Cervical Spine
Content
Each specific situation has to be evaluated on an individual basis. EuroSpine and its members cannot be held responsible for any misunderstandings (or misdiagnosis) based on the information provided here, which in no way attempts to replace a targeted evaluation.
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General aspects
The cervical spine (CS) is the connection between the head and body. Its mobility allows three-dimensional movement of the head, which in turn allows the orientation in space in all directions. It was probably this mobility, together with the erect position and the development of the brain that allowed mankind to fight and defend themselves efficiently in the early days of evolution.The soft tissues of the neck consist of elements for the transportation of food and air, which provide the body and muscles with the basic energy supply to control the above-mentioned motion. Vessels ensure the oxygen supply to the brain. The nervous system running through the cervical spinal canal carries information from the functioning body to the brain and transports signals from the brain to the periphery.
Anatomy of the CS
Spine: The CS comprises seven vertebrae, of which five (C3–C7) follow a principle schematic design of all the vertebrae of the spine and two (C1–C2) have a different anatomical build.back to top |
C1/2 (atlantoaxial) instability
One source of instability in the atlantoaxial segment is the pathological development of the dens axis. This can appear as a non-formation (aplasia) or a separated ossicle (os odontoideum). These conditions lead to an increased range of motion or subluxation between the axis and atlas, which may lead to repetitive trauma and damage of the spinal cord.
Diagnosis: This condition may be diagnosed using radiographs of the neck in flexion/extension, by computer tomography (CT) or magnetic resonance imaging (MRI).
Treatment: Therapeutic options in severe atlantoaxial instability in children, as seen by the members of SSE, include:
Specialist's opinion:
Non-operative | |
Operative, if non-operative is unsuccessful | |
Surgical |
Non-operative | |
Operative, if non-operative is unsuccessful | |
Surgical | |
Other |
Wires C1/2 | |
Screws C1/2 | |
No internal fixation |
With iliac bone | |
With allogenic bone | |
With bone substitute (e.g. hydroxyapatite) | |
Bone morphogenetic proteins |
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Diagnosis: Diagnosis is made by clinical investigation, imaging (predominantly MRI) and discography.
Treatment: The classic way to deal with discogenic pain is immobilization of the painful segment. Fusion is generally performed using an anterior approach, removing and replacing the painful disc using some kind of biocompatible spacer with or without plate fixation.
Only non-operative | |
Surgical, if non-operative tx is unsuccessful | |
Facet blocks | |
Other |
Anterior interbody fusion | |
Motion-preserving techniques (disc prosthesis) | |
Posterior fusion | |
Other |
Only non-operative | |
Surgical, if non-operative tx is unsuccessful | |
Other |
Anterior interbody fusion | |
Disc prosthesis | |
Percutaneous, intradiscal procedures | |
Posterior fusion | |
Other |
Autologous bone (e.g. iliac crest) | |
Bone cement | |
Customized cages (e.g. titanium, PEEK, hydroxyapatite), no autologous bone | |
Cages in combination with autologous bone | |
Cages with bone morphogenetic proteins, etc. | |
Other |
No internal fixation | |
Regular use of plates | |
Plates only in multisegmental interventions | |
Other |
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Depending on the nerve root involved, pain, sensory disturbances or muscular weakness appear in the corresponding segment.
Treatment: The aim of the surgical treatment is to eliminate pressure on the nerve root by removing the protruded disc/bone material. Conservative management with anti-inflammatory medication and muscle exercises may be successful.
Specialist's opinion:
Non-operative | |
Surgical only if herniated disc is involved | |
Non-operative as long as there is no muscular deficit | |
Surgical, if neurological deficit(s) (sensory or motor) exist(s) | |
Surgical, if symptoms (pain) are resistant to non-operative treatment | |
Surgery, if imaging and symptoms (pain or neurology or both) correlate | |
Other |
Percutaneous procedure (e.g. mechanical disc removal, laser) | |
Disc removal – no fusion | |
Disc removal with anterior interbody fusion | |
Disc replacement by disc prosthesis | |
Other |
Percutaneous procedure (e.g. mechanical disc removal, laser) | |
Disc removal – no fusion | |
Disc removal with anterior interbody fusion | |
Disc replacement by disc prosthesis | |
Other |
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Treatment: An important factor for decompressive procedures is timing.
Specialist's opinion:
No surgery | |
Decompressive surgery | |
No surgery now, but when neurological symptoms appear |
Posterior laminoplasty/laminectomy as a standard procedure | |
Anterior decompression (discectomy, corpectomy) as a standard procedure | |
Combined anterior/posterior | |
Anterior or posterior depending on the individual's anatomy |
EuroSpine, April 2007