2/14/2024 0 Comments Cpt x ray cervical spine![]() Ossification of the posterior longitudinal ligament (OPLL) is a condition in which there is pathologic ossification of this ligament in the cervical and/or thoracic spine. Vertebral subluxations, secondary to facet degeneration and ligamentous laxity, can further contribute to spinal stenosis and foraminal narrowing. The combination of the flattened, degenerated uncovertebral joints and facet joint hypertrophy can cause neural foraminal narrowing. The combination of the osteophyte/disc complex and thickened ligamentum flavum causes narrowing of the central spinal canal. The ligamentum flavum may hypertrophy and buckle into the spinal canal. The intervertebral disc may calcify to further stabilize the vertebral motion segment. The osteophytes can become quite large, bringing the degenerated disc material along with them. Osteophytes develop because of periosteal irritation at the vertebral margins in order to increase the weight-bearing surface of the endplates, stabilizing the adjacent vertebra. This then puts greater stress on the vertebral endplates. There is increased load upon the uncovertebral joints, which become flattened to accept the additional load. As we age, the degenerating disc cannot bear or transfer load because of annular fissuring, disappearance of the nucleus pulposus, and dehydration of the disc. These tears, over time, enlarge and extend toward the medial aspect of the disc. In the first and second decades of life, lateral tears occur in the annulus fibrosis. In healthy individuals, the cervical intervertebral disc is similar to the lumbar intervertebral disc, consisting of an annulus fibrosis and nucleus pulposus. ![]() Generally, the midcervical region is most affected. Other causes of acquired cervical spine stenosis include ossification of the posterior longitudinal ligament, ossification/thickening of the ligamentum flavum, rheumatoid arthritis with pannus formation, ankylosing spondylitis, Paget’s disease with basilar impression, and metastatic disease.ĭisc degeneration and the degenerative cascade that follows is the most common cause of acquired cervical spinal stenosis. Degenerative stenosis is the most common type of acquired stenosis. Acquired stenosis is much more common than congenital or developmental stenosis. Therefore, patients with developmental stenosis tend to have symptoms at a younger age. However, with short pedicles, one tends to see symptoms with much milder degenerative changes because the available spinal canal space is already diminished in anterior-posterior diameter and area. Normally, a person would not be symptomatic from degenerative changes until they were moderate or severe. As a person ages, degenerative changes ensue. Developmental stenosis is usually caused by short pedicles. Patients with malformation of the dens or achondroplasia or who have Down syndrome or Klippel-Feil syndrome can present with cervical spinal stenosis. ![]() Congenital cervical stenosis often affects the craniovertebral junction. The signs and symptoms of this condition depend on which part of the cervical cord is compressed.Ĭervical spinal stenosis can be divided into congenital, developmental, and acquired causes. ![]() Cervical myelopathy is the most serious condition that can arise from cervical spinal stenosis. If the stenosis becomes severe enough, myelopathic symptoms can arise. Cervical spinal stenosis can be defined as any narrowing of the spinal canal that causes compression of the contents of the spinal canal because of a mismatch between the available space in the spinal canal and its contents. ![]()
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