UPPER CERVICAL RADICULOPATHY: THE HIDDEN PATHOLOGY OF THE SPINE.

Autor:	Shifflett GD; DISC Sports and Spine Center, Marina Del Rey, CA, USA., Iyer S; Rush University Medical Center, Chicago, IL, USA., Derman PB; Rush University Medical Center, Chicago, IL, USA., Louie PK; Rush University Medical Center, Chicago, IL, USA., An HS; Rush University Medical Center, Chicago, IL, USA.
Jazyk:	angličtina
Zdroj:	Spine surgery and related research [Spine Surg Relat Res] 2018 Feb 28; Vol. 2 (2), pp. 93-97. Date of Electronic Publication: 2018 Feb 28 (Print Publication: 2018).
DOI:	10.22603/ssrr.2017-0077
Abstrakt:	Axial neck pain can frequently be a vexing clinical problem for practitioners. Cervical spine surgery is generally regarded as less successful for axial neck pain than arm complaints. Although only few case series exist in the literature, there is evidence to suggest that upper cervical radiculopathy could be an important, treatable source of axial neck pain. Unlike patients with axial neck pain, patients with radiculopathy usually present with unilateral pain, particularly in the trapezial, parascapular, mid clavicular, or even in the form of suboccipital headaches. Similar to other regions of the cervical spine, initial imaging often consists of plain radiographs of the cervical spine, with the use of magnetic resonance imaging (MRI) or computed tomography (CT) if further evaluation of the pathology is warranted. Selective injections and electromyography can be used in conjunction with the imaging studies to aid with proper diagnosis. The surgical management of upper cervical radiculopathy is reserved for patients who fail to improve with non-operative modalities. Anterior cervical discectomy and fusion (ACDF) remain the most commonly performed and most reliable procedure for the treatment of cervical radiculopathy. Wide decompression of disc material from uncinate to uncinate is performed with or without a foraminotomy on the symptomatic side to address anterior compressive pathology. Artificial disc replacement (ADR) has been recently introduced in hopes of maintaining motion at the pathologic levels. Young patients (<40 years old) with minimal facet joint arthrosis are best indicated for this surgery. Posterior cervical foraminotomy avoids many approach related complications associated with anterior surgery and is the preferred approach when anterior surgery is contraindicated. Very few studies with small sample sizes (likely due to underdiagnosis) make it difficult to perform a comparative analysis of the different types of procedures. Ultimately, an accurate diagnosis is likely the most important predictor of a positive surgical outcome. Competing Interests: Conflicts of Interest: The authors report no relevant financial conflicts of interest regarding this review article.
Databáze:	MEDLINE
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