cervical myelopathy and cervical radiculopathy- Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубліковано 20 вер 2024
- Dr. Ebraheim animated video illustrates spine concepts associated the cervical spine -cervical spondylosis and cervical myelopathy also cervical radiculopathy .cervical spine animation. Cervical disc herniation and surgery is presented.
Cervical Myelopathy:
Patient will have gait disturbance, which is an indication for surgery.
Patient will also have upper motor neuron signs.
Upper extremity weakness.
If the hands are clumsy, you got myelopathy of the hands.
X-ray will show spondylosis and loss of lordosis.
MRI will show compression of the cervical spinal cord.
Some of these patients will have lumbar spinal stenosis and they come to the doctor with an MRI and they have gait disturbance.
Check the C spine; get an MRI of the C spine.
The exam may be confusing because they may come to the doctor with low back pain and positive MRI for lumbar stenosis.
Ask about neck pain and stiffness, and if they feel unstable when they walk, and examine them for upper motor neuron signs:
- Spasticity hyperreflexia
- Hoffman’s sign: presence of this reflex indicates an upper motor neuron lesion due to cervical spinal cord compression.
- Clonus
- Babinski
Gait disturbance can occur in thoracic disc, which occurs in males, there will be pain with radicular symptoms, with normal upper extremity exam and there will be upper motor neuron findings in the lower extremity such as clonus and Babinski reflex.
If you are going to do surgery on cervical myelopathy, which approach will you use?
You will use anterior approach of the cervical spine especially when there is a kyphotic spinal segment.
Go anterior, especially if there is cervical spine kyphosis more than 10° because this can be corrected anteriorly.
The airway compromise occur when the surgery takes more than 5 hours in the upper cervical spine, occurring at more than three levels, and more than 300 ml of blood loss.
You may go posteriorly, laminectomy and posterior fusion, but kyphosis more than 10° is contraindication to going posteriorly.
Usually this operation is done for multilevel decompression.
Complications of the posterior approach:
- Infection
- If you do laminectomy alone, you will have progressive kyphosis.
- C5 nerve root palsy may occur due to the anterior or posterior approach, it is unknown why it happens, the nerve recovers but it takes a long time to recover.
Cervical laminoplasty:
- Is not used when there is fixed cervical spine kyphosis.
Somatosensory Evoked Potentials (SEPs)
- Spinal cord monitoring technique
- Positive if there is a 50% decrease in amplitude or a 10% increase in latency.
Recurrent Laryngeal nerve (RLN):
- Vocal cord paralysis on one side will give hoarseness.
Superior Laryngeal Nerve (SLN):
- Will affect the high note phonation, it can affect singers, there will be no vocal cord paralysis.
- Usually occurs when dealing with upper cervical spine surgical approaches.
Where is the rotation of the C spine mostly occurring? In C1 and C2.
Flexion extension of the C spine mostly occur in C4- C5
Ankylosing Spondylitis:
- HLA-B27 positive
- Chest expansion is less than 1 inch
- Bamboo spine
- May have occult fractures, especially cervical spine fractures; suspect it especially in patients with pain and negative x-rays.
- Need to get MRI or CT scan to see lt.
- Need to admit this patient and have spine precautious because they may have neurological deficit most of the time due to epidural hematoma.
- X-rays will show marginal syndesmophytes.
- Need to recognize the difference between ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH).
- Involvement of the scaroiliac joint and the disc space favors ankylosing spondylitis.
When do you do the surgery and what kind of surgery?
- You do spinal decompression and fusion
- Usually long fusion especially if cervical spine is unstable, if there is progressive neurological deficit, or epidural hemorrhage.
Charcot of the Shoulder:
- They will give you an x-ray of the proximal humerus that clearly disappeared, and they will ask you what are you going to do next?
- You get an MRI of the spine to check for syrengomyelia of the cervical spine.
Cervical spine radiculopathy:
- Pain and/or neurological symptoms resulting from conditions such as a disc herniation that irritates a nerve in the cervical spine.
- Cervical spine and shoulder problems overlap, the patient’s symptoms are relieved by shoulder abduction and placing the hand over the head.
- In cervical disc problems be aware of false positive MRIs.
- It usually involves the lower numbered root, so if you have C6-C7 you will get C7 nerve root compression.
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THANK YOU PROF. DR. NABIL FOR THIS EXCELLENT EXPLANATION 🎉🎉🎉
Such a lovely review. God bless you with long life sir
Dr. You are AWESOME. I have had so many questions and you explain everything beautifully. THANK- YOU
I wish i could get appointment with this very knowledgeable and helpful doctor. I have had surgeries for scoliosis when teen and now have weakness in legs and poor balance.
I’m not Dr. Ebraheim’s patient, but after having ACDF Surgery w/Titanium Implants & Cadaver bones at 4 levels 6/15/21, and his diagnosis is spot on! In 7/15/22 I had Bilateral Laminectomy at two levels, and was in extra pain for too long. An MRI discovered I had developed a Thecal Sac with Synovial Fluid pressing on the nerves. So, I’m waiting to have physical therapy to relieve more pain. Any good professional advice is appreciated. I’ll look through your library. Thanks for your excellent professional info. 11/13/22
You are the best of the best, blessings for you Dr Nebil. Thank you for sharing your knowledge.
I was always looking for these type of videos cause I have a same problem in my cervical the explation was simple and clear.. Thank yy
THIS HAS BEEN VERY HELPFUL THANK YOU VERY MUCH
Ģ
Thank ya. Hope you are well.
this have been very helpful review.thank you very much
Thanks
Thank you very much!
thank you for your explanation.God bless.
Tq sir good information. Recently I had this surgery
how about atlanto axial problem? how to diagnose? what's role of x-ray cspine in flexion and extension?
Very good video
Thanks a lot Sir....please present on CTEV also in details..
The best I've seen so far , my case is severe ...I have all conditions , all symptoms , full pain, full bilateral and every area fully previous injured , all trauma related...I am being denied all help and options..I am told I am too severe
Have you had any improvement?
Best wishes
That's what has happened to me. I went to 13 orthopedic surgeons. I wish I had gone to a few nursurgeons but I didnt know. The radipliopthy is so severe and the back and neck seem to work together and get stuck on a chip of a disk and grabs the nerve cuts off blood flow. But I can still use my hands and arms, my legs on a walk are hit or miss. My dogs are used to taking over on a mile walk. I wish it was like when I got injured but it has gone on too long. We are lucky to not have had a bad surgery. Find a good pain dr that burns nerves and does injections. All I can do now surgery wont be an option nothing left to fix.
Thank you from the Caribbean. It was excellent and informative. I subscribed
Thank you so mmuch Professor.
May Allah SWT widen your knowledge in order to serve the human. Aameen
What a nonsense you are saying???
Great video and explanation. Thank you very much!
I fell down and started having muscle stiffness in right trap muscle and numbness in last two fingers of right hand for first 2 months i didnt went to hospital i thought it would go away later on pain started to increase more and i visited one doctor he said that i was suffering from trapezius tendonitis and it would go away from 3rd month i started having twitchings all over body but they are not painful they would just come and go and pain wasnt going away so after 6 months from falling down i visited many doctors they all would say it is just muscle stiffness nothing serious with it and it would go away but 1 doctor suggested to go for MRI for cervical spine so i went and i found that i have mild disc bulge in c3-c4 segment, loss of cervical lordosis and multilevel partial disc changes so pain from right hand has spread to left hand as well and i even went to massages for pain relief for almost 5-6 sittings , no other symptoms are there and my vitamin D level, vitamin b12 levels are good and i even went for thyroid blood test it is also good as of now pain almost seems to be gone in both hands but few times my last two fingers go numb after waking up from sleep in both hands and muscle twitchings are still there and they are coming all over body. Can anyone please suggest what should i do now..?
very helpful, thanks!
Finally...a video without ego
Spot on!
very helpful review.thank you very much, i am diagnosed with c3/4/5 canal stenosis, no pain just walking problem, how would that be treated?
I suffer from the same problem Mike, have you had any luck resolving it yet?
Excellent! Thanks!
Thank you so much Sir🙏
Great Video!!
Thank you so much sir.
Are there considerations for hypermobility and Ehlers Danlos Syndrome and other connective tissue disorders when doing the clinical assessment?
Thank you
Very informative!😎
Useful video
I was recomended for a laminectomy surgery at levels C3,4,5. My orthopedic surgeon did not recomend fusion. I am 57 years old ... My diagnosis is cervical stenosis with myelopathy. The laminectomy would be done posteriorally. Dr., do you agree with this approach? What do you think?
Awesome 👍 thanks 🙏
Excellent clear, succinct tutorial. Thanks, much appreciated
Sir you are awesome
What cirvical operation is successful please answer
Thank you Dr it was very helpful. I have been on a waiting list in UK for a year already for C5 and C6 with fusion. In constant pain
David Keith have you had yours done?
Hi bro I have a same problem.. And now waiting for my surgery
@@losedarkhorse sorry yes 2020
@@Isaac5123 did you had any problem in post surgery
@@martinchhuan4354 no it was brilliant but its important not to do anything for a year. Now I'm waiting to have some sort of surgery due to nerve root impingement just above
Dr. Nabil, I have a good deal of Cervical Spine Instabilities and issues C4-C7 & T1 & T2 antherospondylioethesis; T9 & T10 disc herniations bulging to the front and to the rear; L2, L3 Disc Bulges and L5-S1 Spondylioethesis , OA in the Hips and Knees, and Dextroscoliosis of 25 Degrees. I have read about prolotherapy for the neck. Do you know anything abouit it? Moreover I have learned ( and is contrary to what my Doctor beleives), that Cervical Instalibities cause Tinnitus, Sinusitis, IBS, GERD, Balance Issues, Dizziness and Vertigo & Bladder /Bowel Incontinence. I have a 1 inch Shorter right leg as a result of a fractured right femur in 1966 (at age 15). After the Body Cast came off, my right leg was 1 inch shorter which was left Unaddressed by the Orto DR. at that time and my parents too. After some 15 years, the Lower back Misery started and has progressed up the spine to the Bridge of My Nose. All the facet Joints are Arthritic and I have DDD throughout.
Superb explanation. May God bless u. Keep it up
Excellent video, diagrams and explanations. I have numbness in my feet, compromised gait and lightheaded. Just got an mri. We will see if my Dr. Knows. Thank you! Drs seem ignorant here in Oregon. Trying OHSU next or maybe in Eugene.
Perfect review thanks
Jenny Keightley yes
My neck injury c6,c7, before 20days
My C1n 2 C 456 KFS Syndrome 56 years old need to find a surgeon that knows mine died n I've haven't found another yet
Ps. Everything on this video is exactly Me 14 MRI N ON N ON THANK U Sr. 👍🏻
Dr. How to spinal cord injury recovey? Very important spinal cord injury any part 2 nd.
Is it possible that the weakness symptoms is unilateral but affect both lower and upper extremities?
very very helpfull
very good job excellent
v good
Sir kaise thik hoga jald se bataye
Thank you for making these videos. I had a ACDF surgery 7 months ago at c6,c7 and I've been having worse pain in my neck, shoulder, left scapula area and down top side of arm into my index and middle finger, left side. New symptom of these fingers being numb. What could this possibly be? I am thinking it's several different nerves and muscles.
shilo day I had cervical fusion just over 4yrs ago now. I've had pain since. Severe sensitivities to water, cloth, pretty much everything. In both arms, hands index and middle fingers. You're the first person whose symptoms are so close to mine! I would love to hear if you get this resolved.
@@noooologic Did you have any improvement in your symptoms?
@@JoBlakeLisbon Hi, while I have shown improvement in my gait, I am still unable to climb a step stool. I have regained control over bodily urges and control. My lumbar hurts constantly now. Iam unable to lie on either side at night for more than 2hrs. While I sleep 8-9hrs, it is very sporadic while moving from bed to couch ect. My cervical fusion dr told me my neck was a trainwreck, and to expect to remain on pain meds the rest of my life. My arms and fingers experience such intense pain I can only describe it being like sticking my fingers into a bag of razors. The same with touching my hair, clothing, water, wind.. How are you doing? What is happening with you? Are your symptoms like mine?
Very helpful. Thank you very much sir
tysm for your videos, keep up the good work
Very informative video ! Great help really.
Thanks a lot
how to treatment for c3 c4 plz reaplay mee sirr
Its going very vast and my English is not so best. I’m a Dutch woman
Thanks sir
If you're a hammer then everything looks like a nail.. Always try a good chiro b4 resorting to surgery..
Patrick follow instructions of Dr I would say. If medication and rest dont help, one could try a chiro but soon may understand like in my case nothing helps but surgery
@@Isaac5123- Hi, Its been a year since u posted that comment and Im wondering how you are now? Wld you still say and suggest the same? Are there improvements or dis-improvements in your quality of life? I apologize if u feel bombarded, i just wonder if fusions, surgery and the (potential) scar tissue have made things better or worse over the past yr? I sincerely wish u the best but need any truth and other advise you might be able to offer based on your experience. 🙂
@@melloyellow5598 Thank you kindly for asking. Having lived on the Med for 13 years I do suffer greatly with cold weather even like today its 17 degrees but no sun. I have improved every time I had surgery but what is very important is not to do much of anything including physio for a year after surgery then take things gently to gety back to it. My final op will be some time due to the corona virus but will need to return to warmer climates. Take care
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Thank you so much.
Thanks
Thank you!!