 and C2. Flexion/extension mostly occurs at the level of C4-C5. Pain and/or neurological symptoms resulting from conditions such as a disc herniation that irritates a nerve in the cervical spine. Cervical spine and shoulder problems overlap. The patient’s symptoms are relieved by shoulder abduction and placing the hand over the head. In cervical disc problems, be aware of false positive MRIs. Cervical disc problems usually affect the lower nerve root. With compression of the C7 nerve root, there will be middle finger numbness, triceps weakness, and the triceps reflex will be affected. The cervical nerve roots are horizontal in orientation. It does not matter if cervical disc herniation is central or foraminal, it will compress the same nerve root. C7 nerve root runs above the pedicle of the C7 vertebra. The patient will come to the doctor with unilateral arm pain that is relieved by arm elevation. The numbness and paresthesia will occur in specific dermatomes. When you examine the patient, do provocative tests such as the Spurling’s test and the shoulder abduction test. Even if there is a bad cervical spine disc problem of MRI, treat it conservatively for about 3 months. Give the patient therapy and nonsteroidal anti-inflammatory drugs (NSAIDs). 75% of the patients will improve with nonoperative treatment. Do surgery when there is progressive pain for 6-12 weeks and progressive neurological deficit.
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Great Video Sir. I am Suffering with Cervical Stenosis and Myelopathy. Also they put it on Bilateral Carpal Tunnel. Work Injury in California. Now live in Columbia SC. Had a Failed Cervical Laminaplasty. Now they want to Offer me $100,000. To Close my Case. I am too Injured.
Great video as usual, wow I love the visuals. Our subscribers should watch your content, especially those who have neck pain
How I wish you practised here on the east coast of Canada. I’ve damaged my back, and have been spending most of my time in bed for
a decade. I’ve been to many doctors, specialists, had so many tests, been to pain clinics. So many diagnoses .
I will not allow any doctor to perform surgery on my back, but this man, I would easily trust with my life to operate on me.
Imagine getting your life back, after being on opioids for 17 years.
I too fear any neck surgery.
I got this, the doctor lied to me and told me my spinal cord is not compressed i have serious symptoms i will get another doctor to help me i have private insurance.
Outstanding. Thank you
Great video !
excellent doctor
Thank you sir..
Thank you. Well done.🙏
Thank you very much,
wonderful again
Thank you Soo much for your videos
Very informative sir
NICE!
This is great information doc! It’s an excellent review as a physical therapist..I see this all the time.
Blessings to you
I called to make an appointment with you for my brother and we never heard back ... he was diagnosed with chondrosarcoma and they had to put cement on his L11 or 12 after Proton therapy and deterioration I can't remember now which one and he is in a lot of pain ... we would like to hear from you. Thank you, we are in California.
I wish I had known
So, if you have areas fixed but didn't have the associated issues, does that mean that will prevent you from getting that in the future? If you did nothing you would eventually have symptoms for that area?For instance no arm pain but had that section worked on, you will have prevented arm pain in the future?
Hello Sir, I suffered with same symptoms. As per MRI there was a compression at C5-6-7. My gait was affected first in same fashion as of shown in VDO & then there was loss of grip in right hand fingers only. After surgery in March 2018, the grip/sensation recovered after 6-7 months however my gait is still affected & there is numbness in legs & a pain in legs & lumber if walk or stand more. Hence please advise how to overcome. Thanks
Where did you had surgery, can you share your number , I need help
Great video! I have numbness in my pinky and ring fingers but my MRI shows neural foraminal stenosis on my C4-6 nerves, which doesn't match the dermatones. What's going on?
Symptoms are more of relevancy than an image.
Great, so my C4-C5 and C6-C7 disc impingement from being rear-ended a year ago is eventually going to make me a cripple.
Doctors don’t want to do surgery until it’s absolutely necessary (last resort).
Sir.You are which country
I got this and sooooo much more!🙄🫣🥳😭🤭