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Pablo Pazmi ño, MD
Orthopaedic Surgery American Academy of Orthopaedic Surgeons Clinical Faculty Olympia Medical Center Cedars Sinai Medical Center Century City Doctors Hospital ,[object Object],[object Object],[object Object]
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dr. V.A.H. Horsley   (1857-1916)
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Three distinct clinical syndromes can result: Type I:  Cervical Radiculopathy: Cmprsn +Inflammation of Spinal Nerve with symptoms that correspond to the level involved Type II:  Cervical Myelopathy: Cord involvement Type III:  Axial Joint Pain (Mechanical neck pain, “discogenic pain”, facet syndrome, painful instability
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October 24,1892   20 YO “builder who under the influence of alcohol, fell off his van on to the road striking his right shoulder.” Over the next 2months he gradually lost control of legs and sphincters Dr Horsley performs the first Laminectomy of 6 th  Cervical Vertebra.  The Spinal cord was found to be compressed by a transverse ridge projecting backwards from the body of the vertebra. Complete recovery by September of that year
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[object Object],[object Object],[object Object],Lord Brain, F.R.S., D.M., F.R.C.P. (1895-1966)
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[object Object],[object Object],[object Object],Dwyer  Spine  15: 453-7, 1990.
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Here is what I mean by a foundation concept. You will see side view images and top down images throughout this presentation and on your MRIs. This can be hard to grasp unless we stop and point a few things out initially The  Sagittal view  is also called the lateral view and this is pictured here it displays the spine as viewed from the SIDE. The  Axial view  is a top down view of the spine. This image repsents a slice obtained as if an Axe were to chop you, therefore the name Axial view.
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Joint Facet Nucleus  Pulposus Right Nerve Root  Left Nerve Root As you can see here on MRI and CT scans the Facet joints end up looking like the buns of a hamburger. Its just the way the happen to look when they are sliced in this plane. We will show you this on some examples later Annulus Fibrosus Axial View of the Disc and Neural elements
Joint Facet Disc Right Nerve Root  Left Nerve Root Axial View
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Joint Facet Disc Right Nerve Root  Left Nerve Root Axial View
Joint Facet Disc Right Nerve Root  Left Nerve Root Next I will show you some MRIs  You will see this is a patient with a left sided herniation pinching off her exiting left nerve root
Joint Facet Disc Right Nerve Root  Left Nerve Root Axial Scans:
Cervical 7 Spinous Process Nerves 2-3 Disc 3-4 Disc 4-5 Disc 5-6 Disc 6-7 Disc
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Neck Pain and Arm Pain : Cervical Radiculopathy by Pablo Pazmino MD

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  • 7. Three distinct clinical syndromes can result: Type I: Cervical Radiculopathy: Cmprsn +Inflammation of Spinal Nerve with symptoms that correspond to the level involved Type II: Cervical Myelopathy: Cord involvement Type III: Axial Joint Pain (Mechanical neck pain, “discogenic pain”, facet syndrome, painful instability
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  • 12. October 24,1892 20 YO “builder who under the influence of alcohol, fell off his van on to the road striking his right shoulder.” Over the next 2months he gradually lost control of legs and sphincters Dr Horsley performs the first Laminectomy of 6 th Cervical Vertebra. The Spinal cord was found to be compressed by a transverse ridge projecting backwards from the body of the vertebra. Complete recovery by September of that year
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  • 19. Here is what I mean by a foundation concept. You will see side view images and top down images throughout this presentation and on your MRIs. This can be hard to grasp unless we stop and point a few things out initially The Sagittal view is also called the lateral view and this is pictured here it displays the spine as viewed from the SIDE. The Axial view is a top down view of the spine. This image repsents a slice obtained as if an Axe were to chop you, therefore the name Axial view.
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  • 28. Joint Facet Nucleus Pulposus Right Nerve Root Left Nerve Root As you can see here on MRI and CT scans the Facet joints end up looking like the buns of a hamburger. Its just the way the happen to look when they are sliced in this plane. We will show you this on some examples later Annulus Fibrosus Axial View of the Disc and Neural elements
  • 29. Joint Facet Disc Right Nerve Root Left Nerve Root Axial View
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  • 35. Joint Facet Disc Right Nerve Root Left Nerve Root Axial View
  • 36. Joint Facet Disc Right Nerve Root Left Nerve Root Next I will show you some MRIs You will see this is a patient with a left sided herniation pinching off her exiting left nerve root
  • 37. Joint Facet Disc Right Nerve Root Left Nerve Root Axial Scans:
  • 38. Cervical 7 Spinous Process Nerves 2-3 Disc 3-4 Disc 4-5 Disc 5-6 Disc 6-7 Disc
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