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myelopathy

Back and Neck Pain, Pain Clinics and Interventional Pain Management in Canada

Teaser: 

Arani Kulamurugan,1 Pranjan Gandhi,2 Markian Pahuta,3 Mohammad Zarrabian,4 Daipayan Guha,5

1Michael DeGroote School of Medicine, McMaster University, Hamilton, ON.
2Michael DeGroote School of Medicine, McMaster University, Hamilton, ON.
3Department of Surgery, Division of Orthopaedics, McMaster University, Hamilton, ON.
4Department of Surgery, Division of Orthopaedics, McMaster University, Hamilton, ON.
5Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON.

CLINICAL TOOLS

Abstract: This paper examines the role of pain clinics in Canada, focusing on non-surgical interventions to manage cervical and lumbar degenerative pathologies. These pathologies have a substantial impact on health care and the economy. Since non-interventional management strategies are often insufficient, pain clinics can be effective in providing image-guided injections to reduce symptoms and rates of surgery. Given the challenges of access and long wait times for treatment, the expansion of pain clinics may be an interim solution to improve outcomes and alleviate the burden on Canadian healthcare.
Key Words: radiculopathy, myelopathy, back pain, neck pain, pain clinic.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
1. Identifying the specific type of back pain guides the choice of treatment, enhancing patient outcomes.
2. Interventional strategies have demonstrated significant benefits when combined with traditional medical and physical therapies.
3. Axial pain, radiculopathy, neurogenic claudication and myelopathy have distinct symptoms and relief mechanisms, making accurate diagnosis critical.
4. Improving the distribution and accessibility of multidisciplinary pain management services will improve the outcomes for patients with chronic pain.
Differentiating Pain Syndromes: It is essential to distinguish among axial neck/back pain, radicular pain, neurogenic claudication and myelopathy to institute proper back pain management. Axial pain is worsened by physical activity, radicular pain is limb dominant, neurogenic claudication is exacerbated by prolonged standing and relieved by sitting, and myelopathy produces upper motor neuron findings in both upper and lower limbs.
Role of Pain Clinics: Offering a wide range of services, pain clinics are cost-effective and improve quality of life and functionality through interventional pain management, mental health support, and physical therapy.
Barriers to Accessing Care: Access to multidisciplinary pain treatment facilities in Canada is limited by long wait times and significant regional variability.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, radiculopathy, myelopathy, back pain, neck pain, pain clinic

Cervical Disc Arthroplasty: A Movement-Sparing Surgical Option in Cervical Disc Degeneration

Teaser: 

Simon Harris, MA, MB, BChir, FRCSC,

Orthopaedic Spine Surgeon, Trillium Health Partners, Mississauga, Ontario.

CLINICAL TOOLS

Abstract: Degeneration of the cervical discs is a common problem and can cause compression of cervical nerve roots and/or the spinal cord. This in turn may lead to permanent neurological injury, disability and socioeconomical impact for the patient. Surgical management typically includes either an Anterior Cervical Decompression and Fusion (ACDF) or a Posterior Decompression with or without fusion or laminoplasty. Over the past 20 years, Cervical Disc Arthroplasty (CDA) has been an increasingly viable alternative to the “Gold Standard” ACDF, after failure of conservative management in the appropriately selected patient. Single and multilevel CDA has a growing body of evidence to support its equivalency - and even superiority - to ACDF in long-term clinical outcomes.
Key Words: Cervical degenerative disc disease; Cervical Disc Replacement; Cervical Disc Arthroplasty; Radiculopathy; Myelopathy.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
Cervical radiculopathy symptoms include pain, paresthesia, numbness, and weakness in a recognised dermatomal and myotomal pattern.
First-line conservative treatment for cervical radiculopathy includes physiotherapy, analgesia, and non-steroidal anti-inflammatories.
Cervical disc replacement is an evidence-supported intervention for upper extremity radiculopathy that has failed conservative treatment.
Many designs of cervical disc arthroplasty are currently available for implantation in North America.
Cervical degenerative disc disease is a common radiographic finding present in both the symptomatic and asymptomatic population.
Axial neck pain, in the absence of red flag symptoms is best managed with an active physiotherapy program and pain management strategies.
Cervical disc arthroplasty is an evidence-supported surgical option to address central or foraminal cervical stenosis at the disc level.
1 or 2-level cervical disc arthroplasty has a lower re-operation rate than anterior cervical decompression and fusion.
Cervical disc arthroplasty procedure can be performed through a 4cm incision in the front of the neck.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, cervical degenerative disc disease, cervical disc replacement, cervical disc arthroplasty, radiculopathy, myelopathy

Degenerative Cervical Myelopathy: Navigating Management in the Primary Care Setting

Teaser: 

Karlo M. Pedro, MD,1 James Milligan, MD,2 Michael G. Fehlings, MD, PhD,3

1 Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.
2 McMaster University, Department of Family Medicine, Hamilton, ON, Canada.
3Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.

CLINICAL TOOLS

Abstract: Degenerative cervical myelopathy (DCM) is a progressive and acquired spinal disorder that represents a potentially reversible cause of spinal cord impairment among adults. It remains underdiagnosed due to a low level of awareness amongst the public and healthcare professionals. Diagnosis is anchored on high clinical suspicion after a thorough history and physical examination and confirmed using magnetic resonance (MR) imaging of the cervical spine. Improving early diagnosis and ensuring timely surgical intervention are crucial in preventing long-term disability and optimizing long-term outcomes for DCM patients.
Key Words:degenerative cervical myelopathy, myelopathy, non-traumatic spinal cord injury, primary care.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

Pre-test CME Quiz Post-test CME Quiz
DCM is the most common cause of non-traumatic spinal cord dysfunction among adults worldwide
DCM is a potentially reversible disease with profound neurologic implications if left untreated
A thorough history and physical examination, supplemented with MR imaging of the cervical spine, are key elements to avoid misdiagnosis and delays in management
The hallmark signs of DCM are deterioration of hand motor function (eg. decreased coordination/clumsiness) as well as gait instability
MRI is the imaging of choice to confirm a diagnosis of DCM
Surgery is the only proven therapy that can halt the progression of DCM
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, degenerative cervical myelopathy, myelopathy, non-traumatic spinal cord injury, primary care