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Mai E, Kim ET, Kaidi A, Subramanian T, Simon CZ, Asada T, Kwas CT, Zhang J, Araghi K, Singh N, Tuma OC, Korsun MK, Allen MRJ, Heuer A, Sheha ED, Dowdell JE, Huang RC, Albert TJ, Qureshi SA, Iyer S. Impact of Preoperative Symptom Duration on Patient-Reported Outcomes Following Cervical Disc Replacement for Cervical Radiculopathy. Spine (Phila Pa 1976) 2024; 49:1251-1258. [PMID: 38679871 DOI: 10.1097/brs.0000000000005020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To determine the impact of preoperative symptom duration on postoperative functional outcomes after cervical disc replacement (CDR) for radiculopathy. SUMMARY OF BACKGROUND DATA CDR has emerged as a reliable and efficacious treatment option for degenerative cervical spine pathologies. The relationship between preoperative symptom duration and outcomes after CDR is not well established. METHODS Patients with radiculopathy without myelopathy who underwent primary 1- or 2-level CDRs were included and divided into shorter (<6 mo) and prolonged (≥6 mo) cohorts based on preoperative symptom duration. Patient-reported outcome measures (PROMs) included neck disability index (NDI), visual analog scale (VAS) neck and arm. Changes in PROM scores and minimal clinically important difference (MCID) rates were calculated. Analyses were conducted on the early (within 3 mo) and late (6 mo-2 y) postoperative periods. RESULTS A total of 201 patients (43.6±8.7 y, 33.3% female) were included. In both early and late postoperative periods, the shorter preoperative symptom duration cohort experienced significantly greater change from preoperative PROM scores compared with the prolonged symptom duration cohort for NDI, VAS-Neck, and VAS-Arm. The shorter symptom duration cohort achieved MCID in the early postoperative period at a significantly higher rate for NDI (78.9% vs. 54.9%, P =0.001), VAS-Neck (87.0% vs. 56.0%, P <0.001), and VAS-Arm (90.5% vs. 70.7%, P =0.002). Prolonged preoperative symptom duration (≥6 mo) was identified as an independent risk factor for failure to achieve MCID at the latest timepoint for NDI (OR: 2.9, 95% CI: 1.2-6.9, P =0.016), VAS-Neck (OR: 9.8, 95% CI: 3.7-26.0, P <0.001), and VAS-Arm (OR: 7.5, 95% CI: 2.5-22.5, P <0.001). CONCLUSIONS Our study demonstrates improved patient-reported outcomes for those with shorter preoperative symptom duration undergoing CDR for radiculopathy, suggesting delayed surgical intervention may result in poorer outcomes and greater postoperative disability. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Eric Mai
- Department of Spine, Hospital for Special Surgery, New York, NY
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY
| | - Eric T Kim
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Austin Kaidi
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Tejas Subramanian
- Department of Spine, Hospital for Special Surgery, New York, NY
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY
| | - Chad Z Simon
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Tomoyuki Asada
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Cole T Kwas
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Joshua Zhang
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Kasra Araghi
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Olivia C Tuma
- Department of Spine, Hospital for Special Surgery, New York, NY
| | | | - Myles R J Allen
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Annika Heuer
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - James E Dowdell
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Russel C Huang
- Department of Spine, Hospital for Special Surgery, New York, NY
| | - Todd J Albert
- Department of Spine, Hospital for Special Surgery, New York, NY
| | | | - Sravisht Iyer
- Department of Spine, Hospital for Special Surgery, New York, NY
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Kulkarni P, Agrawal SK. Design and Validation of a Novel Robotic Neck Brace for Cervical Traction. IEEE/ASME TRANSACTIONS ON MECHATRONICS : A JOINT PUBLICATION OF THE IEEE INDUSTRIAL ELECTRONICS SOCIETY AND THE ASME DYNAMIC SYSTEMS AND CONTROL DIVISION 2024; 29:3092-3099. [PMID: 39246648 PMCID: PMC11378956 DOI: 10.1109/tmech.2024.3402614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
Cervical traction is a common and effective treatment for degenerative disk diseases and pain in the cervical spine. However, the manual or mechanical methods of applying traction to the head-neck are limited due to variability in the applied forces and orientation of the head-neck relative to the shoulder during the procedure. Current robotic neck braces are not designed to provide independent rotation angles and independent vertical translation, or traction, to the brace end-effector connected to the head, making them unsuitable for traction application. This work proposes a novel architecture of a robotic neck brace, which can provide vertical traction to the head while keeping the head in a prescribed orientation, with flexion and lateral bending angles. In this paper, the kinematics of the end-effector attached to the head relative to a coordinate frame on the shoulders are described as well as the velocity kinematics and force control. The paper also describes benchtop experiments designed to validate the position control and the ability of the brace to provide a vertical traction force. It was shown that the maximum achievable end-effector orientations are 16° in flexion, 13.9° in extension, and ± 6.5° in lateral bending. The kinematic model of the active brace was validated using an independent motion capture system with a maximum root mean square error of 2.41°. In three different orientations of the end-effector, neutral, flexed, and laterally bent, the brace was able to provide a consistent upward traction force during intermittent force application. In these configurations, the force error has standard deviations of 0.55, 0.29, and 0.07N, respectively. This work validates the mechanism's ability to achieve a range of head orientations and provide consistent upward traction force in these orientations, making it a promising intervention tool in cases of cervical disk degeneration.
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Affiliation(s)
- Priya Kulkarni
- P. Kulkarni and S. K. Agrawal are with the Robotics and Rehabilitation Laboratory, Department of Mechanical Engineering, Columbia University, New York, NY 10027 USA
| | - Sunil K Agrawal
- P. Kulkarni and S. K. Agrawal are with the Robotics and Rehabilitation Laboratory, Department of Mechanical Engineering, Columbia University, New York, NY 10027 USA
- S. K. Agrawal is with the Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY 10032 USA
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Coker C, Park J, Jacobson RD. Neurologic Approach to Radiculopathy, Back Pain, and Neck Pain. Prim Care 2024; 51:345-358. [PMID: 38692779 DOI: 10.1016/j.pop.2024.02.003] [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] [Indexed: 05/03/2024]
Abstract
Back pain and neck pain are common in clinical practice, but significant challenges and pitfalls exist in their diagnosis, treatment, and management. From the neurologic standpoint, cervical radiculopathy and lumbosacral radiculopathy are characterized by neck pain or back pain accompanied by sensory and motor symptoms in an arm or leg. The basic neurologic examination is vital, but testing like electromyography and MRI is often needed especially in cases that fail conservative management. Oral medications, injection-based therapies, physical therapy, and surgical evaluation all have a place in the comprehensive neurologic management of back and neck pain and associated radiculopathy.
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Affiliation(s)
- Canaan Coker
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 1118, Chicago, IL 60612, USA
| | - Jade Park
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 1118, Chicago, IL 60612, USA
| | - Ryan D Jacobson
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 1118, Chicago, IL 60612, USA.
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Chen M, Yu Q, Cheng S, Hu T, Wang X, Lei B, Qin C, Long Q, Deng Z, Yan Z. Posterior Lateral Endoscopic Cervical Discectomy Through a Lateral Mass Approach in the Treatment of Cervical Spondylotic Radiculopathy. World Neurosurg 2024; 185:e1064-e1073. [PMID: 38490445 DOI: 10.1016/j.wneu.2024.03.024] [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: 02/02/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE The present study outlines the feasibility, safety, and short-term clinical outcomes of posterior lateral endoscopic cervical discectomy (PLECD) through a lateral mass approach for treating cervical spondylotic radiculopathy (CSR). METHODS This single-center retrospective observational study involved 30 patients with single-level CSR who had failed conservative treatment and presented with clinical symptoms consistent with imaging findings undergoing PLECD via a lateral mass approach. Primary outcomes included the visual analog scale (VAS) for neck and arm pain, the Japanese Orthopedic Association (JOA) score, and the modified MacNab criteria. Radiographic follow-up consisted of static and dynamic cervical radiographs and computed tomographic scans. RESULTS Thirty patients (13 men and 17 women; mean age 48.8 ± 11.9 years) underwent this procedure, and the mean operative time was 74.90 ± 13.52 minutes. Mean follow-up was 7.37 ± 2.17 months. The VAS scores for the neck and arm decreased significantly at the last follow-up (neck, 26.80 ± 4.75 to 9.87 ± 1.78; arm, 71.30 ± 8.48 to 14.73 ± 4.00) (P < 0.05). The JOA score also decreased from 13.47 ± 1.36 to 15.90 ± 0.92 at the last follow-up (P < 0.05). Twenty-nine patients demonstrated satisfactory outcomes based on the modified MacNab criteria at the last follow-up. All patients exhibited a positive clinical response, experiencing relief from symptoms. Postoperative computed tomography (CT) scans confirmed the complete removal of lesions. CONCLUSIONS PLECD through a lateral mass approach, as an alternative to conventional "keyhole" approaches, proves to be a novel and viable therapeutic option for CSR, demonstrating both high efficacy and safety.
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Affiliation(s)
- Mingxin Chen
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingshuai Yu
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Si Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Hu
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Wang
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Lei
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chaofan Qin
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingyan Long
- Department of Clinical Skills Training Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhongliang Deng
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengjian Yan
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Ng MK, Kobryn A, Baidya J, Nian P, Emara AK, Ahn NU, Houten JK, Saleh A, Razi AE. Multi-Level Posterior Cervical Foraminotomy Associated With Increased Post-operative Infection Rates and Overall Re-Operation Relative to Anterior Cervical Discectomy With Fusion or Cervical Disc Arthroplasty. Global Spine J 2024; 14:869-877. [PMID: 36052872 PMCID: PMC11192135 DOI: 10.1177/21925682221124530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE Cervical radiculopathy meeting operative criteria has traditionally been managed using anterior cervical discectomy and fusion (ACDF). However, cervical disc arthroplasty (CDA) and posterior cervical foraminotomy (PCF) are also reasonable options. This study aimed to assess differences in postoperative outcomes among patients undergoing multi-level ACDF, CDA, or PCF comparing medical/surgical complications and healthcare utilization parameters. METHODS Patients who underwent multi-level ACDF, CDA, or PCF between 2012 and 2019 were identified from the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. Patients were stratified based on procedure type and propensity score matched to resolve baseline differences. ANOVA was performed to identify differences in medical complications, surgical complications, and healthcare utilization metrics. RESULTS A total of 31 344 patients who underwent an eligible procedure were identified (ACDF: n = 28 089, CDA: n = 1748, PCF: n = 1507), and 684 patients remained in each group following propensity score matching. Patients undergoing multi-level PCF were found to experience longer lengths of hospital stay (PCF: 1.67 ± 1.61 days, ACDF: 1.50 ± 1.32 days, CDA: 1.27 ± 1.05 days, P < .001), higher rates of reoperation (PCF: 3.2%, ACDF: 1.0%, CDA: .4%, P = .020), superficial infection (PCF: 1.3%, ACDF: .3%, CDA: .1%, P = .008) and deep infection (PCF: 1.2%, ACDF: 0%, CDA: 0%, P < .001). There were no outcome differences between multi-level ACDF and CDA. CONCLUSIONS Patients undergoing multi-level PCF were at increased risk for longer hospital stay, re-operation, and infection relative to those undergoing ACDF and CDA. Future research should aim to uncover the precise mechanisms underlying these complications, as well as analyze long term outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mitchell K. Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Andriy Kobryn
- Department of Orthopaedic Surgery, SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Joydeep Baidya
- Department of Orthopaedic Surgery, SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Patrick Nian
- Department of Orthopaedic Surgery, SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Ahmed K. Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicholas U. Ahn
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, OH, USA
| | - John K. Houten
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ahmed Saleh
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Afshin E. Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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Huang L, Chen W, Xu H, Qin H, Jiang H. Odontoid incidence: a constant cervical anatomical feature evident in standing plain radiographs and supine magnetic resonance images. J Orthop Surg Res 2024; 19:63. [PMID: 38218851 PMCID: PMC10787454 DOI: 10.1186/s13018-024-04542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE To assess whether there is a difference between measurements of odontoid incidence (OI) and other cervical sagittal parameters by X-ray radiography and those by supine magnetic resonance imaging (MRI). METHODS Standing X-ray and supine MRI images of 42 healthy subjects were retrospectively analyzed. Surgimap software was employed to measure cervical sagittal parameters including OI, odontoid tilt (OT), C2 slope (C2S), C0-2 angle, C2-7 angle, T1 slope (T1S) and T1S-cervical lordosis (CL). Paired samples t-test was applied to determine the difference between parameters measured by standing X-ray and those by supine MRI. In addition, the statistical correlation between the parameters were compared. The prediction of CL was performed and validated using the formula CL = 0.36 × OI - 0.67 × OT - 0.69 × T1S. RESULTS Significant correlations and differences were found between cervical sagittal parameters determined by X-ray and those by MRI. OI was verified to be a constant anatomic parameter and the formula CL = 0.36 × OI - 0.67 × OT - 0.69 × T1S can be used to predict CL in cervical sagittal parameters. CONCLUSIONS OI is verified as a constant anatomic parameter, demonstrating the necessity of a combined assessment of cervical sagittal balance by using standing X-ray and supine MRI. The formula CL = 0.36 × OI - 0.67 × OT - 0.69 × T1S can be applied to predict CL in cervical sagittal parameters.
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Affiliation(s)
- Longao Huang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Weiyou Chen
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Hongyuan Xu
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Hongyu Qin
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Hua Jiang
- Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
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Costello JE, Shah LM, Peckham ME, Stilwill SE, Safazadeh G, Hutchins TA. Time for change? Radiologists highly concordant assessing change in stenoses on follow-up cervical spine MRI. Neuroradiol J 2023; 36:588-592. [PMID: 37042077 PMCID: PMC10569186 DOI: 10.1177/19714009231163562] [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] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE There is considerable variability among radiologists when grading spinal canal and foraminal stenosis on MRI. However, to date, studies have not evaluated radiologists' agreement when assessing interval change in cervical spine stenoses. The purpose of this study was to evaluate radiologists' concordance for change in cervical spine stenoses on follow-up MRIs, a major indication for these exams. METHODS Initial and follow-up cervical MRIs were retrospectively reviewed by three blinded radiologists. Spinal canal and foramina from C1 through T1 were rated for interval change and concordance between the blinded raters was calculated. The original MRI reports were also reviewed for specific language assessing interval change on the follow-up exams. RESULTS 40 cervical MRI exams and 40 corresponding MRI follow-ups were assessed. Agreement for interval change in spinal canal and foraminal stenosis was near perfect amongst all readers (kappa values of 0.78-0.94). 97% of the original MRI reports used the standard severity scale. 68% of follow-up MRI reports specifically assessed for change. DISCUSSION Blinded radiologists had high agreement when assessing for change in spinal canal and foraminal stenosis on follow-up cervical spine MRIs. Because of inter-rater variability in stenosis grading, reports that do not emphasize change assessment, may imply change that is not truly present. For clarity and consistency in reporting of cervical spine stenoses, change assessment should be emphasized and added to structured reporting templates.
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Affiliation(s)
- Justin E Costello
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
- Walter Reed National Military Medical Center, Department of Neuroradiology, Bethesda, MD, United States
| | - Lubdha M Shah
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Miriam E Peckham
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Sarah E Stilwill
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Ghazaleh Safazadeh
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Troy A Hutchins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
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Węgiel A, Karauda P, Zielinska N, Tubbs RS, Olewnik Ł. Radial nerve compression: anatomical perspective and clinical consequences. Neurosurg Rev 2023; 46:53. [PMID: 36781706 PMCID: PMC9925568 DOI: 10.1007/s10143-023-01944-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/01/2023] [Accepted: 01/16/2023] [Indexed: 02/15/2023]
Abstract
The radial nerve is the biggest branch of the posterior cord of the brachial plexus and one of its five terminal branches. Entrapment of the radial nerve at the elbow is the third most common compressive neuropathy of the upper limb after carpal tunnel and cubital tunnel syndromes. Because the incidence is relatively low and many agents can compress it along its whole course, entrapment of the radial nerve or its branches can pose a considerable clinical challenge. Several of these agents are related to normal or variant anatomy. The most common of the compressive neuropathies related to the radial nerve is the posterior interosseus nerve syndrome. Appropriate treatment requires familiarity with the anatomical traits influencing the presenting symptoms and the related prognoses. The aim of this study is to describe the compressive neuropathies of the radial nerve, emphasizing the anatomical perspective and highlighting the traps awaiting physicians evaluating these entrapments.
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Affiliation(s)
- Andrzej Węgiel
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada, USA
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
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Marco B, Evans D, Symonds N, Peolsson A, Coppieters MW, Jull G, Löfgren H, Zsigmond P, Falla D. Determining the level of cervical radiculopathy: Agreement between visual inspection of pain drawings and magnetic resonance imaging. Pain Pract 2023; 23:32-40. [PMID: 35765137 PMCID: PMC10083927 DOI: 10.1111/papr.13147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Pain drawings are commonly used in the clinical assessment of people with cervical radiculopathy. This study aimed to assess (1) the agreement of clinical interpretation of pain drawings and MRI findings in identifying the affected level of cervical radiculopathy, (2) the agreement of these predictions based on the pain drawing among four clinicians from two different professions (i.e., physiotherapy and surgery) and (3) the topographical pain distribution of people presenting with cervical radiculopathy (C4-C7). METHODS Ninety-eight pain drawings were obtained from a baseline assessment of participants in a randomized clinical trial, in which single-level cervical radiculopathy was determined using MRI. Four experienced clinicians independently rated each pain drawing, attributing the pain distribution to a single nerve root (C4-C7). A post hoc analysis was performed to assess agreement. OUTCOME MEASURES Percentage agreement and kappa values were used to assess the level of agreement. Topographic pain frequency maps were created for each cervical radiculopathy level as determined by MRI. RESULTS The radiculopathy level determined from the pain drawings showed poor overall agreement with MRI (mean = 35.7%, K = -0.007 to 0.139). The inter-clinician agreement ranged from fair to moderate (K = 0.212-0.446). Topographic frequency maps revealed that pain distributions were widespread and overlapped markedly between patients presenting with different levels cervical radiculopathy. CONCLUSION This study revealed a lack of agreement between the segmental level affected determined from the patient's pain drawing and the affected level as identified on MRI. The large overlap of pain and non-dermatomal distribution of pain reported by patients likely contributed to this result.
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Affiliation(s)
- Barbero Marco
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - David Evans
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Natasia Symonds
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping, Sweden
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane, Gold Coast, Queensland, Australia.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gwendolen Jull
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Håkan Löfgren
- Neuro-Orthopedic Center, Ryhov Hospital, Jönköping, Sweden
| | - Peter Zsigmond
- Department of Neurosurgery, Linköping University Hospital, Linköping, Sweden
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Muacevic A, Adler JR. Addition of McKenzie Exercises to a Multimodal Physical Therapy Approach for Cervical Radiculopathy: A Case Report. Cureus 2022; 14:e32992. [PMID: 36712723 PMCID: PMC9879586 DOI: 10.7759/cureus.32992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Cervical radiculopathy is a common subset of neck pain involving cervical nerve root irritation potentially resulting in numbness, radicular pain, and/or upper extremity weakness. The Neck Pain Clinical Practice Guidelines published by the American Physical Therapy Association does not support McKenzie exercises in isolation when treating cervical radiculopathy, but endorses a multimodal physical therapy approach for the management of cervical radiculopathy. The purpose of this case report is to exemplify the treatment of a patient with cervical radiculopathy utilizing McKenzie centralization exercises within a multimodal physical therapy approach for improved patient outcomes. The patient was a 49-year-old female with a past medical history of type 1 diabetes mellitus with a history of subacute cervical pain with left upper extremity radicular symptoms for four months consistent with cervical radiculopathy. Interventions included a multimodal physical therapy approach consisting of McKenzie cervical retraction exercises, thoracic manipulation, rib mobilizations, manual cervical traction, peripheral nerve mobilization, and scapular retraction with postural exercises. The patient received four visits over a five-week period with an emphasis on patient education and independence. Although McKenzie centralization exercises are not supported by the Neck Pain Clinical Practice Guideline (CPG) in isolation, adding these exercises to the supported recommendation of a multimodal physical therapy approach for cervical radiculopathy has promise.
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11
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Cotter T, Mongrain R, Driscoll M. Vacuum curette lumbar discectomy mechanics for use in spine surgical training simulators. Sci Rep 2022; 12:13517. [PMID: 35933556 PMCID: PMC9357010 DOI: 10.1038/s41598-022-17512-5] [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: 04/12/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Simulation in surgical training is a growing field and this study aims to understand the force and torque experienced during lumbar spine surgery to design simulator haptic feedback. It was hypothesized that force and torque would differ among lumbar spine levels and the amount of tissue removed by ≥ 7%, which would be detectable to a user. Force and torque profiles were measured during vacuum curette insertion and torsion, respectively, in multiple spinal levels on two cadavers. Multiple tests per level were performed. Linear and torsional resistances of 2.1 ± 1.6 N/mm and 5.6 ± 4.3 N mm/°, respectively, were quantified. Statistically significant differences were found in linear and torsional resistances between all passes through disc tissue (both p = 0.001). Tool depth (p < 0.001) and lumbar level (p < 0.001) impacted torsional resistance while tool speed affected linear resistance (p = 0.022). Average differences in these statistically significant comparisons were ≥ 7% and therefore detectable to a surgeon. The aforementioned factors should be considered when developing haptic force and torque feedback, as they will add to the simulated lumbar discectomy realism. These data can additionally be used inform next generation tool design. Advances in training and tools may help improve future surgeon training.
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Affiliation(s)
- Trevor Cotter
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, H3A 0C4, Canada.,Orthopedic Research Laboratory, Montreal General Hospital, Montreal, QC, H3H 1V8, Canada
| | - Rosaire Mongrain
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, H3A 0C4, Canada
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, H3A 0C4, Canada. .,Orthopedic Research Laboratory, Montreal General Hospital, Montreal, QC, H3H 1V8, Canada.
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12
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Clinical Efficacy of Epidural Injections of Local Anesthetic Alone or Combined with Steroid for Neck Pain: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8952220. [PMID: 35663039 PMCID: PMC9162875 DOI: 10.1155/2022/8952220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
Aims To compare the effectiveness of cervical epidural injections of local anesthetic with vs. without a steroid. Methods Three databases (PubMed, Embase, and Cochrane library) were used to search and assess all clinical randomized controlled trials regarding the clinical efficacy of epidural injections from January 01, 2009, to October 31, 2020. Cochrane review criteria and the Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment instrument were used to evaluate the methodologic quality of the included studies. Qualitative and quantitative analyses were performed according to best evidence synthesis principles and by single-arm meta-analysis, respectively. Results Based on the search criteria, 4 RCTs were qualitatively and quantitatively analyzed in the single-arm meta-analysis. Treatment with lidocaine alone or with the steroid resulted in decreases of 4.46 and 4.29 points, respectively, in pain scores and of 15.8 and 14.46 points, respectively, in functional scores at 6 months. Similar trends were observed at the 1-year follow-up: pain scores decreased by 4.27 and 4.14 points, while functional scores decreased by 15.94 and 14.44 points in patients with neck pain who received lidocaine without or with the steroid, respectively. In the 3 studies that reported 2-year follow-up data, patients with neck pain treated with lidocaine or lidocaine + steroid showed 4.2- and 4.14-point decreases, in pain score and 15.92- and 14.89-point decreases, respectively, in functional scores. Conclusions The studies showed level I (strong) evidence for short- and long-term improvements in pain relief and functionality with cervical epidural injections of local anesthetic alone or with a steroid in the management of neck pain.
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13
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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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14
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Kim JY, Hong HJ, Lee DC, Kim TH, Hwang JS, Park CK. Comparative analysis of three types of minimally invasive posterior cervical foraminotomy for foraminal stenosis, uniportal endoscopy, biportal endoscopy, and microsurgery: Radiologic and mid-term clinical outcomes. Neurospine 2022; 19:212-223. [PMID: 35130423 PMCID: PMC8987543 DOI: 10.14245/ns.2142942.471] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- Ji Yeon Kim
- Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Hyun Jin Hong
- Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Dong Chan Lee
- Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, Anyang, Korea
- Corresponding Author Dong Chan Lee https://orcid.org/0000-0001-5614-4490 Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, 560 Gyeongsu-daero, Dongan-gu, Anyang 14112, Korea
| | - Tae Hyun Kim
- Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Jin Seob Hwang
- Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Choon Keun Park
- Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, Suwon, Korea
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15
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Kazeminasab S, Nejadghaderi SA, Amiri P, Pourfathi H, Araj-Khodaei M, Sullman MJM, Kolahi AA, Safiri S. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord 2022; 23:26. [PMID: 34980079 PMCID: PMC8725362 DOI: 10.1186/s12891-021-04957-4] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neck pain is one of the most common musculoskeletal disorders, having an age-standardised prevalence rate of 27.0 per 1000 population in 2019. This literature review describes the global epidemiology and trends associated with neck pain, before exploring the psychological and biological risk factors associated with the initiation and progression of neck pain. METHODS The PubMed database and Google Scholar search engine were searched up to May 21, 2021. Studies were included that used human subjects and evaluated the effects of biological or psychological factors on the occurrence or progression of neck pain, or reported its epidemiology. RESULTS Psychological risk factors, such as long-term stress, lack of social support, anxiety, and depression are important risk factors for neck pain. In terms of the biological risks, neck pain might occur as a consequence of certain diseases, such as neuromusculoskeletal disorders or autoimmune diseases. There is also evidence that demographic characteristics, such as age and sex, can influence the prevalence and development of neck pain, although further research is needed. CONCLUSIONS The findings of the present study provide a comprehensive and informative overview that should be useful for the prevention, diagnosis, and management of neck pain.
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Affiliation(s)
- Somaye Kazeminasab
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Deputy, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Parastoo Amiri
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Deputy, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hojjat Pourfathi
- Department of Anesthesiology and Pain Management, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Araj-Khodaei
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Persian Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mark J M Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Saeid Safiri
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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16
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Liu Y, Tang GK, Wang WH, Shi CG, Wang S, Yu L, Yu JM, Ye XJ. Morphology of Herniated Disc as a Predictor for Outcomes of Posterior Percutaneous Full-endoscopic Cervical Discectomy in Treating Cervical Spondylotic Radiculopathy. Orthop Surg 2021; 13:2335-2343. [PMID: 34755465 PMCID: PMC8654662 DOI: 10.1111/os.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/22/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To quantitively characterize the morphology of cervical disc herniation (CDH) causing cervical spondylotic radiculopathy (CSR) and investigate whether the morphological features of CDH are associated with clinical outcomes in CSR patients treated by posterior percutaneous full‐endoscopic cervical discectomy (PPECD). Methods This is a single‐center retrospective study. Eighty‐seven PPECD‐treated patients meeting the inclusion criteria were included between May 2017 and May 2019. Based on preoperative T2‐weighted magnetic resonance imaging (MRI), we designed and measured six morphological parameters of CDH for all patients to reflect its relative position to cervical spinal cord and protruding degree: DC‐SC distance from the center of disc (DC) and the center of spinal cord (SC); DC‐DP distance from the center of cervical disc (DC) to the peak of herniation (DP); internal diameter of the disc; axial length of CDH; central angle of CDH formed by central axes of CDH and spinal cord; the modified index of CDH. We recorded general information, neck disability index (NDI) scores, visual analog scale (VAS) scores of neck and arm of all patients preoperatively and postoperatively at 1‐year follow‐up. The association of preoperative general variables and morphological parameters with clinical outcomes were explored by utilizing logistic regression and receiver operating characteristic curve (ROC) analysis. Results The preoperative neck‐VAS, arm‐VAS, and NDI were significantly decreased after PPECD and remained at a low value at follow‐up. In regards to the morphological parameters of CDH, the mean value of DC‐SC distance, DC‐DP distance, internal diameter of the disc, axial length of CDH, central angle of CDH, and modified index of CDH were 1.61 ± 0.30 cm, 1.66 ± 0.32cm, 1.04 ± 0.21 cm, 0.63 ± 0.19cm, 39.38° ± 11.94°, and 0.39 ± 0.24, respectively. For patients grouped by difference in the recovery rate of NDI and arm‐VAS (excellent improved group, EI; and limited improved group, LI), there were no differences in the age, gender, surgical segments, and morphological parameters, except for the central angle of CDH. According to binary logistic regression analysis, only the preoperative central angle of CDH was significantly associated with postoperative NDI recovery (odds ratio: 0.873; 95% confidence interval: 0.819–0.931, P = 0.002). ROC analysis showed the optimal cut‐off value of the central angle of CDH for predicting the postoperative improvement of functional outcomes is 33.788°. Conclusion Preoperative morphology of CDH is related to the outcomes of CSR patients after PPECD. Patients with a large central angle of CDH (>33.788°) have more likelihood of ameliorating neurological symptoms of CSR. There is the potential to select the central angle of CDH as a predictor for outcomes of PPECD in treating CSR.
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Affiliation(s)
- Yi Liu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Guo-Ke Tang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wei-Heng Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chang-Gui Shi
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Shuang Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lei Yu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiang-Ming Yu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Department of Orthopaedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Jian Ye
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Department of Orthopaedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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17
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Chang PJ, Asher A, Smith SR. A Targeted Approach to Post-Mastectomy Pain and Persistent Pain following Breast Cancer Treatment. Cancers (Basel) 2021; 13:5191. [PMID: 34680339 PMCID: PMC8534110 DOI: 10.3390/cancers13205191] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 01/10/2023] Open
Abstract
Persistent pain following treatment for breast cancer is common and often imprecisely labeled as post-mastectomy pain syndrome (PMPS). PMPS is a disorder with multiple potential underlying causes including intercostobrachial nerve injury, intercostal neuromas, phantom breast pain, and pectoralis minor syndrome. Adding further complexity to the issue are various musculoskeletal pain syndromes including cervical radiculopathy, shoulder impingement syndrome, frozen shoulder, and myofascial pain that may occur concurrently and at times overlap with PMPS. These overlapping pain syndromes may be difficult to separate from one another, but precise diagnosis is essential, as treatment for each pain generator may be distinct. The purpose of this review is to clearly outline different pain sources based on anatomic location that commonly occur following treatment for breast cancer, and to provide tailored and evidence-based recommendations for the evaluation and treatment of each disorder.
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Affiliation(s)
- Philip J. Chang
- Department of Physical Medicine and Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Arash Asher
- Department of Physical Medicine and Rehabilitation, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Sean R. Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA;
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18
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Lin T, Wang Z, Chen G, Liu W. Predictive effect of cervical spinal cord compression and corresponding segmental paravertebral muscle degeneration on the severity of symptoms in patients with cervical spondylotic myelopathy. Spine J 2021; 21:1099-1109. [PMID: 33785472 DOI: 10.1016/j.spinee.2021.03.030] [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: 12/15/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have found that cervical sagittal parameters and spinal cord compression are important risk factors for cervical spondylotic myelopathy (CSM). An increasing number of scholars believe that cervical muscle condition is also one of the factors affecting the severity of symptoms in affected patients. PURPOSE To determine whether: the degree of corresponding segmental paravertebral muscle degeneration is related to the severity of symptoms in patients with CSM; the degree of cervical spinal cord compression can predict the severity of symptoms in patients with CSM. STUDY DESIGN A retrospective study. PATIENT SAMPLE From January 2015 to January 2019, 121 patients with CSM were enrolled. OUTCOME MEASURES The visual analog scale (VAS), neck disability index (NDI) and modified Japanese Orthopedic Association (mJOA) were used to assess cervical spinal function and quality of life. METHODS From January 2015 to January 2019, 121 patients with CSM were enrolled. The inclusion criterion was the presence of complete cervical lateral radiography and magnetic resonance imaging (MRI) data. The following radiographic parameters were measured: (1) C0-C2 Cobb angle; (2) C2-C7 Cobb angle (CL); (3) T1 slope (T1S); (4) neck tilt (NT); (5) C2-C7 sagittal vertical axis (SVA); and (6) T1S-CL. The following MRI parameters were measured: (1) up(low)-fat/muscle; (2) up(low)-fat/centrum; (3) up(low)-muscle/centrum; (4) cervical cord compression index (CCI); (5) S-index; and (6) cervical spinal cord compression area ratio (S0/S1). The VAS, NDI and mJOA were used to assess cervical spinal function and quality of life. The patients were divided into 2 groups according to the mJOA score: group A (mild-moderate symptom group, mJOA score≥12 points) and group B (severe symptom group, mJOA score<12 points). The Pearson correlation coefficient was used to assess the correlations between cervical sagittal parameters, MRI parameters and functional scores. Logistic regression analysis and ROC curve analysis were performed to identify independent risk factors and critical values. RESULTS In patients with CSM, the VAS score is positively correlated with NT, up-fat/centrum, S-index and S0/S1. The NDI is positively correlated with NT, up-fat/muscle, up-fat/centrum, S-index, and S0/S1 and negatively correlated with C0-2N and CL. The mJOA score is positively correlated with CL and negatively correlated with C2-7 SVA, CCI, S-index, and S0/S1. Thus, corresponding segmental paravertebral muscle degeneration has relevance to neck pain, but it is not related to limb weakness, neurological dysfunction, gait impairment, sensation or bladder/bowel function dysfunction. Through mJOA score grouping and binary logistic regression analysis, we found that S0/S1 is the only independent risk factor for severe symptoms in patients with CSM. When S0/S1>0.295, the clinical symptoms of patients are more severe. Thus, in clinical practice, when the degree of spinal cord compression exceeds 30%, the clinical symptoms are more severe. CONCLUSIONS In patients with CSM, corresponding segmental paravertebral muscle degeneration has relevance to neck pain, but it does not relate to limb weakness, neurological dysfunction, gait impairment, sensation or bladder/bowel function dysfunction. Cervical spinal cord compression is the only independent risk factor;when the degree of spinal cord compression exceeds 30%, the clinical symptoms are more severe.
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Affiliation(s)
- Taotao Lin
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 086-350001, China
| | - Zhenyu Wang
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 086-350001, China
| | - Gang Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 086-350001, China
| | - Wenge Liu
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 086-350001, China.
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19
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Kuligowski T, Skrzek A, Cieślik B. Manual Therapy in Cervical and Lumbar Radiculopathy: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116176. [PMID: 34200510 PMCID: PMC8201115 DOI: 10.3390/ijerph18116176] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 01/22/2023]
Abstract
The aim of this study was to describe and update current knowledge of manual therapy accuracy in treating cervical and lumbar radiculopathy, to identify the limitations in current studies, and to suggest areas for future research. The study was conducted according to PRISMA guidelines for systematic reviews. A comprehensive literature review was conducted using PubMed and Web of Science databases up to April 2020. The following inclusion criteria were used: (1) presence of radiculopathy; (2) treatment defined as manual therapy (i.e., traction, manipulation, mobilization); and (3) publication defined as a Randomized Controlled Trial. The electronic literature search resulted in 473 potentially relevant articles. Finally, 27 articles were accepted: 21 on cervical (CR) and 6 in lumbar radiculopathy (LR). The mean PEDro score for CR was 6.6 (SD 1.3), and for LR 6.7 (SD 1.6). Traction-oriented techniques are the most frequently chosen treatment form for CR and are efficient in reducing pain and improving functional outcomes. In LR, each of the included publications used a different form of manual therapy, which makes it challenging to summarize knowledge in this group. Of included publications, 93% were either of moderate or low quality, which indicates that quality improvement is necessary for this type of research.
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Affiliation(s)
- Tomasz Kuligowski
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (T.K.); (A.S.)
| | - Anna Skrzek
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (T.K.); (A.S.)
| | - Błażej Cieślik
- Faculty of Health Sciences, Jan Dlugosz University in Czestochowa, 42-200 Czestochowa, Poland
- Correspondence:
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20
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Borrella-Andrés S, Marqués-García I, Lucha-López MO, Fanlo-Mazas P, Hernández-Secorún M, Pérez-Bellmunt A, Tricás-Moreno JM, Hidalgo-García C. Manual Therapy as a Management of Cervical Radiculopathy: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9936981. [PMID: 34189141 PMCID: PMC8195637 DOI: 10.1155/2021/9936981] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/03/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cervical radiculopathy is defined as a disorder involving dysfunction of the cervical nerve roots characterised by pain radiating and/or loss of motor and sensory function towards the root affected. There is no consensus on a good definition of the term. In addition, the evidence regarding the effectiveness of manual therapy in radiculopathy is contradictory. OBJECTIVE To assess the effectiveness of manual therapy in improving pain, functional capacity, and range of motion in treating cervical radiculopathy with and without confirmation of altered nerve conduction. METHODS Systematic review of randomised clinical trials on cervical radiculopathy and manual therapy, in PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus databases. The PRISMA checklist was followed. Methodological quality was evaluated using the PEDro scale and RoB 2.0. tool. RESULTS 17 clinical trials published in the past 10 years were selected. Manual therapy was effective in the treatment of symptoms related to cervical radiculopathy in all studies, regardless of the type of technique and dose applied. CONCLUSIONS This systematic review did not establish which manual therapy techniques are the most effective for cervical radiculopathy with electrophysiological confirmation of altered nerve conduction. Without this confirmation, the application of manual therapy, regardless of the protocol applied and the manual therapy technique selected, appears to be effective in reducing chronic cervical pain and decreasing the index of cervical disability in cervical radiculopathy in the short term. However, it would be necessary to agree on a definition and diagnostic criteria of radiculopathy, as well as the definition and standardisation of manual techniques, to analyse the effectiveness of manual therapy in cervical radiculopathy in depth.
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Affiliation(s)
- Sergio Borrella-Andrés
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Isabel Marqués-García
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - María Orosia Lucha-López
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Pablo Fanlo-Mazas
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Mar Hernández-Secorún
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Albert Pérez-Bellmunt
- Department of Basic Sciences, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés 08195, Spain
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallés 08195, Spain
| | - José Miguel Tricás-Moreno
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - César Hidalgo-García
- Health Sciences Faculty, University of Zaragoza, Zaragoza 50009, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
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21
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Firmino GF, Schulze ML, Schlindwein MAM, Rampeloti B, Gonçalves MVM, Maçaneiro CH, Dos Santos RA. Neuralgic Amyotrophy: Its Importance in Orthopedics Practice. Spine Surg Relat Res 2021; 5:232-237. [PMID: 34435146 PMCID: PMC8356235 DOI: 10.22603/ssrr.2021-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/17/2021] [Indexed: 11/23/2022] Open
Abstract
The present academic work aims to contribute to an early diagnosis of neuralgic amyotrophy (NA) because of its high prevalence in the population. This disease is a neuromuscular syndrome with unclear etiology; it affects mostly the brachial plexus, causing acute pain in the affected shoulder, paralysis, and disabilities. Considering the importance of an early treatment that can modify the prognosis of the patient, knowing the last updates about the syndrome as its clinical presentation is important. Data analysis was conducted through an online non-systematic review that indicated the epidemiology, pathophysiology, and differential diagnosis and prognosis of NA. Knowledge of the clinical features of NA is not common; however, it is important in orthopedic practice because it requires differentiation from spine pathologies.
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Affiliation(s)
- George Fagundes Firmino
- Medical Student at Department of Medicine, University of the Region of Joinville, Joinville, Brazil
| | - Milena Luisa Schulze
- Medical Student at Department of Medicine, University of the Region of Joinville, Joinville, Brazil
| | | | - Breno Rampeloti
- Medical Student at Department of Medicine, University of the Region of Joinville, Joinville, Brazil
| | | | - Carlos Henrique Maçaneiro
- Professor of Orthopedics and Traumatology, Department of Medicine, University of the Region of Joinville, Joinville, Brazil
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Lam K, Peolsson A, Soldini E, Löfgren H, Wibault J, Dedering Å, Öberg B, Zsigmond P, Barbero M, Falla D. Larger pain extent is associated with greater pain intensity and disability but not with general health status or psychosocial features in patients with cervical radiculopathy. Medicine (Baltimore) 2021; 100:e23718. [PMID: 33663038 PMCID: PMC7909108 DOI: 10.1097/md.0000000000023718] [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: 07/02/2020] [Accepted: 11/16/2020] [Indexed: 01/05/2023] Open
Abstract
Pain as a result of cervical radiculopathy (CR) can be widespread, nondermatomal and individually specific, but the association between pain extent and other clinical features has never been explored. The objective of this study is to investigate whether pain extent relates to clinical variables including pain intensity in addition to health indicators including disability, general health, depression, somatic anxiety, coping strategies or self-efficacy.An observational cohort study was conducted. Participants were recruited from 4 hospital spinal centres in Sweden. Pain extent was quantified from the pain drawings of 190 individuals with cervical disc disease, verified with magnetic resonance imaging (MRI) and compatible with clinical findings (examined by a neurosurgeon), that show cervical nerve root compression. Pain extent was evaluated in relation to neck pain, arm pain, and headache intensity. Multiple linear regression analysis were then used to verify whether pain extent was associated with other health indicators including disability, health-related quality of life, depression, somatic anxiety, coping strategies and self-efficacy.Pain extent was directly related to neck, arm and headache pain intensity (all P < .01). Multiple linear regression revealed that pain extent was significantly associated only to the level of perceived disability (P < .01).Increased pain extent in people with CR is associated with higher headache, neck and arm pain intensity, and disability but not measures of general health, depression, somatic anxiety, coping strategies or self-efficacy.
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Affiliation(s)
- Kwun Lam
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of physiotherapy, Linköping University, Linköping, Sweden
| | - Emiliano Soldini
- Research Methodology Competence Centre, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Håkan Löfgren
- Neuro-Orthopedic Center, Ryhov Hospital, Region Jönköping County, Jönköping. Jönköping, Region Jönköping County, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Johanna Wibault
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of physiotherapy, Linköping University, Linköping, Sweden
- Department of Activity and Health, and Department of Health, Medicine and Caring Sciencess, Linköping University, Linköping, Sweden
| | - Åsa Dedering
- Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of physiotherapy, Linköping University, Linköping, Sweden
| | - Peter Zsigmond
- Department of Neurosurgery, Linköping University Hospital, Linköping
| | - Marco Barbero
- Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Wang Q, Li H, Kong J, Li X, Feng L, Wu Z. Diagnostic agreement between 3.0-T MRI sequences of nerve root and surgery in patients with cervical radiculopathy: A retrospective study. Medicine (Baltimore) 2021; 100:e24207. [PMID: 33530213 PMCID: PMC7850720 DOI: 10.1097/md.0000000000024207] [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: 05/08/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023] Open
Abstract
Currently, minute structures, such as cervical nerve roots, can be viewed using magnetic resonance imaging (MRI) sequences; however, studies comparing multiple sequences in the same set of patients are rare. The aim of the study is to compare the diagnostic values of three 3.0-T MRI sequences used in the imaging of cervical nerve roots.This study included 2 phases. In the first phase (n = 45 patients), the most optimal MRI sequence was determined. In the second phase, this MRI sequence was compared with surgical results (n = 31 patients). The three-dimensional double-echo steady-state (3D-DESS), multi-echo data image combination (MEDIC), and 3D sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE) sequences were performed to analyze the image quality. Furthermore, the most optimal MRI sequence was compared with surgical results to determine the agreement rate.The image quality scores of the 3 sequences were significantly different (P < .05). The score for 3D-DESS sequence was superior to that of MEDIC sequence, while the score for 3D-SPACE sequence was the worst. For visualization of compressed nerve roots, 3D-DESS sequence was superior to the other 2 sequences in terms of the total quality score and compressed nerve root score. Therefore, 3D-DESS sequence was used for MRI in 31 patients with cervical spondylosis in the second phase of this study. The diagnostic agreement rate was 93.5%.This study concluded that in patients with cervical radiculopathy, the 3D-DESS sequence is superior to the MEDIC and 3D-SPACE sequences and shows a high agreement rate with the surgical diagnosis.
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Affiliation(s)
| | | | - Jianjun Kong
- Department of Orthopedics, General Hospital of Jizhong Energy Xingtai Mining Group, Xingtai, Hebei, China
| | | | | | - Zhanyong Wu
- Department of Orthopedics, General Hospital of Jizhong Energy Xingtai Mining Group, Xingtai, Hebei, China
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Hu J, Chen F, Qiu G, Sun T, Yang H, Shen H, Tong P, Chai Y, Zhang X, Zhang W, Yang Z, Jiang H, Pan Y, Zhu T, He C, Xiao W. Jingshu Keli for treating cervical spondylotic radiculopathy: The first multicenter, randomized, controlled clinical trial. J Orthop Translat 2020; 27:44-56. [PMID: 33376673 PMCID: PMC7758457 DOI: 10.1016/j.jot.2020.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background Jingshu Keli (or Jingshu granules), a traditional Chinese medicine, are widely used for treating cervical spondylotic radiculopathy in China; however, no randomized, double-blind, controlled study has verified their effectiveness. Purpose To evaluate the efficacy and safety of Jingshu Keli for the treatment of cervical spondylotic radiculopathy in a randomized controlled trial. Design From August 2015 to July 2017, a multicenter, randomized, double-blind, placebo-controlled trial was conducted at 13 large- and medium-sized hospitals in China. Patient sample A total of 360 and 120 patients were initially enrolled in the Jingshu and control groups, respectively; 386 patients completed the study, with 299 in the Jingshu group and 87 in the control group. Outcome measures The main index for evaluating the curative effect was the pain score on a visual analogue scale (VAS; 0–100 points). Methods All patients were administered a bag of Jingshu Keli or placebo 3 times a day for 4 weeks, and were interviewed at the second and fourth weeks. The decrease in pain scores and rate of change in pain scores after treatment were calculated, related laboratory indices were reviewed, and adverse reactions were recorded. Results In the Per Protocol Set (PPS) analysis, the baseline pain VAS scores in the control and Jingshu groups were 49.31 ± 6.97 and 50.06 ± 7.33, respectively, with no significant difference between the groups (P > 0.05). While there were no differences at 2 weeks between groups, at four weeks the pain VAS scores in the control and Jingshu groups decreased by 12.86 ± 13.45 and 22.72 ± 15.08, respectively relative to the values at baseline, with significant group differences (P < 0.0001). While there were similar significant differences between the groups (P < 0.0001) in the Full Analysis Set (FAS) analyses neither group achieved the minimal clinically important difference at any time point. Conclusions Jingshu Keli are effective for the treatment of cervical spondylotic radiculopathy. Translational potential statement This is the first prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial that confirmed the clinical efficacy and safety of Jingshu Keli for treating cervical spondylotic radiculopathy, which can provide evidence for clinical treatment.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- ANCOVA, analysis of covariance
- AST, aspartate aminotransferase
- BUN, blood urea nitrogen
- Cervical spondylotic radiculopathy
- Cr, creatine
- FAS, full analysis set
- Herbal medicine
- ITT, intention-to-treat
- Jingshu keli
- LOCF, last observation carried forward
- NAG, urine N-acetyl-beta-d-glucosaminidase
- PPS, per-protocol set
- PT, preferred term
- RCT, randomized controlled trial
- Randomized controlled trial
- SAS, safety analysis set
- SNL, spinal nerve ligation
- SOC, system organ class
- TBIL, total bilirubin
- Traditional Chinese medicine
- VAS, visual analogue scale
- γ-GT, γ-glutamyl transpeptidase
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Affiliation(s)
- Jianhua Hu
- Department of Orthopedics, Peking Union Medical College Hospital (PUMCH), Peking, China
| | - Feng Chen
- Department of Orthopedics, Peking Union Medical College Hospital (PUMCH), Peking, China
| | - Guixing Qiu
- Department of Orthopedics, Peking Union Medical College Hospital (PUMCH), Peking, China
| | - Tiansheng Sun
- Department of Orthopedics, People's Liberation Army General Hospital, Peking, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
| | - Huiyong Shen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peijian Tong
- Department of Orthopedics, Zhejiang Provincial Hospital of TCM, Hangzhou, Zhejiang, China
| | - Yimin Chai
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Xueli Zhang
- Department of Spine Surgery, Tianjin People's Hospital, Tianjin, China
| | - Weibin Zhang
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Zhidong Yang
- Department of Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hong Jiang
- Department of Orthopedics, Suzhou Hospital of Traditional Chinese Medicine, Soochow, Jiangsu, China
| | - Yalin Pan
- Department of Orthopedics, People's Hospital of Anyang City, Anyang, Henan, China
| | - Tianliang Zhu
- Department of Orthopedics, Chongqing General Hospital, Chongqing, China
| | - Chengjian He
- Department of Orthopedics, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei, China
| | - Weiping Xiao
- Department of Orthopedics, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi China
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A Comparative Study on the Minimal Invasiveness of Full-Endoscopic and Microendoscopic Cervical Foraminotomy Using Intraoperative Motor Evoked Potential Monitoring. MEDICINA-LITHUANIA 2020; 56:medicina56110605. [PMID: 33187319 PMCID: PMC7698079 DOI: 10.3390/medicina56110605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/19/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Full-endoscopic cervical foraminotomy (FECF) and microendoscopic cervical foraminotomy (MECF) are effective surgeries for cervical radiculopathy and are considered minimally invasive in terms of damage to paraspinal soft tissue. However, no studies have quantitatively compared FECF and MECF in terms of neurological invasiveness. The aim of this study was to compare the neurological invasiveness of FECF and MECF using intraoperative motor evoked potential (MEP) monitoring. Materials and Methods: A chart review was conducted of 224 patients with cervical radiculopathy who underwent FECF or MECF between April 2014 and March 2020. Patients were 37 women and 187 men, with a mean age of 51 (range, 21–86) years. FECF was performed in 143 cases and MECF was performed in 81 cases. Results: Average MEP amplitude significantly increased from 292 mV before to 677 mV after nerve root decompression in patients who underwent the FECF. The average improvement rate was 273%. In patients who underwent the MECF, average MEP amplitude significantly increased from 306 mV before to 432 mV after nerve root decompression. The average improvement rate was 130%. The improvement rate was significantly higher for FECF compared with MECF. Conclusions: MEP amplitude increased after nerve root decompression in both FECF and MECF, but the improvement rate was higher in FECF. These results suggest that FECF might be more minimally invasive than MECF in terms of neurological aspects.
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Is Facet Joint Distraction Associated with Functional Outcome in Patients with Cervical Spondylotic Radiculopathy Treated with Single-Segment Anterior Cervical Discectomy and Fusion? World Neurosurg 2020; 140:e53-e60. [DOI: 10.1016/j.wneu.2020.04.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/20/2022]
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Carvalho-E-Silva AP, Ferreira ML, Ferreira PH, Harmer AR. Does type 2 diabetes increase the risk of musculoskeletal pain? Cross-sectional and longitudinal analyses of UK biobank data. Semin Arthritis Rheum 2020; 50:728-734. [PMID: 32521327 DOI: 10.1016/j.semarthrit.2020.05.007] [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: 08/20/2019] [Revised: 03/22/2020] [Accepted: 05/04/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We investigated cross-sectional associations and whether type 2 diabetes increases the risk of musculoskeletal pain after adjusting for the presence of important comorbidities. METHODS The study employed data from the UK Biobank participants: 495,327 in cross-sectional (2006-2010) and 16,875 in longitudinal (2014-2016) analyses. Type 2 diabetes was self-reported and subsequently confirmed during an interview. Musculoskeletal pain was diagnosed by the participants' reports of back, knee, hip, or neck/shoulder pain that interfered with usual activities in the last month (recent pain), and for more than 3 months (chronic pain). RESULTS In cross-sectional adjusted logistic regression analyses, type 2 diabetes was associated with recent and chronic neck/shoulder pain [OR 1.14, 95%CI 1.10-1.18; OR 1.15, 95%CI 1.10-1.19] and hip pain [OR 1.13, 95%CI 1.08-1.17; OR 1.14 95%CI 1.09-1.19]; and with chronic knee pain [OR 1.01, 95%CI 1.01-1.01]. In longitudinal adjusted analyses, type 2 diabetes increased the risk of recent and chronic neck/shoulder pain [OR 1.39, 95%CI 1.01-1.91; OR 1.56; 95%CI 1.14-2.19]. CONCLUSION People with type 2 diabetes are more likely to report musculoskeletal pain in shoulder/neck, knee or hip. In addition, people with type 2 diabetes, particularly women, are more likely to present with a future episode of neck/shoulder pain. This study highlights the need to consider musculoskeletal screening among patients with diabetes and also serves as a stimulus for investigation of the mechanisms that explain the relationship between musculoskeletal pain and type 2 diabetes; with a view to prevention or improving future treatment.
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Affiliation(s)
- Ana Paula Carvalho-E-Silva
- Musculoskeletal Health Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney
| | - Paulo H Ferreira
- Musculoskeletal Health Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alison R Harmer
- Musculoskeletal Health Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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28
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Abstract
Pain is often the initial complaint for which patients seek medical care, presenting both a diagnostic and therapeutic challenge to the primary care provider. The appreciation of pain is not merely the result of abnormal sensory stimulation causing an unpleasant sensation but rather a combination of the recognition of the somatic discomfort in association with an emotional response to that discomfort. The perception of pain and the extent of distress and disability can vary depending on previous experience, cultural background, situational factors, and comorbid psychiatric disease. Though acute pain is usually the result of tissue damage, this is not always the case, as evidenced by primary headache disorders. Chronic pain may be the result of an injury, irreversible underlying disease, or clinical conditions such as fibromyalgia for which the mechanism remains unclear. Treatment of the underlying cause will usually effect a resolution or improvement in the pain, but when the discomfort persists, a consultation with a neurologist or pain management specialist should be considered.
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Affiliation(s)
- Victor C Wang
- Department of Neurology, Department of Anesthesia, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - William J Mullally
- Graham Headache Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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29
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Liang L, Wei X, Feng M, Zhu L, Yu J, Yang G, Yin X, Zhou S, Li K, Yang M, Wang X. Huangqi Guizhi Wuwu Decoction for treating cervical radiculopathy: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19137. [PMID: 32049834 PMCID: PMC7035008 DOI: 10.1097/md.0000000000019137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Huangqi Guizhi Wuwu Decoction (HGWD) is a common prescription for the treatment of cervical radiculopathy (CR). And the effectiveness and safety of HGWD for CR were assessed in this study. METHODS Seven databases were searched. Randomized controlled trials involving HGWD alone or HGWD combined with conventional treatment were enrolled. The authors in pairs independently assessed the risk of bias and extracted the data. RESULTS Eight studies involving 783 participants with CR were included. Meta-analysis revealed that the efficacy of HGWD for CR was significantly superior compared with control treatment (risk ratio = 1.12, 95% confidence interval [CI]:1.06-1.19, Z = 3.71; P = .0002). Compare with control group, there is an increase in visual analog scale (mean difference [MD] = 0.99; 95% CI: 0.83-1.14; Z = 12.57; P < .00001). There was also an improvement of neck disability index (MD = 9.2; 95% CI: 8.28-10.11; Z = 19.75; P < .00001). Adverse events were not mentioned in the 8 trials. CONCLUSION HGWD alone or HGWD plus other treatment may be helpful to patients with CR. However, the methodological quality of the randomized controlled trials was generally low. Larger and better-designed randomized controlled trials are recommended.
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Affiliation(s)
- Long Liang
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Xu Wei
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Minshan Feng
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Liguo Zhu
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Jie Yu
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Gongbo Yang
- Department of Traumatology and Orthopedics, Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences, Haidian District, Beijing
| | - Xunlu Yin
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Shuaiqi Zhou
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Kaiming Li
- Department of Spine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Chaoyang District
| | - Mao Yang
- First Affiliated Hospital of Anhui University of Chinese Medicine, Shushan District, Anhui, China
| | - Xingyu Wang
- First Affiliated Hospital of Anhui University of Chinese Medicine, Shushan District, Anhui, China
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30
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Predictive Effect of Cervical Sagittal Parameters on Conservative Treatment of Single-Segment Cervical Spondylotic Radiculopathy. World Neurosurg 2020; 134:e1028-e1036. [DOI: 10.1016/j.wneu.2019.11.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/17/2022]
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31
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Mesregah MK, Chantarasirirat K, Formanek B, Buser Z, Wang JC. Perioperative complications of inpatient and outpatient single-level posterior cervical foraminotomy: a comparative retrospective study. Spine J 2020; 20:87-93. [PMID: 31442615 DOI: 10.1016/j.spinee.2019.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Posterior cervical foraminotomy (PCF) is a relatively safe procedure for the treatment of cervical radiculopathy. Though most often performed as an inpatient procedure, there is an increasing number of patients treated in an outpatient setting. PURPOSE This study aimed to compare the perioperative complication rates associated with inpatient and outpatient single-level PCF. STUDY DESIGN/SETTING Retrospective database study. PATIENT SAMPLE Patients with cervical radiculopathy who underwent inpatient or outpatient single-level PCF between 2007 to the first quarter of 2016. OUTCOME MEASURES Charlson Comorbidity Index (CCI) was used as a broad measure of comorbidity. Surgical complications included cervical nerve root injury, dural tear, wound complications, infection, dysphagia, cervicalgia, and revision surgery. Medical complications included pulmonary embolism and lower limb deep vein thrombosis, acute myocardial infarction, acute respiratory failure, pneumonia, sepsis, and urinary complications. METHODS This study was a retrospective review of patients who received single-level PCF from 2007 to the first quarter of 2016 as either outpatients or inpatients using the Humana subset of the PearlDiver Patient Record Database. The incidence of perioperative medical and surgical complications was queried using relevant International Classification of Diseases (ICD-9-CM and ICD-10-CM) and Current Procedural Terminology codes. Multivariate logistic regression analysis, adjusted for age, gender, and CCI, was performed to calculate odds ratios (ORs) of complications among inpatients relative to outpatients treated with PCF. Propensity score matching was done, and comparisons were made for postoperative complications. RESULTS Throughout the time period, 1,469 and 1,192 patients received inpatient and outpatient single-level PCF, respectively. The mean CCIs±standard deviation of inpatient and outpatient groups undergoing PCF were 2.83±3.11 and 1.46±2.21, respectively (p<.001). After propensity score matching, patients who received PCF in an inpatient setting showed significantly higher rates of wound complications (OR=1.53, 95% confidence interval [CI]=1.04-2.23; p=.029), infection (OR=1.91, CI=1.15-3.15; p=.012), acute respiratory failure (OR=2.50, CI=1.23-5.08; p=.011), and urinary tract infections and incontinence (OR=2.11, CI=1.32-3.38; p=.002). CONCLUSIONS Outpatient single-level PCF was associated with a lower rate of perioperative medical and surgical complications. The PCF in the outpatient setting can potentially be a safe procedure for the treatment of cervical radiculopathy with appropriate patient selection.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt
| | - Kunlavit Chantarasirirat
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Blake Formanek
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Liang L, Cui X, Feng M, Zhou S, Yin X, He F, Sun K, Yin H, Xie R, Zhang D, Zhou Y, Wu Y, Tan G, Wang Z, Wang X, Zhang J, Zhu L, Yu J, Wei X. The effectiveness of exercise on cervical radiculopathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16975. [PMID: 31464943 PMCID: PMC6736459 DOI: 10.1097/md.0000000000016975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Significant functional limitations and disabilities are common presenting complaints for people suffering from cervical radiculopathy. Exercise is a common conservative treatment for this disease. Therefore, we conducted a systematic review and meta-analysis to explore the efficacy of exercise in the treatment of cervical radiculopathy. METHODS A systematic literature search for studies will be performed in 7 databases, including PubMed, Web of Science, Embase, the Cochrane Library, the Chinese National Knowledge Infrastructure Database (CNKI), Wanfang database, and VIP database. The methodological quality of the included studies using the risk bias assessment tool of Cochrane and the level of evidence for results are assessed by the GRADE method. Statistical analysis is conducted with Revman 5.3. RESULTS This systematic review and meta-analysis will provide a synthesis of existed evidences for exercise on cervical radiculopathy. CONCLUSION The conclusion of this study will provide evidence to assess effectiveness of exercise on cervical radiculopathy, which can further guide clinical decision-making. PROSPERO REGISTRATION NUMBER CRD42019121886.
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Affiliation(s)
- Long Liang
- Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Xin Cui
- Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Minshan Feng
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Dongcheng District
| | - Shuaiqi Zhou
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing University of Chinese Medicine, Chaoyang District, Beijing
| | - Xunlu Yin
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Dongcheng District
| | - Feng He
- Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Kai Sun
- Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - He Yin
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Dongcheng District
| | - Rong Xie
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing University of Chinese Medicine, Chaoyang District, Beijing
| | - Dian Zhang
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing University of Chinese Medicine, Chaoyang District, Beijing
| | - You Zhou
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing University of Chinese Medicine, Chaoyang District, Beijing
| | - Yue Wu
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing University of Chinese Medicine, Chaoyang District, Beijing
| | - Guihong Tan
- Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Zhengdong Wang
- Wangjing Hospital of China Academy of Chinese Medical Sciences
| | - Xingyu Wang
- First Affiliated Hospital of Anhui University of Chinese Medicine, Shushan District, Anhui, China
| | - Jianhua Zhang
- First Affiliated Hospital of Anhui University of Chinese Medicine, Shushan District, Anhui, China
| | - Liguo Zhu
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Dongcheng District
| | - Jie Yu
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Dongcheng District
| | - Xu Wei
- Wangjing Hospital of China Academy of Chinese Medical Sciences
- Beijing Key Laboratory of Orthopedics of Traditional Chinese Medicine, Dongcheng District
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Choi HS, Lee YJ, Kim MR, Cho JH, Kim KW, Kim EJ, Ha IH. Survey of Integrative Treatment Practices of Korean Medicine Doctors for Cervical Disc Herniation: Preliminary Data for Clinical Practice Guidelines. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:2345640. [PMID: 31534461 PMCID: PMC6732643 DOI: 10.1155/2019/2345640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/18/2018] [Accepted: 12/03/2018] [Indexed: 01/08/2023]
Abstract
A survey study was conducted in Korean medicine doctors who provide nonsurgical integrative treatment for cervical disc herniation (CDH) at spine-specialty hospitals to assess usual treatment practices, diagnosis and treatment methods, and related adverse events for CDH. The questionnaire was jointly developed by clinical experts and methodology experts and was administered to 197 Korean medicine doctors (response rate: 84.9% (n = 197/232)) practicing at spine-specialty Korean medicine hospitals for analysis of general sociodemographic information, practice patterns of CDH including diagnosis and treatment strategies, CDH prognosis, and treatment safety. The average clinical experience of respondents was 9.3±6.4 years, and 4.0±1.8 weeks were regarded to be needed for CDH pain to decrease by 50% and 9.1±3.4 weeks to decrease by 80%. Eight-Principle Pattern and Meridian System Identification were the most commonly used Korean medicine syndrome differentiation methods, and CDH was most often considered to be a result of Qi stagnation and Blood coagulation. The Spurling test was reported to be important in physical examination, and magnetic resonance (MR) images were mostly used for diagnosis and treatment of CDH of various diagnostic tools. Treatment mainly consisted of a nonsurgical, integrative multimodal approach comprising acupuncture, pharmacopuncture, herbal medicine, and Chuna manual therapy. Shinbaro pharmacopuncture and Chungpa-jun, which are well-established herbal treatments supported by evidence, were considered to be of high importance in CDH treatment. With regard to safety, acupuncture was considered to be the safest, while bee venom pharmacopuncture was of highest concern due to potential hypersensitivity. This study is the first report to investigate current practice patterns and approach of Korean medicine doctors to CDH treatment. This data may be of significance to Korean medicine doctors in drawing clinical guidelines and conducting randomized controlled trials (RCTs) to generate high-level evidence on the effectiveness of nonsurgical integrative medicine treatments for CDH.
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Affiliation(s)
- Hee Seung Choi
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Me-riong Kim
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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An SJ, Hong SJ, Kim YU, Lee YK. Best cut-off point of the cervical facet joint area as a new morphological measurement tool to predict cervical foraminal stenosis. J Pain Res 2019; 12:1325-1330. [PMID: 31114310 PMCID: PMC6497142 DOI: 10.2147/jpr.s204567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/06/2019] [Indexed: 01/18/2023] Open
Abstract
Purpose: One of the main factor of cervical foraminal stenosis (CFS) is the hypertrophic change of the cervical facet joint. In order to analyze the connection between CFS and the facet joint hypertrophy, we devised a new morphological parameter, called the cervical facet joint cross-sectional area (CFJA). The CFJA has not yet been investigated for its association with CFS. We hypothesized that the CFJA is an important morphologic parameter in the diagnosis of CFS. Patients and methods: All patients over 50 years of age were included. Data regarding the CFJA were collected from 160 subjects with CFS. A total of 162 control individuals underwent cervical spine magnetic resonance imaging (CMRI) as part of a routine medical examination. Axial T2-weighted CMRI images were acquired from all subjects. We used a picture archiving system to analyze the cross-sectional area of the bone margin of the cervical facet joint at the level of the most stenotic cervical spine in the axial plane. Results: The average CFJA was 109.07±20.91 mm2 in the control group, and 126.75±22.59 mm2 in the CFS group. The CFS group was found to have significantly higher levels of the CFJA (p<0.001) than the control group. ROC curve estimation was used to verify the validity of the CFJA as a new predictor of CFS. In the CFS group, the best cut off-point was 113.14 mm2, with sensitivity =70.6%, specificity =68.6%, and AUC =0.72 (95% CI, 0.66–0.77). Conclusions: CFJA high values were closely associated with a possibility of CFS. We concluded CFJA is easy to use, fast, and useful new morphological parameter to predict CFS.
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Affiliation(s)
- Sang Joon An
- Department of Neurology, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Seok Jun Hong
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University, College of Medicine, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Yoon Kyung Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University, College of Medicine, Seoul, Republic of Korea
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Zhang X, Zhang Z, Wen J, Lu J, Sun Y, Sang D. The effectiveness of therapeutic strategies for patients with radiculopathy: A network meta-analysis. Mol Pain 2018; 14:1744806918768972. [PMID: 29651898 PMCID: PMC5900815 DOI: 10.1177/1744806918768972] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives The aim of this network meta-analysis is to assess the effectiveness of therapeutic strategies for patients with radiculopathy, including physical, medical, surgical, and other therapies. Methods We electronically searched electronic databases including PubMed and Embase for randomized controlled trials. The response rate and visual analog scale of pain change were considered as primary outcomes. The outcomes were measured by odds ratio (OR) value and corresponding 95% credible intervals (CrIs) or standardized mean difference (MD) with 95% CrIs. Besides, surface under cumulative ranking curve (SUCRA) were performed to rank efficacy and safety of treatments on each end points. Results A total of 16 eligible studies with 1071 subjects were included in this analysis. Our results showed that corticosteroid was significantly more effective than control regarding the response rate (OR = 3.86, 95% CrI: 1.16, 12.55). Surgery had a better performance in pain change compared with control (MD = −1.92, 95% CrI: −3.58, −0.15). According to the SUCRA results, corticosteroid, collar, and physiotherapy ranked the highest concerning response rate (SUCRA = 0.656, 0.652, and 0.610, respectively). Surgery, traction, and corticosteroid were superior to others in pain change (SUCRA = 0.866, 0.748, and 0.589, respectively). Conclusion According to the network meta-analysis result, we recommended surgery as the optimal treatment for radiculopathy patients; traction and corticosteroids were also recommended for their beneficial interventions.
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Affiliation(s)
- Xiaoyu Zhang
- 1 Department of General Rehabilitation, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Zhiqiang Zhang
- 2 Community Chronic Disease Research Center, Institute of Chinese Basic Clinical Medicine, 71046 China Academy of Chinese Medical Sciences , Beijing, China
| | - Jianzhong Wen
- 3 Department of Anesthesiology, Second Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Lu
- 4 Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingchun Sun
- 5 Chinese Medicine Treatment Center, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Dechun Sang
- 1 Department of General Rehabilitation, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
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Landén Ludvigsson M, Peterson G, Peolsson A. Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash - Analyses of a randomized clinical trial. Sci Rep 2018; 8:12409. [PMID: 30120313 PMCID: PMC6098137 DOI: 10.1038/s41598-018-30556-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/02/2018] [Indexed: 12/02/2022] Open
Abstract
Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA. Pain/bothersomeness frequency, six measures of arm pain/paraesthesia (VAS scales), and four clinical neurological tests were evaluated after 3 months. The NSE group reported the lowest frequency and lowest levels of arm pain, the highest proportion of participants with at least 50% pain reduction and the highest proportion of normal arm muscle force. The NSEB group reported increased normal tendon reflexes. No improvements were recorded for the PPA group. Neck-specific exercise may improve arm pain and decrease signs of neurological deficits, but the addition of a behavioural approach does not seem to be of additional benefit.
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Affiliation(s)
- Maria Landén Ludvigsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden.
- Rehab Väst, County Council of Östergötland, Department of Rehabilitation and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
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Onda A, Kimura M. Comparisons between the efficacy of limaprost alfadex and pregabalin in cervical spondylotic radiculopathy : design of a randomized controlled trial. Fukushima J Med Sci 2018; 64:73-81. [PMID: 30012938 DOI: 10.5387/fms.2018-07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cervical spondylotic radiculopathy (CSR) is a relatively common neurological disease caused by the mechanical compression of nerve roots. Limaprost, a prostaglandin E1 derivative, functions as a vasodilator and has been used in the treatment of lumbar spinal stenosis in Japan. However, the effects of limaprost in cervical radiculopathy remain unclear. Our aim was to compare the efficacy of limaprost with that of pregabalin, which is widely used for the treatment of neuropathic pain. METHODS In this randomized trial, patients with CSR received either limaprost or pregabalin orally for 8 weeks, along with nonsteroidal anti-inflammatory drugs. The primary outcomes were assessed using a numerical rating scale of pain and numbness, both at rest and during movement. Secondary outcomes were assessed using Short Form-36, provocation tests, painDETECT questionnaire, and subjective global assessment. The obtained data were evaluated according to the per-protocol analysis principle. RESULTS A total of 46 patients were enrolled in this study, and 35 were available for analysis. A greater reduction in pain score was observed in neck pain during movement, and scapular and arm pain both at rest and during movement in the pregabalin-treated group up to 4 weeks. In the limaprost-treated group, numbness of the arm during movement showed a marked alleviation compared to the pregabalin-treated group at 8 weeks. There were no apparent differences between the two groups in terms of the secondary outcomes. CONCLUSIONS Although pregabalin provided an earlier pain relief than limaprost, limaprost was superior to pregabalin in treating arm numbness. Limaprost might be one of the effective therapeutic options for CSR in primary care settings.
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Affiliation(s)
- Akira Onda
- Department of Orthopaedic Surgery, Zenshukai Hospital
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Effectiveness of a multimodal pain management concept for patients with cervical radiculopathy with focus on cervical epidural injections. Sci Rep 2017; 7:7866. [PMID: 28801567 PMCID: PMC5554143 DOI: 10.1038/s41598-017-08350-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/06/2017] [Indexed: 12/31/2022] Open
Abstract
Cervical radiculopathy has become an increasing problem worldwide. Conservative treatment options have been recommended in many reviews on cervical radiculopathy, ranging from different types of physiotherapy to waiting for remission by natural history. No multimodal pain management concept (MPM) on an inpatient basis has been evaluated. This study aimed at showing the positive short-term effects of an inpatient multimodal pain management concept with focus on cervical translaminar epidural steroid injection for patients with cervical radiculopathy. 54 patients who had undergone inpatient MPM for 10 days were evaluated before and after 10-days treatment. The NRS (0-10) value for arm pain could be reduced from 6.0 (IQR 5.7-6.8) to 2.25 (IQR 2.0-3.1) and from 5.9 (IQR 4.8-6.0) to 2.0 (IQR 1.7-2.6) for neck pain. Neck pain was reduced by 57.4% and arm pain by 62.5%. 2 days after epidural steroid injection, pain was reduced by 40.1% in the neck and by 43.4% in the arms. MPM seems to be an efficient short-term approach to treating cervical radiculopathy. Cervical translaminar epidural steroid injection is an important part of this concept. In the absence of a clear indication for surgery, MPM represents a treatment option.
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Chung SH, Bohl DD, Paul JT, Rihn JA, Harrop JS, Ghogawala Z, Hilibrand AS, Grauer JN. Resource utilization for non-operative cervical radiculopathy: Management by surgeons versus non-surgeons. Clin Neurol Neurosurg 2017; 158:98-102. [PMID: 28501759 DOI: 10.1016/j.clineuro.2017.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/23/2017] [Accepted: 04/30/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare the estimated resource utilization for non-operative treatment of cervical radiculopathy if managed by surgeons versus non-surgeons. PATIENTS AND METHODS A Cervical Spine Research Society-sponsored survey was administered at a national spine surgery conference to surgeons and non-surgeons, as classified above. The survey asked questions regarding resource utilization and perceived costs for the "average patient" with cervical radiculopathy managed non-operatively. Resource utilization and perceived costs were compared between surgeon and non-surgeon participants, and between private practice and academic and/or hybrid groups that combine academic and private practices. RESULTS In total, 101 of the 125 conference attendees participated in the survey (return rate 80.8%, of which 60% were surgeons). Surgeon and non-surgeon estimates for duration of non-operative care did not differ (3.3 versus 4.2 months, p=0.071). Estimates also did not differ for estimated number of physical therapy visits (10.5 versus 10.5, p=0.983), cervical injections (1.4 versus 1.7, p=0.272), chiropractic visits (3.1 versus 3.7, p=0.583), or perceived days off from work (14.9 versus 16.3, p=0.816). The only difference identified was that surgeon estimates of the number of physician visits while providing non-operative care were lower than non-surgeon estimates (3.2 versus 4.0, p=0.018). In terms of estimated costs, surgeon and non-surgeon were mostly similar (only difference being that surgeon estimates for the total cost of physician visits per patient were lower than non-surgeon estimates ($382 versus $579, p=0.007). Surgeon estimates for the percent of their patients that go on to receive surgery within 6 months were higher than non-surgeon estimates (28.6% versus 18.8%, p=0.018). Similarly, surgeon estimates for the percent of their patients to go on to receive surgery within 2 years were higher than non-surgeon estimates (37.8% versus 24.8%, p=0.013). Academic/hybrid and private practice group resource utilization estimates and costs were also compared, and no significant differences were found in any comparisons. Additionally, no significant differences were found in these groups for duration of non-operative care, or the estimates of the percent of patients who go on to receive surgery within 6 months or two years. CONCLUSION These data suggest that patients with cervical radiculopathy managed by surgeons and those by non-surgeons have overall similar resource utilization during a non-operative trial. This suggests that relatively similar care is provided regardless of whom initiates the non-operative trial (surgeon or non-surgeon). Although surgeons thought their patients more likely to undergo surgery following a non-operative trial, this may be a bias due to patient referral-specifically, surgeons may be more likely than non-surgeons to manage patients with more severe or longer-standing radiculopathy.
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Affiliation(s)
- Sophie H Chung
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Avenue, New Haven, CT 06510, USA.
| | - Daniel D Bohl
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Avenue, New Haven, CT 06510, USA.
| | - Jonathan T Paul
- Departments of Orthopaedic Surgery and Neurological Surgery, Thomas Jefferson University and The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | - Jeffrey A Rihn
- Departments of Orthopaedic Surgery and Neurological Surgery, Thomas Jefferson University and The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | - James S Harrop
- Departments of Orthopaedic Surgery and Neurological Surgery, Thomas Jefferson University and The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | - Zoher Ghogawala
- Department of Neurosurgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA.
| | - Alan S Hilibrand
- Departments of Orthopaedic Surgery and Neurological Surgery, Thomas Jefferson University and The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Avenue, New Haven, CT 06510, USA.
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Wei X, Wang S, Li L, Zhu L. Clinical Evidence of Chinese Massage Therapy ( Tui Na) for Cervical Radiculopathy: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:9519285. [PMID: 28303163 PMCID: PMC5337873 DOI: 10.1155/2017/9519285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/26/2017] [Indexed: 01/23/2023]
Abstract
Objective. The review is to assess the current evidence of Chinese massage therapy (Tui Na) for cervical radiculopathy. Methods. Seven databases were searched. Randomised controlled trials incorporating Tui Na alone or Tui Na combined with conventional treatment were enrolled. The authors in pairs independently assessed the risk of bias and extracted the data. Results. Five studies involving 448 patients were included. The pooled analysis from the 3 trials indicated that Tui Na alone showed a significant lowering immediate effects on pain score (SMD = -0.58; 95% CI: -0.96 to -0.21; Z = 3.08, P = 0.002) with moderate heterogeneity compared to cervical traction. The meta-analysis from 2 trials revealed significant immediate effects of Tui Na plus cervical traction in improving pain score (MD = -1.73; 95% CI: -2.01 to -1.44; Z = 11.98, P < 0.00001) with no heterogeneity compared to cervical traction alone. No adverse effect was reported. There was very low quality or low quality evidence to support the results. Conclusions. Tui Na alone or Tui Na plus cervical traction may be helpful to cervical radiculopathy patients, but supportive evidence seems generally weak. Future clinical studies with low risk of bias and adequate follow-up design are recommended.
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Affiliation(s)
- Xu Wei
- Department of Scientific Research, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
| | - Shangquan Wang
- Department of General Orthopedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
| | - Linghui Li
- Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
| | - Liguo Zhu
- Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
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Park J, Park WY, Hong S, An J, Koh JC, Lee YW, Kim YC, Choi JB. Diagnostic Accuracy of the Neck Tornado Test as a New Screening Test in Cervical Radiculopathy. Int J Med Sci 2017; 14:662-667. [PMID: 28824298 PMCID: PMC5562117 DOI: 10.7150/ijms.19110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 04/17/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The Spurling test, although a highly specific provocative test of the cervical spine in cervical radiculopathy (CR), has low to moderate sensitivity. Thus, we introduced the neck tornado test (NTT) to examine the neck and the cervical spine in CR. OBJECTIVES The aim of this study was to introduce a new provocative test, the NTT, and compare the diagnostic accuracy with a widely accepted provocative test, the Spurling test. DESIGN Retrospective study. METHODS Medical records of 135 subjects with neck pain (CR, n = 67; without CR, n = 68) who had undergone cervical spine magnetic resonance imaging and been referred to the pain clinic between September 2014 and August 2015 were reviewed. Both the Spurling test and NTT were performed in all patients by expert examiners. Sensitivity, specificity, and accuracy were compared for both the Spurling test and the NTT. RESULTS The sensitivity of the Spurling test and the NTT was 55.22% and 85.07% (P < 0.0001); specificity, 98.53% and 86.76% (P = 0.0026); accuracy, 77.04% and 85.93% (P = 0.0423), respectively. CONCLUSIONS The NTT is more sensitive with superior diagnostic accuracy for CR diagnosed by magnetic resonance imaging than the Spurling test.
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Affiliation(s)
- Juyeon Park
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Woo Young Park
- Department of Anesthesia, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seungbae Hong
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Jiwon An
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Jae Chul Koh
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Youn-Woo Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Yong Chan Kim
- Department of Anesthesiology and Pain Medicine, Gwangmyeong Saeum Hospital, Gwangmyeong, Korea
| | - Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
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Whitfield P, Yuen J. https://www.acnr.co.uk/2017/09/anterior-cervical-discectomy-and-fusion-acdf-for-degenerative-cervical-diseases-six-decades-on/. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2017. [DOI: 10.47795/iwdk8512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Interreader Reliability and Clinical Validity of a Magnetic Resonance Imaging Grading System for Cervical Foraminal Stenosis. J Comput Assist Tomogr 2017; 41:926-930. [DOI: 10.1097/rct.0000000000000628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nevalainen MT, Foran PJ, Roedl JB, Zoga AC, Morrison WB. Cervical facet oedema: prevalence, correlation to symptoms, and follow-up imaging. Clin Radiol 2016; 71:570-5. [PMID: 27055743 DOI: 10.1016/j.crad.2016.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/22/2016] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the prevalence of cervical facet oedema in patients referred for magnetic resonance imaging (MRI) to investigate neck pain and/or radiculopathy, and to investigate whether there is a correlation between the presence of oedema and patients' symptoms. MATERIALS AND METHODS A retrospective report review of 1885 patients undergoing cervical spine MRI between July 2008 and June 2015 was performed. Exclusion criteria included acute trauma, surgery, neoplastic disease, or infection in the cervical spine. One hundred and seventy-three MRI studies with cervical facet oedema were evaluated by each of the two radiologists. In these patients, the grade of bone marrow oedema (BMO) and corresponding neuroforaminal narrowing at the cervical facets was assessed. Correlation with symptoms was performed based on pre-MRI questionnaire. RESULTS The prevalence of cervical facet oedema was 9%; the most commonly affected levels were C3-4, C4-5, and C2-3. A total of 202 cervical facets were evaluated: mild BMO was seen in 35%, moderate in 41%, and severe in 24% of cases. Surrounding soft-tissue oedema was observed in 36%, 69%, and 92% of the BMO grades, respectively. The correlations between unilateral radiculopathy and ipsilateral facet BMO grades were 79%, 83%, and 73% (chi-square, p<0.001), respectively. Furthermore, neuroforaminal narrowing on the corresponding level was found in 35%, 38%, and 11% of cases, respectively. At follow-up imaging, facet oedema was most likely to remain unchanged or to decrease. CONCLUSION The prevalence of cervical facet oedema is 9%. Cervical facet oedema is associated with ipsilateral radiculopathy. Neuroforaminal narrowing, however, is not associated with facet oedema.
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Affiliation(s)
- M T Nevalainen
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA 19107, USA; Department of Diagnostic Radiology, Oulu University Hospitaļ P.O. Box 50, 90029, Oulu, Finland.
| | - P J Foran
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA 19107, USA
| | - J B Roedl
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA 19107, USA
| | - A C Zoga
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA 19107, USA
| | - W B Morrison
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA 19107, USA
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Wei X, Wang S, Li J, Gao J, Yu J, Feng M, Zhu L. Complementary and Alternative Medicine for the Management of Cervical Radiculopathy: An Overview of Systematic Reviews. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:793649. [PMID: 26345336 PMCID: PMC4541004 DOI: 10.1155/2015/793649] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/03/2015] [Indexed: 12/30/2022]
Abstract
Background. Complementary and alternative medicine (CAM) is widely applied in the clinical practice of neck pain owing to cervical radiculopathy (CR). While many systematic reviews exist in CAM to improve CR, research is distributed across population, intervention, comparison, and setting. Objective. This overview aims to summarize the characteristics and evaluate critically the evidence from systematic reviews. Methods. A comprehensive literature search was performed in the six databases without language restrictions on February 24, 2015. We had identified relevant systematic reviews that examined the subjects with neck pain due to cervical radiculopathy undergoing CAM. Two authors independently appraised the methodological quality using the revised assessment of multiple systematic reviews instrument. Results. We had included eight systematic reviews. The effectiveness and safety of acupotomy, acupuncture, Jingfukang granule, manual therapies, and cervical spine manipulation were investigated. Based on available evidence, the systematic reviews supported various forms of CAM for CR. Nevertheless, the methodological quality for most of systematic reviews was low or moderate. In addition, adverse reactions of primary studies were infrequent. Conclusions. Current systematic reviews showed potential advantages to CAM for CR. Due to the frequently poor methodological quality of primary studies, the conclusions should be treated with caution for clinical practice.
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Affiliation(s)
- Xu Wei
- Department of Scientific Research, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
| | - Shangquan Wang
- Department of General Orthopedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
| | - Jinxue Li
- Department of Scientific Research, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
| | - Jinghua Gao
- Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
| | - Jie Yu
- Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
| | - Minshan Feng
- Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
| | - Liguo Zhu
- Department of Spine, Wangjing Hospital, China Academy of Chinese Medical Sciences, Huajiadi Street, Chaoyang District, Beijing 100102, China
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Therapeutic efficacy observation on bloodletting and cupping for cervical radiculopathy. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2015. [DOI: 10.1007/s11726-015-0859-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jingtong Granule: A Chinese Patent Medicine for Cervical Radiculopathy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:158453. [PMID: 26064154 PMCID: PMC4443761 DOI: 10.1155/2015/158453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/15/2015] [Indexed: 11/18/2022]
Abstract
Objective. This paper systematically assessed the efficacy and safety of Jingtong granule (JG) for cervical radiculopathy (CR). Methods. Randomized controlled trials comparing JG with no intervention, placebo, or conventional therapies were retrieved. The trials testing JG combined with conventional therapies versus conventional therapies were also enrolled. Study selection, methodological assessment, data extraction, and analysis were conducted in accordance with the Cochrane standards. The strength of evidence was evaluated according to GRADE approach. Results. Three trials with 400 participants were included. Methodological quality was evaluated as generally low. One study found that JG showed significant difference on decreasing pain scores compared with placebo. Meta-analysis indicated that JG plus conventional analgesic exhibited a significant immediate effect on the pain scores (WMD = 1.63; 95% CI: 1.29 to 1.98; P < 0.00001). Additionally, JG combined with analgesic presented beneficial immediate effect on neck disability index. However, the treatment effects of JG demonstrated in the trials were not large, and the safety of JG was unproven. Finally the evidence level was evaluated to be low. Conclusions. Our results indicated that JG showed some potential benefits for CR. Nevertheless, treatment effects are uncertain due to both the methodological concerns and the very modest reported improvements.
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