OKOJ, Volume 15, No. 5

Cervical Degenerative Disease

Cervical degenerative disease, the most common cause of spinal cord impairment worldwide, affects up to 180 of every 100,000 people, and its treatment comprises a large portion of surgical spinal pathology. Cervical degenerative disease encompasses several pathologic processes such as cervical disk derangement (herniated or protruding disks), spondylosis, and ossification of the posterior longitudinal ligament; these processes can result in symptomatic cervical radiculopathy and/or myelopathy. A wide range of treatment options, both surgical and nonsurgical, exists for symptomatic cervical degenerative disorders, depending on the specific compressive pathology. Surgical treatment is typically recommended for patients with myelopathy, and for those with persistent pain or worsening neurologic findings. Cervical fusion, disk arthroplasty, and laminoplasty are all commonly used, effective techniques, each with specific advantages and disadvantages. Complications and sequelae of surgical intervention for cervical degenerative disease are adjacent-segment disease, pseudarthrosis, neurologic injury, postoperative kyphosis, and infection. It is important to understand the epidemiology, pathophysiology, diagnosis, and management of cervical degenerative disease and its complications.

    • Keywords:
    • adjacent-segment disease

    • anterior cervical diskectomy and fusion

    • C5 nerve palsy

    • cervical disk replacement

    • cervical spondylosis

    • disk herniation

    • laminectomy

    • laminoplasty

    • myelopathy

    • ossification of the posterior longitudinal ligament

    • pseudarthrosis

    • radiculopathy

    Lumbar Stenosis and Degenerative Spondylolisthesis

    The management of spinal stenosis and spondylolisthesis has evolved over the years. Nonsurgical management is typically attempted first, including activity modification, use of NSAIDs, a structured physical therapy regimen, epidural steroid injections, and patient education on the benefits of a healthy lifestyle (eg, control of diabetes, weight loss programs, exercise, cessation of nicotine consumption). Several surgical options are available for managing lumbar spinal stenosis with or without spondylolisthesis in appropriately selected patients. Techniques include open laminectomy, open arthrodesis, and minimally invasive surgery. Options for anterior column support include posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, and anterior lumbar interbody fusion. No clear consensus exists that one technique is superior to another. Anterior column support and interbody fusion are used at the surgeon’s discretion because of the lack of strong data to support better clinical outcomes. Minimally invasive techniques have shown promising results of faster rehabilitation, lower infection rates, and faster return to function.

      • Keywords:
      • degenerative spondylolisthesis

      • interbody fusion

      • lumbar laminectomy

      • lumbar spinal stenosis

      • minimally invasive surgery

      • posterolateral fusion

      Neuromuscular Spine Deformity

      Scoliosis is common in children with neuromuscular disorders. Impaired trunk balance and the strength of trunk muscles are important factors in the pathomechanism of scoliosis. The specific characteristics of each neuromuscular disorder determine the efficacy of nonsurgical management, the indications for surgery, the time of intervention, and the expected postoperative complications. Segmental posterior spinal fusion has been an effective definitive treatment for neuromuscular scoliosis, and the role of growth-modulating devices in younger children has been recently reported. In general, the complication rate is higher in patients with neuromuscular conditions than in children and adolescents who have scoliosis and no comorbidities. Treatment techniques and the postoperative course differ in each disorder. Despite advances in scoliosis surgery and an improved understanding of underlying neuromuscular mechanisms in many disorders, further research is needed to provide optimal orthopaedic care for children with neuromuscular disorders and scoliosis.

        • Keywords:
        • cerebral palsy

        • Duchenne muscular dystrophy

        • neuromuscular scoliosis

        • Rett syndrome

        • spinal muscular atrophy