Cervical disc degeneration: important considerations for the manual therapist

Rethinking neck-related arm pain: hypothetical clinical scenarios to differentiate the underlying IASP-defined pain mechanisms

Neck-related arm pain is frequently encountered in clinical settings, yet its underlying pain mechanisms remain elusive. While such pain radiating from the neck to the arm is often attributed to injuries or diseases of the nervous system (neuropathic pain), it can also arise from nociceptive (referred) or nociplastic sources. Regrettably, patients exhibiting this specific pain distribution are frequently diagnosed with varying terms, including 'cervicobrachialgia', 'cervicobrachial neuralgia', 'cervicobrachial pain syndrome', and 'cervical radiculopathy'. The ambiguity surrounding these diagnostic labels complicates the clinical reasoning process. It is imperative for clinicians to discern and comprehend the dominant pain mechanism. Three distinct hypothetical clinical scenarios depict patients with almost identical pain distribution but divergent dominant pain mechanisms. Within these scenarios, both subjective and objective examinations are employed to elucidate the dominant pain mechanism associated with neck-related arm pain: nociceptive, neuropathic, and nociplastic. Furthermore, clinicians must remain aware that the dominant pain mechanism can evolve over time.

Needle-scalpel therapy inhibits the apoptosis of nucleus pulposus cells via the SDF-1/CXCR4 axis in a rat degenerative cervical intervertebral disc model

As a common disease, cervical spondylosis (CS) results from the degeneration of the cervical intervertebral disc. However, there are still no effective clinical strategies for the treatment of this disease. Needle-scalpel (Ns), a therapy guided by traditional Chinese medicine theory, alleviates intervertebral disc degradation and is widely used in the clinic to treat CS. Stromal cell-derived factor-1 (SDF-1) and its receptor CXC receptor 4 (CXCR4) in nucleus pulposus cells play an important role in CS onset and development. This study aimed to explore whether Ns can relieve pain and regulate the SDF-1/CXCR4 axis in nucleus pulposus cells to inhibit apoptosis, thereby delaying cervical intervertebral disc degradation in a rat model of CS. It was found that the Ns-treated groups exhibited higher mechanical allodynia scores than the model group, and H&E staining, MRI, and scanning electron microscopy revealed that Ns therapy inhibited intervertebral disc degeneration. Additionally, Ns therapy significantly inhibited increases in the RNA and protein expression levels of SDF-1 and CXCR4. Furthermore, these treatments alleviated the apoptosis of nucleus pulposus cells, which manifested as a decline in the proportion of apoptotic nucleus pulposus cells and inhibition of the decrease in the levels of Bcl-2/Bax. These findings indicated that Ns mitigated CS-induced pain, inhibited the apoptosis of nucleus pulposus cells, and alleviated intervertebral disc degeneration in CS rats. These effects may be mediated by specifically regulating the SDF-1/CXCR4 signaling axis. Based on these findings, we conclude that Ns might serve as a promising therapy for the treatment of CS.

Exploring the latest advancements in physical therapy techniques for treating cervical spondylosis patients: A narrative review

Cervical spondylosis is a widespread medical condition that significantly impacts patients' quality of life. Treatment options include surgical and conservative approaches, with conservative treatment often being the preferred choice. Rehabilitation therapy is an essential component of conservative treatment, and advancements in technology have the way to the development of new physiotherapy techniques. The effectiveness of treatment largely hinges on the patient's ability to improve their dysfunction. This study aims to provide valuable insights into the use of new physical therapy techniques, such as Sling Exercises Training (SET), fascia manipulation, muscle energy technique (MET), and proprioceptive neuromuscular facilitation (PNF), that aid the rehabilitation of cervical spondylosis. By scrutinizing the current research status of these techniques, this study aims to present innovative ideas enhancing the rehabilitation process and outcomes for patients suffering from cervical spondylosis.

Intervertebral Canals and Intracanal Ligaments as New Terms in Terminologia anatomica

This study addresses the cervical part of the vertebral column. Clinical pictures of dystrophic diseases of the cervical part of the vertebral column do not always correspond only to the morphological changes-they may be represented by connective tissue formation and nerve and vessel compression. To find out the possible reason, this morphometric study of the cervical part of the vertebral column in 40 cadavers was performed. CT scans were performed on 17 cadaveric material specimens. A total of 12 histological samples of connective tissue structures located in intervertebral canals (IC) were studied. One such formation, an intracanal ligament (IL) located in the IC, was found. Today, there is no term "intervertebral canal", nor is there a detailed description of the intervertebral canal in the cervical part of the vertebral column. Cervical intervertebral canals make up five pairs in segments C2-C7. On cadavers, the IC lateral and medial apertures were 0.9-1.5 cm and 0.5-0.9 cm, correspondingly. According to our histological study, the connective tissue structures in the IC are ligaments-IL. According to the presence of these ligaments, ICs were classified into three types. Complete regional anatomy characterization of the IC of the cervical part of the vertebral column with a description of its constituent anatomical elements was provided. The findings demonstrate the need to include the terms "intervertebral canal" and "intervertebral ligament" in the Terminologia anatomica.