Report of the SIG Spondylotic cervical Myelopathy CSM

Report of the SIG Spondylotic cervical Myelopathy (CSM) Chair Meeting, Abu Dhabi 5 th-8 th March, 2015 Chair: J. Opara, Katowice Co-Chair: F. Gerstenbrand, Vienna

Main aims of the SIG SCM • • Description of the clinical symptoms Pathophysiological background Neuroimaging Treatment Working basis of the SIG SCM: • University Clinic for Neurology, Katowice, Poland • University Clinic for Neurology, Salzburg, Austria • Karl Landsteiner Research Institute, Vienna, Austria

Human axis organ I Functions • Carrying the human body • Carrying the human head with brain and important sensory organs • Responsible for movements of the head in all dimensions • Fixation of shoulder girdle and the upper extremities • Fixation of pelvis with the lower limbs • Fixation of inner organs: - chest with cardio-respiratory organs - abdominal organs

Human axis organ II Regulated by postural and turning reflexes of the midbrain-pontine centre • Basis for all movements of the human body in the gravity field of the earth • Adaptation of the human body in the gravity field • Adaption of the body position by the postural and turning reflexes due to the vestibular apparatus and the proprioception

Vertebragenic Disturbances Sensoric Pathways

Lattice tower position a) Human: lattice tower position b) Gorilla: lattice tower position, rest of vault bridge construction a) b)

Malposition a) Humpback b) Normal position Quelle: H. Tilscher: Die Wirbelsäule der Frau. Verlagshaus der Ärzte, Wien, 2005 a) b) c) d) Normal position Humpback, lumbal hyperlordosis Flatback

Dysfunction of Cervical Spine Neurological Manifestations • • Cervicogenic headache Cervicale syndromes Vertebro-basilar insufficiency Cervical vertebrostenosis (spinal cord lesion) • Spondylotic cervical myelopathy

Spondylotic Cervicale Myelopathia • Symptoms – – – – Flaccide paresis of spreading hands Atrophia of hand muscles both sides Spastic paraparesis of legs Dissociated sensory disturbance C 6 downwards Epicritic disturbances, legs, trunk, upper extremities Bladder dysfunction, urge to urinate Bowel dysfunction Vertebrostenosis cervical spine, middle-lower part • X-ray, cervical MRI – typical findings • Differential diagnosis – A. spinalis anterior syndrome

Cervical Vertebrostenosis MRI cervical (T 2) • Disc protusion C 5/C 6 and C 6/C 7 Stretched position lower part in cervical spine

Vertebrostenosis MRI cervical (T 2) Changement in various head positions

Cervical Vertebrostenosis Myelography • Disc protrusion C 4/C 5, C 5/C 6

Cervical Vertebrostenosis Cervical MRI (T 2) • vertebrostenosis C 5/C 6, C 6/C 7 • Local lesion in the myelon C 6

Vertebral Spine - Prophylaxis Some possibilities Source: J. Krämer, Prophylaxe von Wirbelsäulenschäden am Arbeitsplatz, in: Neuroorthopädie 4, 1988

Isometric Excercises Source: Degenerative Erkrankungen der Halswirbelsäule, Goldhahn et al, 1994

Special Exercises for the Vertebral Spine • Left side: wrong exercise Quelle: H. Tilscher: Die Wirbelsäule der Frau. Verlagshaus der Ärzte, Wien, 2005

Possibilities of cooperation with other SIG‘s - - Neuropathic pain Neurosurgical, reconstructive and restaurative rehabilitation Paediatric neurorehabilitation Posture, mobility and falls Neurological rehabilitation and clinical trials