Spinal Deformity and Degeneration

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Spinal Deformity and Degeneration

• Shay Bess, MD
• Assistant Professor of Orthopaedic Surgery
• University of Utah School of Medicine

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Spine Surgery Overview

• Trauma
• Tumor
• Infection
• Degenerative
• Radiculopathy
• Myelopathy
• Deformity
• Scoliosis
• Kyphosis

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Goals

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

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Degenerative Conditions

• Radiculopathy Myelopathy

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General Anatomy
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Regional Anatomy
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Radiculopathy

• Nerve Root Compression
• Cervical
• Thoracic
• Lumbar
• Spinal Nerve Anatomy

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Radiculopathy

• Etiology
• Mechanical Compression
• Disc Herniation (HNP)
• Foraminal Stenosis

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Radiculopathy

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

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Radiculopathy

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

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Cervical Radiculopathy
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Cervical Radiculopathy
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Lumbar Radiculopathy
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Radiculopathy

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

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Cervical Radiculopathy

• Treatment
• Nonoperative
• Physical Therapy
• NASIDs
• Selective Root Injection
• ACDF
• Anterior Cervical Discectomy Fusion
• Posterior Foramenotomy and Discectomy

Courtesy of Dan Riew, MD
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Lumbar Radiculopathy

• Treatment
• Nonoperative
• Physical Therapy
• NASIDS
• Selective Root Injection
• Discectomy

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Myelopathy

• Spinal Cord Compression
• Location
• Cervical?
• Thoracic?
• Lumbar?
• Why?

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Myelopathy

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

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Myelopathy

• Symptoms
• Upper Motor Neuron
• Hyperreflexia
• Pathologic reflexes
• Babinski
• Hoffman
• Inverted brachioradialis

Grading Reflexes 0 Absent 1 Diminished 2
Normal 3 Increased 4 Increased with
associated clonus
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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
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Myelopathy

• Treatment
• Surgery
• Decompress Offending Agent
• Anterior Procedures
• Posterior Procedures

Anterior Cervical Corpectomy
Courtesy of Dan Riew, MD
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Myelopathy
Posterior Cervical Laminaplasty
Courtesy of Dan Riew, MD
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Spinal Defomity

• Scoliosis Kyphosis

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Spinal Deformity

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

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Scoliosis

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

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Kyphosis

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

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Spinal Deformity

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

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Spinal Deformity

• Operative Treatment
• High Risk Progression
• Etiology
• Large deformity
• Remaining growth
• Cosmesis
• Disability

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Spinal Deformity Treatment
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Spinal Deformity Treatment
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Spinal Deformity Treatment
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Summary

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

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Thank You