5: Spine 1 ). Figure 1 ). Discom- Other causes of 1 Figure 2 ( These injections are 2 4,5 Orthopaedic Knowledge Update 11 Conversely, facet joint injections are 3 The cervical disk is composed of the outer anulus Arthritic changes involving the atlantoaxial joint are Facet joint pain results from spondylotic changes, pain mean thatpain the related evaluation to degenerativedisk, can disease the be facet can difficult. joint, stemrologic the from Axial compression. atlantoaxial the Although joint, radicularradiates and/or pain into neu- typically theproximal, arm, and the neck mostnent pain of severe may radicular pain be symptoms. usually a is significant compo- fibrosus and thedergo nucleus degeneration pulposus, with bothbral aging. of disk, which Within metabolic un- thetion changes, of interverte- annular disk tearing,loss material, of hernia- dehydration disk height ofigin can the occur. of One nucleus, pain theory and in locatesneurologic the the ingrowth or- disk into itself, the as anulus. a result of vascular or valuable for elucidating painically and can distinct be pain guided distributions. by clin- Treatment The key issue ining treatment the decision true makingpatient pain is generator. identify- has This task axialwith is pain difficult if only. nonsurgical the Treatment should intervention. begin Anti-inflammatory Evaluation A valid and reliableerative test disks to remains identify symptomatic elusive.and degen- Diskography inconsistent. is Imaging, unreliable includingicant MRI, false-positive has rate ative signif- because most changes ofsource shown the of degenera- on pain. imaging studies are not the fort primarily occurs withinvolves rotation the to occipitocervical the region,into affected the and side, occiput. often The radiates the diagnosis focus is may easily be missed on because the subaxial spine. known to be a cause of axial pain axial pain probably areation. directly related to disk degener- the action ofstress, which inflammatory presumably occur mediators,eration with and progressive of degen- increased theumn intervertebral of disk. the As cervicalthe the spine physiologic becomes anterior load, less the col- joints able undergo posterior increased to structures stress. support andbecome With facet time, hypertrophic, the arthritic, joint and can painful ( both diagnostic and therapeutic. Justin W. Miller, MD Rick C. Sasso, MD Axial Neck Pain Introduction © 2014 American Academy of Orthopaedic Surgeons Dr. Sasso orroyalties an from immediate Medtronic; family hasin stock member or Biomet; has stock has options received receivedfrom held research or Cerapedics, institutionalStryker; support and Medtronic, serves as Smithcommittee a board member member, & of owner, officer, theety. or Nephew, Cervical Neither Spine Dr. and Research Millerber Soci- has nor received any anythingstock immediate of options family value held from mem- tion in or related a has directly commercial stockchapter. or company or or indirectly institu- to the subject of this Etiology Axial neck painsymptoms related is to oneoften the is cervical of spine. self-limiting, thebe This and condition resolved in most almost with commonwill all minimal have initial patients, intervention. persistent it pain,tion Some can however, and patients and treatment furtherpain will evalua- can be occur required.cipital in Axial or the or periorbital paraspinal referred scapular region, musculature, areas. the or The oc- generators the presence in trapezial of the or neck severalprovide region inter- potential an complicates pain the accuratevague ability and to and prompt subjective diagnosis.physical nature examination The of findings, often symptoms,cific and the tests the lack to paucity diagnose of of the spe- anatomic source of the axial The somewhat vagueoften term, is cervical used disk toing describe disease, degenerative the most pathology cervical involv- disksymptoms. itself So-called as cervical wella disk as broad disease clinical associated encompasses spectrum clinical from in minimal which axial the neck symptomstic pain range of to myelopathy. symptoms Between characteris- thesemay two extremes, have patients aseverity combination of the of disease, symptoms,loss including debilitating of depending axial motion, on pain, radiculopathy,imbalance, numbness, and tingling, gait finepose motor of dysfunction. treatmentclinical decision For categories can making, the belopathy, three pur- used: and overlapping axial cervical neck spondylotic pain, myelopathy. radicu- Cervical Disk Disease Chapter 49 5: Spine 2 ramn failnc anhspoie clinical provided has pain surgical neck the evidence, axial benefit. I level of is of there treatment lack Although a a pain. and last after neck the controversy axial benefit is treating provide fusion for Surgical can recourse made. steroid is diagnosis a pathologic without or with rhpei nweg pae11 Update Knowledge Orthopaedic perma- allevi- sustains not damage. rarely often nent nerve lesion are The offensive radiculopathy. nerve the re- any ates that from the known nerve well the of is lieving it response However, understood. the entirely fac- The determining myoto- paresthesias. pattern, tors and dermatomal hyporeflexia, a radicu- weakness, in mal of pain symptoms include and lopathy signs The with inflammation. ischemia, pathology and compression, root mechanical nerve including by etiologies caused is Radiculopathy Etiology therapy physical Moderate- of pain. cervical use benefit. chronic the for potential supports evidence of quality of are course short a immobilization and modification, activity medication, 5: Section iue1 Figure Radiculopathy ehnclcmrsincnocrdrcl nthe in directly occur can compression Mechanical 7,8 Spine To h evclsiesoigsgiiatfacet significant showing spine cervical the of CT on arwn n rhii hne (arrow). changes arthritic and narrowing joint 6 neto flclanesthetic local of Injection rfctcpueiflig ri a cu indirectly occur ( can instability it or and or narrowing osteophyte, foraminal infolding, herniation, through disk capsule hard facet or or soft a of presence eil on riain rmcaia instability. mechanical ma- disk or root. to irritation, exposure joint the of terial, result of a inflammation as occurs from Inflammation possibly and pression iue3 Figure iue2 Figure 4 .Icei hne a eutfo ietcom- direct from result can changes Ischemic ). xa 2wihe R ftecria pn show- spine cervical the of MRI T2-weighted Axial n otds enaincuigsignificant (arrow). causing impingement herniation neurologic disk soft a ing pnmuhooti aigahsoigbilat- showing radiograph odontoid Open-mouth rlC-2jit ihuiaea arthritic (arrows). unilateral changes with joints C1-C2 eral 04Aeia cdm fOtoadcSurgeons Orthopaedic of Academy American 2014 © iue 3 Figures 5: Spine 3 ). (Repro- B Cervical Disk Disease Orthopaedic Knowledge Up- Orthopaedic Knowledge Update 11 Chapter 49: The placement of the selective 9 ) and reflex examination ( A Typically, narcotic medications have a limited urgeons, 2005, pp 527-534.) 10 S The use of imaging studies (plain radiographs, MRI, The Spurling maneuver,the in neck and which rotates the thepain, head can patient toward help the extends differentiate sidefrom a of true typical other cervical rootSpurling potential etiology sign, sources the maneuverpatient’s of typical re-creates pain. or pain. During enhancesnician In the the must examination, a keep thesources in cli- positive of mind upperor the extremity a need pain, peripheral such to nerve. as rule the out shoulder and other CT myelogram) andinjections diagnostic selective should nerve be root Imaging primarily studies confirmatory may inresults reveal nature. can the be pathology,ties. though equivocal Selective the or nerve show rootcisely identify injections multiple the can abnormali- symptomatic be areaings if used the are to imaging pre- find- equivocal. Treatment Treatment should begin withcause nonsurgical most measures be- cervicaltime. radicular During the pain acutesteroids, will NSAIDs, phase, and improve the a patientcation. over short can course be of given narcotic medi- ability to control nerve-relatedsparingly. pain The and key should is be to used break the cycle of acute pain so nerve root injection isination guided findings. by Electromyography the historytion and testing and nerve can exam- conduc- be usedogy, to such identify as nonradicular peripheral pathol- neuropathy. . 6 and Figures 5 , ed 8. Rosemont, IL, American Academy of Orthopaedic chematic drawings showing the upper extremity dermatome distribution ( stenosis (arrow). duced from Grauer NJ,date Beiner JM, Albert TJ: Cervical disk disease, in Vaccaro AR, ed: Axial CT of the cervical spine showing foraminal S Figure 5 Figure 4 © 2014 American Academy of Orthopaedic Surgeons Detection of radicular pathology oftenforward is and fairly is straight- basedneurologic on examination, a and completeand correlation history, diagnostic a with studies. detailed imaging Theination history and are physicaland exam- crucial. provocative testing Classic ofing dermatome muscles the and upper distributions extremities reflexes are involv- shown in Evaluation 5: Spine 4 eto satpco otoes,bti etil a di- has certainly it but in- value. controversy, root of agnostic nerve topic selective a benefi- of is be jection benefit may therapeutic injection The root medical cial. nerve oral by selective If relieved long- a symptoms. not therapy, their are radicular symptoms shown patient’s treating diminish have the for data dramatically effectiveness good and term no quickly pain, can radicular steroids oral oaiooy hc a enwl ecie else- described well been has where. which foraminotomy, and study. durability long-term further arm to for requires related wear, and potential as ACDA, neck The after success. Short complications for overall 36-Item scales and Survey pain, component, Outcomes physical Medical Form the Index, ra evclDs mln MdrncSofamor those (Medtronic to ACDF. superior implant the of significantly using outcomes Disc found ACDA Danek) of Cervical study of those follow-up Bryan with 4-year compared lacking, A promising ACDF. are are results data early long-term the nonsur- Although arthroplasty unsuccessful treatment. after gical disease disk disk cervical tomatic cervical anterior fusion (ACDA). and and proce- diskectomy cervical anterior agent (ACDF) anterior the Standard include remove radiculopathy. dures to the is goal causing The pathology. radicular rhpei nweg pae11 Update Knowledge Orthopaedic effects. adverse potential the alleviated. of been has pain exacerbating program the avoid therapy until To physical delayed structured is months. a of weak- discomfort, period the or ra- a the paresthesias over of of ness healing resolution gradual with tolerate diculopathy, can patient the that 5: Section erlgcdfctmyb addt o ugcltreat- progressive surgical for a candidate has a ment. be or may deficit treatment, neurologic 6 nonsurgical least at of undergone weeks has pain, root nerve incapacitating iue6 Figure otro ahlg a etetdtruhlamino- through treated be can pathology Posterior CAi eaieynwsria pinfrsymp- for option surgical new relatively a is ACDA treating for available are options surgical Several trissol eue prnl,i tal because all, at if sparingly, used be should Steroids 12 14,15 Spine 13 S cdm fOrthopaedic of Academy letT:Cria ikdsae nVcaoA,ed: AR, Vaccaro in disease, disk Cervical TJ: Albert h esrsicue h ekDisability Neck the included measures The hmtcdaigsoigteupreteiymtreaiain Rpoue rmGae J enrJM, Beiner NJ, Grauer from (Reproduced examination. motor extremity upper the showing drawing chematic 9 ain h otne ohave to continues who patient A 11 S ren,20,p 527-534.) pp 2005, urgeons, lhuhteueof use the Although rhpei nweg Update Knowledge Orthopaedic it fptet ihcria pnyoi myelopathy, spondylotic one cervical approximately with however. in patients classic absent of These fifth completely extremities. upper are the in findings seen be nerve find- may neuron sign, concomitant ings motor With lower Lhermitte concurrent reflex. compression, the radial root sign, inverted an Hoffman the and the clonus, sign, hyperreflexia, in include Babinski abnormal- signs disturbance neuron tract motor Long have lower ities. and may may upper findings both patient Examination include condi- function. the the bladder If and severe, bowel numbness. or is weakness gait, tion diffuse and as writing well including as functions, as motor be fine other not may pathology. but radicular with crucial as straightforward are examination physical ino hs atr htrsl ncria spondylotic cervical in result that factors myelopathy. these of tion ino h pnlcr ( cord spinal the compres- ana- to of these lead of can sion All conditions physiologic lordosis. and of fla- tomic loss posterior ligamentum and the instability, the of vum, herniation, of buckling or ligament, pathology bulging longitudinal disk development, changes height, dy- disk osteophyte Spondylotic or of static compression. loss from include cord result degenerative spinal directly cervical to namic believed in is signs Myelopathy disease associated its symptoms. with de- and dysfunction to cord used spinal is myelopathy, scribe term, all-encompassing The Etiology ies,crnct,lvl fivleet n factors and understood. fully involvement, the not are of of that severity levels the chronicity, on disease, depend cervical diagnosed myelopathy clinically spondylotic of symptoms and signs The Evaluation hoisicueicei,ifamto,eea glio- demyelination. edema, and inflammation, com- dysfunction sis, clinical ischemia, how to clear include leads entirely cord Theories spinal not the is spinal of It pression the predispose compression. can to canal cord spinal the of narrowing evclSodltcMyelopathy Spondylotic Cervical ainstpclydsrb ifclyi adand hand in difficulty describe typically Patients 04Aeia cdm fOtoadcSurgeons Orthopaedic of Academy American 2014 © 16,17 d8 oeot L American IL, Rosemont, 8. ed , ti otlkl combina- a likely most is It 18 iue7 Figure hruhhsoyand history thorough A .Congenital ). . 5: Spine 5 22 Rapid neuro- 21 Cervical Disk Disease Orthopaedic Knowledge Update 11 Chapter 49: This research justifies a strong rec- 23 19,20 with the greatest improvement in those who had , Surgical treatment entails decompression of the neu- An anterior procedure can directly treat anterior pa- A posterior procedure can be used to treat posterior Recent research found that surgical decompression Nonsurgical treatment of cervical spondylotic mye- have electrophysiologic changes.tials Motor-evoked poten- have provedevoked potentials. to be more sensitive than sensory- Treatment The natural history ofis cervical not spondylotic well myelopathy understood,progress although slowly the over disease time appearsescence with to and variable periods gradual of stepwise qui- decline. rologic elements. There isterior debate (ACDF, as ACDA, tonectomy, corpectomy), whether a an posterior fusion an- procedure (lami- is most efficacious laminoplasty),dylotic for pathology. treating cervical spon- or athology and improve combined volved levels lordosis, providing with stabilitycord. to fusion Stability the of spine isronment the and believed for spinal in- to recovery provide ofever, the this an neurologic belief optimal elements; mayACDA envi- how- be may unfounded. be One single-levelpression indication myelopathy caused with for cord bychoice com- a of large multilevelbased retrodiscal ACDF on fragment. the orpatient’s location The healing corpectomy of potential should because thequires multilevel be pathology fusion ACDF of as re- more well surfaces as than the corpectomy. pathology directly. Lordosiswith can fusion. be Both fusion partially andtion corrected laminoplasty and decrease thereby mo- improvefusion stability. clearly A provides posteriordecreased cervical stability, and with overall laminoplasty,rectly motion which decompress is the is spinalLaminoplasty meant cord should and to be preserve indi- avoidedkyphotic motion. if because the the cervicalrior, spine spinal and is progression cord of willwill the be not deformity allowed drift and toment poste- myelopathy continue. is Lordosis a orposterior necessary neutral laminectomy prerequisite align- and for decompressiontinely a should be laminoplasty. rou- accompanied A to by prevent postlaminectomy instrumentation kyphosis. and fusion led to significanttients improvement with in mild the toathy outcomes severe of cervical pa- spondyloticsevere myelopathy. myelop- ommendation for surgical interventionmoderate to myelopathy treat and mildto or a treat severe definite myelopathy. recommendation logic decline is thetient exception be and treated requiresmuch with that debate surgical the as decompression. pa- subclinical to There myelopathy. the is best treatment of patientslopathy with isinflammatory medications, limited and andalities orthosis. do to These not mo- affectdetrimental activity the to overall a patient’s condition modification,decline condition and and by may leading anti- masking be to further a delay in surgical treatment. Fig- 16,17 agittal T2-weighted MRI of the cervical spine showing spondylotic changes, includingheight disk collapse (*), diskand bulging buckling (small of arrow), thearrow), ligamentum with flavum intrinsic (large cord changes just anterior. S ). Changes in signal intensity on T2-weighted (hy- Electrodiagnostic studies are used to diagnose spinal Plain radiographs, CT myelogram, and MRI are use- Figure 7 © 2014 American Academy of Orthopaedic Surgeons cord dysfunction.potentials Motor-evoked can and showtion sensory-evoked patterns. abnormalities Patients in withlotic subclinical central myelopathy cervical (with conduc- spondy- subtle or no physical signs) may ful for diagnosing andwith evaluating pathology cervical associated graphs are spondylotic used to assess myelopathy.overall gross alignment spondylotic of Plain changes the and are cervical radio- superior spine. CT for myelograms teophytes assessing or bony pathology, ossificationligament, such of as as well the os- aslogic posterior indirect structures. longitudinal MRI compression is of superiorrologic the for structures neuro- evaluating (the the spinal neu- soft-tissue cord structures, and such nerve as roots)vum, the and and disk, posterior ligamentum longitudinalused fla- ligament. to MRI detect canwell the be extent as and intrinsicure cause changes 7 of within compressionperintense) as the or T1-weighted spinal (hypointense) cordbelieved sequences to are ( indicate cord pathology.sus There on is no the consen- meaninginclude ischemia, of inflammation, these edema, changes;however,myelination. gliosis, theories and de- 5: Spine 6 in r ae n fe hyaesl-iiigadre- and self-limiting are they time. complica- often with these and solve of rare, Most result are procedure. tions can surgical complications any from cardiopulmonary comor- Medical or instability, injury. bidities neurologic pseudarthrosis, instru- and failure, injury, blindness, vascular graft leakage, or fluid mentation hema- cerebrospinal retropharyngeal toma, hematoma, epidural palsy, root with dysphagia, time. expect over to improvement counseled gradual disk be degenerative should cervical disease for surgery undergoing tients ei n esrmn ol r orydefined. poorly are cri- tools diagnostic measurement because and pa- difficult teria of is assessment dysphagia with The tients pressure. and cuff procedure, of endotracheal multilevel length high a extended retraction, include wound factors surgery, risk identifiable but ugr,tpclywt infcn mrvmn over improvement anterior after significant month first with time. the during typically 50% surgery, as high as is rhpei nweg pae11 Update Knowledge Orthopaedic principles, exe- occur. these sound rarely to and complications adherence prob- plan, with the treatment Fortunately, of a cution. diagnosis of prompt development is key lem, The outcome indicated rates. positive however, success a high to benign; in dis- result and treatments disk surgical self-limiting cervical are to my- severe related in ease to pain symptoms present neck Most axial spine elopathy. from cervical vary and the ways many of changes Degenerative pos- a with occur can also procedure. it af- terior procedure, prevalent anterior which more an of is ter common dysphagia most Although dysphagia. the is complications, disease to disk lead degenerative can cervical of treatment Surgical 5: Section Summary Complications Surgical evclsodltcmeoah saciia di- clinical a is myelopathy spondylotic Cervical • had Disc Cervical Bryan the using Arthroplasty of cause • missed easily an is arthritis Atlantoaxial • Points Study Key te opiain nld on neto,nerve infection, wound include complications Other os n ugcltetetotni eurdto required symp- progression. is its and often halt treatment signs surgical of and constellation toms, a with agnosis fusion. and cervi- diskectomy anterior cal than outcomes better significantly pain. neck axial 25 h tooyo ypai sntetrl clear, entirely not is dysphagia of etiology The Spine 24 h eotdicdneo dysphagia of incidence reported The 26,27 Pa- 2 letT,MrelS:Sria aaeeto cervical of management Surgical SE: Murrell TJ, Albert 12. use The AJ: Cole LN, Packia-Raj GS, Hyman IA, Young 11. 0 eieM,Abr J mt D evclradiculopa- Cervical MD: Smith TJ, Albert MJ, Levine 10. noae References Annotated .DyrA pilC odkN evclzygapophyseal Cervical N: Bogduk C, Aprill A, Dwyer 4. Mark TS, Dina DO, Davis PR, McCowin SD, Boden 3. Osteoar- HH: Bohlman M, Leventhal AJ, Ghanayem 2. ner- of mechanisms possible and Pathology H: Brisby 1. .Arl ,DyrA odkN evclzygapophyseal Cervical N: Bogduk A, Dwyer C, Aprill 5. .PltM cofra ,GltwieN ta:Anterior al: et N, Goldthwaite J, Schofferman M, Palit 7. for Exercises al: et CH, Goldsmith A, Gross TM, Kay 6. .SsoR,Mcde ,Nrmn ,SihM Selec- M: Smith D, Nordmann K, Macadaeg RC, Sasso 9. Out- P: Kos JR, Malcolm EE, Transfeldt TA, Garvey 8. t hrp rvddn eei o ekpain. neck for benefit no including provided region, extrem- therapy upper ity cervicoscapular Nonspecific strengthening. the and stretching to ther- specific combined with apies moderate improvement found symptom pain of of neck studies evidence adult controlled for randomized exercise of therapeutic review literature A on anpten:I td nnra volunteers. normal in study 1976) A Pa I. (Phila Spine patterns: pain joint prospec- 1178-1184. A of subjects: investigation. scans asymptomatic tive in magnetic-resonance spine Abnormal cervical the S: Wiesel AS, 1996;78(9):1300-1307. follow-up arthrodesis. Long-term with joints: treatment atlanto-axial after the of throsis degeneration. Am disc Surg to response system vous on anpten:I.Aciia evaluation. 1976) clinical Pa A II. patterns: pain joint iccoyadfso o h aaeeto neck of management the for fusion pain. and discectomy 2012;8:CD004250. disorders. neck mechanical 368-376. radiculopathy. 228-238. manag- for disease. spinal steroids ing epidural/transforaminal lumbar of h:Danssadnnprtv management. Surg nonoperative Orthop Acad and Diagnosis thy: imaging. to 2005;18(6):471-478. Comparison resonance outcome radiculopathy: surgical cervical magnetic predict and can lumbar injections for root axial- nerve tive dominant for treated pain. 2002;27(17):1887-1895. patients spine per- cervical as mechanical by fusion and discectomy ceived cervical anterior of come pn PiaP 1976) Pa (Phila Spine 04Aeia cdm fOtoadcSurgeons Orthopaedic of Academy American 2014 © 068(up 2):68-71. 2006;88(suppl 1990;15(6):458-461. mAa rhpSurg Orthop Acad Am J mAa rhpSurg Orthop Acad Am J oeJitSr Am Surg Joint Bone J 1996;4(6):305-316. 1990;15(6):453-457. ohaeDtbs ytRev Syst Database Cochrane 1999;24(21):2224-2228. pnlDsr Tech Disord Spinal J pn PiaP 1976) Pa (Phila Spine oeJitSr Am Surg Joint Bone J oeJoint Bone J pn (Phila Spine 2007;15(4): 1990;72(8): 1999;7(6): JAm 5: Spine 7 J Neurosurg Spine Cervical Disk Disease 2007;7(2):141-147. 2000;25(6):670-676. 2010;35(9, suppl):S76-S85. Spine J Orthopaedic Knowledge Update 11 2010;67(2):543. 2002;27(22):2453-2458. Chapter 49: Neurosurgery Spine (Phila Pa 1976) Spine (Phila Pa 1976) phagia after anterior cervicalprospective spine cohort surgery: study. A two-year and delayed complicationstreatment associated of with cervical the302 spondylotic surgical patients myelopathy from based theSpondylotic AOSpine on North America Myelopathy Cervical 2012;16(5):425-432. Study. anterior cervicalSpine spine (Phila Pa surgery: 1976) A prospective study. Postoperative dysphagia ingery. anterior cervical spine sur- come of patients treatedspective, for cervical multicenter myelopathy: study A with pro- view. independent clinical re- North America Cervicalgical Spondylotic outcomes Study: of 2-year a prospective sur- patients. multicenter study in 280 A systematic reviewsurgery of found dysphagia2008. 17 after The appropriate cervical reportedcantly articles spine rates but from of1 were 1990 year dysphagia found of to varied 13%multilevel to to signifi- surgery 21%. decline, and Associated female risk with sex. factors a included plateau at A prospective studymoderate, or followed severe 278 cervical1 spondylotic patients year myelopathy after with for surgicalincluded mild, decompression. the Outcome measures modifiedtion score, Japanese the Orthopaedic Nurickand Scale, Medical Associa- the Outcomes Neck Studysion Disability 36-Item 2). Index, Short On Form allicant (ver- measures, improvement there was fromtion a baseline, statistically of and signif- the withscore, modified the the Japanese measures excep- Orthopaedicdependent showed Association on that improvement theLevel was preoperative of not severity evidence: II. of myelopathy. An analysis of outcomesadverse data events, complications for within 302cedure, 30 patients days and included of complications theprocedure. pro- 31 Early days complications to werepatients 2 more likely who years among after wereposterior the older procedure, a or longerblood had surgical loss a compared time, with and combinedment other greater of anterior- patients. cervical Surgical spondyloticof treat- myelopathy neurologic had a complicationsterm low and morbidity. rate minimal risk of long- 27. Lee MJ, Bazaz R, Furey CG, Yoo J: Risk factors for dys- 24. Fehlings MG, Smith JS, Kopjar B, et al: Perioperative 25. Bazaz R, Lee MJ, Yoo JU: Incidence of dysphagia after 26. Riley LH III, Vaccaro AR, Dettori JR, Hashimoto R: 22. Sampath P, Bendebba M, Davis JD, Ducker TB: Out- 23. Fehlings MG, Kopjar B, Arnold PM, et al: AOSpine , 2009; ,ed10. 1972;95(1): Eur J Neurol Spine (Phila Pa J Bone Joint Surg Brain 1963;2(5373):1607- Spine (Phila Pa 1976) Br Med J Orthopaedic Knowledge Update Orthopaedic Knowledge Update 1990;26(2):217-227. 2004;29(12):E239-E247. 2011;93(18):1684-1692. cervical arthroplastytomy compared and with fusion: Four-yearspective, anterior clinical randomized outcomes controlled discec- trial. inAm a pro- in Fischgrund JS, ed: ed 9. Rosemont, IL,Surgeons, American Academy 2008, of pp Orthopaedic 541-549. Flynn JM, ed: nance imagingNeurosurgery and cervical spondylotic myelopathy. associated with cervical spondylosis. Rosemont, IL, American Academygeons, of 2011, Orthopaedic pp 611-622. Sur- 87-100. lence of physicalspective, signs controlled in study. cervical myelopathy: A pro- 1610. 34(9):890-895. sod M: The valuepotentials of in motor evaluation andpresence of somatosensory evoked of cervical1976) myelopathy peripheral in neuropathy. the tor over somatosensory evoked potentialssis in of the diagno- cervical2004;11(9):621-626. spondylotic myelopathy. cervical spondylosis. A multicenter prospectivethe randomized Bryan study artificial disk compared withvical fusion spondylosis. for Early treatment and ofrevealed midterm cer- (48-month) significantly results superior resultsLevel after of arthroplasty. evidence: I. Cervical degenerative disease resultsradiculopathy, in and axial myelopathy. neck Thedisease pain, involves treatment nonsurgical of and surgicaling such on means the depend- severity andof symptoms. successful There are surgical apathology, options multitude according including toplasty, decompression, and the arthroplasty. type fusion, of lamino- © 2014 American Academy of Orthopaedic Surgeons 13. Sasso RC, Anderson PA, Riew KD, Heller JG: Results of 14. Murrey DB: Degenerative disease of the cervical spine, 15. Rhee JM, Riew KD: Cervical degenerative disease, in 16. Mehalic TF, Pezzuti RT, Applebaum BI: Magnetic reso- 17. Nurick S: The pathogenesis of the spinal cord disorder 18. Rhee JM, Heflin JA, Hamasaki T, Freedman B: Preva- 19. Chistyakov AV, Soustiel JF, Hafner H, Kaplan B, Fein- 20. Simó M, Szirmai I, Arányi Z: Superior sensitivity of mo- 21. Lees F, Turner JW: Natural history and prognosis of