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Li Y, Wu B, Li M, Pang X, Yang L, Dai C, Peng B. Patient-Reported Outcome Measures following Coblation Nucleoplasty for Cervical Discogenic Dizziness. J Clin Med 2023; 12:4413. [PMID: 37445446 DOI: 10.3390/jcm12134413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] [Imported: 09/20/2023] Open
Abstract
BACKGROUND There is little research in the literature comparing the efficacy of coblation nucleoplasty with conservative treatment in the treatment of cervical discogenic dizziness and reporting the achieved rate of minimal clinically important differences (MCID) and patient acceptable symptom state (PASS) after surgery. This retrospective study aims to explore the patient-reported outcome measures (PROM) following coblation nucleoplasty for cervical discogenic dizziness and to compare the therapeutic effect of coblation nucleoplasty with prolonged conservative treatment. METHODS Sixty-one patients with cervical discogenic dizziness and a positive intradiscal diagnostic test eligible for single-level cervical coblation nucleoplasty were included in the study. Among these 61 patients, 40 patients underwent cervical coblation nucleoplasty, while the remaining 21 patients refused surgery and received continued conservative treatment. The primary PROMs were the intensity and frequency of dizziness and secondary PROMs were related to the neck disability index (NDI) and visual analog scale (VAS) for neck pain (VAS-neck) during a 12-month follow-up period. Moreover, the achieved rate of MCID and PASS in both groups was assessed 12 months after surgery. RESULTS Dizziness intensity, dizziness frequency, VAS-neck score, and NDI score were significantly improved from the baseline at all follow-up time points in both treatment groups, except for showing no significant improvement in dizziness frequency in the conservative treatment group at 6 and 12 months after surgery. However, at each follow-up time point, the above indexes were lower in the surgery group than in the conservative treatment group. In addition, the achieved rates for PASS and MCID in all indexes in the surgery group were significantly higher than those in the conservative treatment group at 12 months after surgery. CONCLUSIONS Cervical coblation nucleoplasty significantly improved the intensity and frequency of dizziness, neck pain, and NDI in patients with cervical discogenic dizziness, and the results were superior to those from prolonged conservative treatment. Meanwhile, cervical coblation nucleoplasty is a good choice for patients with chronic neck pain and refractory cervical discogenic dizziness who have not demonstrated the indications for open surgery and have not responded well to conservative treatment.
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Affiliation(s)
- Yongchao Li
- Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Bing Wu
- Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Mao Li
- Department of Surgery, Peking University Hospital, Beijing 100034, China
| | - Xiaodong Pang
- Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Liang Yang
- Department of Orthopeadics, Featured Medical Center of Chinese People's Armed Police Forces, Tianjin 300162, China
| | - Chen Dai
- Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Baogan Peng
- Department of Orthopedics, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
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Dai C, Qu B, Peng B, Liu B, Li Y, Niu C, Peng B, Li D. Phosphoglycerate mutase 5 facilitates mitochondrial dysfunction and neuroinflammation in spinal tissues after spinal cord injury. Int Immunopharmacol 2023; 116:109773. [PMID: 36773566 DOI: 10.1016/j.intimp.2023.109773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/27/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] [Imported: 09/20/2023]
Abstract
Spinal cord injury (SCI) is a high incidence worldwide that causes a heavy physical and psychological burden to patients. It is urgent to further reveal the pathological mechanism and effective treatment of SCI. Mitochondrial dysfunction plays an important role in the disease progression of SCI. As a mitochondrial membrane protein, phosphoglycerate mutase 5 (PGAM5) is mainly involved in mitochondrial function and mitosis to modulate cellular physiological functions, but the roles of PGAM5 in spinal tissues remain to be unreported after SCI. The purpose of this study was to evaluate the role of PGAM5 in SCI mice and its relationship with neuroinflammation. The results showed that the mitochondrial membrane protein PGAM5 was involved in microglia activation after SCI, and PGAM5 deletion could improve mitochondrial dysfunction (including abnormal mtDNA, ATP synthases, and ATP levels, Cyt C expression, and ROS and rGSH levels) in spinal cord tissue after SCI, Arg1/iNOS mRNA level, iNOS expression, and pro-inflammatory cytokines TNF-α, IL-1β, and IL-18 levels. In vitro, H2O2 increased TNF-α, IL-1β, and IL-18 levels in BV2 cells, and PGAM5-sh and Nrf2 activators significantly reversed H2O2-induced iNOS expression and proinflammatory cytokine production. Furthermore, IP/Western blotting results revealed that PGAM5-sh treatment significantly reduced the interaction of PGAM5 with Nrf2 and enhanced the nuclear translocation of Nrf2 in BV2 cells. The data suggested that PGAM5 was involved in the cascade of oxidative stress and inflammatory response in microglia via facilitating the expression level of Nrf2 in the nucleus after SCI. It provided a reference for clarifying the pathological mechanism and therapeutic target of SCI.
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Affiliation(s)
- Chen Dai
- Orthopedics and Trauma Department, The 963rd (224th) Hospital of People's Liberation Army, 963rd Hospital of Joint Logistics Support Force of PLA, Jiamusi, Heilongjiang 154007, China; Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100039, China
| | - Bo Qu
- Tianjin University, Tianjin Key Laboratory for Disaster and Emergency Medicine Technology, Tianjin 300072, China
| | - Bibo Peng
- Outpatient Department, The Third Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Bin Liu
- Department of Orthopaedics, General Hospital of Northern Theater Command, No.83, Wenhua Road, Shenhe District, Shenyang 110016, China
| | - Yongchao Li
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100039, China
| | - Chunlei Niu
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100039, China
| | - Baogan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100039, China.
| | - Duanming Li
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100039, China.
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Peng BG, Yan XJ. Barriers to mesenchymal stromal cells for low back pain. World J Stem Cells 2022; 14:815-821. [PMID: 36619693 PMCID: PMC9813839 DOI: 10.4252/wjsc.v14.i12.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/30/2022] [Accepted: 11/30/2022] [Indexed: 12/21/2022] [Imported: 09/20/2023] Open
Abstract
Intervertebral disc degeneration is the main cause of low back pain. In the past 20 years, the injection of mesenchymal stromal cells (MSCs) into the nucleus pulposus of the degenerative disc has become the main approach for the treatment of low back pain. Despite the progress made in this field, there are still many barriers to overcome. First, intervertebral disc is a highly complex load-bearing composite tissue composed of annulus fibrosus, nucleus pulposus and cartilaginous endplates. Any structural damage will change its overall biomechanical function, thereby causing progressive degeneration of the entire intervertebral disc. Therefore, MSC-based treatment strategies should not only target the degenerated nucleus pulposus but also include degenerated annulus fibrosus or cartilaginous endplates. Second, to date, there has been relatively little research on the basic biology of annulus fibrosus and cartilaginous endplates, although their pathological changes such as annular tears or fissures, Modic changes, or Schmorl's nodes are more commonly associated with low back pain. Given the high complexity of the structure and composition of the annulus fibrosus and cartilaginous endplates, it remains an open question whether any regeneration techniques are available to achieve their restorative regeneration. Finally, due to the harsh microenvironment of the degenerated intervertebral disc, the delivered MSCs die quickly. Taken together, current MSC-based regenerative medicine therapies to regenerate the entire disc complex by targeting the degenerated nucleus pulposus alone are unlikely to be successful.
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Affiliation(s)
- Bao-Gan Peng
- Department of Orthopaedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
| | - Xiu-Jie Yan
- Department of Orthopaedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
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Yang L, Li Y, Dai C, Pang X, Li D, Wu Y, Chen X, Peng B. Anterior cervical decompression and fusion surgery for cervicogenic headache: A multicenter prospective cohort study. Front Neurol 2022; 13:1064976. [PMID: 36504652 PMCID: PMC9731211 DOI: 10.3389/fneur.2022.1064976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] [Imported: 09/20/2023] Open
Abstract
Background Cervicogenic headache (CEH) has long been recognized as a referred pain deriving from pathological changes in the upper cervical nerves. However, previous clinical studies found that anterior lower cervical discectomy for the treatment of cervical myelopathy and/or radiculopathy can also help relieve associated headaches. To date, there is still a lack of large sample and prospective study to investigate the effect of anterior cervical decompression and fusion (ACDF) on CEH associated with cervical spondylosis. Methods A total of 656 patients with cervical radiculopathy and/or myelopathy were enrolled in three spinal centers. Among them, 221 patients who were diagnosed with CEH were collected in this study, and 204 completed a 1-year follow-up. The primary endpoint was headache intensity during a 12-month follow-up period measured by the numeric pain rating scale (NPRS). The secondary outcome measures included headache frequency, headache duration, and the neck disability index (NDI). Results Among all 204 patients with CEH who completed a 1-year follow-up, 166 received anterior cervical surgery (surgery group) and 38 received conservative treatment (conservative group). There were statistically significant lower NPRS in the surgical group during follow-up. Between-group differences showed that NPRS in the surgery group was significantly greater improvement at 1 month (2.8, 95% CI: 2.0, 3.6), 3 months (2.6, 95% CI: 1.8, 3.4), 6 months (2.4, 95% CI: 1.6, 3.2), and 12 months (1.5, 95% CI: 0.7, 2.4) (p < 0.05 for all). There were statistically significant lower NDI, less frequent headaches, and lower headache duration in the surgery group during follow-up (p < 0.05 for all). Conclusion This study indicates that ACDF can effectively relieve CEH associated with cervical myelopathy and/or radiculopathy.
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Affiliation(s)
- Liang Yang
- Department of Orthopeadics, Featured Medical Center of Chinese People's Armed Police Forces, Tianjing, China,Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yongchao Li
- Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chen Dai
- Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaodong Pang
- Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Duanming Li
- Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ye Wu
- Department of Orthopeadics, Beijing 304th Hospital, Beijing, China
| | - Xiongsheng Chen
- Department of Orthopeadics, Spine Center, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China,Xiongsheng Chen
| | - Baogan Peng
- Department of Orthopeadics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China,*Correspondence: Baogan Peng
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Yang L, Li Y, Pang X, Li D, Wu Y, Chen X, Peng B. Anterior Cervical Decompression and Fusion Surgery for Cervical Spondylosis with Concomitant Tinnitus: A Multicenter Prospective Cohort Study. Orthop Surg 2022; 15:133-140. [PMID: 36394075 PMCID: PMC9837213 DOI: 10.1111/os.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022] [Imported: 09/20/2023] Open
Abstract
OBJECTIVE Cervical spondylosis is often accompanied by tinnitus. Up to now, there is a lack of large samples and prospective studies to investigate the effect of anterior cervical decompression and fusion (ACDF) on tinnitus associate with cervical spondylosis. To this end, we performed a prospective cohort study to assess the effectiveness of ACDF on the relief of tinnitus. METHODS This was a multicenter, prospective, cohort clinical study. Between August 2017 and August 2018, 174 patients with cervical spondylosis accompanied by tinnitus were enrolled, with a follow-up of 12 months. Among the 174 patients, 142 received anterior cervical surgery (surgery group) and 32 received conservative treatment (conservative group). The primary end point was the mean change in scores on the tinnitus functional index (TFI). The secondary end points included tinnitus loudness, modified Japanese orthopaedic association scores (mJOA) for spinal cord function, and visual analogue scale (VAS) for neck pain. All the above indexes were measured before treatments and at 1, 3, 6, and 12 months after treatments. One-way analysis of variance and paired samples t-test was adopted for statistical analysis. RESULTS The TFI score was reduced immediately after cervical decompression surgery (from 54.7 ± 15.6 to 32.3 ± 12.5, P < 0.001) and this was sustained at 12 months (P < 0.001). The TFI score of the conservative group also decreased (from 53.9 ± 16.8 to 45.2 ± 13.6, P < 0.001), but the effect was not maintained at 12 months (P = 0.069). There was a significant improvement in tinnitus loudness (from 5.2 ± 1.6 to 2.6 ± 1.9, P < 0.001), mJOA (from 12.0 ± 1.6 to 14.2 ± 1.6, P < 0.001), and VAS for neck pain (from 58.5 ± 9.6 to 22.0 ± 16.4, P < 0.001) in the surgical group. Improvements in the surgical group were statistically significantly greater than that in the conservative group (P < 0.001). CONCLUSION This study indicates that anterior cervical surgery can relieve tinnitus in patients with cervical spondylosis and that tinnitus is an accompanying manifestation of cervical spondylosis.
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Affiliation(s)
- Liang Yang
- Department of OrthopaedicsFeatured Medical Center of Chinese People's Armed Police ForcesTianjingChina,Department of OrthopaedicsThe Third Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yongchao Li
- Department of OrthopaedicsThe Third Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xiaodong Pang
- Department of OrthopaedicsThe Third Medical Center of Chinese PLA General HospitalBeijingChina
| | - Duanming Li
- Department of OrthopaedicsThe Third Medical Center of Chinese PLA General HospitalBeijingChina
| | - Ye Wu
- Department of OrthopaedicsBeijing 304th HospitalBeijingChina
| | - Xiongsheng Chen
- Spine Center, Department of OrthopaedicsShanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Baogan Peng
- Department of OrthopaedicsThe Third Medical Center of Chinese PLA General HospitalBeijingChina
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Li Y, Yang L, Dai C, Peng B. Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment. J Clin Med 2022; 11:6293. [DOI: 10.3390/jcm11216293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 01/17/2023] [Imported: 09/20/2023] Open
Abstract
Basic science and clinical evidence suggest that cervical spine disorders can lead to dizziness. The cervical spine has highly developed proprioceptive receptors, whose input information is integrated with the visual and vestibular systems in the central nervous system, acting on the neck and eye muscles to maintain the coordinative motion of the head, eyes, neck, and body through various reflex activities. When the cervical proprioceptive input changes due to the mismatch or conflict between vestibular, visual, and proprioceptive inputs, cervicogenic dizziness may occur. The diagnosis of cervicogenic dizziness can be determined based on clinical features, diagnostic tests, and the exclusion of other possible sources of dizziness. The cervical torsion test appears to be the best diagnostic method for cervicogenic dizziness. Based on the available evidence, we first developed the diagnostic criteria for cervicogenic dizziness. Treatment for cervicogenic dizziness is similar to that for neck pain, and manual therapy is most widely recommended.
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Peng B, Li Y. Concerns about cell therapy for intervertebral disc degeneration. NPJ Regen Med 2022; 7:46. [PMID: 36068218 DOI: 10.1038/s41536-022-00245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 08/10/2022] [Indexed: 01/17/2023] [Imported: 09/20/2023] Open
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Li DM, Li YC, Jiang W, Peng BG. Application of a new anatomic hook-rod-pedicle screw system in young patients with lumbar spondylolysis: A pilot study. World J Clin Cases 2022; 10:5680-5689. [PMID: 35979102 PMCID: PMC9258354 DOI: 10.12998/wjcc.v10.i17.5680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis. However, the current pedicle screw-laminar hook fixation system is not specifically designed for lumbar spondylolysis.
AIM To investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults.
METHODS We designed a new anatomic hook-rod-pedicle screw system for young patients with lumbar spondylolysis. The isthmus and the corresponding pedicle screw entry point were exposed through the intermuscular approach. Autogenous iliac bone graft was obtained to bridge the isthmus defect, and then the anatomic hook-rod-pedicle screw system was used to fix the isthmus in 15 young patients.
RESULTS At 24 mo follow-up, the visual analogue scale score of low back pain decreased from 6.73 ± 0.88 to 0.73 ± 0.59, and the Oswestry disability index score decreased from 58.20 ± 8.99 to 7.87 ± 4.97. Computed tomography showed bilateral isthmic bone healing in 14 cases and unilateral isthmic bone healing in 1 case. Magnetic resonance imaging showed that the lumbar disc signal of diseased segment and adjacent segments had no change compared with that before surgery. The pain visual analogue scale score of the donor site was 0.20 ± 0.41 at the last follow-up. According to the Modified Macnab score, the excellent and good rate was 100%.
CONCLUSION The application of this new anatomical hook-rod-pedicle screw system to treat young patients with lumbar spondylolysis has the advantages of less trauma, a simple operation and satisfactory clinical effects.
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Affiliation(s)
- Duan-Ming Li
- Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Yong-Chao Li
- Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Wei Jiang
- Department of Anesthesiology, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Bao-Gan Peng
- Department of Orthopaedics, The Third Medical Center of PLA General Hospital, Beijing 100039, China
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Zhang X, Wang G, Niu C, Kuang Z, Peng B. Analysis of injury and pain scores during fusion surgery for multisegmental lumbar spinal stenosis in elderly patients. Folia Neuropathol 2022; 60:355-361. [PMID: 36382489 DOI: 10.5114/fn.2022.118801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] [Imported: 09/20/2023] Open
Abstract
INTRODUCTION Lumbar stenosis has become a common disease. Controversies exist regarding fusion surgery. MATERIAL AND METHODS The patients were divided into groups per the method of fusion received: the posterolateral fusion group (group P) and the intervertebral fusion group (group I). The patients were further divided into groups based on the number of fusion segments: the 2-segment group (P2 and I2), the 3-segment group (P3 and I3), and the 4-segment group (P4 and I4). The operative time, intraoperative blood loss, blood transfusion volume, and postoperative drainage volume were summarized. In particular, wound healing appearance and management were observed. RESULTS The operation time and blood transfusion volume of the P2 and P3 groups were significantly less than those of the I2 and I3 groups (p < 0.05). The postoperative drainage volume of group I4 was less than that of group P4 (p < 0.05). Postoperative numeric rating scale (NRS) scores of P2 and P3 groups were lower than those of I2 and I3 groups (p < 0.05), while the NRS scores of P4 group were higher than those of I4 group (p < 0.05). CONCLUSIONS Posterolateral and intervertebral fusion techniques can be used in the surgical treatment of elderly patients with lumbar spinal stenosis. The posterolateral fusion method should be used when three or fewer segments require surgery. The intervertebral fusion method should be used when four segments require surgery.
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Affiliation(s)
- Xinyu Zhang
- Department of Orthopaedics, The Third Medical Centre, Chinese PLA General Hospital, China
| | - Guanjun Wang
- Department of Orthopaedics, The Third Medical Centre, Chinese PLA General Hospital, China
| | - Chunlei Niu
- Department of Orthopaedics, The Third Medical Centre, Chinese PLA General Hospital, China
| | - Zhengda Kuang
- Department of Orthopaedics, The Third Medical Centre, Chinese PLA General Hospital, China
| | - Baogan Peng
- Department of Orthopaedics, The Third Medical Centre, Chinese PLA General Hospital, China
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Dai C, Liu B, Peng B, Qu B, Lin J, Peng B, Li DM. Entinostat Improves Motor Function and Neuronal Damage Via Downregulating NLRP3 Inflammasome Activation After Spinal Cord Injury. Front Pharmacol 2021; 12:774539. [PMID: 34899337 PMCID: PMC8664236 DOI: 10.3389/fphar.2021.774539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/25/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Spinal cord injury (SCI), a major public health problem, has no effective treatment. A large number of studies have confirmed that histone deacetylases (HDACs) are involved in the physiologic processes that occur following SCI. We tried to uncover the potential neuroprotective role of entinostat (a class I HDAC inhibitor) in SCI. Methods: We conducted a study on a preclinical mouse model of SCI and OGD-induced neuronal damage to present the role of entinostat by the analysis of motor function, histopathologic damage, local NLRP3 inflammasome activation, and neuronal damage. Results: The results showed that entinostat suppressed HDAC activation (including HDAC1 and HDAC3 expression), improved the grip strength and BMS score, spinal edema, cell death, and local NLRP3 inflammasome activation in the spinal cord following SCI. Furthermore, entinostat significantly increased OGD-inhibited neuronal activity and decreased PI-positive cells, HDAC activation, caspase-1 activation, IL-1β and IL-18 levels, and NLRP3 expression. Conclusion: In summary, we first documented that entinostat improved the motor function, histopathologic damage, and local inflammatory response and NLRP3 inflammasome activation in the spinal cord following SCI and also presented the neuroprotective role of OGD-induced neuronal damage via the NLRP3 inflammasome. Thus, our study has the potential to reveal the interaction between the HDAC and NLRP3 inflammasome in the pathologic process as well as SCI and further promote the clinical indications of HDACi entinostat and clinical treatment for the inflammatory response after SCI.
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Affiliation(s)
- Chen Dai
- Orthopedics and Trauma Department, The 963rd (224th) Hospital of People's Liberation Army, 963rd Hospital of Joint Logistics Support Force of PLA, Jiamusi, China.,Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Bin Liu
- Department of Orthopaedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Bibo Peng
- Outpatient Department, The Third Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Bo Qu
- Tianjin University, Tianjin Key Laboratory for Disaster and Emergency Medicine Technology, Tianjin, China
| | - Jiezhi Lin
- Military Burn Center, The 963rd (224th) Hospital of People's Liberation Army, 963rd Hospital of Joint Logistics Support Force of PLA, Jiamusi, China
| | - Baogan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Duan-Ming Li
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing, China
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Li DM, Peng BG. Surgical treatment of four segment lumbar spondylolysis: A case report. World J Clin Cases 2021; 9:4408-4414. [PMID: 34141808 PMCID: PMC8173437 DOI: 10.12998/wjcc.v9.i17.4408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Four-level lumbar spondylolysis is extremely rare. So far, only 1 case has been reported in the literature.
CASE SUMMARY A 19-year-old man presented with severe back pain irresponsive to conservative therapies for 2 years. Lumbar radiographs and two-dimensional computed tomography scan showed four segment lumbar spondylolysis on both sides of L2-L5. Lumbar magnetic resonance imaging showed normal signal in all lumbar discs. Because daily activities were severely limited, surgery was recommended for the case. The patient underwent four-level bilateral isthmic repair at L2-L5. During surgery, L2-L5 isthmi were curetted bilaterally, freshened, and then grafted with autologous iliac bone that was bridged and compressed with a pedicular screw connected to a sub-laminar hook by a short rod. The symptoms of back pain almost disappeared. He has been followed-up for 96 mo, and his symptoms have never recurred. Fusion was found in all repaired isthmi 14 mo after surgery according to evaluation of lumbar radiography and computed tomography scan.
CONCLUSION We report here 1 case of four-level lumbar spondylolysis that was treated successfully with direct isthmic repair.
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Affiliation(s)
- Duan-Ming Li
- Department of Orthopedics, The Third Medical Center of People's Liberation Army General Hospital, Beijing 100039, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center of People's Liberation Army General Hospital, Beijing 100039, China
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Liu JF, Shen W, Huang D, Song T, Tao W, Liu Q, Huang YQ, Zhang XM, Xia LJ, Wu DS, Liu H, Chen FY, Liu TH, Peng BG, Liu YQ. Expert consensus of Chinese Association for the Study of Pain on the radiofrequency therapy technology in the Department of Pain. World J Clin Cases 2021; 9:2123-2135. [PMID: 33850931 PMCID: PMC8017496 DOI: 10.12998/wjcc.v9.i9.2123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
On the basis of continuous improvement in recent years, radiofrequency therapy technology has been widely developed, and has become an effective method for the treatment of various intractable pain. Radiofrequency therapy is a technique that uses special equipment and puncture needles to output ultra-high frequency radio waves and accurately act on local tissues. In order to standardize the application of radiofrequency technology in the treatment of painful diseases, Chinese Association for the Study of Pain (CASP) has developed a consensus proposed by many domestic experts and scholars.
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Affiliation(s)
- Jin-Feng Liu
- Department of Algology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Wen Shen
- Department of Algology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Dong Huang
- Department of Algology, The Third Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China
| | - Tao Song
- Department of Algology, The First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Wei Tao
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen 518000, Guangdong Province, China
| | - Qing Liu
- Department of Algology, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - You-Qing Huang
- Department of Algology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Xiao-Mei Zhang
- Department of Algology, The First Affiliated Hospital of Kunming Medical University, Kunming 650000, Yunnan Province, China
| | - Ling-Jie Xia
- Department of Algology, Henan Provincial Hospital, Zhengzhou 450000, Henan Province, China
| | - Da-Sheng Wu
- Department of Algology, Jilin Province People's Hospital, Changchun 130000, Jilin Province, China
| | - Hui Liu
- Department of Algology, West China Hospital of Sichuan University, Chengdu 610000, Sichuan Province, China
| | - Fu-Yong Chen
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen 518000, Guangdong Province, China
| | - Tang-Hua Liu
- Department of Algology, The Third People's Hospital of Yibin, Yibin 644000, Sichuan Province, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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Peng BG, Liu YQ, Ma K. Editorial for the special issue of the Chinese Association for the Study of Pain. World J Clin Cases 2021; 9:2022-2026. [PMID: 33850921 PMCID: PMC8017508 DOI: 10.12998/wjcc.v9.i9.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/19/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023] Open
Abstract
The Ministry of Health of China officially issued a document, adding the first level diagnosis and treatment discipline “Algology” in the list of diagnosis and treatment subjects of medical institutions on July 16, 2007. As the most important pain academic organization in China, the Chinese Association for the Study of Pain has made outstanding contributions in promoting the development of pain discipline and in establishing pain standards and disease diagnosis and treatment guidelines. In this special issue, under the leadership of Yan-Qing Liu, Chairman of the 7th Committee of the Chinese Association for the Study of Pain, nine consensus and one guideline were included.
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Affiliation(s)
- Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Ke Ma
- Department of Algology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
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Ma K, Jiang W, Wang YX, Wang L, Lv Y, Liu JF, Liu RG, Liu H, Xiao LZ, Du DP, Lu LJ, Yang XQ, Xia LJ, Huang D, Fu ZJ, Peng BG, Liu YQ. Expert consensus of the Chinese Association for the Study of Pain on pain treatment with the transdermal patch. World J Clin Cases 2021; 9:2110-2122. [PMID: 33850930 PMCID: PMC8017498 DOI: 10.12998/wjcc.v9.i9.2110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/14/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic pain lasting more than 3 mo, or even several years can lead to disability. Treating chronic pain safely and effectively is a critical challenge faced by clinicians. Because administration of analgesics through oral, intravenous or intramuscular routes is not satisfactory, research toward percutaneous delivery has gained interest. The transdermal patch is one such percutaneous delivery system that can deliver drugs through the skin and capillaries at a certain rate to achieve a systemic or local therapeutic effect in the affected area. It has many advantages including ease of administration and hepatic first pass metabolism avoidance as well as controlling drug delivery, which reduces the dose frequency and side effects. If not required, then the patch can be removed from the skin immediately. The scopolamine patch was the first transdermal patch to be approved for the treatment of motion sickness by the Food and Drug Administration in 1979. From then on, the transdermal patch has been widely used to treat many diseases. To date, no guidelines or consensus are available on the use of analgesic drugs through transdermal delivery. The pain branch of the Chinese Medical Association, after meeting and discussing with experts and based on clinical evidence, developed a consensus for promoting and regulating standard use of transdermal patches containing analgesic drugs.
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Affiliation(s)
- Ke Ma
- Department of Algology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Wei Jiang
- Department of Anesthesiology, Third Medical Center of People’s Liberation Army General Hospital, Beijing 100039, China
| | - Yun-Xia Wang
- Department of Algology, The Third People’s Hospital of Hubei Province, Hubei Zhongshan Hospital, Wuhan 430033, Hubei Province, China
| | - Lin Wang
- Department of Algology, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Yan Lv
- Department of Algology, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China
| | - Jin-Feng Liu
- Department of Algology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Rong-Guo Liu
- Department of Algology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Hui Liu
- Department of Algology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li-Zu Xiao
- Department of Algology, Shenzhen Sixth People’s Hospital (Nanshan Hospital), Shenzhen 518000, Guangdong Province, China
| | - Dong-Ping Du
- Department of Algology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, China
| | - Li-Juan Lu
- Department of Algology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Xiao-Qiu Yang
- Department of Algology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ling-Jie Xia
- Department of Algology, Henan Provincial People’s Hospital, Zhengzhou 450000, Henan Province, China
| | - Dong Huang
- Department of Algology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Zhi-Jian Fu
- Department of Algology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
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Cao QW, Peng BG, Wang L, Huang YQ, Jia DL, Jiang H, Lv Y, Liu XG, Liu RG, Li Y, Song T, Shen W, Yu LZ, Zheng YJ, Liu YQ, Huang D. Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases 2021; 9:2077-2089. [PMID: 33850927 PMCID: PMC8017503 DOI: 10.12998/wjcc.v9.i9.2077] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/02/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Myofascial pain syndrome (MPS) is characterized by myofascial trigger points and fascial constrictions. At present, domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS. Due to the lack of specific laboratory indicators and imaging evidence, there is no unified diagnostic criteria for MPS, making it easy to confuse with other diseases. The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS. This article reviews relevant domestic and foreign literature on the definition, epidemiology, pathogenesis, clinical manifestation, diagnostic criteria and treatments of MPS. The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors, including pain physicians to manage patients with MPS.
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Affiliation(s)
- Qi-Wang Cao
- Department of Algology, The Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410016, Hunan Province, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
| | - Lin Wang
- Department of Algology, Affiliate Hospital of the Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - You-Qing Huang
- Department of Algology, The Second Affiliate Hospital of the Kunming Medical University, Kunming 650101, Yunnan Province, China
| | - Dong-Lin Jia
- Department of Algology, Peking University Third Hospital, Beijing 100083, China
| | - Hao Jiang
- Department of Algology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
| | - Yan Lv
- Department of Algology, Xijing Hospital, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
| | - Xian-Guo Liu
- Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510089, Guangdong Province, China
| | - Rong-Guo Liu
- Department of Algology, Fujian Provincial Hospital, Fujian Shengli Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
| | - Ying Li
- Department of Algology, Affiliate Hospital of the Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Tao Song
- Department of Algology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wen Shen
- Department of Algology, Affiliate Hospital of the Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
| | - Ling-Zhi Yu
- Department of Algology, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, Shandong Province, China
| | - Yong-Jun Zheng
- Department of Algology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Dong Huang
- Department of Algology, The Third Xiangya Hospital of Central South University, Changsha 410001, Hunan Province, China
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Xiao H, Peng BG, Ma K, Huang D, Liu XG, Lv Y, Liu Q, Lu LJ, Liu JF, Li YM, Song T, Tao W, Shen W, Yang XQ, Wang L, Zhang XM, Zhuang ZG, Liu H, Liu YQ. Expert panel’s guideline on cervicogenic headache: The Chinese Association for the Study of Pain recommendation. World J Clin Cases 2021; 9:2027-2036. [PMID: 33850922 PMCID: PMC8017501 DOI: 10.12998/wjcc.v9.i9.2027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023] Open
Abstract
Cervicogenic headache (CEH) has been recognized as a unique category of headache that can be difficult to diagnose and treat. In China, CEH patients are managed by many different specialties, and the treatment plans remain controversial. Therefore, there is a great need for comprehensive evidence-based Chinese experts’ recommendations for the management of CEH. The Chinese Association for the Study of Pain asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with CEH. A group of multidisciplinary Chinese Association for the Study of Pain experts identified the clinically relevant topics in CEH. A systematic review of the literature was performed, and evidence supporting the benefits and harms for the management of CEH was summarized. Twenty-four recommendations were finally developed through expert consensus voting for evidence quality and recommendation strength. We hope this guideline provides direction for clinicians and patients making treatment decisions for the management of CEH.
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Affiliation(s)
- Hong Xiao
- Department of Algology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
| | - Ke Ma
- Department of Algology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Dong Huang
- Department of Algology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Xian-Guo Liu
- Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Yan Lv
- Department of Algology, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China
| | - Qing Liu
- Department of Algology, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Li-Juan Lu
- Department of Algology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Jin-Feng Liu
- Department of Algology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Yi-Mei Li
- Department of Algology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Tao Song
- Department of Algology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wei Tao
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen 518055, Guangdong Province, China
| | - Wen Shen
- Department of Algology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
| | - Xiao-Qiu Yang
- Department of Algology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lin Wang
- Department of Algology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Xiao-Mei Zhang
- Department of Algology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Zhi-Gang Zhuang
- Department of Algology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
| | - Hui Liu
- Department of Algology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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Abstract
Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness. Anterior cervical surgery can eliminate not only chronic neck pain, cervical radiculopathy or myelopathy, but also dizziness. Immunohistochemical studies show that a large number of mechanoreceptors, especially Ruffini corpuscles, are present in degenerated cervical discs. The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease (i.e. cervical discogenic dizziness). Disc degeneration is characterized by an elevation of inflammatory cytokines, which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization. Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system, resulting in sensory mismatches with vestibular and visual information and leads to dizziness. In addition, neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles. Like cervical discogenic pain, the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out. Conservative treatment is effective for the majority of patients. Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.
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Affiliation(s)
- Tang-Hua Liu
- Department of Algology, The Third People's Hospital of Yibin, Yibin 644000, Sichuan Province, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
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Zhuang ZG, Lu LJ, Peng BG, Ma K, Cai ZY, Fu ZJ, Liu GZ, Liu JF, Liu WT, Li XH, Song T, Wu DS, Yao J, Yao P, Yu JS, Liu YQ. Expert consensus of Chinese Association for the Study of Pain on the application of ozone therapy in pain medicine. World J Clin Cases 2021; 9:2037-2046. [PMID: 33850923 PMCID: PMC8017497 DOI: 10.12998/wjcc.v9.i9.2037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/15/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023] Open
Abstract
This consensus was compiled by first-line clinical experts in the field of pain medicine and was organized by the Chinese Association for the Study of Pain. To reach this consensus, we consulted a wide range of opinions and conducted in-depth discussions on the mechanism, indications, contraindications, operational specifications and adverse reactions of ozone iatrotechnique in the treatment of pain disorders. We also referred to related previous preclinical and clinical studies published in recent years worldwide. The purpose of this consensus is to standardize the rational application of ozone iatrotechnique in pain treatment, to improve its efficacy and safety and to reduce and prevent adverse reactions and complications in this process.
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Affiliation(s)
- Zhi-Gang Zhuang
- Department of Algology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
| | - Li-Juan Lu
- Department of Algology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
| | - Ke Ma
- Department of Algology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Zhen-Yu Cai
- Department of Algology, The First Affiliated Hospital of Xiamen University, Xiamen 361005, Fujian Province, China
| | - Zhi-Jian Fu
- Department of Algology, Shandong Provincial Hospital, Jinan 250021, Shandong Province, China
| | - Guang-Zhao Liu
- Department of Algology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jin-Feng Liu
- Department of Algology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Wen-Tao Liu
- Department of Pharmacology, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Xiao-Hong Li
- Department of Algology, Foshan First People’s Hospital, Foshan 528000, Guangdong Province, China
| | - Tao Song
- Department of Algology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Da-Sheng Wu
- Department of Algology, Jilin Provincial People's Hospital, Changchun 130499, Jilin Province, China
| | - Jing Yao
- Department of Algology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550025, Guizhou Province, China
| | - Peng Yao
- Department of Algology, Sheng Jing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jian-She Yu
- Department of Algology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, Inner Mongolia Autonomous Region, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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Peng B, Yang L, Li Y, Liu T, Liu Y. Cervical Proprioception Impairment in Neck Pain-Pathophysiology, Clinical Evaluation, and Management: A Narrative Review. Pain Ther 2021; 10:143-164. [PMID: 33464539 PMCID: PMC8119582 DOI: 10.1007/s40122-020-00230-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022] Open
Abstract
Neck pain is very common, but most of the causes are unknown, making diagnosis and treatment extremely challenging. Current studies have found that one of the main problems in patients with neck pain is the impairment of cervical proprioception, which subsequently leads to cervical sensorimotor control disturbances. Cervical spine has a very delicate proprioceptive system that plays a crucial role in controlling posture and balance. Cervical proprioceptive impairment in neck pain occurs through a variety of mechanisms. Experimental neck muscle pain induced by injection of hypertonic saline results in inhibition of the activation of painful muscle; chronic neck pain causes structural and functional impairment of cervical muscles; excessive activation of mechanoreceptors in degenerative cervical discs and facet joints produces a large number of erroneous sensory signals. Clinical examinations to assess the link between structural pathology and neck pain have been unsuccessful, opening the way for the development of function-based tests. To date, eight neck sensorimotor control tests have been reported to evaluate patients with chronic neck pain. Although some tests may involve different subsystems (such as oculomotor system and vestibular system), all tests measure sensorimotor control in the neck, and the most commonly used is cervical joint position error (JPE) test. Current studies support the effectiveness of exercises targeting different aspects of sensorimotor function, in particular retraining aimed at improving cervical proprioception and muscle coordination. Based on the available evidence, it is recommended that patients with neck pain should be assessed and managed for cervical proprioceptive impairment and sensorimotor control disturbances.
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Affiliation(s)
- Baogan Peng
- Department of Spinal Surgery, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing, China.
| | - Liang Yang
- Department of Spinal Surgery, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Yongchao Li
- Department of Spinal Surgery, The Third Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Tanghua Liu
- Department of Algology, Lizhuang Tongji Hospital, Yibin, Sichuan, China
| | - Yanqing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Pang X, Liu C, Peng B. Anterior Cervical Surgery for the Treatment of Cervicogenic Headache Caused by Cervical Spondylosis. J Pain Res 2020; 13:2783-2789. [PMID: 33173327 PMCID: PMC7646456 DOI: 10.2147/jpr.s275680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/29/2020] [Indexed: 01/03/2023] Open
Abstract
Study Design Retrospective study. Objective To report the efficacy of anterior cervical surgery for the relief of cervicogenic headache (CEH) caused by cervical spondylosis. Methods From January 2014 to December 2016, a total of 166 cases of cervical radiculopathy and/or myelopathy received anterior cervical decompression and fusion (ACDF) in our institution, among which 50 cases (mean age 44.7 years) were accompanied by CEH and followed up at 3, 6, 12, and 24 months postoperatively, respectively. Neck pain and headache scores according to neck disability index (NDI) were documented for all patients at regular intervals. The results measured at different follow-up time point were compared statistically. Results All 50 patients reported neck pain and headache at the same time before surgery. The average NDIs for neck pain before and after surgery were 2.86 (95% CI: 2.7–3.0) preoperatively, 0.98 (95% CI: 0.8–1.1) at 3 months, 0.68 (95% CI: 0.5–0.9) at 6 months, 0.62 (95% CI: 0.5–0.8) at 12 months, and 0.60 (95% CI: 0.4–0.8) at 24 months postoperatively, respectively. The average NDIs for CEH before and after surgery were 2.32 (95% CI: 2.2–2.5) preoperatively, 0.62 (95% CI: 0.5–0.8) at 3 months, 0.60 (95% CI: 0.4–0.8) at 6 months, 0.56 (95% CI: 0.4–0.7) at 12 months, and 0.50 (95% CI: 0.3–0.7) at 24 months postoperatively, respectively. The neck pain and headache improved in all cases and the NDI score of neck pain or headache at each follow-up point after surgery was significantly different from that before surgery (P <0.001). The simple correlation analysis between neck pain and headache was performed, and the Pearson coefficient r was 0.71, indicating a positive correlation between neck pain NDI and headache NDI. No serious surgical complications were found. Conclusion Our study suggests that patients with cervical spondylosis complicated with CEH are always accompanied by neck pain. ACDF can not only relieve neck pain but also improve the accompanying CEH.
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Affiliation(s)
- Xiaodong Pang
- Department of Spinal Surgery, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, People's Republic of China
| | - Chunyu Liu
- Department of Spinal Surgery, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, People's Republic of China
| | - Baogan Peng
- Department of Spinal Surgery, The Third Medical Center of Chinese PLA General Hospital, Beijing 100039, People's Republic of China
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Wu B, He X, Peng BG. Pyogenic discitis with an epidural abscess after cervical analgesic discography: A case report. World J Clin Cases 2020; 8:2318-2324. [PMID: 32548162 PMCID: PMC7281055 DOI: 10.12998/wjcc.v8.i11.2318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/26/2020] [Accepted: 05/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Chronic neck pain is a common clinical problem. It has long been considered that degenerative cervical disc is an important source of chronic neck pain. In the clinic, cervical discography is thought to be a useful and safe method to distinguish aging discs from pathological discs, and the probability of complications caused by it is really rare. However, once complication occurs, it is likely to cause fatal consequences to patients. Therefore, accurate judgment and effective treatment are crucial.
CASE SUMMARY A 45-year-old female was admitted to the department with a 5-year history of severe neck pain, dizziness, and tinnitus. In order to find the diseased disc, analgesic discography was performed on C4/5 and 6/7 discs successively. Unfortunately, Discitis with an epidural abscess was caused during the procedures. With the help of magnetic resonance imaging, an accurate diagnosis was made and an urgent anterior cervical operation was given subsequently. The patient ultimately recovered well.
CONCLUSION Discitis with epidural abscess is a rare complication after cervical discography, which needs accurate diagnosis and effective antibiotic treatment.
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Affiliation(s)
- Bing Wu
- Department of Spinal Surgery, the Third Medical Center, PLA General Hospital, Beijing 100039, China
| | - Xin He
- Department of Orthopedics, the First Hospital of Qiqihar, Qiqihar 161000, Heilongjiang Province, China
| | - Bao-Gan Peng
- Department of Spinal Surgery, the Third Medical Center, PLA General Hospital, Beijing 100039, China
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Li YC, Feng XF, Pang XD, Tan J, Peng BG. Lumbar disc rehydration in the bridged segment using the BioFlex dynamic stabilization system: A case report and literature review. World J Clin Cases 2020; 8:1958-1965. [PMID: 32518787 PMCID: PMC7262709 DOI: 10.12998/wjcc.v8.i10.1958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/09/2020] [Accepted: 04/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In recent years, the mechanical concept of intervertebral disc regeneration has become more and more popular due to the increasing awareness of the importance of preservation of spine movement. Interestingly, there is increasing evidence, however, that dynamic stabilization systems may compensate non-physiological loads, limit pathological movement, normalize disc height and intradiscal pressure, and provide an adaptive environment for disc regeneration.
CASE SUMMARY The patient was a 54-year-old man, who presented with a 10-year history of mechanical back pain, which had become progressively serious and radiated into the left lower limb with numbness 3 mo prior. He had decreased muscle strength (class IV) of the left dorsal extensor and plantar flexor. Magnetic resonance imaging scans showed L3-S1 disc degeneration and L4-L5 disc herniation. Because the patient did not respond to various conservative treatments, he underwent a posterior L4-5 discectomy with fixation of the BioFlex dynamic stabilization system (Bio-Spine, Seoul, Korea). Preoperative symptoms were relieved and lumbar function was markedly improved after the operation. L4-L5 disc rehydration of instrumented segment was noted on magnetic resonance imaging at the 2-year follow-up.
CONCLUSION Rehydration of the degenerated disc in our patient indicates that the BioFlex dynamic stabilization system may promote disc regeneration. Further research is needed to provide more evidence to support lumbar disc rehydration in the bridged segment using this system.
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Affiliation(s)
- Yong-Chao Li
- Department of Spinal Surgery, The Third Medical Center of PLA General Hospital, Beijing 100039, China
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Xiao-Fei Feng
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Xiao-Dong Pang
- Department of Spinal Surgery, The Third Medical Center of PLA General Hospital, Beijing 100039, China
| | - Jun Tan
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
- Department of Orthopedics, Pinghu Second People’s Hospital, Pinghu 314201, Zhejiang Province, China
| | - Bao-Gan Peng
- Department of Spinal Surgery, The Third Medical Center of PLA General Hospital, Beijing 100039, China
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Wu B, Yang L, Peng B. Ingrowth of Nociceptive Receptors into Diseased Cervical Intervertebral Disc Is Associated with Discogenic Neck Pain. Pain Med 2020; 20:1072-1077. [PMID: 30848823 DOI: 10.1093/pm/pnz013] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the distribution of nociceptive nerve fibers in the cervical intervertebral discs of patients with chronic neck pain and determine whether these nociceptive nerve fibers are related to discogenic neck pain. METHODS We collected 43 samples of cervical intervertebral discs from 34 patients with severe chronic neck pain (visual analog scale [VAS] ≥ 70 mm), 42 samples from 36 patients who suffered cervical spondylotic radiculopathy or myelopathy without neck pain or with mild neck pain (VAS ≤ 30 mm) and 32 samples from eight donators to investigate their innervation immunohistochemically using an antibody against neuropeptide substance P. RESULTS The immunohistochemical investigation revealed that substance P-positive nerve fibers were obviously increased in number and deeply ingrown into the inner anulus fibrosus and even into the nucleus pulposus in the degenerative cervical discs of patients with severe neck pain in comparison with the discs of patients with cervical spondylotic radiculopathy or myelopathy and normal control discs (P<0.01). CONCLUSIONS The current study may indicate a key role of nociceptive nerve fibers in the pathogenesis of neck pain of cervical disc origin.
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Affiliation(s)
- Bing Wu
- Department of Spinal Surgery, The Third Medical Center of PLA General Hospital, Jinzhou Medical University Postgraduate Training Base,Beijing, P.R. China
| | - Liang Yang
- Department of Spinal Surgery, The Third Medical Center of PLA General Hospital, Jinzhou Medical University Postgraduate Training Base,Beijing, P.R. China
| | - Baogan Peng
- Department of Spinal Surgery, The Third Medical Center of PLA General Hospital, Jinzhou Medical University Postgraduate Training Base,Beijing, P.R. China
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Peng B, Bogduk N, DePalma MJ, Ma K. Chronic Spinal Pain: Pathophysiology, Diagnosis, and Treatment. Pain Res Manag 2019; 2019:1729059. [PMID: 31511783 DOI: 10.1155/2019/1729059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 11/18/2022]
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Abstract
OBJECTIVESBACKGROUND Objectives To determine the extent and strength of evidence that supports the belief that cervical intervertebral discs are a source of neck pain. DESIGN Design The evidence from anatomical, laboratory, experimental, diagnostic, and treatment studies was summarized and analyzed for concept validity, face validity, content validity, and construct validity. RESULTS Results Evidence from basic sciences shows that cervical discs have a nociceptive innervation, and experimental studies show that they are capable of producing neck pain. Disc stimulation has been developed as a diagnostic test but has rarely been used in a disciplined fashion. The prevalence of cervical disc pain has not been properly established but appears to be low. No treatment has been established that reliably achieves complete relief of neck pain in substantial proportions of patients. CONCLUSIONS Conclusions Basic science evidence supports the concept of cervical disc pain, but epidemiologic and clinical evidence to vindicate the clinical application of the concept is poor or lacking.
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Affiliation(s)
- Baogan Peng
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing, Peoples Republic of China
| | - Nikolai Bogduk
- Faculty of Medicine and Health Sciences, The University of Newcastle, Newcastle, Australia
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Ma K, Zhuang ZG, Wang L, Liu XG, Lu LJ, Yang XQ, Lu Y, Fu ZJ, Song T, Huang D, Liu H, Huang YQ, Peng BG, Liu YQ. The Chinese Association for the Study of Pain (CASP): Consensus on the Assessment and Management of Chronic Nonspecific Low Back Pain. Pain Res Manag. 2019;2019:8957847. [PMID: 31511784 PMCID: PMC6714323 DOI: 10.1155/2019/8957847] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 06/06/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023]
Abstract
Chronic nonspecific low back pain (CNLBP) is defined as pain or discomfort originating from the waist, which lasts for at least 12 weeks, but no radiculopathy or specific spinal diseases. CNLBP is a complicated medical problem and places a huge burden on healthcare systems. Clinical manifestation of CNLBP includes discogenic LBP, zygapophyseal joint pain, sacroiliac joint pain, and lumbar muscle strain. Further evaluation should be completed to confirm the diagnosis including auxiliary examination, functional assessment, and clinical assessment. The principle of the management is to relieve pain, restore function, and avoid recurrence. Treatment includes conservative treatment, minimally invasive treatment, and rehabilitation. Pharmacologic therapy is the first-line treatment of nonspecific LBP, and it is most widely used in clinical practice. Interventional therapy should be considered only after failure of medication and physical therapy. Multidisciplinary rehabilitation can improve physical function and alleviate short-term and long-term pain. The emphasis should be put on the prevention of NLBP and reducing relevant risk factors.
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Li Y, Feng X, Tan J, Peng B. Letter to the Editor concerning "Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study" by Fischgrund JS, et al. [Eur Spine J; (2018) 27(5): 1146-1156]. Eur Spine J 2019; 28:2223. [PMID: 31309332 DOI: 10.1007/s00586-019-06061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 06/22/2019] [Accepted: 07/02/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Yongchao Li
- Department of Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Xiaofei Feng
- Department of Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Jun Tan
- Department of Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China.
| | - Baogan Peng
- Department of Spinal Surgery, The Third Medical Center of PLA General Hospital, 69 Yongding Road, Beijing, 100039, China.
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Xiao H, Peng B, Ma K, Huang D, Liu X, Lu Y, Liu Q, Lu L, Liu J, Li Y, Song T, Tao W, Shen W, Yang X, Wang L, Zhang X, Zhuang Z, Liu H, Liu Y. The Chinese Association for the Study of Pain (CASP): Expert Consensus on the Cervicogenic Headache. Pain Res Manag. 2019;2019:9617280. [PMID: 31065305 PMCID: PMC6466854 DOI: 10.1155/2019/9617280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/15/2019] [Accepted: 02/24/2019] [Indexed: 02/05/2023]
Abstract
Cervicogenic headache is a relatively common but unique form of headache, and in China, as well as in several other countries, both diagnosis and a clear evidence-based treatment plan remain controversial. Therefore, the Chinese Association for the Study of Pain organized a meeting of pain management experts and created an expert consensus on the diagnosis and treatment of cervicogenic headache in China. This article summarizes the conclusions of the consensus group regarding the epidemiology, etiology, clinical features, diagnosis, differential diagnosis, treatment, and rehabilitation of cervicogenic headache in China.
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Wu B, Zhan G, Tian X, Fan L, Jiang C, Deepti B, Cao H, Li J, Lian Q, Huang X, Xu F. Comparison of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with and without Foraminoplasty for Lumbar Disc Herniation: A 2-Year Follow-Up. Pain Res Manag 2019; 2019:6924941. [PMID: 30719201 DOI: 10.1155/2019/6924941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022]
Abstract
Background Both transforaminal percutaneous endoscopic lumbar discectomy with foraminoplasty (TF PELF) and transforaminal percutaneous endoscopic lumbar discectomy without foraminoplasty (TF PELD) were developed for lumbar disc herniation (LDH) patients. However, the safety and effectiveness between the TF PELF and TF PELD have not been investigated. Methods Of the included 140 LDH patients, 62 patients received TF PELF (PELF group) and 78 patients received TF PELD (PELD group). The operation time, the duration of staying at the hospital, and complication incidences were recorded. All patients were followed up for 2 years, where low back and leg visual analogue scale (VAS) pain ratings and Oswestry Disability Index (ODI) were compared between the 2 groups before and after surgery. Modified Macnab criterion was estimated for all patients at postoperative 2 years. Results There were no significant difference of the operation time, number of days staying at the hospital, and the incidence of complications between the 2 groups (P > 0.05). Two cases in the PELF group and 1 case in the PELD group received a second surgery due to unrelieved symptoms postoperatively. Low back and leg VAS and ODI scores decreased in both groups after operation (P < 0.01), respectively, but were not significant between the 2 groups over time (P > 0.05). Six patients in the PELF group and 3 patients in the PELD group did not continue the follow-up; thus, only 131 patients completed Macnab evaluation. The satisfactory rate was reported as 80.4% in the PELF group and 90.7% in the PELD group (P > 0.05). Conclusions This study suggested that the safety and effectiveness of TF PELF are comparable to TF PELD for LDH patients.
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Yang J, Yang X, Wang L, Zhang W, Yu W, Wang N, Peng B, Zheng W, Yang G, Jiang X. Biomimetic nanofibers can construct effective tissue-engineered intervertebral discs for therapeutic implantation. Nanoscale 2018; 9:13095-13103. [PMID: 28848971 DOI: 10.1039/c7nr03944a] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present a total tissue engineered (TE) intervertebral disc (IVD) to address IVD degradation, which is a major cause of chronic neck and back pain. The TE IVD is comprised of an alginate hydrogel-based nucleus pulposus (NP) and hierarchically organized, concentric ring-aligned electrospun (ES) polycaprolactone (PCL)/poly (d,l-lactide-co-glycolide) (PLGA)/Collagen type I (PPC)-based annulus fibrosus (AF). The TE IVD exhibits excellent hydrophilicity to simulate highly hydrated native IVD. Long-term in vivo implantation assays demonstrate the excellent structural (shape maintenance, hydration, and integration with surrounding tissues) and functional (mechanical supporting and flexibility) performances of the TE IVD. Our study provides a novel approach for treating IVD degeneration.
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Affiliation(s)
- Junchuan Yang
- National Engineering Research Center for Nano-Medicine, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, China.
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Abstract
Cervical intervertebral disc has long been considered a common source of neck pain. However, the pain caused by the disc itself has not been clearly defined so far, and its diagnosis and treatment has always been controversial. Degenerative cervical disc has a rich supply of nerve fibers, is prone to inflammatory reactions, and is susceptible to pain that can be provoked by disc stimulation or distention, and can be eliminated by block. Overwhelming clinical evidence demonstrates that neck pain in patients with degenerative cervical radiculopathy or myelopathy can be subsided rapidly by anterior cervical surgery, further indicating that this neck pain stems from the pathology of cervical disc itself. Cervical discography is advocated as the only test that connects disease to symptoms, but the procedure remains controversial. If strict criteria and technique are maintained, discography can discriminate painful, symptomatic discs from nonpainful, asymptomatic discs. Discogenic neck pain alone without cervical disc herniation or cervical spondylosis accounts for a large proportion of chronic neck pain. For these patients who continue to have refractory neck pain and fail to respond to conservative treatment, anterior cervical fusion surgery or artificial cervical disc replacement may be a better choice, and preoperative cervical discography can guarantee the excellent surgical results. Existing basic and clinical studies have scientifically shown that cervical intervertebral disc degeneration can lead to neck pain.
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Affiliation(s)
- Baogan Peng
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing 100039, People's Republic of China,
| | - Michael J DePalma
- Interventional Spine and Musculoskeletal Care, Virginia iSpine Physicians, PC Virginia Spine Research Institute, Inc Richmond, VA, USA
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Yang L, Chen J, Yang C, Pang X, Li D, Wu B, Wu Y, Lu X, Xu J, Chen X, Peng B. Cervical Intervertebral Disc Degeneration Contributes to Dizziness: A Clinical and Immunohistochemical Study. World Neurosurg 2018; 119:e686-e693. [PMID: 30092465 DOI: 10.1016/j.wneu.2018.07.243] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Dizziness often happens in patients with chronic neck pain with only cervical disc degeneration but without cervical radiculopathy or myelopathy. We prospectively selected a series of patients who showed cervical disc degeneration with concomitant chronic neck pain and intractable dizziness who did not respond to conservative treatment to test a new diagnostic method for this dizziness, to analyze the results of anterior cervical discectomy and fusion (ACDF) surgery based on the test, and to explore its pathogenesis. METHODS Seventy-seven patients who had a transient neck pain and dizziness relief after injection of bupivacaine into a suspected disc were included in the study. In total, 52 underwent ACDF as surgery group, and 25 refused surgery and accepted conservative treatments as conservative group from June, 2015 to October, 2016 with subsequent follow-up to 1 year. The outcomes were visual analogue scale for neck pain, Neck Disability Index, and intensity and frequency of dizziness. During ACDF, the 72 specimens of degenerative cervical discs were collected to determine the innervation in degenerative cervical discs immunohistochemically. RESULTS After surgery, the patients experienced a significant reduction in neck pain and dizziness. Symptomatic relief in surgery group was obviously better than conservative group at each time point of follow-up (P = 0.001). Ruffini corpuscles and substance P-positive free nerve fibers were obviously increased in the number and deeply ingrown into the inner degenerative cervical discs. CONCLUSIONS Current clinical and immunohistochemical studies strongly suggest that chronic neck pain and intractable dizziness in this series of patients stem from the degenerative cervical discs.
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Affiliation(s)
- Liang Yang
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Jindong Chen
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Cheng Yang
- Department of Orthopedics, Changzheng Hospital, Shanghai, China
| | - Xiaodong Pang
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Duanming Li
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Bing Wu
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Ye Wu
- Department of Orthopeadics, 304th Hospital, Beijing, China
| | - Xiang Lu
- Department of Orthopeadics, 304th Hospital, Beijing, China
| | - Jinlin Xu
- Department of Spinal Surgery, Laizhou People Hospital, Shandong, China
| | - Xiongsheng Chen
- Department of Orthopedics, Changzheng Hospital, Shanghai, China.
| | - Baogan Peng
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China.
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Peng B, Yang L, Yang C, Pang X, Chen X, Wu Y. The effectiveness of anterior cervical decompression and fusion for the relief of dizziness in patients with cervical spondylosis: a multicentre prospective cohort study. Bone Joint J 2018; 100-B:81-87. [PMID: 29305455 DOI: 10.1302/0301-620x.100b1.bjj-2017-0650.r2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Cervical spondylosis is often accompanied by dizziness. It has recently been shown that the ingrowth of Ruffini corpuscles into diseased cervical discs may be related to cervicogenic dizziness. In order to evaluate whether cervicogenic dizziness stems from the diseased cervical disc, we performed a prospective cohort study to assess the effectiveness of anterior cervical discectomy and fusion on the relief of dizziness. PATIENTS AND METHODS Of 145 patients with cervical spondylosis and dizziness, 116 underwent anterior cervical decompression and fusion and 29 underwent conservative treatment. All were followed up for one year. The primary outcomes were measures of the intensity and frequency of dizziness. Secondary outcomes were changes in the modified Japanese Orthopaedic Association (mJOA) score and a visual analogue scale score for neck pain. RESULTS There were significantly lower scores for the intensity and frequency of dizziness in the surgical group compared with the conservative group at different time points during the one-year follow-up period (p = 0.001). There was a significant improvement in mJOA scores in the surgical group. CONCLUSION This study indicates that anterior cervical surgery can relieve dizziness in patients with cervical spondylosis and that dizziness is an accompanying manifestation of cervical spondylosis. Cite this article: Bone Joint J 2018;100-B:81-7.
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Affiliation(s)
- B Peng
- General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, China
| | - L Yang
- General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, China
| | - C Yang
- Changzheng Hospital, 415 Fengyang Rd, Huangpu Qu, Shanghai 200000, China
| | - X Pang
- General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, China
| | - X Chen
- Changzheng Hospital, 415 Fengyang Rd, Huangpu Qu, Shanghai 200000, China
| | - Y Wu
- 304th Hospital, 28 Fuxing Rd, Haidian Qu, Beijing 100853, China
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Yang J, Wang L, Zhang W, Sun Z, Li Y, Yang M, Zeng D, Peng B, Zheng W, Jiang X, Yang G. Reverse Reconstruction and Bioprinting of Bacterial Cellulose-Based Functional Total Intervertebral Disc for Therapeutic Implantation. Small 2017; 14. [PMID: 29265567 DOI: 10.1002/smll.201702582] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/23/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Junchuan Yang
- National Engineering Research Center for Nano-Medicine; Department of Biomedical Engineering; College of Life Science and Technology; Huazhong University of Science and Technology; Wuhan 430074 China
- CAS Center of Excellence for Nanoscience; Beijing Engineering Research Center for BioNanotechnology; CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety; National Center for NanoScience and Technology; Beijing 100190 China
| | - Le Wang
- CAS Center of Excellence for Nanoscience; Beijing Engineering Research Center for BioNanotechnology; CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety; National Center for NanoScience and Technology; Beijing 100190 China
| | - Wei Zhang
- Department of Spinal Surgery; General Hospital of Armed Police Force; Beijing 100190 China
| | - Zhen Sun
- National Engineering Research Center for Nano-Medicine; Department of Biomedical Engineering; College of Life Science and Technology; Huazhong University of Science and Technology; Wuhan 430074 China
| | - Ying Li
- National Engineering Research Center for Nano-Medicine; Department of Biomedical Engineering; College of Life Science and Technology; Huazhong University of Science and Technology; Wuhan 430074 China
- CAS Center of Excellence for Nanoscience; Beijing Engineering Research Center for BioNanotechnology; CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety; National Center for NanoScience and Technology; Beijing 100190 China
| | - Mingzhu Yang
- CAS Center of Excellence for Nanoscience; Beijing Engineering Research Center for BioNanotechnology; CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety; National Center for NanoScience and Technology; Beijing 100190 China
| | - Di Zeng
- National Engineering Research Center for Nano-Medicine; Department of Biomedical Engineering; College of Life Science and Technology; Huazhong University of Science and Technology; Wuhan 430074 China
| | - Baogan Peng
- Department of Spinal Surgery; General Hospital of Armed Police Force; Beijing 100190 China
| | - Wenfu Zheng
- CAS Center of Excellence for Nanoscience; Beijing Engineering Research Center for BioNanotechnology; CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety; National Center for NanoScience and Technology; Beijing 100190 China
| | - Xingyu Jiang
- CAS Center of Excellence for Nanoscience; Beijing Engineering Research Center for BioNanotechnology; CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety; National Center for NanoScience and Technology; Beijing 100190 China
- University of Chinese Academy of Sciences; Beijing 100049 China
| | - Guang Yang
- National Engineering Research Center for Nano-Medicine; Department of Biomedical Engineering; College of Life Science and Technology; Huazhong University of Science and Technology; Wuhan 430074 China
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Li Y, Zhang X, Pang X, Yang L, Peng B. Occipitocervical Hemolymphangioma in an Adult with Neck Pain and Stiffness: Case Report and Literature Review. Case Rep Med 2017; 2017:1-6. [PMID: 29362566 PMCID: PMC5738575 DOI: 10.1155/2017/7317289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/18/2017] [Indexed: 01/06/2023] Open
Abstract
Introduction Hemolymphangioma is an extremely rare malformation of the lymphatic and blood vessels. A limited number of hemolymphangioma cases occurring in the pancreas, extremities, spleen, and other organs have been reported until September 2017. To the best of our knowledge, no cases of hemolymphangioma in the occipitocervical region have been reported in the literature. Case Presentation We reported the case of a 23-year-old male patient with an occipitocervical lesion presenting atypically as neck pain and stiffness over a period of five months. Although hemolymphangioma has historically demonstrated a female predilection (2.25 : 1 female to male) and presentation in the third to fourth decades of life, this case is an atypical manifestation occurring in a young male patient. The clinical characteristics and management choices of this uncommon case of hemolymphangioma in the occipitocervical region are discussed, and a review based on the available literature is also presented. Conclusion Hemolymphangioma of the occipitocervical region is an uncommon presentation of a rare lesion. Although rare, hemolymphangioma should be considered a differential diagnosis for masses occurring in the occipitocervical region. Complete surgical resection is the treatment of choice and affords a good prognosis.
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Abstract
Vertigo is one of the most common presentations in adult patients. Among the various causes of vertigo, so-called cervical vertigo is still a controversial entity. Cervical vertigo was first thought to be due to abnormal input from cervical sympathetic nerves based on the work of Barré and Liéou in 1928. Later studies found that cerebral blood flow is not influenced by sympathetic stimulation. Ryan and Cope in 1955 proposed that abnormal sensory information from the damaged joint receptors of upper cervical regions may be related to pathologies of vertigo of cervical origin. Further studies found that cervical vertigo seems to originate from diseased cervical intervertebral discs. Recent research found that the ingrowth of a large number of Ruffini corpuscles into diseased cervical discs may be related to vertigo of cervical origin. Abnormal neck proprioceptive input integrated from the signals of Ruffini corpuscles in diseased cervical discs and muscle spindles in tense neck muscles secondary to neck pain is transmitted to the central nervous system and leads to a sensory mismatch with vestibular and other sensory information, resulting in a subjective feeling of vertigo and unsteadiness. Further studies are needed to illustrate the complex pathophysiologic mechanisms of cervical vertigo and to better understand and manage this perplexing entity.
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Yang L, Yang C, Pang X, Li D, Chen X, Shi J, Zhou X, Wu Y, Lu X, Yang H, Jia L, Peng B. Cervical Decompression Surgery for Cervical Spondylotic Myelopathy and Concomitant Hypertension: A Multicenter Prospective Cohort Study. Spine (Phila Pa 1976) 2017; 42:903-8. [PMID: 27792119 DOI: 10.1097/BRS.0000000000001941] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We performed decompression surgery or conservative treatments on 135 cervical spondylotic myelopathy (CSM) patients with concomitant hypertension and did follow-up assessments up to 1 year to examine the change of blood pressure, spinal cord function, and cervical pain. OBJECTIVE The aim of this study was to determine whether concomitant hypertension is relieved after decompression surgery, and whether it is related to the improvement of spinal cord function or cervical pain. SUMMARY OF BACKGROUND DATA In clinical practice, we often found that some patients with CSM have concomitant hypertension. Interestingly, after CSM was treated successfully by decompression surgery, some patients' high blood pressure returned to normal range even without oral medications. METHODS We enrolled 135 CSM patients with hypertension, 103 of whom received decompression surgery, and remaining 32 patients accepted conservative treatments. We did follow-up assessments at 3, 6, and 12 months. The primary endpoints were changes of blood pressure, and secondary endpoints were changes of modified Japanese Orthopedic Association (mJOA) score and cervical pain visual analogue scale (VAS). Spearman correlation coefficients were calculated between changes in systolic blood pressure (SBP) and mJOA scores, VAS scores. RESULTS In patients with decompression surgery, the significant decrease in both SBP and diastolic blood pressure (DBP) that was seen 3 months and sustained through subsequent visit at 12 months. Paired-samples t test showed that both SBP and DBP were significantly lower than baseline blood pressure at all time points after procedure (P < 0.001). Significant correlation was found between the improvement rates of mJOA score and changes in SBP (r = -0.579, P < 0.001). But the correlation between changes in VAS score and changes in SBP was not significant (r = 0.58, P = 0.571). CONCLUSION Cervical decompression surgery could reduce concomitant high blood pressure in CSM patients, indicating a significant association between the decrease in blood pressure and the improvement of spinal cord function. LEVEL OF EVIDENCE 2.
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Abstract
STUDY DESIGN We collected the samples of cervical intervertebral discs from patients with vertigo to examine the distribution and types of mechanoreceptors in diseased cervical disc. OBJECTIVE The aim of this study was to determine whether mechanoreceptors are distributed more abundantly in cervical discs from patients with cervical spondylosis, and whether they are related to vertigo. SUMMARY OF BACKGROUND DATA Previous limited studies have found that normal cervical intervertebral discs are supplied with mechanoreceptors that have been considered responsible for proprioceptive functions. Several clinical studies have indicated that the patients with cervical spondylosis manifested significantly impaired postural control and subjective balance disturbance. METHODS We collected 77 samples of cervical discs from 62 cervical spondylosis patients without vertigo, 61 samples from 54 patients with vertigo, and 40 control samples from 8 cadaveric donors to investigate distribution of mechanoreceptors containing neurofilament (NF200) and S-100 protein immunoreactive nerve endings. RESULTS The immunohistochemical investigation revealed that the most frequently encountered mechanoreceptors were the Ruffini corpuscles in all groups of cervical disc samples. They were obviously increased in the number and deeply ingrown into inner annulus fibrosus and even into nucleus pulposus in the diseased cervical discs from patients with vertigo in comparison with the discs from patients without vertigo and control discs. Only three Golgi endings were seen in the three samples from patients with vertigo. No Pacinian corpuscles were found in any samples of cervical discs. CONCLUSION The diseased cervical discs from patients with vertigo had more abundant distribution of Ruffini corpuscles than other discs. A positive association between the increased number and ingrowth of Ruffini corpuscles in the diseased cervical disc and the incidence of vertigo in the patients with cervical spondylosis was found, which may indicate a key role of Ruffini corpuscles in the pathogenesis of vertigo of cervical origin. LEVEL OF EVIDENCE 1.
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Yin J, Peng BG, Li YC, Zhang NY, Yang L, Li DM. Differences of Sagittal Lumbosacral Parameters between Patients with Lumbar Spondylolysis and Normal Adults. Chin Med J (Engl) 2017; 129:1166-70. [PMID: 27174324 PMCID: PMC4878161 DOI: 10.4103/0366-6999.181972] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Recent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of investigation for Han Chinese people concerning the normal range of spinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population. METHODS A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force (Beijing, China) were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A: 36 patients with simple lumbar spondylolysis, and Subgroup B: 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis (slip percentage <30%). Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L5 incidence, L5 slope, and sacral table angle (STA), were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t- test. RESULTS There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher (P < 0.05) in the spondylolysis group than those in the control group, but STA was lower (P < 0.001) in the spondylolysis group. CONCLUSIONS Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.
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Affiliation(s)
- Jin Yin
- Department of Spinal Surgery, General Hospital of Armed Police Forces, Beijing 100039, China
| | - Bao-Gan Peng
- Department of Spinal Surgery, General Hospital of Armed Police Forces, Beijing 100039, China
| | - Yong-Chao Li
- Department of Orthopedics Surgery, Gaoyou People's Hospital Affiliated to Soochow University, Yangzhou, Jiangsu 225600, China
| | - Nai-Yang Zhang
- Department of Spinal Surgery, General Hospital of Armed Police Forces, Beijing 100039, China
| | - Liang Yang
- Department of Spinal Surgery, General Hospital of Armed Police Forces, Beijing 100039, China
| | - Duan-Ming Li
- Department of Spinal Surgery, General Hospital of Armed Police Forces, Beijing 100039, China
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Chen Z, Peng B, Li D, Pang X, Yang H. Minimum 5-year follow-up study on the effects of the Wallis dynamic stabilization system in the treatment of lumbar degenerative disease. Chin Med J (Engl) 2014; 127:3587-91. [PMID: 25316234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Short-term outcomes of the Wallis system in the treatment of lumbar degenerative disease (LDD) have been shown to be effective, whereas there is a paucity of studies on the mid-long-term effects of the treatment of the Wallis system. This study was to evaluate the mid-long-term effects of the Wallis dynamic stabilization system in the treatment of LDD. METHODS A total of 26 patients who received the treatment of the Wallis system between February 2008 and January 2009 were included in the study, with 14 patients (Group 1) with L4/5 disc herniation and 12 patients (Group 2) with L5/S1 disc herniation and L4/5 intervertebral disc degeneration (IDD). Visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical outcomes and lumbar X-rays and MRI were obtained to observe imaging changes before and after operation. RESULTS The mean follow-up period was (63.50±2.12) months. The mean ODI and VAS scores decreased obviously three months and five years after operation (P < 0.05). In Groups 1 and 2, L4/5 Cobb angle and range of motion (ROM) decreased and L4/5 posterior disc height increased at the last follow-up (P < 0.05). There were no statistically significant changes in L4/5 anterior disc height and L3/4 University of California at Los Angeles grading before and after operation. There was no statistically significant change in Pfirrmann grading system of L4/5 IDD in Group 2 before and after operation. Adjacent segment degeneration at the last follow-up was found in two patients (2/26, 7.69%) and Modic changes in L4/5 endplates were detected in one patient (1/26, 3.85%). CONCLUSIONS The mid-long-term effects of the Wallis system in the treatment of LDD were satisfied. The Wallis system, as a dynamic stabilization system, which can preserve some ROM of the fixed segment, sustain the lumbar stabilization, and prevent adjacent segment disease and fixed segment degeneration, is an effective instrument to treat LDD.
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Abstract
Three-level lumbar spondylolyses are extremely rare. So far, only 11 cases were reported in the literature. Treatment of multilevel spondylolyses has not been consistent. Conservative treatment is commonly considered first in most patients, but those who remain symptomatic may benefit from operative treatment. We report here 3 cases of 3-level lumbar spondylolyses that were treated successfully with direct isthmic repair in 2 cases and a combined surgery of isthmic repair and interbody fusion in 1 case. Our clinical results indicated that direct defect repair using the screw-hook technique is a simple and safe procedure for the motion segment with normal disc. If the involved disc shows degenerative change, fusion surgery should be consideredSurgical treatment of multilevel spondylolyses varies between fusion, direct isthmic repair, and combined management associating 2 procedures at different levels. The success of management of the 3 patients with 3-level spondylolyses depends on the choice of appropriate treatment for every patient.
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Affiliation(s)
- Baogan Peng
- From the Department of Spinal Surgery, Institute of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
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Li Y, Peng B. Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo. Pain Physician 2015. [PMID: 26218949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cervical vertigo is characterized by vertigo from the cervical spine. However, whether cervical vertigo is an independent entity still remains controversial. In this narrative review, we outline the basic science and clinical evidence for cervical vertigo according to the current literature. So far, there are 4 different hypotheses explaining the vertigo of a cervical origin, including proprioceptive cervical vertigo, Barré-Lieou syndrome, rotational vertebral artery vertigo, and migraine-associated cervicogenic vertigo. Proprioceptive cervical vertigo and rotational vertebral artery vertigo have survived with time. Barré-Lieou syndrome once was discredited, but it has been resurrected recently by increased scientific evidence. Diagnosis depends mostly on patients' subjective feelings, lacking positive signs, specific laboratory examinations and clinical trials, and often relies on limited clinical experiences of clinicians. Neurological, vestibular, and psychosomatic disorders must first be excluded before the dizziness and unsteadiness in cervical pain syndromes can be attributed to a cervical origin. Treatment for cervical vertigo is challenging. Manual therapy is recommended for treatment of proprioceptive cervical vertigo. Anterior cervical surgery and percutaneous laser disc decompression are effective for the cervical spondylosis patients accompanied with Barré-Liéou syndrome. As to rotational vertebral artery vertigo, a rare entity, when the exact area of the arterial compression is identified through appropriate tests such as magnetic resonance angiography (MRA), computed tomography angiography (CTA) or digital subtraction angiography (DSA) decompressive surgery should be the chosen treatment.
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Affiliation(s)
| | - Baogan Peng
- Postgraduate Training Base of General Hospital of Armed Police Force of Liaoning Medical University, Beijing; Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing 100039, China
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Li Y, Pang X, Yang H, Gao C, Peng B. Hemolymphangioma of the waist: A case report and review of the literature. Oncol Lett 2015; 9:2629-2632. [PMID: 26137118 DOI: 10.3892/ol.2015.3071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 02/26/2015] [Indexed: 12/19/2022] Open
Abstract
Hemolymphangioma is a malformation of the lymphatic and blood vessels. To the best of our knowledge, only a limited number of hemolymphangioma cases have been reported in the literature thus far, with no cases developed in the waist region. The present study reported the case of a 17-year-old male patient with hemolymphangioma growing on the waist, presented with back pain for four months. Upon physical examination, the lesion was identified to be oval in shape, soft and compressible, with mild tenderness. No abnormalities were detected in the results of laboratory examinations. However, a magnetic resonance imaging (MRI) scan revealed a tumor with low signal intensity on T1-weighted imaging (WI) and high signal intensity on T2-WI. The mass was successfully removed during surgery. During the seven-month follow-up period, the patient was asymptomatic with no evidence of recurrence. The present study discussed the imaging findings and pathological features of this uncommon case and reviewed the relevant literature.
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Affiliation(s)
- Yongchao Li
- Postgraduate Training Base, General Hospital of Armed Police Force, Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China ; Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing 100039, P.R. China
| | - Xiaodong Pang
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing 100039, P.R. China
| | - Hong Yang
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing 100039, P.R. China
| | - Chunhua Gao
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing 100039, P.R. China
| | - Baogan Peng
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing 100039, P.R. China
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Abstract
Cervical spondylosis and hypertension are all common diseases, but the relationship between them has never been studied. Patients with cervical spondylosis are often accompanied with vertigo. Anterior cervical discectomy and fusion is an effective method of treatment for cervical spondylosis with cervical vertigo that is unresponsive to conservative therapy. We report 2 patients of cervical spondylosis with concomitant cervical vertigo and hypertension who were treated successfully with anterior cervical discectomy and fusion. Stimulation of sympathetic nerve fibers in pathologically degenerative disc could produce sympathetic excitation, and induce a sympathetic reflex to cause cervical vertigo and hypertension. In addition, chronic neck pain could contribute to hypertension development through sympathetic arousal and failure of normal homeostatic pain regulatory mechanisms. Cervical spondylosis may be one of the causes of secondary hypertension. Early treatment for resolution of symptoms of cervical spondylosis may have a beneficial impact on cardiovascular disease risk in patients with cervical spondylosis.
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Affiliation(s)
- Baogan Peng
- From the Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
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Chen Z, Peng B, Li Y, Zhu J. [Clinical outcomes for Bioflex system in the treatment of lumbar degenerative disease]. Zhonghua Yi Xue Za Zhi 2014; 94:3439-42. [PMID: 25622679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the clinical outcomes of Biofelx dynamic stabilization system in the treatment of lumbar degenerative disease (LDD). METHODS A total of 29 patients (16 males, 13 females) received the treatment of Bioflex between June 2011 and April 2013 were recruited. There were with lumbar spinal stenosis (n = 15), lumbar disc herniation (n = 10) and lumbar spondylolisthesis (n = 4). And they underwent one-segment (n = 14), two-segment (n = 10), three-segment (n = 3) and four-segment (n = 2) implantations. Mean age was 52.3 (38-62) years. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical outcomes. And lumbar radiography was used to observe disc height (DH) and range of motion (ROM) in fixed segment and cranial adjacent segment before and after operation. RESULTS The mean follow-up period was 22.6 ± 2.1 (8-32) months. The mean ODI score decreased from 39.96 ± 2.58 preoperatively to 11.26 ± 1.76 at 3 months postoperatively (P < 0.05) and 3.97 ± 1.30 at the last follow-up (P < 0.05). The mean VAS score for low back pain dropped from 7.34 ± 0.80 preoperatively to 2.63 ± 1.01 at 3 months postoperatively (P < 0.05) and 0.91 ± 0.32 at the last follow-up (P < 0.05). The mean VAS score for leg pain deceased from 8.63 ± 0.95 preoperatively to 2.13 ± 0.62 at 3 months postoperatively and 0.58 ± 0.65 at the last follow-up (P < 0.05). The implanted segment preserved some ROM at the last follow-up. Compared to preoperative, no statistically significance existed in postoperative DH and ROM (P > 0.05). CONCLUSION The clinical outcomes of Bioflex system are excellent in the treatment of LDD. As an effective therapy for non-fusion of LDD, it may preserve some ROM of fixed segment and prevent increased range of motion in adjacent segment.
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Affiliation(s)
- Zheng Chen
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing 100039, China
| | - Baogan Peng
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing 100039, China.
| | - Yongchao Li
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing 100039, China
| | - Jiajun Zhu
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing 100039, China
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Affiliation(s)
- Baogan Peng
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing, China
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Pang X, Yang H, Peng B. Human umbilical cord mesenchymal stem cell transplantation for the treatment of chronic discogenic low back pain. Pain Physician 2014; 17:E525-30. [PMID: 25054402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic low back pain is one of the major causes of disability and thus has a major socioeconomic impact. Intervertebral disc degeneration is the main cause of chronic low back pain. Treatment for chronic discogenic low back pain has traditionally been limited to either conservative management or surgical fusion. If conservative treatment fails, then surgical fusion is commonly considered. Current treatments are limited to treat the symptoms and not the underlying biologic alterations of the disc. OBJECTIVE Human umbilical cord tissue-derived mesenchymal stem cells (HUC-MSCs) contain stem cells and possess the ability to regenerate degenerative discs. Based on the results of previous in vitro and animal experiments, we conducted a preliminary study to test the feasibility and safety and to obtain an early indication for the therapeutic value of HUC-MSC transplantation in patients with chronic discogenic low back pain. STUDY DESIGN This is the first study involving treatment of chronic low back pain using HUC-MSC transplantation. SETTING The study was performed at a spine center in China. METHODS Two patients with chronic discogenic low back pain were treated with HUC-MSC transplantation. An 11-point visual analog scale (VAS, 0-10) and Oswestry Disability Index (ODI, 0-100) were used to assess the back pain symptoms and the lumbar function, respectively. RESULTS After transplantation, the pain and function improved immediately in the 2 patients. The VAS and ODI scores decreased obviously during a 2-year follow-up period. LIMITATIONS The shortcoming of this study is that it is a preliminary study with only 2 patients. CONCLUSION The clinical outcomes indicated that HUC-MSC transplantation is a favorable alternative method for the treatment of chronic discogenic low back pain.
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Affiliation(s)
| | | | - Baogan Peng
- The Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
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Affiliation(s)
- Baogan Peng
- Department of Spinal Surgery, Institute of Spinal Surgery of Armed Police Force, General Hospital of Armed Police Force, Beijing, China
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Affiliation(s)
- Baogan Peng
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China.
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