ImageVerifierCode 换一换
格式:DOC , 页数:4 ,大小:52KB ,
文档编号:442339      下载积分:4 文币
快捷下载
登录下载
邮箱/手机:
温馨提示:
系统将以此处填写的邮箱或者手机号生成账号和密码,方便再次下载。 如填写123,账号和密码都是123。
支付方式: 支付宝    微信支付   
验证码:   换一换

优惠套餐
 

温馨提示:若手机下载失败,请复制以下地址【https://www.163wenku.com/d-442339.html】到电脑浏览器->登陆(账号密码均为手机号或邮箱;不要扫码登陆)->重新下载(不再收费)。

已注册用户请登录:
账号:
密码:
验证码:   换一换
  忘记密码?
三方登录: 微信登录  
下载须知

1: 试题类文档的标题没说有答案,则无答案;主观题也可能无答案。PPT的音视频可能无法播放。 请谨慎下单,一旦售出,概不退换。
2: 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。
3: 本文为用户(金钥匙文档)主动上传,所有收益归该用户。163文库仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对上载内容本身不做任何修改或编辑。 若此文所含内容侵犯了您的版权或隐私,请立即通知163文库(点击联系客服),我们立即给予删除!。
4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
5. 本站仅提供交流平台,并不能对任何下载内容负责。
6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。

版权提示 | 免责声明

1,本文(医科大学精品课件:Cervical Spondylosis-颈椎病CBL 预习资料.doc)为本站会员(金钥匙文档)主动上传,163文库仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对上载内容本身不做任何修改或编辑。
2,用户下载本文档,所消耗的文币(积分)将全额增加到上传者的账号。
3, 若此文所含内容侵犯了您的版权或隐私,请立即通知163文库(发送邮件至3464097650@qq.com或直接QQ联系客服),我们立即给予删除!

医科大学精品课件:Cervical Spondylosis-颈椎病CBL 预习资料.doc

1、Cervical Spondylosis: Patient History and Case Cervical Spondylosis Cervical spondylosis (spon-dee-low-sis) can be thought of as “grey hair“ of the spine. This means that if you live long enough (and that may only mean forty- to fifty-years of age in some populations) x-rays of your spine will event

2、ually show signs of cervical spondylosis. As described above, the term refers to osteophytes (os-t-o-fights), or bony overgrowths, that protrude from the vertebral bodies as well as narrowing occurring across the disc spaces as the disc degenerates. Though they can compress the spinal cord (like Mrs

3、. S) or a spinal nerve root (like Mr. D), the vast majority of these osteophytes do not cause any nerve problems. They are a sign, however, that the disc between the vertebrae and the facets (fah-sets) has become degenerative. Degenerative discs can cause pain. The mechanism of pain is, unfortunatel

4、y, not well understood. It is thought to be transmitted by tiny nerve endings that innervate the back part of the disc and facet joints. Degeneration can cause pain from the disc, facet joint, or both concomitantly. Diagnostic efforts are aimed to determine which of these structures are the pain gen

5、erators. Therapy is directed to relieving stresses being placed on these areas. Presentation Mrs. P is a forty-two year old woman who was involved in a motor vehicle accident ten years ago. Since then, her neck has never felt “right.“ She has frequent neck spasms, which cause her to miss many days o

6、f work as an assembly line worker. Mrs. P states her neck pain frequently radiates to the base of her head and down into her shoulder blades. She has no arm or leg pain, no bowel or bladder complaints, and no problems with coordination of her hands or feet. Mrs. P has taken many pain medications ove

7、r the past ten years. In the first couple of years, ibuprofen was working adequately. About seven years ago, an emergency room physician gave her a shot of Demerol?, which she felt disagreed with her, but did temporarily relieve her pain. Two weeks later, the pain was back. Her primary care doctor b

8、egan to prescribe a mild narcotic, Vicodin?, about three years ago. She takes this on occasion, but she does not like the “spacey“ feeling she gets when she takes it. She has had two courses of physical therapy in the past. In describing the therapy she states she was given exercises concentrating o

9、n extending her neck. She felt this made her pain worse, despite the therapists reassurance that this would help relieve the pressure across her intervertebral discs. Mrs. P refuses to go back to physical therapy. Her primary care doctor has also instructed his patient to use a home traction set up.

10、 Attaching to the top of a door, Mrs. P uses upright sitting traction. This consists of a chin-head strap connected to a rope, which runs over a pulley. The other end of the rope has light weights (five to ten pounds) attached, which deliver an upward force along Mrs. Ps neck. When she is in the tra

11、ction setup, she experiences some relief, but it is short-lived. The pain usually returns thirty minutes after she has stopped the traction. Mrs. P also uses a soft cervical collar when she has extreme neck spasms. Again, the relief is temporary. She returns to her primary care doctor for a regular

12、visit and to discuss the options for her excruciating neck pain. Examination Mrs. Ps primary care doctor performs a careful neurologic exam, which shows no abnormalities of nerve function. Her neck is stiff with a markedly decreased range of motion. She notices that when the doctor was testing exten

13、sion (head to the back) the pain became much worse. Diagnostic Tests Over the years, Mrs. P has had numerous x-rays of the spine. Her latest x-ray showed degenerative changes with multiple osteophytes growing from the front and back of the C5 and C6 vertebral bodies. An MRI of her neck, taken one ye

14、ar ago, showed no nerve or spinal cord compression, but shortening of the intervertebral disc height. This suggests that the disc has become dried and degenerated and that it is not functioning normally. More importantly, there appears to be degeneration of the facet joints as well at the C5 and C6

15、level. Having treated Mrs. Ps painful neck for many years to no avail, her doctor has decided to seek a specialist consultation from a pain management physician. Specialist Consultation The pain management doctor reviews Mrs. Ps records, chart, x-rays, and MRI. His examination demonstrates that her

16、pain is worse with extension of the neck. He tells her that she has what appears to be degenerative cervical spondylosis at the C5-6 level. Because her neck pain is worse with extension, the doctor believes that Mrs. P has pain associated with facet arthritis. He suggests that she undergo a series o

17、f injections into the facet joints to determine if this decreases her pain. The injections would be Lidocaine? (a numbing medicine) and corticosteroids (to decrease the inflammation). She agrees with this plan. The injections into the facet joint of C5-6 gave Mrs. P substantial relief. She has seen

18、the pain doctor two more times over the past ten months since her initial visit. Each time, the facet injection helps her pain dramatically to a point where she can skip taking her pain medicines some days. Unfortunately, the effects have lasted only about three months after each injection. The pain

19、 doctor is confident that her “pain generator“ is the facet joints at C5-6 in her cervical spine. He explains to Mrs. P that if the pain continues she might be interested in surgery to fuse these two vertebrae together. This would eliminate motion at the painful joints and hopefully relieve her pain

20、. The doctor explains that the procedure has about a 70 percent success rate in providing long-lasting pain relief. He states that he does not perform the surgery and that she would need to be referred to a spine surgeon. Mrs. P thinks about her options carefully. Though her pain is continuing, she

21、is not willing to have surgery yet. Because of the temporary relief of the injections, she feels that she has been able to resume, to some degree, her regular activities. As this is the first time she has had improvement over the past ten years, she would like to postpone surgery for as long as poss

22、ible. The doctor agreed fully with this decision. Surgery on the neck for neck pain is not nearly as reliable at relieving pain as is surgery on the neck to decrease arm pain. Conclusion Degenerative disorders of the spine continue to be a significant cause of neck pain in todays population. Underst

23、anding of these problems continues to grow. With that, patients understanding should follow suit. Affected patients should be aware of the possible treatment modalities, including medication, therapy, braces, selective injections, and surgery. The best patient is an informed one who understands the natural progression of these disorders, as well as the benefits, risks, and complications of available treatments.

侵权处理QQ:3464097650--上传资料QQ:3464097650

【声明】本站为“文档C2C交易模式”,即用户上传的文档直接卖给(下载)用户,本站只是网络空间服务平台,本站所有原创文档下载所得归上传人所有,如您发现上传作品侵犯了您的版权,请立刻联系我们并提供证据,我们将在3个工作日内予以改正。


163文库-Www.163Wenku.Com |网站地图|