Description
This presentation, delivered by Andrew Young from the Royal Orthopaedic Hospital, focuses on the complexity of degenerative spine conditions, particularly cervical and lumbar issues, within a 15-minute framework. Young acknowledges the challenging breadth of the topic, emphasizing the dense, information-rich slides that he won't read out loud, encouraging attendees to photograph them instead.
He begins by outlining the key conditions affecting the cervical region, such as spondylosis, myelopathy, and radiculopathy, while noting that rheumatoid disorders will be discussed separately. He highlights the prevalence of cervical myelopathy in older patients, mentioning its significant representation in American Board exams and underscoring the importance of recognizing tandem lumbar and cervical stenosis in patients presenting with ataxia. Young describes the typical clinical presentation of myelopathy, including gait imbalance and hand clumsiness, pointing out that many patients may plateau, but some may experience regression over time, indicating the need for monitoring and potential intervention.
The presentation then transitions to lumbar issues, including disc herniation and chronic back pain, emphasizing that most patients will improve over time through non-operative treatments. Lumbar stenosis is illustrated as analogous to cervical stenosis, with common symptoms exacerbating during activities such as walking. Young explains treatment pathways, indicating that surgery should be reserved for progressive cases or those with significant neurological deficits.
Young discusses various imaging considerations, such as the significance of MRI findings in older patients, cautioning against misinterpreting degenerative changes as pathological. The presentation touches on the delicate balance between surgical benefits and risks, particularly with anterior surgeries, and highlights that complications can arise, leading to adjacent-segment degeneration.
Finally, Young concludes with a brief discussion on complications and outcomes of spinal surgeries, reminding practitioners to take patient histories thoroughly and recognize 'red flags' signaling serious underlying conditions. He encourages clinicians to remain vigilant in differentiating between various spinal pathologies, particularly in the context of increasing consultations following the shift towards virtual healthcare. As he concludes, Young reflects on the commonality of back pain and the ongoing research into surgical management, reiterating the importance of a nuanced approach to spine care.