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Cervical Facet Fracture/Dislocation
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
Anterior cervical discectomy and fusion ± open reduction (indicated after failed closed reduction or in the presence of an anterior disc causing cord compression seen on MRI c-spine) Standard Smith–Robinson anterior cervical approachUnilateral dislocations can be reduced by distracting vertebral bodies with Caspar pins and then rotating the proximal pin towards the side of the dislocationBilateral dislocations can be reduced by placing converging Caspar pins (10–20 degrees angle) and then compressing the ends together to unlock the facet jointsPosterior instrumented stabilisation ± open reduction when closed reduction fails or is contraindicated and if open anterior reduction fails or is not required (e.g. no anterior disc prolapse)
Diabetic Neuropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Treatments for lumbar radiculopathy are varied, including back supports, medications, physical therapy, spinal corticosteroid injections, and surgery. For cervical radiculopathy, surgical options are varied. Techniques include anterior cervical discectomy to achieve decompression, anterior cervical discectomy and fusion, total disc arthroplasty, laminotomy, and corpectomy. Physiotherapy and surgery together provide better results. Epidural corticosteroid injections are also helpful. These injections often are sufficient, and surgery can be avoided. Thoracic radiculopathy can often be treated nonsurgically, though minimally invasive surgery is often helpful. Medications include NSAIDs, oral or injected corticosteroids, narcotic analgesics, physical therapy, and application of ice or heat.
C3-4 injury
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
A 14-year-old male landed on his neck while doing backflips on a trampoline. He complained of neck, left shoulder, and arm pain with paresthesia. The lateral cervical spine radiograph demonstrated step-offs at C3-4 of both the anterior and posterior vertebral lines suggestive of ligamentous injury. A CT revealed a C4 compression deformity, grade 2 anterolisthesis, and a jumped C3/C4 facet. The patient underwent an open anterior cervical discectomy and fusion.
High-dose cervical mobilization to improve central sensitization for a patient with post-fusion neck pain
Published in Physiotherapy Theory and Practice, 2023
Robert T. LeBeau, Stephen Shaffer, Darren Earnshaw
Patients may experience continued pain after an anterior cervical discectomy with fusion (ACDF) procedure. Complications are noted in 24% of patients post-ACDF, with 19% of patients requiring pain management and 17% reporting radicular symptoms (Kienapfel et al., 2004). High rates of adjacent segment disease (ASD) are noted after fusion surgery (Goffin et al., 2004; Wang et al., 2017). Physical therapy has been recommended for care of ASD, but specific treatment techniques and dosage have not been reported (Bhargava et al., 2005). Cohorts receiving surgery and rehabilitation compared to surgery alone demonstrated reduced health-care utilization and improved return to work status (Mayer, Anagnostis, Gatchel, and Evans, 2002). The above studies collectively demonstrate the importance of effective post-operative treatment to improve function and reduce pain.
Safety and feasibility of an early telephone-supported home exercise program after anterior cervical discectomy and fusion: a case series
Published in Physiotherapy Theory and Practice, 2021
Rogelio A. Coronado, Clinton J. Devin, Jacquelyn S. Pennings, Oran S. Aaronson, Christine M. Haug, Erin E. Van Hoy, Susan W. Vanston, Kristin R. Archer
Anterior cervical discectomy and fusion (ACDF) is the most common surgery for cervical spine degenerative conditions (Marquez-Lara, Nandyala, Fineberg, and Singh, 2014; Oglesby et al., 2013; Wang et al., 2009). An estimated 150,000 individuals elect to undergo ACDF surgery in the United States each year (Oglesby et al., 2013). Marawar et al. (2010) reported an 8-fold increase in the total number of ACDFs from 1990 to 2004 and Marquez-Lara, Nandyala, Fineberg, and Singh (2014) demonstrated a steady increase from 2002 to 2011. Average hospital charges per patient including charges for inpatient stay, surgeon, and instrumentation exceed $50,000 (Alosh, Li, Riley, and Skolasky, 2015; Lord et al., 2017). Total mean direct and indirect costs over a two-year period after ACDF has been estimated at over $21,000 (Chotai et al., 2017). Despite the increased utilization, approximately 40% of patients report persistent disability and pain following surgery (De la Garza-Ramos et al., 2016; Massel et al., 2017; Peolsson, Vavruch, and Oberg, 2006).
The update on scales and questionnaires used to assess cervical spine disorders
Published in Physical Therapy Reviews, 2021
Łukasz Pulik, Nicola Dyrek, Aleksandra Piwowarczyk, Kaja Jaśkiewicz, Sylwia Sarzyńska, Paweł Łęgosz
The Conservative treatment of NP is aimed at function regain and pain alleviation. Such practices as strength training of the neck and upper limbs are a well-proven method of treatment and bring moderate therapeutic benefits [16]. The other conservative treatment modalities also include spinal manipulation [17], massage [18], and electrotherapy [1]. However, these methods do not bring significant improvement in long-term pain relief. Recently, other procedures such as trapezoid needling, administration of botulinum toxin type A and local saline injections have become frequently used. Surgical treatment is considered if there is no response to minimally invasive methods. The indications for surgery depend on the type and source of pain. A wide range of surgical techniques is available, including corpectomy and spinal fusion, anterior cervical discectomy and fusion, laminoplasty, and laminectomy and fusion [19].