RESUMEN
To explore whether the potential instability of the cervical spine and cervical muscle degeneration in patients with cervical spondylotic radiculopathy (CSR) affect the efficacy of cervical traction, and whether cervical traction can aggravate the potential instability of the cervical spine. We divided the 113 recruited CRS patients into three groups based on the differences in horizontal displacement and abnormal angle, and measured the degree of cervical muscle degeneration in the patients through MRI. Considering functional scores, VAS, NDI and PCS scores of the three groups post-treatment were significantly improved. Through the intergroup analysis, we found that the improvement in functional scores in the mild and moderate instability trend groups was better than that in the severe group. Through MRI measurements, we found that the degree of cervical muscle degeneration was significantly increased in the severe instability trend group. Regarding the changes in X-Ray imaging parameters pre- and post-treatment, no significant differences were observed pre- and post-treatment. For patients with CSR, the more serious their predisposition for cervical instability was, the more severe the degree of cervical muscle degeneration was, which means the worse the curative effect was, but cervical traction did not aggravate the potential degree of cervical instability.
Asunto(s)
Vértebras Cervicales , Imagen por Resonancia Magnética , Radiculopatía , Espondilosis , Tracción , Humanos , Masculino , Femenino , Espondilosis/diagnóstico por imagen , Espondilosis/patología , Persona de Mediana Edad , Tracción/métodos , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Radiculopatía/diagnóstico por imagen , Radiculopatía/etiología , Adulto , Anciano , Resultado del Tratamiento , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/terapiaRESUMEN
To investigate the effects of refined nursing strategies on postoperative quality of life, pain level, psychological condition, and other rehabilitation training of patients with cervical spondylosis. This study is a retrospective study, and 500 patients with cervical spondylosis admitted to our hospital from April 2022 to June 2023 were selected as the study objects. They were divided into a control group (250 cases) and an experimental group (250 cases) according to whether they received personalized intensive care. The control group received standard nursing care, while the experimental group was given personalized, high-quality nursing care. The refined nursing strategy comprises individualized rehabilitation training plans, psychological support, nutritional counseling, and pain management. Indicators such as pain level, cervical spine function, quality of life, complication statistics, and nursing satisfaction were employed to evaluate the clinical efficacy of 2 nursing methods. In the pain assessment, patients in the experimental and control groups had pain scores of (1.98â ±â 0.84) and (5.78â ±â 0.63), respectively, after the nursing intervention. The reduction in pain for patients in the experimental group was highly significant (Pâ <â .05) compared to pre-nursing care. Six months after the commencement of healthcare, the cervical spine function scores of the experimental and control groups were (93.36â ±â 4.74) and (82.68â ±â 5.42), respectively. Moreover, the cervical spine function recovery of the experimental group was deemed significant. The experimental group exhibited a lower probability of complications compared to the control group. Additionally, the quality of life was significantly higher in the experimental group than in the control group (Pâ <â .05). Improvement time and healing time were significantly shorter in the patients of the experimental group in comparison to the control group. In terms of nursing satisfaction, the experimental group had a significantly higher satisfaction rate of 87.57% than the control group (Pâ <â .05). The refined nursing strategy significantly improved the speed and quality of patients' functional recovery. Additionally, the implementation of personalized and comprehensive nursing techniques during postoperative treatment for cervical spondylosis resulted in a significant improvement in patient's quality of life and satisfaction with the treatment process.
Asunto(s)
Calidad de Vida , Espondilosis , Humanos , Masculino , Femenino , Estudios Retrospectivos , Espondilosis/cirugía , Espondilosis/rehabilitación , Persona de Mediana Edad , Vértebras Cervicales , Dimensión del Dolor , Adulto , Manejo del Dolor/métodos , Manejo del Dolor/enfermería , Anciano , Resultado del Tratamiento , Periodo Posoperatorio , Dolor Postoperatorio/rehabilitación , Dolor Postoperatorio/enfermeríaRESUMEN
BACKGROUND Cervical spondylosis (CS) is a degenerative disease of the cervical spine characterized by persistent neck pain. Cervical facet joint mobilization (CM) and the osteopathic muscle energy technique (MET) are effective manual procedures for the treatment of neck pain. In this study, we compared the efficacy of the MET and CM techniques on pain, disability, and proprioception in 76 patients with CS. MATERIAL AND METHODS A total of 96 participants with a diagnosis of CS were randomized into an electro-thermal therapy (ET) group (control group, n=32), ET+MET group (experiment I, n=32), and ET+CM group (experiment II, n=32). All patients received 3 treatment sessions per week for 4 consecutive weeks. Pain intensity, functional disability and cervical position sense were measured using the visual analog scale (VAS), Copenhagen Neck Functional Disability Scale (CNFDS), and cervical range of motion (CROM) device. RESULTS The study was completed by 76 participants. VAS and CNFDS scores decreased significantly after treatment in all 3 groups (P<0.001); however, there was no significant difference between the groups (P>0.05). Between-group analysis showed a significant difference in extension joint position error in favor of MET (P<0.001), while there was no significant difference between the groups in other movement directions (P>0.05). CONCLUSIONS MET and CM have similar effects on improving pain and disability in individuals with CS and chronic neck pain. However, the results of this study show that MET combined with ET is a more effective method for improving cervical position sense.
Asunto(s)
Vértebras Cervicales , Dolor de Cuello , Dimensión del Dolor , Propiocepción , Rango del Movimiento Articular , Espondilosis , Humanos , Espondilosis/terapia , Espondilosis/fisiopatología , Femenino , Masculino , Persona de Mediana Edad , Dolor de Cuello/terapia , Dolor de Cuello/fisiopatología , Propiocepción/fisiología , Adulto , Dimensión del Dolor/métodos , Vértebras Cervicales/fisiopatología , Resultado del Tratamiento , Osteopatía/métodos , Evaluación de la Discapacidad , Articulación Cigapofisaria/fisiopatologíaRESUMEN
To explore the favorable factors that help slow the progression of disease in patients with mild Cervical Spondylotic Myelopathy (CSM). A retrospective analysis was conducted, involving the enrollment of 115 CSM patients. The categorization of patients into two groups was based on the duration of symptoms, assessments using the mJOA scale and Health Transition (HT) scores: mild-slow group and severe-rapid group. We found that the patients in both groups had similar degrees of spinal cord compression, but mild-slow group were older and had smaller C2-C7 cobb angle (Flexion) (CL(F)), C2-C7 cobb angle (Range of motion) (CL(ROM)), Transverse area (TA), Normal-TA, Compressive spinal canal area (CSCA), Normal-Spinal canal area (Normal-SCA) and lower Spinal cord increased signal intensity (ISI) Grade than the severe-rapid group. A binary logistic regression analysis showed that CL(ROM) and Normal-TA are favorable factors to help slow the progression of disease patients with mild CSM. Through ROC curves, we found that when CL(ROM) < 39.1° and Normal-TA < 80.5mm2, the progression of disease in CSM patients may be slower. Meanwhile, we obtained a prediction formula by introducing joint prediction factor: L = CL(ROM) + 2.175 * Normal-TA. And found that when L < 213.0, the disease progression of patients may be slower which was superior to calculate CL(ROM) and Normal-TA separately.
Asunto(s)
Vértebras Cervicales , Progresión de la Enfermedad , Espondilosis , Humanos , Masculino , Femenino , Persona de Mediana Edad , Espondilosis/diagnóstico por imagen , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Estudios Retrospectivos , Anciano , Compresión de la Médula Espinal/patología , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/patología , Rango del Movimiento Articular , Curva ROC , Adulto , Índice de Severidad de la EnfermedadRESUMEN
AIM: To compare the preoperative and postoperative increased signal intensity (ISI) outcomes of cervical spondylotic myelopathy (CSM) patients who underwent posterior decompression and fusion, and to assess the correlation between ISI changes and postsurgical clinical prognosis. MATERIAL AND METHODS: The results from 123 patients were evaluated. In addition to demographic data, such as age and gender, factors, including body mass index (BMI); smoking history; duration of symptoms; follow-up periods; levels of decompression and fusion; comorbidities, such as diabetes, coronary artery disease, and hypertension; ISI grading; cervical sagittal vertical axis; C2-7 cervical lordosis parameters; and Modified Japanese Orthopedic Association (mJOA) scores, were statistically analyzed preoperatively and postoperatively. RESULTS: ISI improved in 39 patients (31.7%), remained unchanged in 53 patients (latent, 43.1%), and deteriorated in 31 patients (25.2%). There were no statistically significant differences in terms of age, gender, BMI, or levels of decompression and fusion between patients with ISI improvement, latent ISI, and worsened ISI. Patients with ISI improvement had the highest postoperative C2-7 lordosis values and shortest duration of symptoms. There was no statistically significant difference in the mJOA scores between patients with and without ISI improvement. CONCLUSION: ISI improvement in CSM patients undergoing posterior cervical decompression and fusion is influenced by symptom duration and preoperative-postoperative cervical lordosis values. However, this study did not find a correlation between ISI improvement and clinical recovery based on the mJOA scores.
Asunto(s)
Vértebras Cervicales , Descompresión Quirúrgica , Fusión Vertebral , Espondilosis , Humanos , Masculino , Femenino , Fusión Vertebral/métodos , Persona de Mediana Edad , Espondilosis/cirugía , Descompresión Quirúrgica/métodos , Vértebras Cervicales/cirugía , Anciano , Resultado del Tratamiento , Adulto , Enfermedades de la Médula Espinal/cirugía , Imagen por Resonancia Magnética , Estudios RetrospectivosRESUMEN
OBJECTIVES: This study aimed to compare the clinical efficacy and complication rates of decompression with unilateral biportal endoscopy (UBE) and percutaneous endoscopy (PE) in cervical spondylotic radiculopathy (CSR). MATERIALS AND METHODS: A comprehensive literature review was conducted up to April 2024 across multiple databases, including EMBASE, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data, focusing on clinical studies that compare UBE with PE for posterior foraminotomy and discectomy decompression in CSR. The meta-analysis was performed with an emphasis on evaluating clinical outcomes such as operation time, blood loss, incision length, Neck Disability Index (NDI), Visual Analog Scale (VAS) for neck pain and arm pain, and complications. RESULTS: Out of an initial 1,041 studies identified from electronic databases, eight were deemed eligible based on title, abstract, and full-text screening. These studies involved 552 patients (269 males, 283 females; mean age: 53.9±11.4 years; range, 30 to 79 years), with 287 in the UBE group and 265 in the PE group. Meta-analysis indicated no significant difference in operation time between UBE and PE (mean difference [MD]=-3.68; 95% confidence interval [CI]:-19.38, 12.02; p=0.65). However, both blood loss (MD=17.01; 95% CI: 2.61, 31.41; p=0.02) and incision length (MD=11.62; 95% CI: 9.23, 14.01; p<0.00001) were significantly lower in the PE group compared to the UBE group. Regarding clinical outcomes, no significant differences were observed between the two groups in terms of NDI (MD=0.12; 95% CI:-0.10, 0.34; 0.28), VAS for neck pain (MD=-0.06; 95% CI:-0.19, 0.06; p=0.32), VAS for arm pain (MD=-0.14; 95% CI:-0.26, -0.01; p=0.84), or complications (OR=1.07; 95% CI: 0.54, 2.10; p=0.85). CONCLUSION: Our findings suggest that there are no significant disparities in clinical outcomes between UBE and PE, encompassing NDI, VAS for arm pain, and VAS for neck pain, as well as complication rates. Notably, compared to PE, UBE results in increased bleeding and longer incision lengths when treating CSR, without substantially reducing operation time.
Asunto(s)
Descompresión Quirúrgica , Endoscopía , Radiculopatía , Espondilosis , Humanos , Vértebras Cervicales/cirugía , Descompresión Quirúrgica/métodos , Descompresión Quirúrgica/efectos adversos , Endoscopía/efectos adversos , Endoscopía/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Radiculopatía/etiología , Radiculopatía/cirugía , Espondilosis/complicaciones , Espondilosis/cirugía , Resultado del TratamientoAsunto(s)
Imagen por Resonancia Magnética , Compresión de la Médula Espinal , Espondilosis , Humanos , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Espondilosis/diagnóstico por imagen , Gadolinio , Vértebras Cervicales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Médula Espinal/diagnóstico por imagen , Médula Espinal/patologíaRESUMEN
OBJECTIVE: To observe the clinical efficacy of meridian massage in the treatment of cervical spondylotic radiculopathy. METHODS: Sixty-four patients with cervical radiculopathy treated from March 2020 to June 2023 were divided into the observation group and the treatment group, with 32 cases in each group. The observation group received conventional treatment, including 14 males and 18 females with an average age of (41.34±7.23) years old ranging from 32 to 55 years old;the disease duration ranged from 9 to 17 months with an average of (14.23±3.56) months;C5 and C6 nerve root compression occurred in 12 cases, C7 nerve root compression occurred in 17 cases, C8 nerve root compression occurred in 3 cases. The treatment group received massage therapy on the basis of conventional treatment, including 17 males and 15 females with an average age of (40.86±6.97) years old ranging from 30 to 54 years old;the disease duration ranged from 8 to 18 months with an average of (15.43±3.48) months;C5 and C6 nerve root compression occurred in 14 cases, C7 nerve root compression occurred in 16 cases, C8 nerve root compression occurred in 2 cases. The clinical efficacy was evaluated by visual analogue scale(VAS), neck disability index(NDI) and clinical assessment scale for cervical spondylosis(CASCS) before and after 2-week treatment, and the range of motion of cervical spine was compared before and after treatment. RESULTS: After 2-week treatment, the VAS and NDI scores of the treatment group and the observation group decreased, while the CASCS scores increased(P<0.001). After 2-week treatment, the VAS and NDI scores were lower and the CASCS scores were higher in the treatment group than those of the observation group(P<0.001). Comparing with those before treatment, the range of motion of flexion, extension, left flexion, right flexion, left rotation and right rotation after 2-week treatment increased in two groups(P<0.05). Comparing with the observation group, the range of motion of flexion, extension, left flexion, right flexion, left rotation and right rotation increased more significantly in the treatment group(P<0.05). CONCLUSION: Meridian massage is effective in the treatment of cervical Spondylotic radiculopathy, which can effectively relieve neck pain, improve clinical symptoms and improve patient satisfaction.
Asunto(s)
Masaje , Radiculopatía , Espondilosis , Humanos , Femenino , Masculino , Radiculopatía/terapia , Persona de Mediana Edad , Adulto , Espondilosis/terapia , Masaje/métodos , Meridianos , Vértebras Cervicales , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate the clinical effect of anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylosis of vertebral artery type(CSA). METHODS: The clinical data of 42 patients with CSA from January 2020 to January 2022 were retrospectively analyzed. There were 25 males and 17 females, aged from 30 to 74 years old with an average of (53.9±11.0) years old. There were 18 cases with single-segment lesions, 17 cases with two-segment lesions, and 7 cases with three-segment lesions. The American Academy of Otolaryngology-Head and Neck Surgery's Hearing and Balance Committee score (CHE), the Neck Disability Index (NDI) and the cervical curvature Cobb angle were recorded before surgery and after surgery at 6 months. RESULTS: All 42 ACDF patients were followed up for 6 to 30 months with an average of (14.0±5.2) months. The operative time ranged from 95 to 220 min with an average of (160.38±36.77) min, the intraoperative blood loss ranged from 30 to 85 ml with an average of (53.60±18.98) ml. Tow patients had mild postoperative dysphagia, which improved with symptomatic treatment such as nebulized inhalation. CHE score decreased from (4.05±0.96) preoperatively to (2.40±0.70) at 6 months postoperatively (t=12.97, P<0.05). The number of improved vertigo at 6 months postoperatively was 38, with an improvement rate of 90.5%. NDI score was reduced from (34.43±8.04) preoperatively to (20.76±3.91) at 6 months postoperatively (t=11.83, P<0.05). The cervical curvature Cobb angle improved from (8.04±6.70)° preoperatively to (12.42±5.23)° at 6 months postoperatively (t=-15.96, P<0.05). CONCLUSION: The ACDF procedure has outstanding clinical efficacy in treating CSA. The operation can rapidly relieve patients' episodic vertigo symptoms by relieving bony compression and reconstructing cervical curvature. However, it is necessary to strictly grasp the indications for surgery and clarify the causes of vertigo in patients, and ACDF surgery is recommended for CSA patients for whom conservative treatment is ineffective.
Asunto(s)
Vértebras Cervicales , Discectomía , Fusión Vertebral , Espondilosis , Arteria Vertebral , Humanos , Masculino , Femenino , Persona de Mediana Edad , Discectomía/métodos , Fusión Vertebral/métodos , Espondilosis/cirugía , Anciano , Adulto , Vértebras Cervicales/cirugía , Arteria Vertebral/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The study of TCM manipulation's mechanism is the key scientific issue in the current manipulation research. It is the key and difficult point on the road of modernization and internationalization of Chinese orthopedics and traumatology. Meanwhile, it is also an important way to clarify systematically the scientific connotation of TCM manipulation. At present, our country is in an important period when multi-disciplinary intersection lead knowledge production, scientific innovation, and discipline development. The trend of cross-innovation between Chinese orthopedics and traumatology and other disciplines provides the carrier and method for the study of TCM manipulation's mechanism. Cervical spondylosis is the traditional dominant disease of Chinese orthopedics and traumatology. In recent years, many scholars have applied multi-disciplinary techniques and theories to explore the mechanism of TCM manipulation by focusing on the four dimensions of muscle, bone, blood vessel and nerve. The article takes the treatment of cervical spondylosis by TCM manipulation as the research entry point, and integrates the application status and implementation strategies of various techniques and theories under the background of multi-disciplinary intersection, which is conducive to the better combination, innovation and transformation of Chinese orthopedics and traumatology with other disciplines, and provides ideas and references for systematically clarifying the scientific connotation of TCM manipulation.
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Medicina Tradicional China , Espondilosis , Humanos , Espondilosis/terapiaRESUMEN
OBJECTIVE: This study aims to investigate the occurrence of postoperative kinesiophobia in patients with CSM and compare the postoperative recovery of patients with and without kinesiophobia to understand its influence on clinical outcomes in CSM. METHODS: Between November 2020 and November 2022, surgical treatment was performed in the neurosurgical wards of 2 Grade III Class A general public hospitals in the Fujian Province. The demographic and disease data of the patients were collected, and patients were divided into a kinesiophobia group and non-kinesiophobia group according to the Tampa kinesiophobia Scale (TSK). The cervical dysfunction index, cervical Japanese Orthopaedic Association (JOA) rating, self-anxiety rating, and activity of daily living rating scales were collected three months postoperatively. The influence of postoperative kinesiophobia on early rehabilitation was also analysed. RESULTS: A total of 122 patients were an average age of (55.2 ± 10.3) years included in this study. The average score of kinesophobia after surgery was 41.2 ± 4.5, with an incidence of 75.4%. Multivariate logistic regression analysis showed that age (OR = 1.105, 95% CI = 1.014-1.204), neck disability index (NDI) (OR = 1.268, 95% CI = 1.108-1.451), diabetes mellitus (OR = 0.026, 95% CI = 0.001-0.477), and Japanese Orthopaedic Association (JOA) score (OR = 0.698, 95% CI = 0.526-0.927) were associated with the occurren. CONCLUSION: Doctors should be aware of kinesiophobia in patients with CSM. Education regarding kinesiophobia, strategies to avoid it, and treatment strategies using a multidisciplinary approach can improve recovery outcomes.
Asunto(s)
Vértebras Cervicales , Espondilosis , Humanos , Persona de Mediana Edad , Femenino , Masculino , Estudios Transversales , Espondilosis/cirugía , Espondilosis/psicología , Espondilosis/rehabilitación , Anciano , Resultado del Tratamiento , Vértebras Cervicales/cirugía , Trastornos Fóbicos/psicología , Trastornos Fóbicos/etiología , Trastornos Fóbicos/epidemiología , Adulto , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/psicología , Enfermedades de la Médula Espinal/rehabilitación , Periodo Posoperatorio , Complicaciones Posoperatorias/psicología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , KinesiofobiaRESUMEN
OBJECTIVE: To put forward a new index of cervical curvature evaluation - relative cervical curvature area, and a new classification of cervical spine was proposed according to the relative cervical curvature area. METHODS: A total of 167 subjects with cervical spondylosis were included in the study. Firstly, 119 subjects were selected to measure C2-C7 lordosis angle by Cobb angle method, Harrison posterior tangent method, and Jackson physiological stress line method, and then their relative cervical curvature area, C1-C7 Cobb angle, C7 slope, and T1 slope were measured. The correlation between relative cervical curvature area and 3 measurement methods and common sagittal parameters was analyzed. According to the angle classification method, we calculated the diagnostic boundary value of the relative cervical curvature area classification, and selected 48 subjects to evaluate its diagnostic efficacy. Finally, 119 subjects were re-evaluated according to the diagnostic threshold and the number of intersections to verify the feasibility of the new classification. RESULTS: The results showed that the relative cervical curvature area index had good intraobserver and interobserver repeatability. Relative cervical curvature area was correlated with Harrison posterior tangent method (r = 0.930), Cobb angle method (r = 0.886), and Jackson physiological stress line method (r = 0.920), and correlated with C1-C7 Cobb angle, C7 slope, and T1 slope. The relative cervical curvature area has a good diagnostic performance for distinguishing patients with lordosis, straightening, and kyphosis. According to the new classification of cervical spine, 119 subjects were divided into 57 simple lordosis, 11 simple straightening, 4 simple kyphosis, 26 S-type, and 21 RS-type. CONCLUSIONS: The relative cervical curvature area uses the area parameter instead of the original angle parameter and distance parameter to incorporate the change of segmental curvature, which makes up for the shortcomings of the Cobb angle method that only evaluates the curvature of 2 vertebrae, and better reflects the cervical curvature. Studies have shown that relative cervical curvature area has good repeatability and diagnostic value, and found that it has a good correlation with common cervical sagittal parameters. The new classification of cervical spine makes up for the disadvantage that the angle classification method cannot distinguish between S-type and RS-type, and initially proposes to use the number of intersections and the relative absolute value area to reflect the severity of S-type.
Asunto(s)
Vértebras Cervicales , Lordosis , Espondilosis , Humanos , Vértebras Cervicales/diagnóstico por imagen , Femenino , Masculino , Persona de Mediana Edad , Lordosis/diagnóstico por imagen , Espondilosis/diagnóstico por imagen , Adulto , Anciano , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos X/métodosRESUMEN
STUDY DESIGN: Retrospective Cohort Study. OBJECTIVES: This study measures the subcutaneous fat index (SFI) of the cervical spine in patients with spinal cervical spondylosis using cervical magnetic resonance imaging and explores its relationship with neck pain in patients with spinal cervical spondylosis. METHODS: In this single-center retrospective study, 298 patients hospitalized for spinal cervical spondylosis between January and June 2021 were initially considered. After applying inclusion and exclusion criteria, 93 patients were enrolled. The cervical magnetic resonance imaging data for these patients were analyzed using A-Site software. The SFI was measured at the median sagittal plane on T2-weighted images. Patients were categorized into 2 groups based on their admission complaints: those with cervical pain and those without it. Differences between these groups were then statistically analyzed. RESULTS: The mean SFIs with standard deviations for the neck and non-neck pain groups were 36.4% ± 7.7% and 27.0% ± 7.9%, respectively, with a significant difference (P < 0.0001). The SFI was consistently higher across all neck segments in the neck pain group compared to the nonneck pain group (P < 0.05). The 2 groups had no statistically significant difference in the body mass index. CONCLUSIONS: The SFI provides a more precise assessment of muscle and fat distribution in the posterior cervical region than body mass index and is generally higher in patients with spinal cervical spondylosis who experience neck pain. These findings suggest the importance of early functional exercises postsurgery for potentially improving surgical outcomes in this patient population.
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Vértebras Cervicales , Imagen por Resonancia Magnética , Dolor de Cuello , Espondilosis , Grasa Subcutánea , Humanos , Espondilosis/cirugía , Espondilosis/complicaciones , Espondilosis/diagnóstico por imagen , Femenino , Masculino , Estudios Retrospectivos , Dolor de Cuello/etiología , Dolor de Cuello/diagnóstico por imagen , Persona de Mediana Edad , Grasa Subcutánea/diagnóstico por imagen , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Anciano , Adulto , Estudios de Cohortes , Índice de Masa CorporalRESUMEN
As a common disease, cervical spondylosis (CS) results from the degeneration of the cervical intervertebral disc. However, there are still no effective clinical strategies for the treatment of this disease. Needle-scalpel (Ns), a therapy guided by traditional Chinese medicine theory, alleviates intervertebral disc degradation and is widely used in the clinic to treat CS. Stromal cell-derived factor-1 (SDF-1) and its receptor CXC receptor 4 (CXCR4) in nucleus pulposus cells play an important role in CS onset and development. This study aimed to explore whether Ns can relieve pain and regulate the SDF-1/CXCR4 axis in nucleus pulposus cells to inhibit apoptosis, thereby delaying cervical intervertebral disc degradation in a rat model of CS. It was found that the Ns-treated groups exhibited higher mechanical allodynia scores than the model group, and H&E staining, MRI, and scanning electron microscopy revealed that Ns therapy inhibited intervertebral disc degeneration. Additionally, Ns therapy significantly inhibited increases in the RNA and protein expression levels of SDF-1 and CXCR4. Furthermore, these treatments alleviated the apoptosis of nucleus pulposus cells, which manifested as a decline in the proportion of apoptotic nucleus pulposus cells and inhibition of the decrease in the levels of Bcl-2/Bax. These findings indicated that Ns mitigated CS-induced pain, inhibited the apoptosis of nucleus pulposus cells, and alleviated intervertebral disc degeneration in CS rats. These effects may be mediated by specifically regulating the SDF-1/CXCR4 signaling axis. Based on these findings, we conclude that Ns might serve as a promising therapy for the treatment of CS.
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Apoptosis , Quimiocina CXCL12 , Modelos Animales de Enfermedad , Degeneración del Disco Intervertebral , Núcleo Pulposo , Ratas Sprague-Dawley , Receptores CXCR4 , Animales , Receptores CXCR4/metabolismo , Receptores CXCR4/genética , Quimiocina CXCL12/metabolismo , Apoptosis/efectos de los fármacos , Núcleo Pulposo/metabolismo , Núcleo Pulposo/efectos de los fármacos , Núcleo Pulposo/patología , Degeneración del Disco Intervertebral/metabolismo , Degeneración del Disco Intervertebral/patología , Degeneración del Disco Intervertebral/tratamiento farmacológico , Ratas , Masculino , Vértebras Cervicales , Transducción de Señal/efectos de los fármacos , Espondilosis/metabolismo , Espondilosis/patologíaRESUMEN
BACKGROUND: Poor neurological recovery in patients after anterior cervical discectomy and fusion has been frequently reported; however, no study has analyzed the preoperative imaging characteristics of patients to investigate the factors affecting surgical prognosis. The purpose of this study was to investigate the factors that affect the preoperative imaging characteristics of patients and their influence on poor neurologic recovery after anterior cervical discectomy and fusion. METHODS: We retrospectively analyzed the clinical data of 89 patients who met the criteria for anterior cervical discectomy and fusion for the treatment of single-level cervical spondylotic myelopathy and evaluated the patients' neurological recovery based on the recovery rate of the Japanese Orthopaedic Association (JOA) scores at the time of the final follow-up visit. Patients were categorized into the "good" and "poor" groups based on the JOA recovery rates of ≥ 50% and < 50%, respectively. Clinical information (age, gender, body mass index, duration of symptoms, preoperative JOA score, and JOA score at the final follow-up) and imaging characteristics (cervical kyphosis, cervical instability, ossification of the posterior longitudinal ligament (OPLL), calcification of herniated intervertebral discs, increased signal intensity (ISI) of the spinal cord on T2-weighted imaging (T2WI), and degree of degeneration of the discs adjacent to the fused levels (cranial and caudal) were collected from the patients. Univariate and binary logistic regression analyses were performed to identify risk factors for poor neurologic recovery. RESULTS: The mean age of the patients was 52.56 ± 11.18 years, and the mean follow-up was 26.89 ± 11.14 months. Twenty patients (22.5%) had poor neurological recovery. Univariate analysis showed that significant predictors of poor neurological recovery were age (p = 0.019), concomitant OPLL (p = 0.019), concomitant calcification of herniated intervertebral discs (p = 0.019), ISI of the spinal cord on T2WI (p <0.05), a high grade of degeneration of the discs of the cranial neighboring levels (p <0.05), and a high grade of discs of the caudal neighboring levels (p <0.05). Binary logistic regression analysis showed that ISI of the spinal cord on T2WI (p = 0.001 OR = 24.947) and high degree of degeneration of adjacent discs on the cranial side (p = 0.040 OR = 6.260) were independent risk factors for poor neurological prognosis. CONCLUSION: ISI of the spinal cord on T2WI and high degree of cranial adjacent disc degeneration are independent risk factors for poor neurological recovery after anterior cervical discectomy and fusion. A comprehensive analysis of the patients' preoperative imaging characteristics can help in the development of surgical protocols and the management of patients' surgical expectations.
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Vértebras Cervicales , Discectomía , Recuperación de la Función , Fusión Vertebral , Humanos , Discectomía/métodos , Discectomía/efectos adversos , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Anciano , Adulto , Espondilosis/cirugía , Espondilosis/diagnóstico por imagen , Imagen por Resonancia Magnética , Estudios de Seguimiento , Resultado del TratamientoRESUMEN
The paper introduces professor ZHANG Weihua's experience in treatment of cervical spondylotic radiculopathy (CSR) with ulna-tibia needling therapy combined with decompression-loosening manual manipulation. Using "palpating, detecting and imaging observing", professor ZHANG Weihua gives the accurate diagnosis for the location, the stage and the severity of the disease. According to the nature of the disease, CSR is treated in three stages. He proposes the academic thought, "taking the tendons as the outline, regarding the meridians as the essential, rooting at qi and blood, co-regulating tendons and bones". The ulna-tibia needling therapy and decompression-loosening manual manipulation are combined in treatment. In the ulna-tibia needling therapy, the acupuncture is delivered at the lower 1/3 of the cutaneous regions of taiyang and shaoyang meridians, on the ulnar region (belt-like distribution). The decompression-loosening manual manipulation is operated in 3 steps, i.e. relaxing the nape region, decompressing and relaxing (includes positioning rotational wrenching, upward and backward elevation) and supination wrenching, and analgesia and regulating tendons; and the manipulation for analgesia and regulating tendons is supplemented to enhance the effect.
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Terapia por Acupuntura , Radiculopatía , Espondilosis , Humanos , Terapia por Acupuntura/métodos , Terapia por Acupuntura/instrumentación , Espondilosis/terapia , Radiculopatía/terapia , Masculino , Persona de Mediana Edad , Cúbito , Terapia Combinada , Femenino , Adulto , Descompresión Quirúrgica/métodos , Manipulaciones Musculoesqueléticas/métodos , Puntos de AcupunturaRESUMEN
INTRODUCTION: Low back and neck pain are common musculoskeletal disorders with multiple treatment options. India's traditional medical systems, known as Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homoeopathy) offer range of interventions and are widely used. In view of limited documentation of adverse events following Ayush interventions for lumbar and cervical spondylosis, we synthesized evidence and estimated proportion of studies reporting adverse events. METHODS: We systematically searched all published documents from biomedical and multidisciplinary abstract and citation databases and Ayush-specific repositories from their inception to April 2021. We selected studies as per inclusion criteria and extracted information, adhering to PRISMA guidelines. We systematically reviewed the qualitative evidence form the selected studies. RESULTS: Majority (94%) of the selected 113 studies were interventional studies and included 77 (68.1%) journal articles and 35 (31%) academic dissertations. Among the Ayush systems, considerable proportion was from Ayurveda (32.7%), followed by Siddha (24.8%), Yoga (22.1%), Unani (15.9%) and Homoeopathy (4.4%). Almost three-fourths of the studies were on lumbar spondylosis (65%; n = 74), followed by cervical spondylosis (31%; n = 35), and the remaining four included both. Thirteen percent of the 113 studies described adverse events [Yoga = 9.7%; Unani = 1.8% and Homoeopathy = 1.8%]. More adverse events were reported among the studies on lumbar (9.7%) than cervical spondylosis (2.7%). The nature of interventions were non-pharmacological (10.6%; n = 12), pharmacological (n = 2; 1.8%) or combined (n = 1; 0.9%). CONCLUSIONS: Only one in eight studies reported any adverse event following Ayush interventions for cervical and lumbar spondylosis. There could be certain degree of underreporting of adverse events and requires further exploration. PROSPERO Registration ID CRD42020167433.
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Espondilosis , Humanos , Espondilosis/terapia , India/epidemiología , Medicina Ayurvédica/métodos , Medicina Ayurvédica/efectos adversos , Vértebras Lumbares , Vértebras Cervicales , Dolor de Cuello/terapiaRESUMEN
OBJECTIVES: To investigate potential of enhancing image quality, maintaining interobserver consensus, and elevating disease diagnostic efficacy through the implementation of deep learning-based reconstruction (DLR) processing in 3.0 T cervical spine fast magnetic resonance imaging (MRI) images, compared with conventional images. METHODS: The 3.0 T cervical spine MRI images of 71 volunteers were categorized into two groups: sagittal T2-weighted short T1 inversion recovery without DLR (Sag T2w-STIR) and with DLR (Sag T2w-STIR-DLR). The assessment covered artifacts, perceptual signal-to-noise ratio, clearness of tissue interfaces, fat suppression, overall image quality, and the delineation of spinal cord, vertebrae, discs, dopamine, and joints. Spanning canal stenosis, neural foraminal stenosis, herniated discs, annular fissures, hypertrophy of the ligamentum flavum or vertebral facet joints, and intervertebral disc degeneration were evaluated by three impartial readers. RESULTS: Sag T2w-STIR-DLR images exhibited markedly superior performance across quality indicators (median = 4 or 5) compared to Sag T2w-STIR sequences (median = 3 or 4) (p < 0.001). No statistically significant differences were observed between the two sequences in terms of diagnosis and grading (p > 0.05). The interobserver agreement for Sag T2w-STIR-DLR images (0.604-0.931) was higher than the other (0.545-0.853), Sag T2w-STIR-DLR (0.747-1.000) demonstrated increased concordance between reader 1 and reader 3 in comparison to Sag T2w-STIR (0.508-1.000). Acquisition time diminished from 364 to 197 s through the DLR scheme. CONCLUSIONS: Our investigation establishes that 3.0 T fast MRI images subjected to DLR processing present heightened image quality, bolstered diagnostic performance, and reduced scanning durations for cervical spine MRI compared with conventional sequences.
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Vértebras Cervicales , Aprendizaje Profundo , Imagen por Resonancia Magnética , Espondilosis , Humanos , Espondilosis/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Masculino , Adulto , Femenino , Vértebras Cervicales/diagnóstico por imagen , Persona de Mediana Edad , Anciano , Procesamiento de Imagen Asistido por Computador/métodosRESUMEN
STUDY DESIGN: Retrospective cohort analysis. OBJECTIVE: The purpose of this study is to investigate whether the removal of the posterior longitudinal ligament (PLL) affects the mid-term outcome of anterior cervical fusion for cervical spondylosis with sympathetic symptoms(CSSS). METHODS: From January 2012 to July 2013, 66 patients who were diagnosed with CSSS with ≥ 10-year follow-up at our institution were assessed. All patients were divided into two groups: Group A (36 cases) in which patients underwent anterior cervical fusion with PLL resection and Group B (30 cases) in which patients underwent anterior cervical fusion without PLL resection. The sympathetic symptom 20-point system was used to evaluate the sympathetic symptoms, such as tinnitus, headache and vertigo, etc. And the neurological status was assessed by the Japanese Orthopedic Association (JOA) scores. Clinical and radiologic data were evaluated preoperatively, 9 days, 3 months, 6 months, 12 months, 24 months, 60 months, and 120 months postoperatively. Data collected included all perioperative complications as morbidities that occurred during the period of follow-up. RESULTS: The postoperative JOA scores and 20-point score can be significantly improved compared with preoperative whether the PLL is removed in both groups. However, the postoperative 20-point score of patients in group A was significantly different from that in group B. No loosening and displacement of prosthesis occurred. CONCLUSION: A better clinical effect could be attained when resecting the PLL in the operation. The PLL may play an important role in CSSS. The mid-term outcomes of anterior cervical fusion with PLL resection were satisfied in treating CSSS.
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Vértebras Cervicales , Ligamentos Longitudinales , Fusión Vertebral , Espondilosis , Humanos , Masculino , Femenino , Espondilosis/cirugía , Espondilosis/complicaciones , Persona de Mediana Edad , Fusión Vertebral/métodos , Estudios Retrospectivos , Vértebras Cervicales/cirugía , Resultado del Tratamiento , Anciano , Ligamentos Longitudinales/cirugía , Adulto , Estudios de Cohortes , Estudios de SeguimientoRESUMEN
BACKGROUND: Cervical spondylosis (CS), including myelopathy and radiculopathy, is the most common degenerative cervical spine disease. This study aims to evaluate the clinical outcomes of unilateral biportal endoscopy (UBE) compared to those of conventional anterior cervical decompression and fusion (ACDF) for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs. METHODS: A prospective, randomized, controlled, noninferiority trial was conducted. The sample consisted of 131 patients who underwent UBE or ACDF was conducted between September 2021 and September 2022. Patients with cervical nerve roots or coexisting spinal cord compression symptoms and imaging-defined unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs were randomized into two groups: a UBE group (n = 63) and an ACDF group (n = 68). The operative time, blood loss, length of hospital stay after surgery, and perioperative complications were recorded. Preoperative and postoperative modified Japanese Orthopaedic Association (mJOA) scale scores, visual analog scale (VAS) scores, neck disability index (NDI) scores, and recovery rate (RR) of the mJOA were utilized to evaluate clinical outcomes. RESULTS: The hospital stay after surgery was significantly shorter in patients treated with UBE than in those treated with ACDF (p < 0.05). There were no significant differences in the neck or arm VAS score, NDI score, mJOA score, or mean RR of the mJOA between the two groups (p < 0.05). Only mild complications were observed in both groups, with no significant difference (p = 0.30). CONCLUSION: UBE can significantly relieve pain and disability without severe complications, and most patients are satisfied with this technique. Consequently, this procedure can be used safely and effectively as an alternative to ACDF for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry on 02/08/2023 ( http://www.chictr.org.cn , #ChiCTR2300074273).