医科大学精品课件：Cervical Spondylosis-颈椎病CBL 预习资料

1、Cervical Spondylosis: Patient History and CaseCervical SpondylosisCervical spondylosis (spon-dee-low-sis) can be thought of as grey hair of the spine. This means that if you live long enough (and that may only mean forty- to fifty-years of age in some populations) x-rays of your spine will eventuall

2、y show signs of cervical spondylosis.As described above, the term refers to osteophytes (os-t-o-fights), or bony overgrowths, that protrude from the vertebral bodies as well as narrowing occurring across the disc spaces as the disc degenerates. Though they can compress the spinal cord (like Mrs. S)

3、or a spinal nerve root (like Mr. D), the vast majority of these osteophytes do not cause any nerve problems. They are a sign, however, that the disc between the vertebrae and the facets (fah-sets) has become degenerative.Degenerative discs can cause pain. The mechanism of pain is, unfortunately, not

4、 well understood. It is thought to be transmitted by tiny nerve endings that innervate the back part of the disc and facet joints. Degeneration can cause pain from the disc, facet joint, or both concomitantly. Diagnostic efforts are aimed to determine which of these structures are the pain generator

5、s. Therapy is directed to relieving stresses being placed on these areas.PresentationMrs. P is a forty-two year old woman who was involved in a motor vehicle accident ten years ago. Since then, her neck has never felt right. She has frequent neck spasms, which cause her to miss many days of work as

6、an assembly line worker. Mrs. P states her neck pain frequently radiates to the base of her head and down into her shoulder blades. She has no arm or leg pain, no bowel or bladder complaints, and no problems with coordination of her hands or feet.Mrs. P has taken many pain medications over the past

7、ten years. In the first couple of years, ibuprofen was working adequately. About seven years ago, an emergency room physician gave her a shot of Demerol?, which she felt disagreed with her, but did temporarily relieve her pain. Two weeks later, the pain was back.Her primary care doctor began to pres

8、cribe a mild narcotic, Vicodin?, about three years ago. She takes this on occasion, but she does not like the spacey feeling she gets when she takes it. She has had two courses of physical therapy in the past. In describing the therapy she states she was given exercises concentrating on extending he

9、r neck. She felt this made her pain worse, despite the therapists reassurance that this would help relieve the pressure across her intervertebral discs. Mrs. P refuses to go back to physical therapy.Her primary care doctor has also instructed his patient to use a home traction set up. Attaching to t

10、he top of a door, Mrs. P uses upright sitting traction. This consists of a chin-head strap connected to a rope, which runs over a pulley. The other end of the rope has light weights (five to ten pounds) attached, which deliver an upward force along Mrs. Ps neck. When she is in the traction setup, sh

11、e experiences some relief, but it is short-lived. The pain usually returns thirty minutes after she has stopped the traction.Mrs. P also uses a soft cervical collar when she has extreme neck spasms. Again, the relief is temporary. She returns to her primary care doctor for a regular visit and to dis

12、cuss the options for her excruciating neck pain.ExaminationMrs. Ps primary care doctor performs a careful neurologic exam, which shows no abnormalities of nerve function. Her neck is stiff with a markedly decreased range of motion. She notices that when the doctor was testing extension (head to the

13、back) the pain became much worse.Diagnostic TestsOver the years, Mrs. P has had numerous x-rays of the spine. Her latest x-ray showed degenerative changes with multiple osteophytes growing from the front and back of the C5 and C6 vertebral bodies. An MRI of her neck, taken one year ago, showed no ne

14、rve or spinal cord compression, but shortening of the intervertebral disc height. This suggests that the disc has become dried and degenerated and that it is not functioning normally. More importantly, there appears to be degeneration of the facet joints as well at the C5 and C6 level. Having treate

15、d Mrs. Ps painful neck for many years to no avail, her doctor has decided to seek a specialist consultation from a pain management physician.Specialist ConsultationThe pain management doctor reviews Mrs. Ps records, chart, x-rays, and MRI. His examination demonstrates that her pain is worse with ext

16、ension of the neck. He tells her that she has what appears to be degenerative cervical spondylosis at the C5-6 level. Because her neck pain is worse with extension, the doctor believes that Mrs. P has pain associated with facet arthritis. He suggests that she undergo a series of injections into the

17、facet joints to determine if this decreases her pain. The injections would be Lidocaine? (a numbing medicine) and corticosteroids (to decrease the inflammation). She agrees with this plan.The injections into the facet joint of C5-6 gave Mrs. P substantial relief. She has seen the pain doctor two mor

18、e times over the past ten months since her initial visit. Each time, the facet injection helps her pain dramatically to a point where she can skip taking her pain medicines some days. Unfortunately, the effects have lasted only about three months after each injection.The pain doctor is confident tha

19、t her pain generator is the facet joints at C5-6 in her cervical spine. He explains to Mrs. P that if the pain continues she might be interested in surgery to fuse these two vertebrae together. This would eliminate motion at the painful joints and hopefully relieve her pain. The doctor explains that

20、 the procedure has about a 70 percent success rate in providing long-lasting pain relief. He states that he does not perform the surgery and that she would need to be referred to a spine surgeon.Mrs. P thinks about her options carefully. Though her pain is continuing, she is not willing to have surgery yet. Because of the temporary relief of the injections, she feels that she has been able to resume, to some degree, her regular activities. As this is the first time she has had improvement over the past ten years, she would like to postpone surgery for as long as possible. The doct