Degenerative Disk Disease Cervical Spine
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DDD - CERVICAL SPINE • ANATOMY
STRUCTURE AND COMPOSITION • • • •
Outer anulus fibrosus Inner anulus fibrosus Nucleus pulposus Vertebral end plates
MECHANICAL FUNCTION
DISK AGING • Decrease in volume – – – –
loss of disk height protrusion of central disk into vertebral body decrease in height+ bulging of anulus changes in disk tissue microstructure/composition
DEGENERATION • Acceleration of normal aging processes? • Distinct process superimposed?
FEATURES OF DDD
HERNIATION • Most often occur at the junction of the posterior anulus and the vertebral body. • Start with fissures
HISTORY • 1838 - pathologic findings in 2 cases of cord compression by ‘intervertebral substance’ • 1934 - 4case reports of cervical disk protrusions • 1950’s- Smith-Robinson started anterior approach with interbody fusion.
Incidence/Epidemiology • M : F = 1.4 : 1 • Horal; 40% pop’n Sweden affected with neck pain. • MRI studies show degeneration progresses with age • Factors associated with disk injury • Factors not associated
SIGNS AND SYMPTOMS • Symptoms related to; – the spine itself – nerve root compression – myleopathy (midline cervical compression)
DDX • Extrinsic vs Intrinsic ddx’s. • Extrinsic: Chest tumors, peripheral nerve compressions, arthritis(shoulder/upper extremity), TMJ, rotator cuff tears, impingements. • Intrinsic: herniation, hypertrophic arthritis. Congenital factors like spinal stenosis. Tumors and fractures.
CATEGORIZATION • 1. Unilateral soft dick protrusion with nerve root compression • 2. Foraminal spur or hard disk with root compression • 3. Medial soft disk protrusion with cord compression • 4. Transverse ridge or cervical spondylosis with cord compression.
TESTING • • • • •
X-rays Cervical myelography CT scan MRI Discography?
CONSERVATIVE TX • Rest, massage, ice, NSAID. • Various braces and traction treatment.
SURGERY • INDICATIONS; – failure of conservative therapy – increasing neurologic deficit – cervical myelopathy that is progressive
WHAT SURGERY? • Anterior approach • Posterior approach
STRUCTURE AND COMPOSITION • • • •
Outer anulus fibrosus Inner anulus fibrosus Nucleus pulposus Vertebral end plates
MECHANICAL FUNCTION
DISK AGING • Decrease in volume – – – –
loss of disk height protrusion of central disk into vertebral body decrease in height+ bulging of anulus changes in disk tissue microstructure/composition
DEGENERATION • Acceleration of normal aging processes? • Distinct process superimposed?
FEATURES OF DDD
HERNIATION • Most often occur at the junction of the posterior anulus and the vertebral body. • Start with fissures
HISTORY • 1838 - pathologic findings in 2 cases of cord compression by ‘intervertebral substance’ • 1934 - 4case reports of cervical disk protrusions • 1950’s- Smith-Robinson started anterior approach with interbody fusion.
Incidence/Epidemiology • M : F = 1.4 : 1 • Horal; 40% pop’n Sweden affected with neck pain. • MRI studies show degeneration progresses with age • Factors associated with disk injury • Factors not associated
SIGNS AND SYMPTOMS • Symptoms related to; – the spine itself – nerve root compression – myleopathy (midline cervical compression)
DDX • Extrinsic vs Intrinsic ddx’s. • Extrinsic: Chest tumors, peripheral nerve compressions, arthritis(shoulder/upper extremity), TMJ, rotator cuff tears, impingements. • Intrinsic: herniation, hypertrophic arthritis. Congenital factors like spinal stenosis. Tumors and fractures.
CATEGORIZATION • 1. Unilateral soft dick protrusion with nerve root compression • 2. Foraminal spur or hard disk with root compression • 3. Medial soft disk protrusion with cord compression • 4. Transverse ridge or cervical spondylosis with cord compression.
TESTING • • • • •
X-rays Cervical myelography CT scan MRI Discography?
CONSERVATIVE TX • Rest, massage, ice, NSAID. • Various braces and traction treatment.
SURGERY • INDICATIONS; – failure of conservative therapy – increasing neurologic deficit – cervical myelopathy that is progressive
WHAT SURGERY? • Anterior approach • Posterior approach
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