Cervical Vertebrae: Anatomy, Function, and Rehabilitation (2022)

Your neck, also known as the cervical spine, is a complex series of bones, discs, muscles, nerves, and ligaments. There are seven bones, each called a cervical vertebra, that are stacked upon one another.

These cervical vertebrae are specially shaped and configured to allow for maximum motion while supporting your skull and protecting your spinal cord, neighboring blood vessels, and nerves.

Cervical Vertebrae: Anatomy, Function, and Rehabilitation (1)

Anatomy

The seven cervical vertebrae can be divided into two groups: atypical vertebrae and typical vertebrae.

Atypical Vertebrae

The atypical vertebrae are cervical level one and two (C1 and C2). Cervical one is also called the atlas, as it supports the weight of your skull. Cervical two is called the axis, as it is the one essential for allowing rotation to occur in the cervical spine. Both the atlas and axis are small, flat vertebrae.

The atlas at cervical level one is a flat, ring-shaped vertebra. It does not have a vertebral body. The flat area on its superior surface supports your skull. Most of the flexion and extension that occurs during head nodding occurs at the articulation between your skull and the atlas.

(Video) Functional Rehabilitation of the Cervical Spine - Eric Hansen, M.D.

Cervical level two is called the axis, and has a large bony protrusion called the dens or odontoid process. This bony odontoid process passes up through the ring-like atlas vertebrae and forms the atlantoaxial joint. This is where about 50% to 60% of cervical rotation occurs. Small ligaments attach the odontoid process to the atlas.

Typical Cervical Vertebrae

Cervical level three through six are considered typical cervical vertebra and are similar in shape and function. Each vertebra has a vertebral body, arch, and facet joint (one on each side of the vertebra).

The vertebral body is the large cylindrical bone towards the front of the vertebra. It supports the load of the skull and vertebrae above it. The intervertebral disc attaches to the vertebral body.

The arch of each vertebra is made up of two pedicles and two laminae. The pedicles arise from the vertebral body and wrap around the back to the laminae.

The laminae on each side of the vertebra attach in the back to form the spinous process. The arch forms the ring of bone that protects your spinal cord. The transverse process, a small bony prominence on each side of the vertebra, has a hole in it that houses the ascending vertebral arteries.

The facet joints of each cervical vertebra provide an articulation point for the bone above and below it. These joints are like other joints in the body in that they are lined with smooth cartilage and allow for pain-free gliding and sliding between two bones.

The seventh cervical vertebra is slightly different from cervical levels three through six. This bone has a larger surface area on its body to attach to the thoracic vertebra below it, forming the cervicothoracic junction.

(Video) Cervical Spine Anatomy & Some Pathology

There is no hole in the transverse processes of this vertebra for the vertebral artery as in the vertebrae above it. Cervical seven also has the largest spinous process in the cervical spine; it's the bump that you can easily see and palpate when you bend your neck forward.

There should be a slight forward curve in your neck when the seven cervical vertebrae are stacked upon one another. This curve is called lordosis. Loss of the lordosis may signify spinal muscle spasm or problems with the discs between each cervical vertebra.

Function

The main function of the cervical vertebrae is to protect your spinal cord. The seven bones stacked upon one another form a bony tunnel for your spinal cord to travel through.

The articulation of two bones creates a small hole, called a foramen, through which your peripheral spinal nerves travel. These nerves traverse through your shoulder and down to your arm and hand.

The cervical vertebrae also work to allow for maximal motion to occur. The joints of the vertebra allow for flexion, extension, and side bending.

The special shape of the first and second cervical vertebrae supports the weight of your skull and allows for significant rotation to happen in your upper cervical spine. This allows you to move your head freely in many different directions.

Another important function of your cervical vertebrae is to protect blood vessels that provide circulation to your brain. There is a small hole on each side of the cervical vertebrae, and through this hole passes the vertebral basilar artery. The bony cervical vertebrae protect this vital blood vessel.

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The cervical vertebrae also provide an attachment point for many muscles in your shoulders and trunk.

The Key Muscle for Your Neck Function

Associated Conditions

The cervical vertebrae protect your spinal cord and blood vessels and allow for quite a bit of motion to occur. But they are also subjected to possible injury that may cause pain or loss of mobility in your neck. Problems that may occur with cervical vertebrae and cause neck pain may include:

  • Cervical vertebra fracture
  • Degenerative disc disease
  • Cervical stenosis
  • Herniated disc
  • Cervical arthritis

Each of these conditions may cause pain in your neck, shoulder, or arms. You may also experience tightness in muscles around your neck and shoulders or a loss of movement in one or more motions in your neck.

Cervical stenosis may cause a serious condition called cervical myelopathy where your cervical vertebra presses upon your spinal cord. This may cause pain, tingling in your arms or legs, or loss of balance while walking.

This is considered a medical emergency, and rapid decompression of your spinal cord via surgery is usually recommended. Likewise, a fracture of a cervical vertebra is considered dangerous, as this may lead to injury to your spinal cord.

(Video) C3 C4 C5 Definitions. Cervical Spinal Cord Injury Symptoms, Causes, Treatments, and Recovery.

If you are experiencing neck pain or difficulty moving your head, visit your physician right away. They can examine you and diagnose your condition. Then you can begin regaining normal pain-free mobility.

Rehabilitation

If you have neck pain, arm pain coming from your neck, or loss of cervical motion, you may benefit from working with a physical therapist to regain pain-free mobility. Most often, neck conditions respond well to conservative treatments, allowing you to quickly return to your previous level of pain-free function.

Various treatments for your neck may include:

  • Exercise: Exercises like cervical rotation, side bending, or retraction may be performed to improve the overall range of motion in your neck.
  • Postural instruction: A forward head posture may place increased stress and strain on your neck, leading to pain or limited mobility.
  • Heat: Heat is often used for neck pain to decrease muscle spasms and improve circulation to the muscles of your neck.
  • Cervical traction: Traction may be used to decrease pain and pressure between cervical joints and discs.
  • Massage: Massage is used to increase blood flow and decrease pain in muscles around your cervical spine.
  • Electrical stimulation: Electrical stimulation, often in the form of transcutaneous electrical neuromuscular stimulation (TENS), may be used to decrease pain and increase local blood flow.

Most episodes of neck pain or cervical radiculopathy resolve within a few weeks. If your pain persists, visit your physician. You may require more invasive treatments such as spinal injections or surgery.

If your neck pain has come on as the result of trauma, you should seek medical care right away. An X-ray can be taken to assess bone integrity, and a magnetic resonance imaging (MRI) test can check the status of the soft tissue around your neck.

If trauma has occurred, you may be required to immobilize your neck with a cervical collar while things are healing. Once healed, you may benefit from the treatments above to regain normal mobility in your cervical spine.

FAQs

What are the functions of cervical vertebrae? ›

Your cervical spine consists of the first seven vertebrae in your spine. It provides support for the weight of your head, surrounds and protects your spinal cord, and allows for a wide range of head motions.

What are the main features of the cervical vertebrae? ›

The main anatomical characteristics of a typical cervical vertebra that separate it from other types of vertebrae are the small size, transverse foramina, saddle-shaped body, and bifid spinous process (Fig. 1.7.

What are the 7 cervical vertebrae? ›

Position of human cervical vertebrae (shown in red). It consists of 7 bones, from top to bottom, C1, C2, C3, C4, C5, C6, and C7.

What is the name and function of the second cervical vertebra? ›

Axis (C2) The second cervical vertebra, or axis, supports the dens, or odontoid process, which projects rostrally from the body, serving as a pivotal restraint against horizontal displacement of the atlas.

What is the best treatment for cervical spondylosis? ›

Treatment
  • Nonsteroidal anti-inflammatory drugs. NSAIDs , such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), are commonly available without a prescription. ...
  • Corticosteroids. A short course of oral prednisone might help ease pain. ...
  • Muscle relaxants. ...
  • Anti-seizure medications. ...
  • Antidepressants.

What type of bone is the cervical vertebrae? ›

Cervical Vertebrae (C1 – C7)

The cervical spine is further divided into two parts; the upper cervical region (C1 and C2), and the lower cervical region (C3 through C7). C1 is termed the Atlas and C2 the Axis. The Occiput (CO), also known as the Occipital Bone, is a flat bone that forms the back of the head.

How does the structure of cervical vertebrae aid in their function? ›

The cervical vertebrae also work to allow for maximal motion to occur. The joints of the vertebra allow for flexion, extension, and side bending. The special shape of the first and second cervical vertebrae supports the weight of your skull and allows for significant rotation to happen in your upper cervical spine.

What is found only in the cervical vertebrae? ›

Another feature unique to the cervical vertebrae is the bifid spinous process (See “physiologic variants” section), which may serve to increase surface area for muscle attachment. The spinous process of cervical vertebrae increases as the spinal column descends.

Why is C7 important? ›

The body of C7 supports the collective weight of the head and neck. Lateral Facets, allow C7's body to form joints with the C6 vertebra above it and the T1 below it. The facets surrounding the body provide both stability and flexibility to the neck.

What is cervical problem? ›

Cervical spondylosis is the degeneration of the bones and disks in the neck. This condition can lead to a variety of problems, including herniated disks and bone spurs. As people age, the structures that make up the backbone and neck gradually develop wear and tear.

What muscles attach C7? ›

Muscle attachments

Trapezius, spinalis capitis, semispinalis thoracis, multifidus and interspinales all attach to the tubercle of the spinous process.

What is the significance of the C3 C4 and C5 vertebrae? ›

The Relationship Between the C3, C4, & C5 Vertebrae

These vertebrae protect the spinal cord running through the cervical region of the spine, as well as provide support for the neck and head. The C3, C4, & C5 vertebrae form the midsection of the cervical spine.

What does C5 C6 and C7 control? ›

Roots C5, C6, and C7 produce the long thoracic nerve, responsible for controlling the serratus anterior.

Why C2 is called axis? ›

Axis: The axis is the second cervical vertebra (symbol: C2). It is called the "axis" because the uppermost cervical vertebra (called the atlas) rotates about the odontoid process of C2. The joint between the axis and atlas is a pivot type of joint. It allows the head turn.

What is the function of lumbar vertebrae? ›

Your lumbar vertebrae provide stability for your back and spinal column and allow for a point of attachment for many muscles and ligaments. Your lumbar vertebrae support most of your body's weight. It's also the center of your body's balance.

What are the functions of thoracic vertebrae? ›

Supporting your chest and abdomen: Your thoracic spine helps stabilize your rib cage, and your rib cage, in turn, helps stabilize your thoracic spine. Together, your thoracic spine and ribcage protect your heart and lungs.

How does the structure of cervical vertebrae aid in their function? ›

The cervical vertebrae also work to allow for maximal motion to occur. The joints of the vertebra allow for flexion, extension, and side bending. The special shape of the first and second cervical vertebrae supports the weight of your skull and allows for significant rotation to happen in your upper cervical spine.

Paraspinal muscles are those long back muscles that sometimes get ropy. Learn their names, locations, and actions.

The paraspinal muscles are the "action" muscles of the back.. This may be why the word "paraspinals" and the term "paraspinal muscles" are commonly used to refer to this important group of back muscles.. The entire three layers of the intrinsic back muscles are located beneath two more superficial back muscle groups which together make up the extrinsic back muscles.. Causes include poor posture (which places direct strain on the muscles), muscle strain, and muscle atrophy (in which the diminished muscle mass weakens spinal support).. The cervical portion of the iliocostalis muscle attaches to the back of the transverse processes of the fourth through the seventh cervical vertebrae.. Like the iliocostalis muscle, the longissimus originates from a broad tendon on the back of the hip bones, the back of the sacrum bone, the ligaments of the sacroiliac joints , and the spinous processes of the lower lumbar vertebra.. Like the iliocostalis and longissimus muscles, the spinalis originates from a broad tendon on the back of the hip bones, the back of the sacrum bone, the ligaments of the sacroiliac joints, and the spinous processes of the lower lumbar vertebra, including the ligaments that connect these processes to one another.

The muscles of your back are complex and work together to provide support, movement, and stability. They can be affected by various conditions.

The muscles of your back support your spine, attach your pelvis and shoulders to your trunk, and provide mobility and stability to your trunk and spine.. The intermediate layer of back muscles includes the serratus posterior superior and inferior.. The inferior serratus posterior originates from thoracic 11 through lumbar level three and attaches at ribs nine through 12.. Your quadratus lumborum, or QL, is the deepest back muscle and originates from your iliac crest and insert on the transverse process of lumbar one through five and the lower part of your twelfth rib.. Each muscle in the deep, intermediate, and superficial layer come in pairs; there is one on the left and one on the right side of your body.. Your back muscles work by stabilizing and moving your spine, trunk, and shoulders.. Common problems with the muscles of your back or conditions that can cause muscular back pain may include:. The muscles in the back are the trapezius, rhomboids, latissimus dorsi, erector spinae, multifidus, and quadratus lumborum.

The guide to T1 - T8 spinal cord vertebrae injuries, symptoms, and recovery options for patients.

The T1 vertebra is the first of twelve vertebrae of the thoracic spinal column.. Since each descending vertebra is larger than the one before it to support the greater weight, thoracic vertebra T1 is the smallest vertebra of the thoracic region.. The T2 vertebra is the second vertebra in the thoracic spinal column.. The T4-T8 vertebrae make up the rest thoracic vertebrae before the thoracic vertebrae T9 - T12.. The T4 and T5 vertebrae are the most commonly injured thoracic vertebrae.. The T2 vertebra is a member of the thoracic vertebrae column, located between the cervical vertebrae and the lumbar spinal vertebrae.. The T4 - T8 vertebrae are located between the T3 and T9 vertebrae and help to make up the thoracic vertebrae column.. The T1-T8 vertebrae have similarities such as each of these thoracic vertebrae being directly attached to the rib cage and containing nerve roots that exit the spinal column at each vertebral level of the spine.. T1: First thoracic vertebra T2: Second thoracic vertebra T3: Third thoracic vertebra T4: Fourth thoracic vertebra T5: Fifth thoracic vertebra T6: Sixth thoracic vertebra T7: Seventh thoracic vertebra T8: Eighth thoracic vertebra. T1 vertebrae: the medial side of the forearm, and flexes the wrist T2 vertebrae: the posterior aspect of the upper arms T3 vertebrae: the pectoral area in the chest T4, T5, T6, T7, & T8 vertebrae: the remaining muscles in the chest and trunk of the body. However, the T4 and T5 vertebrae are the most commonly injured thoracic vertebrae.. Having misaligned thoracic vertebrae will produce the pain symptoms corresponding with the areas that each vertebra controls.

Original Editors - Stacy Callow

A comparison between a cervical disc arthroplasty with anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy works to the advantage the arthroplasty where there was a lower incidence of complications13.. (level of evidence: 2B ). [7] Auffinger BM et al., ‘Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference.’ PLoS One.. (level of evidence: 3B). [12] Davis RJ et al., ‘Cervical total disc replacement with the Mobi-C cervical artificial disc compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled multicenter clinical trial: clinical article.’ J Neurosurg Spine.. (level of evidence: 1B). [13] Ding C et al., ‘Comparison of cervical disc arthroplasty with anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy.’ Acta Orthop Belg.. (level of evidence: 2B). [14] Zigler JE et al., ‘ProDisc-C and anterior cervical discectomy and fusion as surgical treatment for single-level cervical symptomatic degenerative disc disease: five-year results of a Food and Drug Administration study.’ Spine (Phila Pa 1976) 2013 Feb 1;38(3):203-9.

The primary goal of surgery for cervical radiculopathy is to relieve symptoms by decompressing, or relieving pressure on, the compressed nerves in the neck. In most cases, surgery involves removing pieces of bone or soft tissue (such as a herniated disk)—or both.

Anterior Cervical Diskectomy and Fusion (ACDF) Artificial Disk Replacement (ADR) Posterior Cervical Laminoforaminotomy. The procedure involves removing the problematic disk or bone spurs and then stabilizing the spine through spinal fusion.. Restore alignment of the spine Maintain the space available for the nerve roots to leave the spine Limit motion across the degenerated segment of the spine. During the procedure, your doctor will remove the problematic disk and any additional bone spurs, if necessary.. After the disk space has been cleared out, your doctor will use spinal fusion to stabilize your spine.. All spinal fusions use some type of bone material, called a bone graft, to help promote the fusion.. In some cases, the doctor may implant a metal, plastic, or bone spacer between the two adjoining vertebrae.. This spacer, or "cage," usually contains bone graft material to allow a spinal fusion to occur between the two vertebrae.. After the bone graft is placed or the cage is inserted, your doctor will use metal screws and plates to increase the rate of fusion and further stabilize the spine.. If only a small amount of bone is needed, your doctor may be able to use the bone spurs removed from your neck as the autograft.. During the surgery, your doctor will remove your problematic disk and then insert an artificial disk implant into the disk space.. He or she then removes the bone, bone spurs, and tissues that are compressing the nerve root.. If your compression is due to a herniated disk, your doctor will remove the portion of the disk that is compressing the nerve, as well.. Unlike ACDF, posterior cervical laminoforaminotomy does not require spinal fusion to stabilize the spine.. The procedure can be performed as open surgery, in which your doctor uses a single, larger incision to access your spine.

Rothman Orthopaedic Institute Spine Team annually performs more than 3,000 spine surgeries in the Philadelphia greater metropolitan area.

Cervical, Thoracic, Lumbosacral, and Intervertebral Spinal Conditions Cervical Spine Disorders and Disc Replacement Scoliosis and Spinal Deformities Spinal Cord Injury Spinal Trauma Spinal Fusion Spinal Infections Spinal Tumors Spondylolisthesis Minimally Invasive Techniques and Image Guided Technology Comprehensive Treatment of Degenerative Disc Disease Image Guided Technologies in the Management of Spinal Disorders Techniques in Spinal Instrumentation. Rothman Orthopaedic Institute Spine Team annually performs more than 3,000 spine surgeries in the Philadelphia greater metropolitan area.. The spine can be affected by arthritis, degenerative wear and tear problems affecting the joints and disks, as well as a variety of other abnormalities that cause back or neck pain, numbness and weakness.. Problems in the low back or lumbar spine can affect the leg and foot, while problems in the cervical spine of the neck can affect the arms and hands.. Understanding the fundamental anatomy and function of the spine is key to understanding injuries to and diseases of the spine.. Vertebrae - The spine has 33 doughnut-shaped bones called vertebrae.. Each year back pain affects millions of people in the United States and more specifically, sends thousands of people to the hospital for back surgery in the Philadelphia and New Jersey area.. By taking several simple steps now, we can all improve the health of our back and neck, and diminish the chances of developing spine problems later in life.. Each time we lift too much, or lift in an awkward way, we risk injury to our spine.. When lifting or lowering an object, bend your hips and knees and keep your back straight.. Keep your shoulder blades pulled back and down, and your knees and back straight.. Make sure that your back is well supported by your chair, and that the chair is not pinching the back of your knees.. However, if you must sleep on your back, place a pillow under your knees, to help maintain the natural curves of your spine.

Use this page to view details for the Local Coverage Determination for Epidural Steroid Injections for Pain Management.

Contractor NameContract TypeContract NumberJurisdictionStates Novitas Solutions, Inc. A and B MAC. 04111 - MAC A. J - H. Colorado Novitas Solutions, Inc. A and B MAC. 04112 - MAC B. J - H. Colorado Novitas Solutions, Inc. A and B MAC. 04211 - MAC A. J - H. New Mexico Novitas Solutions, Inc. A and B MAC. 04212 - MAC B. J - H. New Mexico Novitas Solutions, Inc. A and B MAC. 04311 - MAC A. J - H. Oklahoma Novitas Solutions, Inc. A and B MAC. 04312 - MAC B. J - H. Oklahoma Novitas Solutions, Inc. A and B MAC. 04411 - MAC A. J - H. Texas Novitas Solutions, Inc. A and B MAC. 04412 - MAC B. J - H. Texas Novitas Solutions, Inc. A and B MAC. 04911 - MAC A. J - H. ColoradoNew MexicoOklahomaTexas Novitas Solutions, Inc. A and B MAC. 07101 - MAC A. J - H. Arkansas Novitas Solutions, Inc. A and B MAC. 07102 - MAC B. J - H. Arkansas Novitas Solutions, Inc. A and B MAC. 07201 - MAC A. J - H. Louisiana Novitas Solutions, Inc. A and B MAC. 07202 - MAC B. J - H. Louisiana Novitas Solutions, Inc. A and B MAC. 07301 - MAC A. J - H. Mississippi Novitas Solutions, Inc. A and B MAC. 07302 - MAC B. J - H. Mississippi Novitas Solutions, Inc. A and B MAC. 12101 - MAC A. J - L. Delaware Novitas Solutions, Inc. A and B MAC. 12102 - MAC B. J - L. Delaware Novitas Solutions, Inc. A and B MAC. 12201 - MAC A. J - L. District of Columbia Novitas Solutions, Inc. A and B MAC. 12202 - MAC B. J - L. District of Columbia Novitas Solutions, Inc. A and B MAC. 12301 - MAC A. J - L. Maryland Novitas Solutions, Inc. A and B MAC. 12302 - MAC B. J - L. Maryland Novitas Solutions, Inc. A and B MAC. 12401 - MAC A. J - L. New Jersey Novitas Solutions, Inc. A and B MAC. 12402 - MAC B. J - L. New Jersey Novitas Solutions, Inc. A and B MAC. 12501 - MAC A. J - L. Pennsylvania Novitas Solutions, Inc. A and B MAC. 12502 - MAC B. J - L. Pennsylvania Novitas Solutions, Inc. A and B MAC. 12901 - MAC A. J - L. DelawareDistrict of ColumbiaMarylandNew JerseyPennsylvania. Acceptable scales include, but are not limited to: Verbal rating scales, Numerical Rating Scale (NRS) and Visual Analog Scale (VAS) for pain assessment, and Pain Disability Assessment Scale (PDAS), Oswestry Disability Index (ODI), Oswestry Low Back Pain Disability Questionnaire (OLBPDQ), Quebec Back Pain Disability Scale (QBPDS), Roland Morris Pain Scale, Back Pain Functional Scale (BPFS), and the Patient-Reported Outcomes Measurement Information System (PROMIS) profile domains to assess function.. ESIs to treat non-specific low back pain (LBP), axial spine pain, complex regional pain syndrome, widespread diffuse pain, pain from neuropathy from other causes, or cervicogenic headaches are considered investigational and therefore are not considered medically reasonable and necessary.. 23 A systematic review comparing ESIs to conservative treatment for patients with lumbosacral radicular pain reported that ESIs were more effective for alleviating lumbosacral radicular pain but not function in both short and intermediate terms compared to conservative treatment, however this effect was not maintained at long-term follow-up.. 31 A 2012 prospective study on 10,261 fluoroscopic guided epidural procedures included 2,376 cervical interlaminar epidural injections, 301 thoracic interlaminar epidural injections, 1,450 lumbar interlaminar epidural injections, 1,395 caudal epidural injections, 1,310 lumbar transforaminal epidural injections, and 839 caudal epidural adhesiolysis procedures.. The North American Spine Society (NASS) Choosing Wisely recommendations include: “Elective spinal injections, such as epidural steroid injections, should be performed under imaging guidance using fluoroscopy or CT with contrast enhancement (unless contraindicated) to ensure correct placement of the needle and to maximize diagnostic accuracy and therapeutic efficacy.” 43 The NASS published guidelinessuggest that while there is some evidence to support ultrasound-guided lumbar TFESI, this data is limited and, due to the risk of serious complications with ESIs, it is not considered standard care.. In the 2015 systematic review of 52 RCTs with placebo control or active-control design looking at the efficacy of epidural injections in managing chronic spinal pain, they concluded Level II evidence for caudal and lumbar interlaminar epidural injections with Level III evidence for lumbar transforaminal epidural injections for lumbar spinal stenosis.. A 2018 systematic review and meta-analysis of randomized controlled trials comparing outcomes of epidural steroids (ES) versus placebo after lumbar discectomy in lumbar disc herniation reported on 12 studies with 1,006 patients (502 in ESI group and 504 in placebo group) and found an unstandardized mean difference of VAS of back pain at 1 week and 1 month, leg pain at 1 week and 1 month, morphine consumption and hospital stay was - 0.53 (95% CI - 1.42, 0.36) score, - 0.89 (95% CI - 1.36, - 0.42) score, - 0.63 (95% CI - 0.75, - 0.50) score, - 0.47 (95% CI - 0.78, - 0.15) score, - 8.47 (95% CI - 16.16, - 0.78) mg and - 0.89 (95% CI - 1.49, - 0.30) days lower when compared to placebo after lumbar discectomy in patients with lumbar disc herniation.. 71 In the 2015 systematic review, also published by this group, on the efficacy of epidural injections for chronic spinal pain, they rate the evidence Level II for long-term management of cervical disc herniation with ILESI, Level II for cervical spinal stenosis management with an interlaminar approach, Level II for post cervical surgery syndrome treated with cervical ILESI, and Level II to III in managing thoracic disc herniation with an interlaminar approach.. A 2013 systematic analysis identified nine studies with ≥ 50% pain relief after TFESIs for radicular pain after a single injection and reported 94% required a single injection and 4% required a second injection to achieve this level of pain relief.. The 2020 NASS Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis and Treatment of Low Back Pain concludes that there is insufficient evidence to make a recommendation for or against the use of caudal or interlaminar epidural steroid injections in patients with low back pain with Grade of Recommendation: I (good evidence for or against recommending intervention).. The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain provided updated guidelines for Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition).. Narouze S, Benzon HT, Provenzano D, et al. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

Learn about Dr. Alexander R. Vaccaro, President of Rothman Orthopaedic Institute and orthopedic spine specialist for over 25 years.

Singh, K., Vaccaro A.R..: Intradural Disc Herniation – Lumbar Spine, in Master Cases: Spine Surgery, Case 19, 150, Vaccaro AR, Albert TJ (eds.).. Vaccaro, A R, Singh, K., Donohue, J.C.: Spinal Meningeal or Perineural Cysts, In Master Cases: Spine Surgery, Case 20, 157, Vaccaro AR, Albert TJ (eds.).. Sharan, A.D., Vaccaro A.R.., Albert, T.J.: Ankylosing Spondylitis- Cervical Osteotomy, in Master Cases: Spine Surgery, Case 27, 215, Vaccaro AR, Albert TJ (eds.).. Albert, T.J., Vaccaro A.R..: Postlaminectomy Kyphosis, in Master Cases: Spine Surgery, Case 51, 420, Vaccaro AR, Albert TJ (eds).. Shetty, T.A.P., Rajasekaran, S., Vaccaro A.R..: “Use of Navigation in Spine Surgery.” The Spine: Medical and Surgical Management, by Alexander R. Vaccaro, 1st ed., vol.

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