Chadi Tannoury, MD. Orthopaedic Spine Surgeon Co-Director ... · May 2 & 3, 2016 70 y F with...

Work Related Injuries WorkshopMay 2 & 3, 2016

Chadi Tannoury, MD.Orthopaedic Spine Surgeon

Co-Director of Spine FellowshipBoston Medical Center

SURGICAL OPTIONS10 min

Disclosure N0 COI

NECK SESSION Neck Injuries: Whiplash, Minor Fx (Dr. Mostoufi)

Disc HNP: Non-Op Rx (Dr. Feliz)

Pain Generator: C spine vs Shoulder (Dr. T Tannoury)

Surgical Options

Neck Injury Presentations NECK PAIN

SHOULDER PAIN

ARM PAIN

N/T/Weakness: UE/LE

Loss Dexterity/Imbalance

Anatomy

Radiculopathy/ Myelopathy -Pathophysiology:

Direct Mechanical compression NRoot/Cord:

Uncus joint

Facet joint

Disk Osteophyte Complx

Disc Herniation - OPLL

Infolding Ligamentum flavum

Most Common Causes Neck Pain Cervical Sprain

Cervical Spondylosis

Cervical radiculopathy

Cervical myelopathy

Fracture

Dwyer Et al, Bogduk et al

Cervical Sprain / Whiplash

Discogenic Pain (Spondylosis)

Work Related Injuries WorkshopMay 2 & 3, 2016© Wolfgang Rauschning

Cervical Radiculopathy PINCH’ed NERVE Pain is often accentuated by maneuvers that

stretch the involved nerve root. Some examplesinclude: Coughing Sneezing Reaching

Radicular Pain

Spinal Cord Compression:Myelopathy Neck Pain

UE: Radiculopathy Weakness/N/T Clumsiness

LE: Loss of Balance Frequent Falls Gait disturbances

Cervical Fractures Vertebral Body: Compression fractures Burst fractures

Facet fractures Subluxation Dislocation

Facet Fractures / Dislocation

MANAGEMENT - Terminology Axial Neck Pain (without neurologic deficits): Typically conservative mgmt (PT) Facet block? RFA?

Arm Pain: Radiculopathy PT/ Traction / Injections Surgery: if conservative management fails

Surgery: Weakness, Myelopathy, Instability (Fracture,Stenosis, HNP, Infection, Tumor, etc)

Surgical Options - Terminology Anterior cervical diskectomy and fusion (ACDF) Anterior cervical corpectomy and fusion (ACCF) Cervical disk arthropasty – replacement (cTDR)

Posterior cervical laminotomy - Foraminotomy Posterior cervical laminectomy & Fusion Posterior cervical laminoplasty

Positioning and Anatomy Mild Neck extension

Anatomy

Discectomy and Decompression

HT: 5-10mm

W: 10-15mm

Depth: 12-17mm

Bone Graft Placement

corpectomy

fusion and plating

Anterior Plating

32 F s/p chiropractic manip – U&LEweakness

42y F with C6 & C7 radic

45 y F – Roll over MVA: C5-6-7

Adjacent segment disease

Multilevel: C3-C7

Multilevel: C3-T1

50 M with chronicprogressive difficulty ambulating

Corpectomy & fusion

55 F w L Neck/shoulder Pain, Lbiceps weak

C4 corpectomy – ACF C3-5

70 y F with MyelopathyC4 Corpectomy – ACF C3-5

Cervical Disc Arthroplasty Artificial disc replacement

Preserves ROM

Decrease risk of adjacent DD Decrease Reoperation rate 1 level: ACDF 17.3% vs cTDR 4.5% 2 level: ACDF 21% vs. cTDR 7.3%

Jackson JNS 2016 (5 yr f-up)

39 y M w C7 Radiculopathy

45 y F with C7 radiculopathy

Cervical Foraminotomy

Not tissue preserving!

Multifidus is destroyed !!

Cervical laminectomy and fusion

Cervical Laminoplasty

55 M – U/L ext weak, clumsiness

Cervical Laminectomy & fusion

64 y F w hand N/T & diff Dexterity

56 y M w Myelopathy

60 y M w severe myelopathy

Stage I: Corpec C5-ACCF C3-6

Stage II – Post Lami Fusion

Anterior: ACDF/ACCF cTDR

Posterior: Laminectomy/foraminotomy +/- Fusion Laminoplasty

Combined

60 y F, fall face down, neck pain

Thank You!

Chadi Tannoury, MD. Orthopaedic Spine Surgeon Co-Director ... · May 2 & 3, 2016 70 y F with...

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