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Phẫu thuật cổ tử cung

Cổ tử cung radiculopathy trình bày như bánh mì trong một phân phối dermatomal. Mặc dù liệu pháp nonoperative bảo thủ, một tập hợp lớn các bệnh nhân sẽ cần can thiệp phẫu thuật. Chỉ định phẫu thuật bao gồm radiculopathy ngoan cố mặc dù điều trị nonoperative hơn khoảng 6 tuần | Surgical Management of Cervical Radiculopathy Todd J. Albert MD and Samuel E. Murrell MD Abstract Cervical radiculopathy presents as pain in a dermatomal distribution. Despite conservative nonoperative therapy a large subset of patients will require surgical intervention. Indications for surgery include recalcitrant radiculopathy despite nonoperative treatment for more than 6 weeks and progressive motor deficit or disabling motor deficit deltoid palsy wrist drop prior to 6 weeks. Anterior and posterior approaches have both yielded successful results in appropriately selected patients. Anterior cervical diskectomy and fusion is the generally preferred tretment for radiculopathy when there is a significant component of axial neck pain when the disease is centrally located or when there is any degree of segmental kyphosis. Posterior laminoforaminotomy is an acceptable choice for lateral soft disk herniations with predominant arm pain and for caudal lesions in large short-necked individuals. J Am Acad Orthop Surg 1999 7 368-376 Cervical radiculopathy a disease process defined by the presence of motor and or sensory abnormalities in the distribution of a specific nerve root is a clinical diagnosis. Causes of radiculopathy include cervical spondylosis uncinate hypertrophy with foraminal stenosis soft disk herniations foraminal stenosis secondary to facet hypertrophy instability spondylolisthesis and retrolisthesis. The cause of the radiculopathy dictates the optimal surgical approach. A previous review article 1 the first of a two-part series discussed the diagnosis and nonoperative treatment of cervical radiculopathy. In this article we will address the operative management of cervical radiculopathy focusing on surgical indications and the guidelines for choosing among the various surgical approaches on the basis of pathologic anatomy. Surgical Indications and Approaches The natural history of cervical radiculopathy has been described in detail by several authors.2-4 .