Diagnostics and Imaging
Functional radiographs are used to assess the condition of the affected segment. The images are taken in positions of maximum flexion (flexion) and extension (extension). This allows for visualization of the artificial intervertebral disc and evaluation of segmental motion preservation.
Treatment approaches
The choice of management strategy depends on the severity of the clinical picture.
- Conservative therapy: Effective for mild cases and preserved spinal canal area (greater than 70 mm²). About 75% of patients with radiculopathy recover without surgery, as nerve root inflammation and disc herniations can regress spontaneously. In cases of pronounced symptoms, a conservative approach typically yields no results.
- Surgical treatment: Demonstrates high efficacy (over 90%) in relieving radiculopathy symptoms. In myelopathy, surgery also improves the condition and relieves pain, but the success rate is slightly lower.
The main risk of surgery (especially with spinal fusion of three or more vertebrae) is the development of «adjacent segment disease» (adjacent segment disease), in which adjacent cervical levels undergo an accelerated degenerative process.
Risks of Manual Therapy
Holistic medicine methods (specifically, manual therapy) in cervical spondylosis are associated with unjustified risks.
Although serious complications are uncommon, cervical spine manipulations can provoke:
- Formation of a new intervertebral disc herniation;
- Exacerbation of an existing herniation;
- Specific types of strokes.
Such procedures are strictly contraindicated in the presence of upper cervical bone anomalies, as well as in the presence of neurological deficits (numbness, decreased muscle strength in the limbs).
Double Crush Syndrome
The double crush hypothesis (double crush hypothesis) suggests that nerve root compression at the cervical level makes distal segments of this nerve more vulnerable.
For example, against the background of cervical spondylosis, a patient may develop carpal tunnel syndrome with minimal pressure on the median nerve in the wrist area. It is believed that proximal compression disrupts normal axonal transport. Despite its logic, the concept remains scientifically unproven due to the ethical impossibility of conducting placebo-controlled trials on humans with artificial nerve compression.
Briefly: answers to topical questions
What grades of vertebral displacement are distinguished in spondylolisthesis according to the Meyerding radiological classification?
In spondylolisthesis, four degrees of vertebral displacement relative to the underlying one (usually S1) are distinguished, although the name of the Meyerding classification itself is not mentioned in the materials.
- Grade I — displacement by 1/4 of the vertebral body surface.
- Grade II — displacement by 1/2 of the surface.
- Grade III — displacement by 3/4 of the surface.
- Grade IV — displacement of the entire vertebral body surface.
Which pharmacological drug groups and physical therapy methods are included in the conservative treatment of degenerative spondylolisthesis?
According to the sources, conservative therapy for spondylolisthesis includes the following pharmacological and physical therapy methods:
- NSAIDs.
- Non-opioid analgesics.
- B vitamins.
- Novocaine blocks.
- Physiotherapy (PT).
- Balneotherapy.
What specific types of surgical interventions (types of decompression and options for interbody fusion) are used for degenerative spondylolisthesis?
Decompressive interventions and fusion are described in sources for degenerative spondylolisthesis, but specific options for interbody fusion are not detailed.
Decompressive interventions:
- Laminectomy — removal of the vertebral lamina.
- Laminotomy — removal of a small part of the vertebral lamina.
- Foraminotomy — decompression at the level of the intervertebral foramen.
- Extended decompression — resection of articular processes; wherein the absence of facet joints leads to instability and requires supplementing the surgery with spinal fusion.
- Minimally invasive decompression using a microscope, endoscope, tubular retractors, and ports.
Stabilizing intervention:
- Spinal fusion — used to stabilize the spine; the source provides an example of fusion for degenerative anterolisthesis of L4–L5 using pedicle screws and rods.
Which specific clinical symptoms and pathological reflexes indicate the development of spondylotic cervical myelopathy?
The development of spondylotic cervical myelopathy is indicated by sensory, motor, and pelvic disturbances, while specific names of pathological reflexes are not provided.
- Sensory disturbances — bilateral paresthesias, numbness and tingling with a non-dermatomal distribution (non-dermatomal distribution), impaired proprioception.
- Motor disturbances — muscle weakness, loss of dexterity, decreased coordination, and gait instability.
- Pelvic disorders — central-type urinary incontinence (urinary incontinence).
- Long tract signs — occur below the level of spinal cord compression.
Class and exam questions
In what cases will conservative treatment of radiculopathy be most successful?
It yields good results for mild symptoms and sufficient spinal canal area (>70 mm²).
What is «adjacent segment disease»?
This is accelerated degeneration of cervical segments located above or below the area of performed surgical fusion (especially when fixing 3 or more vertebrae).
What is the main modifiable risk factor for radiculopathy?
Smoking is the primary modifiable risk factor.
What else to study on this topic
- Anatomy and topography of the brachial plexus (from roots to branches)
- Innervation by terminal branches of the brachial plexus (radial, median, ulnar nerves)
- Transient brachial plexus neuropathy (Burners and Stingers syndrome)
- Comprehensive neurological examination and differential diagnosis of dermatomal disorders
- Provocative tests for differentiating cervical pathology from shoulder joint diseases
Master the entire topic in the "Traumatology" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on «Degenerative spondylolisthesis» and 812 other pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
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