AAOS Comprehensive Orthopaedic Review 4: Print + Ebook (AAOS - American Academy of Orthopaedic Surgeons)

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Section 2 | Spine

acute radicular pain, but their ability to favorably alter the natural history of cer vical radiculopathy over the long term has not been demonstrated. • Rare but substantial complications, such as infections, hyperglycemia, and osteo necrosis, can occur but generally require high and prolonged usage. d. Physical therapy • Physical therapy has not been shown to alter the natural history of cervical radiculopathy. • Massage and modalities such as heat, ice, electrical stimulation, and ultrasonography have not been proven to be beneficial. • Postural education, ergonomics, and life style modifications may be beneficial. • Isometric exercises to strengthen the cervi cal musculature are instituted as acute pain resolves. • Aerobic conditioning may be helpful in relieving symptoms. e. Cervical adjustment (chiropractic manipulation) • The efficacy of cervical manipulation has not been established. • For neck pain and cervicogenic headaches, cervical manipulation provides short-term benefits, with a complication rate between 0.5 and 1.0 per 1 million manipulations.

f. Cervical steroid injections • These injections are commonly used in the nonsurgical management of radiculopathy, both lumbar and cervical. • Injections allow specific targeting of problematic root(s) and the dorsal root ganglion, resulting in a greater local concentration of steroid at the desired location. • They provide diagnostic information by blocking the pain associated with a symp tomatic root. This is especially useful in localizing the level causing pain because anomalous distributions are common. • Complications of cervical injections are rare but include dural puncture, meningitis, epidural abscess, intraocular hemorrhage, adrenocortical suppression, epidural hema toma, vertebral artery injury, and root or spinal cord injury. 3. Surgical treatment—overview a. Indications include severe or progressive neu rologic deficit (weakness or numbness) or substantial pain that fails to respond to non surgical treatment. b. Cervical radiculopathy may be addressed through an anterior or posterior surgi cal approach, depending on the pathology ( Table 2 ).

2 | Spine

TABLE 2 Common Surgical Approaches for Cervical Radiculopathy Approach Advantages

Disadvantages

ACDF

Direct removal of anterior pathology without neural retraction Bone graft restores height and provides indirect foraminal decompression Fusion prevents recurrent neural compression Muscle-sparing approach Minimal motion sparing Small difference in adjacent-segment revision surgery rates at 10 years No fusion-related complications

Fusion-related issues: Autograft harvest morbidity Nonunions Plate complications May accelerate adjacent-segment degeneration

Unable to correct kyphosis Technically more demanding Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

ACDA

Posterior laminoforaminotomy

Avoids fusion Can be performed with minimal invasiveness

Symptoms may recur at the surgical segment Removal of anterior pathology would require neural retraction

ACDA = anterior cervical disk arthroplasty, ACDF = anterior cervical compression and fusion

AAOS Comprehensive Orthopaedic Review 4

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