So, what are the pathologies that we usually see on a cervical spine? This is a case of a congenital cervical stenosis. These patients usually are asymptomatic throughout their life, unless they have superimposed degenerative changes or superimposed injury. In case of a trauma, they are at higher risk of having a neurological involvement.
Now, this is a common case, degenerative spine disc herniation. In this case, the disc has gone behind the vertebral body also causing the pinching of the cord. They can also be a lateral herniations causing only the nerve root involvement, causing radiculopathy. These patients mostly present with radiculopathy but can have central upper motor neuron symptoms also.
This is also a degenerative spine, but to mention here is the ossification of the posterior longitudinal ligament. This is called an OPLL. These patients are a little tough to treat surgically because the dura is adhered onto this calcification. Going from front is risky. Sometimes we have to do that, but we try not to go from the front, rather go from the back. These patients already have a stiff spine. Only if they are symptomatic, do we treat them surgically.
This is an uncommon situation, but happens in a younger population because of the trauma, mostly motor vehicle accidents. Second is falls. This is like a jumped facet here. The facet has jumped over here. There’s a fracture and a subluxation.
These patients can present with only radiculopathy. They can present even late if they are not diagnosed. And they are just presenting with radiculopathy after, say a week of injury, or they can be in the emergency room with even complete quadriplegia quadriparesis. These patients do need surgical management in the form of reduction and fixation, sometimes front and back.
And this is another degenerative condition in which the subtle instability on C4-5 level. These patients are again… Degenerative patients only need surgical treatment if they have failed conservative measures, which include physical therapy, medications and injections.
Mostly we do epidurals for this, sometimes the pain physicians are great at doing it. Rarely, we will do a root block. A root block has a little more complication rates on the cervical spine because of the presence of the vertebral artery there.