19.3 ๐ฉบ ๅ ง็งๅฐ็ง่ๅ็
R2-R3 / Fellow ็ญ็ดใ่จๅบๆฑบ็ญใ็นๆฎๆ็พคใๅฐ็ฃๅฐ็ฃๅฅไฟๆ ๅขใ
19.3.0.1 ๐ ไธ้ ้้ปๆด็
- 22E ๅผท่ชฟ๏ผcervical myelopathy ๆฏๆผธ้ฒใๆๆผ่จบ็ใๆฒ้ปๆฎบๆใ
- VAD ๆฏๅนด่ผ stroke ้่ฆๅๅ ๏ผ้้ซ่ญฆ่ฆบ
- RA ๆฃ่ C1-C2 instability ๆฏ้บป้ๅๅฟ ๆชข
- Cervical disc / spondylosis ้่ฆๅนณ่กก conservative vs surgical
- Taiwan๏ผๅฅไฟ MRI cervical ้ๅถใๅพฉๅฅ็ง / ็ฅๅคๅๅ
19.3.0.2 ๐ 22E vs 21E ๅทฎ็ฐ
| ้ ็ฎ | 21E | 22E |
|---|---|---|
| Cervical myelopathy ๅผท่ชฟ | ๆ | ๅผทๅๆฉๆ่พจ่ญ |
| VAD ๅนด่ผ stroke ่ง่ฒ | ็ฅ | ๅผทๅ |
| Cannabinoid for chronic neck pain | ็ฅ | ๆ๏ผmodest evidence๏ผ |
| Cervical disc replacement | ๆ | ๅผทๅ๏ผvs ACDF๏ผ |
| RA ๆฒป็ๆฐ่ฅ | TNF | + IL-6, JAK |
19.3.0.3 ๐ง ๆทฑๅบฆๆฉ่ฝ
19.3.0.3.1 Cervical Spondylotic Myelopathy (CSM)
- ็ ็๏ผๆ ขๆง disc ้ๅ + osteophyte + ligamentum flavum ่ฅๅ + facet hypertrophy โ spinal canal narrowing
- ้ฒๅฑๆฉๅถ๏ผMechanical compression + ischemic injury + secondary inflammation
- MRI T2 ้ซ่จ่ = myelomalacia๏ผๅทฒๆ cord injury๏ผโ ้ ๅพๅทฎ indicator
- ็ผ็ ๆจกๅผ๏ผstepwise ่้ linear๏ผๅฏ่ฝ็ช็ถๆกๅ
19.3.0.4 ๐ ้ฒ้ๆฒป็
19.3.0.4.1 Cervical Myelopathy
- Conservative๏ผtractionใPTใNSAID โ ่ผๅบฆ myelopathy
- Surgical decompression๏ผmoderate-severe progressive deficit
- ACDF๏ผAnterior Cervical Discectomy + Fusion๏ผ
- Cervical disc replacement (artificial disc)
- Posterior laminoplasty / laminectomy + fusion
19.3.0.4.2 Cervical Radiculopathy
- Conservative๏ผ80% ๆนๅ 6 ้ฑ
- Epidural steroid for refractory
- ACDF or posterior foraminotomy for surgical
- Disc replacement vs ACDF๏ผdisc replacement preserve motion๏ผlong-term outcomes ๆฅ่ฟ
19.3.0.5 ๐ Clinical Pearls (10 ๆข)
- ใHand clumsiness + gait imbalance + Lhermitte = cervical myelopathyใ
- MRI T2 hyperintensity (myelomalacia) ๆฏ้ ๅพไธไฝณ่จ่
- VAD ๅจๅนด่ผ stroke ๅ ~20%
- ้ ธ้จ chiropractic manipulation ๅพๆฐ็ผ้ ธ็ + neuro = VAD until proven otherwise
- RA ้บป้ๅๅฟ ๆ flexion-extension X-ray
- Disc replacement preserve motion vs ACDF lose motion
- NEXUS sensitive 99%+ but specificity ~13%
- Canadian C-spine Rule ๆดๅ ท็น็ฐๆง
- ่ไบบ occult odontoid fracture ไธๅฎนๅฟฝ่ฆ
- Whiplash ๆฉๆ mobilization > soft collar
19.3.0.6 ๐ ็นๆฎๆ ๅข
19.3.0.6.1 1. RA ็ ไบบ
- C1-C2 instability 25%
- Pre-op flexion-extension X-ray
- ADI > 3 mm = unstable
- Subaxial subluxation ไนๅธธ
- ๆฒป็ RA ็ณป็ตฑๆง + ๅฟ ่ฆๆ cervical fusion
19.3.0.6.2 2. Down syndrome
- Atlantoaxial instability ~15%
- ้ๅๅ่ๅ้่ฉไผฐ
- ADI > 4-5 mm = high risk
19.3.0.6.3 3. Connective tissue disease๏ผMarfan, EDS๏ผ
- VAD ้ขจ้ช โ
- ้ฟๅ chiropractic + ้ซ่กๆ้ๅ
19.3.0.6.4 4. ่ไบบ่ทๅ
- Odontoid (C2) fracture ๅจ่ไบบ็นๅฅๅธธ่ฆ
- Type II๏ผbase of dens๏ผๆไธ็ฉฉใ้ขจ้ช้ซ
- Halo vs surgical screw fixation
19.3.0.7 ๐ ๅฐ็ฃ Context
19.3.0.7.1 ๅฅไฟ็ตฆไป
- MRI cervical๏ผlimited indication๏ผred flagsใไฟๅฎๅคฑๆ๏ผ
- Cervical fusion๏ผๅฅไฟ
- Disc replacement๏ผๅฅไฟ๏ผ้จๅ็ขๅ + ๆขไปถ๏ผ
- Epidural steroid๏ผๅฅไฟ
19.3.0.8 โ ๏ธ ่้ๅฐ้ทๅ
- ่ไบบ่ทๅ้ ธ็็ถ strain๏ผodontoid fracture ๆผ
- Myelopathy ็ถ่ๅๆๅปถ๏ผcord ๆฐธไน ๆๅท
- ๆจๆฟๅพๆฐ็ผ้ ธ็ + Horner ๆฒๆฅ VAD
- RA ็ ไบบ้บป้ๅไธๆฅ C-spine
- Whiplash ้ๅบฆ collar > 1 ้ฑ
- Routine MRI for acute mechanical neck pain
- Cervical disc replacement ไธ่ฉไผฐๆฃ่ facet ้ๅ
- ไธๆ office worker ๅงฟๅข้ ้ฒ
19.3.0.9 ๐ ๅ งๅฐ่้้ป้ ๆธฌ
19.3.0.10 ๐ ๅปถไผธ้ฑ่ฎ
- AAOS Clinical Practice Guideline on Cervical Radiculopathy
- AANS / CNS Cervical Spine Guideline
- CADISS Trial โ VAD antiplatelet vs anticoagulation
- ACR Vasculitis (when relevant)
- ๅฐ็ฃ้ชจ็ง / ็ฅๅคๆๅผ
19.3.0.11 ๐ ไธ้ๆฎตๆๆ็ดขๅผ
- ้ซๅญธ็ๆฆๅฟต โ Ch 19 medstudent.md
- ๅ่่กๅบ โ Ch 19 board-prep.md
- Harrison 22E ๅๆ โ Ch 19
โ ๏ธ ๆฌ md ็บ claude-opus-4-7 ๆฐๅฏซ๏ผ2026-05-08๏ผ๏ผๆช็ถ็ง้ซๅธซ้ฉ่ญใ