Systematic Approach to the Patient to Minimize Errors of Diagnosis and Surgical Indications

  • Umile Giuseppe LongoEmail author
  • Luca Denaro
  • Vincenzo Denaro

Neck pain is an important cause of disability, leading to approximately 1.9 million physician visits annually in the United States [1]. The diagnosis of the pathology responsible for neck pain can be often challenging [2]. Neck pain can arise from pathologies of the cervical spine, as well as from brachial plexus, shoulder, or peripheral nerves, and a systematic approach to the patient is of crucial importance to avoid errors of diagnosis and to plan the optimal management [3]. Orthopedists must never forget that they are managing patients (person with problems), and not “cases”, “admissions”, or “diseases” [4]. This remains a key point in this era of high technology in clinical medicine. Critical to patient's safety in cervical spinal surgery is ensuring that the correct patient, proper surgical site, and the extent of the pathologic lesion are all properly and precisely identified preoperatively, and confirmed by the appropriate investigations [2]. Correct clinical evaluation and adequate preoperative planning contribute to minimize complications and improve outcome [5–8]. Complete preoperative evaluation involves history-taking, clinical examination, and, depending on the clinical suspicion, radiographs, magnetic resonance imaging (MRI), computed tomography (CT), bone scan, electromyography (EMG), and somatosensory-evoked potentials (SEPs) and motor-evoked potentials (MEPs) [9]. Clinical presentation and the severity of signs and symptoms must also be considered prior to surgery, as well as age, general health of the patient, and comorbidities (diabetes mel-litus, hypertension, cardiovascular disease, obesity, asthma, chronic obstructive pulmonary disease, coagu-lopathy, osteoporosis) (see Chap. 1) [10].


Cervical Spine Neck Pain Thoracic Outlet Syndrome Cervical Lordosis Anterior Horn Cell 
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Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Umile Giuseppe Longo
    • 1
    Email author
  • Luca Denaro
    • 2
  • Vincenzo Denaro
    • 3
  1. 1.Department of Orthopedic and Trauma SurgeryCampus Biomedico UniversityRomeItaly
  2. 2.Department of NeuroscienceUniversity of PaduaPaduaItaly
  3. 3.Department of Orthopaedic and Trauma SurgeryCampus Bio-Medico UniversityRomeItaly

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