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Causes and Treatments of Neck and Arm Pain. Brian T. Ragel, MD Department of Neurosurgery. Introduction. Anatomy Definitions Cervical spondylosis Herniated disc Dx / Tx Axial neck pain Radiculopathy Myelopathy. Cervical Spondylosis. degenerative aging process from wear and tear

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causes and treatments of neck and arm pain

Causes and Treatmentsof Neck and Arm Pain

Brian T. Ragel, MD

Department of Neurosurgery

introduction
Introduction
  • Anatomy
  • Definitions
    • Cervical spondylosis
    • Herniated disc
  • Dx / Tx
    • Axial neck pain
    • Radiculopathy
    • Myelopathy
cervical spondylosis
Cervical Spondylosis
  • degenerative aging process from wear and tear
    • “bone spurs”
    • loss of disc height
    • Osteophytes
    • Mineral deposition in ligaments and discs
axial neck pain
Axial Neck Pain
  • Sx
    • Neck pain (poorly understood)
    • Nerve endings in discs and facets
    • musculoskeletal
  • Dx
    • ?
  • Tx
    • NSAID and physical therapy
natural history of axial neck pain
Natural History of Axial Neck Pain
  • Notes:
    • 66% of all adults will have neck pain
    • Rothman, no difference b/w op and non-op
    • Gore, no correlation b/w neck pain and x-ray
cervical radiculopathy
Cervical Radiculopathy
  • Sx
    • Sx’s in dermatomal distribution from compressed nerve root
      • Example: C6 radiculopathy will produce pain/numbness in lateral biceps -> lateral forearm -> thumb
  • Dx – sx / exam / MRI
  • Tx
    • ACDF / disc arthroplasty
    • Posteriorforaminotomy
cervical myelopathy
Cervical Myelopathy
  • Sx
    • Sx’s N/T, clumsy hands, spastic gait, leg weakness due to spinal cord compression
  • Dx – sx / exam / MRI
  • Tx
    • ACDF (usually > 1 level)
    • Posterior decompression
natural history of cervical myelopathy
Natural History of Cervical Myelopathy
  • Lees and Turners
    • usually stable nonprogressive disability
    • progressive deterioration exception
  • Symon et al, 67% steady decline
  • Nonrandomized MCT in 2000
    • 20 surgery with improved function
    • 23 non-op with decline in ADL
summary
Summary
  • Cervical spondylosis (degeneration)
  • Dx / Tx
    • Axial neck pain
    • Radiculopathy
    • Myelopathy
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