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Zanwar R, Wani S. Reliability and validity of modified upper limb neurodynamic tests in patients with cervical radiculopathy. Hong Kong Physiother J 2024; 44:137-146. [PMID: 38510155 PMCID: PMC10949103 DOI: 10.1142/s1013702524500112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/23/2023] [Indexed: 03/22/2024] Open
Abstract
Background Neurodynamic Tests (NDTs) are used to assess neural mechanosensitivity in various conditions such as neural sliding, tension or inflammatory dysfunction. But in some upper quadrant dysfunctions, standard testing procedure of NDT cannot be assessed or tolerated by patient. Objective The purpose of the study was to determine the validity, intra-rater and inter-rater reliability of modified NDTs via median and ulnar nerve in patients with cervical radiculopathy. Methods Thirty-three patients (18 men and 15 women, mean age ± SD - 40 . 18 ± 9 . 01 ) with cervical radiculopathy having positive response to standard NDTs were included in the study. Modified neurodynamic tests for median & ulnar nerve were performed with modification in the sequencing of standard neurodynamic test at lower degrees of glenohumeral abduction and external rotation. Outcome measures used were angle of elbow extension for median nerve and angle elbow flexion for ulnar nerve at the point of pain onset indicated by "OP" (Onset of Pain). Results Reliability of OP was evaluated using measurement of Intra-class Correlation Coefficient (ICC), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) values. Results indicated high ICC values and low SEM values for OP during modified median and modified ulnar NDTs (M-MNT1 and M-UNT) on symptomatic side of patients with cervical radiculopathy. Spearman correlation analysis for validity of test score showed strong correlation (r = 0 . 767 ) with standard NDT. Conclusion There was strong correlation between Modified NDTs and standard tests depicting good validity and substantial reliability of OP during M-MNT1 and M-UNT for positive NDT response in patients with cervical radiculopathy.
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Affiliation(s)
- Rupa Zanwar
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Surendra Wani
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
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2
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Joo HJ, Choi S, Kim BH, Kim MS, Shim GY, Chung SJ, Chon J, Yoo MC, Soh Y. Therapeutic Efficacy of Ultrasound-Guided Selective Nerve Block on Chronic Cervical Radiculopathy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1002. [PMID: 38929619 PMCID: PMC11205526 DOI: 10.3390/medicina60061002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/09/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Cervical radiculopathy (CR) manifests as pain and sensorimotor disturbances in the upper extremities, often resulting from nerve root compression due to intervertebral disc herniation, degenerative changes, or trauma. While conservative treatments are initially preferred, persistent or severe cases may require surgical intervention. Ultrasound-guided selective nerve root block (SNRB) has emerged as a promising intervention for alleviating symptoms and potentially obviating the need for surgery. This study evaluates the therapeutic efficacy of ultrasound-guided SNRB in managing chronic CR, aiming to determine its potential in symptom relief and delaying or avoiding surgical procedures. Materials and Methods: A retrospective analysis was conducted on 720 outpatients treated for CR between October 2019 and March 2022. After excluding patients with traumatic CR, previous surgeries, malignancies, progressive neurological symptoms requiring immediate surgery, or inadequate conservative treatment, 92 patients who had experienced cervical radicular pain for more than three months and had failed to improve after more than six weeks of conservative treatment with VAS scores ≥ 5 were included. The patients underwent single or multiple ultrasound-guided SNRB procedures, involving the injection of dexamethasone and lidocaine under real-time ultrasound guidance. Symptom severity was assessed at the baseline, and at 4, 8, and 12 weeks post-procedure using the Visual Analog Scale (VAS). The data collected included age, sex, presence of neck and/or radicular pain, physical examination findings, recurrence of symptoms, improvement in symptoms, and whether surgical intervention was ultimately required. Statistical analyses were performed to identify the factors associated with symptom improvement or recurrence. Results: Significant symptom improvement was observed in 69 (75.0%) participants post-SNRB, with 55 (79.7%) showing improvement at 4 weeks, 11 (15.9%) at 8 weeks, and 3 (4.4%) at 12 weeks. Symptom recurrence, defined by an increase in VAS score accompanied by a pain flare lasting at least 24 h after a pain-free interval of at least one month, was noted in 48 (52.2%) patients. The presence of combined neck and radicular pain was a significant predictor of recurrence (p = 0.008). No significant associations were found between symptom relief and factors such as age, gender, initial pain severity, or MRI findings. Conclusions: Ultrasound-guided SNRB effectively manages chronic CR, providing substantial symptom relief and potentially reducing the need for surgical intervention. This technique offers a promising conservative treatment option, especially given its real-time visualization advantages and minimal radiation exposure.
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Affiliation(s)
- Hyo Jin Joo
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.J.J.); (S.C.); (G.Y.S.); (J.C.)
| | - Seongmin Choi
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.J.J.); (S.C.); (G.Y.S.); (J.C.)
- Department of Physical Medicine & Rehabilitation, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Byoung Hoon Kim
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.J.J.); (S.C.); (G.Y.S.); (J.C.)
| | - Min-Su Kim
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.J.J.); (S.C.); (G.Y.S.); (J.C.)
| | - Ga Yang Shim
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.J.J.); (S.C.); (G.Y.S.); (J.C.)
- Department of Physical Medicine & Rehabilitation, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Sung Joon Chung
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.J.J.); (S.C.); (G.Y.S.); (J.C.)
| | - Jinmann Chon
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.J.J.); (S.C.); (G.Y.S.); (J.C.)
- Department of Physical Medicine & Rehabilitation, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Myung Chul Yoo
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.J.J.); (S.C.); (G.Y.S.); (J.C.)
- Department of Physical Medicine & Rehabilitation, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Yunsoo Soh
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (H.J.J.); (S.C.); (G.Y.S.); (J.C.)
- Department of Physical Medicine & Rehabilitation, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
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Feuerriegel GC, Marth AA, Germann C, Wanivenhaus F, Nanz D, Sutter R. 7 T MRI of the Cervical Neuroforamen: Assessment of Nerve Root Compression and Dorsal Root Ganglia in Patients With Radiculopathy. Invest Radiol 2024; 59:450-457. [PMID: 37855725 DOI: 10.1097/rli.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVES The aim of this study was to assess the diagnostic value of 3-dimensional dual-echo steady-state (DESS) magnetic resonance imaging (MRI) of the cervical spine at 7 T compared with 3 T in patients with cervical radiculopathy. MATERIALS AND METHODS Patients diagnosed with cervical radiculopathy were prospectively recruited between March 2020 and January 2023 before undergoing surgical decompression and received 3-dimensional DESS imaging at 3 T and 7 T MRI. Cervical nerve root compression and the dimensions of the dorsal root ganglia were assessed by 2 radiologists independently. Signal intensity, visibility of nerve anatomy, diagnostic confidence, and image artifacts were evaluated with Likert scales. The degree of neuroforaminal stenosis was assessed on standard clinical 3 T scans. Statistics included the analysis of the diagnostic accuracy and interreader reliability. The Wilcoxon signed rank test was used to assess differences between the groups. RESULTS Forty-eight patients (mean age, 57 ± 12 years; 22 women) were included in the study with the highest prevalence of severe neuroforaminal stenosis observed at C6 (n = 68) followed by C7 (n = 43). Direct evaluation of nerve root compression showed significantly higher diagnostic confidence and visibility of cervical nerve rootlets, roots, and dorsal root ganglia on 7 T DESS than on 3 T DESS (diagnostic confidence: P = 0.01, visibility: P < 0.01). Assessment of nerve root compression using 7 T DESS allowed more sensitive grading than standard clinical MRI ( P < 0.01) and improved the performance in predicting sensory or motor dysfunction (area under the curve combined: 0.87). CONCLUSIONS 7 T DESS imaging allows direct assessment of cervical nerve root compression in patients with radiculopathy, with a better prediction of sensory or motor dysfunction than standard clinical MRI. Diagnostic confidence and image quality of 7 T DESS were superior to 3 T DESS.
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Affiliation(s)
- Georg C Feuerriegel
- From the Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Zurich, Switzerland (G.C.F., A.A.M., C.G., D.N., and R.S.); Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland (A.A.M. and D.N.); and Department of Orthopedic Surgery, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Zurich, Switzerland (F.W.)
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Changoor S, Farshchian J, Patel N, Coban D, Abdelmalek G, Sinha K, Hwang K, Emami A. Comparing outcomes between anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) in the treatment of cervical radiculopathy. Spine J 2024; 24:800-806. [PMID: 38185140 DOI: 10.1016/j.spinee.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/27/2023] [Accepted: 12/27/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND CONTEXT Anterior cervical disc replacement (ACDR) and minimally invasive posterior cervical foraminotomy (MI-PCF) have emerged as two increasingly popular alternatives to anterior cervical discectomy and fusion (ACDF) for the management of cervical radiculopathy. Both techniques provide advantages of segmental motion preservation and lower rates of adjacent segment degeneration (ASD) compared to ACDF. PURPOSE The purpose of this study was to analyze the clinical and functional outcomes of patients undergoing ACDR or MI-PCF for the treatment of unilateral cervical radiculopathy. STUDY DESIGN/SETTING Retrospective Cohort Review. PATIENT SAMPLE A total of 152 patients were included (86 ACDR and 66 MI-PCF). OUTCOME MEASURES (1) Patient demographics; (2) perioperative data; (3) rates of complications and revisions; (5) visual analogue scale (VAS) and Neck Disability Index (NDI) scores. METHODS A retrospective cohort review was performed to identify all patients at a single institution between 2012-2020 who underwent 1- or 2- level ACDR or MI-PCF from C3-C7 with a minimum follow-up of 24 months. Patient demographics, perioperative data, postoperative complications, and revisions were analyzed. Patient reported outcome measures including VAS and NDI scores were compared. RESULTS The ACDR group had a significantly greater mean operative time (99.8 minutes vs 79.2 minutes, p<.001), but comparable estimated blood loss and length of stay following surgical intervention (p=.899). The overall complication rate was significantly greater in the ACDR group than the MI-PCF group (24.4% vs 6.2%; p=.003) but was largely driven by approach-related dysphagia in 20.9% of ACDR patients. The MI-PCF group had significantly greater revision rates (13.6% vs 1.2%; p=.002) with an average time to revision of 20.7 months in the MI-PCF group compared to 40.3 months in the ACDR group. The ACDR cohort had significantly greater improvements in NDI scores at the final follow-up (25.0 vs 21.3, p<.001). CONCLUSION Our results suggest that ACDR offer clinically relevant advantages over MI-PCF in terms of long-term revision rates despite an increased approach-related risk of transient postoperative dysphagia. Additionally, patients in the ACDR cohort achieved greater mean improvements in NDI scores but these results may have limited clinical significance due to inability to reach minimally clinically important difference (MCID) thresholds.
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Affiliation(s)
- Stuart Changoor
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Joseph Farshchian
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Neil Patel
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Daniel Coban
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - George Abdelmalek
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Kumar Sinha
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Ki Hwang
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA
| | - Arash Emami
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, 07503 USA.
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Aldin Z, Diss JK, Mahmood H, Sadik T, Basra H, Ahmed M, Danawi Z, Gul A, Sayed-Noor AS. Long-term effectiveness of transforaminal anterolateral approach CT-guided cervical epidural steroid injections for cervical radiculopathy treatment. Clin Radiol 2024; 79:e775-e783. [PMID: 38369438 DOI: 10.1016/j.crad.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/18/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024]
Abstract
AIM To evaluate the long-term clinical effectiveness of computed tomography (CT)-guided transforaminal cervical epidural steroid injection using an anterolateral approach for the treatment of cervical radiculopathy (CR) using well-established robust clinical scoring systems for neck pain and neck disability. Despite its widespread use, evidence to support the long-term benefit of routine cervical epidural steroid injection is currently very limited. MATERIALS AND METHODS This study included 113 patients with magnetic resonance imaging (MRI)-confirmed CR who underwent a steroid injection at a single cervical level via a unilateral transforaminal anterolateral approach. Pain was assessed quantitatively at pre-injection, 15 minutes post-injection, 1 month, 3 months, and at 1 year. Neck disability was assessed using the Oswestry Neck Disability Index (NDI) at pre-injection, 1 month, 3 months, and 1 year time points. RESULTS Eighty patients completed the study. Sixty per cent reported reduced neck pain (mean pain reduction, 55%), which was clinically significant in 45% cases. Furthermore, 66% reported an improvement in neck disability (mean improvement, 51%), which was clinically significant for 56% patients. Clinically significant good outcomes in both neck pain and neck disability were evident from as early as 1-month, and importantly, were independent both of pre-treatment CR characteristics (including severity of pre-injection neck pain or disability) and of findings on pre-injection MRI imaging. CONCLUSION Transforaminal anterolateral approach CT-guided epidural steroid injection resulted in a clinically significant long-term improvement in both neck pain and disability for half of the present cohort of patients with unilateral single-level CR. This improvement was independent of the severity of the initial symptoms and pre-injection MRI findings.
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Affiliation(s)
- Z Aldin
- Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK
| | - J K Diss
- Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK.
| | - H Mahmood
- Imaging Department, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea and Westminster Hospital, Chelsea, London, UK
| | - T Sadik
- Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK
| | - H Basra
- Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK
| | - M Ahmed
- Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK
| | - Z Danawi
- Department of Trauma and Orthopaedics, Southend University Hospital, Southend, Essex, UK
| | - A Gul
- Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK
| | - A S Sayed-Noor
- Department of Surgical and Perioperative Sciences (Orthopedics), Sundsvall and Norrland University Hospitals, Umeå University, Stockholm, Sweden; Clinical Sciences Department, College of Medicine, University of Sharjah, United Arab Emirates
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6
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Rayegani SM, Bahrami MH, Aalipour K, Malek Mahmoudi R, Maleki Kahaki S. Optimization of Muscle Selection for Needle Electromyography in Isolated C6 Root Lesion: A Prospective Chart Review Study. Am J Phys Med Rehabil 2024; 103:439-443. [PMID: 38063323 DOI: 10.1097/phm.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVES The aim of the study is to evaluate muscles with more prominent needle electromyographic findings to optimize needle electromyography screening of isolated C6 radiculopathy in patients with C6 root lesions. DESIGN This prospective clinical study was performed on 39 patients with isolated and unilateral cervical radiculopathy selected from all referrals of 1733 patients to the electrodiagnosis unit of the physical medicine and rehabilitation department of a tertiary medical center (from April 2021 to December 2021). The presence of fibrillation potentials, positive sharp waves, and/or neurogenic motor action potentials that occurred in isolation or combination with selected muscles was considered an abnormal finding. RESULTS Of 1733 referrals, 39 patients (18 males [46.1%] and 21 females [53.8%]), with a mean age of 49.7 ± 9.6 yrs, were found eligible. According to needle electromyography findings, the most involved muscles in C6 root lesion were pronator teres (100%), followed by extensor carpi radialis longus (94.8%), flexor carpi radialis (89.7%), brachioradialis (82%), infraspinatus (82%), supraspinatus (79.4%), deltoid (74.3%), biceps brachii (64.1%), extensor digitorum communis (33.3%), and triceps brachii (15.3%) muscles. CONCLUSIONS The pronator teres is the most involved muscle of patients diagnosed with C6 radiculopathy. It might be considered the key muscle for screening and accurate diagnosis of C6 root involvement.
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Affiliation(s)
- Seyed Mansoor Rayegani
- From the Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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7
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Huang CC, Fitts J, Huie D, Bhowmick DA, Abd-El-Barr MM. Evolution of Cervical Endoscopic Spine Surgery: Current Progress and Future Directions-A Narrative Review. J Clin Med 2024; 13:2122. [PMID: 38610887 PMCID: PMC11012719 DOI: 10.3390/jcm13072122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As scientific evidence accumulates, the efficacy and safety of cervical endoscopic spine surgery are continually affirmed. Both anterior and posterior endoscopic approaches have surfaced as viable alternative treatments for various cervical spine pathologies. Newer techniques, such as endoscopic-assisted fusion, the anterior transcorporeal approach, and unilateral laminotomy for bilateral decompression, have been developed to enhance clinical outcomes and broaden surgical indications. Despite its advantages, this approach faces challenges, including a steep learning curve, increased radiation exposure for both surgeons and patients, and a relative limitation in addressing multi-level pathologies. However, the future of cervical endoscopic spine surgery is promising, with potential enhancements in clinical outcomes and safety on the horizon. This progress is fueled by integrating advanced imaging and navigation technologies, applying regional anesthesia for improved and facilitated postoperative recovery, and incorporating cutting-edge technologies, such as augmented reality. With these advancements, cervical endoscopic spine surgery is poised to broaden its scope in treating cervical spine pathologies while maintaining the benefits of minimized tissue damage and rapid recovery.
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Affiliation(s)
- Chuan-Ching Huang
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Jamal Fitts
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - David Huie
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Deb A. Bhowmick
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Muhammad M. Abd-El-Barr
- Division of Spine, Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
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Chien KT, Chen YC, Chang TK, Liu YC, Chen LP, Huang YC, Lian YS, Li JY. Novel Cervical Endoscopic Unilateral Laminoforaminotomy for Bilateral Decompression in Cervical Spondylosis Myeloradiculopathy: A Technical Note and Clinical Results. J Clin Med 2024; 13:1910. [PMID: 38610675 PMCID: PMC11012691 DOI: 10.3390/jcm13071910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/05/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This study investigates the efficacy of the Cervical Endoscopic Unilateral Laminoforaminotomy for Bilateral Decompression (CE-ULFBD) technique in treating cervical myeloradiculopathy, primarily caused by degenerative spondylosis. Traditionally managed through multisegmental anterior cervical discectomy and fusion (ACDF) or laminoplasty combined with foraminotomy, this condition has recently experienced a promising shift towards minimally invasive approaches, particularly endoscopic spinal decompression. While empirical evidence is still emerging, these techniques show potential for effective treatment. Method: The objective was to evaluate the outcomes of CE-ULFBD in achieving single or multilevel bilateral foraminal and central decompression, emphasizing the reduction of injury to posterior cervical muscles and the associated postoperative neck soreness common in conventional procedures. This paper delineates the surgical procedures involved in CE-ULFBD and presents the clinical outcomes of nine patients diagnosed with myeloradiculopathy due to severe cervical stenosis. Result: Assessments were conducted using the Visual Analogue Scale (VAS) for neck and arm pain and the Modified Japanese Orthopaedic Association scale (mJOA) for the activity measurement of daily living. Results indicated a considerable decrease in pain levels according to the VAS, coupled with significant improvements in functional capacities as measured by the mJOA scale. Additionally, no major postoperative complications were noted during the follow-up period. Conclusion: The study concludes that CE-ULFBD is a safe and effective approach for the treatment of cervical myeloradiculopathy resulting from severe cervical stenosis, offering a viable and less invasive alternative to traditional decompressive surgeries.
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Affiliation(s)
- Kai-Ting Chien
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
- Institute of Applied Arts, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Yu-Cheng Chen
- Department of Medical Education, MacKay Memorial Hospital, Taipei 104217, Taiwan
| | - Ting-Kuo Chang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
- Department of Medicine, Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Yueh-Ching Liu
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
| | - Lei-Po Chen
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
- Department of Medicine, Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Yu-Ching Huang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
| | - Yan-Shiang Lian
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
| | - Jian-You Li
- Institute of Applied Arts, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
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Schachar J, Bocage A, Nelson NC, Early PJ, Mariani CL, Olby NJ, Muñana KR. Clinical and imaging findings in dogs with nerve root signature associated with cervical intervertebral disc herniation. J Vet Intern Med 2024; 38:1111-1119. [PMID: 38216520 PMCID: PMC10937489 DOI: 10.1111/jvim.16982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Intervertebral disc herniation (IVDH) is the most common spinal cord disease in dogs. Little information is available regarding the clinical presentation of nerve root signature (NRS) associated with cervical IVDH. HYPOTHESIS/OBJECTIVE To detail the clinical and magnetic resonance imaging (MRI) findings in dogs with NRS associated with cervical IVDH. ANIMALS Forty-seven client-owned dogs presenting with thoracic limb NRS and MRI confirmed IVDH. METHODS Medical records from 2010 to 2020 were retrospectively reviewed for dogs that met inclusion criteria. Imaging studies were evaluated by 2 individuals to characterize location and severity of neural tissue compression. RESULTS Chondrodystrophoid dogs comprised the majority of the study cohort, with dachshund the most common breed (n = 10). Three-quarters of dogs were ≥7 years of age. Interobserver agreement was moderate or good for all of the imaging variables evaluated. The C6-C7 intervertebral disc space was significantly overrepresented (P = .01), comprising 32% (15/47) of the affected discs. However, 42% (20/47) of cases involved C2-C3 though C4-C5 disc sites. Disc material was more frequently located laterally compared to medially within the vertebral canal (P = .0005), and to be associated with compression of the nerve root at the level of the intervertebral foramen (P = .012). CONCLUSION/CLINICAL IMPORTANCE NRS is most commonly associated with lateralized or foraminal cervical disc herniations. It is most prevalent with C6-C7 intervertebral disc involvement, suggesting that there might be unique anatomic factors that contribute to development of NRS at this site, but can be a clinical manifestation of IVDH occurring anywhere along the cervical spine.
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Affiliation(s)
- Jordan Schachar
- Department of Clinical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
- Present address:
Garden State Veterinary SpecialistsTintonNew JerseyUSA
| | - Alan Bocage
- Department of Molecular and Biomedical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
- Present address:
Mount Laurel Animal HospitalMount LaurelNew JerseyUSA
| | - Nathan C. Nelson
- Department of Molecular and Biomedical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
| | - Peter J. Early
- Department of Clinical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
| | - Christopher L. Mariani
- Department of Clinical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
| | - Natasha J. Olby
- Department of Clinical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
| | - Karen R. Muñana
- Department of Clinical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
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10
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Hesni S, Baxter D, Saifuddin A. The imaging of cervical spondylotic myeloradiculopathy. Skeletal Radiol 2023; 52:2341-2365. [PMID: 37071191 DOI: 10.1007/s00256-023-04329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
This review provides a detailed description of the imaging features of cervical spondylotic myelopathy and radiculopathy, with a focus on MRI. Where relevant, we will outline grading systems of vertebral central canal and foraminal stenosis. Whilst post-operative appearances of the cervical spine are outside the scope of this paper, we will touch on imaging features recognised as predictors of clinical outcome and neurological recovery. This paper will serve as a reference for both radiologists and clinicians involved in the care of patients with cervical spondylotic myeloradiculopathy.
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Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK.
| | - David Baxter
- Department of Surgery, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
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11
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Berntheizel EK, Tollefson LJ, Fischer CP, Stefanowicz ET. A Patient With Pancoast Tumor Presenting With Cervical Radiculopathy: A Case Report. J Chiropr Med 2023; 22:328-333. [PMID: 38205223 PMCID: PMC10774608 DOI: 10.1016/j.jcm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/07/2023] [Accepted: 07/21/2023] [Indexed: 01/12/2024] Open
Abstract
Objective The purpose of this report was to describe a patient with a Pancoast tumor who presented for chiropractic care with neck and arm pain. Clinical Features A 52-year-old male patient with right-sided cervicothoracic pain and numbness in the right upper extremity presented to a chiropractic office for care. The patient reported an occupational history of repetitive lifting motions and overuse injuries. The patient denied history of smoking at the time of presentation. Intervention and Outcome Radiographic imaging revealed tracheal deviation. A chest computed tomography image demonstrated a large lesion in the apex of the right lung, suggestive of bronchogenic carcinoma. The patient was referred to an oncology clinic, where he admitted to having a 20-year history of smoking. The diagnosis of adenocarcinoma was made via biopsy, and the oncologist's evaluation confirmed the cancer to be stage IIIC. The patient received palliative care treatments, as the advanced state of his condition determined that he was not a candidate for surgical intervention. Conclusion Chiropractors and other first-contact health care providers must keep in mind unusual presentations masquerading as common conditions. This case demonstrates the importance of including apical lung tumors in the differential diagnosis of unilateral arm and neck pain and neurologic deficits of the upper extremity. This case demonstrates the importance of thorough follow-up on images ordered, including the ordering clinicians viewing the images themselves.
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12
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Li NY, Yang DS, Dwivedi S, Gil JA, Daniels AH. Complications and Reoperation Following Surgery for Concurrent Carpal Tunnel and Cervical Spine Compression. Hand (N Y) 2023:15589447231158807. [PMID: 36946591 DOI: 10.1177/15589447231158807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Patients with carpal tunnel syndrome (CTS) may also have cervical radiculopathy (CR) or vice versa, potentially requiring carpal tunnel release (CTR) and anterior cervical discectomy and fusion (ACDF). This study evaluates whether there is an increased risk of complications following CTR or ACDF in patients with concurrent CTS and CR (CTS-CR) compared with those with only CTS or CR. METHODS A multipayer database was used to identify patients with CTS-CR. From this cohort, patients who underwent CTR and/or ACDF were identified. Patients with CTS-CR undergoing surgery were compared with those undergoing surgery with only CTS or CR. Multivariable logistic regression was used to compare matched populations to assess postoperative complications and risk of undergoing both procedures. RESULTS A total of 110 379 patients with CTS-CR were identified. Carpal tunnel release was performed in 21 152 patients (19.2%) with CTS-CR, from which 835 (0.76%) underwent ACDF. Anterior cervical discectomy and fusion was performed in 6960 patients (6.31%) with CTS-CR followed by CTR in 1098 patients (0.99%). Patients with CTS-CR were at greater risk of reoperation and complex regional pain syndrome following CTR. In ACDF, patients with CTS-CR were at greater risk of reoperation. Obesity and tobacco use were significant risk factors in patients with CTS-CR who underwent both CTR and ACDF rather than a single surgery. CONCLUSIONS Examination of more than 100 000 patients with CTS-CR found a greater likelihood of reoperation and perioperative complications following surgery than those without concurrent diagnoses. Obesity and smoking increased the risk for patients undergoing both procedures. Patients presenting with CTS-CR are high risk and should be counseled on risk of complication and reoperation and optimized to reduce risk of undergoing both CTR and ACDF.
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Affiliation(s)
- Neill Y Li
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Daniel S Yang
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Shashank Dwivedi
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
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Unusual Radiological Finding Adds Rare Condition to Differential for Neck Pain and Stiffness. J Emerg Med 2023; 64:363-365. [PMID: 36925438 DOI: 10.1016/j.jemermed.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 03/17/2023]
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14
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Peolsson A, Löfgren H, Dedering Å, Kristedal M, Öberg B, Zsigmond P, Wibault J. Neurological outcomes after surgery and postoperative rehabilitation for cervical radiculopathy due to disc disease: a 2-year-follow-up of a randomized clinical trial. Sci Rep 2023; 13:3830. [PMID: 36882483 PMCID: PMC9992477 DOI: 10.1038/s41598-023-31005-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Reports on neurological outcomes in patients with cervical radiculopathy (CR) undergoing surgery and postoperative rehabilitation are important to inform prognosis. This 2-year-follow-up of a randomized clinical trial aimed to compare secondary neurological outcomes between structured postoperative rehabilitation and a standard approach after surgery for CR. A secondary aim was to increase knowledge about recovery of neurological impairments in relation to patient-reported neck disability. Neurological outcomes included assessment of sensibility, motor function, arm reflexes and the Spurling test. A total of 153 and 135 participants (> 70% response rate) completed the clinical examination. Between-group differences, changes over time, and associations between persistent neurological impairments and the Neck Disability Index were investigated. No between-group differences were reported (p > 0.07), and neurological impairments in sensibility, motor function, and a positive Spurling test decreased over time in both groups (p < 0.04). Persistent impairments in sensibility and reflex arm were most frequent at follow-up, whereas, a persistent positive Spurling test, and impairments in motor function were associated with higher NDI score. Neurological outcomes improved over time in patients undergoing surgery for CR with no between-group differences., However, persistent neurological impairments were common, and associated with poorer outcome for patient-reported neck disability.Clinical registration: clinicaltrial.gov NCT01547611, 08/03/2012, Title: Outcome of physiotherapy after surgery for cervical disc disease: a prospective multi-centre trial.
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Affiliation(s)
- Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Occupational and Environmental Medicine Center, Linköping University, Linköping, Sweden
| | - Håkan Löfgren
- Neuro-Orthopedic Center, Jönköping, Region Jönköping County, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Åsa Dedering
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Kristedal
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Peter Zsigmond
- Department of Neurosurgery, Linköping University Hospital, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Johanna Wibault
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden. .,Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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The Effectiveness of Neuromobilization in Patients With Cervical Radiculopathy: A Systematic Review With Meta-Analysis. J Sport Rehabil 2023; 32:325-334. [PMID: 36395760 DOI: 10.1123/jsr.2022-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown. OBJECTIVE To determine the effectiveness of NE in CR on pain, function, and ROM. DESIGN Systematic review and meta-analysis. EVIDENCE ACQUISITION An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR. EVIDENCE SYNTHESIS Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was -1.33/10 (95% confidence interval [CI], -1.80 to -0.86; P < .01; I2 = 0%), for function with the Neck Disability Index was -1.21/50 (95% CI, -1.67 to -0.75; P < .01; I2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE. CONCLUSIONS Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results.
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Novel MRI signs of ruptured disc in the cervical spine with intraoperative comparisons. Eur Radiol 2023; 33:1475-1485. [PMID: 36066732 DOI: 10.1007/s00330-022-09124-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/04/2022] [Accepted: 08/19/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of two novel MRI signs for extruded disc (ED) and uncontained ED (ruptured disc, RD) in the cervical spine using intraoperative findings as reference. METHODS This retrospective study included patients who underwent cervical spine MRI and surgery for disc pathology with intraoperative confirmation of RD from September 1, 2016, to January 31, 2021. Two radiologists determined whether the disc was extruded or ruptured with and without the aid of two novel MRI signs suggesting RD (sign 1: blurred margin of the disc; sign 2: mushroom-shaped disc). The diagnostic performance was analyzed using surgical findings as reference. Intra- and interobserver agreements were measured for each MRI sign. RESULTS A total of 91 patients totaling 131 discs were enrolled (mean age: 56.02 ± 12.93; range: 26-88; 62 men and 29 women), of whom 62 were surgically confirmed with RD. When the diagnosis was based exclusively on existing ED definitions, ED was diagnosed with 62.9-79.0% sensitivity and 80.2% accuracy, whereas RD was diagnosed with 35.5-45.2% sensitivity and 67.9-71.0% accuracy. However, when the two novel MRI signs were used as an aid in the diagnosis, ED was diagnosed with 95.2-96.8% sensitivity and 84.0-88.5% accuracy, while RD was diagnosed with 95.2-96.8% sensitivity and 84.0-89.3% accuracy. Intra- and interobserver agreement was substantial (k = 00.77-0.86, 0.69-0.79, respectively, p < 0.001). CONCLUSIONS The detection of two novel MRI signs on preoperative MRI can lead to a more accurate RD diagnosis. KEY POINTS • The diagnostic sensitivity of MRI for cervical ruptured disc is very low (about 35-45 %) using the standardized definition of lumbar disc nomenclature. • Two novel MRI signs can lead to a more accurate diagnosis of the surgically confirmed ruptured disc in the cervical spine. • These two novel MRI signs showed substantial intra-and interobserver reliabilities.
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Jackson JA, Liv P, Sayed-Noor AS, Punnett L, Wahlström J. Risk factors for surgically treated cervical spondylosis in male construction workers: a 20-year prospective study. Spine J 2023; 23:136-145. [PMID: 36028215 DOI: 10.1016/j.spinee.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Degenerative changes due to cervical spondylosis (CS) can detrimentally affect work ability and quality of life yet understanding of how physical exposure affects disease progression is limited. PURPOSE To assess the associations between occupational physical exposures and occurrence of surgically treated cervical spondylosis (ST-CS) and early exit from the labor market via disability pension. STUDY DESIGN/SETTING Prospective register study with 20 years follow-up period. PATIENT SAMPLE Swedish construction workers participating in a national health surveillance project conducted between 1971 and 1993. OUTCOME MEASURES Surgically treated cervical spondylosis (ST-CS) and early labor market exit at a minimum rate of 25% time on disability pension. METHODS Associations between occupational physical exposures (job exposure matrix) and subsequent ST-CS (National Hospital in-patient register) and early labor market exit via disability pension (Swedish Social Insurance Agency register) were assessed in a cohort of male construction workers (n=237,699). RESULTS A total of 1381 ST-CS cases were present and a 20 years incidence rate of 35.1 cases per 100,000 person years (95% confidence interval (CI) 33.2-36.9). Increased relative risk (RR) for ST-CS was found for workers exposed to non-neutral (RR 1.40, 95% CI 1.15-1.69), and awkward neck postures (1.52, 1.19-1.95), working with the hands above shoulder height (1.30, 1.06-1.60), and high upper extremity loading (1.35, 1.15-1.59). Increased risk was also present for workers who reported frequent neck (3.06, 2.18-4.30) and upper back (3.84, 2.57-5.73) pain in the 12 months prior to survey. Among workers with elevated arm exposure, higher risk was seen in those who also had more frequent neck pain. ST-CS cases took early retirement more often (41.3%) and at a younger age (53 years) than the total study cohort (14.8% and 56 years of age, respectively). CONCLUSIONS Occupational exposure to non-neutral neck postures, work with hands above shoulders and high loads born through the upper extremities increased the risk for ST-CS and early retirement due to disability. Decreasing postural and load exposure is salient for primary, secondary, and tertiary prevention of CS. Neck pain was shown to be a prognostic factor for ST-CS, which stresses the importance of acting early and taking preventative action to reduce workplace exposure, and the need for systematic medical check-ups within primary or occupational care to mitigate disease progression and early labour market exit due to disability.
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Affiliation(s)
- Jennie A Jackson
- Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden; Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden.
| | - Per Liv
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Arkan S Sayed-Noor
- Deparment of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Laura Punnett
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, USA
| | - Jens Wahlström
- Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden
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Comparison of neural mobilization and conservative treatment on pain, range of motion, and disability in cervical radiculopathy: A randomized controlled trial. PLoS One 2022; 17:e0278177. [PMID: 36472990 PMCID: PMC9725158 DOI: 10.1371/journal.pone.0278177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, cervical range of motion, and disability. METHODS It was a randomized clinical trial; data was collected from Mayo Hospital, Lahore. Eighty-eight patients fulfilling the sample selection criteria were randomly assigned into group 1 (neural mobilization) and group 2 (conventional treatment). Pain intensity was measured on a numeric pain rating scale, range of motion with an inclinometer, and functional status with neck disability index (NDI). Data were analyzed using SPSS, repeated measure ANOVA for cervical ranges and the Friedman test for NPRS and NDI were used for within-group analysis. Independent samples t-test for cervical ranges and Mann-Whitney U test for NPRS and NDI were used for between-group comparisons. RESULTS There was a significant improvement in pain, disability, and cervical range of motion after the treatment in both groups compared to the pre-treatment status (p < 0.001), and when both groups were compared neural mobilization was more effective than conventional treatment in reducing pain and neck disability (p < 0.001), but there was no significant difference present in the mean score of cervical range of motion between both groups. (p>0.05). CONCLUSIONS The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patients with cervical radiculopathy, however, neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy. TRIAL REGISTRATION RCT20190325043109N1.
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Hong CG, Nam WD. Reliability and Diagnostic Accuracy of Standard Dermatomes and Myotomes for Determining the Pathologic Level in Surgically Verified Patients With Cervical Radiculopathy. Neurospine 2022; 19:1006-1012. [PMID: 36597659 PMCID: PMC9816603 DOI: 10.14245/ns.2244194.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/17/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the reliability and diagnostic accuracy of typical dermatomes and myotomes for determining the pathologic level in surgically verified patients with cervical radiculopathy. METHODS Patients who underwent single-level surgery due to cervical radiculopathy with at least a 60% reduction in preoperative symptoms or recovery of muscle power after surgery were included. The observed clinical symptoms (pain, paresthesia, motor weakness) were compared to those of typical cervical dermatomes and myotomes. RESULTS Among the 227 patients reviewed, 142 (62.6%) had a standard dermatomal pattern, and 74 of 110 (67.3%) had a standard myotomal pattern. The myotome of C5/6 radiculopathy showed much more variance than those of other cervical segments. Among the patients with severe motor weakness (muscle strength ≤ grade 3 or obvious muscle atrophy), all those with involvement of root C5, C7, and C8 showed a typical pattern (C4/5: 13 of 13 patients, C6/7: 5 of 5 patients, C7/T1: 3 of 3 patients), while only 2 of the 6 patients (33.3%) with severe motor weakness caused by C5/6 radiculopathy fit the typical pattern. CONCLUSION Among various symptoms, cervical myotome is of great value in determining the pathological level. However, it should be noted that there is high variability in human dermatomes and myotomes, especially for motor weakness due to C6 root compression, which is more variable than others.
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Affiliation(s)
- Chul Gie Hong
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Woo Dong Nam
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea,Corresponding Author Woo Dong Nam Department of Orthopedic Surgery, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon 24289, Korea
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Chen J, Chen R, Li Y, Chen M, Lv Z, Zeng H, Lian Q. Systematic Review and Meta-Analysis of the Evaluation of the Efficacy of Manipulation and Cervical Traction in the Treatment of Radical Cervical Spondylosis. Emerg Med Int 2022; 2022:3837995. [PMID: 36247705 PMCID: PMC9560847 DOI: 10.1155/2022/3837995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background With the accelerated pace of life in modern society, changes in work style, and the popularity of computers, the prevalence of cervical spondylosis (CSR) is increasing, and the age of onset is advancing. Once suffering from this disease, it is often difficult to cure and recurring, with complex clinical symptoms, causing a serious impact on human health. Objective To evaluate the efficacy of manipulation and cervical traction in the treatment of radical cervical spondylosis. Methods The PubMed, CNKI, and Wanfang databases were searched for literature. The literature related to this study was included according to selective criteria and inhibitory elimination criteria, and valuable information was selected for statistical analysis, resulting in a total of 11 randomized controlled trials with 994 subjects. Results The short-term efficacy of manual treatment for CSR was superior to that of cervical traction alone (P < 0.05); subgroup analysis showed that the short-term efficacy of pulling or rotational manipulation was superior to that of cervical traction (P < 0.05). The mean difference between symptoms and manipulation VAS scores was higher before and after treatment when compared with cervical traction for CSR (P < 0.05); the subgroup analysis showed that VAS scores, upper extremity anesthesia scores, and survivorship scores were lower for pulling or rotating manipulation than for cervical traction (P < 0.05). Conclusion The advantages of manual therapy in terms of short-term efficacy, VAS pain scores, neck pain, upper extremity anesthesia, and survivorship improvement provide a theoretical basis for its clinical impact.
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Affiliation(s)
- Jianquan Chen
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Rongbin Chen
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Yong Li
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Maoshui Chen
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Zhouming Lv
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Haobin Zeng
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Qiang Lian
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
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Effects of Neurodynamic Mobilization on Health-Related Quality of Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized Trial. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9385459. [PMID: 36246968 PMCID: PMC9556173 DOI: 10.1155/2022/9385459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022]
Abstract
Purpose Cervical radiculopathy is disorder of cervical spinal nerve root affecting large number of population. Previously many studies are conducted to design suitable protocol for management of this disorder, but they lack in quality. The purpose of this study was to compare the effects of neural mobilization and cervical isometrics on health-related quality of life and deep flexors endurance in cervical radiculopathy. Methods A double-blinded randomized clinical trial was conducted at Mayo Hospital, Lahore, Pakistan. Eighty-eight patients within the age range of 35-50 years were included in the study after taking their consent. In the experimental group (n = 44), median nerve mobilization was applied along with cervical isometric exercises. The control group (n = 44) performed cervical isometric exercises alone. Muscle endurance was measured by craniocervical flexion test and quality of life on 36 items short form health survey SF-36 scale. Measurements were taken at baseline, at 2nd week, and at 4th week. For missing data, intention-to-treat analysis was used. Results Within-group comparison with Friedman test showed a significant difference between pre, mid, and posttreatment scores on craniocervical flexion test and in all domains of SF 36 in both groups. While between-group comparison with Mann–Whitney U test showed all variables were similar at baseline but after 4 weeks there was a statistically significant improvement in craniocervical flexion test scores and all domains of SF 36 in the experimental group. But domain of pain showed mean rank of 49.43 after 4 weeks in the experimental group and 39.57 in the control group with p = 0.065 and d = 0.579, while for all the other 7 domains values were p < .05 and d > 0.25. Conclusion Neural mobilization combined with cervical isometrics shows significant effects in improving quality of life and deep flexors endurance in patients with cervical radiculopathy than cervical isometrics alone.
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Kalaskar A, Paniker J, Gavai P. A case of sub-acute compartment syndrome of bilateral pectoralis major, deltoid and triceps muscles. Shoulder Elbow 2022; 14:551-554. [PMID: 36199505 PMCID: PMC9527486 DOI: 10.1177/17585732211043520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A 19-year-old healthy bodybuilder presented to the emergency department with gradually worsening pain in both his upper arms and shoulders and inability to fully flex his elbows. The haematological investigations revealed a markedly raised Creatinine Kinase (74,400 U/L) and myoglobinuria. The patient required an emergency surgical decompression of the pectoral and the anterior and posterior compartments of arms of both upper limbs with secondary closure after 48 h. The patient had an uneventful post-op and recovery of his functions with some initial restriction of full flexion of his left elbow and some weakness in his triceps, all of which gradually improved.
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Affiliation(s)
- A Kalaskar
- Rotherham NHS Foundation Trust, Rotherham, UK
| | - J Paniker
- Rotherham NHS Foundation Trust, Rotherham, UK
| | - P Gavai
- Rotherham NHS Foundation Trust, Rotherham, UK
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Abstract
PURPOSE OF REVIEW Treatment of overhead athletes requires a systematic approach that will make an accurate diagnosis, deliver effective treatment, and make timely and safe return to sport. RECENT FINDINGS New data has shown success rates and return to play effectiveness after different types of cervical and lumbar surgery. Cervical foraminotomy has been shown to have the highest rate and fastest return to play, but with the highest incidence of need for revision surgery. Cervical artificial disc replacement has shown promising results in the general population and is being done more commonly in elite athletes, but has an unknown risk for failure. Cervical fusion is a well-established and effective treatment, but has the longest healing time and risk for adjacent level pathology. In the lumbar spine, discectomy has a long and proven track record, fusion is rarely performed but can be effective, and artificial disc replacement is extremely rare in an elite athlete. An effective and comprehensive approach can diagnose, treat, and return overhead athletes to competitive play.
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Dernek B, Ulusoy İ, Aydoğmuş S, Duymuş TM, Kesiktaş FN, Dıraçoğlu D. Ultrasound-guided cervical selective nerve block: A case series. J Back Musculoskelet Rehabil 2022; 35:1013-1019. [PMID: 35213343 DOI: 10.3233/bmr-210076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cervical radiculopathy is characterized by pain, numbness, tingling, and weakness, mostly in an affected extremity, reflecting compression of a nerve in the neck is compressed or irritated where it emerges from the spinal cord. Diagnosis requires a detailed anamnesis, physical examination, and imaging. Physical therapy, exercise, medical therapy, and injections are the preferred treatments, but injections into the cervical region are only indicated if conservative treatment is ineffective. OBJECTIVE This study explored the utility of selective cervical nerve root blocks (SNRBs) performed at various levels under ultrasound guidance (USG). METHODS We evaluated patients diagnosed with cervical radiculopathy via physical examination and magnetic resonance imaging from November 2019 to March 2020. We included those who did not respond to conservative treatment and therefore received SNRBs at various levels. Sixty-three patients were evaluated over 6 months in terms of pain, functional status, and complications. RESULTS We retrospectively evaluated patients with cervical herniated discs who received SNRBs at various levels between C4-7 under USG. Pain and functional status improved in month 1 and was maintained until at least month 6. CONCLUSION SNRB injections performed under USG effectively treated pain and poor functional status in selected patients. The procedure is safe (especially) for patients who do not respond to conservative treatment.
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Affiliation(s)
- Bahar Dernek
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | | | - Suavi Aydoğmuş
- Department of Orthopedic Surgery, Klinikum Esslingen, Esslingen am Neckar, Germany
| | | | - Fatma Nur Kesiktaş
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Demirhan Dıraçoğlu
- Department of Physical Medicine and Rehabilitation, Istanbul University Faculty of Medicine, Istanbul, Turkey
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25
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Seth NH, Joshi MV, Phansopkar P. C5 Nerve Root Palsy: An Uncommon Postoperative Complication and Its Management. Cureus 2022; 14:e28988. [PMID: 36249642 PMCID: PMC9548415 DOI: 10.7759/cureus.28988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/09/2022] [Indexed: 11/05/2022] Open
Abstract
The standard treatment for multiple levels of cervical prolapsed intervertebral disk (PIVD) is anterior cervical decompression and fusion. Although it is associated with positive outcomes, it is also fraught with complications. In this report, we present an unusual postoperative case of a 58-year-old male who underwent anterior decompression and cervical fusion at two levels - C4-C5 and C5-C6 - for traumatic PIVD and developed a postoperative complication of unilateral C5 motor palsy, making it difficult for the patient to elevate the shoulder. This postoperative complication had no known cause, but it could be iatrogenic or due to structural variation. There is sparse research on possible ways to avoid this complication. Physiotherapy management is critical in improving the patient's functional recovery. The neck and upper extremity functional measure scale and Neurogenic Claudication Outcome Score (NCOS) scale were used for measuring outcomes. The patient also had a two-year history of tingling and numbness in both lower extremities, which was treated conservatively. The difficulties that physiotherapists encounter in managing this uncommon postoperative complication in addition to the lumbar PIVD make it unique. The key to a better prognosis is early detection and management.
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Li J, Jia Y, Qin Y, Peng Z, Wang G. Clinical validity of the smallest oblique sagittal area of the neural foramen in patients with suspected cervical spondylotic radiculopathy. J Orthop Surg (Hong Kong) 2022; 30:23094990211073628. [PMID: 35041554 DOI: 10.1177/23094990211073628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the smallest oblique sagittal area of the neural foramen in detecting cervical spondylotic radiculopathy (CSR) and to determine its potential significance for treatment decisions. METHODS The subjects of the study were patients with CSR who visited the spine surgery from 2016 to 2019. All patients were compared according to the minimum oblique sagittal area and the cut-off point value, and they were divided into positive and negative parameters. The changes in neck disability index (NDI), Japanese Orthopaedic Association score (JOA), and visual analog scale (VAS) during the two treatment groups from baseline to at least 24 months of follow-up were compared. RESULTS In the surgery group, there was no significant difference in symptom improvement between patients with positive and negative parameters. In the non-surgical group, for patients with positive parameters, NDI decreased by 2.35, JOA increased by 0.88, and neck VAS score improved by 0.42. For patients with negative parameters, NDI decreased by 10.32, JOA increased by 2.86 on average, and neck VAS score improved by 2.46 points on average (both p<0.01 on t test). CONCLUSIONS Patients with both positive and negative parameters showed significant improvement in their symptoms after surgery, and the smallest oblique sagittal area of the neural foramen seems to be unable to predict the outcome of the surgery. However, in non-surgical patients, symptomatic improvement was more limited in patients with positive parameters than in those with negative parameters. This suggests that patients with positive parameters may be more suitable for surgery and those with negative parameters are more suitable for conservative treatment.
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Affiliation(s)
- Jin Li
- The People's Hospital of Baoan Shenzhen, Shenzhen, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yukun Jia
- The People's Hospital of Baoan Shenzhen, Shenzhen, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yuantian Qin
- Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zhan Peng
- The People's Hospital of Baoan Shenzhen, Shenzhen, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Guangye Wang
- The People's Hospital of Baoan Shenzhen, Shenzhen, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Emami A, Coban D, Changoor S, Dunn C, Sahai N, Sinha K, Hwang KS, Faloon M. Comparing Mid-Term Outcomes Between ACDF and Minimally Invasive Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy. Spine (Phila Pa 1976) 2022; 47:324-330. [PMID: 34107527 DOI: 10.1097/brs.0000000000004140] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare minimally invasive posterior cervical foraminotomy (MI-PCF) and anterior cervical discectomy and fusion (ACDF) in the treatment of unilateral cervical radiculopathy. SUMMARY OF BACKGROUND DATA MI-PCF has been shown to be equally effective as ACDF in treating cervical radiculopathy due to foraminal stenosis and similar pathologies. Additionally, it has been hypothesized that preserving motion and avoiding fusion reduces risk for adjacent segment disease, but potentially increases risk for subsequent revision to an ACDF. With similar short-term outcomes and substantial advantages, MI-PCF may be an effective alternative to ACDF for addressing appropriate cervical pathology. METHODS A retrospective review was performed to identify patients between 2009 and 2013 who underwent ACDF or MI-PCF with a minimum follow-up of 7 years. Demographic data was recorded. Revision rates and average time to revision between cohorts were compared. Clinical outcomes were assessed at each follow-up visit with Neck Disability Index and Visual Analog Scale for neck and Visual Analog Scale for arm pain scores. All complications were reviewed. Standard binomial and categorical comparative analysis were performed. RESULTS A total of 251 consecutive patients were included (205 ACDF, 46 MI-PCF). Mean follow-ups for the ACDF and MI-PCF groups were 98.3 and 95.9 months, respectively. Complication rates were 2.9% and 2.2% for the ACDF and MI-PCF cohorts, respectively (P = 0.779). Revision rates were 7.8% for the ACDF cohort and 8.7% for the MI-PCF cohort (P = 0.840). Both cohorts experienced significant improvements in their clinical scores compared with their preoperative values. Final Visual Analog Scale for neck pain (ACDF: 2.6; MI-PCF: 1.6) and Visual Analog Scale for arm pain (ACDF: 1.1; MI-PCF: 0.4) scores differed significantly at final follow-up (P = < 0.001; P = < 0.001). CONCLUSION MI-PCF is a safe and effective alternative to ACDF in the treatment of cervical radiculopathy, demonstrating substantial benefit. After final follow-up, MI-PCF demonstrated superior improvements in Visual Analog Scale scores, without increased complication or revision rates.Level of Evidence: 3.
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Affiliation(s)
- Arash Emami
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ
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28
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Lan X, Wang Z, Huang Y, Ni Y, He Y, Wang X, Wu C, Hu R, Han R, Guo G, Li Z, Zhang X, Zhang J, Liao Q, Huang D, Zhou H. Clinical and Radiological Comparisons of Percutaneous Low-Power Laser Discectomy and Low-Temperature Plasma Radiofrequency Ablation for Cervical Radiculopathy: A Prospective, Multicenter, Cohort Study. Front Surg 2022; 8:779480. [PMID: 35223967 PMCID: PMC8863912 DOI: 10.3389/fsurg.2021.779480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background Minimally invasive techniques, such as percutaneous low-power laser discectomy (PLLD) and low-temperature plasma radiofrequency ablation (coblation) can be applied to treat degenerative cervical radiculopathy. However, less evidence supports the superiority of distinct minimally-invasive therapy. Our study aimed to evaluate the clinical and radiological characteristics of the PLLD and coblation for cervical radiculopathy. Methods This was a prospective, multicenter, cohort study (ChiCTR-ONC-17010356). The modified Macnab criteria was performed to assess the clinical improvement pre- and post-surgery. To evaluate the radiological effect, the Pfirrmann grading system and disk herniation index were applied with MRI. Results In this study, 28 patients were enrolled in the coblation group and 30 patients in the PLLD group. The mean good-excellent rate at 3-month follow-up was 82.1% for PLLD group, and 66.7% for coblation group, respectively (p = 0.179). The PLLD group achieved higher good-excellent rate 6 and 12 months after discharge (92.9 vs. 70.0%, p = 0.026). Radiological data revealed that PLLD but not coblation treatment achieved significant reduction of disk herniation index (p < 0.0001). Coblation treatment did not change the Pfirrmann grades of cervical radiculopathy patients (n = 18), and 7 out of 17 (41.2%) patients achieved improvement after PLLD therapy. None obvious adverse event was observed in this study. Conclusion Both PLLD and coblation are effective and safe option for patients with cervical radiculopathy. Better long-term clinical outcomes may be potentially associated with the improvement of disk degeneration after PLLD treatment.
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Affiliation(s)
- Xueqin Lan
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Department of Anesthesiology, The Affiliated Changsha Central Hospital, University of South China, Changsha, China
| | - Ziyang Wang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuzhao Huang
- Department of Orthopedics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuncheng Ni
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yunwu He
- Department of Pain, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Xiaofeng Wang
- Department of Pain, Hunan Aerospace Hospital, Changsha, China
| | - Chunsheng Wu
- Department of Pain, People's Hospital of Xiangxi Prefecture, Jishou University, Jishou, China
| | - Rong Hu
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Rui Han
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Gangwen Guo
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhenxing Li
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Zhang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jianping Zhang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qin Liao
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
- *Correspondence: Dong Huang
| | - Haocheng Zhou
- Department of Pain, Institute of Pain Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
- Haocheng Zhou
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29
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Ghaith AK, Onyedimma C, Jarrah R, Bhandarkar AR, Graepel SP, Yolcu YU, El-Sammak S, Michalopoulos GD, Elder BD, Bydon M. Rate of C8 Radiculopathy in Patients Undergoing Cervicothoracic Osteotomy: A Systematic Appraisal of the Literature. World Neurosurg 2022; 161:e553-e563. [DOI: 10.1016/j.wneu.2022.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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30
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Ghatge S, Shah R, Surya N, sankhala S, Unadkat C, Khan G, Modi D. Ozone disc nucleolysis in cervical intervertebral disc herniation: A nonrandomized prospective analysis in 246 patients. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:114-120. [PMID: 35837424 PMCID: PMC9274671 DOI: 10.4103/jcvjs.jcvjs_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/08/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Inherent complications associated with surgery and limited success of percutaneous minimally invasive procedures make researches wanting for an ideal treatment for cervical disc herniation. Objective: We prospectively study the role of ozone disc nucleolysis in cervical intervertebral disc herniation. Patients and Methods: From January 2008 to December 2020, we prospectively study 246 consecutive patients of cervical disc herniation treated by a single session of intradiscal injection of ozone–oxygen mixture (ozone disc nucleolysis). There were 55% of females and 45% of males. Age ranged from 28 to 68 years with a mean of 47. The outcome was measured on visual analog scale (VAS) scale and neck disability index (NDI) along with Mcnab method. Results: The mean baseline VAS score was 7.87 which became 3.09 at 1 month, 1.42 at 3 months, 1.40 at 6 months, and 1.35 at 1 year. The mean NDI was 36.27 at baseline which improved to 9.24 at 1 month, 6.25 at 3 months, 6.20 at 6 months, and 6.22 at 1 year. This was found to be significant with P < 0.05. Modified McNab criterion showed excellent recovery in 138 (56.10%), good recovery in 50 (20.32%), and fair recovery in 22 (8.94%), resulting in a successful rate of 85.36%. Mediocre recovery was seen in the remaining 36 patients amounting to a 14.64% failure rate. Conclusion: This study showed that ozone disc nucleolysis significantly reduces the pain related to cervical disc herniation along with a significant reduction in disability.
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31
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So JS, Kim YJ, Lee SK, Cho CS. Importance of Differential Diagnosis of a Possible Brain Tumor in Patients with Cervical Radiculopathy. J Korean Neurosurg Soc 2021; 65:145-150. [PMID: 34923783 PMCID: PMC8752896 DOI: 10.3340/jkns.2021.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
Lesions occurring simultaneously in the somatosensory or motor cortex of the brain and the cervical spine are rare. Brain tumors can cause similar symptoms to cervical lesions which can lead to confusion in treatment priorities. Moreover, if cervical disease is noticeably observed in radiologic findings of a patient complaining of cervical radiculopathy with non-specific electromyography results, it is common to no longer perform further evaluation. Here we introduce two cases where the cause of cervical radiculopathy was first considered to be the result of a degenerative cervical disease but was later discovered to be a result of a brain tumor.
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Affiliation(s)
- Jin-Shup So
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
| | - Young-Jin Kim
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
| | - Sang-Koo Lee
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
| | - Chun-Sung Cho
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
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32
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Kartha S, Ghimire P, Winkelstein BA. Inhibiting spinal secretory phospholipase A 2 after painful nerve root injury attenuates established pain and spinal neuronal hyperexcitability by altering spinal glutamatergic signaling. Mol Pain 2021; 17:17448069211066221. [PMID: 34919471 PMCID: PMC8721705 DOI: 10.1177/17448069211066221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Neuropathic injury is accompanied by chronic inflammation contributing to the onset and maintenance of pain after an initial insult. In addition to their roles in promoting immune cell activation, inflammatory mediators like secretory phospholipase A2 (sPLA2) modulate nociceptive and excitatory neuronal signaling during the initiation of pain through hydrolytic activity. Despite having a known role in glial activation and cytokine release, it is unknown if sPLA2 contributes to the maintenance of painful neuropathy and spinal hyperexcitability later after neural injury. Using a well-established model of painful nerve root compression, this study investigated if inhibiting spinal sPLA2 7 days after painful injury modulates the behavioral sensitivity and/or spinal dorsal horn excitability that is typically evident. The effects of sPLA2 inhibition on altered spinal glutamatergic signaling was also probed by measuring spinal intracellular glutamate levels and spinal glutamate transporter (GLAST and GLT1) and receptor (mGluR5, GluR1, and NR1) expression. Spinal sPLA2 inhibition at day 7 abolishes behavioral sensitivity, reduces both evoked and spontaneous neuronal firing in the spinal cord, and restores the distribution of neuronal phenotypes to those of control conditions. Inhibiting spinal sPLA2 also increases intracellular glutamate concentrations and restores spinal expression of GLAST, GLT1, mGluR5, and GluR1 to uninjured expression with no effect on NR1. These findings establish a role for spinal sPLA2 in maintaining pain and central sensitization after neural injury and suggest this may be via exacerbating glutamate excitotoxicity in the spinal cord.
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Affiliation(s)
- Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Prabesh Ghimire
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Swanson BT, Creighton D. Cervical disc degeneration: important considerations for the manual therapist. J Man Manip Ther 2021; 30:139-153. [PMID: 34821212 DOI: 10.1080/10669817.2021.2000089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Cervical disc degeneration (CDD) is a progressive, age-related occurrence that is frequently associated with neck pain and radiculopathy. Consistent with the majority of published clinical practice guidelines (CPG) for neck pain, the 2017 American Physical Therapy Association Neck Pain CPG recommends cervical manipulation as an intervention to address acute, subacute, and chronic symptoms in the 'Neck Pain With Mobility Deficits' category as well for individuals with 'Chronic Neck Pain With Radiating Pain'. While CPGs are evidence-informed statements intended to help optimize care while considering the relative risks and benefits, these guidelines generally do not discuss the mechanical consequences of underlying cervical pathology nor do they recommend specific manipulation techniques, with selection left to the practitioner's discretion. From a biomechanical perspective, disc degeneration represents the loss of structural integrity/failure of the intervertebral disc. The sequelae of CDD include posterior neck pain, segmental hypermobility/instability, radicular symptoms, myelopathic disturbance, and potential vascular compromise. In this narrative review, we consider the mechanical, neurological, and vascular consequences of CDD, including information on the anatomy of the cervical disc and the mechanics of discogenic instability, the anatomic and mechanical basis of radiculitis, radiculopathy, changes to the intervertebral foramen, the importance of Modic changes, and the effect of spondylotic hypertrophy on the central spinal canal, spinal cord, and vertebral artery. The pathoanatomical and biomechanical consequences of CDD are discussed, along with suggestions which may enhance patient safety.
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Affiliation(s)
- Brian T Swanson
- Department of Rehabilitation Sciences University of Hartford, West Hartford, CT, USA
| | - Douglas Creighton
- Human Movement Science Department Oakland University, Rochester, MI, USA
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Metal-on-metal versus metal-on-plastic artificial discs in two-level anterior cervical disc replacement: a meta-analysis with follow-up of 5 years or more. Spine J 2021; 21:1830-1838. [PMID: 33940171 DOI: 10.1016/j.spinee.2021.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although highlighted in joint arthroplasty studies, long-term outcomes between differing biomaterial composites, such as metal-on-metal (MoM) and metal-on-plastic (MoP) in anterior cervical disc replacement (ACDR) have not been thoroughly investigated. PURPOSE The purpose of this study was to evaluate the patient-reported clinical outcomes, overall reoperation rates, complications, and rates of ASD of MoM versus MoP artificial discs in two-level ACDR for the treatment of cervical DDD. STUDY DESIGN/SETTING Meta-analysis and systematic review. PATIENT SAMPLE Nine hundred eighty patients (442 MoM, 538 MoP) across seven studies. OUTCOME MEASURES Patient reported clinical outcomes (NDI, VAS-n, VAS-a), overall reoperation rates, complications, and rates of ASD. METHODS A systematic search strategy of three electronic databases (PubMed, CINAHL Plus, and SCOPUS) was conducted utilizing terms related to two-level ACDR. All studies included had a sample size of >10 patients, had a minimum 5-year follow-up, and reported data on adjacent segment disease. Cadaver studies, non-English manuscripts, articles with less than 5-year follow-up and studies in which only single-level ACDR was investigated were excluded. A total of seven studies were included in this analysis. Studies were analyzed for demographic data, clinical outcome scores (NDI, VAS-neck, and VAS-arm), overall reoperation rates, complications, and rates of ASD. A random-effects model of meta-analysis was used for groups that were determined to be heterogenous and a fixed-effects model was utilized for groups that were not. An overlap of 95% confidence intervals suggests no statistically significant difference at the p<.05 level. RESULTS Seven studies were included with data on 980 patients (442 MoM, 538 MoP). The study population was 52.84% female, with a mean age of 48.01 years, and a mean follow-up of 85.66 months. The mean improvement in NDI was 34.42 (95% CI, 32.49-36.36) and 29.72 (95% CI, 27.15-32.29) for the MoM and MoP groups, respectively. The mean improvement in VAS-neck was 11.20 (95% CI, 10.69-11.70) and 8.78 (95% CI, 7.81-9.74) for the MoM and MoP groups, respectively. The mean improvement in VAS-arm was 10.73 (95% CI, 9.83-11.63) and 8.49 (95% CI, 7.59-9.39) for the MoM and MoP groups, respectively. 3.85% (95% CI, 2.40-6.10) of patients who underwent ACDR with a MoM implant required reoperation compared to 5.33% (95% CI, 3.68-7.65) of patients with a MoP implant. Heterotopic ossification and dysphagia were the most common complications in both groups. The MoM cohort showed a higher incidence of HO (72.62% vs. 21.07%), but a lower incidence of dysphagia (0.96% vs. 16.31%) compared to the MoP cohort. The MoM cohort had a larger proportion of patients with ASD who underwent subsequent surgery at an adjacent level (7.89% MoM versus 1.91% MoP). CONCLUSIONS Our present meta-analysis suggests that the use of MoM artificial discs in two-level ACDR results in superior clinical outcome score improvement, but higher rates of ASD requiring secondary surgery compared to MoP discs after a follow-up period of 5 years or more.
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Abstract
The key to successful treatment of elite athletes is optimizing the medical care at every step: injury prevention and sport-specific training; comprehensive history and physical examination; high-quality and complete diagnostic studies; accurate diagnosis; control and completion of rehabilitation program; minimally invasive, safe, and effective surgeries; risk assessment for return to sport; guided and gradual return to sport; and continued rehabilitation and exercise program after return to sport.
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Affiliation(s)
- Robert G Watkins
- Marina Spine Center, 4640 Admiralty Way, Suite 600, Marina del Rey, CA, 90292, USA.
| | - Robert G Watkins
- Marina Spine Center, 4640 Admiralty Way, Suite 600, Marina del Rey, CA, 90292, USA
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36
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Levy HA, Karamian BA, Henstenburg J, Larwa J, Canseco JA, Haislup B, Chang M, Patel P, Radcliff KE, Woods BI, Kurd MF, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The impact of preoperative motor weakness on postoperative opioid use after ACDF. J Orthop 2021; 26:23-28. [PMID: 34276147 DOI: 10.1016/j.jor.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/27/2021] [Indexed: 11/19/2022] Open
Abstract
This study aims to determine if preoperative weakness is an isolated risk factor for prolonged postoperative opioid use after anterior cervical discectomy and fusion (ACDF). Patients with preoperative weakness were significantly more likely to have prolonged and inappropriate opioid use and have a single prescription mean morphine equivalent (MME) ≥ 200. Logistic regression isolated preoperative weakness, opioid tolerance, depression, and VAS Neck pain as independent predictors of extended opioid use. High postoperative opioid dose (MME ≥ 90) correlated with opioid tolerance, younger age, male sex, greater CCI, prior cervical surgery, and preoperative VAS Neck pain on regression.
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Affiliation(s)
- Hannah A Levy
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey Henstenburg
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph Larwa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brett Haislup
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Chang
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Parthik Patel
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kris E Radcliff
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Chang MC, Kim TU. Commentary on the Article "A Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter vs Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain: Six-Month Results" by McCormick et al. PAIN MEDICINE 2021; 22:1461-1462. [PMID: 33619559 DOI: 10.1093/pm/pnaa479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Tae Uk Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Dankook University, Cheonan, Republic of Korea
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Diagnostic Implication and Clinical Relevance of Dermatomal Somatosensory Evoked Potentials in Patients with Radiculopathy: A Retrospective Study. Pain Res Manag 2021; 2021:8850281. [PMID: 34158875 PMCID: PMC8187040 DOI: 10.1155/2021/8850281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/01/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
Objective Dermatomal somatosensory evoked potentials (DSEPs) are used to evaluate abnormalities of the somatosensory tract. There have been some studies on the diagnostic value of DSEP in radiculopathy, but it is still controversial. The purpose of our study is to evaluate the diagnostic implication and clinical relevance of DSEPs in patients with radiculopathy by comparing DSEP findings to radiculopathy symptoms and intervertebral foramen (IVF) or spinal canal stenosis in lumbar magnetic resonance imaging (MRI). Methods This retrospective study reviewed the medical records of patients (n = 59) who were examined by DSEP (each L4 and L5 dermatome) and lumbar MRI. Radiculopathy symptoms and DSEPs results were compared. For the evaluation of IVF and spinal canal size, sagittal (each bilateral L4/5 and L5/S1 IVF) and axial MR images were selected at the most stenotic level. The sizes of the IVF and spinal canal were measured by the pixel counts of selected MR images. In addition, stenosis severity was morphologically graded on a 4-point scale. DSEP results were compared with the size and grade of the IVF or spinal canal stenosis. Results DSEPs showed high sensitivity for radiculopathy symptoms. The IVF size at L4/5 and L5/S1 (pixel counts) was significantly related to either L4 or L5 dermatomal somatosensory pathway dysfunction, respectively. However, spinal stenosis (pixel counts and grade) and IVF stenosis grade were not significantly related to DSEPs. Conclusion This paper could be helpful in the electrophysiologic diagnosis of lumbar radiculopathy.
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Klimov VS, Kelmakov VV, Clyde BL, Evsyukov AV, Loparev EA, Amelina EV, Bervitskiy AV, Ponomarenko AP, Rzaev JA. Long-term clinical and radiological outcomes of anterior uncoforaminotomy for unilateral single-level cervical radiculopathy: retrospective cohort study. Spine J 2021; 21:915-923. [PMID: 33545373 DOI: 10.1016/j.spinee.2021.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior cervical discectomy and fusion is a common procedure for degenerative cervical radiculopathy. In 1996, Dr. H.D. Jho reported an operative technique allowing nerve root decompression via anterior uncoforaminotomy whereas avoiding fusion. PURPOSE To assess long-term clinical and radiological outcomes of anterior uncoforaminotomy in patients with degenerative cervical spine pathology. STUDY DESIGN A single clinic, retrospective cohort study. PATIENT SAMPLE Adult patients who underwent anterior uncoforaminotomy from 2013 to 2018. OUTCOME MEASURES Clinical outcomes were assessed using VAS, NDI, SF-36 criteria. Radiological parameters included sagittal balance, disc height and White anPanjabi criterion. MATERIALS AND METHODS All patients underwent unilateral single-level anterior uncoforaminotomy, and long-term clinical and radiologic follow up was carried out. Clinical outcomes were assessed using VAS, NDI, SF-36 criteria. Radiological parameters evaluated included sagittal balance, disc height and White and Panjabi criteria (3.5 mm of translation, 11 degrees of kyphosis). The mean follow-up period was 33.3 ± 10.6 months (range 12-57 months). RESULTS All measures of clinical outcome improved. VAS (neck) and VAS (arm) decreased 3 [2; 4] and 5 [3; 5.2] points (median [interquartile range]), respectively (p<0.001); NDI improved from 0.38 [0.36; 0.4], to 0.29 [0.22; 0.34] (p<0.001). Two patients (6%) required additional surgery one year after operation. There were no complications in the perioperative period. Disc height decreased 0.8 mm [0.1; 2.1] (p<0.001). All patients retained stability of the cervical spine based on White and Panjabi criteria. Sagittal balance parameters did not change significantly. CONCLUSION Uncoforaminotomy is an effective and safe method to decompress a unilateral single-level nerve root in degenerative cervical radiculopathy whereas preserving anatomy and motion of the cervical spine.
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Affiliation(s)
- Vladimir S Klimov
- The "State Medical University "of the Ministry of Health of Russia, 630091, Siberian Federal District, Novosibirsk Region, Novosibirsk, Krasny Prospect Str., 52
| | - Vladislav V Kelmakov
- The " Federal Neurosurgical Center " of the Ministry of Health of the Russian Federation Novosibirsk., 630087, Novosibirsk Region, Novosibirsk, Nemirovicha-Danchenko Str., 132/1.
| | - Brent L Clyde
- Creighton University Medical School, Department of Surgery, CHI Health Clinic Neurosurgery, 7710 Mercy Rd, Suite 2000, Omaha, NE 68124
| | - Aleksey V Evsyukov
- The " Federal Neurosurgical Center " of the Ministry of Health of the Russian Federation Novosibirsk., 630087, Novosibirsk Region, Novosibirsk, Nemirovicha-Danchenko Str., 132/1
| | - Evgeniy A Loparev
- The " Federal Neurosurgical Center " of the Ministry of Health of the Russian Federation Novosibirsk., 630087, Novosibirsk Region, Novosibirsk, Nemirovicha-Danchenko Str., 132/1
| | - Evgenia V Amelina
- FGBUN Institute of Computational Technologies SB RAS, 630090, Novosibirsk Region, Novosibirsk, Academician Lavrentyev Ave, 6
| | - Anatoliy V Bervitskiy
- The " Federal Neurosurgical Center " of the Ministry of Health of the Russian Federation Novosibirsk., 630087, Novosibirsk Region, Novosibirsk, Nemirovicha-Danchenko Str., 132/1
| | - Anton P Ponomarenko
- State Budgetary Institution of Public Health of the Novosibirsk Regional City Clinical Hospital No.1, 630047, Novosibirsk Region, Novosibirsk, St Zalessky, 6
| | - Jamil A Rzaev
- The " Federal Neurosurgical Center " of the Ministry of Health of the Russian Federation Novosibirsk., 630087, Novosibirsk Region, Novosibirsk, Nemirovicha-Danchenko Str., 132/1; Novosibirsk State University, 630090, Novosibirsk Region, Novosibirsk, Ul. Pirogova, 2
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Zhou S, Liu B, Guo J. Comparison of the efficacy and safety of acupuncture and acupotomy for patients with cervical spondylotic radiculopathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25239. [PMID: 33787607 PMCID: PMC8021338 DOI: 10.1097/md.0000000000025239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There is no systematic review to compare the efficacy of acupuncture and acupotomy in patients with cervical spondylotic radiculopathy. It is worthy to critically review the evidence of the comparison of these 2 therapies to inform clinical practice. Therefore, the purpose of this study was to compare the efficacy and safety of acupuncture and acupotomy in the treatment of cervical spondylotic radiculopathy and to provide evidence for clinical practice. METHODS Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library were searched in March 2021 by 2 independent reviewers. Data extraction was performed independently, and any conflict was resolved before final analysis. Only randomized clinical trials were included in this study. Outcomes included pain intensity, symptom score, neck disability index, total effective rate, and curative rate. The Cochrane risk of bias tool is used to evaluate the risk of bias of included randomized controlled trials by 2 independent reviewers. RESULTS We hypothesized that these 2 methods would provide similar therapeutic benefits. The results of this research will be delivered in a peer-reviewed journal. CONCLUSION This study expects to provide credible and scientific clinical evidence for the efficacy and safety of acupuncture and acupotomy in the treatment of cervical spondylotic radiculopathy. OSF REGISTRATION NUMBER 10.17605/OSF.IO/U7T6A.
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Abstract
Cervical radiculopathy is a neurological condition caused by dysfunction or compression of a cervical nerve root. Patients often report unilateral neck pain with radiation to the ipsilateral arm, often with sensory changes in a dermatomal distribution. Weakness and reflex changes are also commonly found and can be very troubling for patients. Careful history and examination is important to identify any more concerning features such as progressive symptoms and features of myelopathy, which could prompt surgical management. Although the majority of patients will see an improvement in their symptoms over time with conservative management, surgery is indicated in patients with debilitating pain, progressive neurology, significant weakness, instability or myelopathy. Advancements in surgical techniques offer a range of potential operations that should be considered carefully for each patient. This article outlines the clinical approach to presentation, pathophysiology, diagnosis and management.
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Affiliation(s)
- Surendra Patnaik
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Alastair Carr
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Praveen Inaparthy
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Will Km Kieffer
- Department of Trauma and Orthopaedic Surgery, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
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High-resolution in vivo MR imaging of intraspinal cervical nerve rootlets at 3 and 7 Tesla. Eur Radiol 2021; 31:4625-4633. [PMID: 33409779 DOI: 10.1007/s00330-020-07557-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES No routine imaging technology allows reliable visualization of nerve rootlets inside the spinal canal with positive contrast. The stronger MR signal at 7 T, with optimized protocols, may offer a solution. The purpose was to evaluate the potential of 3D Dual-Echo Steady-State (DESS) MR imaging of the cervical spine at 3 and 7 T in assessing the micro-anatomy of the nerve rootlets. MATERIALS/METHODS This prospective study was approved by the local ethics committee. Twenty-one patients, clinically referred to cervical-spine MRI, underwent additional MR exams at 3 T and 7 T, each of which consisted of a single 3D-DESS series with equal acquisition times. Artifacts, visualization quality, and number of identified rootlets (C2 to C8) were rated by two musculoskeletal radiologists. Results were compared by Wilcoxon tests. Interobserver reliability was assessed using weighted κ statistics and intraclass correlation coefficient (ICC). RESULTS Intraspinal rootlets could successfully be visualized at both field strengths. Rating differences for artifacts and quality of rootlet depiction were not significant for the two field strengths. The mean number of identified rootlets was larger for 7-T than for 3-T MR for every assessed nerve; however, this difference was not statistically significant using the Bonferroni correction (p values ranging from 0.002 to 0.53). Interobserver agreement was substantial to almost perfect (weighted κ values of 0.69 and 0.82). The ICC for the number of identified rootlets was 0.80. CONCLUSION Non-invasive 3D-DESS MR-imaging at 3 and 7 T has the potential to provide precise assessments of the micro-anatomy of intraspinal cervical nerve roots. KEY POINTS • Cervical rootlets can be successfully visualized with positive contrast using 3D-DESS MR-imaging. • 3D-DESS MR-imaging at 3 and 7 T provides precise assessments of the micro-anatomy of cervical nerves. • The mean number of identified cervical rootlets using 3D-DESS was larger for 7 T than for 3 T MR; however, this difference was not statistically significant.
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Systematic review of radiological cervical foraminal grading systems. Neuroradiology 2021; 63:305-316. [PMID: 33392737 DOI: 10.1007/s00234-020-02596-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
The study design of this paper is systematic review. The purpose of this review is to evaluate the existing radiological grading systems that are used to assess cervical foraminal stenosis. The importance of imaging the cervical spine using CT or MRI in evaluating cervical foraminal stenosis is widely accepted; however, there is no consensus for standardized methodology to assess the compression of the cervical nerve roots. A systematic search of Ovid Medline databases, Embase 1947 to present, Cinahl, Web of Science, Cochrane Library, ISRCTN and WHO international clinical trials was performed for reports of cervical foraminal stenosis published before 01 February 2020. In collaboration with the University of Leeds, a search strategy was developed. A total of 6952 articles were identified with 59 included. Most of the reports involved multiple imaging modalities with standard axial and sagittal imaging used most. The grading themes that came from this systematic review show that the most mature for cervical foraminal stenosis is described by (Kim et al. Korean J Radiol 16:1294, 2015) and (Park et al. Br J Radiol 86:20120515, 2013). Imaging of the cervical nerve root canals is mostly performed using MRI and is reported using subjective terminology. The Park, Kim and Modified Kim systems for classifying the degree of stenosis of the nerve root canal have been described. Clinical application of these scoring systems is limited by their reliance on nonstandard imaging (Park), limited validation against clinical symptoms and surgical outcome data. Oblique fine cut images derived from three dimensional MRI datasets may yield more consistency, better clinical correlation, enhanced surgical decision-making and outcomes.
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Ndafia N, Ndubuisi C, Ohaegbulam S. Cervical hemilaminectomy in the management of degenerative cervical spine myelopathy: Utilization and outcome from a neurosurgical institution in Nigeria. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_155_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Khan I, Sivaganesan A, Archer KR, Bydon M, McGirt MJ, Nian H, Harrell FE, Foley KT, Mummaneni PV, Bisson EF, Shaffrey C, Harbaugh R, Asher AL, Devin CJ. Does Neck Disability Index Correlate With 12-Month Satisfaction After Elective Surgery for Cervical Radiculopathy? Results From a National Spine Registry. Neurosurgery 2020; 86:736-741. [PMID: 31268151 DOI: 10.1093/neuros/nyz231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Modern healthcare reforms focus on identifying and measuring the quality and value of care. Patient satisfaction is particularly important in the management of degenerative cervical radiculopathy (DCR) since it leads to significant neck pain and disability primarily affecting the patients' quality of life. OBJECTIVE To determine the association of baseline and 12-mo Neck Disability Index (NDI) with patient satisfaction after elective surgery for DCR. METHODS The Quality Outcomes Database cervical module was queried for patients who underwent elective surgery for DCR. A multivariable proportional odds regression model was fitted with 12-mo satisfaction as the outcome. The covariates for this model included patients' demographics, surgical characteristics, and baseline and 12-mo patient reported outcomes (PROs). Wald-statistics were calculated to determine the relative importance of each independent variable for 12-mo patient satisfaction. RESULTS The analysis included 2206 patients who underwent elective surgery for DCR. In multivariable analysis, after adjusting for baseline and surgery specific variables, the 12-mo NDI score showed the highest association with 12-mo satisfaction (Waldχ2-df = 99.17, 58.1% of total χ2). The level of satisfaction increases with decrease in 12-mo NDI score regardless of the baseline NDI score. CONCLUSION Our study identifies 12-mo NDI score as a very influential driver of 12-mo patient satisfaction after surgery for DCR. In addition, there are lesser contributions from other 12-mo PROs, baseline Numeric Rating Scale for arm pain and American Society of Anesthesiologists (ASA) grade. The baseline level of disability was found to be irrelevant to patients. They seemed to only value their current level of disability, compared to baseline, in rating satisfaction with surgical outcome.
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Affiliation(s)
- Inamullah Khan
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ahilan Sivaganesan
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohamad Bydon
- Department of Neurological Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota
| | - Matthew J McGirt
- Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Hui Nian
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kevin T Foley
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Robert Harbaugh
- Department of Neurosurgery, Penn State University, Hershey, Pennsylvania
| | - Anthony L Asher
- Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
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Dernek B, Aydoğmuş S, Duymuş TM, Adıyeke L, Yardımcı MY, Kesiktaş FN, Sindel D, Ketenci A. The incidence of impingement syndrome in cases of cervical radiculopathy: An analysis of 220 cases. J Back Musculoskelet Rehabil 2020; 33:363-366. [PMID: 31815687 DOI: 10.3233/bmr-181354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND We hypothesized that cervical radiculopathy (CR) has a role in subacromial impingement syndrome (SAIS) etiology, which cannot be directly connected to anatomical causes. OBJECTIVE We aimed to investigate the presence of cervical radiculopathy in patients with SAIS diagnosed clinically and radiologically. METHODS Patients who had a clinical and radiological SAIS diagnosis between 2014 and 2016 were included in the study. Patients with secondary causes that led to SAIS were excluded. Cervical MRI of all patients with SAIS was examined for cervical radiculopathy. RESULTS A significant (p< 0.05) relationship was found between SIAS and the presence of root compression on the same side. 35% of the patients with SIAS had root compression on the same side. CONCLUSIONS Cervical radiculopathy and shoulder impingement syndrome can be easily confused due to the similarity of the symptoms and the anatomical proximity of the lesions. Although both diseases can occur with different mechanisms, we believe that there is a cause and effect relationship between them.
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Affiliation(s)
- Bahar Dernek
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Suavi Aydoğmuş
- Istanbul Maltepe State Hospital, Altaycesme Camli sok. Maltepe, Istanbul, Turkey
| | | | - Levent Adıyeke
- Istanbul Haydarpasa Numune Training and Research Hospital, Department of Orthopaedic and Trauma, Istanbul, Turkey
| | - Merve Yıldız Yardımcı
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Fatma Nur Kesiktaş
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
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Samartsev IN, Zhivolupov SA, Vorobyova MN, Parshin MS, Nazhmudinov RZ. [The optimization of differential diagnosis and treatment of cervical radiculopathy (SHERPA study)]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:37-46. [PMID: 33081445 DOI: 10.17116/jnevro202012009137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To improve the algorithm of differential diagnosis and complex treatment of patients with CR. MATERIAL AND METHODS Forty-two patients with CR were divided into 2 groups. Patients of the first group (n=21) received basic treatment (NSAID, myorelaxants, local injections with glucocorticoids (on demand), B vitamins and non-pharmacological methods) and the anticholinesterase drug ipidacrine. The second group (n=21) had only basic treatment. The total duration of the study was 45 days. The effectiveness of treatment was evaluated with VAS, NDI, GROC and total duration of disability period. RESULTS A battery of tests for the diagnosis of CR that included Spurling test, motor strength deficiency, ULTT, pain pattern, shoulder adduction test (diagnostic complex SPASIBO), has been developed. A positive result of all 5 tests guarantees the 94.7% accuracy of CR diagnosis. The application of ipidacrine has allowed a significant (p<0.05) reduction of pain, enhancement of daily living activities and subjective improvement of well-being of patients after 1 month of treatment and mostly after 45 days. Besides, there was a considerable (p<0.05) reduction of the disability period in the first group of patients compared to the control one. CONCLUSION The diagnostic complex SPASIBO should be used in diagnosis of CR. It is highly recommended to include ipidacrine in the complex treatment of CR.
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Hagan CR, Anderson AR. Cervical spine thrust and non-thrust mobilization for the management of recalcitrant C6 paresthesias associated with a cervical radiculopathy: a case report. Physiother Theory Pract 2020; 38:1311-1318. [PMID: 32896223 DOI: 10.1080/09593985.2020.1818340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The conservative management of cervical radiculopathy is supported by moderate evidence to include interventions such as manual therapy, traction, and therapeutic exercise. There is sparse evidence, however, to support specific manual therapy techniques, particularly thrust manipulation. CASE DESCRIPTION A 35-year-old male presented to physical therapy with a clinical diagnosis of cervical radiculopathy. He complained of neck and upper arm pain with 1st and 2nd digit paresthesias. He was initially managed with repeated movements that restored the cervical range of motion and centralized neck and upper arm pain. Non-thrust upslope joint mobilizations resulted in improved sensation detection in the hand, but the paresthesias did not completely resolve. Immediately following cervical spine upslope thrust manipulation, symptoms fully resolved. Outcomes: The patient fully returned to prior level of function. His DASH score reduced from 40/100 to 2/100, PSFS improved from 1.66/10 to 9.66/10, and he reported to be 'a great deal better' on the GROC. DISCUSSION This case demonstrates the safe and effective utilization of cervical spine thrust manipulation and non-thrust mobilization in the management of a patient with cervical radiculopathy with lingering paresthesias in the distal upper extremity.
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Affiliation(s)
- Christopher R Hagan
- OMPT Fellowship, University of Illinois at Chicago, Chicago, IL, USA.,Rush University Medical Center, Chicago, IL, USA
| | - Alexandra R Anderson
- OMPT Fellowship, University of Illinois at Chicago, Chicago, IL, USA.,UI Health, Chicago, IL, USA
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Savva C, Korakakis V, Efstathiou M, Karagiannis C. Cervical traction combined with neural mobilization for patients with cervical radiculopathy: A randomized controlled trial. J Bodyw Mov Ther 2020; 26:279-289. [PMID: 33992259 DOI: 10.1016/j.jbmt.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/24/2020] [Accepted: 08/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although both neural mobilization (NM) and cervical traction (CT) are widely used interventions in cervical radiculopathy (CR), there is limited clinical data to support their use. OBJECTIVE To evaluate the effects of CT, with or without the addition of NM, on pain, function, and disability in patients with CR. DESIGN A randomized, double-blinded, placebo-controlled clinical trial. METHODS 66 patients with CR were randomly allocated to: a group (n = 22) received CT combined with NM (CT + NM), a group (n = 22) received CT combined with sham NM (CT + shamNM) and a wait-list control (WLC) group (n = 22). The Neck Disability Index (NDI), the Patient-Specific Functional Scale, the Numeric Pain Rating Scale (NPRS), grip strength and cervical spine mobility were used as outcome measures. A two-way analysis of variance was used to evaluate differences between the three groups at baseline and at 4-week follow-up. RESULTS Statistically and clinically significant between-group differences at 4-week follow-up were found between CT + NM and WLC groups in favor of CT + NM group in NDI scores (d = 1.30), NRPS (d = 1.94), and active cervical rotation towards the opposite arm (d = 1.18) and between CT + NM and CT + shamNM groups in favor of CT + NM group in NRPS (d = 1.21). No significant differences were observed between CT + shamNM and WLC groups in all outcome measures. Clinically significant within-group improvements were found only for the CT + NM group. CONCLUSION At 4-week follow-up, CT in combination with NM resulted in improved outcomes in pain, function and disability in patients with CR.
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Affiliation(s)
- Christos Savva
- Department of Health Science, European University, Diogenous 6, Engomi, Nicosia, Cyprus.
| | | | - Michalis Efstathiou
- Department of Life and Health Sciences, University of Nicosia, 46 Makedonitissas Avenue, Nicosia, Cyprus
| | - Christos Karagiannis
- Department of Health Science, European University, Diogenous 6, Engomi, Nicosia, Cyprus
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Alamri ZA, Althobaiti NK, Halabi AT, Bashraheel HO, Shalwala AR, Alyousef MA. Medical students vs general public awareness regarding disc prolapse in Jeddah. J Family Med Prim Care 2020; 9:3030-3036. [PMID: 32984168 PMCID: PMC7491761 DOI: 10.4103/jfmpc.jfmpc_36_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/12/2020] [Accepted: 03/22/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Disc herniation is a condition where tearing occurs in the outer annular layer of the intervertebral pad leading the inner gel-like material to bulge ouwards the spinal cord, due to the high load of the vertebrae. This will produce back pain and symptoms in different sites according to the level of the herniation in the vertebral column. AIM To compare the level of awareness regarding disc herniation among the general population and medical students in Jeddah. METHODOLOGY A descriptive cross-sectional study was conducted through an electronic questionnaire to assess the level of awareness regarding disc prolapse among the general population and medical students in Jeddah. The questionnaire was in the Arabic language, it was taken and validated by the previous study which took place in Taif. RESULTS Our studied sample involved 1026 individuals aged between 11 and 99 years, with a mean age of 34.03 ± 13.28 years old. More than half of the respondents were female (55.4%), most of them were Saudi nationals (90.1%), and most of them have received a higher education (67.7%). Results showed that 54.1% of the general population and 77.7% of medical students reported good knowledge regarding this condition. CONCLUSION This study revealed that the level of awareness regarding disc prolapse among the general population and medical students was poor in some respects such as: knowledge about the preventive measures, symptoms of the disease, the most common site in the spine affected by the disease, and the gold standard imaging method to diagnose this disease.
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Affiliation(s)
- Zeyad A. Alamri
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Anas T. Halabi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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