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Kouser V H, Nayab M, Ansari AN, Mir MA, Anwar M. Efficacy of wet cupping in the pain management of cervical spondylosis - A randomized, controlled, open -label, parallel-group clinical trial. J Bodyw Mov Ther 2024; 39:126-131. [PMID: 38876616 DOI: 10.1016/j.jbmt.2024.02.044] [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: 02/05/2022] [Revised: 11/27/2023] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND AND OBJECTIVE Cervical spondylosis is a chronic degenerative process of the cervical spine characterized by pain in neck, degenerative changes in intervertebral disc and osteophyte formation. Cervical spondylosis is translated as Waja' ur Raqaba, a type of joint pain. The present study was aimed to evaluate the effect of wet cupping in the pain management of cervical spondylosis. METHODS This Open, randomized, controlled, clinical study was conducted on 44 patients. Subjects in the test group (n = 22) received a series of three-staged wet cupping treatment, performed on 0, 7th and 14th day. Subjects in the control group (n = 22) received 12 sittings of Transcutaneous Electrical Nerve Stimulation (TENS): 6 sittings per week for two weeks. The objective findings of treatment were assessed with the help of VAS, Neck Disability Index (NDI) and Cervical range of motion. RESULTS Intra group comparison in test group from baseline to 21st day were found highly significant (p < 0.001) in terms of VAS, NDI, Flexion, Extension and Left rotation score. While in Right rotation, Left rotation and Left lateral flexion score were found moderately significant (p < 0.01). Statistically significant difference was observed between two groups at 21st day in VAS scale, NDI, and Cervical range of motion score (p < 0.001). INTERPRETATION AND CONCLUSION Ḥijāma Bish Sharṭ was found better in the management of pain due to cervical spondylosis than TENS. It can be concluded that Ḥijāma Bish Sharṭ may a better option for the pain management of cervical spondylosis. CLINICAL TRIAL REGISTRATION The trial was registered on clinical trial registry website (www.ctri.nic.in) bearing a CTRI Number, CTRI/2020/03/024,249.
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Affiliation(s)
- Hina Kouser V
- PG Scholar, Dept. of Ilaj Bit Tadbeer, NIUM, Bengaluru, India
| | - Mohd Nayab
- Assistant Professor, Dept. of Ilaj Bit Tadbeer, NIUM, Bengaluru, India.
| | | | - Manzoor Ahmad Mir
- Medical Officer, Government Health Services, Jammu and Kashmir, India
| | - Mohd Anwar
- Professor & Chairman, Dept. of Ilaj Bit Tadbeer, AKTC, AMU, Aligarh, India
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Zhang P, Zheng H, Luo J, Xu J. Comparative efficacy of zero-profile implant and conventional cage-plate implant in the treatment of single-level degenerative cervical spondylosis: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:364. [PMID: 38898517 PMCID: PMC11188160 DOI: 10.1186/s13018-024-04729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/06/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND In recent years, the zero-profile implant (Zero-p) has emerged as a promising internal fixation technique. Although studies have indicated its potential superiority over conventional cage-plate implant (Cage-plate) in the treatment of degenerative cervical spondylosis, there remains a lack of definitive comparative reports regarding its indications, safety, and efficacy. METHODS A computerized search was conducted on English and Chinese databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, Wanfang and VIP. Additionally, a manual search was meticulously carried out on Chinese medical journals, spanning from the inception of the respective databases until August 2023. The meta-analysis utilized a case-control study approach and was executed through the utilization of RevMan 5.3 software. Stringent quality evaluation and data extraction procedures were implemented to guarantee the reliability and validity of the findings. RESULTS Nine high-quality studies with 808 patients were included. Meta-analysis showed that the operation time (MD = - 13.28; 95% CI (- 17.53, - 9.04), P < 0.00001), intraoperative blood loss (MD = - 6.61; 95% CI (- 10.47, - 2.75), P = 0.0008), incidence of postoperative dysphagia at various time points: within the first month after surgery (OR = 0.36; 95% CI (0.22, 0.58), P < 0.0001), 1-3 months after surgery (OR = 0.20; 95% CI (0.08, 0.49), P = 0.0004), the final follow-up (OR = 0.21; 95% CI (0.05, 0.83), P = 0.003) and the rate of postoperative adjacent disc degeneration (OR = 0.46; 95% CI (0.25, 0.84), P = 0.01) were significantly lower in the Zero-p group than in the Cage-plate group. Additionally, was also significantly lower in the Zero-p group. However, there were no significant differences in the JOA score, the final follow-up NDI score, surgical segmental fusion rate, postoperative height of adjacent vertebrae, or postoperative subsidence rate between the two groups. CONCLUSION In summary, when treating single-segment degenerative cervical spondylosis, both internal fixation techniques are reliable and effective. However, Zero-P implant offer several advantages over cage-plate implant, including shorter operation duration, less intraoperative blood loss, reduced postoperative dysphagia, and slower adjacent disc degeneration. Additionally, Zero-P implant has a broader application space, making them a preferred choice in certain cases.
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Affiliation(s)
- Peng Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350000, China
| | - Hongyu Zheng
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, Hubei, China
| | - Jun Luo
- Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350000, China
| | - Jie Xu
- Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350000, China.
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Liu C, Ran J, Hou B, Li Y, Morelli JN, Li X. Causal effects of body mass index, education, and lifestyle behaviors on intervertebral disc disorders: Mendelian randomization study. J Orthop Res 2024; 42:183-192. [PMID: 37408137 DOI: 10.1002/jor.25656] [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: 02/02/2023] [Revised: 05/26/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023]
Abstract
This study aimed to investigate the causal risk factors for intervertebral disc disorders (IVDD) to help establish prevention strategies for IVDD-related diseases. We performed two-sample Mendelian randomization analyses to investigate the causal effects of body mass index (BMI), education, and lifestyle behaviors (sedentary behavior, smoking, and sleeping) on thoracic/thoracolumbar/lumbosacral IVDD (TTL-IVDD) and cervical IVDD. The inverse-variance weighted (IVW) method was conducted as the primary model to pool effect sizes using odds ratio and 95% confidence interval. The strength of causal evidence was evaluated from the effect size and different Mendelian randomization methods (MR-Egger/weighted median/weighted mode method, Cochran's Q test, leave-one-out analysis, MR Steiger, MR-PRESSO and radial IVW analyses). We found strong evidence for the causal associations between IVDD and BMI (TTL-IVDD, 1.27 [1.18, 1.37], p = 2.40 × 10-10 ; cervical IVDD, 1.24 [1.12, 1.37, p = 6.58 × 10-5 ), educational attainment (TTL-IVDD, 0.57 [0.51, 0.64], p = 9.64 × 10-21 ; cervical IVDD, 0.58 [0.49, 0.68], p = 1.78 × 10-10 ), leisure television watching (TTL-IVDD, 1.54 [1.29, 1.84], p = 7.80 × 10-6 ; cervical IVDD, 1.65 [1.29, 2.11], p = 0.0001), smoking initiation (TTL-IVDD, 1.37 [1.25, 1.50], p = 1.78 × 10-10 ; cervical IVDD, 1.32 [1.16, 1.51], p = 6.49 × 10-5 ), short sleep (TTL-IVDD, 1.28 [1.09, 1.49], p = 0.0027; cervical IVDD, 1.53 [1.21, 1.94], p = 0.0008), or frequent insomnia (TTL-IVDD, 1.20 [1.11, 1.30], p = 1.54 × 10-5 ; cervical IVDD, 1.37 [1.20, 1.57], p = 7.80 × 10-6 ). This study provided genetic evidence that increased BMI, low educational attainment, sedentary behavior by leisure television watching, smoking initiation, short sleep, and frequent insomnia were causal risk factors for IVDD. More efforts should be directed toward increasing public awareness of these modifiable risk factors and mobilizing individuals to adopt healthy lifestyles.
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Affiliation(s)
- Chanyuan Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Ran
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Bowen Hou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yitong Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - John N Morelli
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xiaoming Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Mohseni F, Rahmani N, Mohseni Bandpei MA, Abdollahi I. Reliability of ultrasonography to measure cervical multifidus, semispinalis cervicis and longus colli muscles dimensions in patients with unilateral cervical disc herniation: An observational cross-sectional test-retest study. J Bodyw Mov Ther 2024; 37:399-403. [PMID: 38432836 DOI: 10.1016/j.jbmt.2023.11.008] [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: 06/19/2022] [Revised: 10/03/2023] [Accepted: 11/06/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Ultrasonography (US) has been suggested to assess the morphology and function of cervical muscles; but little is known about the reliability of the US measures in patients with cervical disc herniation (CDH). The purpose of this study was to evaluate within-day inter and intra-rater and between-day intra-rater reliability of US to measure dimensions of deep cervical muscles in patients with unilateral CDH. METHODS Thirty patients with unilateral CDH participated. Anterior-posterior and lateral dimension of longus colli (LC), multifidus (MF) and semispinalis cervicis (SC) were measured using B-mode ultrasound. The measurements were repeated by rater A 1 h (for within-day reliability) and one week (for between-day reliability) later. For inter-rater reliability, rater B performed all muscles measurements like rater A. RESULTS Within-day reliability measurement for all muscles was good to excellent with IntraClass Correlation Coefficients (ICC) ranging from 0.82 to 0.96, standard error of measurement (SEM) from 0.18 to 0.46 and minimal detectable changes (MDC) from 0.43 to 1.09. Between-day reliability was good for all muscle dimensions with ICC ranging from 0.75 to 0.89, SEM from 0.30 to 0.64 and MDC from 0.71 to 1.52. Inter-rater reliability was also good with ICC ranging from 0.75 to 0.89, SEM from 0.34 to 0.65 and MDC from 0.81 to 1.55. CONCLUSIONS US was demonstrated to have high within-day inter and intra-rater and between-day intra-rater reliability to measure muscles dimensions in patients with unilateral CDH. It can be used to assess deep cervical muscles or to monitor the effects of interventions.
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Affiliation(s)
- Fariba Mohseni
- Physiotherapy Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nahid Rahmani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | | | - Iraj Abdollahi
- Physiotherapy Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Pu J, Cao W, Chen Y, Fan Y, Cao Y. Ultrasound-guided injection acupotomy as a minimally invasive intervention therapy for cervical spondylotic radiculopathy: a randomized control trial. Ann Med 2023; 55:2233556. [PMID: 37417721 PMCID: PMC10332182 DOI: 10.1080/07853890.2023.2233556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE To explore the efficacy and safety of ultrasound-guided injection acupotomy as a minimally invasive intervention treatment of cervical spondylotic radiculopathy (CSR). METHODS 160 CSR subjects were recruited who met the inclusion criteria in our hospital from October 2019 to December 2021. The subjects were randomly divided into the experimental and control group, with 80 cases in each. The experimental group received ultrasound-guided injection acupotomy as a minimally invasive intervention therapy. The control group received ultrasound-guided selective nerve root block (SNRB). The Odom's criteria clinical curative effect, visual analogue scale (VAS), neck disability index (NDI), and 36-Item Short Form Health Survey questionnaire (SF-36) were used to evaluate the outcome of subjects at several different points in time. RESULTS At 30 min and 1 month after the end of treatment, there was no significant difference in any scores. However, after six months, the excellent and good rate was better in the experimental group compared to the control (RD = 0.175; 95% CI, 0.044-0.300, p = 0.009). The total effective rate was also better in the experimental group (RD = 0.126; 95% CI, 0.021-0.232, p = 0.018). In contrast, the VAS score (MD = -0.500; 95% CI, -1.000-0.000, p = 0.030) and NDI score (MD = -6.460; 95% CI, -11.067 to -1.852, p = 0.006) were lower in the experimental group compared to the control. The total SF-36 score was higher in the experimental group (MD = 7.568; 95% CI, 2.459-12.677, p = 0.004). CONCLUSION Ultrasound-guided injection acupotomy minimally invasive interventional treatment of CSR has no significant difference in short-term curative effect compared with ultrasound-guided SNRB, but the data indicators are significantly better than the latter at 6 months after the end of the course of treatment, showing better long-term efficacy.
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Affiliation(s)
- Jianfeng Pu
- Department of Acupuncture, Zhangjiagang Second People’s Hospital, Zhangjiagang City, Jiangsu Province, China
| | - Wenping Cao
- Department of Acupuncture, Zhangjiagang Second People’s Hospital, Zhangjiagang City, Jiangsu Province, China
| | - Yetin Chen
- Department of Acupuncture, Zhangjiagang Second People’s Hospital, Zhangjiagang City, Jiangsu Province, China
| | - Yunwu Fan
- Department of Pain Medicine, Zhangjiagang Second People’s Hospital, Zhangjiagang City, Jiangsu Province, China
| | - Ye Cao
- Department of Pain Medicine, Zhangjiagang Second People’s Hospital, Zhangjiagang City, Jiangsu Province, China
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Hajeeyeh M, Wilartratsami S, Phisalprapa P, Piyapromdee U, Sornsa-Ard T, Kositamongkol C, Vamvanij V, Luksanapruksa P. Cost-utility Analysis of Anterior Cervical Discectomy and Fusion for Cervical Spondylosis Patients Comparing Polyetheretherketone Versus Tricortical Iliac Crest Bone Graft. Clin Spine Surg 2023; 36:E353-E361. [PMID: 37296495 DOI: 10.1097/bsd.0000000000001468] [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: 04/13/2022] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To perform a cost-utility analysis and to investigate the clinical outcomes and patient's quality of life after anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis compared between fusion with polyetheretherketone (PEEK) and fusion with tricortical iliac bone graft (IBG) in Thailand. SUMMARY OF BACKGROUND DATA ACDF is one of the standard treatments for cervical spondylosis. The fusion material options include PEEK and tricortical IBG. No previous studies have compared the cost-utility between these 2 fusion material options. PATIENTS AND METHODS Patients with cervical spondylosis who were scheduled for ACDF at Siriraj Hospital (Bangkok, Thailand) during 2019-2020 were prospectively enrolled. Patients were allocated to the PEEK or IBG fusion material group according to the patient's choice of fusion material. EuroQol-5 dimensions 5 levels and relevant costs were collected during the operative and postoperative periods. A cost-utility analysis was performed using a societal perspective. All costs were converted to 2020 United States dollars (USD), and a 3% discount rate was used. The outcome was expressed as the incremental cost-effectiveness ratio. RESULTS Thirty-six patients (18 ACDF-PEEK and 18 ACDF-IBG) were enrolled. Except for Nurick grading, there was no significant difference in patient baseline characteristics between groups. The average utility at 1 year after ACDF-PEEK and ACDF-IBG were 0.939 ± 0.061 and 0.798 ± 0.081, respectively ( P < 0.001). The total lifetime cost of ACDF-PEEK and ACDF-IBG was 83,572 USD and 73,329 USD, respectively. The incremental cost-effectiveness ratio of ACDF-PEEK when compared with that of ACDF-IBG showed a gain of 4468.52 USD/quality-adjusted life-years, which is considered cost-effective at the Thailand willingness-to-pay threshold of 5115 USD/quality-adjusted life-year gained. CONCLUSIONS ACDF-PEEK was found to be more cost-effective than ACDF-IBG for treating cervical spondylosis in Thailand. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | | | - Pochamana Phisalprapa
- Department of Medicine, Division of Ambulatory Medicine, Mahidol University, Bangkok
| | - Urawit Piyapromdee
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima
| | | | | | - Visit Vamvanij
- Division of Spine Surgery, Department of Orthopedic Surgery
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Tehseen A, Ali H, Husain N, Varda HK. The efficacy and safety of dry cupping in cervical spondylosis with optimization of cup application time - a randomized clinical trial. Drug Metab Pers Ther 2023; 38:113-119. [PMID: 35751549 DOI: 10.1515/dmpt-2022-0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/10/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Dry cupping therapy (DCT) is considered beneficial in the amelioration of cervical spondylosis (CS) symptoms in Unani medicine. Therefore, the focus of this study was to ascertain the efficacy of DCT and optimal cup application time duration for CS. METHODS It was a randomized clinical trial involving 45 participants with clinically diagnosed CS. The eligible subjects were randomly categorized into three groups, each having 15 participants. Each of the three groups, i.e., A, B, and C, received DCT daily for 15 days for 8 min, 10 min, and 12 min, respectively. All the participants were evaluated at the baseline, 7th, and 15th days of the trial using the neck disability index (NDI) as well as the visual analogue scale (VAS). RESULTS The baseline mean ± SD of NDI and VAS scores were significantly reduced in all the three groups at the end of the trial. Although all three groups were statistically equal in terms of NDI, group-C demonstrated greater efficacy in terms of VAS. CONCLUSIONS The per-protocol analysis showed that dry cupping effectively alleviated neck pain across all treatment groups. Although, this effect on neck disability index was statistically equal in all three groups, the 12-min protocol was more successful in reducing pain.
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Affiliation(s)
- Ayesha Tehseen
- Department of Ilaj bil Tadbir, Luqman Unani Medical College Hospital and Research Center, Bijapur, India
| | - Hamid Ali
- Department of Ilaj bil Tadbir, National Institute of Unani Medicine, Bengaluru, India
| | - Nazim Husain
- Department of Moalajat, Luqman Unani Medical College Hospital and Research Center, Bijapur, India
| | - Hina Kouser Varda
- Department of Ilaj bil Tadbir, National Institute of Unani Medicine, Bengaluru, India
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Gazzeri R, Tribuzi S, Galarza M, Luigi Giuseppe Leoni M, Occhigrossi F. Ultrasound-Guided percutaneous laser disc decompression (PLDD) with fluoroscopic validation for the treatment of cervical disc herniation: Technical note. PAIN MEDICINE 2022:6873750. [PMID: 36469340 DOI: 10.1093/pm/pnac188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative for the treatment of cervical soft disc herniations. Repeated X-Ray scanning is essential when performing this technique. DESIGN Technical note. METHODS We present a new method for the treatment of cervical disc herniation using ultrasound to guide the needle entry to the cervical disc, to avoid excess of radiation exposure during the surgical procedure. We evaluated the efficacy of this cervical approach.We retrospectively reviewed the clinical data of 14 cases who underwent a PLDD under ultrasound (US) guidance for the treatment of contained cervical disc herniation using a 1470 Nm diode laser. The lower cervical discs (C5-C6 and C6-C7) were the most affected sites, accounting for 78.6% of surgical discs.A significant NRS reduction between baseline and 1 month (p = 0.0002) and between baseline and 12 months (p = 0.0007) was observed. CONCLUSIONS Our results support the conclusion that US guided PLDD with fluoroscopic validation is a minimally invasive technique for patients affected by herniated cervical discs, but proper choice of patients is critical. This approach should not be performed except after adequate training under close supervision of surgeons experienced in this procedure and in interventional US.
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Affiliation(s)
- Roberto Gazzeri
- Pain Therapy Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Susanna Tribuzi
- Pain Therapy Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Marcelo Galarza
- Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
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Liu C, Wang J, Hou B, Li Y, Morelli JN, Zhang P, Ran J, Li X. Diurnal Variation in Hydration of the Cervical Intervertebral Disc Assessed Using T2 Mapping of Magnetic Resonance Imaging. Korean J Radiol 2022; 23:638-648. [PMID: 35617994 PMCID: PMC9174496 DOI: 10.3348/kjr.2021.0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/10/2022] [Accepted: 04/01/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The study aimed to investigate the diurnal variation in cervical disc hydration and its relationship with cervical degeneration. Materials and Methods C3–C7 discs of 86 prospectively enrolled participants (37 males, 49 females; mean age ± standard deviation, 23.5 ± 2.5 years) were assessed using T2 mapping in the morning and evening. All discs were stratified by Miyazaki grade or C2–C7 Cobb angle and T2 values (T2). The degree of diurnal T2 variation (T2-DDV), defined as (morning T2 – evening T2)/morning T2 × 100%, was measured for the entire disc, annulus fibrosus (AF), nucleus pulposus (NP), and endplate zones. Results T2 of the entire disc decreased significantly after the daytime load (p < 0.001), with a T2-DDV of 13.3% for all discs and 16.0%, 12.2%, and 13.0% for healthy (grade I), mild degenerative (grade II), and advanced degenerative (grade III/IV) discs, respectively. T2 of regional NPs and AFs decreased significantly from morning to evening (p ≤ 0.049) except in the healthy anterior inner AF (p = 0.092). Compared with healthy discs, mild degenerative discs displayed lower T2 and T2-DDV in regional NPs (p < 0.001). Advanced degenerative discs showed higher T2-DDV in the anterior inner AF compared with healthy discs (p = 0.050). Significant diurnal T2 changes in the endplate zones were observed only in healthy discs (p = 0.013). Cervical discs in the low Cobb angle group showed higher T2-DDV in the anterior AFs and anterior NP and lower T2-DDV in the posterior AF than those in the high Cobb angle group (p ≤ 0.041). Conclusion This study characterized the diurnal variation in hydration of the cervical discs as assessed using T2 mapping and revealed early chemo-mechanical coupling dysfunction in degenerating discs. Cervical sagittal alignment on MRI can affect the diurnal stress patterns of the cervical discs. T2 mapping is sensitive to disc biomechanical dysfunction and offers translational potential from biomechanical research to clinical application.
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Affiliation(s)
- Chanyuan Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyi Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bowen Hou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yitong Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - John N Morelli
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peisen Zhang
- Department of Rehabilitation Medicine, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Jun Ran
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoming Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Petersen JA, Brauer C, Thygesen LC, Flachs EM, Lund CB, Thomsen JF. Prospective, population-based study of occupational movements and postures of the neck as risk factors for cervical disc herniation. BMJ Open 2022; 12:e053999. [PMID: 35228284 PMCID: PMC8886406 DOI: 10.1136/bmjopen-2021-053999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE We studied the associations between objectively measured occupational neck exposures in a job exposure matrix (JEM) and cervical disc herniation (CDH). DESIGN A cohort study of Danish workers who ever held at least one of 29 jobs (eg, dentists, hairdressers, childcare, carpenters) from 1981 to 2016 was formed. Representative whole work-day inclinometric measurements from previous studies using triaxial accelerometers measuring neck angular velocity and posture of the neck were used as exposure in a JEM. Job titles were retrieved from the Danish Occupational Cohort with eXposure data database. The risk of CDH by quintiles of cumulated exposure was assessed by incidence rate ratios (IRR), adjusted for age, sex, calendar-year, previous lumbar disc herniation and educational level, using Poisson regression models. SETTING Nationwide Danish registers. PARTICIPANTS 852 625 Danish workers within 29 different job-titles. OUTCOME MEASURES First diagnosis of CDH was retrieved from the Danish National Patient Register. RESULTS We found 14 000 cases of CDH during 20.2 million person-years of follow-up. Increasing levels of neck angular velocity showed a decreasing risk with IRR 0.90 (95% CI 0.86 to 0.95) when the highest level of cumulative exposure (dynamic work) was compared with the lowest (static work). Similar results were found for extension and flexion of the neck, though not statistically significant for extension. Multiple sensitivity analyses did not change the results. CONCLUSION In this large register-based study based on a JEM, we found no evidence of an increased risk of CDH with increasing cumulated angular velocity, flexion or extension of the neck. Factors other than occupational dynamic neck movements and bent neck position seem to be important in the development of CDH.
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Affiliation(s)
| | - Charlotte Brauer
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Kobenhavn, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Christina Bach Lund
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Kobenhavn, Denmark
| | - Jane Frølund Thomsen
- Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Kobenhavn, Denmark
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Lieberman Lawry L, Stroupe Kannappan N, Canteli C, Clemmer W. Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo. BMJ Open 2022; 12:e052306. [PMID: 35110316 PMCID: PMC8811576 DOI: 10.1136/bmjopen-2021-052306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To understand the prevalence of mental health disorders in Ebola-affected communities and their association with condom use. DESIGN Cross-sectional study. SETTING Beni, Butembo and Katwa health zones, Democratic Republic of Congo (DRC). PARTICIPANTS 223 adult Ebola survivors, 102 sexual partners and 74 comparison respondents. PRIMARY AND SECONDARY OUTCOME MEASURES Post-traumatic stress disorder (PTSD), depression, anxiety, substance use, suicidal ideation and attempts, stigma, condom use and sexual behaviour. RESULTS Most respondents reported to be married, Christian, from the Nande ethnic group, and farmers/herders. Survivors met symptom criteria for depression at higher rates than partners (23.5% (95% CI 18.0 to 29.1) vs 5.7 (1.2 to 10.1); p<0.001). PTSD symptom criteria for survivors (24.1%, 95% CI 18.5% to 29.7%) and partners (16.7%, 95% CI 9.4% to 23.9%) were four times greater than the comparison participants (6.0%, 95% CI 0.6% to 11.4%). Two times as many survivors as partners reported that sexual activity precautions were discussed at discharge (71.5% (95% CI 65.6 to 77.5) vs 36.2% (95% CI 26.9 to 45.5); p<0.001). The majority of survivors (95.0 (95% CI 85.1% to 98.5%) and partners 98.5% (95% CI 89.6% to 99.8%; p=0.26) participated in risky sexual behaviour after the survivor left the Ebola treatment centre. The ability to refuse sex or insist on condom use before Ebola had a threefold increase in the odds of condom use (adjusted OR 3.3, 95% CI 1.7 to 6.1, p<0.001). Up to 36% of the comparison group held discriminatory views of survivors. CONCLUSIONS The new outbreaks in both Guinea and DRC show Ebola remains in semen longer than previously known. Understanding and addressing condom non-use and updating condom use guidelines are necessary to protect against future Ebola outbreaks, especially among sexual partners who did not have similar access to health information regarding sexual transmission of Ebola. Mental health treatment and decreasing stigma in Ebola areas is a priority.
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Affiliation(s)
- Lynn Lieberman Lawry
- Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - William Clemmer
- Health, IMA World Health, Goma, Democratic Republic of the Congo
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12
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Lin PI, Chen TH, Chung HH, Su TM, Ma CC, Ou TC. Factors Associated with Postoperative Rehospitalization in Patients with Cervical Disc Herniation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031687. [PMID: 35162713 PMCID: PMC8835259 DOI: 10.3390/ijerph19031687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/05/2023]
Abstract
Cervical disc herniation (CDH) is a prevalent disease because of the poor living habits of and great pressure in modern society. Patients experience hand numbness, neck stiffness, soreness, and weakness due to neck nerve root compression, which leads to a gradual increase of neurosurgery outpatients. Although poor posture by the overuse of computers is possibly the origin of CDH, analysis of related factors causing the rehospitalization for CDH patients after surgery in Taiwan is not commonly reported. Thus, the present study focused on the demographics and surgery-related treatment on the relevance of rehospitalization for CDH patients after surgery. The design of the study was retrospective, and we collected data by medical record review, which was derived from the inpatient surgery data of patients at a medical center in southern Taiwan. The study lasted two years from 1 January 2017 to 31 December 2018, and a total of 248 patients underwent surgery for intervertebral disc protrusion in the neck. The retrospective study adopted narrative statistics, the chi-squared test, and binary logistic regression analysis to identify factors affecting postoperative rehospitalization. Among 248 postoperative patients with intervertebral disc protrusion, 178 underwent cervical fusion surgery, and 32 were rehospitalized after surgery for one-year follow up, accounting for an overall prevalence rate of 12.9%. There were no significant differences in sex, age, occupation, hypertension, anterior cervical discectomy and fusion, artificial disc replacement, hybrid surgery, and postoperative cervical coil use (p > 0.05). The results of binary logistic regression analysis showed statistically significant differences in abnormal body mass index (p = 0.0187, 95% CI = 1.238-10.499), diabetes (p = 0.0137, 95% CI = 1.288-9.224) and cervical vertebral surgery hospital days (p = 0.0004, 95% CI = 1.028-1.102), predicting the outcome of rehospitalization for CDH patients after surgery. The above results showed that abnormal body mass index, diabetes, and cervical vertebral surgery hospitalization days impacted rehospitalization in CDH patients after surgery. Thus, to prevent diabetes, weight control must be monitored, and maintaining correct posture can reduce CDH and decrease the rate of rehospitalization after surgery, which provides a critical reference for hospital managers and clinical staff.
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Affiliation(s)
- Pei-I Lin
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
| | - Tai-Hsiang Chen
- Administrative Office, Weihope Clinic, Kaohsiung 804, Taiwan;
- College of Management, Yuan Ze University, Taoyuan 320, Taiwan
| | - Hsien-Hui Chung
- Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County 907, Taiwan;
| | - Tsung-Ming Su
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
- College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
| | - Chen-Chung Ma
- Department of Healthcare Administration, I-Shou University, Kaohsiung 824, Taiwan
- Correspondence: (C.-C.M.); (T.-C.O.); Tel.: +886-7615-1100 (ext. 7602) (C.-C.M.); +886-2263-0588 (ext. 6091) (T.-C.O.)
| | - Tzu-Chi Ou
- Department of Medical Education, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei 236, Taiwan
- Correspondence: (C.-C.M.); (T.-C.O.); Tel.: +886-7615-1100 (ext. 7602) (C.-C.M.); +886-2263-0588 (ext. 6091) (T.-C.O.)
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13
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URAN ŞAN A, KELEŞ H. The effect of vertebral artery characteristics on cervical discogenic pain and disability. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.954040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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14
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Effect of Traditional Korean Medicine Treatment Including Acupotomy on the Level of Pain and Quality of Life of Patients with Cervical Herniated Intervertebral Disc: A Retrospective Observational Study. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2021.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The purpose of this study was to statistically analyze the treatment effect and patient satisfaction of traditional Korean medicine, including acupotomy treatment of cervical herniated intervertebral disc. Methods: This was a retrospective study of 22 patients who received traditional Korean medicine including acupotomy treatment amongst all patients diagnosed with cervical herniated intervertebral discs at the Korean Medicine hospital in Daejeon, Korean, from January 01, 2020 to April 30, 2021. The clinical data from patient medical records were statistically analyzed. Results: The Numeric Rating Scale, the European Quality of Life 5 Dimensions, and the European Quality of Life Visual Analogue Scale questionnaire scores were each compared before and after traditional Korean medicine treatment, including acupotomy, showed significantly improved scores after treatment (p < 0.001). Out of a total of 22 patients, 11 rated the treatment “very satisfactory” (50%), 5 “satisfactory” (22.7%), 5 “indifferent” (22.7%), 1 “unsatisfactory” (4.5%), and 0 “very unsatisfactory” (0%). Of the total 22 patients, 17 patients (77.3%) were willing to have further treatment, and 5 patients (22.7%) were not willing. Conclusion: Traditional Korean medicine treatment including acupotomy was an effective treatment for cervical herniated intervertebral discs. To determine the effect of an individual application (e.g., acupotomy) of traditional Korean medicine treatment for cervical herniated intervertebral disc, a prospective, controlled study is needed.
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Zou L, Zhong C, Xu X, Liu F, Wang C, Shi B. Effect of Baduanjin exercise on cervical spondylosis: A protocol for the systematic review of randomized controlled trials. Medicine (Baltimore) 2021; 100:e24813. [PMID: 33761641 PMCID: PMC9282061 DOI: 10.1097/md.0000000000024813] [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: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The study aims to evaluate the effectiveness and safety of Baduanjin exercise for patients with cervical spondylosis (CS). METHODS We will retrieve a randomized controlled trial of Baduanjin for CS from the following electronic databases establishment to May 2021: The Cochrane Library, MEDLINE, EMBASE, Web of Science, Springer, World Health Organization International Clinical Trials Registry Platform (ICTRP), China National Knowledge Infrastructure (CNKI), Wan-fang database, Chinese Scientific Journal Database (VIP), Chinese Biomedical Literature Databases (CBM), and other databases. Two independent researchers will operate article retrieval, duplication removing, screening, quality evaluation, and data analyses by Review Manager (V.5.3.5). Meta-analyses, subgroup analysis, and/or descriptive analysis will be performed based on the included data conditions. RESULTS The results of this study will provide researchers in the field of CS with a current synthesis of high-quality evidence. CONCLUSION This conclusion of this study will provide the evidence of whether Baduanjin is an effective and safe intervention for patients with CS. PROSPERO REGISTRATION NUMBER CRD42020211019.
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Affiliation(s)
- Liang Zou
- School of Acupuncture-Tuina, Shandong University of Traditional Chinese Medicine
- Affiliated Hospital of Back and Neck Pain, Shandong First Medical University
| | - Chongfu Zhong
- The First Affiliated Hospital of Shandong University of Chinese Medicine, Jinan, Shandong, China
| | - Xiaohui Xu
- Affiliated Hospital of Back and Neck Pain, Shandong First Medical University
| | - Fanjie Liu
- Affiliated Hospital of Back and Neck Pain, Shandong First Medical University
| | - Congan Wang
- Affiliated Hospital of Back and Neck Pain, Shandong First Medical University
| | - Bin Shi
- Affiliated Hospital of Back and Neck Pain, Shandong First Medical University
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Zhuang L, Wang L, Xu D, Wang Z, Liang R. Association between excessive smartphone use and cervical disc degeneration in young patients suffering from chronic neck pain. J Orthop Sci 2021; 26:110-115. [PMID: 32205018 DOI: 10.1016/j.jos.2020.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/29/2020] [Accepted: 02/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND With the popularity of smartphones, cervical spondylosis is becoming more and more common among young people. The aim of this study was to investigate the association between excessive smartphone use and cervical disc degeneration in young patients suffering from chronic neck pain. METHODS A total of 2438 young patients suffering from chronic neck pain were included into this study. All patients underwent the Magnetic Resonance Imaging (MRI) examination of the cervical spine. The degree of cervical disc degeneration, the dependent variable, was evaluated by Cervical Disc Degeneration Scale (CDDS) which was developed from Pfirrmann classification. Smartphone use, the primary independent variable, was assessed by Smartphone Addiction Scale (SAS). RESULTS In all, 52.9% patients were categorized as smartphone overuse. Patients with overuse of smartphones had higher CDDS scores than those who did not use smartphone excessively. CONCLUSIONS The results indicate that cervical disc degeneration may be associated with excessive smartphone use, such use may lead to cervical spondylosis.
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Affiliation(s)
- Linbo Zhuang
- Department of Orthopedics, Baoan Central Hospital of Shenzhen, The Fifth Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, 518102, China.
| | - Lisheng Wang
- Department of Orthopedics, Baoan Central Hospital of Shenzhen, The Fifth Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, 518102, China.
| | - Dongming Xu
- Department of Orthopedics, Baoan Central Hospital of Shenzhen, The Fifth Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, 518102, China.
| | - Zhiyong Wang
- Department of Orthopedics, Baoan Central Hospital of Shenzhen, The Fifth Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, 518102, China.
| | - Renzheng Liang
- Department of Orthopedics, Baoan Central Hospital of Shenzhen, The Fifth Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, 518102, China.
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Zhuang Q, Feng H, Jing F, Rong J, Lv Y, Jing F, Zhang J. Effect of Yijinjing exercise on cervical spondylosis: A protocol for systematic review. Medicine (Baltimore) 2020; 99:e20764. [PMID: 32629655 PMCID: PMC7337593 DOI: 10.1097/md.0000000000020764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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 Cervical spondylosis (CS) is a common disease due to the modern lifestyle. Yijinjin, a kind of traditional Chinese exercise, is frequently used for the prevention of CS by Traditional Chinese Medicine doctors. However, there is no relevant systematic review show its effectiveness and safety. The study aims to evaluate the effectiveness and safety of Yijinjing for patients with CS. METHODS The following electronic databases will be searched from the respective dates of database inception to June 1st, 2020: The Cochrane Library, Web of Science, Springer, EMBASE, MEDLINE, the World Health Organization International Clinical Trials Registry Platform, the Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang database, the Chinese Scientific Journal Database, and other sources. All published randomized controlled trials (RCTs) and blinded researches that are relevant to the subject of interest only will be contained. Two independent researchers will operate article retrieval, duplication removing, screening, quality evaluation, and data analyses by Review Manager (V.5.3.5). Meta-analyses, subgroup analysis and/or descriptive analysis will be performed based on the included data conditions. RESULTS High-quality synthesis and/or descriptive analysis of current evidence will be provided from the neck disability index, neck pain questionnaire questionnaires, patient satisfaction scale and adverse reactions. CONCLUSION This study will provide the evidence of whether Yijinjing is an effective and safe intervention for people with CS. PROSPERO REGISTRATION NUMBER CRD42020164706.
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Affiliation(s)
- Qian Zhuang
- School of Acupuncture-Tuina, Shandong University of Traditional Chinese Medicine, Jinan
| | - Huichao Feng
- School of Acupuncture-Tuina, Shandong University of Traditional Chinese Medicine, Jinan
| | - Fushi Jing
- Department of Rehabilitation, The People's Hospital of Juxian, Juxian
| | - Jiao Rong
- School of Acupuncture-Tuina, Shandong University of Traditional Chinese Medicine, Jinan
| | - Yueming Lv
- School of Acupuncture-Tuina, Shandong University of Traditional Chinese Medicine, Jinan
| | - Fujie Jing
- School of Acupuncture-Tuina, Shandong University of Traditional Chinese Medicine, Jinan
| | - Jing Zhang
- Laboratory management office, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Ahmed SB, Qamar A, Imram M, Fahim MF. Comparison of neck length, relative neck length and height with incidence of cervical spondylosis. Pak J Med Sci 2020; 36:219-223. [PMID: 32063963 PMCID: PMC6994911 DOI: 10.12669/pjms.36.2.832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective: To compare the neck length, relative neck length and height between patients with cervical spondylosis and healthy subjects. Methods: This case control study was conducted at Patel hospital, Karachi after the ethical approval of Bahria University Medical and Dental College (BUMDC) and Patel hospital from September 2018 - February 2019. It enrolled eighty eight cases of cervical spondylosis and eighty eight healthy subjects. Radiographs were taken in the lateral view and neck length was measured as the distance from external occipital protuberance to seventh cervical vertebra spinous process. Then relative neck length was measured by dividing the neck length with height and multiplying it by 100. The Kellgren Lawrence grade scale was used to assess the severity of cervical spondylosis. Results: A total of 176 participants were analyzed. It was found that the height remains the significant determinant. The comparison of cases with control group was done using independent T-test which showed that the cases were significantly shorter than controls with a p-value < 0.05. The other variables such as neck length, and relative neck length were insignificant. Conclusion: Short height can be considered as a risk factor for cervical spondylosis. Short-statured individuals should be counseled to adopt measures for the prevention of cervical spondylosis.
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Affiliation(s)
| | - Aisha Qamar
- Prof. Dr. Aisha Qamar, MBBS, M.Phil Anatomy. Department of Anatomy, Bahria University Medical and Dental College, DHA Phase-II, Karachi, Pakistan
| | - Muhammad Imram
- Dr. Muhammad Imran, MBBS, FCPS. HOD Department of Radiology, Patel Hospital, Karachi, Pakistan
| | - Muhammad Faisal Fahim
- Muhammad Faisal Fahim, M.Sc (Statistics), Researcher and Consultant Statistician, Bahria University Medical and Dental College, DHA Phase-II, Karachi, Pakistan
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