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Spinal Deformity and Degeneration

Spinal Deformity and Degeneration. Shay Bess, MD Assistant Professor of Orthopaedic Surgery University of Utah School of Medicine. Spine Surgery Overview. Trauma Tumor Infection Degenerative Radiculopathy Myelopathy Deformity Scoliosis Kyphosis. Goals. Peripheral Nerve Anatomy

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Spinal Deformity and Degeneration

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  1. Spinal Deformity and Degeneration Shay Bess, MD Assistant Professor of Orthopaedic Surgery University of Utah School of Medicine

  2. Spine Surgery Overview • Trauma • Tumor • Infection • Degenerative • Radiculopathy • Myelopathy • Deformity • Scoliosis • Kyphosis

  3. Goals • Peripheral Nerve Anatomy • Cervical • Lumbar • Identify and Differentiate • Radiculopathy • Myelopathy • Differentiate and Measure • Coronal imbalance • Sagittal imbalance

  4. Degenerative Conditions Radiculopathy & Myelopathy

  5. General Anatomy

  6. Regional Anatomy

  7. Radiculopathy • Nerve Root Compression • Cervical • Thoracic • Lumbar • Spinal Nerve Anatomy

  8. Radiculopathy • Etiology • Mechanical Compression • Disc Herniation (HNP) • Foraminal Stenosis

  9. Radiculopathy • Spinal Nerve Exiting Anatomy • Correlate Pathoanatomy • L4-5 Disc Herniation • Symptoms? • C4-5 Disc Herniation • Symptoms?

  10. Radiculopathy • Symptoms • Anatomic distribution • Lower motor neuron • Weakness • Sensory deficit • Diminished reflexes

  11. Cervical Radiculopathy

  12. Cervical Radiculopathy

  13. Lumbar Radiculopathy

  14. Radiculopathy • Spinal Nerve Exiting Anatomy • Correlate Pathoanatomy • L4-5 Disc Herniation • Symptoms? • C4-5 Disc Herniation • Symptoms?

  15. Cervical Radiculopathy • Treatment • Nonoperative • Physical Therapy • NASIDs • Selective Root Injection • ACDF • Anterior Cervical Discectomy & Fusion • Posterior Foramenotomy and Discectomy Courtesy of Dan Riew, MD

  16. Lumbar Radiculopathy • Treatment • Nonoperative • Physical Therapy • NASIDS • Selective Root Injection • Discectomy

  17. Myelopathy • Spinal Cord Compression • Location • Cervical? • Thoracic? • Lumbar? • Why?

  18. Myelopathy • Symptoms • Upper Motor Neuron • Unsteady gait • Poor manual dexterity • Loss proprioception • Normal strength • Normal sensation

  19. Myelopathy Grading Reflexes 0 = Absent 1+= Diminished 2+ = Normal 3+ = Increased 4+ = Increased with associated clonus • Symptoms • Upper Motor Neuron • Hyperreflexia • Pathologic reflexes • Babinski • Hoffman • Inverted brachioradialis

  20. Myelopathy • Etiology • Cord Compression • Disc • Soft disc herniation (HNP) • Hard Disc • Degenerative Instability • Disc incompetence • Facet incompetence • OPLL • Tumor • Infection Courtesy of Henry Bohlman, MD

  21. Myelopathy • Treatment • Surgery • Decompress Offending Agent • Anterior Procedures • Posterior Procedures Anterior Cervical Corpectomy Courtesy of Dan Riew, MD

  22. Myelopathy Posterior Cervical Laminaplasty Courtesy of Dan Riew, MD

  23. Spinal Defomity Scoliosis & Kyphosis

  24. Spinal Deformity • Definition of Terms • Coronal plane • Scoliosis • Sagittal plane • Lordosis • Kyphosis • Normal Spinal Alignment

  25. Scoliosis • Coronal Deformity • Evaluation • Cobb Angle Measurement • Top of the top • Bottom of the bottom • Perpendiculars

  26. Kyphosis • Sagittal Deformity • Cobb Angle Measurement • Thoracic Kyphosis • T5-T12 • 40 degrees • Lumbar Lordosis • T12-S1 • 60 degrees • 20-40 degrees > thoracic kyphosis • Regional Deformity

  27. Spinal Deformity • Treatment • Risk of progression • Etiology • Curve size • Remaining growth • menarche • age • Appearance • Symptoms • Nonoperative • Observation • Bracing

  28. Spinal Deformity • Operative Treatment • High Risk Progression • Etiology • Large deformity • Remaining growth • Cosmesis • Disability

  29. Spinal Deformity Treatment

  30. Spinal Deformity Treatment

  31. Spinal Deformity Treatment

  32. Summary • Diagnose, Differentiate, Pathoanatomy • Radiculopathy • Myelopathy • Identify and Measure Spinal Deformity • Coronal imbalance= scoliosis • Sagittal imbalance= kyphosis • Effective Treatment algorithms

  33. Thank You

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