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Stingers and Transient Paresis

Chapter Preview Chapter Synopsis Cervical cord neurapraxia and stingers can create significant angst in players, coaches, families, and spectators. Avoidance of permanent injury is tantamount. Effective postinjury management of the injured athlete by medical personnel either on the field or in the hospital setting can reduce the risk of secondary neurologic injury. This chapter covers the mechanisms, examination, imaging, and management of stingers and transient paresis.…

Traumatic Arterial Injuries: Diagnosis and Management

Chapter Preview Chapter Synopsis Vertebral artery injuries (VAIs) are becoming increasingly recognized as more screening protocols are being used. Angiography is the gold standard, but many centers are using computed tomography angiography (CTA) or magnetic resonance angiography (MRA) as the initial screening study. Treatment is recommended for all patients with symptomatic injuries. Treatment of asymptomatic injuries remains controversial, and treatments should be individualized to each particular…

Spinal Cord Injuries and Syndromes

Chapter Preview Chapter Synopsis Spinal cord injury (SCI) is a serious worldwide health problem, often resulting in significant morbidity and permanent neurologic deficits. The American Spinal Injury Association (ASIA) impairment scale can be used to classify the extent of the injury and can also serve as a predictor of neurologic outcome. Several common discrete clinical syndromes are associated with incomplete SCI and cover a broad range…

Subaxial Cervical Spine Injuries

Chapter Preview Chapter Synopsis Injuries to the subaxial cervical spine comprise the majority of cervical spine injuries annually. Since 2000, novel classification systems have been developed to provide a uniform method of characterizing subaxial cervical spine injuries and to help guide treatment. Surgical intervention is aimed at restoring mechanical stability and improving neurologic outcome. The surgical approach largely depends on the mechanism of injury, the location…

Occipitocervical and Upper Cervical Spine Fractures

Chapter Preview Chapter Synopsis The occipitocervical junction consists of structurally important osseous and ligamentous complexes that stabilize the skull base to the spine. Compromise of either the complex bony or ligamentous complex places the integrity of the occipitocervical junction at risk. Because of the proximity of neurovascular structures, acute loss of occipitocervical structural integrity carries a high mortality. This chapter reviews the classification system, imaging, surgical…

Ossification of the Posterior Longitudinal Ligament

Chapter Preview Chapter Synopsis Ossification of the posterior longitudinal ligament (OPLL) has unique characteristics in multiple lesions from the cervical spine to the lumbar spine and in its gradual extension of ossification. The clinical course resembles that of spondylosis. However, in some patients, extremely severe compression of the spinal cord can occur. The purpose of this chapter is to describe the epidemiology, pathophysiology, diagnosis, and treatment…

Cervical Deformity and Treatment Algorithms

Chapter Preview Chapter Synopsis Cervical deformity is disruption of normal cervical alignment. This chapter focuses on the different causes of cervical deformity, normative data, and deformity evaluation and examination and presents various treatment options for the proper management of these debilitating conditions. Important Points Disruption of normal cervical lordosis can result in loss of horizontal gaze and resulting mechanical neck pain. Main etiologic factors in cervical…

Cervical Spondylotic Myelopathy

Chapter Preview Chapter Synopsis Cervical spondylotic myelopathy (CSM) is spinal cord dysfunction accompanying age-related degeneration of the cervical spine. The lack of prospective studies of its natural history and vague clinical symptoms pose difficult challenges for clinicians. This chapter aims to resolve conflicts concerning the pathophysiology, natural history, and various treatment algorithms through evidence based in the current literature. Important Points The pathophysiology of CSM relates…

Cervical Radiculopathy

Chapter Preview Chapter Synopsis Cervical radiculopathy is defined as pain with or without a motor, sensory, or reflex deficit that is caused by cervical nerve root compression or irritation. Typically, cervical radiculopathy has a favorable natural history. This chapter reviews the epidemiology, natural history, pathogenesis, and differential diagnosis of the disease. Important Points Neural compression resulting in radiculopathy can result from a variety of sources, the…

Cervical Degenerative Disk Disease

Chapter Preview Chapter Synopsis Cervical disk degeneration becomes more prevalent with increasing age and can affect both male and female patients equally. Genes associated with disk degeneration include those coding for collagen I and IX, vitamin D receptor, and matrix metalloproteinase-3. Disk degeneration begins with a loss of water content in the nucleus pulposus that leads to an increased loss of proteoglycan and altered collagen content.…

Neurophysiologic Monitoring of the Cervical Spine

Chapter Preview Chapter Synopsis This chapter discusses the application of various intraoperative neurophysiologic monitoring (IONM) techniques (also known as modalities) during cervical spine surgery, namely, somatosensory-evoked potentials (SSEPs), transcranial electrical motor-evoked potentials (TCeMEPs), direct epidural potentials, spontaneous electromyography (sEMG), triggered electromyography (tEMG), and train of four (TOF). Each modality is briefly discussed separately and in terms of technical and anesthetic considerations, to provide better understanding of…

Magnetic Resonance Imaging of the Cervical Spine

Chapter Preview Chapter Synopsis Magnetic resonance imaging (MRI) is instrumental in evaluation of symptomatic cervical spine degeneration and guidance of surgical treatment. In the setting of trauma, MRI can help define unexplained neurologic injuries, assess for soft tissue damage, and exclude cervical spine injury. It has also become extremely beneficial in the diagnosis and management of spinal infection and inflammatory conditions of the spine and in…

Radiographic and Computed Tomography Evaluation of the Cervical Spine

Chapter Preview Chapter Synopsis Conventional radiographs and computed tomography (CT) imaging are integral parts of the evaluation of a patient with suspected cervical spine abnormalities. The treating clinician must have a thorough understanding of the role of the imaging studies available, the radiographic views that should be obtained, and the ability to differentiate normal from abnormal findings. This chapter discusses the conventional radiographic views most commonly…

Evaluation of the Cervical Spine

Chapter Preview Chapter Synopsis This chapter describes a methodical approach to the patient with suspected cervical spine disease. Characteristic aspects of the history and physical examination are discussed and warning flags for musculoskeletal and neurologic diseases which mimic spinal disease are discussed. Relevant diagnostic tests are described. The chapter concludes with a brief discussion of disability and workers’ compensation assessments and how these evaluations differ from…

Biomechanics of the Cervical Spine

Chapter Preview Chapter Synopsis The determination of spine stability is a controversial topic and continues to evolve. Understanding the anatomy and the biomechanical principles is fundamental to the performance of successful cervical spine surgery. The clinician must possess broad knowledge of the properties and characteristics of the implants available in spine reconstructions. The goals of this chapter are to introduce the basic biomechanical principles of the…

Developmental and Congenital Disorders of the Cervical Spine

Chapter Preview Chapter Synopsis Congenital anomalies of the pediatric cervical spine arise from a failure of normal development occurring early in the embryonic process. Failure to recognize these pathologic processes risks overlooking segmental instability, developing progressive spinal deformity, encroachment on the space available for the spinal cord (SAC), and the risk for myelopathy. This chapter reviews the embryology, biomechanics, and associated developmental and congenital disorders of…

Anterior Approaches and Surgical Considerations for Pathology of the Cervicothoracic Junction

Chapter Preview Chapter Synopsis Surgical exposure of the anterior cervicothoracic junction poses a unique challenge for spine surgeons. Several distinct features of this region contribute to the difficulty of approach. However, given the complexities and challenges of this region, subsequent modifications have been described. This chapter primarily focuses on two anterior cervicothoracic junction exposure techniques: the supraclavicular approach and the transmanubrial transclavicular approach. Important Points The…

Posterior Surgical Approach to the Cervical Spine

Chapter Preview Chapter Synopsis The midline posterior approach is the most commonly used approach to the cervical spine. It allows efficient and safe access to the posterior elements of the occipitocervical region and the subaxial cervical spine. It is indicated for a variety of cervical spine procedures, including fusions, decompressions, evacuation of tumors, reduction of facet dislocations and posterior element fractures, and removal of accessible herniated…

Anterior Surgical Approach to the Cervical Spine

Chapter Preview Chapter Synopsis The approach to the anterior cervical spine is one of the most common approaches performed in cervical spine surgery. Because of the vital anatomy near the surgical dissection, potential complications from this approach are severe. Therefore, a thorough understanding of the anatomy is crucial to performing this elegant approach safely and expeditiously. This chapter describes and illustrates the approach and provides insight…

Approaches to the Upper Cervical Spine

Chapter Preview Chapter Synopsis The upper cervical spine encompasses the area spanning the occiput, the atlas (C1), the axis (C2), and the C2-C3 motion segment. The authors discuss four main approaches to the upper cervical spine: the dorsal or posterior, the posterolateral transcondylar, the transoral transpalatopharyngeal, and the transcervical extrapharyngeal. The indications for, applications of, and descriptions of each approach are reviewed. Important Points Selection of…