Degenerative Cervical Myelopathy and Radiculopathy by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783319979526
Publisher: Springer International Publishing

Preoperative Evaluation

A comprehensive evaluation of the patient should be performed prior to performing laminoplasty. The evaluation should include a detailed clinical questionnaire, a thorough physical examination, and appropriate diagnostic imaging modalities. A detailed review should include the documentation of all cervical spine-related symptoms, especially symptoms indicating progressive spinal cord compression. Timing, onset, chronicity, exacerbating factors, the overall course and trajectory, history of falls, changes and bowel and bladder function, the presence of axial neck pain, and the distribution of arm pain are essential to document. Physical exam should document range of motion of the neck, gait pattern, muscle weakness in upper or lower extremities, and signs of upper motor neuron dysfunction such as hyperreflexia and Hoffmann’s or Babinski reflex. The radiographic evaluation of patients for whom laminoplasty may be considered includes standard anterior-posterior (AP) and lateral radiographs, flexion and extension lateral radiographs, and oblique radiographs (to visualize the neural foramen) of the cervical spine. These are used to assess cervical alignment, ROM, degenerative changes, instability and spondylolisthesis, underlying congenital stenosis, foraminal stenosis, autofusions, and other pathologies of the cervical spine.

Magnetic resonance imaging (MRI) is used to evaluate the severity and craniocaudal extent of stenosis as well as study contributing etiologies such as disk bulging, uncovertebral and facet arthrosis, hypertrophy and infolding of the ligamentum flavum, underlying congenital stenosis, deformity, or ossification of the posterior longitudinal ligament (OPLL) . Computed tomography (CT) of the cervical spine is indicated for the evaluation of bony or calcified causes of stenosis, including OPLL and uncovertebral or facet arthrosis causing foraminal stenosis. CT myelography is indicated when MRI is contraindicated or cannot be obtained. If a CT scan is obtained, a topographic reconstruction of the posterior cervical spine may provide reference landmarks that supplement intraoperative fluoroscopic examination.

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