Update Management of Spine

Muhammad Faris, MD
Chief of Neurospine Division Dept of Neurosurgey Airlangga University Soetomo General Hospital
mfarisns@fk.unair.ac.id
 Introduction
Anatomy
History
ClinicalFindings
Pathophysiology
PainSources
Investigation
Treatment
 Why so mysterious?

Clinical history/diagnosis not appreciated

Anatomy/imaging misinterpreted
Postural radiculopathy not understood
Atypical leg pain not interpreted
Neurogenic claudication not defined/explained
Cauda equina syndrome not diagnosed
Role of associated LBP/deformity not appreciated
Anatomy
ANATOMY
 History
Patientwilldescribe
a. Cervicalpain Burningsensation,tinglingornumbnessin the
armandfinger,lossoffinemotorskill,stifnessintheneck

b. Buttockpainorlegpain
Heavinessweakness
Tirednessinlegsonwalking
Neurogenicclaudication
Paincausedbymotion
 video
 Clinical symptoms
Neck pain or Low back pain

Sciatic pain

Unilateral radicular symptoms may result from severe foraminal or l lateral

recess stenosis

Claudicatio intermitten

Lumbar canal stenosis classically presents as bilateral neurogenic

claudication

Paraesthesiae

Muscle weakness

Disturbance of spinchter

Cauda equina syndrome

 Pathophysiology
Trauma
Repetitivetrauma
Infection(mostlyTB)
Vascular
Neoplasma
Degenerative
Minimallyinvasiveoropensurgery
Pathophysiology
 Pathophysiology
Disc degeneration
Facet arthrosis
Hypertrophy of the
ligamentum flavum

Canal narrowing
Venous stricture
 Pain Sources
Muscles
Bones
Disc
Facet joint
Ligament
 Investigations
Plain films ?
CT?
MRI?
A combination of modalities?
Is there a consensus?
 My Approach to Success in
Image Interpretation

Know what to order.

Know what an optimal imaging series is and dont
accept less.

Read by check list (ABC)

Know the common lesions.
Know the commonly MISSED lesions.
Donoharm
TECHNICAL???
 Path of Treatment

Minimal invasive
Open surgery
 Surgery options

1. Laminectomy
2. Laminotomy
3. Micro-decompression
4. Fusion
5. InterLaminar device
6. Endoscopic Decompression
7. Percutaneous laser disc decompression
 Selection of
the appropriate approach

Depends on a variety of factors including :

clinical symptoms,
spinal level,
location of compression,
number of involved levels, and
the pathology
the presence/absence of spinal instability
or
spinal deformity.
 Minimal invasive surgery keyhole

Cranial space spherical keyhole

Spinal space cylindrical Multiple keyholes

Case 1
Video
 Case2
2010 2012
 Case 3
Preop Postop
MOST CASES!!!!
VIDEO
VIDEO
 C-1

C-1

C-2
C-2

C-3

C-1
 C-1 R

C-2

1
R

3
R
 Emergency cases

Acute radicular pain

Progressive neurological deficit
Cauda equina syndrome saddle back anesthesia,
autonomic disturbance
Thank You