Neurosurgery notes/Spine/Spinal Degenerative Diseases/Cervical degenerative disease

Cervical degenerative disease

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Parent item
Spinal Degenerative Diseases
Sub-item
Cervical radiculopathy
Degenerative cervical Myelopathy (DCM)
Silent spondylotic cervical cord compression
Other causes of myelopathy
Postlaminectomy cervical deformity
Cervical Spondylotic Amyotrophy (CSA)
 

Pathology of degenerative cervical spinal disease

  • Degeneration of musculoskeletal tissues is a biological inevitability,
  • Rate of degeneration is related to
    • loading of use
    • Intensity of use over time.
    • Smoking
    • Genetic predisposition
    • Localized trauma
    • Infection
  • Mech of C spine degen:
    • Intervertebral discs bear the load of the head and neck → Axial loading through the nucleus pulposus converted to hoop stresses acting on the annulus fibrosus and vertebral endplates → Continuous mechanical loading alters the cellular composition of the nucleus pulposus with reduction in hydrophilic proteoglycans and increase in collagen (type II, III, VI, and IX) → intervertebral height is reduced → cracks and fissures appear in the annulus and vertebral end plates → nucleus pulposus herniation → Stresses are transferred to facet joints leading to segmental hypermobility → to accommodate the new stresses on facet joints → osteophytic spurs form at the facet in an attempt to increase stability → Stenosis of the cross-sectional area of spinal canal of >30% leads to myelopathy (Yu et al., 1986) → Compression of cord or nerve → chronic cord ischaemia → neuroinflammatory response → Demyelination of the corticospinal tracts, central grey matter degeneration with loss of interneurons, anterior horn cell atrophy and gliosis (Kalsi- Ryan et al., 2013).
  • Histological changes observed in ligamentous hypertrophy include
    • Hyperplasia of non-fibrous cartilage,
    • Metaplasia
    • Capillary hyperplasia
  • The commonest levels affected are C6/ 7 and C5/ 6.
Features
< 55 years
>55 years
Neural compression
Soft disc (nucleus pulposus)
Osteophytes and hard disc (thickened annulus)
Deformity
None
Multilevel degenerative changes: straightening or the adoption of kyphotic, hyperlordotic, or scoliotic curvatures.
  • 16% of the normal adult population has some degree of straightening or reversal of cervical lordosis

Clinical presentation and investigation

  • Radiology
    • Xray
      • Oblique cervical spine films can occasionally demonstrate foraminal narrowing.
      • Further dynamic cervical spine radiographs may assist in identifying instability which can affect surgical planning.
    • MRI imaging of the cervical spine is used to confirm the diagnosis.
    • CT scan of the cervical spine may be useful for assessing the degree of osteophytosis and the extent of foraminal stenosis.
    • Myelography has excellent sensitivity for detecting spinal cord compression but may miss very lateral nerve root foramen stenosis.