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Nonetheless, it is important to try to establish the level of a suspected entrapment by history and examination to allow appropriate interpretation of MRI findings. Many patients will present with symptoms and signs of a monoradiculopathy, although functional overlap between nerve roots and multiple root entrapment means that symptoms and signs are not always clear cut. In the earliest stages paraesthesia may be prominent with the more typical radicular pain following at an interval. Symptoms most commonly begin on waking in the morning without any precipitating event. Referred pain in the arm from nerve root irritation is often referred to as brachalgia and can be severe. Unfortunately, such information is not available as randomised clinical studies have not addressed this issue.ĬLINICAL PRESENTATION OF CERVICAL DEGENERATIVE DISEASE Radiculopathies To do this we need to understand both the natural history of cervical spondylosis and the expected outcomes with surgery.
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Thus, as with all surgical procedures, a careful consideration of the benefit from surgery must be balanced against risk. However, the resultant loss of spinal movement following such a fusion may result in accelerated degeneration at adjacent spinal levels. This can result in worsened (and potentially disabling) postoperative neck pain, and to avoid this complication decompression procedures may be combined with a simultaneous fusion. The decompression itself may lead to a relative destabilisation of the cervical spine by interference with muscle, ligament or bone.
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Surgery is generally used in degenerative disease for decompression of spinal cord or nerve roots. Cervical disc degeneration reaches a prevalence of nearly 95% by the age of 65 years, so it is hardly surprising if the majority of patients have some abnormality on their scan. Such findings must, however, be put into perspective. MRI scans may well reinforce this delusion by demonstrating abnormalities. Patients and doctors may feel that there is “something” that should be done although, in fact, this is rarely the case. Neck, shoulder, and brachial pain is frequently encountered and the majority of patients presenting with these symptoms do not need consideration for surgery. Cervical degenerative disease is common and it is often difficult to distinguish pathological changes from the normal aging process.