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McDonnell P, Jagadamma KC, Rangra P. A clinical audit of the Emergency Department: Doctors' opinions on the diagnosis and management of cervical spine radiculopathy. Musculoskeletal Care 2024; 22:e1878. [PMID: 38553832 DOI: 10.1002/msc.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE A clinical audit was carried out on the opinions of doctors working in the Emergency Department (ED) of a large urban hospital regarding the diagnosis and management of cervical spine radiculopathy (CSR). Using international guidelines and current research, it aimed to determine if patients attending this ED were diagnosed and managed in line with best practice, and to identify any discrepancies or areas for improvement in relation to this. METHOD Doctors working in this ED were sent an online questionnaire and descriptive analysis was performed on the results to ascertain how they diagnose and manage patients who present with symptoms of CSR. It covered; presentation and definitions of CSR, identification of red flags, clinical tests used, diagnostic test criteria, appropriate management, education and advice given, and the criteria for further management. Additionally, it looked at their opinion on the services' needs. RESULTS Most agreed that CSR will improve within 4 weeks with non-operative management; however, there was a lack of consensus regarding the most affected nerve root, differential diagnosis and appropriate diagnostic tests. Opinions aligned regarding the identification of red flags and early management, especially with widespread neurological deficits. However, the management of ongoing pain or new neurological signs, differed between clinicians. Most participants strongly agreed that access to MRIs affected referrals within an ED episode. CONCLUSION Overall, the opinions matched recommended guidelines; however, some gaps in knowledge and differing management approaches were identified, indicating the need for ongoing education and standardisation of management.
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Schachar J, Bocage A, Nelson NC, Early PJ, Mariani CL, Olby NJ, Muñana KR. Clinical and imaging findings in dogs with nerve root signature associated with cervical intervertebral disc herniation. J Vet Intern Med 2024; 38:1111-1119. [PMID: 38216520 PMCID: PMC10937489 DOI: 10.1111/jvim.16982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Intervertebral disc herniation (IVDH) is the most common spinal cord disease in dogs. Little information is available regarding the clinical presentation of nerve root signature (NRS) associated with cervical IVDH. HYPOTHESIS/OBJECTIVE To detail the clinical and magnetic resonance imaging (MRI) findings in dogs with NRS associated with cervical IVDH. ANIMALS Forty-seven client-owned dogs presenting with thoracic limb NRS and MRI confirmed IVDH. METHODS Medical records from 2010 to 2020 were retrospectively reviewed for dogs that met inclusion criteria. Imaging studies were evaluated by 2 individuals to characterize location and severity of neural tissue compression. RESULTS Chondrodystrophoid dogs comprised the majority of the study cohort, with dachshund the most common breed (n = 10). Three-quarters of dogs were ≥7 years of age. Interobserver agreement was moderate or good for all of the imaging variables evaluated. The C6-C7 intervertebral disc space was significantly overrepresented (P = .01), comprising 32% (15/47) of the affected discs. However, 42% (20/47) of cases involved C2-C3 though C4-C5 disc sites. Disc material was more frequently located laterally compared to medially within the vertebral canal (P = .0005), and to be associated with compression of the nerve root at the level of the intervertebral foramen (P = .012). CONCLUSION/CLINICAL IMPORTANCE NRS is most commonly associated with lateralized or foraminal cervical disc herniations. It is most prevalent with C6-C7 intervertebral disc involvement, suggesting that there might be unique anatomic factors that contribute to development of NRS at this site, but can be a clinical manifestation of IVDH occurring anywhere along the cervical spine.
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Affiliation(s)
- Jordan Schachar
- Department of Clinical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
- Present address:
Garden State Veterinary SpecialistsTintonNew JerseyUSA
| | - Alan Bocage
- Department of Molecular and Biomedical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
- Present address:
Mount Laurel Animal HospitalMount LaurelNew JerseyUSA
| | - Nathan C. Nelson
- Department of Molecular and Biomedical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
| | - Peter J. Early
- Department of Clinical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
| | - Christopher L. Mariani
- Department of Clinical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
| | - Natasha J. Olby
- Department of Clinical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
| | - Karen R. Muñana
- Department of Clinical SciencesCollege of Veterinary Medicine, NC State UniversityRaleigh, North Carolina 27606USA
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Nathani HR, Athawale V, Ratnani G. Integrative Physiotherapy Management of Cervical Radiculopathy and Concurrent Tarlov Cysts. Cureus 2024; 16:e57204. [PMID: 38681406 PMCID: PMC11056202 DOI: 10.7759/cureus.57204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Tarlov cysts, also known as perineural cysts, are usually associated with lumbar discomfort and neurological deficits, with an uncertain etiology that may involve genetic predisposition and collagen disorders, possibly influenced by traumatic events and hemorrhagic episodes. Diagnostic methods such as magnetic resonance imaging or computed tomography myelography are commonly employed and treatment approaches range from conservative measures to more invasive interventions. This case involves a 42-year-old female with cervical pain and upper limb symptoms; a comprehensive assessment, including diagnostic imaging and physiotherapeutic interventions, resulted in significant improvements in pain intensity, range of motion, manual muscle testing, and functional scale scores after a two-week physiotherapy intervention. These findings contribute to advancing our understanding of managing Tarlov cysts associated with cervical radiculopathy, highlighting the potential efficacy of physiotherapeutic interventions in enhancing patient outcomes.
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Affiliation(s)
- Harsh R Nathani
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vrushali Athawale
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Grisha Ratnani
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Hansen LM, Jiang EX, Hodson NM, Livingston N, Kazanjian A, Wu M, Day CS. Patients With and Without Double Crush Syndrome Achieve Similar Rates of Clinical Improvement Following Carpal Tunnel Release. Hand (N Y) 2024:15589447241233764. [PMID: 38420760 DOI: 10.1177/15589447241233764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The purpose of this study is to compare outcomes of carpal tunnel release (CTR) in patients with and without double crush syndrome (DCS), defined as concurrent carpal tunnel syndrome (CTS) and cervical radiculopathy at C5-T1 on preoperative nerve conduction studies. METHODS Patients with preoperative nerve conduction studies who underwent unilateral, isolated CTR were retrospectively identified. All patients completed preoperative and 3-month postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) and pain interference (PI), and Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires, and responded to the anchor question: "Since your treatment, how would you rate your overall function?" (much worse, worse, slightly worse, no change, slightly improved, improved, much improved). Preoperative, postoperative, and changes in scores for UE, PI, and QuickDASH were compared, as were the anchor question responses and rates of achieving the minimal clinically important difference (MCID). RESULTS Sixty-three patients with DCS and 115 patients with CTS only were included. At 3- to 4-month follow-up, absolute and change in UE, PI, and QuickDASH scores were not statistically different between patients with DCS and CTS. Rates of anchor question response and MCID achievement were comparable for patients with CTS only and DCS on each questionnaire. The MCID achievement ranged from 48.4% to 68.8% in the unmatched cohort and 48.4% to 60% in the matched group. CONCLUSIONS At 3 to 4 months, patients with DCS experience similar patient-reported symptomatic and functional improvement, and achieve MCID of outcome measures at comparable rates to patients with CTS only. For patients with nerve compression at the carpal tunnel and cervical spine, CTR is a reasonable first step prior to proceeding with cervical spine decompression.
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Affiliation(s)
- Logan M Hansen
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Eric X Jiang
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Noah M Hodson
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, MI, USA
| | | | - Ani Kazanjian
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Mitchell Wu
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Charles S Day
- Department of Orthopedic Surgery, Henry Ford Health, Detroit, MI, USA
- School of Medicine, Wayne State University, Detroit, MI, USA
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Semonche A, Rinaldo L, Lee Y, Dubnicoff T, Matles H, Chou D, Abla A, Chang EF. Microvascular decompression of a vertebral artery loop causing cervical radiculopathy: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23254. [PMID: 38408348 PMCID: PMC10901126 DOI: 10.3171/case23254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/09/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Vertebral artery loops are a rare cause of cervical radiculopathy. Surgical options for nerve root decompression include an anterior or posterior approach, with or without additional microvascular decompression. OBSERVATIONS The authors describe a case of a 49-year-old man with a long-standing history of left-sided neck pain and migraines, who was found to have a vertebral artery loop in the left C3-4 neural foramen compressing the left C4 nerve root. The patient underwent a posterior cervical decompression with instrumented fusion and macrovascular decompression of the left C4 nerve root via Teflon felt insertion. In a literature review, we identified 20 similar cases that had also been managed surgically. LESSONS Although the anterior approach is more frequently described in the literature, a posterior approach for nerve compression by a vertebral artery loop is also a safe and effective treatment. The authors report the third case of this surgical approach with a good outcome.
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Affiliation(s)
- Alexa Semonche
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Lorenzo Rinaldo
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Young Lee
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Todd Dubnicoff
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Harlan Matles
- 2Menlo Park Concierge Medicine, Menlo Park, California
| | - Dean Chou
- 3Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; and
| | - Adib Abla
- 4Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Edward F Chang
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Mashauri HL, Makunga FJ, Luhwago EC, Ndale E, Kilonzo KG. Is it myocardial infarction? A case report of C7 cervical radiculopathy with cervical angina. SAGE Open Med Case Rep 2024; 12:2050313X231223434. [PMID: 38187813 PMCID: PMC10768626 DOI: 10.1177/2050313x231223434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Cervical radiculopathy refers to the mechanical compression or inflammation of any of the cervical roots which lead to their dysfunction. Male sex, uncontrolled diabetes mellitus, manual labor-related occupation or activities are among the possible factors which can predispose or precipitate the occurrence of cervical radiculopathy. A 63 years old male presented with cervicogenic angina which was refractory to painkillers. C7 cervical radiculopathy might present with cervicogenic angina and pose a clinical diagnosis challenge given its similarity in clinical presentation with other clinical conditions like myocardial infarction. Clinicians should have a high index of suspicion to differentiate the two conditions. Nevertheless, ruling out firstly myocardial infarction and pulmonary embolism among patients presenting with chest pain is of clinical benefit in terms of morbidity and mortality of a patient. Furthermore, proper and timely physical examination should be emphasized to be conducted to every patient so as to avoid delayed diagnosis and management.
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Affiliation(s)
- Harold L Mashauri
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Emergency Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Frank J Makunga
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Elisha C Luhwago
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Eliasa Ndale
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Kajiru G Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
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Chu ECP, Ng L. Dystonic Tremor as an Atypical Presentation of Cervical Radiculopathy. Cureus 2024; 16:e51441. [PMID: 38298318 PMCID: PMC10829058 DOI: 10.7759/cureus.51441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 02/02/2024] Open
Abstract
Cervical radiculopathy often presents with neck pain, sensory disturbances, or motor weakness. This case report describes an atypical presentation of cervical radiculopathy manifesting as dystonic tremor and brachialgia, which has been documented only once previously. A 46-year-old, right-handed, male delivery worker presented with severe neck pain that gradually evolved into a dystonic tremor and sharp aching pain across his right shoulder. Despite medical intervention, his symptoms persisted, leading him to seek chiropractic care. Physical examination and diagnostic tests revealed degenerative osteophytes, causing bilateral foraminal impingement and narrowing. As orthopedic interventions only provide temporary relief, the patient opted for conservative chiropractic management, which led to a remarkable reduction in pain and complete resolution of the dystonic tremor and brachialgia. This case demonstrates that cervical disc prolapse may manifest with dystonic tremor due to excruciating radiculopathy. Additionally, it emphasizes the potential benefits of chiropractic care in managing such atypical presentations and underscores the need for further research on the mechanisms and management of such cases.
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Affiliation(s)
- Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Lucina Ng
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
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Silver J, Mancini M, Pavano C, Bauer J, Barkay G, Moss I, Mallozzi S. C5 nerve root palsy (without prior cervical decompression) case series: 9 patients with critical delay to presentation. J Back Musculoskelet Rehabil 2023:BMR230182. [PMID: 38250753 DOI: 10.3233/bmr-230182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Distinguishing between cervical nerve root and intrinsic shoulder pathology can be a difficult task given the overlapping and often coexisting symptoms. OBJECTIVE The objective of this study was to highlight the often-complicated presentation of these symptoms and the subsequent potential for delay in care regarding this subset of patients. METHODS A total of 9 patients, managed by one of two different surgeons, were identified with a history of C5 nerve root palsy. A chart review was conducted, and the following information was recorded: presenting complaint, time from symptom onset to diagnosis, time from symptom onset to presentation to a spine surgeon, first specialist seen for symptoms, non-spinal advanced imaging and treatment conducted before diagnosis, preoperative and postoperative exam, time to recovery, and type of surgery. RESULTS We observed an average time from onset of symptoms to presentation to a spine surgeon to be 31.6 weeks. These patients' time to full recovery after cervical decompression was 15 weeks. CONCLUSION We observed a critical delay to presentation in this series of patients with C5 nerve palsy. C5 nerve palsy should remain an elemental part of the differential diagnosis in the setting of any shoulder or neck pain presenting with weakness.
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Rifi Z, Thum JA, Sten MS, Florence TJ, Dorsi MJ. Blood pressure cuff-induced radial nerve palsy following minimally invasive lateral microdiscectomy: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23468. [PMID: 37956419 PMCID: PMC10651385 DOI: 10.3171/case23468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The authors describe a rare case of transient postoperative wrist and finger drop following a prone position minimally invasive surgery (MIS) lateral microdiscectomy. OBSERVATIONS Hand and wrist drop is an unusual complication following spine surgery, especially in prone positioning. The authors' multidisciplinary team assessed a patient with this complication following MIS lateral microdiscectomy. The broad differential diagnosis included radial nerve palsy, C7 radiculopathy, stroke, and spinal cord injury. Given the patient's supinator weakness, intact pronation and wrist flexion, and transient recovery within 4 weeks, the most likely diagnosis was radial nerve neuropraxia secondary to ischemic compression. After careful consideration of the operative environment and anatomical constraints, the patient's blood pressure cuff was found to be the most probable source of compression. LESSONS Blood pressure cuff-induced peripheral nerve injury may be a source of postoperative radial nerve neuropraxia in patients undergoing spine surgery. Careful considerations must be given to the blood pressure cuff location, which should not be placed at the distal end of the humerus due to higher susceptibility of peripheral nerve compression. Spine surgeons should be aware of and appropriately localize postoperative deficits along the neuroaxis, including central versus proximal or distal peripheral injuries, in order to guide appropriate postoperative management.
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Affiliation(s)
- Ziad Rifi
- David Geffen School of Medicine and
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Jasmine A Thum
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and
| | - Margaret S Sten
- Georgetown University School of Medicine, Georgetown University, Washington, DC
| | - Timothy J Florence
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
| | - Michael J Dorsi
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California
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Guadarrama-Ortiz P, Ruíz-Rivero CO, Capi-Casillas D, Román-Villagómez A, Prieto-Rivera ÁD, Choreño-Parra JA. Demographic and Clinical Characteristics of Patients With Cervical Spine Degeneration Reveal Frequent Cervicolumbar Tandem Spinal Stenosis in Mexico. Int J Spine Surg 2023; 17:670-677. [PMID: 37460237 PMCID: PMC10623664 DOI: 10.14444/8520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Limited literature exists regarding the differences in demographics, causes, comorbidities, presentation, and structural changes associated with cervical spine degeneration in patients from distinct geographic regions. The authors aimed to evaluate the demographic and clinical characteristics of patients with cervical spine degeneration admitted to a single center in Mexico. METHODS This study enrolled patients with degenerative disease of the cervical spine. Clinical data were retrieved from medical records and retrospectively characterized. RESULTS A total of 50 patients with cervical spine degeneration were included in the analysis. Of these, 26% were men with a median age of 54 years. Hypertension, depression, anxiety, obesity, and alcohol consumption were presented in about a quarter of the participants. In addition, we observed hypertriglyceridemia and hypercholesterolemia in 72% and 46% of participants, respectively. The median duration of symptoms was 11 months, including radicular arm/neck pain (80%), tingling (80%), reduced muscle strength (48%), and gait disturbances (48%). Forty percent of patients had 2 cervical segments radiologically involved, mainly at C5-C6, with changes such as disc herniation (88%), foraminal stenosis with nerve root compression (67%), reduced spinal canal-to-vertebral body ratio (38%), and ligamentum flavum hypertrophy (24%). Also, 22% of patients showed degenerative cervical myelopathy. Strikingly, 48% of enrolled individuals showed cervicolumbar tandem spinal stenosis, mainly in L4-L5 and L5-S1, who were generally older, had a longer duration of symptoms, and had a higher comorbidity burden, including hyperglycemia, hypertension, and depression. CONCLUSIONS The demographic and clinical characteristics of degenerative cervical spine disease in Mexico differ with respect to other geographical regions by a younger age of diagnosis, a high frequency of cardiovascular, metabolic, and mental health comorbidities, and an increased prevalence of concomitant lumbar spinal stenosis. CLINICAL RELEVANCE Our findings reveal a considerably high burden of cervicolumbar tandem spinal stenosis as a distinctive feature of Mexican patients with cervical spine degeneration. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Parménides Guadarrama-Ortiz
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| | - César Osvaldo Ruíz-Rivero
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| | - Deyanira Capi-Casillas
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| | - Alondra Román-Villagómez
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| | - Ángel Daniel Prieto-Rivera
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| | - José Alberto Choreño-Parra
- Department of Clinical Research, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
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Lee DH, Lee HJ, Cho JH, Hwang CJ, Yang JJ, Lee CS, Park S. Foraminal Restenosis After Posterior Cervical Foraminotomy for the Treatment of Cervical Radiculopathy. Global Spine J 2023; 13:2357-2366. [PMID: 35323054 PMCID: PMC10538319 DOI: 10.1177/21925682221083268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To elucidate incidence, risk factor, and clinical effect of bone regrowth after posterior cervical foraminotomy (PCF). METHODS Ninety-eight patients who underwent PCF for the treatment of cervical radiculopathy and were followed up for >2 years were retrospectively reviewed. Foraminal dimension, sagittal gap at resected area, facet thickness, lamina length, and cervical range of motion (ROM) were measured. Neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDI) were recorded. Radiographic measures were compared between segments with foraminal narrowing of ≥20% at the 2-years follow-up (restenosis segments) and foraminal narrowing of <20% (patent segments). RESULTS Sixty-nine patients with 109 segments were included. 73.4% (80/109) of foramens demonstrated foraminal narrowing and decrease of foraminal dimension of ≥20% occurred in 30.3% (30/109). Foraminal dimension at postoperative 2-days was significantly higher in the restenosis segments (P = .047). Furthermore, increase of foraminal dimension was significantly associated with foraminal restenosis of ≥20% (P = .018). Facet thickness was significantly higher in the restenosis segments compared to patent segments at postoperative 2-years follow-up (P = .038). Neck pain VAS was significantly aggravated only in the restenosis group at postoperative 2-years follow-up (P < .001). CONCLUSIONS Foraminal narrowing commonly occurs after PCF due to bone healing. Bone growth occurs in all directions while medial facet growth contributes more to foraminal restenosis. Greater widening of foramen during PCF is a risk factor for postoperative foramen restenosis. Therefore, amount of bone resection should be kept optimal and excessive resection should be avoided to prevent foramen restenosis.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong-Joo Lee
- Department of Orthopedic surgery, Busan Bumin Hospital, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
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Cao T. Surgical intervention as a viable treatment option for brachioradial pruritus. J Spine Surg 2023; 9:245-246. [PMID: 37841783 PMCID: PMC10570650 DOI: 10.21037/jss-23-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/30/2023] [Indexed: 10/17/2023]
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Gideon B, Takebayashi K, Inui T, Oshima Y, Iwai H, Inanami H, Koga H. Comparison of the Outcomes of Microendoscopic Cervical Foraminotomy versus Full-endoscopic Cervical Foraminotomy for the Treatment of Cervical Radiculopathy. Neurol Med Chir (Tokyo) 2023; 63:426-431. [PMID: 37423752 PMCID: PMC10556212 DOI: 10.2176/jns-nmc.2023-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/08/2023] [Indexed: 07/11/2023] Open
Abstract
This study aimed to compare the outcomes of microendoscopic cervical foraminotomy (MECF) versus full-endoscopic cervical foraminotomy (FECF) for treating cervical radiculopathy (CR).A retrospective study was performed on patients with CR treated using MECF (n = 35) or FECF (n = 89). A 16-mm tubular retractor and endoscope was used for MECF, while a 4.1-mm working channel endoscope was used for FECF. Patient background and operative data were collected. The numerical rating scale (NRS) and the Neck Disability Index scores were recorded preoperatively and at 1 year postoperatively. Postoperative subjective satisfaction was also assessed.Although the NRS, and NDI scores, as well as postoperative satisfaction at 1 year considerably improved in both groups, one of the background data (number of operated vertebral level) was significantly different. Therefore, we separately analyzed single- and two-level CR. In single-level CR, operation time, intraoperative bleeding, postoperative stay, NDI after 1 year, and reoperation rate were statistically superior in FECF group. In two-level CR, the postoperative stay was statistically superior in FECF group. Three postoperative hematomas were observed in the MECF group, while none was observed in the FECF group.Operative outcomes did not significantly differ between groups. We did not observe postoperative hematoma in FECF even without placement of a postoperative drain. Therefore, we recommend FECF as the first option for the treatment of CR as it has a better safety profile and is minimally invasive.
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Affiliation(s)
- Blumstein Gideon
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital
- Department of Orthopaedics, Cedars Sinai Marina Del Rey Hospital
| | - Kento Takebayashi
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital
- Department of Neurosurgery, Iwai FESS Clinic
| | - Takahiro Inui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital
| | - Hiroki Iwai
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital
| | - Hirohiko Inanami
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital
| | - Hisashi Koga
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital
- Department of Neurosurgery, Iwai FESS Clinic
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Abstract
STUDY DESIGN Cross-sectional, international survey. OBJECTIVES To evaluate the knowledge of spine surgeons regarding the use of electromyography (EMG) and nerve conduction studies (NCS) for degenerative cervical spine conditions (DCC). METHODS All members of AO Spine International were emailed an anonymous survey to evaluate their clinical knowledge about the use of EMG and nerve conduction studies for DCC. Descriptive statistics were used to analyze the results, as well as to compare the answers among different groups of surgeons and assess demographic characteristics. RESULTS A total of 402 participants answered the survey, 91.79% were men from the 5 continents. There were 221 orthopedic surgeons (55.39%) and 171 neurosurgeons (42.86%), more than a half of them with a complete spinal fellowship (56.44%). The most common reasons that surgeons obtain the test is to differentiate a radiculopathy from a peripheral nerve compression (88.06%). As a group, the responding surgeons' knowledge regarding EMG-NCS was poor. Only 53.46% of surgeons correctly answered that EMG-NCS is unable to differentiate a C5 from a C6 radiculopathy. Only 23.47% of the surgeons knew that EMG-NCS are not able to diagnose a pre vs a post-fixed brachial plexus. Only 25% of the surgeons correctly answered a question regarding the test's ability to diagnose other neurological diseases. CONCLUSIONS We found that our respondents' knowledge regarding EMG-NCS for DCC was poor. Identifying the weak points of knowledge about EMG-NCS may help to educate surgeons on the indications for the test and the proper way to interpret the results.
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Affiliation(s)
- Andrei Fernandes Joaquim
- Professor of Neurosurgery, Department of Neurology, Discipline of Neurosurgery, University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Carlos Roberto Martins
- Neurophysiologist, Department of Neurology, Discipline of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - K. Daniel Riew
- Professor of Orthopedic Surgery, Department of Orthopaedics, Department of Neurological Surgery, Weill-Cornell Medical Center, The Och Spine Hospital at New York-Presbyterian, Columbia University Medical Center, New York, NY, USA
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15
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Teymouri A, Emami Razavi SZ, Azadvari M, Hosseini M. Characteristics of carpal tunnel syndrome in patients with cervical radiculopathy: A cross-sectional study. Health Sci Rep 2023; 6:e1575. [PMID: 37736308 PMCID: PMC10509651 DOI: 10.1002/hsr2.1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/29/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023] Open
Abstract
Background and Aims Cervical radiculopathy (CR) is a group of signs and symptoms caused by cervical root dysfunction. Patients with this condition may also have carpal tunnel syndrome (CTS), which is caused by compression of the median nerve in the carpal tunnel. This coexistent condition is referred to as double crush syndrome (DCS) which is explained by proximal disruption in axoplasmic flow that may result in nerve dysfunction. Yet, the accuracy of this hypothesis remains controversial. Materials and Methods Patients with confirmed CR according to electromyography were included in this retrospective study. However, we omitted patients with overt diabetic neuropathy, prior spinal or hand surgery and/or fractures, and rheumatoid arthritis. Patients underwent electrodiagnostic studies, and the results were used to determine CTS severity. We used Pearson's χ 2 test to assess the correlation between the severity of CTS and CR. Descriptive analysis was used to report patient characteristics and the prevalence of CTS in CR patients. Results We included 291 participants, 59% of whom were women. Although insignificant, DCS was observed more in women (n = 110) compared to men (n = 71). However, we found that patients with DCS (54.81 ± 13.3) were older than non-DCS patients (43.71 ± 12.94) which was statistically significant (p < 0.05). There was statistically no correlation between the severity of CR and CTS, ipsilaterlly (p > 0.05). In total, CTS was observed in 62.2% (n = 181) patients. Conclusion In summary, we found a relatively high prevalence of DCS in the present study. In patients with and without DCS, gender did not seem to play a role but the growing age seemed to contribute to DCS. The severity of CTS was not related to CR severity at any cervical level, which negates a causal relation between the pre-existing CR and newly diagnosed CTS.
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Affiliation(s)
- Alireza Teymouri
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Seyede Zahra Emami Razavi
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Mohaddeseh Azadvari
- Department of Physical Medicine and Rehabilitation, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Maryam Hosseini
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
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16
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Kim HS, Wu PH, Chin BZJ, Jang IT. Clinical and Radiological Outcomes of a Comparative Study of Anterior Cervical Decompression and Fusion with Partial Pediculotomy, Partial Vertebrotomy (PPPV) Posterior Endoscopic Cervical Decompression (PECD) for Cervical Foraminal Pathology. Medicina (Kaunas) 2023; 59:1222. [PMID: 37512034 PMCID: PMC10383634 DOI: 10.3390/medicina59071222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/08/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The purpose was to compaSre medium-term clinical and radiological outcomes of Partial Pediculotomy, Partial Vertebrotomy (PPPV) Posterior Endoscopic Cervical Decompression (PECD) surgery versus Anterior Cervical Discectomy and Fusion (ACDF) for patients with cervical disc herniations and foraminal pathologies. Materials and Methods: A prospective registry of patients who had undergone either PPPV PECD surgery or ACDF surgery for cervical disc herniation or foraminal pathologies under a single fellowship-trained spine surgeon was performed. The baseline characteristics and operative details including complications were recorded for all included patients. The clinical outcomes evaluated include VAS, MJOA, motor score, and NDI and MacNab's score. The radiological parameters in neutral-measured facet length, facet area, disc height, C2-C7 angle, neck tilt angle, T1 slope and thoracic inlet angle were also evaluated. Results: A total of 55 patients (29 PPPV PECD, 26 ACDF) were included, with mean follow-up periods of 21.9 and 32.3 months, respectively. Each cohort was noted to have a single case of surgical complication. Statistically significant changes of facet area (49.05 ± 14.50%) and facet length (52.71 ± 15.11%) were noted in the PPPV PECD group. At neutral alignment of the neck on a lateral X-ray, compared to ACDF, PPPV PECD had a statistically significant change in neck tilt angle (-11.68 ± 17.35°) and T1 slope angle (-11.69 ± 19.58°). Whilst both PPPV PECD and ACDF had significant improvements in VAS, MJOA and NDI postoperatively, PPPV PECD was found to be superior across all above scores at various follow-up timepoints compared to its ACDF counterparts. Conclusions: PPPV PECD surgery achieved a satisfactory radiological correction of neck alignment and significantly improved clinical outcomes at medium-term follow-up for our cohort of patients, highlighting its feasibility in treating patients with cervical disc herniations and foraminal pathologies.
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Affiliation(s)
- Hyeun Sung Kim
- Harrison Spinartus Hospital, Chungdam, Seoul 06084, Republic of Korea
| | - Pang Hung Wu
- Achieve Spine and Orthopaedic Centre, Mount Elizabeth Hospital, Singapore 228510, Singapore
| | - Brian Zhao Jie Chin
- Orthopaedic Surgery, Jurong Health Campus, National University Health System, 1 Jurong East Street 21, Singapore 609606, Singapore
| | - Il Tae Jang
- Spines Surgery, Nanoori Gangnam Hospital, Seoul 06048, Republic of Korea
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17
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Tan BH, Sockalingam S, Ganesan D. The use of intraoperative CT navigation for posterior cervical spine foraminotomy. Br J Neurosurg 2023:1-4. [PMID: 37345453 DOI: 10.1080/02688697.2023.2225611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVES Posterior cervical foraminotomy is a surgical procedure used to treat unilateral cervical radiculopathy. It provides direct decompression of the nerve root without the necessity of fusion while maintaining cervical mobility. With the advancement in image-guidance technology and minimal access techniques, intra-operative CT has provided a safer, more accurate instrumentation placement with less radiation exposure to operative staff and provides better anatomical visualization quality compared to traditional intra-operative imaging techniques. This case series aims to address the applications of advanced image guidance in posterior cervical foraminotomy and describe the nuances. METHOD A technical report on a series of seven cases on intraoperative CT navigation for posterior cervical foraminotomy surgery. Posterior cervical foraminotomy was performed in all patients under CT guided navigation system without an image intensifier. In one case after the foraminotomy, the extruded disc was carefully removed by gentle retraction. RESULT From 1 January 2020 to 31 December 2021, a total of seven patients with nine cervical foraminotomy procedures were performed using the aid of CT-guided navigation. The series comprised five women and two men whose mean age was 50.6 years. In all cases, the radiculopathy symptoms were diminished significantly. There were no cases of instability on the dynamic cervical radiograph. There were no complications during the surgical procedure. CONCLUSION The navigation also allows the surgeon to localise the index level accurately and appraise the adequacy of the intended decompression in three planes of the CT scan image. The ability to perform accurate spine navigation would be the precursor for robotic spinal surgery.
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Affiliation(s)
- Bih Huei Tan
- Department of Surgery, Neurosurgery Division, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sutharshan Sockalingam
- Department of Surgery, Neurosurgery Division, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Dharmendra Ganesan
- Department of Surgery, Neurosurgery Division, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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18
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Tang B, Zhu LG, Wei X, Ding WY, Xu ZW, Sun K, Yin H. [Expert consensus for Jingtong Granules in treatment of cervical radiculopathy in clinical application]. Zhongguo Zhong Yao Za Zhi 2023; 48:2260-2264. [PMID: 37282914 DOI: 10.19540/j.cnki.cjcmm.20221230.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
With the effects of activating blood and resolving stasis, and moving Qi to relieve pain, Jingtong Granules is widely used in the treatment of cervical radiculopathy in China. Long-term clinical application and related evidence have shown that the prescription has ideal effect in alleviating the pain in neck, shoulder, and upper limbs, stiffness or scurrying numbness, and scurrying pain caused by this disease. However, there is a lack of consensus on the clinical application of Jingtong Granules. Therefore, clinical first-line experts and methodology experts from all over the country were invited to compile this expert consensus. This expert consensus is expected to guide clinicians to use Jingtong Granules in a standardized and reasonable way, improve clinical efficacy, reduce medication risks, and benefit patients. First, according to the clinical experience of experts and the standard development procedures, the indications, syndrome characteristics, clinical advantages, and possible adverse reactions of Jingtong Granules were summarized. Then, through face-to-face interview of clinical doctors in traditional Chinese medicine and western medicine and survey of the clinical application, the clinical problems were summed up, and the consensus was reached with the nominal group method to form the final clinical problems. Third, evidence retrieval was carried out for the clinical problems, and relevant evidence was evaluated. The GRADE system was employed to rate the quality of evidence. Fourth, 5 recommendation items and 3 consensuses items were summarized with the nominal group method. Opinions and peer reviews on the consensus content were solicited through expert meetings and letter reviews. The final consensus includes the summary of evidence on the clinical indications, effectiveness, and safety of Jingtong Granules, which can serve as a reference for clinicians in hospitals and primary health institutions.
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Affiliation(s)
- Bin Tang
- Wangjing Hospital of China Academy of Chinese Medical Sciences Beijing 100102, China the First Affiliated Hospital of Guangxi University of Chinese Medicine Nanning 530022, China
| | - Li-Guo Zhu
- Wangjing Hospital of China Academy of Chinese Medical Sciences Beijing 100102, China
| | - Xu Wei
- Wangjing Hospital of China Academy of Chinese Medical Sciences Beijing 100102, China
| | - Wen-Yuan Ding
- the Third Hospital of Hebei Medical University Shijiazhuang 050051, China
| | - Zhan-Wang Xu
- the Affiliated Hospital of Shandong University of Traditional Chinese Medicine Ji'nan 250011, China
| | - Kai Sun
- Wangjing Hospital of China Academy of Chinese Medical Sciences Beijing 100102, China
| | - He Yin
- Wangjing Hospital of China Academy of Chinese Medical Sciences Beijing 100102, China
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Hermansen A, Kammerlind AS, Wibault J, Löfgren H, Zsigmond P, Dedering Å, Öberg B, Peolsson A. Dizziness and balance outcomes after two different postoperative rehabilitation approaches following neck surgery: analyses of a multicenter randomized controlled trial. Physiother Theory Pract 2023; 39:750-760. [PMID: 35156511 DOI: 10.1080/09593985.2022.2029654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Dizziness and balance problems are common symptoms in patients with cervical radiculopathy. OBJECTIVE To evaluate the effect of neck surgery postoperatively combined with either structured rehabilitation or standard approach in patients with cervical radiculopathy and dizziness and/or balance problems, and investigate factors influencing dizziness and balance at 6-month follow-up. METHODS Individuals (n = 149) with cervical radiculopathy and dizziness and/or balance problems were randomized preoperatively to structured postoperative rehabilitation or standard postoperative approach. Outcomes were intensity of dizziness and subjective balance, and clinical measures of balance. RESULTS Self-reported measures improved at three months (p ˂ 0.001 to p = .007) and the standing balance at six months (p = .008). No between-group differences. Baseline values, neck pain, and physical activity level explained 23-39% of the variance in 6-month outcomes for self-reported measures. Baseline values and physical activity level explained 71% of the variance in walking balance, and lower baseline scores were significantly associated with standing balance impairments (OR 0.876). CONCLUSION Patients improved significantly in dizziness and subjective balance intensity shortly after surgery, and in standing balance at 6 months, independent of postoperative rehabilitation. Neck pain, physical activity, and neck muscle function influenced dizziness and balance, although preoperative values and neck pain were of most importance for 6-month outcomes.
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Affiliation(s)
- Anna Hermansen
- Department of Health, Medicine and Caring Sciences , Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Ann-Sofi Kammerlind
- Department of Health, Medicine and Caring Sciences , Unit of Physiotherapy, Linköping University, Linköping, Sweden
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Johanna Wibault
- Department of Activity and Health, Region Östergötland, Linköping, Sweden
| | - Håkan Löfgren
- Neuroorthopedic Center, Jönköping, Region Jönköping County, Jönköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Peter Zsigmond
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Neurosurgery, Region Östergötland, Linköping, Sweden
| | - Åsa Dedering
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Birgitta Öberg
- Department of Health, Medicine and Caring Sciences , Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences , Unit of Physiotherapy, Linköping University, Linköping, Sweden
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20
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Chu ECP, Yun S, Huang KHK. Cervicogenic Angina and Dyspnea Secondary to Cervical Radiculopathy. Cureus 2023; 15:e37515. [PMID: 37064724 PMCID: PMC10099400 DOI: 10.7759/cureus.37515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 04/18/2023] Open
Abstract
Cervicogenic angina and dyspnea are conditions characterized by chest discomfort and breathing difficulties that resemble angina pectoris and dyspnea of cardiac origin. However, this condition is caused by cervical spine pathology, cervical spondylosis, and radiculopathy. This case study reports a 66-year-old man who presented with cervicogenic angina and dyspnea due to cervical radiculopathy to a chiropractic clinic. The patient underwent a comprehensive diagnostic evaluation, including taking the patient's history, a physical examination, and radiological investigations, which demonstrated cervical spine involvement consistent with a cervicogenic origin of the pain. The patient's angina-like symptoms and dyspnea improved significantly after chiropractic manipulation of the spine, soft tissue mobilization, and other manual therapies. Accurate diagnosis is essential to minimize unnecessary cardiac interventions and ensure proper therapy for underlying cervical spine problems. This case demonstrates the necessity of conservative management, such as chiropractic care, for patients presenting with cervicogenic angina and dyspnea, particularly when a diagnostic assessment reveals cervical spinal involvement.
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Affiliation(s)
- Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, HKG
| | - Steve Yun
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, HKG
| | - Kevin Hsu Kai Huang
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, HKG
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21
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Li NY, Yang DS, Dwivedi S, Gil JA, Daniels AH. Complications and Reoperation Following Surgery for Concurrent Carpal Tunnel and Cervical Spine Compression. Hand (N Y) 2023:15589447231158807. [PMID: 36946591 DOI: 10.1177/15589447231158807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Patients with carpal tunnel syndrome (CTS) may also have cervical radiculopathy (CR) or vice versa, potentially requiring carpal tunnel release (CTR) and anterior cervical discectomy and fusion (ACDF). This study evaluates whether there is an increased risk of complications following CTR or ACDF in patients with concurrent CTS and CR (CTS-CR) compared with those with only CTS or CR. METHODS A multipayer database was used to identify patients with CTS-CR. From this cohort, patients who underwent CTR and/or ACDF were identified. Patients with CTS-CR undergoing surgery were compared with those undergoing surgery with only CTS or CR. Multivariable logistic regression was used to compare matched populations to assess postoperative complications and risk of undergoing both procedures. RESULTS A total of 110 379 patients with CTS-CR were identified. Carpal tunnel release was performed in 21 152 patients (19.2%) with CTS-CR, from which 835 (0.76%) underwent ACDF. Anterior cervical discectomy and fusion was performed in 6960 patients (6.31%) with CTS-CR followed by CTR in 1098 patients (0.99%). Patients with CTS-CR were at greater risk of reoperation and complex regional pain syndrome following CTR. In ACDF, patients with CTS-CR were at greater risk of reoperation. Obesity and tobacco use were significant risk factors in patients with CTS-CR who underwent both CTR and ACDF rather than a single surgery. CONCLUSIONS Examination of more than 100 000 patients with CTS-CR found a greater likelihood of reoperation and perioperative complications following surgery than those without concurrent diagnoses. Obesity and smoking increased the risk for patients undergoing both procedures. Patients presenting with CTS-CR are high risk and should be counseled on risk of complication and reoperation and optimized to reduce risk of undergoing both CTR and ACDF.
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Affiliation(s)
- Neill Y Li
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Daniel S Yang
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Shashank Dwivedi
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
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Guo L, Wang J, Zhao Z, Li J, Zhao H, Gao Y, Chen C. Microscopic Anterior Cervical Discectomy and Fusion Versus Posterior Percutaneous Endoscopic Cervical Keyhole Foraminotomy for Single-level Unilateral Cervical Radiculopathy: A Systematic Review and Meta-analysis. Clin Spine Surg 2023; 36:59-69. [PMID: 35344521 PMCID: PMC9949523 DOI: 10.1097/bsd.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE The objective of this study was to compare the safety of microscopic anterior cervical discectomy and fusion (MI-ACDF) and posterior percutaneous endoscopic keyhole foraminotomy (PPEKF) in patients diagnosed with single-level unilateral cervical radiculopathy. SUMMARY OF BACKGROUND DATA After conservative treatment, the symptoms will be relieved in about 90% of cervical radiculopathy patients. For the other one tenth of patients, surgical treatment is needed. The overall complication rate of MI-ACDF and PPEKF ranges from 0% to 25%, and the reoperation rate ranges from 0% to 20%. MATERIALS AND METHODS Electronic retrieval of studies from PubMed, Embase, and Cochrane Library was performed to identify comparative or single-arm studies on MI-ACDF and PPEKF. A total of 24 studies were included in our meta-analysis by screening according to the inclusion and exclusion criteria. After data extraction and quality assessment of the included studies, a meta-analysis was performed by using the R software. The pooled incidences of efficient rate, total complication rate, and reoperation rate were calculated. RESULTS A total of 24 studies with 1345 patients (MI-ACDF: 644, PPEKF: 701) were identified. There was no significantly statistical difference in pooled patient effective rate (MI-ACDF: 94.3% vs. PPEKF: 93.3%, P =0.625), total complication rate (MI-ACDF: 7.1% vs. PPEKF: 4.7%, P =0.198), and reoperation rate (MI-ACDF: 1.8% vs. PPEKF: 1.1%, P =0.312). However, the common complications of the 2 procedures were different. The most common complications of MI-ACDF were dysphagia and vertebral body sinking, whereas the most common complication of PPEKF was nerve root palsy. CONCLUSIONS Both MI-ACDF and PPEKF can provide a relatively safe and reliable treatment for single-level unilateral cervical radiculopathy. The 2 techniques are not significantly different in terms of effective rate, total complication rate, and reoperation rate.
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Affiliation(s)
| | | | | | - Jing Li
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital
| | | | - Yong Gao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Chao Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Orthopaedics, Hefeng Central Hospital, Enshi, Hubei Province, China
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23
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Hara S, Lønne VV, Aasdahl L, Salvesen Ø, Solberg T, Gulati S, Hara KW. Return to Work After Surgery for Cervical Radiculopathy: A Nationwide Registry-based Observational Study. Spine (Phila Pa 1976) 2023; 48:253-260. [PMID: 36122300 PMCID: PMC9855750 DOI: 10.1097/brs.0000000000004482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An observational multicenter study. SUMMARY OF BACKGROUND DATA Return to work (RTW) is increasingly used to assess the standard, benefit, and quality of health care. OBJECTIVE The aim of this study was to evaluate sick leave patterns among patients undergoing surgery for cervical radiculopathy and identify predictors of successful RTW using two nationwide databases. MATERIALS AND METHODS Data from the Norwegian Registry for Spine Surgery (NORspine) and the Norwegian Labour and Welfare Administration were linked on an individual level. We included patients between 18 and 60 years of age registered in NORspine from June 2012 through December 2019 that were temporarily out of the labor force for medical reasons at the time of surgery. We assessed types and grades of sickness benefits before and after surgery and conducted logistic regression analyses. RESULTS Among 3387 patients included in the study, 851 (25.1%) received temporary benefits one year before surgery. The proportion of recipients increased steadily towards surgery. Postoperatively the medical benefit payment decreased rapidly, and half of the patients had already returned to work by four months. The rate of RTW reached a plateau at one year. By the end of the third year, 2429 patients (71.7%) had returned to work. The number of sick days, categorized as 90 or less, during the year before surgery had the most powerful association with RTW at two years (odds ratio: 4.54, 95% CI: 3.42-6.03, P <0.001). Improvement in neck-related disability was the second strongest predictor (odds ratio: 2.17, 95% CI: 1.69-2.78, P <0.001). CONCLUSION RTW after cervical radiculopathy surgery occurs primarily during the first year. The strongest predictor of RTW was fewer sick days before surgery. The clinical improvement after surgery had a lesser impact. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Sozaburo Hara
- Department of Neurosurgery, St. Olav’s University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vetle V. Lønne
- Department of Neurosurgery, St. Olav’s University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lene Aasdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Unicare Helsefort Rehabilitation Centre, Rissa, Norway
| | - Øyvind Salvesen
- Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore Solberg
- Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway
- Norwegian Registry for Spine Surgery (NORspine), Tromsø, Norway
| | - Sasha Gulati
- Department of Neurosurgery, St. Olav’s University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Board for Spinal Surgery, St. Olav’s University Hospital, Trondheim, Norway
| | - Karen W. Hara
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- NAV Advisory Service for Trøndelag, Norway
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Oshina M, Kawamura N, Hara N, Higashikawa A, Ono T, Takeshita Y, Azuma S, Fukushima M, Iwai H, Kaneko T, Inanami H, Oshima Y. A Propensity Score-matched Analysis of Clinical Outcomes Between Single-level and Multilevel Intervertebral Decompression for Cervical Radiculopathy. Spine (Phila Pa 1976) 2023; 48:247-252. [PMID: 36255352 PMCID: PMC9855740 DOI: 10.1097/brs.0000000000004508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN Retrospective multicenter study with propensity score matching. OBJECTIVE To compare the clinical outcomes of single-level and multilevel intervertebral decompression for cervical degenerative radiculopathy. SUMMARY OF BACKGROUND DATA In patients with cervical radiculopathy, physical examination findings are sometimes inconsistent with imaging data. Multilevel decompression may be necessary for multiple foraminal stenosis. Additional decompression is more invasive yet expected to comprehensively decompress all suspected nerve root compression areas. However, the surgical outcomes of this approach compared with that of single-level decompression remain unknown. MATERIALS AND METHODS The data of patients with spinal surgery for pure cervical radiculopathy were collected. Patients were categorized into the single-level (SLDG) or multilevel (MLDG) intervertebral decompression group at C3/C4/C5/C6/C7/T1. Demographic data and patient-reported outcome scores, including the Neck Disability Index (NDI) and Numerical Rating Scale (NRS) scores for pain and numbness in the neck, upper back, and arms, were collected. The NDI improvement rates and changes in NRS scores were analyzed one year postoperatively at patient-reported outcome evaluation. Propensity score matching was performed to compare both groups after adjusting for baseline characteristics, including the preoperative NDI and NRS scores. RESULTS Among the 357 patients in this study, SLDG and MLDG comprised 231 and 126 patients, respectively. Two groups (n=112, each) were created by propensity score matching. Compared with the MLDG, the SLDG had a higher postoperative NDI improvement rate ( P =0.029) and lower postoperative arm numbness NRS score ( P =0.037). Other outcomes tended to be more favorable in the SLDG than in the MLDG, yet no statistical significance was detected. CONCLUSIONS In patients with cervical radiculopathy, the surgical outcomes of the SLDG showed better improvement in clinical outcomes than those of the MLDG. Numbness remained on the distal (arms) rather than the central (neck and upper back) areas in patients receiving multilevel decompression.
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Affiliation(s)
- Masahito Oshina
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Akiro Higashikawa
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kanagawa, Japan
| | - Takashi Ono
- Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Yujiro Takeshita
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, Kanagawa, Japan
| | - Seiichi Azuma
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | | | - Hiroki Iwai
- Iwai Orthopedic Medical Hospital, Tokyo, Japan
| | | | | | - Yasushi Oshima
- Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan
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Ma L, Wang Y, Yao M, Huang B, Deng J, Wen H. Evaluating the Extent of Ultrasound-Guided Cervical Selective Nerve Root Block in the Lower Cervical Spine: Evidence Based on Computed Tomography Images. J Pain Res 2023; 16:669-676. [PMID: 36908928 PMCID: PMC9999714 DOI: 10.2147/jpr.s399431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
Objective To verify the injectate dispersal patterns (IDP) and therapeutic outcome of ultrasound-guided cervical selective nerve root block (UG-SCNRB) in treating cervical radiculopathy (CR). Methods Overall, 18 CR patients were recruited to undergo UG-SCNRB in the CT room. Following placement of the puncture needle tip between the target nerve root and posterior tubercle, 3 mL of the drug was administered per root (0.33% lidocaine 0.5 mL + Compound betamethasone injection 0.5mL + methylcobalamin injection 1mL + iohexol 1mL). Subsequently, the IDP was assessed on postintervention CT scan images. Results In all, 18 participants were analyzed. We injected 21 target cervical nerve roots, namely, 1 C4 nerve, 9 C5 nerves, and 11 C6 nerves. Among the IDPs on postintervention CT scan images, two IDPs were most prevalent, namely, the contrast spread into the extraforaminal spaces (Zone I, the interscalene) in 100% (21/21) of cases, and the foraminal space spread (Zone II) in 61.90% (13/21) of cases. The injectate spread into the epidural spaces (Zone III) in only 2 out of 21 cases (9.52%). The pain relief was significantly improved two hours after surgery, compared to the preoperative VAS pain scores (2 hours, 1.39±0.50 vs VAS at baseline, P<0.01). The VAS pain scores during follow-up were significantly lower than preoperation (1 weeks, 1.94±0.54 vs VAS at baseline; 2 weeks, 2.61±0.70, P<0.01 vs VAS at baseline; 4 weeks, 2.67±0.59, P<0.01 vs VAS at baseline). Conclusion We verified, via CT imaging, that the UG-SCNRB drug diffusion was within safe range (the injectate mainly spread to the extraforaminal spaces), and without any serious complications, such as, intravascular drug injection, extensive diffusion of the epidural space, and general spinal anesthesia.
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Affiliation(s)
- Ling Ma
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Yi Wang
- Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Ming Yao
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Bing Huang
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Jiajia Deng
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China
| | - Huaichang Wen
- Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sun B, Xu C, Qi M, Shen X, Zhang K, Yuan W, Liu Y. Predictive Effect of Intervertebral Foramen Width on Pain Relief After ACDF for the Treatment of Cervical Radiculopathy. Global Spine J 2023; 13:133-139. [PMID: 33557606 PMCID: PMC9837496 DOI: 10.1177/2192568221993444] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate the relationship between the preoperative width of the intervertebral foramen (WIVF) and the pain relief in patients who underwent anterior cervical discectomy and fusion (ACDF) for the treatment of cervical radiculopathy. METHODS Patients were divided into 2 groups based on pain relief status at the 6-month follow-up (pain relief group: 430 patients; persistent pain group: 108 patients). Possible factors such as age, sex, body mass index (BMI), the symptom duration, the preoperative Japanese Orthopedic Association (JOA) scores, the canal stenosis status, and the graft material were obtained. The C2-C7 Cobb angle, disc space, and width and height of the intervertebral foramen were measured on X-ray and CT 3-dimension reconstruction. Multivariate logistic regression was performed to identify the factors that affected pain relief. A receiver operating characteristic (ROC) curve was drawn for the predictive factors to determine the optimal threshold for foreseeing persistent pain. RESULTS There were significant differences in the preoperative WIVF, symptom duration and ratio of disc space distraction between the 2 groups (each P < 0.05). The regression model showed that pain relief was negatively affected by the symptom duration and ratio of disc space distraction. Besides, an increase in the preoperative width of the intervertebral foramen (WIVF) could significantly decrease the possibility of persistent pain. Based on the ROC curve, the optimal threshold of preoperative WIVF was 4.35 mm. CONCLUSION When the preoperative WIVF is equal to or less than 4.35 mm, the possibility of the occurrence of postoperative persistent pain significantly increased.
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Affiliation(s)
- Baifeng Sun
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Chen Xu
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Min Qi
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Xiaolong Shen
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Ke Zhang
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Wen Yuan
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China
| | - Yang Liu
- Spine Center, Department of Orthopedics,
Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of
China,Yang Liu, Spine Center, Department of
Orthopedics, Changzheng Hospital, Naval Medical University, 415th Feng Yang
Road, Shanghai 200003, People’s Republic of China.
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28
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Danielsen E, Gulati S, Salvesen Ø, Ingebrigtsen T, Nygaard ØP, Solberg TK. Clinical outcomes after surgery for cervical radiculopathy performed in public and private hospitals : a nationwide relative effectiveness study. Bone Joint J 2023; 105-B:64-71. [PMID: 36587250 PMCID: PMC9948431 DOI: 10.1302/0301-620x.105b1.bjj-2022-0591.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS The number of patients undergoing surgery for degenerative cervical radiculopathy has increased. In many countries, public hospitals have limited capacity. This has resulted in long waiting times for elective treatment and a need for supplementary private healthcare. It is uncertain whether the management of patients and the outcome of treatment are equivalent in public and private hospitals. The aim of this study was to compare the management and patient-reported outcomes among patients who underwent surgery for degenerative cervical radiculopathy in public and private hospitals in Norway, and to assess whether the effectiveness of the treatment was equivalent. METHODS This was a comparative study using prospectively collected data from the Norwegian Registry for Spine Surgery. A total of 4,750 consecutive patients who underwent surgery for degenerative cervical radiculopathy and were followed for 12 months were included. Case-mix adjustment between those managed in public and private hospitals was performed using propensity score matching. The primary outcome measure was the change in the Neck Disability Index (NDI) between baseline and 12 months postoperatively. A mean difference in improvement of the NDI score between public and private hospitals of ≤ 15 points was considered equivalent. Secondary outcome measures were a numerical rating scale for neck and arm pain and the EuroQol five-dimension three-level health questionnaire. The duration of surgery, length of hospital stay, and complications were also recorded. RESULTS The mean improvement from baseline to 12 months postoperatively of patients who underwent surgery in public and private hospitals was equivalent, both in the unmatched cohort (mean NDI difference between groups 3.9 points (95% confidence interval (CI) 2.2 to 5.6); p < 0.001) and in the matched cohort (4.0 points (95% CI 2.3 to 5.7); p < 0.001). Secondary outcomes showed similar results. The duration of surgery and length of hospital stay were significantly longer in public hospitals. Those treated in private hospitals reported significantly fewer complications in the unmatched cohort, but not in the matched cohort. CONCLUSION The clinical effectiveness of surgery for degenerative cervical radiculopathy performed in public and private hospitals was equivalent 12 months after surgery.Cite this article: Bone Joint J 2023;105-B(1):64-71.
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Affiliation(s)
- Elisabet Danielsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Correspondence should be sent to Elisabet Danielsen. E-mail:
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Øystein P. Nygaard
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Tore K. Solberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
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29
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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] [What about the content of this article? (0)] [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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Abstract
AIMS The aim of this study was to investigate whether the type of cervical disc herniation influences the severity of symptoms at the time of presentation, and the outcome after surgical treatment. METHODS The type and extent of disc herniation at the time of presentation in 108 patients who underwent anterior discectomy for cervical radiculopathy were analyzed on MRI, using a four-point scale. These were dichotomized into disc bulge and disc herniation groups. Clinical outcomes were evaluated using the Neck Disability Index (NDI), 36-Item Short Form Survey (SF-36), and a visual analogue scale (VAS) for pain in the neck and arm at baseline and two years postoperatively. The perceived recovery was also assessed at this time. RESULTS At baseline, 46 patients had a disc bulge and 62 had a herniation. There was no significant difference in the mean NDI and SF-36 between the two groups at baseline. Those in the disc bulge group had a mean NDI of 44.6 (SD 15.2) compared with 43.8 (SD 16.0) in the herniation group (p = 0.799), and a mean SF-36 of 59.2 (SD 6.9) compared with 59.4 (SD 7.7) (p = 0.895). Likewise, there was no significant difference in the incidence of disabling arm pain in the disc bulge and herniation groups (84% vs 73%; p = 0.163), and no significant difference in the incidence of disabling neck pain in the two groups (70.5% (n = 31) vs 63% (n = 39); p = 0.491). At two years after surgery, no significant difference was found in any of the clinical parameters between the two groups. CONCLUSION In patients with cervical radiculopathy, the type and extent of disc herniation measured on MRI prior to surgery correlated neither to the severity of the symptoms at presentation, nor to clinical outcomes at two years postoperatively.Cite this article: Bone Joint J 2022;104-B(11):1242-1248.
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Affiliation(s)
- Xiaoyu Yang
- Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mark P Arts
- Department of Neurosurgery, Haaglanden Medical Centre, The Hague, the Netherlands
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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Yin M, Ding X, Zhu Y, Lin R, Sun Y, Xiao Y, Wang T, Yan Y, Ma J, Mo W. Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Uncinate Process Resection: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1956-1967. [PMID: 35349779 PMCID: PMC9609504 DOI: 10.1177/21925682221084969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This is a meta-analysis and systematic review of the available literature. OBJECTIVE In the case of severe foraminal stenosis, conducting uncinate process resection (UPR) during ACDF could achieve complete nerve root decompression and significant relief of neurological symptoms for CR. However, there is some controversy regarding its necessity and safety. This study aims to compare the safety and efficacy of ACDF with UPR and ACDF. METHODS The following electronic databases were searched: Medline, PubMed, Embase, the Cochrane Central Register of Controlled Trials, Evidence Based Medicine Reviews, VIP, and CNKI. And the following data items were considered: baseline demographics, efficacy evaluation indicators, radiographic outcome, and surgical details. RESULTS 10 studies were finally identified, including 746 patients who underwent ACDF with UPR compared to 729 patients who underwent ACDF. The group of ACDF with UPR had statistically longer intraoperative time (95% CI: 4.83, 19.77, P = .001) and more intraoperative blood loss (95% CI: 12.23, 17.76, P < .001). ACDF with UPR obtained a significantly better improvement of Arm VAS at postoperative first follow-up (95% CI: -1.85, -.14 P = .02). There was no significant difference found in improvement of Neck VAS at postoperative latest follow-up (95% CI: -.88, .27, P = .30), improvement of Arm VAS at postoperative latest follow-up (95% CI: -.59, -.01, P = .05), improvement of NDI (95% CI: -2.34, .33, P = .14), JOA (95% CI: -.24, .43, P = .56), change of C2-C7 lordosis (95% CI: -.87, 1.33, P = .68), C2-C7 SVA (95% CI: -.73, 5.08, P = .14), T1 slope (95% CI: -2.25, 1.51, P = .70), and fusion rate (95% CI: .83, 1.90 P = .29). CONCLUSION ACDF with UPR is an effective and necessary surgical method for CR patients with severe foraminal stenosis.
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Affiliation(s)
- Mengchen Yin
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Xing Ding
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Yuefeng Zhu
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China
| | - Rui Lin
- Guangdong Provincial Hospital of
Chinese Medicine, Guangzhou, China
| | - Yueli Sun
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Xiao
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Tao Wang
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Yinjie Yan
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Junming Ma
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Mo
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
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Dernek B, Ulusoy İ, Aydoğmuş S, Duymuş TM, Kesiktaş FN, Dıraçoğlu D. Ultrasound-guided cervical selective nerve block: A case series. J Back Musculoskelet Rehabil 2022; 35:1013-1019. [PMID: 35213343 DOI: 10.3233/bmr-210076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cervical radiculopathy is characterized by pain, numbness, tingling, and weakness, mostly in an affected extremity, reflecting compression of a nerve in the neck is compressed or irritated where it emerges from the spinal cord. Diagnosis requires a detailed anamnesis, physical examination, and imaging. Physical therapy, exercise, medical therapy, and injections are the preferred treatments, but injections into the cervical region are only indicated if conservative treatment is ineffective. OBJECTIVE This study explored the utility of selective cervical nerve root blocks (SNRBs) performed at various levels under ultrasound guidance (USG). METHODS We evaluated patients diagnosed with cervical radiculopathy via physical examination and magnetic resonance imaging from November 2019 to March 2020. We included those who did not respond to conservative treatment and therefore received SNRBs at various levels. Sixty-three patients were evaluated over 6 months in terms of pain, functional status, and complications. RESULTS We retrospectively evaluated patients with cervical herniated discs who received SNRBs at various levels between C4-7 under USG. Pain and functional status improved in month 1 and was maintained until at least month 6. CONCLUSION SNRB injections performed under USG effectively treated pain and poor functional status in selected patients. The procedure is safe (especially) for patients who do not respond to conservative treatment.
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Affiliation(s)
- Bahar Dernek
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | | | - Suavi Aydoğmuş
- Department of Orthopedic Surgery, Klinikum Esslingen, Esslingen am Neckar, Germany
| | | | - Fatma Nur Kesiktaş
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Demirhan Dıraçoğlu
- Department of Physical Medicine and Rehabilitation, Istanbul University Faculty of Medicine, Istanbul, Turkey
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33
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Kwon J, Oh D, Lee B, Lee H, Ko M, Moon S, Park Y, Kim S, Kim S. Neuropathic Pain Component in Patients with Cervical Radicular Pain: A Single-Center Retrospective Study. Medicina (Kaunas) 2022; 58:medicina58091191. [PMID: 36143868 PMCID: PMC9506234 DOI: 10.3390/medicina58091191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives: Evidence regarding the prevalence of neuropathic pain in patients with cervical radicular pain is limited. This study aimed to investigate the prevalence of neuropathic pain components in patients with cervical radicular pain using established screening tools and identify the relationship between neuropathic pain components and clinical factors. Materials and Methods: Data from 103 patients (aged ≥ 20 years) with cervical radicular pain who visited our pain clinic were analyzed retrospectively. Demographic characteristics, history of neck surgery, pain intensity using numeric rating score, dominant pain site, duration of symptoms, and neck disability index were assessed. The prevalence of neuropathic pain components was defined according to the Douleur Neuropathique 4 questions and painDETECT questionnaire tools. Patient characteristics were compared using the chi-square test or Fisher’s exact test for categorical variables and the independent t-test or Mann−Whitney U test for continuous variables. The correlation between neck disability index and other variables was analyzed using Pearson’s correlation coefficient. Results: Of the 103 patients, 29 (28.1%) had neuropathic pain components. The neck disability index was significantly higher (p < 0.001) for patients in the neuropathic pain group (23.79 ± 6.35) than that in the non- neuropathic pain group (18.43 ± 7.68). The Douleur Neuropathique 4 questions (r = 0.221, p < 0.025) and painDETECT questionnaire (r = 0.368, p < 0.001) scores positively correlated with the neck disability index score. Conclusions: The prevalence of neuropathic pain components in patients with cervical radicular pain was low. The patients in our study showed a strong correlation between functional deterioration and their neuropathic pain screening score. This study may be useful in understanding the characteristics of cervical radicular pain.
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Mallard F, Wong JJ, Lemeunier N, Côté P. Effectiveness of Multimodal Rehabilitation Interventions for Management of Cervical Radiculopathy in Adults: An Updated Systematic Review from the Ontario Protocol for Traffic Injury Management (Optima) Collaboration. J Rehabil Med 2022; 54:jrm00318. [PMID: 35797062 PMCID: PMC9422871 DOI: 10.2340/jrm.v54.2799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To update the systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration and to evaluate the effectiveness of multimodal rehabilitation interventions for the management of adults with cervical radiculopathy. STUDY DESIGN Systematic review and best-evidence synthesis. METHODS Eligible studies (from January 2013 to June 2020) were critically appraised using the Scottish Intercollegiate Guidelines Network and Risk of Bias 2.0 criteria. The certainty of the evidence was assessed according to Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Four RCTs were deemed acceptable and 1 RCT was considered low quality. In adults with recent-onset cervical radiculopathy, multimodal rehabilitation was associated with a trivial and nonclinically important reduction in neck pain compared with mechanical cervical traction; no differences in disability were reported (1 study, 360 participants, low certainty of the evidence). In adults with cervical radiculopathy of any duration, (i) multimodal rehabilitation may be more effective than prescribed physical activity and brief cognitive-behavioural approach; specifically, a small reduction in arm pain and in function was found (1 study, 144 participants, low certainty of the evidence); (ii) no difference in pain reduction was found between multimodal rehabilitation interventions compared with an epidural steroid injection (1 study, 169 participants, low certainty of the evidence); and (iii) compared with surgery combined with neck exercises, multimodal rehabilitation interventions lead to similar arm pain reduction and improvement in function (1 study, 68 participants, low certainty of the evidence). CONCLUSION The evidence suggests that some multimodal rehabilitation care may provide small and trivial reduction in neck pain or improvement in function to patients with cervical radiculopathy.
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Affiliation(s)
- Fabrice Mallard
- Division of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Institut Franco-Européen de Chiropraxie (IFEC), Toulouse, France.
| | - Jessica J Wong
- Division of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Institute for Disability and Rehabilitation Research (IDRR)
| | - Nadège Lemeunier
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Equipe constitutive du Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), Unité Mixte de Recherche (UMR) 1295, unité mixte Institut national de la santé et de la recherche médicale (INSERM) - Université Toulouse III Paul Sabatier, Toulouse, France
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research (IDRR); Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
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Sarmiento JM, Hanna G, Baron EM, Lanman TH, Lauryssen C, Cuéllar JM. Anterior Cervical Foraminotomy for Radiculopathy After Cervical Artificial Disc Replacement: Technique Description and Case Report. Int J Spine Surg 2022; 16:384-392. [PMID: 35444046 PMCID: PMC9930657 DOI: 10.14444/8219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients may occasionally have persistent or recurrent radicular symptoms after cervical artificial disc replacement (ADR) for cervical spondylotic radiculopathy. We describe our approach using anterior cervical foraminotomy (ACF) to provide symptom relief in such patients without the need to convert to a fusion or remove the ADR implant. METHODS Our operative technique for ACF after cervical ADR begins by starting at the lateral edge of the ADR at the superior end plate of the inferior vertebral body. The ipsilateral uncovertebral joint is drilled with a combination of a high-speed burr and diamond-coated burr to minimize the risk of injury to the vertebral artery. The neuroforamen is entered after drilling through the posterior aspect of the uncinate process. The exiting cervical nerve root should be directly visualized, and a Kerrison rongeur may be used to trace along the nerve root laterally to remove any remaining uncinate osteophyte or process. We queried our internal database for patients with recurrent or new radicular pain following cervical ADR who underwent ACF. Clinical characteristics and outcomes were reported. RESULTS Five patients with recurrent radicular symptoms after ADR were reviewed. Two ACFs were performed at C5-6, and 2 were performed at C6-7. Four patients developed ipsilateral recurrent radicular symptoms, and only 1 patient developed contralateral new radicular symptoms. Three patients reported complete resolution of their new or recurrent radicular symptoms following ACF, and 2 patients reported only partial resolution. No patients required conversion to a fusion. CONCLUSIONS In patients with recurrent symptoms of cervical spondylotic radiculopathy following ADR, ACF with uncovertebral joint resection can be used to provide direct foraminal decompression without the need for implant removal. This approach also preserves motion at the affected level, preserves cervical spinal stability, and prevents the need for spinal fusion. CLINICAL RELEVANCE Patients with persistent or recurrent radicular symptoms after cervical ADR may achieve resolution of symptoms through a modified ACF technique. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | - Todd H. Lanman
- Advanced Disc Replacement & Spinal Restoration Center, Beverly Hills, CA, USA
| | | | - Jason M. Cuéllar
- Cedars-Sinai Spine Center, Los Angeles, CA, USA,Advanced Disc Replacement & Spinal Restoration Center, Beverly Hills, CA, USA
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Plener J, Ammendolia C, Hogg-Johnson S. Nonoperative management of degenerative cervical radiculopathy: protocol of a systematic review. J Can Chiropr Assoc 2022; 66:74-84. [PMID: 35655692 PMCID: PMC9103640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Degenerative cervical radiculopathy (DCR) is a common condition which, due to the aging global population, is expected to worsen over time. For the majority of patients with DCR, surgical intervention is not required as nonoperative management is sufficient for symptom improvement. However, there are significant gaps within the literature as the majority of past systematic reviews assessing conservative interventions are outdated, or omit relevant studies due to strict inclusion/exclusion criteria. Therefore, an updated understanding of the effectiveness of noninvasive nonoperative management for DCR is required. METHODS We will search MEDLINE, CENTRAL, Embase, PsycINFO, and CINAHL from inception, as well as hand-search reference lists of included studies and previous systematic reviews, to identify peer-reviewed randomized controlled trials on this topic. DISCUSSION The results of this review will provide an understanding of the effectiveness of various nonoperative interventions. The quality of evidence will also be assessed using the GRADE approach. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021249699.
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Affiliation(s)
- Joshua Plener
- Division of Graduate Studies, Canadian Memorial Chiropractic College
- Institute for Health Policy Management and Evaluation, University of Toronto
| | - Carlo Ammendolia
- Institute for Health Policy Management and Evaluation, University of Toronto
- Department of Medicine, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College
- Dalla Lana School of Public Health, University of Toronto
- Institute for Disability and Rehabilitation Research
- Faculty of Health Sciences, Ontario Tech University
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Ikegami S, Uehara M, Miyaoka Y, Kuraishi S, Oba H, Munakata R, Takizawa T, Kamanaka T, Hatakenaka T, Takahashi J. A Novel Technique for Cervical Microscopic Foraminotomy Utilizing Spinous Process Splitting: Microscopic Mini-Open Foraminotomy. Spine Surg Relat Res 2021; 5:431-436. [PMID: 34966871 PMCID: PMC8668205 DOI: 10.22603/ssrr.2021-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/21/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction In this study, we present “microscopic mini-open foraminotomy (MicroMOF)” as a new, less invasive method for posterior cervical foraminotomy. Technical Note Using surgical microscope guidance, the spinous process is hemi-split, and the posterior muscle is detached from the laminar subperiosteal surface. Bony resection is then performed obliquely from medial posterior to lateral anterior under lateral-tilted surgical field exposure. MicroMOF has been performed successfully for cervical radiculopathy and cervical spondylotic amyotrophy, which achieved postoperative symptom improvement with few complications. Conclusions The novel MicroMOF foraminotomy technique has been found to protect the nerve root and vertebral artery and help preserve muscle and cervical facet joint bone.
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Affiliation(s)
- Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shugo Kuraishi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ryo Munakata
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Takizawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takayuki Kamanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Terue Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Kontakis M, Marques C, Löfgren H, Mosavi F, Skeppholm M, Olerud C, MacDowall A. Artificial disc replacement and adjacent-segment pathology: 10-year outcomes of a randomized trial. J Neurosurg Spine 2021:1-9. [PMID: 34920425 DOI: 10.3171/2021.9.spine21904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Artificial disc replacement (ADR) is designed to preserve motion and thus protect against adjacent-segment pathology (ASP) and act as an alternative treatment to fusion surgery. The question remains, how well do ADR devices perform after 10 years of follow-up compared with fusion surgery in terms of patient satisfaction, sustainability, and protection against ASP? METHODS This was the 10-year follow-up study of 153 participants who underwent ADR or fusion surgery after anterior decompression due to cervical degenerative radiculopathy (ISRCTN registration no. 44347115). Scores on the Neck Disability Index (NDI), EQ-5D, and visual analog scale for neck and arm pain were obtained from the Swedish Spine Registry and analyzed using ANCOVA. Information about secondary surgical procedures was collected from medical records and presented as Kaplan-Meier curves. MRI and flexion-extension radiography were performed, and ASP was graded according to the Miyazaki classification system. RESULTS Ten participants were lost to follow-up, which left 143 participants (80 underwent ADR and 65 underwent anterior cervical discectomy and fusion). There were no differences between groups in terms of patient-reported outcome measures (10-year difference in NDI scores 1.7 points, 95% CI -5.1 to 8.5, p = 0.61). Nineteen (24%) participants in the ADR group compared with 9 (14%) in the fusion group underwent secondary surgical procedures. The higher reoperation rate of the ADR group was mainly due to 11 female participants with device loosening. The rates of reoperation due to ASP were similar between groups, which was confirmed with MRI assessment of ASP that also showed no differences between the groups (p = 0.21). CONCLUSIONS This was the first 10-year follow-up study to compare ADR with fusion surgery and to provide MRI information for the assessment of ASP. The authors found no benefit of ADR over fusion surgery after anterior decompression for cervical degenerative radiculopathy.
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Affiliation(s)
- Michael Kontakis
- 1Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Catarina Marques
- 1Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Löfgren
- 2Neuro-Orthopaedic Center, Jönköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Firas Mosavi
- 3Department of Radiology, Uppsala University Hospital, Uppsala, Sweden; and
| | - Martin Skeppholm
- 4Department of Learning, Informations, Management and Ethics (LIME), Medical Management Center, Health Economics and Health Evaluation Research Group, Karolinska Institutet, Stockholm and Center for Spine Surgery in Stockholm, Sophiahemmets Sjukhus, Stockholm, Sweden
| | - Claes Olerud
- 1Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Anna MacDowall
- 1Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Sun B, Xu C, Zhang Y, Wu S, Wu H, Zhang H, Shen X, Zhang Z, Yuan W, Liu Y. Intervertebral Foramen Width Is an Important Factor in Deciding Additional Uncinate Process Resection in ACDF-a Retrospective Study. Front Surg 2021; 8:626344. [PMID: 34869546 PMCID: PMC8639498 DOI: 10.3389/fsurg.2021.626344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Anterior cervical discectomy and fusion (ACDF) has been established as a classic procedure for the management of cervical radiculopathy. However, it is unclear whether combined uncinate process resection (UPR) is necessary for treating cervical radiculopathy. Here, we investigated the clinical outcome of ACDF combined with UPR compared to ACDF alone to determine the necessity of UPR in treating cervical radiculopathy. Hypothesis: Uncinate process resection may be necessary in certain patients along with ACDF to achieve better clinical outcomes of cervical radiculopathy. Patients and Methods: Fifty-five patients underwent ACDF with UPR, and 126 patients without UPR were reviewed. The width and height of the intervertebral foramen were measured by 45° oblique X-rays. We also measured the Japanese Orthopedic Association (JOA) score and visual analog scale (VAS) score. C2-C7 Cobb angles were obtained from all patients pre- and post-operatively. Meanwhile, linear regression analysis was used to evaluate the relationship between the clinical outcomes and the intervertebral foramen width before surgery. Results: Linear regression analysis indicated that the improvement in the JOA and VAS scores was irrelevant to both the pre-operative width of the intervertebral foramen (wIVF) and the height of the intervertebral foramen (hIVF) in the ACDF+UPR group. However, pre-operative wIVF was associated with post-operative JOA and VAS scores in the ACDF alone group. Those with pre-operative wIVF <3 mm in the ACDF group had the least improvement in post-operative clinical symptoms due to the change in wIVF (P > 0.05). The ACDF group whose wIVF was over 3 mm showed similar clinical outcomes to the ACDF + UPR group, and wIVF significantly increased post-operatively (P < 0.05). The fusion rate and C2-C7 Cobb angles did not show significant differences between the two groups (P > 0.05). Discussion: Our current findings suggest that UPR should be considered when wIVF is <3 mm pre-operatively. However, there is no need to sacrifice the uncovertebral joint in ACDF when the pre-operative wIVF is over 3 mm. Level of Evidence: Level III.
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Affiliation(s)
- Baifeng Sun
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Chen Xu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yizhi Zhang
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Shenshen Wu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.,Department of Trauma and Joint, People's Hospital of Liaoning Province, Shenyang, China
| | - Huiqiao Wu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Hao Zhang
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xiaolong Shen
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zifan Zhang
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wen Yuan
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yang Liu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
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Wichmann TO, Bech-Azeddine R, Norling AL, Einarsson HB, Rasmussen MM. Comparison of outcomes and complications between one- and two-level anterior cervical discectomy and fusion: a population-based study of 410 patients. Br J Neurosurg 2021:1-6. [PMID: 34821187 DOI: 10.1080/02688697.2021.2005778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/30/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to compare outcomes and patient satisfaction, and secondly to compare complication rates between one- and two-level anterior cervical discectomy and fusion (ACDF) for cervical radiculopathy. METHODS Data from patients receiving one- or two-level ACDF for cervical radiculopathy at two institutions were prospectively collected and retrospectively analysed. Patients were separated into one-level ACDF and two-level ACDF. Comparison analyses of patient-reported outcome measures (PROMs) comprising Visual Analogue Scale for neck pain (VAS-NP) and arm pain (VAS-AP), Neck Disability Index (NDI), and EQ-5D 3-level version (EQ-5D-3L) were performed between baseline and 1-year follow-up and between groups as well as achievement of minimal clinically important differences (MCID) in PROMs and satisfaction. Additionally, complications were compared between groups. RESULTS A total of 410 patients (270 one-level and 140 two-level) were included. PROMs improved significantly from baseline to 1-year follow-up (p < 0.001) in both groups. When comparing PROMs between one- and two-level ACDF, a trend towards greater improvement was observed in patients undergoing one-level ACDF, notably in EQ-5D-3L (p = 0.073). Significantly more patients in the one-level group achieved MCID in VAS-NP compared to patients in the two-level group (56% vs 44%, p = 0.025). Two hundred and ninety-six (67%) patients reported to be satisfied, but the one-level group trended to be more satisfied (70% vs. 62%). One-level ACDF further demonstrated a trend of more favourable complication profiles; however, complication rates were low in both groups. The risk of intraoperative complications was 2.4%, postoperative complications in-hospital were 1.2%, and patient-reported postoperative events post-discharge 42%. CONCLUSIONS One- and two-level ACDF are effective procedures for degenerative cervical nerve root compression. Yet, significantly more patients in the one-level group achieved MCID in neck pain compared to patients in the two-level group.
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Affiliation(s)
| | - Rachid Bech-Azeddine
- Copenhagen Spinal Research Unit - Center of Rheumatology and Spine Diseases Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Anna Louise Norling
- Copenhagen Spinal Research Unit - Center of Rheumatology and Spine Diseases Rigshospitalet Glostrup, Glostrup, Denmark
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Abdalbary SA, Abdel-Wahed M, Amr S, Mahmoud M, El-Shaarawy EAA, Salaheldin S, Fares A. The Myth of Median Nerve in Forearm and Its Role in Double Crush Syndrome: A Cadaveric Study. Front Surg 2021; 8:648779. [PMID: 34621777 PMCID: PMC8490666 DOI: 10.3389/fsurg.2021.648779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/19/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose: This study aims to histologically compare the median nerve in the arm, forearm, and wrist, to help understand how cervical radiculopathy in a double crush phenomenon causes distal nerve dysfunction at the carpal tunnel and median nerve with concurrent absence of symptoms at the forearm. Methods: The study was performed on 12 fresh cadaveric upper limbs free from any injury or operation. Male cadavers in the age range of 35–40 years were used. The dissection of the median nerve and the histological examination of the specimens from the arm, forearm, and wrist were conducted to evaluate variations in the epineurium thickness (μm), perineurium thickness (μm), number of fascicles per nerve trunk, area percent of myelin covering, and area percent of neurolemmal sheath. Results: Morphometric and statistical results of the cadaveric median nerve trunk revealed that the mean epineurium and perineurium thickness measured in H&E-stained sections in the forearm were significantly greater than those in the arm and wrist specimens. Further, the mean percent area of the myelin covering in the forearm was significantly lower than that in the arm and wrist specimens in the sections stained with osmium oxide (p < 0.001). There were, however, no significant differences in the neurolemmal sheath among the arm, forearm, and wrist specimens in the silver-stained sections. Conclusion: The histological differences explained the high concomitant occurrence of carpal tunnel syndrome (CTS) and cervical radiculopathy and the concurrent absence of symptoms at the forearm. Hence, we suggest cautious evaluation of patients with upper limb symptoms, since the management of these conditions requires a different approach.
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Affiliation(s)
- Sahar A Abdalbary
- Department of Orthopaedic Physical Therapy, Faculty of Physical Therapy, Nahda University in Beni Suef, Beni Suef, Egypt
| | - Mohamed Abdel-Wahed
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Sherif Amr
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Mostafa Mahmoud
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Ehab A A El-Shaarawy
- Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Safinaz Salaheldin
- Department of Histology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Amal Fares
- Department of Histology, Faculty of Medicine, Cairo University, Giza, Egypt
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Nomura H, Nomura S. Simultaneous herpes zoster rash in the upper extremity and interscapular region that resembles innervation zone of the dorsal ramus of the cervical nerve root: a case report. AME Case Rep 2021; 5:25. [PMID: 34312604 DOI: 10.21037/acr-21-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023]
Abstract
In daily medical practice, scapular pain associated with cervical radiculopathy is commonly seen prior to the onset of pain of the upper extremity; however, the cause of the scapular pain is uncertain. We report a case of herpes zoster with simultaneous skin rash in both the upper extremity and interscapular region, which corresponds to the painful scapular region in case of C8 cervical radiculopathy. A 71-year-old healthy woman complained of shoulder and scapular pain followed by a blistering skin rash on both the ulnar side of her upper extremity and intrascapular region on the right side. She was diagnosed with herpes zoster and was prescribed amenamevir as oral treatment with vidarabine ointment. After 1 year, she still had mild causalgia on her III-V fingers and needed oral treatment with pregabalin. To our knowledge, this is the first case report of a herpes zoster rash in the upper extremity and intrascapular region simultaneously. We speculate that the rash in the two regions is caused by the varicella zoster virus (VZV) traveling from the same ganglion, probably the C8 ganglion, considering the dermatome of the rash area in the upper extremity and the intrascapular region correspond to the innervation zone of the medial branches of the dorsal ramus of the cervical nerve root, which resembles the scapular region in case of cervical radiculopathy. This phenomenon implies the mechanism of scapular pain is related to cervical radiculopathy. Further case reports are needed to confirm this.
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Dy CJ, Colorado BS, Landau AJ, Brogan DM. Interpretation of Electrodiagnostic Studies: How to Apply It to the Practice of Orthopaedic Surgery. J Am Acad Orthop Surg 2021; 29:e646-e654. [PMID: 33739943 PMCID: PMC8217100 DOI: 10.5435/jaaos-d-20-00322] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/21/2021] [Indexed: 02/01/2023] Open
Abstract
Electrodiagnostic studies may help orthopaedic surgeons to identify and confirm nerve pathology, determine severity of disease, localize the lesion, identify concomitant or alternative pathology, and prognosticate potential outcomes with nonoperative or operative treatment. Surgeons should recognize the indications for electrodiagnostic studies, principles of their performance, and how to assess the primary data generated by the examination and how it can inform their treatment plans.
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Affiliation(s)
- Christopher J. Dy
- Department of Orthopaedic Surgery; Washington University School of Medicine – St. Louis, MO
- Department of Surgery, Division of Public Health Sciences; Washington University School of Medicine – St. Louis, MO
| | - Berdale S. Colorado
- Department of Orthopaedic Surgery; Washington University School of Medicine – St. Louis, MO
- Department of Neurology; Washington University School of Medicine – St. Louis, MO
| | - Andrew J. Landau
- Department of Orthopaedic Surgery; Washington University School of Medicine – St. Louis, MO
| | - David M. Brogan
- Department of Orthopaedic Surgery; Washington University School of Medicine – St. Louis, MO
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Wang Y, Zhu Y, Wang W, Shi Y, Yang J. New Simple Ultrasound-Guided Transforaminal Injection in Patients With Radiculopathy in the Lower Cervical Spine: A Computed Tomography-Controlled Study. J Ultrasound Med 2021; 40:1401-1409. [PMID: 33026685 DOI: 10.1002/jum.15523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/09/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the feasibility of a new simple ultrasound-guided transforaminal injection in patients with cervical radiculopathy. METHODS Ultrasound scans of the neck in a plastic model and in 5 unaffected participants were first performed to identify the intervertebral foramen. Then ultrasound-guided transforaminal injections were performed in 20 patients with radiculopathy in the lower cervical spine, and computed tomography was used to verify the accuracy. Complications, the visual analog score, and the neck disability index were assessed at 1 and 3 months after the injection. RESULTS Computed tomography confirmed that the needle tip was correctly placed in the intervertebral foramen in 88.5% (23 of 26) of injections. No immediate or short-term complications were observed in all patients. The visual analog score and neck disability index at 1 and 3 months were significantly lower than those before the injection (both P < .0001). CONCLUSIONS Ultrasound may be a feasible and accurate method to guide cervical transforaminal injection.
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Affiliation(s)
- Yuexiang Wang
- Departments of Ultrasound, the first center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yaqiong Zhu
- Departments of Ultrasound, the first center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Wei Wang
- Departments Orthopedics, the first center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yizheng Shi
- Anesthesia Operation Center, the first center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jing Yang
- Pain Department, the first center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
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Arnold PM, Vaccaro AR, Sasso RC, Goulet B, Fehlings MG, Heary RF, Janssen ME, Kopjar B. Two-Year Clinical and Radiological Outcomes in Patients With Diabetes Undergoing Single-Level Anterior Cervical Discectomy and Fusion. Global Spine J 2021; 11:458-464. [PMID: 32875918 PMCID: PMC8119920 DOI: 10.1177/2192568220914880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Secondary analysis of data from the multicenter, randomized, parallel-controlled Food and Drug Administration (FDA) investigational device exemption study. OBJECTIVE Studies on outcomes following anterior cervical discectomy and fusion (ACDF) in individuals with diabetes are scarce. We compared 24-month radiological and clinical outcomes in individuals with and without diabetes undergoing single-level ACDF with either i-FACTOR or local autologous bone. METHODS Between 2006 and 2013, 319 individuals with single-level degenerative disc disease (DDD) and no previous fusion at the index level underwent ACDF. The presence of diabetes determined the 2 cohorts. Data collected included radiological fusion evaluation, neurological outcomes, Neck Disability Index (NDI), Visual Analog Scale (VAS) scores, and the 36-Item Short Form Survey Version 2 (SF-36v2) Physical and Mental component summary scores. RESULTS There were 35 individuals with diabetes (11.1%; average body mass index [BMI] = 32.99 kg/m2; SD = 5.72) and 284 without (average BMI = 28.32 kg/m2; SD = 5.67). The number of nondiabetic smokers was significantly higher than diabetic smokers: 73 (25.70%) and 3 (8.57%), respectively. Preoperative scores of NDI, VAS arm pain, and SF-36v2 were similar between the diabetic and nondiabetic participants at baseline; however, VAS neck pain differed significantly between the cohorts at baseline (P = .0089). Maximum improvement for NDI, VAS neck and arm pain, and SF-36v2 PCS and MCS scores was seen at 6 months in both cohorts and remained stable until 24 months. CONCLUSIONS ACDF is effective for cervical radiculopathy in patients with diabetes. Diabetes is not a contraindication for patients requiring single-level surgery for cervical DDD.
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Affiliation(s)
- Paul M. Arnold
- Carle Spine Institute, IL, USA,Paul M. Arnold, Carle Spine Institute,
610 N. Lincoln Avenue, Urbana, IL 61801 USA.
| | | | - Rick C. Sasso
- Indiana University School of Medicine, Indiana Spine Group, IN, USA
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Shrestha D, Shrestha R, Grotle M, Nygaard ØP, Solberg TK. Validation of the Nepali versions of the Neck Disability Index and the Numerical Rating Scale for Neck Pain. Spine (Phila Pa 1976) 2021; 46:E325-E332. [PMID: 33181772 PMCID: PMC7864651 DOI: 10.1097/brs.0000000000003810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 08/20/2020] [Accepted: 09/15/2020] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study with a test-retest design. OBJECTIVE To translate and culturally adapt the numerical rating scale (NRS) for neck pain intensity and the Neck Disability Index (NDI), and asses their measurement properties in a Nepalese neck pain population. SUMMARY OF BACKGROUND DATA Neck pain is one of the most common musculoskeletal disorders in Nepal. Research on neck pain disorders has been hampered by lack of standardized patient-reported outcome measures (PROMs) in Nepali language. Therefore, we aimed at validating a Nepali version of the NDI and NRS neck pain. METHODS At Dhulikhel hospital in Nepal, 150 patients with neck pain and/or cervical radiculopathy completed the translated self-administered questionnaires. We had made one cultural adaption of the NDI driving item in the final Nepali version. Relative reliability was analyzed with intraclass correlation coefficient (ICC 2.1) and absolute reliability with the smallest detectable change (SDC). Internal consistency was assessed by Cronbach alpha. Construct and discriminative validity was assessed by Spearman correlation for a priori hypotheses, receiver-operating characteristics curves, and analysis of variance. Time spent and assistance needed to complete the questionnaires were used to assess feasibility. RESULTS Test-restest reliability was excellent with ICC (95% confidence intervals) of 0.87 (0.66, 0.94) for NDI and 0.97 (0.94, 0.99) for NRS neck pain. The absolute reliability was acceptable (a SDC of 1.6 for NRS and 9.3 for NDI) and a Cronbach alpha (internal consistency) of 0.70 for NDI, as well as acceptable construct validity, discriminative validity, and feasibility. CONCLUSION The Nepali versions of the NRS neck pain and NDI can be recommended for assessing pain and disability among patients with neck pain and cervical radiculopathy, but their responsiveness to change remains to be tested.Level of Evidence: 2.
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Affiliation(s)
- Dipak Shrestha
- Department of Orthopaedics, Dhulikhel Hospital, Kathmandu University Hospital and Kathmandu University School of Medical Sciences, Nepal
| | - Rohit Shrestha
- Department of Orthopaedics, Dhulikhel Hospital, Kathmandu University Hospital and Kathmandu University School of Medical Sciences, Nepal
| | - Margreth Grotle
- Oslo Metropolitan University, Faculty of Health Sciences and FORMI, Clinic for surgery and neurology (C1), Oslo University Hospital, Norway
| | - Øystein P. Nygaard
- National advisory unit on spinal surgery, St. Olavs Hospital, Trondheim and Department of Neuroscience, Faculty of medicine, Norwegian University of Science and Technology, Norway
| | - Tore K. Solberg
- Department of Neurosurgery, University Hospital of Northern Norway and Institute for clinical medicine, Arctic University of Norway (UiT), Tromsø, Norway
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Marrache M, Harris AB, Puvanesarajah V, Raad M, Hassanzadeh H, Riley LH, Skolasky RL, Bicket M, Jain A. Health Care Resource Utilization in Commercially Insured Patients Undergoing Anterior Cervical Discectomy and Fusion for Degenerative Cervical Pathology. Global Spine J 2021; 11:108-115. [PMID: 32875850 PMCID: PMC7734273 DOI: 10.1177/2192568219899340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
STUDY DESIGN Retrospective review of an administrative database. OBJECTIVES The aim of our study was to investigate the distribution of spending for the entire episode of care among nonelderly, commercially insured patients undergoing elective, inpatient anterior cervical discectomy and fusion (ACDF) surgeries for degenerative cervical pathology. METHODS Using a private insurance claims database, we identified patients who underwent single-level, inpatient ACDF for degenerative spinal disease. Patients were selected using a combination of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Entire episode of care was defined as 6-months before (preoperative) to 6 months after (postoperative) the surgical admission. RESULTS In our cohort containing 33 209 patients, perioperative median spending per patient (MSPP) within the year encompassing surgery totaled $37 020 (interquartile range [IQR] $28 363-$49 206), with preoperative, surgical admission, and postoperative spending accounting for 9.8%, 80.7%, and 9.5% of total spending, respectively. Preoperatively, MSPP was $3109 (IQR $1806-$5215), 48% of patients underwent physical therapy, and 31% underwent injections in the 6 months period prior to surgery. Postoperatively, MSPP was $1416 (IQR $398-$3962), and unplanned hospital readmission (6% incidence) accounted for 33% of the overall postoperative spending. Discharge to a nonhome discharge disposition was associated with higher postoperative spending ($14 216) compared with patients discharged home ($1468) and home with home care ($2903), P < .001. CONCLUSION Understanding the elements and distribution of perioperative spending for the episode of care in patients undergoing ACDF surgery for degenerative conditions is important for health care planning and resource allocation.
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Affiliation(s)
| | | | | | - Micheal Raad
- The Johns Hopkins University, Baltimore, MD, USA
| | | | - Lee H. Riley
- The Johns Hopkins University, Baltimore, MD, USA
| | | | - Mark Bicket
- The Johns Hopkins University, Baltimore, MD, USA
| | - Amit Jain
- The Johns Hopkins University, Baltimore, MD, USA,Amit Jain, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, JHOC 5223, Baltimore, MD 21287, USA.
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Godek P, Murawski P, Ruciński W, Guzek M. Biological, Mechanical or Physical? Conservative Treatment of Cervical Radiculopathy. Ortop Traumatol Rehabil 2020; 22:409-419. [PMID: 33506805 DOI: 10.5604/01.3001.0014.6045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is equivocal evidence in support of the effectiveness of each of the three co-existing approaches to conservative treatment of cervical radiculopathy (CR): biological (regenerative), mechanical (decompression) and physical (analgesic and anti-inflammatory). The aim of the study was to compare the effectiveness of the three treatment approaches in CR. MATERIAL AND METHODS A total of 90 patients were assigned to six treatment groups. Biological treatment: 4 ultra-sound-guided periradicular injections of ACS or PRP (1 per week); Mechanical treatment: manual therapy (MT) or traction therapy (TT) - 8 ses-sions (two per week); Physical treatment: laser therapy (LT) or collagen magnetophoresis (CM) - 8 sessions (two per week). As-sessment: before therapy (W0), after completion of the treatment (W1), two months after completion (W2). Assessment tools: NRS (0-10), NDI (0-50), cross section root area in mm2 in ultrasound examination (CRA) and hand sensorimotor function test (DPT). RESULTS The largest reduction in mean NRS, NDI and CRA values at W2 was observed with the biological treatments (NRS: ACS 71.7%, PRP 70.6%, NDI: ACS 61.5%, PRP 56.6%, CRA: ACS 23.6 %, PRP 25%). Improvement of hand sensorimotor functions was observed at both W1 and W2 only in the PRP group. The PRP group demonstrated a stronger analgesic effect than the ACS group at W1 (58.82% compared to 43.39%), but ACS therapy had the same effectiveness during the follow-up period. Other methods reduced pain and disability at W1, but further reduction of mean NRS values during the follow-up period was only evident in the CM group (32.25%), very mild in the MM (19.35%) and LT groups (18.75%), and the TT group actually demonstrated a regression (-5.58%). In 3 cases, TT exacerbated the symptoms, which resulted in termination of the therapy. CONCLUSIONS 1. Biological treatments were more effective than mechanical and physical therapies in reducing pain, im-proving the disability index and proprioception of the hand both immediately on completion of therapy and after a follow-up period, which may suggest their regenerative properties. 2. Physical and mechanical therapies produced improvement in the above-mentioned indicators on completion of the therapy, but subsequently exerted a very slight effect during the follow-up period without evident regenerative effects; moreover, a regression of the results was actually recorded for traction therapy. 3. Caution should be paid when using traction therapy in the acute period of root oedema, due to possible signs of intolerance of the procedure and exacerbation of the discomfort.
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Affiliation(s)
- Piotr Godek
- Sutherland Medical Center, Warszawa, Polska / Sutherland Medical Center, Warsaw, Poland
| | - Piotr Murawski
- Oddział Teleinformatyki, Wojskowy Instytut Medyczny, Warszawa, Polska / ICT Department, Military Medical Institute, Warsaw, Poland
| | - Wojciech Ruciński
- Sutherland Medical Center, Warszawa, Polska / Sutherland Medical Center, Warsaw, Poland
| | - Michał Guzek
- ArenaMed, Warszawa, Polska / ArenaMed, Warsaw, Poland
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Yoshida T, Suwazono S, Sueyoshi T, Izumi Y, Nodera H. Diagnostic usefulness of denervation edema in the multifidus muscles using 3-Tesla magnetic resonance imaging in cervical radiculopathy. Muscle Nerve 2020; 63:365-370. [PMID: 33314190 DOI: 10.1002/mus.27142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Diagnosing cervical radiculopathy (CR) can be difficult because of symptomatic overlap with peripheral neuropathies. In this retrospective observational study, we aimed to determine whether short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) sequences are useful for detecting signs of denervation in the multifidus muscles in patients with CR. METHODS We analyzed the data of 18 patients with CR who developed arm weakness within 1 year. We also included 10 patients with sensorimotor symptoms involving the upper extremities who did not have intervertebral foraminal stenosis on MRI as controls. For each patient with CR, the signal intensity (SI) of the affected multifidus muscles was measured and compared to that on the contralateral side (signal intensity ratio: SIR). RESULTS Control patients without CR did not exhibit STIR signal abnormalities in the multifidus muscles. Most of the 18 patients with CR were male (83.3%), and the mean age was 59.4 years. Thirteen of 18 CR patients (72.2%) were determined to have STIR signal abnormalities by a radiologist. The mean SIR in the 13 patients with increased SI was significantly higher than that in the five patients without signal abnormalities (1.23 vs 0.97, P = .004), supporting the radiologist's diagnosis. The distribution of signal abnormalities closely followed those identified via clinical and electrophysiological tests, especially severe weakness (P = .044). CONCLUSIONS Denervation edema of the multifidus muscles can be detected in CR and correlates with clinical/electrophysiological tests and weakness severity, which may aid in CR diagnostics.
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Affiliation(s)
| | - Shugo Suwazono
- Center for Clinical Neuroscience and Division of Neurology, National Hospital Organization Okinawa National Hospital, Ginowan, Japan
| | | | - Yuishin Izumi
- Department of Neurology, Tokushima University School of Medicine, Tokushima, Japan
| | - Hiroyuki Nodera
- Department of Neurology, Kanazawa Medical University, Uchinada, Japan
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Hirahata M, Kitagawa T, Fujita M, Shiboi R, Kawano H, Iwai H, Inanami H, Koga H. A Comparative Study on the Minimal Invasiveness of Full-Endoscopic and Microendoscopic Cervical Foraminotomy Using Intraoperative Motor Evoked Potential Monitoring. Medicina (Kaunas) 2020; 56:E605. [PMID: 33187319 DOI: 10.3390/medicina56110605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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