--- title: 'Treatment Reveal' type: 'lesson' url: 'https://doc.social/courses/cervical-radiculopathy-spectrum-of-presentation-and-continuum-of-care/treatment-reveal' course: 'Cervical Radiculopathy: Spectrum of Presentation and Continuum of Care' course_url: 'https://doc.social/courses/cervical-radiculopathy-spectrum-of-presentation-and-continuum-of-care' position: '6 of 6' author: 'Dr. Paul Houle' transcript: 'yes' --- # Treatment Reveal ## Summary _This lesson is a recording without a written summary._ ## Transcript 880 words · 5 min · 5 speakers · automatically transcribed (aws-transcribe) and not checked by a person; it may contain errors, particularly in names, drugs and dosages. The recording is the source. [0:00] Speaker 1: Excellent. So, uh, before they, uh, started, uh, 50% of respondents said that they would do an ACDF. 25% said they do posterior cervical, and 25% said, uh, cervical arthroplasty. When I was looking at this, this case, the guy is an incredibly motivated, um, just loved his job as a hard worker, really wanted to get better, uh, so I had, there were no, there were none of the red flags. He wasn't a drug seeker. [0:28] Speaker 1: Um, this, and I, and keeping in mind when I, and I looked at this, um, this, uh, this case, you know, I, I took into consideration that he was in Pain and spasm when this was taken and lying down. So you do get a little bit of the reversal of the normal loosis when you're in spasm and lying down. [0:48] Speaker 1: There was some disc degeneration at C3-4, some disc degeneration at C4-5, elevation of the, uh, postal longitudinal ligament, and I felt that taking care of the disc at C5-6, I felt, in my opinion, the best option for him, um, was this. So I performed a cervical arthroplasty utilizing the MoBC. [1:11] Speaker 1: Um, I've seen him, uh, in follow up. He has had a complete resolution of his radicular symptoms, complete resolution of his neck Pain. Um, he would have gone back to work if his job hadn't been, uh, postponed due to COVID. [1:29] Speaker 1: So, uh, he's actually done quite well. He's 2 months out. Uh, and this is what I chose to do. And [1:36] Speaker 2: it looks great. [1:37] Speaker 1: Thank [1:37] Speaker 3: you. No. [1:43] Speaker 1: So great job. Thanks. Um, we do have one, a couple of people saying they would do an ACDF and of course, Dr. Gardai, uh, is weighing in. He said he would do posterior cervical endoscopic foraminotomy. [1:55] Speaker 1: And if you ever get a chance to watch some of his videos, he does an absolutely amazing job, uh, with the endoscope, uh, so it's certainly uh another option. Yeah, I, [2:04] Speaker 4: I gotta say just looking at the, you know, we didn't have the sagittal MRI scan to really, uh, be prepared before, but he's got underlying cervical stenosis and, and adjacent level disease. I mean, I, I think he's a great candidate for posterior cervical. I, I would have done what I was assigned to talk about, which is a posterior cervical foraminotomy. [2:24] Speaker 2: And, and Paul, because he did have some change to the levels above, that's even more reason, even though Don doesn't think you get adjacent segment disease with fusions or it doesn't make any difference. But that's why I would have done an arthroplasty if we'd seen all the [2:36] Speaker 2: pictures. [2:37] Speaker 1: And, and actually, you know, I used to do a fair number of posterior cervical foraminotomies. Um, I was actually heavily influenced by, uh, Doctor Kork's group. Uh, one of my, my chief resident, Doctor Mike Cowan, uh, was one of, uh, Dom's partners, and I was heavily influenced by, uh, actually your group, Dom, and I did a fair number of them, and, and I had a lot of success and had a lot of failures, and I sort of got away from it. I still do it on occasion when I think it's a better option for a patient. [3:07] Speaker 1: But I have to say my in in my patient population my go to Operations in ACDF and when I get a young person with a normal looking Spine more normal looking Spine, I in a single level disease I'll try for an arthroplasty and that's my sort of the way I think of things. [3:25] Speaker 5: Yeah, I would, I, I would chime in with, with back up Roger on the cervical foraminotomy as well. I think that that is becoming a lost art and it's sad, and that's kind of goes out to, uh, you know, the residency directors and folks in residency. You need to get a training because it is a technically more demanding procedure, but once you kind of get down to the logistics. [3:48] Speaker 5: of it in our case sitting cervical, Roger's case, you know, prone with pins and then with a with a tube. It really is a very slick operation. Again, motion preserving, minimally invasive, no implants. I do think that the that the indications are narrowest of the three that we've talked about, but actually this patient actually fits it pretty well. [4:12] Speaker 1: So interestingly, uh, now the results are in, uh, uh, of the respondents, 57% said they would do a posterior cervical, 28% said they would do artificial disc, and 14% said they would do an ACDF. Uh, [4:28] Speaker 2: Dom, I'm so sorry to hear that. [4:31] Speaker 4: All right guys. [4:32] Speaker 5: The sharks strong work, Roger. There you go. [4:37] Speaker 1: So you know, I, I think, uh, there you go. I mean, I, what's, uh, old is new again, and I think that with, uh, some of the endoscopic techniques with direct visualization, um, I think there's a bright future for a cervical foraminotomy. [4:55] Speaker 2: So. [4:57] Speaker 1: All right, well, uh, this has been a really wonderful discussion. And as always, I always learn a lot from listening to experts talk and something I don't get a lot of chance to do. So I thank all of you for participating and sharing your knowledge with everybody. ## In this course - [Previous: Discussion](https://doc.social/llms/courses/cervical-radiculopathy-spectrum-of-presentation-and-continuum-of-care/discussion.md) - [All lessons: Cervical Radiculopathy: Spectrum of Presentation and Continuum of Care](https://doc.social/llms/courses/cervical-radiculopathy-spectrum-of-presentation-and-continuum-of-care.md)