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SURGICAL DISORDERS OF THE CERVICAL SPINE: PRESENTATION AND MANAGEMENT OF COMMON DISORDERS
  1. George P Malcolm
  1. Correspondence to:
 Mr George Malcolm, Department of Neurosurgery, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK;
 george.malcolm{at}north-bristol.swest.nhs.uk

https://doi.org/10.1136/jnnp.73.suppl_1.i34

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    “This man needs to see a Doctor!” So wrote an exasperated neurologist after reviewing a patient on the neurosurgical ward. Unfortunately this comment still springs to mind when one considers the clinical management of some cervical spine problems.

    Magnetic resonance imaging (MRI) scanning has led to a tidal wave of referrals of cervical spine problems to neurosurgeons. However, in many cases, the problem is more apparent on the scan than clinical assessment. MRI scanning cannot replace thoughtful history taking and clinical examination, and does not provide the necessary information for diagnosis and treatment. As a rule of thumb appropriate management depends in equal part on history, examination, and investigations.

    ▸ SPINAL DEGENERATIVE DISEASE

    Cervical degenerative disease is common and it is often difficult to distinguish pathological changes from the normal aging process. Neck, shoulder, and brachial pain is frequently encountered and the majority of patients presenting with these symptoms do not need consideration for surgery. Patients and doctors may feel that there is “something” that should be done although, in fact, this is rarely the case. MRI scans may well reinforce this delusion by demonstrating abnormalities. Such findings must, however, be put into perspective. Cervical disc degeneration reaches a prevalence of nearly 95% by the age of 65 years, so it is hardly surprising if the majority of patients have some abnormality on their scan.

    Surgery is generally used in degenerative disease for decompression of spinal cord or nerve roots. The decompression itself may lead to a relative destabilisation of the cervical spine by interference with muscle, ligament or bone. This can result in worsened (and potentially disabling) postoperative neck pain, and to avoid this complication decompression procedures may be combined with a simultaneous fusion. However, the resultant loss of spinal movement following such a fusion may result in accelerated degeneration at adjacent spinal …

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