Spinal Deformity and Degeneration Shay Bess, MD Assistant Professor of Orthopaedic Surgery University of Utah School of Medicine

Spine Surgery Overview Trauma Tumor Infection Degenerative Radiculopathy Myelopathy Deformity Scoliosis Kyphosis

Goals Peripheral Nerve Anatomy Identify and Differentiate Cervical Lumbar Identify and Differentiate Radiculopathy Myelopathy Differentiate and Measure Coronal imbalance Sagittal imbalance

Degenerative Conditions Radiculopathy & Myelopathy

General Anatomy

Regional Anatomy

Radiculopathy Nerve Root Compression Cervical Thoracic Lumbar Spinal Nerve Anatomy

Radiculopathy Etiology Mechanical Compression Disc Herniation (HNP) Foraminal Stenosis

Radiculopathy Spinal Nerve Exiting Anatomy Correlate Pathoanatomy L4-5 Disc Herniation Symptoms? C4-5 Disc Herniation

Radiculopathy Symptoms Anatomic distribution Lower motor neuron Weakness Sensory deficit Diminished reflexes

Cervical Radiculopathy

Cervical Radiculopathy

Lumbar Radiculopathy

Radiculopathy Spinal Nerve Exiting Anatomy Correlate Pathoanatomy L4-5 Disc Herniation Symptoms? C4-5 Disc Herniation

Cervical Radiculopathy Treatment Nonoperative Physical Therapy NASIDs Selective Root Injection ACDF Anterior Cervical Discectomy & Fusion Posterior Foramenotomy and Discectomy Courtesy of Dan Riew, MD

Lumbar Radiculopathy Treatment Nonoperative Physical Therapy NASIDS Selective Root Injection Discectomy

Myelopathy Spinal Cord Compression Location Cervical? Thoracic? Lumbar? Why?

Myelopathy Symptoms Upper Motor Neuron Unsteady gait Poor manual dexterity Loss proprioception Normal strength Normal sensation

Myelopathy Symptoms Upper Motor Neuron Hyperreflexia Pathologic reflexes Babinski Hoffman Inverted brachioradialis Grading Reflexes 0 = Absent 1+= Diminished 2+ = Normal 3+ = Increased 4+ = Increased with associated clonus

Myelopathy Etiology Cord Compression Disc Degenerative Instability Soft disc herniation (HNP) Hard Disc Degenerative Instability Disc incompetence Facet incompetence OPLL Tumor Infection Courtesy of Henry Bohlman, MD

Anterior Cervical Corpectomy Myelopathy Treatment Surgery Decompress Offending Agent Anterior Procedures Posterior Procedures Anterior Cervical Corpectomy Courtesy of Dan Riew, MD

Myelopathy Posterior Cervical Laminaplasty Courtesy of Dan Riew, MD

Spinal Defomity Scoliosis & Kyphosis 4

Spinal Deformity Definition of Terms Coronal plane Scoliosis Sagittal plane Lordosis Kyphosis Normal Spinal Alignment

Scoliosis Coronal Deformity Evaluation Cobb Angle Measurement Top of the top Bottom of the bottom Perpendiculars

Kyphosis Sagittal Deformity Cobb Angle Measurement Thoracic Kyphosis 40 degrees Lumbar Lordosis T12-S1 60 degrees 20-40 degrees > thoracic kyphosis Regional Deformity

Spinal Deformity Treatment Risk of progression Etiology Curve size Remaining growth menarche age Appearance Symptoms Nonoperative Observation Bracing

Spinal Deformity Operative Treatment High Risk Progression Cosmesis Etiology Large deformity Remaining growth Cosmesis Disability

Spinal Deformity Treatment

Spinal Deformity Treatment

Spinal Deformity Treatment

Summary Diagnose, Differentiate, Pathoanatomy Radiculopathy Myelopathy Identify and Measure Spinal Deformity Coronal imbalance= scoliosis Sagittal imbalance= kyphosis Effective Treatment algorithms

Thank You