neck pain myelopathy and radiculopathy clinical assessment and management n.
Skip this Video
Download Presentation
Neck Pain, Myelopathy and Radiculopathy Clinical Assessment and Management

Loading in 2 Seconds...

play fullscreen
1 / 39

Neck Pain, Myelopathy and Radiculopathy Clinical Assessment and Management - PowerPoint PPT Presentation

  • Uploaded on

Neck Pain, Myelopathy and Radiculopathy Clinical Assessment and Management. Mr. David Bell London Neurosurgery Partnership. Introduction. Consultant neurosurgeon Subspecialty - complex spine surgery NHS base at Kings College Hospital Part of London Neurosurgery Partnership

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Neck Pain, Myelopathy and Radiculopathy Clinical Assessment and Management' - ginger-franco

Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
neck pain myelopathy and radiculopathy clinical assessment and management

Neck Pain, Myelopathy and RadiculopathyClinical Assessment and Management

Mr. David Bell

London Neurosurgery Partnership

  • Consultant neurosurgeon
  • Subspecialty - complex spine surgery
  • NHS base at Kings College Hospital
  • Part of London Neurosurgery Partnership
  • 11 consultant group treating all disorders of the brain and spinal cord

To discuss common clinical scenarios

To explain common diagnoses and treatment

To identify how to investigate and who to refer


Mechanical neck pain -Pain felt within the neck and shoulders/trapezius exacerbated by movement

Radiculopathy – Clinical syndrome of arm pain, weakness or numbness caused by nerve root irritation

Myelopathy – clinical syndrome of loss of dexterity and gait disturbance due to spinal cord compression

red flags
Red Flags


Weight loss

History of cancer

Progressive neurological deficit

Nocturnal pain

Severe pain requiring opiates

investigation of neck pain
Investigation of Neck Pain

No need for imaging or blood tests initially

No role for plain x-rays

If red flags then needs cross-sectional imaging

Usually MRI or CT

incidence of mri abnormalities
Incidence of MRI Abnormalities
  • 30 asymptomatic subjects
    • 22 (73%) bulging discs
    • 15 (50%) focal disc protrusions
    • 1 extrusion
    • 4 (13%) cord compression
  • 100 asymptomatic subjects
    • 40-55 y o: disc protrusions in 20%
    • 64+ y o: 57%
    • Cord compression 7%
management of neck pain
Management of Neck pain



Add opiates as required


Acupuncture/Dry needling

surgery for neck pain
Surgery for Neck Pain

Unusual for degenerative neck pain

Instability due to tumour/infection/trauma responds well to surgery

Occasional fusion for degenerative disease

cervical radiculopathy
Cervical Radiculopathy

Less common than simple neck pain

Neuralgic pain radiating down arm

Sensory disturbance in distribution of affected nerve

Rarely motor deficits

Usually accompanied by neck pain

foraminal narrowing
Foraminal Narrowing
  • Progressive narrowing of exit foramina occurs with normal ageing
  • Typically asymptomatic
differential diagnosis
Differential Diagnosis

Shoulder/Elbow pathology

If sensory disturbance it has to be neural

Thoracic outlet syndrome

Brachial neuritis

Entrapment neuropathy – median/ulnar


MRI cervical spine

Nerve conduction studies

Brachial plexus imaging

natural history
Natural History

Spontaneous resolution within 6-12 weeks occurs in 90% of attacks

Investigate urgently/refer those with severe pain or progressive motor deficits

treatment of radiculopathy
Treatment of Radiculopathy

Physical therapies









cervical nerve root injections
Cervical Nerve root injections
  • ?risk of paraplegia
  • Interscalene block
  • Temporary
  • Local anaesthetic/ steroid
surgery for radiculopathy
Surgery for Radiculopathy

Anterior cervical discectomy

Cervical disc replacement

Posterior foraminotomy

discectomy replacement

Bloodless plane to spine

Removal of compression without manipulation of spinal cord

Preservation of normal motion/reduce adjacent segment disease

90% relief from arm pain

cervical total disc replacement
Cervical Total Disc Replacement
  • Preserve motion
  • Reduce stresses on adjacent disc
  • Prevent adjacent segment disease
  • Popular
  • Lack of evidence of efficacy at current time
  • Expensive

1 in 1000 risk of paralysis

1% risk of vocal cord paresis

Transient hoarseness/dysphagia common

posterior foraminotomy
Posterior Foraminotomy

Posterior approach


No risk to oesophagus/trachea

Some neck pain

90% effective

cervical myelopathy
Cervical Myelopathy
  • Clinical syndrome of spinal cord irritation/compression
  • Insidious loss of fine finger movement
  • Gait ataxia
  • Urinary hesitancy
  • Increased tone
  • Spastic reflexes
  • Rombergs positive
  • Unable to heel-toe walk
  • L’Hemitte’s phenomenon
myelopathy causes
Myelopathy - Causes
  • Most commonly degenerative
  • Disc-osteophyte bars
  • OPLL
  • Tumour
natural history1
Natural History
  • Limited data
  • Some non –progressive
  • Most slowly progressive
  • Occasional rapidly progressive
myelopathy treatment
Myelopathy Treatment
  • Observational
  • Supportive - OT/physio
  • Surgery – Anterior cervical discectomy/corpectomy
  • Posterior cervical laminectomy +/- fusion
  • 50% notice improvement in hand/leg function
  • Others arrest progression
  • 1% continue to deteriorate
  • 1 in 1000 risk of paralysis
  • 1 in 10,000 risk of death