CERVICAL HERNIATED DISC:

SYMPTOMS AND DIAGNOSIS ___________________________________

GIOSUE’ GARGIULO

S.S.C.V.D. CHIRURGIA VERTEBRALE

U.O. ORTOPEDIA

CERVICAL HERNIATED

DISC _____________________________

MAN 6.5/ 100.000

FEMALE 4.6/ 100.000

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AGE 40-54 Y.

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LEVEL :

- C5-C6 30%

- C6-C7 55%

- OTHERS 15%

CERVICAL HERNIATED DISC

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- CENTRAL

- POSTERO-LATERAL

- LATERAL

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- DEGENERATIVE CHANGES

- TRAUMA

CLINICAL

PRESENTATION ____________________

- ACUTE

- CERVICAL PAIN

- RADICULAR PAIN

- MIELOPATHY

PHYSICAL EXAMINATION

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- Lhermitte sign

- Spurling sign

- Axial compression

CERVICAL NERVE ROOT

INVOLVEMENT

_________________________ -PERIPHERICAL RADUCULAR

OVERLAP

-MOTOR PREVALENCE : - C5-C6 DELTOID + BICEPS

- C7 TRICEPS

- C8 FINGHER EXTENSOR

- C8-T1 HAND INTRINSIC MUSCLES

SYMPTOMS

_______________________________ - ARM PAIN 99 %

- NECK PAIN 80%

- SCAPULAR PAIN 52%

- ANT. CHEST PAIN 18%

- HEADACHE 9%

- CERVICAL ANGINA 3%

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- PAIN DERMATOMAL PATT. 55%

- PAIN NON DERMATOMAL PATT. 45%

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- ONE LEVEL RESP. 87%

- TWO LEVELS RESP. 13%

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- PAIN CORRISPONDENCE C5 - C8

- MOTOR CORRISPONDENCE C5 - C8

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- SURGICAL SITE PREDICTED 71%

IMAGING

ANGLED SAGITTAL MRI

SHIM J.H. et al.

Eur. Spine J. , 2009 aug, , 18(8) : 1109-16

E.M.G. _____________________________________

- RADICULAR PERIPHERAL OVERLAP

- D.D. POLINEUROPATHY

- D.D. FOCAL PERIPHERAL NEUROPATHY

- NEGATIVE EMG DOES NOT ESCLUDE

RADICOLOPATHY

P.E.M. _______________________

- CORD COMPRESSION

DIFFERENTIAL DIAGNOSIS : - NECK PAIN

- ARM PAIN _______________________________________

- CERVICAL SPINE DISEASE

- NEUROLOGICAL PATHOLOGY

( CORD – ROOTS )

D.D. CERVICAL PATHOLOGY ___________________________________

- DEGENERATIVE

- TRAUMA

- NEOPLASM

- INFECTION

- REUMATHOID

- POSTURAL

- PSYCHOLOGIC

- VISCERAL PATHOLOGY OF THE NECK

SPONDYLOGENIC CONDITIONS

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- DISC DEGENERATION

- FACETS DEGENERATION

CERVICAL TUMORS

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- PRIMARY

- SECONDARY

METASTASIS

D.D. BONE

________________ SHOULDER V.S.

C5 RADICULOPATHY

D.D. INTRINSIC NERVE CONDITIONS

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- NEOPLASM

- INFLAMMATORY ( HERPES ZOSTER)

- DEMYELINATING CONDITIONS

- SYRINGOMYELIA

CERVICO-THORACIC-BRACHIAL TUNNEL

D.D. EXTRINSIC NERVE CONDITIONS

CERVICAL COST

Angio

Base Iperabduction superior arm

SUPERIOR THORACIC SYNDROME

PANCOAST TUMOR

PERISCAPULAR TUMOR

SUPERIOR ARM

NERVE ENTRAPMENT SYNDROME

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- DOUBLE CRUSH SYNDROME

- PHYSICAL EXAMINATION

- ELECTRODIAGNOSTIC TESTS

CONCLUSION

________________________ -NATURAL HISTORY

-CLINICAL FINDINGS

-IMAGING

-DIFFERENTIAL DIAGNOSIS

NEUROLOGICAL DAMAGE

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-VASCULAR SUPPLY

- AXOPLASMATIC FLOW

CERVICAL PAIN

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-SINUVERTEBRAL

NERVE

PATHOGENESIS