Comparative Management of Spine Pathology

1. Degenerative spine

1. Cervical

1. One level cervical radiculopathy from facet/uncovertebral joint hypertrophy
2. One level cervical radiculopathy from herniated disc in young patient
3. One level cervical radiculopathy from herniated disc in older patient
4. Cervical stenosis with preservation of lordosis
5. Adjacent segment disease after single level ACDF
6. Adjacent segment disease after PCF (cervicothoracic junction)
7. Multilevel cervical stenosis from OPLL
8. Multilevel cervical stenosis from 3-4 discs
9. Anterior C1-2 pannus
10. Basilar impression

2. Thoracolumbar

1. Adjacent segment disease at thoracolumbar junction
2. Thoracic calcified disc (central)
3. Lower thoracic disc herniation
4. High lumbar stenosis (thoracolumbar junction)

3. Lumbosacral

1. Single level disc disease with back pain
2. Radiculopathy from foraminal stenosis
3. Grade 1 spondy without instability on flex/ext and claudication
4. Grade 1 spondy with back pain only
5. Grade 2/3 spondy
6. >Grade 3 spondy
7. Second herniated disc (same level) in a young patient
8. Second herniated disc (same level) in older patient
9. Flat back syndrome after laminectomy
10. Lumbar pseudoarthrosis at L5-S1
11. Pure back pain with multi level degenerative disc disease

2. Traumatic spine (10-15)

1. Cervical

1. Bilateral C2 pars fractures
2. Type II acute odontoid fracture
3. Type II chronic odontoid fracture in geriatric patient
4. Unilateral cervical pedicle/transverse foramen fracture
5. Central cord syndrome without instability
6. Central cord with instability Vertebral artery injury with unstable cervical spine
7. C1 burst fracture with TL disruption

2. Thoracolumbar

1. Compression fracture with back pain
2. Burst fracture without PLC injury
3. Burst fracture with PLC injury
4. Pure bony Chance fracture
5. Ankylosing spondylotic fracture
6. Complete spinal cord injury
7. Incomplete spinal cord injury
8. Gunshot wound to the spine

3. Lumbosacral

1. Compression fracture
2. Burst fracture without PLC injury
3. Burst fracture with PLC injury
4. Zone 3 sacral fracture
5. Chronic L5 pars fractures with back pain and spondy

3. Spinal deformity

1. Adolescent idiopathic scoliosis
2. Scoliosis in cerebral palsy
3. Proximal junctional kyphosis after T10-pelvis
4. Isolated coronal deformity with back pain
5. Coronal and sagittal deformity with back pain (adult idiopathic)
6. Flat back after fusion
7. Progressive cervical kyphosis after laminectomy
8. Fixed cervical kyphosis (chin on chest)
9. Degenerative scoliosis with one level radiculopathy
10. Proximal junctional kyphosis after T3-pelvis
11. Iatrogenic deformity after Harrington rod
12. Broken rod after scoliosis correction with back pain

4. Spinal Oncology (10-15)

1. Isolated met vertebral body (thoracic)
2. Cervical epidural met (ventral)
3. Multiple metastases to various levels, back pain only
4. Multiple metastases with one level symptomatic
5. Pathologic vertebral body fracture
6. Meningioma
7. Cervical chordoma
8. Sacral chordoma
9. Chondrosarcoma
10. Schwannoma
11. Ependymoma
12. Glioma
13. Giant Cell tumor
14. Schwannoma
15. Multiple neurofibromas
16. Intradural schwannomatosis
17. Hemangioblastoma

5. Other (epidural abscess or something like that) (10-15)

1. Spontaneous CSF leak nerve root sleeve cyst
2. Epidural abscess with stenosis without myelopathy
3. Osteomyelitis with fracture
4. Osteomyeltiis with back pain, no instability
5. Infection post instrumentation
6. Spinal Type I AVF