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Albert-Lucena D, Navarro-Santana MJ, Díaz-Arribas MJ, Rabanal-Rodríguez G, Valera-Calero JA, Fernández-de-Las-Peñas C, Cook C, Plaza-Manzano G. Diagnostic accuracy of neurodynamic tests in upper-limb entrapment neuropathies: A systematic review and meta-analysis. Musculoskelet Sci Pract 2025; 77:103317. [PMID: 40156954 DOI: 10.1016/j.msksp.2025.103317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 03/04/2025] [Accepted: 03/18/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND Upper-limb neurodynamic tests are commonly used to diagnose neuropathies in this area, including cervical radiculopathy and carpal tunnel syndrome, although their diagnostic accuracy remains uncertain across different conditions and criteria. OBJECTIVE To assess the diagnostic accuracy of upper-limb neurodynamic tests and their variations and criteria for upper-limb entrapment neuropathies. METHODS A systematic review with meta-analysis was conducted in different databases (for their inception in February 2025), including studies evaluating the diagnostic accuracy of these tests. Sensitivity, specificity, likelihood ratios (LR), diagnostic odds ratios, diagnostic accuracy and the area under the curve (AUC) were calculated using a bivariate and univariate meta-analysis. The quality of evidence was evaluated using the GRADE approach, and meta-regression was performed to examine the influence of diagnostic criteria. RESULTS Twelve studies were included. Likelihood ratios for neuropathic pain conditions were LR+:1.65 and LR-:0.57, for cervical radiculopathy were LR+:2 and LR-:0.47, and for carpal tunnel syndrome were LR+:1.45 and LR-:0.66. The upper-limb neurodynamic test 2A showed the highest diagnostic accuracy (AUC: 0.76), with LR+:2.59 and LR-:0.42 for cervical radiculopathy, while test 3 had the highest specificity (0.92; LR+:7, LR-:0.48). Diagnostic accuracy for carpal tunnel syndrome was lower (AUC: 0.62). Meta-regression showed significant diagnostic criteria interaction, favoring structural differentiation maneuvers (p = 0.002). CONCLUSION Upper-limb neurodynamic tests show moderate sensitivity and low to moderate specificity for diagnosing upper-limb entrapment neuropathies, with diagnostic accuracy varying across conditions. The certainty of evidence ranges from very low to moderate, emphasizing the need for cautious clinical interpretation. Diagnostic reference criteria significantly influence test performance.
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Affiliation(s)
- Daniel Albert-Lucena
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040, Madrid, Spain.
| | - Marcos José Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040, Madrid, Spain; Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
| | - María José Díaz-Arribas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040, Madrid, Spain; Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
| | - Gabriel Rabanal-Rodríguez
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040, Madrid, Spain.
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040, Madrid, Spain; Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922, Alcorcón, Spain.
| | - Chad Cook
- Department of Orthopaedics, Duke University, Department of Population Health Sciences, Duke Clinical Research Institute, Durham, NC, USA.
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040, Madrid, Spain; Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040, Madrid, Spain.
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She D, Yan Y, Hong J, Jiang D, Jiang H, Zou Y, Zhao X, Cao D. The value of MR neurography in assessing lesions of the thoracic dorsal root ganglia in patients with zoster-associated pain. Eur Radiol 2025:10.1007/s00330-025-11575-4. [PMID: 40240558 DOI: 10.1007/s00330-025-11575-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Revised: 01/21/2025] [Accepted: 02/19/2025] [Indexed: 04/18/2025]
Abstract
OBJECTIVES To evaluate the imaging characteristics of the thoracic dorsal root ganglia (DRG) in patients with zoster-associated pain (ZAP) using magnetic resonance neurography (MRN) and its correlation with disease stages and serological marker. METHODS Twenty-six consecutive ZAP patients with different disease stages (acute herpes neuralgia, subacute herpes neuralgia, and postherpetic neuralgia) and thirteen healthy subjects were scanned on a 3-T MR scanner for thoracic DRG visualization. The T1-T12 DRG for each ZAP patient were divided into three groups (prominent affected segment, rash distribution segment, and non-rash distribution segment). The volume and T2 signal intensity (SI) of thoracic DRG were measured and compared. The visual analog scale (VAS) and serological data were also recorded. RESULTS The volume ratio of prominent affected thoracic DRG in ZAP patients was larger than that in non-rash distribution segment of ZAP patients and that in the healthy group, respectively (both p < 0.05). The volume ratio of affected DRG in the acute herpes neuralgia and subacute herpes neuralgia group was both higher than that in the postherpetic neuralgia group (both p < 0.05). For T2 SI, no differences were found among three disease stages. The ESR index was the only parameter associated with volume ratio of prominent affected DRG segment (r = 0.48, p = 0.01). CONCLUSION MRN is able to visualize and identify morphological changes of thoracic DRG of ZAP patients. The imaging characteristics of affected thoracic DRG exhibit differences across different disease stages, which was associated with ESR index in ZAP patients. KEY POINTS Question Magnetic resonance neurography is able to detect the abnormal imaging features of dorsal root ganglia (DRG) in zoster-associated pain patients. Findings Magnetic resonance neurography (MRN) demonstrates a difference in the volume ratio of affected DRG among three disease stages in zoster-associated pain (ZAP) patients. Clinical relevance Combining serological parameter with observed thoracic DRG volume changes on MRN may serve as a viable predictor for ZAP development.
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Affiliation(s)
- Dejun She
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Yalan Yan
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Junhuan Hong
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Dongmei Jiang
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Hao Jiang
- Department of Pain Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Ying Zou
- Department of Dermatology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | | | - Dairong Cao
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China.
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China.
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Lutke Schipholt IJ, Koop MA, Coppieters MW, van de Giessen EM, Lammerstma AA, ter Meulen BC, Vleggeert-Lankamp C, van Berckel BN, Bot J, van Helvoirt H, Depauw PR, Boellaard R, Yaqub M, Scholten-Peeters G. Neuroinflammation at the Neuroforamina and Spinal Cord in Patients with Painful Cervical Radiculopathy and Pain-Free Participants: An [ 11C]DPA713 PET/CT Proof-of-Concept Study. J Clin Med 2025; 14:2420. [PMID: 40217878 PMCID: PMC11989976 DOI: 10.3390/jcm14072420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2025] [Revised: 03/28/2025] [Accepted: 03/30/2025] [Indexed: 04/14/2025] Open
Abstract
Background/Objectives: The complex pathophysiology of painful cervical radiculopathy is only partially understood. Neuroimmune activation in the dorsal root ganglion and spinal cord is assumed to underlie the genesis of radicular pain. Molecular positron emission tomography (PET) using the radiotracer [11C]DPA713, which targets the 18-kDa translocator protein (TSPO), offers the ability to quantify neuroinflammation in humans in vivo. The primary objectives of this study were to (1) assess whether uptake of [11C]DPA713, a metric of neuroinflammation, is higher in the neuroforamina and spinal cord of patients with painful cervical radiculopathy compared with that in pain-free participants and (2) assess whether [11C]DPA713 uptake is associated with clinical parameters, such as pain intensity. Methods: Dynamic 60 min [11C]DPA713 PET/CT scans were acquired, and regions of interest were defined for neuroforamina and spinal cord. Resulting time-activity curves were fitted to a single-tissue compartment model using an image-derived input function, corrected for plasma-to-whole blood ratios and parent fractions, to obtain the volume of distribution (VT) as the primary outcome measure. Secondary neuroinflammation metrics included 1T2k VT without metabolite correction (1T2k_WB) and Logan VT. Results: The results indicated elevated levels of 1T2k VT at the neuroforamina (p < 0.04) but not at the spinal cord (p = 0.16). Neuroforamina and spinal cord 1T2k VT lack associations with clinical parameters. Secondary neuroinflammatory metrics show associations with clinical parameters such as the likelihood of neuropathic pain. Conclusions: These findings enhance our understanding of painful cervical radiculopathy's pathophysiology, emphasizing the neuroforamina levels of neuroinflammation as a potential therapeutic target.
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Affiliation(s)
- Ivo J. Lutke Schipholt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences—Program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; (I.J.L.S.)
- Laboratory Medical Immunology, Department of Clinical Chemistry, Amsterdam University Medical Centre, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Meghan A. Koop
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences—Program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; (I.J.L.S.)
| | - Michel W. Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences—Program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; (I.J.L.S.)
- School of Health Sciences and Social Work, Griffith University, Brisbane 4215, Australia
| | - Elsmarieke M. van de Giessen
- Radiology & Nuclear Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Adriaan A. Lammerstma
- Radiology & Nuclear Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Bastiaan C. ter Meulen
- Department of Neurology, OLVG Amsterdam, 1091 AC Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics Amsterdam Movement Sciences Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 9713 GZ Amsterdam, The Netherlands
| | | | - Bart N.M. van Berckel
- Radiology & Nuclear Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Joost Bot
- Radiology & Nuclear Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | | | - Paul R. Depauw
- Department of Neurosurgery, Elisabeth-TweeSteden Ziekenhuis, 5022 GC Tilburg, The Netherlands
| | - Ronald Boellaard
- Radiology & Nuclear Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Radiology & Nuclear Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Gwendolyne Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences—Program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; (I.J.L.S.)
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Nguyen K, Brandt Z, Shin D, Kubba R, Vyhmeister E, Razzouk J, Shaffrey C, Cheng W, Danisa O. Assessment of age-related variation in cervical neuroforaminal dimensions. J Clin Neurosci 2025; 134:111095. [PMID: 39923436 DOI: 10.1016/j.jocn.2025.111095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 01/24/2025] [Accepted: 01/28/2025] [Indexed: 02/11/2025]
Abstract
Radiographic parameters for diagnosing cervical neuroforaminal stenosis (CNFS) are not well described. To develop definitive criteria for diagnosis of CNFS, a standardized baseline of average neuroforaminal dimensions must first be established. Thus, the aim of this study was to: (1) use computed tomography (CT) of patients without neck pain or spinal pathology to establish mean cervical neuroforaminal dimensions (CNFD) across multiple age groups and (2) assess differences in CNFD by age. Cervical CT scans of 1,457 asymptomatic patients were reviewed to measure CNFD, defined as follows: axial width, craniocaudal height, and area. Patients were divided into four groups based on age: 18-35, 36-50, 51-64, and 65 + years. Statistical analyses were used to assess differences in CNFD according to age group.Mean overall CNFD for the 18-35 year-old cohort were 6.43 mm for width, 9.28 mm for height, and 58.85 mm2 for area. For the 36-50 year-old cohort, dimensions were 5.89 mm for width, 8.63 mm for height, and 52.78 mm2 for area. For the 51-64 year-old cohort, dimensions were 5.29 mm for width, 8.52 mm for height, and 48.93 mm2 for area. Finally, the 65 + year-old cohort had dimensions of 5.09 mm for width, 8.16 mm for height, and 45.91 mm2 for area. Significant differences in CNFD were observed between age groups, with dimensions decreasing in size from the younger to older age groups. In the studied population, CNFD decreased progressively with age. The results of our study may have utility in the diagnosis of CNFS.
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Affiliation(s)
- Kai Nguyen
- School of Medicine Loma Linda University Loma Linda CA USA.
| | - Zachary Brandt
- School of Medicine Loma Linda University Loma Linda CA USA
| | - David Shin
- School of Medicine Loma Linda University Loma Linda CA USA
| | - Rohan Kubba
- School of Medicine Loma Linda University Loma Linda CA USA
| | | | - Jacob Razzouk
- School of Medicine Loma Linda University Loma Linda CA USA
| | - Christopher Shaffrey
- Department of Orthopedic Surgery and Neurosurgery, Duke University Health Durham NC USA
| | - Wayne Cheng
- Department of Orthopedic Surgery, Jerry L. Pettis Veterans Affairs (VA) Medical Center Loma Linda CA USA
| | - Olumide Danisa
- Department of Orthopedic Surgery and Neurosurgery, Duke University Health Durham NC USA
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Qiu Z, Liu T, Zeng C, Yang M, Yang H, Xu X. Exploratory study on the ascending pain pathway in patients with chronic neck and shoulder pain based on combined brain and spinal cord diffusion tensor imaging. Front Neurosci 2025; 19:1460881. [PMID: 40012685 PMCID: PMC11861079 DOI: 10.3389/fnins.2025.1460881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 01/27/2025] [Indexed: 02/28/2025] Open
Abstract
Objective To explore the changes in the white matter microstructure of the ascending pain conduction pathways in patients with chronic neck and shoulder pain (CNSP) using combined brain and spinal cord diffusion tensor imaging techniques, and to assess its correlation with clinical indicators and cognitive functions. Materials and methods A 3.0T MRI scanner was used to perform combined brain and spinal cord diffusion tensor imaging scans on 31 CNSP patients and 24 healthy controls (HCs), extracting the spinothalamic tract (STT) and quantitatively analyzing the fractional anisotropy (FA) and mean diffusivity (MD) which reflect the microstructural integrity of nerve fibers. Additionally, these differences were subjected to partial correlation analysis in relation to Visual Analog Scale (VAS) scores, duration of pain, Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). Results Compared to HCs, CNSP patients showed decreased mean FA values and increased mean MD values in bilateral intracranial STT compared to the HC group, but two-sample t-test results indicated no statistically significant differences (p > 0.05). FA values of the left STT (C2 segment, C5 segment) and right STT (C1 segment, C2 segment) were significantly decreased in bilateral cervical STTs of CNSP patients; MD values of the left STT (C1 segment, C2 segment, C5 segment) and right STT (C1 segment, C5 segment) were significantly increased (p < 0.05). Partial correlation analysis results showed that FA values of STT in CNSP patients were negatively correlated with VAS scores, duration of pain, SAS scores, and SDS scores, while MD values were positively correlated with VAS scores and duration of pain (Bonferroni p < 0.05). Conclusion This research identified that patients with CNSP exhibited reduced mean FA and increased mean MD in the bilateral intracranial STT, although these differences were not statistically significant (p > 0.05). Conversely, significant abnormalities were observed in specific segments of the bilateral cervical STT (p < 0.05), which were also correlated with variations in pain intensity, illness duration, and levels of anxiety and depression. These findings contribute a novel neuroimaging perspective to the evaluation and elucidation of the pathophysiological mechanisms underlying chronic pain in the ascending conduction pathways.
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Affiliation(s)
- Zhiqiang Qiu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tianci Liu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chengxi Zeng
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Maojiang Yang
- Department of Pain, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - HongYing Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaoxue Xu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Citko A, Górski S, Marcinowicz L, Mateusz C, Matylda S. Nonspecific cervical spine pain/neck pain/in medical personnel of north-eastern Poland-A cross-sectional study. Front Med (Lausanne) 2024; 11:1466370. [PMID: 39717177 PMCID: PMC11663661 DOI: 10.3389/fmed.2024.1466370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 10/22/2024] [Indexed: 12/25/2024] Open
Abstract
Both mechanical and psychological overload are inherent to the work of nurses and paramedics, resulting spondylogenic pain. Aim of the study To identify potential risk factors influencing the prevalence of non-specific cervical spine pain in professionally active nurses and paramedics. Material and methods 324 nurses (53.2% of the total) and 285 paramedics (46.8%) were included in the study-609 people in total. The study was carried out using an auditorium survey technique supervised by the researchers. The methods used were: Nordic Musculoskeletal Questionnaire, a spinal pain questionnaire validated according to IEA guidelines, a short version of the IPAQ and the author's survey questionnaire, concerning sociodemographic data, chronic diseases including metabolic syndrome (MetS). A univariate logistic regression model was used in the statistical analysis. The level of statistical significance was taken as p < 0.05. Results Recurrent NP was significantly more common in paramedics compared to nurses (29.5 % vs. 9.3 %; p < 0.0001). In a univariate logistic regression model, the risk of NP was significantly increased by: length of service > 15 years (p < 0.024), presence of: low back pain (p < 0.0001), type 2 diabetes (p = 0.013), hypertension (p < 0.001), depression (p < 0.01). Of the modifiable factors, the risk of NP was significantly increased by high physical activity and short sleep <7 h (p < 0.001).
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Affiliation(s)
- Anna Citko
- Akademia Medyczna Nauk Stosowanych i Holistycznych, Warsaw, Mazowieckie Voivodeship, Poland
- European University of Applied Medical and Social Sciences, Olsztyn, Warminsko-Mazurskie Voivodeship, Poland
| | - Stanisław Górski
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Malopolskie Voivodeship, Poland
| | - Ludmiła Marcinowicz
- Department of Obstetrics, Gynecology and Maternity Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Podlaskie Voivodeship, Poland
| | - Cybulski Mateusz
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Podlaskie Voivodeship, Poland
| | - Sierakowska Matylda
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Podlaskie Voivodeship, Poland
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Zanwar R, Wani S. Reliability and validity of modified upper limb neurodynamic tests in patients with cervical radiculopathy. Hong Kong Physiother J 2024; 44:137-146. [PMID: 38510155 PMCID: PMC10949103 DOI: 10.1142/s1013702524500112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/23/2023] [Indexed: 03/22/2024] Open
Abstract
Background Neurodynamic Tests (NDTs) are used to assess neural mechanosensitivity in various conditions such as neural sliding, tension or inflammatory dysfunction. But in some upper quadrant dysfunctions, standard testing procedure of NDT cannot be assessed or tolerated by patient. Objective The purpose of the study was to determine the validity, intra-rater and inter-rater reliability of modified NDTs via median and ulnar nerve in patients with cervical radiculopathy. Methods Thirty-three patients (18 men and 15 women, mean age ± SD - 40 . 18 ± 9 . 01 ) with cervical radiculopathy having positive response to standard NDTs were included in the study. Modified neurodynamic tests for median & ulnar nerve were performed with modification in the sequencing of standard neurodynamic test at lower degrees of glenohumeral abduction and external rotation. Outcome measures used were angle of elbow extension for median nerve and angle elbow flexion for ulnar nerve at the point of pain onset indicated by "OP" (Onset of Pain). Results Reliability of OP was evaluated using measurement of Intra-class Correlation Coefficient (ICC), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) values. Results indicated high ICC values and low SEM values for OP during modified median and modified ulnar NDTs (M-MNT1 and M-UNT) on symptomatic side of patients with cervical radiculopathy. Spearman correlation analysis for validity of test score showed strong correlation (r = 0 . 767 ) with standard NDT. Conclusion There was strong correlation between Modified NDTs and standard tests depicting good validity and substantial reliability of OP during M-MNT1 and M-UNT for positive NDT response in patients with cervical radiculopathy.
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Affiliation(s)
- Rupa Zanwar
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Surendra Wani
- Department of Musculoskeletal Physiotherapy, MGM Institute of Physiotherapy, Aurangabad, Maharashtra, India
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Parker BA, Cunningham CA, Bathini AR, Patel NP, Martini WA. Atraumatic Cervical Disc Herniation With Rapidly Progressive Myelopathy in a 47-Year-Old Male: A Case Report. Cureus 2024; 16:e74152. [PMID: 39712852 PMCID: PMC11662945 DOI: 10.7759/cureus.74152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 12/24/2024] Open
Abstract
Atraumatic acute myelopathy caused by idiopathic disc herniation is rare. This case presents a 47-year-old male with a sudden onset of severe neck pain and weakness upon waking that progressively worsened. His rapidly progressive myelopathy led to an MRI of the cervical spine, revealing severe spinal canal stenosis at the C6-C7 level due to a large disc herniation deforming the spinal cord. The patient underwent anterior cervical discectomy and fusion (ACDF) at the C6-C7 level. Postoperatively, he showed significant improvement in pain and paresthesia, though some residual numbness and balance issues persisted. This case highlights the rapid progression and severe neurological impact of cervical spinal stenosis due to disc herniation. Despite reassuring findings on initial CT imaging, the patient's rapidly worsening symptoms on reassessment prompted an MRI, which confirmed the diagnosis and highlighted the urgent need for surgical intervention. The successful outcome for this patient is largely due to the rapid identification and surgical decompression of his severe cervical spinal cord compression. Cervical spinal stenosis, particularly when associated with disc herniation, can lead to profound, irreversible neurological impairment if not promptly addressed. This case demonstrates the critical need for early clinician identification and surgical intervention to prevent permanent deficits and improve patient outcomes.
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Hage R, Roussel N, Dierick F, Da Natividade J, Jones M, Fourré A. Rethinking neck-related arm pain: hypothetical clinical scenarios to differentiate the underlying IASP-defined pain mechanisms. J Man Manip Ther 2024; 32:378-389. [PMID: 38087995 PMCID: PMC11257017 DOI: 10.1080/10669817.2023.2292909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023] Open
Abstract
Neck-related arm pain is frequently encountered in clinical settings, yet its underlying pain mechanisms remain elusive. While such pain radiating from the neck to the arm is often attributed to injuries or diseases of the nervous system (neuropathic pain), it can also arise from nociceptive (referred) or nociplastic sources. Regrettably, patients exhibiting this specific pain distribution are frequently diagnosed with varying terms, including 'cervicobrachialgia', 'cervicobrachial neuralgia', 'cervicobrachial pain syndrome', and 'cervical radiculopathy'. The ambiguity surrounding these diagnostic labels complicates the clinical reasoning process. It is imperative for clinicians to discern and comprehend the dominant pain mechanism. Three distinct hypothetical clinical scenarios depict patients with almost identical pain distribution but divergent dominant pain mechanisms. Within these scenarios, both subjective and objective examinations are employed to elucidate the dominant pain mechanism associated with neck-related arm pain: nociceptive, neuropathic, and nociplastic. Furthermore, clinicians must remain aware that the dominant pain mechanism can evolve over time.
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Affiliation(s)
- Renaud Hage
- Traitement Formation Thérapie Manuelle (TFTM), Manual Therapy Center, Brussels, Belgium
- CeREF Technique, Haute Ecole Louvain en Hainaut, Mons, Belgium
- Faculté des Sciences de la Motricité, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Nathalie Roussel
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Antwerp, Belgium
| | - Frédéric Dierick
- Faculté des Sciences de la Motricité, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, Luxembourg, Luxembourg
| | - Joël Da Natividade
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, Luxembourg, Luxembourg
| | - Mark Jones
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Antoine Fourré
- Traitement Formation Thérapie Manuelle (TFTM), Manual Therapy Center, Brussels, Belgium
- Faculté des Sciences de la Motricité, UCLouvain, Ottignies-Louvain-la-Neuve, Belgium
- Faculty of Medicine and Health Sciences, Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Antwerp, Belgium
- Department of Neurosciences, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
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10
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Valentine MJ, Hayat F, Kayastha A, Newsome-Cuby TR, Nguyen ATN, AlDallal U, Ismail M. An Unidentified Infiltrative Etiology of Spinal Cord Compression: A Case Report and Literature Review. Cureus 2024; 16:e60141. [PMID: 38864071 PMCID: PMC11166180 DOI: 10.7759/cureus.60141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024] Open
Abstract
Spinal cord compression is a neurosurgical emergency. Symptoms of this disorder are highlighted as back pain, ambulatory difficulties, and bladder/bowel incontinence. Diagnostic imaging is not indicated in many circumstances of nonspecific back pain; however, the addition of neurologic deficits in the setting of back pain justifies radiologic imaging. Various pathologies can cause constriction of the spinal cord due to the delicate nature of spinal cord anatomy. Etiologies may include trauma, neoplasms, and infections. In this report, we present an unusual case of a 31-year-old male who presented to the emergency department with a history of chronic back pain accompanied by neurological deficits, ataxia, and bladder dysfunction. Contrast-enhanced MRI imaging heightened the suspicion of a neoplastic etiology; however, neuropathology revealed a non-neoplastic nature with abnormal lymphohistiocytic infiltrate suspicious for Langerhans cell histiocytosis or infectious etiology. A second opinion was provided by Mayo Clinic Laboratories, resulting in the definitive conclusion that the mass was non-neoplastic and tested negative for SD1a and Langerhin, biomarkers used to diagnose Langerhans cell histiocytosis. This unusual non-neoplastic lesion exemplifies one of many diverse and multifaceted pathologies that can precipitate spinal cord compression. Additionally, these findings underscore the importance of considering both neoplastic and non-neoplastic causes in the differential diagnosis of spinal cord compression, thereby enhancing clinical vigilance and improving patient outcomes for underlying spinal conditions.
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Affiliation(s)
| | - Fakhar Hayat
- Neurosurgery, King Hamad University Hospital, Al Sayh, BHR
| | - Ankur Kayastha
- Medical School, Kansas City University, Kansas City, USA
| | | | | | - Usama AlDallal
- School of Medicine, Royal College of Surgeons In Ireland - Medical University of Bahrain, Manama, BHR
| | - Mohamed Ismail
- Neurosurgery, King Hamad University Hospital, Al Sayh, BHR
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11
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Ng MK, Kobryn A, Baidya J, Nian P, Emara AK, Ahn NU, Houten JK, Saleh A, Razi AE. Multi-Level Posterior Cervical Foraminotomy Associated With Increased Post-operative Infection Rates and Overall Re-Operation Relative to Anterior Cervical Discectomy With Fusion or Cervical Disc Arthroplasty. Global Spine J 2024; 14:869-877. [PMID: 36052872 PMCID: PMC11192135 DOI: 10.1177/21925682221124530] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE Cervical radiculopathy meeting operative criteria has traditionally been managed using anterior cervical discectomy and fusion (ACDF). However, cervical disc arthroplasty (CDA) and posterior cervical foraminotomy (PCF) are also reasonable options. This study aimed to assess differences in postoperative outcomes among patients undergoing multi-level ACDF, CDA, or PCF comparing medical/surgical complications and healthcare utilization parameters. METHODS Patients who underwent multi-level ACDF, CDA, or PCF between 2012 and 2019 were identified from the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. Patients were stratified based on procedure type and propensity score matched to resolve baseline differences. ANOVA was performed to identify differences in medical complications, surgical complications, and healthcare utilization metrics. RESULTS A total of 31 344 patients who underwent an eligible procedure were identified (ACDF: n = 28 089, CDA: n = 1748, PCF: n = 1507), and 684 patients remained in each group following propensity score matching. Patients undergoing multi-level PCF were found to experience longer lengths of hospital stay (PCF: 1.67 ± 1.61 days, ACDF: 1.50 ± 1.32 days, CDA: 1.27 ± 1.05 days, P < .001), higher rates of reoperation (PCF: 3.2%, ACDF: 1.0%, CDA: .4%, P = .020), superficial infection (PCF: 1.3%, ACDF: .3%, CDA: .1%, P = .008) and deep infection (PCF: 1.2%, ACDF: 0%, CDA: 0%, P < .001). There were no outcome differences between multi-level ACDF and CDA. CONCLUSIONS Patients undergoing multi-level PCF were at increased risk for longer hospital stay, re-operation, and infection relative to those undergoing ACDF and CDA. Future research should aim to uncover the precise mechanisms underlying these complications, as well as analyze long term outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mitchell K. Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Andriy Kobryn
- Department of Orthopaedic Surgery, SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Joydeep Baidya
- Department of Orthopaedic Surgery, SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Patrick Nian
- Department of Orthopaedic Surgery, SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Ahmed K. Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicholas U. Ahn
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, OH, USA
| | - John K. Houten
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ahmed Saleh
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Afshin E. Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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12
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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] [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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13
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Pour-Rashidi A, Arabkheradmand J, Rahimian E, Aarabi J, Fallahpour M. Prone extension views in cervical MRI: A case-driven Novel approach. Heliyon 2024; 10:e23251. [PMID: 38163148 PMCID: PMC10755320 DOI: 10.1016/j.heliyon.2023.e23251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
The cervical spinal canal has a wide range of motion and specific biomechanics involved with different pathologies that may cause dynamic cord compressions. This study has introduced new protocol for acquiring an extension view of cervical MRI to assess dynamic cervical spinal canal compromise. We posit that dynamic MRI comprising extension view in prone position could be a practical option when deciding the best approach in treating challenging patients.
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Affiliation(s)
| | | | | | - Judith Aarabi
- Community College of Baltimore County, School of Health Professions, Baltimore, MD, USA
| | - Mahshid Fallahpour
- Department of Public Health, San Diego State University (SDSU)-University of California San Diego (UCSD), San Diego, CA 92182, USA
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14
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Zhao H, Wang C, Wang X, Ju J, Yan C, Shi B. Efficacy and Safety of Acupuncture in the Treatment of Radicular Cervical Spondylosis: A Systematic Review and Meta-Analysis. Comb Chem High Throughput Screen 2024; 27:2951-2962. [PMID: 37957858 PMCID: PMC11497143 DOI: 10.2174/0113862073265007231108050338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/27/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Cervical spondylotic radiculopathy is a serious and common degenerative disease of the cervical spine due to irritation and compression of the nerve roots of the cervical spine, resulting in a series of clinical symptoms based on sensory, motor and reflex disorders, such as numbness and pain in the neck, shoulders, upper limbs and fingers. Acupuncture is highly effective in treating CSR and has become a common treatment accepted by patients. This study aims to systematically review and analyze existing randomized controlled trials (RCTs) to evaluate the efficacy and safety of acupuncture in the treatment of CSR. METHODS We used the following eight databases for literature data search: PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Biology Medicine Disc ( CBMdisc), Wanfang Database and China Science and Technology Journal Database (VIP). The search consisted of randomized controlled studies of acupuncture for CSR between 2000 and 2020 and the methodological quality of the included studies was assessed according to the Cochrane Collaboration's "Risk of Bias Assessment Tool."RevMan 5.4 software was used for statistical analysis only. Study screening, data extraction and statistics, and assessment of the risk of bias of the included studies were performed independently by two reviewers. RESULT 27 studies with 3124 patients were included. The results of the meta-analysis of the total efficiency index for acupuncture for CSR were [RR = 1.14,95% CI (1.09,1.19)]. The results of the meta-analysis of the PPI index were [MD = -0.35, 95% CI (-0.61,-0. 09)]. The results of META analysis of the total effective rate, VAS score, PRI(A) score, PRI(S) score and PRI(T) score showed heterogeneity in the studies included for each outcome index, and sources of heterogeneity were sought through subgroup analysis and sensitivity analysis to ensure more stable and reliable data results. The results of the combined meta-analysis showed that the treatment group was significantly more effective than the control group and more effective in lowering the nerves to reduce the pain index in patients with CSR, with a statistically significant difference (P<0.05). This indicates that acupuncture treatment is superior to traction for CSR. CONCLUSION Acupuncture is significantly more effective than traction therapy in the treatment of cervical spondylosis and can reduce the pain index of patients with CSR.
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Affiliation(s)
- Hongfei Zhao
- School of Acupuncture-Tuina, Shandong University of Traditional Chinese Medicine, Jinan 250013, China
| | - Congan Wang
- Shandong First Medical University Affiliated Neck Shoulder Waist Leg Pain Hospital, Jinan, 250031, China
- Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine, Jinan, 250399, China
| | - Xuan Wang
- Shandong First Medical University Affiliated Neck Shoulder Waist Leg Pain Hospital, Jinan, 250031, China
| | - Jing Ju
- Weihai Hospital of Traditional Chinese Medicine, Shandong, 264200, China
| | - Chunchun Yan
- Shandong First Medical University Affiliated Neck Shoulder Waist Leg Pain Hospital, Jinan, 250031, China
| | - Bin Shi
- Shandong First Medical University Affiliated Neck Shoulder Waist Leg Pain Hospital, Jinan, 250031, China
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15
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Hadgaonkar SR, Situt NV, Marya S, Aiyer SN, Sancheti PK. Cervical Schwannoma camouflaged by cervical intervertebral disc prolapse-A case report. Spinal Cord Ser Cases 2023; 9:52. [PMID: 37898665 PMCID: PMC10613260 DOI: 10.1038/s41394-023-00609-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023] Open
Abstract
INTRODUCTION Cervical prolapsed intervertebral disc is one of the common conditions causing cervical myeloradiculopathy. Anterior Cervical Discectomy and Fusion (ACDF) is the standard line of management for the same. Intradural neurogenic origin tumors are relatively rare and can present with features of myeloradiculopathy. Radiological imaging plays important role in diagnosis of such pathologies. CASE REPORT We report a patient with C5-6 cervical disc prolapse that presented with radiculopathy symptoms in the right upper limb, which was refractory to conservative care. He underwent a C5-6 ACDF and reported complete relief from symptoms at 4 weeks. He developed deteriorating symptoms over the next 10 weeks and presented at 14 weeks follow-up with severe myeloradiculopathy symptoms on the left upper limb with upper limb weakness. A fresh MRI identified an intradural extramedullary tumor with cystic changes at the index surgery level. This was treated with tumor excision and histopathology confirmed a diagnosis of schwannoma. Simultaneous presence of cord signal changes with disc herniation obscured the cystic schwannoma which became apparent later on contrast enhanced MRI imaging. CONCLUSION Careful review of preoperative imaging and contrast MRI study may help in diagnosing cystic schwannomas with concomitant cervical disc herniations that have cord signal changes.
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Affiliation(s)
- Shailesh R Hadgaonkar
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, 411005, India
| | - Nishad V Situt
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, 411005, India.
| | - Shivan Marya
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, 411005, India
| | - Siddharth N Aiyer
- Department of Spine Surgery, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, 411005, India
| | - Parag K Sancheti
- The Dean, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, 411005, India
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16
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Wang MX, Kim JK, Chang MC. Deep Learning Algorithm Trained on Cervical Magnetic Resonance Imaging to Predict Outcomes of Transforaminal Epidural Steroid Injection for Radicular Pain from Cervical Foraminal Stenosis. J Pain Res 2023; 16:2587-2594. [PMID: 37525821 PMCID: PMC10387248 DOI: 10.2147/jpr.s409841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE A convolutional neural network (CNN) is one of the representative deep learning (DL) model that is especially useful for image recognition and classification. In the current study, using cervical axial magnetic resonance imaging (MRI) data obtained prior to transforaminal epidural steroid injection (TFESI), we developed a CNN model to predict the therapeutic outcome of cervical TFESI in patients with cervical foraminal stenosis. PATIENTS AND METHODS We retrospectively recruited 288 patients with cervical foraminal stenosis who received cervical TFESI due to cervical radicular pain. We collected single T2-axial spine MR image obtained from each patient. The image showing narrowest width of the neural foramen in the level at which TFESI was performed was used for input data. A "favor outcome" was defined as a ≥ 50% reduction in the NRS score at 2 months post-TFESI vs the pretreatment NRS score. A "poor outcome" was defined as a < 50% reduction in the NRS score at 2 months post-TFESI vs the pretreatment score. RESULTS The area under the curve of our developed model for predicting therapeutic outcome of cervical TFESI in patients with cervical spinal stenosis was 0.801. CONCLUSION We showed that a CNN model trained using cervical axial MRI could be helpful for predicting therapeutic outcome after cervical TFESI in patients with cervical foraminal stenosis.
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Affiliation(s)
- Ming Xing Wang
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Jeoung Kun Kim
- Department of Business Administration, School of Business, Yeungnam University, Gyeongsan-si, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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17
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Shi T, Chen Z, Li W, Wang Z, Liu W. Prevalence of sleep disturbance in patients with cervical radiculopathy and an analysis of risk factors: a cross-sectional study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1624-1635. [PMID: 36935452 DOI: 10.1007/s00586-023-07655-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/01/2023] [Accepted: 03/12/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Previous research has shown that many patients with musculoskeletal diseases suffer from sleep disturbances. However, the sleep quality of patients with cervical radiculopathy (CR) has yet to be fully investigated. This study aims to investigate the prevalence and status of sleep disturbances in patients with CR and identify the mechanisms and risk factors associated with this condition. METHODS We conducted a cross-sectional study of patients diagnosed with CR. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used to evaluate the sleep quality of patients and determine whether patients experience sleep disturbances. In addition, we analyzed the clinical and radiological risk factors of sleep disturbance and determined the key risk factors related to sleep disturbance by multivariable analysis. RESULTS According to specific inclusion and exclusion criteria, 186 patients with CR were finally included, with a mean age of 59.1 ± 14.3 years, of which 113 (60.8%) were female. Sleep disturbance was defined as a PSQI score ≥ 6 and was identified in 56.5% of patients (105/186). By performing multivariate analysis, we determined that sleep disturbance was closely related to the female gender, a higher Beck Depression Inventory (BDI) score, a reduction in cervical mobility, an increase in C2-C7 sagittal vertical axis (C2-C7 SVA), and severe asymmetry of the paravertebral muscle at C5 and C6 levels. CONCLUSION In this study, we identified the high prevalence and potential high-risk factors of sleep disturbance in patients with CR. Clinicians should closely evaluate and monitor such patients and consider appropriate treatment strategies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tengbin Shi
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China
| | - Zhi Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China
| | - Wenwen Li
- School of Health, Fujian Medical University, Fuzhou, 350108, Fujian, People's Republic of China
| | - Zhenyu Wang
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China
| | - Wenge Liu
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China.
- School of Health, Fujian Medical University, Fuzhou, 350108, Fujian, People's Republic of China.
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18
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Zhang Z, Xu C, Wen G, Dong M, Shen X, Gong B, Sun B, Qi M, Tian Y, Liu Y, Yuan W. Postoperative hematoma in cervical spondylosis patient complicated with Huntington's disease: Case report and literature review. SAGE Open Med Case Rep 2023; 11:2050313X221147191. [PMID: 36643711 PMCID: PMC9834929 DOI: 10.1177/2050313x221147191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
Hematoma is a life-threatening complication of anterior surgery in cervical spondylosis patients. Herein, we report a cervical spondylosis patient complicated with Huntington's disease, who developed unexpected neck hematoma after anterior cervical discectomy and fusion (ACDF) surgical treatment. During the debridement, we found no noticeable vessel lesions and concluded that the occurrence of postoperative hematoma might be due to the drainage displacement caused by excessive uncontrolled movements of the neck after the operation. The patient recovered well, and further literature review suggests that chorea secondary to Huntington's disease likely increases mechanical stress on the cervical spine, indicating an internal relationship between degenerative cervical spondylosis and Huntington's disease. Cervical spondylotic patients complicated with Huntington's disease can be treated with surgical intervention but need to be immobilized and under close observation.
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Affiliation(s)
- Zifan Zhang
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Chen Xu
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Guoqing Wen
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Minjie Dong
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Xiaolong Shen
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Baofeng Gong
- Department of Neurology, Shanghai
Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Baifeng Sun
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Min Qi
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Ye Tian
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Yang Liu
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China
| | - Wen Yuan
- Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai,
China,Wen Yuan, Spine Center, Department of
Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, 415th
Fengyang Road, Shanghai 200003, China.
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19
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Zhang J, Zhou Q, Yan Y, Ren J, Wei S, Zhu H, Song Z. Efficacy and safety of percutaneous endoscopic cervical discectomy for cervical disc herniation: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:519. [PMID: 36456964 PMCID: PMC9714009 DOI: 10.1186/s13018-022-03365-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Since there are currently no systematic evidence-based medical data on the efficacy and safety of PECD, this meta-analysis pooled data from studies that reported the efficacy or safety of PECD for cervical disc herniation to examine the efficacy, recurrence and safety of using PECD to treat cervical disc herniation. METHODS We searched the PubMed, EMBASE and Cochrane Library databases for studies published from inception to July 2022. Nine nonrandomized controlled trials (non-RCTs) that reported the efficacy or safety of percutaneous endoscopic cervical discectomy for cervical disc herniation were included. We excluded duplicate publications, studies without full text, studies with incomplete information, studies that did not enable us to conduct data extraction, animal experiments and reviews. STATA 15.1 software was used to analyse the data. RESULTS The proportions of excellent and good treatment results after PECD for CDH were 39% (95% CI: 31-48%) and 47% (95% CI: 34-59%), respectively. The pooled results showed that the VAS scores at 1 week post-operatively (SMD = -2.55, 95% CI: - 3.25 to - 1.85) and at the last follow-up (SMD = - 4.30, 95% CI: - 5.61 to - 3.00) after PECD for cervical disc herniation were significantly lower than the pre-operative scores. The recurrence rate of neck pain and the incidence of adverse events after PECD for cervical disc herniation were 3% (95% CI: 1-6%) and 5% (95% CI: 2-9%), respectively. Additionally, pooled results show that the operative time (SMD = - 3.22, 95% CI: - 5.21 to - 1.43) and hospital stay (SMD = - 1.75, 95% CI: - 2.67to - 0.84) were all significantly lower for PECD than for ACDF. The pooled results also showed that the proportion of excellent treatment results was significantly higher for PECD than for ACDF (OR = 2.29, 95% CI: 1.06-4.96). CONCLUSION PECD has a high success rate in the treatment of CHD and can relieve neck pain, and the recurrence rate and the incidence of adverse events are low. In addition, compared with ACDF, PECD has a higher rate of excellent outcomes and a lower operative time and hospital stay. PECD may be a better option for treating CHD.
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Affiliation(s)
- Jinjie Zhang
- grid.417400.60000 0004 1799 0055The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000 China
| | - Qiujun Zhou
- grid.268505.c0000 0000 8744 8924Department of First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310000 China
| | - Yan Yan
- grid.24695.3c0000 0001 1431 9176The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguanjie, Chaoyang District, Beijing, 100029 China
| | - Jianlei Ren
- grid.417400.60000 0004 1799 0055The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000 China
| | - Shenyu Wei
- grid.412465.0Department of Hepato-Pancreato-Biliary Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310000 China
| | - Haijia Zhu
- grid.507982.10000 0004 1758 1016Hangzhou Children’s Hospital, Hangzhou, 310000 China
| | - Zhoufeng Song
- grid.417400.60000 0004 1799 0055The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000 China
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Lutke Schipholt IJ, Scholten-Peeters GGM, Koop MA, Bonnet P, Bontkes HJ, Coppieters MW. Systemic neuroimmune responses in people with non-specific neck pain and cervical radiculopathy, and associations with clinical, psychological, and lifestyle factors. Front Mol Neurosci 2022; 15:1003821. [PMID: 36311017 PMCID: PMC9608367 DOI: 10.3389/fnmol.2022.1003821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/20/2022] [Indexed: 08/09/2023] Open
Abstract
Neuroimmune responses remain understudied in people with neck pain. This study aimed to (1) compare a broad range of systemic neuroimmune responses in people with non-specific neck pain (N = 112), cervical radiculopathy (N = 25), and healthy participants (N = 23); and (2) explore their associations with clinical, psychological and lifestyle factors. Quantification of systemic neuroimmune responses involved ex vivo serum and in vitro evoked-release levels of inflammatory markers, and characterization of white blood cell phenotypes. Inflammatory indices were calculated to obtain a measure of total immune status and were considered the main outcomes. Differences between groups were tested using analyses of covariance (ANCOVA) and multivariable regression models. Compared to healthy participants, the ex vivo pro-inflammatory index was increased in people with non-specific neck pain (β = 0.70, p = 0.004) and people with cervical radiculopathy (β = 0.64, p = 0.04). There was no difference between non-specific neck pain and cervical radiculopathy (β = 0.23, p = 0.36). Compared to non-specific neck pain, people with cervical radiculopathy showed lower numbers of monocytes (β = -59, p = 0.01). There were no differences between groups following in vitro whole blood stimulation (p ≥ 0.23) or other differences in the number and phenotype of white blood cells (p ≥ 0.07). The elevated ex vivo neuroimmune responses in people with non-specific neck pain and radiculopathy support the contention that these conditions encompass inflammatory components that can be measured systemically. There were multiple significant associations with clinical, psychological and lifestyle factors, such as pain intensity (β = 0.25) and anxiety (β = 0.23) in non-specific neck pain, visceral adipose tissue (β = 0.43) and magnification (β = 0.59) in cervical radiculopathy, and smoking (β = 0.59) and visceral adipose tissue (β = 0.52) in healthy participants. These associations were modified by sex, indicating different neuroimmune associations for females and males.
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Affiliation(s)
- Ivo J. Lutke Schipholt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Laboratory Medical Immunology, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, Netherlands
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Gwendolyne G. M. Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Meghan A. Koop
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Laboratory Medical Immunology, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Petra Bonnet
- Laboratory Medical Immunology, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Hetty J. Bontkes
- Laboratory Medical Immunology, Department of Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Michel W. Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
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21
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Kitamura K, Hayashi H, Ishibashi R, Toda H. Recovery from hemidiaphragmatic paralysis with improved respiratory function following cervical laminoplasty and foraminotomy: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22282. [PMID: 36461835 PMCID: PMC9552678 DOI: 10.3171/case22282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hemidiaphragmatic paralysis can occasionally be caused by cervical canal and foraminal stenosis. Rarely is the effect of surgical decompression on hemidiaphragmatic paralyzed patient respiratory function recorded. This report details a case of postoperative respiratory function restoration in a patient with cervical spondylosis-related hemidiaphragmatic paralysis. OBSERVATIONS A 77-year-old woman suffered hemidiaphragmatic paralysis caused by cervical canal and foraminal stenosis. The phrenic nerve palsy was thought to be caused by compression of the cervical spinal cord and its nerve root. The patient received a C3 laminectomy, a C4-6 laminoplasty, and a left C3-4 and C4-5 posterior foraminotomy. After surgery, she improved her maximum inspiratory pressure and respiratory function. LESSONS Cervical canal and foraminal stenosis may cause hemidiaphragmatic paralysis due to radiculopathy-induced phrenic nerve palsy. Laminoplasty and posterior foraminotomy can restore respiratory dysfunction related to diaphragmatic paralysis by decompressing the ventral horn of the spinal cord and spinal nerve root.
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22
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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, LITHUANIA) 2022; 58:medicina58091191. [PMID: 36143868 PMCID: PMC9506234 DOI: 10.3390/medicina58091191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [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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Ma W, Peng Y, Zhang S, Wang Y, Gan K, Zhao X, Xu D. Comparison of Percutaneous Endoscopic Cervical Keyhole Foraminotomy versus Microscopic Anterior Cervical Discectomy and Fusion for Single Level Unilateral Cervical Radiculopathy. Int J Gen Med 2022; 15:6897-6907. [PMID: 36061960 PMCID: PMC9439641 DOI: 10.2147/ijgm.s378837] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the clinical and radiological outcomes between microscopic anterior cervical discectomy and fusion (ACDF) and percutaneous endoscopic cervical keyhole foraminotomy (PECF) for single level unilateral cervical radiculopathy. Methods A total of 127 patients (59 in PECF VS 68 in ACDF) were enrolled in this study from April 2016 to May 2018 with a minimum follow-up of 2 years. Clinical data including baseline data, Neck Disability Index (NDI), and Visual Analogue Scale for neck and arm (VAS-n, VAS-a) were collected and compared. Radiological evaluation such as disc height, ROM of cervical, Cobb’s angle of cervical and Cobb’s angle of operated segment was measured by two experienced radiologists in twice. Results There was no significant difference between the two groups in the baseline data, and hospital stay was significantly decreased in PECF group than ACDF group (P < 0.001). PECF group did not yield superior better outcomes in NDI, VAS-a and VAS-n than ACDF group except at 1-month follow-up. As for radiological outcomes, PECF group has significantly better cervical motion, cervical angle and segmental angle than ADCF group at 12- and 24-month follow-up visit (P < 0.05); however, ACDF had shown better disc height restoration and maintenance than PECF (P < 0.05). More complications including surface hematoma and swallowing difficulty were occurred in ADCF group. Conclusion Percutaneous endoscopic cervical keyhole foraminotomy could be the alternative method for anterior cervical discectomy and fusion in selective cases. However, the indication should be fulfilled, more studies need to be conducted to further testify the efficacy of PECF.
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Affiliation(s)
- Weihu Ma
- Orthopedic Department, Ningbo No.6 Hospital, Zhejiang, Ningbo, People’s Republic of China
| | - Yujie Peng
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Song Zhang
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Yulong Wang
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Kaifeng Gan
- Orthopedic Department, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xuchen Zhao
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Dingli Xu
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
- Correspondence: Dingli Xu, Email
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Circumferential Decompression Technique of Posterior Endoscopic Cervical Foraminotomy. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5873333. [PMID: 35111847 PMCID: PMC8803431 DOI: 10.1155/2022/5873333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/12/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Abstract
Objective Cervical osseous foraminal stenosis (COFS) results from the uncinate process and facet hyperostosis. Currently, the optimal surgical technique for the treatment of COFS remains controversial. Materials and Methods Patients with COFS presenting radiculopathy underwent posterior endoscopic cervical foraminotomy by the circumferential decompression technique. The neck disability index (NDI), the visual analogue scale (VAS), and the modified MacNab criteria were used to evaluate the outcomes. In addition, the range of motion (ROM) and the slippage distance between the operated vertebrae in flexion-extension position were measured to evaluate the stability of the cervical spine. Results There were 24 consecutive patients in the study. The mean follow-up period was 16.2 months (range: 12-26 months). The NDI and VAS scores for arm/neck pain improved significantly from preoperatively to the last follow-up. The satisfaction rate by modified MacNab criteria was 91.7% on the third postoperative day and 100% on the day of final follow-up. There were no significant differences in intervertebral ROM or slippage distance between the last follow-up and preoperatively (P = 0.968, P = 0.394). Arm pain occurred in one patient, and sustained fingers numbness in two patients, but these symptoms resolved at the last follow-up. Conclusions Posterior endoscopic cervical foraminotomy by the circumferential decompression technique is a safe and effective treatment for COFS. Moreover, it preserves the stability and physiological mobility of the cervical spine.
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Lin M, Abd MA, Taing A, Tsai CT, Vrionis FD, Engeberg ED. Robotic Replica of a Human Spine Uses Soft Magnetic Sensor Array to Forecast Intervertebral Loads and Posture after Surgery. SENSORS (BASEL, SWITZERLAND) 2021; 22:s22010212. [PMID: 35009754 PMCID: PMC8749580 DOI: 10.3390/s22010212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 05/07/2023]
Abstract
Cervical disc implants are conventional surgical treatments for patients with degenerative disc disease, such as cervical myelopathy and radiculopathy. However, the surgeon still must determine the candidacy of cervical disc implants mainly from the findings of diagnostic imaging studies, which can sometimes lead to complications and implant failure. To help address these problems, a new approach was developed to enable surgeons to preview the post-operative effects of an artificial disc implant in a patient-specific fashion prior to surgery. To that end, a robotic replica of a person's spine was 3D printed, modified to include an artificial disc implant, and outfitted with a soft magnetic sensor array. The aims of this study are threefold: first, to evaluate the potential of a soft magnetic sensor array to detect the location and amplitude of applied loads; second, to use the soft magnetic sensor array in a 3D printed human spine replica to distinguish between five different robotically actuated postures; and third, to compare the efficacy of four different machine learning algorithms to classify the loads, amplitudes, and postures obtained from the first and second aims. Benchtop experiments showed that the soft magnetic sensor array was capable of precisely detecting the location and amplitude of forces, which were successfully classified by four different machine learning algorithms that were compared for their capabilities: Support Vector Machine (SVM), K-Nearest Neighbor (KNN), Random Forest (RF), and Artificial Neural Network (ANN). In particular, the RF and ANN algorithms were able to classify locations of loads applied 3.25 mm apart with 98.39% ± 1.50% and 98.05% ± 1.56% accuracies, respectively. Furthermore, the ANN had an accuracy of 94.46% ± 2.84% to classify the location that a 10 g load was applied. The artificial disc-implanted spine replica was subjected to flexion and extension by a robotic arm. Five different postures of the spine were successfully classified with 100% ± 0.0% accuracy with the ANN using the soft magnetic sensor array. All results indicated that the magnetic sensor array has promising potential to generate data prior to invasive surgeries that could be utilized to preoperatively assess the suitability of a particular intervention for specific patients and to potentially assist the postoperative care of people with cervical disc implants.
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Affiliation(s)
- Maohua Lin
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (M.A.A.); (C.-T.T.)
| | - Moaed A. Abd
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (M.A.A.); (C.-T.T.)
| | - Alex Taing
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22904, USA;
| | - Chi-Tay Tsai
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (M.A.A.); (C.-T.T.)
| | - Frank D. Vrionis
- Department of Neurosurgery, Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL 33486, USA
- Correspondence: (F.D.V.); (E.D.E.)
| | - Erik D. Engeberg
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, FL 33431, USA; (M.L.); (M.A.A.); (C.-T.T.)
- Center for Complex Systems and Brain Sciences, Florida Atlantic University, Boca Raton, FL 33431, USA
- Correspondence: (F.D.V.); (E.D.E.)
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26
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Kartha S, Ghimire P, Winkelstein BA. Inhibiting spinal secretory phospholipase A 2 after painful nerve root injury attenuates established pain and spinal neuronal hyperexcitability by altering spinal glutamatergic signaling. Mol Pain 2021; 17:17448069211066221. [PMID: 34919471 PMCID: PMC8721705 DOI: 10.1177/17448069211066221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Neuropathic injury is accompanied by chronic inflammation contributing to the onset and maintenance of pain after an initial insult. In addition to their roles in promoting immune cell activation, inflammatory mediators like secretory phospholipase A2 (sPLA2) modulate nociceptive and excitatory neuronal signaling during the initiation of pain through hydrolytic activity. Despite having a known role in glial activation and cytokine release, it is unknown if sPLA2 contributes to the maintenance of painful neuropathy and spinal hyperexcitability later after neural injury. Using a well-established model of painful nerve root compression, this study investigated if inhibiting spinal sPLA2 7 days after painful injury modulates the behavioral sensitivity and/or spinal dorsal horn excitability that is typically evident. The effects of sPLA2 inhibition on altered spinal glutamatergic signaling was also probed by measuring spinal intracellular glutamate levels and spinal glutamate transporter (GLAST and GLT1) and receptor (mGluR5, GluR1, and NR1) expression. Spinal sPLA2 inhibition at day 7 abolishes behavioral sensitivity, reduces both evoked and spontaneous neuronal firing in the spinal cord, and restores the distribution of neuronal phenotypes to those of control conditions. Inhibiting spinal sPLA2 also increases intracellular glutamate concentrations and restores spinal expression of GLAST, GLT1, mGluR5, and GluR1 to uninjured expression with no effect on NR1. These findings establish a role for spinal sPLA2 in maintaining pain and central sensitization after neural injury and suggest this may be via exacerbating glutamate excitotoxicity in the spinal cord.
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Affiliation(s)
- Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Prabesh Ghimire
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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27
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Devin CJ, Asher AL, Alvi MA, Yolcu YU, Kerezoudis P, Shaffrey CI, Bisson EF, Knightly JJ, Mummaneni PV, Foley KT, Bydon M. Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database. J Neurosurg Spine 2021; 35:399-409. [PMID: 34243164 DOI: 10.3171/2020.12.spine202002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The impact of the type of pain presentation on outcomes of spine surgery remains elusive. The aim of this study was to assess the impact of predominant symptom location (predominant arm pain vs predominant neck pain vs equal neck and arm pain) on postoperative improvement in patient-reported outcomes. METHODS The Quality Outcomes Database cervical spine module was queried for patients undergoing 1- or 2-level anterior cervical discectomy and fusion (ACDF) for degenerative spine disease. RESULTS A total of 9277 patients were included in the final analysis. Of these patients, 18.4% presented with predominant arm pain, 32.3% presented with predominant neck pain, and 49.3% presented with equal neck and arm pain. Patients with predominant neck pain were found to have higher (worse) 12-month Neck Disability Index (NDI) scores (coefficient 0.24, 95% CI 0.15-0.33; p < 0.0001). The three groups did not differ significantly in odds of return to work and achieving minimal clinically important difference in NDI score at the 12-month follow-up. CONCLUSIONS Analysis from a national spine registry showed significantly lower odds of patient satisfaction and worse NDI score at 1 year after surgery for patients with predominant neck pain when compared with patients with predominant arm pain and those with equal neck and arm pain after 1- or 2-level ACDF. With regard to return to work, all three groups (arm pain, neck pain, and equal arm and neck pain) were found to be similar after multivariable analysis. The authors' results suggest that predominant pain location, especially predominant neck pain, might be a significant determinant of improvement in functional outcomes and patient satisfaction after ACDF for degenerative spine disease. In addition to confirmation of the common experience that patients with predominant neck pain have worse outcomes, the authors' findings provide potential targets for improvement in patient management for these specific populations.
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Affiliation(s)
- Clinton J Devin
- 1Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado
- 2Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony L Asher
- 3Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Mohammed Ali Alvi
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Yagiz U Yolcu
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Christopher I Shaffrey
- 5Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Erica F Bisson
- 6Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | | | - Praveen V Mummaneni
- 8Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Kevin T Foley
- 9Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Mohamad Bydon
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Fibrous Connection Between Cervical Nerve and Zygapophysial Joint and Implication of the Cervical Spondylotic Radiculopathy: An Anatomic Cadaveric Study. Spine (Phila Pa 1976) 2021; 46:E704-E709. [PMID: 33337682 DOI: 10.1097/brs.0000000000003895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Observational, anatomical, cadaveric study. OBJECTIVE We anatomically investigated the fibrous connection between the cervical nerves and the zygapophysial joint capsules. SUMMARY OF BACKGROUND DATA Cervical spondylotic radiculopathy is caused by the compression of the cervical nerves as the static factor and head and neck movements as the dynamic factor. To understand the dynamic pathology of cervical spondylotic radiculopathy, the anatomic relationship between the cervical nerves and the zygapophysial joints needs to be investigated in detail. METHODS In 11 cadavers, we dissected both sides from the C5 to C7. For macroscopic examination, we observed structures connecting the cervical nerves and the zygapophysial joints in 18 cervical nerves from three cadavers. In 14 sides of eight cadavers, we histologically analyzed the fibrous structures and their attachments. RESULTS Macroscopically, the fibrous band connected the cranial surface of the cervical nerve to the lateral and inferior aspects of the transverse process. In four of 18 nerves, the fibrous bands were divided into two fascicles by loose connective tissues. In addition, the fibrous bands extended along the dorsal aspect of the posterior tubercle of the transverse process and attached to the zygapophysial joint capsule. Histologically, densely stained fibrous tissues overlaid the zygapophysial joint capsule and extended to the recess between the posterior tubercle and inferior articular process on the cranial vertebral body. CONCLUSION We macroscopically and histologically clarified the fibrous bands connecting the cervical nerve to the zygapophysial joint capsule. The fibrous bands may help clarify the pathology of cervical spondylotic radiculopathy associated with the zygapophysial joints as dynamic factors.Level of Evidence: N/A.
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Brunori A, Delitala A. Non-Compressive, Disabling, Cervical Radiculopathy and Neck Pain: Cave Osteoid Osteoma. Cureus 2021; 13:e15209. [PMID: 34178528 PMCID: PMC8221648 DOI: 10.7759/cureus.15209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cervical radiculopathy is a common clinical condition with an annual incidence of 85/10,000. Refractory cases with positive disco-vertebral imaging findings are routinely referred to the Neurosurgeon for evaluation and treatment. In the absence of a clearcut compressive etiology, other rarer but surgically curable causes must be considered before recommending conservative management. We discuss the case of an otherwise active, healthy patient with an invalidating, refractory, relapsing nuchal pain and cervical radiculopathy. Only careful and state-of-the-art neuroimaging led to the correct diagnosis: an osteoid osteoma of the right C6 lamina was diagnosed and microsurgically resected allowing complete recovery and cure. The clinical features of these rare tumors in this unusual location are reviewed. The case is relevant for multifold reasons: it draws attention to rare conditions which can mimic radicular compression; emphasizes the need for a careful evaluation and appreciation of specific clinical symptoms and signs associated with non-compressive radiculopathies; prompts planning of a state of the art imaging workup, in order to rule out such an elusive tumor. All these measures minimize the risk of overlooking the present and other rare pathologies, sparing patients a long path of time-consuming, frustrating and cost-ineffective studies and treatment modalities.
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30
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Jeoung J, Choi HS, Woo SR, Kang S, Yoon JS. Is Abnormal Electrodiagnostic Finding Related to the Cross-Sectional Area of the Nerve Root in Cervical Radiculopathy? Ann Rehabil Med 2021; 45:116-122. [PMID: 33985315 PMCID: PMC8137382 DOI: 10.5535/arm.20172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the relevance of electrodiagnosis (EDX) in the cross-sectional area (CSA) of the nerve root of patients with cervical radiculopathy (CR) by using high-resolution ultrasonography (HRUS). Methods The CSAs of the cervical nerve roots at C5, C6, and C7 were measured bilaterally using HRUS in 29 patients with unilateral CR whose clinical symptoms, magnetic resonance imaging (MRI) findings, and EDX results corresponded with each other (CR-A group), and in 26 patients with unilateral CR whose clinical symptoms and MRI findings matched with each other but did not correspond with the EDX findings (CR-B group). Results The CSA of the affected side in each nerve root was significantly larger than that of the unaffected side in both the CR-A and CR-B groups. The side-to-side difference in the bilateral CSAs of the nerve root and the ratio of the CSAs between the unaffected and affected sides were statistically larger in the CR-A group than in the CR-B group. Conclusion The increased CSAs in the CR-A group reflect the physiological changes of the cervical nerve root, which is supported by the EDX findings.
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Affiliation(s)
- JuHyong Jeoung
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Hyuk Sung Choi
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Sang Rok Woo
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
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Jung JW, Park YC, Lee JY, Park JH, Jang SH. Bilateral musculocutaneous neuropathy: A case report. World J Clin Cases 2021; 9:1237-1246. [PMID: 33644190 PMCID: PMC7896669 DOI: 10.12998/wjcc.v9.i5.1237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Isolated musculocutaneous nerve injury is a rare condition. Herein, we report the first case of bilateral musculocutaneous neuropathy after vigorous stretching of both upper extremities with normal results of sensory nerve action potential. Clinicians should be aware of this rare condition that can appear bilaterally. In addition, the interpretation of the aberrant electrodiagnostic study results of this case was discussed.
CASE SUMMARY A 29-year-old male complaining of bilateral forearm tingling and upper extremity weakness visited the outpatient clinic. The symptoms began 6 mo prior, and he visited another hospital before visiting our department. The diagnosis was not made even after cervical spine magnetic resonance imaging, electrodiagnostic study, brain magnetic resonance imaging, and arteriography were conducted. The patient performed unique exercises that stretched the pectoralis minor and coracobrachialis muscles. On the follow-up electrodiagnostic study, abnormal spontaneous activities in the bilateral biceps and brachialis muscles were observed. The patient was diagnosed with bilateral musculocutaneous neuropathy. Steroid pulse therapy was administered for approximately 6 wk. After treatment, his muscle strength returned to the predisease condition.
CONCLUSION Clinicians should be aware of this condition, have adequate understanding of anatomy, and advise to correct inappropriate exercises.
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Affiliation(s)
- Ji Won Jung
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
| | - Yu Chan Park
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
| | - Jae Young Lee
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
| | - Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Guri 11923, South Korea
| | - Seong Ho Jang
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Guri 11923, South Korea
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Ha NTT, Vuong NL, Lua TT, Nguyen TTM, Nghia DT, Nga HTV, Anh PTV, Truc TT, Dung DV. Vietnamese herbal medicine (TD0019) in the treatment of cervical radiculopathy: A double-blind phase-2 randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yeni YN, Baumer T, Oravec D, Basheer A, Bey MJ, Bartol SW, Chang V. Correlation of neural foraminal motion after surgical treatment of cervical radiculopathy with long-term patient reported outcomes. JOURNAL OF SPINE SURGERY 2020; 6:18-25. [PMID: 32309642 DOI: 10.21037/jss.2020.03.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Post-surgical changes in adjacent segment motion are considered a factor in further development of degeneration and cervical radiculopathy. The objective was to examine the extent of correlations between physiological motion of cervical foramina and long-term patient reported outcomes (PRO). Methods Biplane X-ray imaging and CT-based markerless tracking were used to measure 3D static and dynamic dimensions during neck axial rotation and extension from 18 patients treated for C5-6 radiculopathy with fusion or arthroplasty. Minimum foraminal height (FH.Min) and width (FW.Min), and their range (FH.Range and FW.Range) achieved during a motion task were calculated for adjacent levels (C4-5 and C6-7) at 2.0±0.6 years post-surgery. The modified Japanese Orthopedic Association score (mJOAS), the Neck Disability Index (NDI) including the visual analogue scale (VAS) for neck and arm pain, and the EuroQol EQ-5D score were recorded at 6.5±1.1 years post-surgery. The relationships between 6.5-year outcomes and 2-year foraminal motion were examined using regression. Results Worsening patient-reported outcomes were generally associated with lower values of FW.Min (P<0.05 to P<0.008), the associations being stronger for neck extension (r2 up to 0.43). Dynamic foraminal measurements from the C6-7 level more significantly and consistently correlated with mJOAS, EQ-5D and NDI Arm Pain VAS (r2=0.27 to 0.43; P<0.03 to P<0.008), whereas those from the C4-5 level correlated with NDI Neck Pain VAS (r2=0.33; P<0.02). Conclusions Dynamic 3D foraminal dimensions at 2-year post-surgery, notably FW.Min measured in neck extension at adjacent levels, were associated with PRO at 6.5 years post-surgery. These relationships provide insight into the motion related factors in development of pain and loss of function, and may help develop markers or objective outcome measures.
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Affiliation(s)
- Yener N Yeni
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Timothy Baumer
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Daniel Oravec
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Bey
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Stephen W Bartol
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Victor Chang
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
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Association Between Diaphragmatic Paralysis and Ipsilateral Cervical Spondylosis on MRI. Lung 2019; 197:727-733. [PMID: 31535202 DOI: 10.1007/s00408-019-00271-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Diaphragmatic paralysis (DP) is an important cause of dyspnea with many underlying etiologies; however, frequently no cause is identified despite extensive investigation. We hypothesized that cervical spondylosis (CS), as manifest by cervical neuroforaminal stenosis on magnetic resonance imaging (MRI), is an underrecognized cause of unilateral DP. METHODS A retrospective study was performed assessing cervical spine imaging utilization in the investigation of unilateral DP, and the contribution of CS to its pathogenesis. To assess the relationship between CS and DP, comparison was made between severity of ipsilateral and contralateral foraminal stenosis on cervical spine MRI in individuals with idiopathic DP, and to controls with DP of known etiology. RESULTS Record searches identified 334 individuals with DP who were classified as idiopathic (n = 101) or DP of known etiology (n = 233). Of those with idiopathic DP, only 37% had undergone cervical spine imaging. Cervical spine MRIs, available for 32 individuals from the total cohort identified (n = 15 idiopathic DP, n = 17 DP of known etiology), were reviewed and severity of CS graded (0-2). In idiopathic DP, CS was significantly more severe (grade 2 stenosis) on the side of DP at C3-C4 (73% affected vs 13% unaffected side; p = 0.031) and C4-C5 (60% affected vs 20% unaffected side; p = 0.0039), while no difference was observed in DP of known etiology. Overall severity of CS across all cervical spine levels was significantly worse in idiopathic DP versus those with DP of known etiology. CONCLUSIONS In unilateral idiopathic DP, severity of CS is associated with DP laterality and is an underrecognized cause of diaphragmatic dysfunction. We propose that evaluation of 'idiopathic' DP should routinely include cervical spine imaging, preferably by MRI.
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Choi HS, Lee YJ, Kim MR, Cho JH, Kim KW, Kim EJ, Ha IH. Survey of Integrative Treatment Practices of Korean Medicine Doctors for Cervical Disc Herniation: Preliminary Data for Clinical Practice Guidelines. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:2345640. [PMID: 31534461 PMCID: PMC6732643 DOI: 10.1155/2019/2345640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/18/2018] [Accepted: 12/03/2018] [Indexed: 01/08/2023]
Abstract
A survey study was conducted in Korean medicine doctors who provide nonsurgical integrative treatment for cervical disc herniation (CDH) at spine-specialty hospitals to assess usual treatment practices, diagnosis and treatment methods, and related adverse events for CDH. The questionnaire was jointly developed by clinical experts and methodology experts and was administered to 197 Korean medicine doctors (response rate: 84.9% (n = 197/232)) practicing at spine-specialty Korean medicine hospitals for analysis of general sociodemographic information, practice patterns of CDH including diagnosis and treatment strategies, CDH prognosis, and treatment safety. The average clinical experience of respondents was 9.3±6.4 years, and 4.0±1.8 weeks were regarded to be needed for CDH pain to decrease by 50% and 9.1±3.4 weeks to decrease by 80%. Eight-Principle Pattern and Meridian System Identification were the most commonly used Korean medicine syndrome differentiation methods, and CDH was most often considered to be a result of Qi stagnation and Blood coagulation. The Spurling test was reported to be important in physical examination, and magnetic resonance (MR) images were mostly used for diagnosis and treatment of CDH of various diagnostic tools. Treatment mainly consisted of a nonsurgical, integrative multimodal approach comprising acupuncture, pharmacopuncture, herbal medicine, and Chuna manual therapy. Shinbaro pharmacopuncture and Chungpa-jun, which are well-established herbal treatments supported by evidence, were considered to be of high importance in CDH treatment. With regard to safety, acupuncture was considered to be the safest, while bee venom pharmacopuncture was of highest concern due to potential hypersensitivity. This study is the first report to investigate current practice patterns and approach of Korean medicine doctors to CDH treatment. This data may be of significance to Korean medicine doctors in drawing clinical guidelines and conducting randomized controlled trials (RCTs) to generate high-level evidence on the effectiveness of nonsurgical integrative medicine treatments for CDH.
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Affiliation(s)
- Hee Seung Choi
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Me-riong Kim
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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An SJ, Hong SJ, Kim YU, Lee YK. Best cut-off point of the cervical facet joint area as a new morphological measurement tool to predict cervical foraminal stenosis. J Pain Res 2019; 12:1325-1330. [PMID: 31114310 PMCID: PMC6497142 DOI: 10.2147/jpr.s204567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/06/2019] [Indexed: 01/18/2023] Open
Abstract
Purpose: One of the main factor of cervical foraminal stenosis (CFS) is the hypertrophic change of the cervical facet joint. In order to analyze the connection between CFS and the facet joint hypertrophy, we devised a new morphological parameter, called the cervical facet joint cross-sectional area (CFJA). The CFJA has not yet been investigated for its association with CFS. We hypothesized that the CFJA is an important morphologic parameter in the diagnosis of CFS. Patients and methods: All patients over 50 years of age were included. Data regarding the CFJA were collected from 160 subjects with CFS. A total of 162 control individuals underwent cervical spine magnetic resonance imaging (CMRI) as part of a routine medical examination. Axial T2-weighted CMRI images were acquired from all subjects. We used a picture archiving system to analyze the cross-sectional area of the bone margin of the cervical facet joint at the level of the most stenotic cervical spine in the axial plane. Results: The average CFJA was 109.07±20.91 mm2 in the control group, and 126.75±22.59 mm2 in the CFS group. The CFS group was found to have significantly higher levels of the CFJA (p<0.001) than the control group. ROC curve estimation was used to verify the validity of the CFJA as a new predictor of CFS. In the CFS group, the best cut off-point was 113.14 mm2, with sensitivity =70.6%, specificity =68.6%, and AUC =0.72 (95% CI, 0.66–0.77). Conclusions: CFJA high values were closely associated with a possibility of CFS. We concluded CFJA is easy to use, fast, and useful new morphological parameter to predict CFS.
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Affiliation(s)
- Sang Joon An
- Department of Neurology, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Seok Jun Hong
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University, College of Medicine, Seoul, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary's Hospital, Incheon, Republic of Korea
| | - Yoon Kyung Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University, College of Medicine, Seoul, Republic of Korea
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McDonald MA, Kirsch CF, Amin BY, Aulino JM, Bell AM, Cassidy RC, Chakraborty S, Choudhri AF, Gemme S, Lee RK, Luttrull MD, Metter DF, Moritani T, Reitman C, Shah LM, Sharma A, Shih RY, Snyder LA, Symko SC, Thiele R, Bykowski J. ACR Appropriateness Criteria® Cervical Neck Pain or Cervical Radiculopathy. J Am Coll Radiol 2019; 16:S57-S76. [DOI: 10.1016/j.jacr.2019.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 12/12/2022]
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Abbott A, Allard M, Kierkegaard M, Peolsson A, Dedering Å. What Biopsychosocial Factors are Associated With Work Ability in Conservatively Managed Patients with Cervical Radiculopathy? A Cross-Sectional Analysis. PM R 2019; 12:64-72. [PMID: 31033147 DOI: 10.1002/pmrj.12177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 04/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND No previous studies have investigated what biopsychosocial factors are associated with self-reported work ability in conservatively managed patients with cervical radiculopathy. OBJECTIVE To develop a theoretical model of factors and potential processes associated with variation in work ability based on a thorough assessment of biopsychosocial variables in conservatively managed patients with cervical radiculopathy. DESIGN Cross-sectional observational study. SETTING Tertiary neurosurgery clinic. PATIENTS A total of 144 conservatively managed patients with cervical pain and radiculopathy participated in the study. METHODS From 64 biopsychosocial candidate variables, significant (P < .05) bivariate correlators with Work Ability Index (WAI) were entered as independent variables in a categorical regression. Elastic net regularization maintained the most parsimonious set of independent variables significantly associated with variation in WAI as the dependent variable. Process analysis of significant independent variable associations with WAI was performed. MAIN OUTCOME MEASUREMENT WAI. RESULTS From 42 bivariate correlates of WAI, multivariate regression displayed a total of seven variables that were significantly (F [25,98] = 5.74, P < .05) associated with 65.8% of the variation in WAI. The Neck Disability Index (NDI) and Fear-Avoidance Beliefs Questionnaire Work subscale (FABQ-W) were significant individual factors within the final regression model. Process analysis displayed FABQ-W having a significant specific indirect association with the direct association between NDI and WAI, with the model associated with 77% of the variability in WAI (F [2,84] = 141.17, P < .001). CONCLUSION Of 64 candidate biopsychosocial factors, NDI and FABQ-W were the most significant multivariate correlates with work ability. FABQ-W has a significant indirect association with baseline NDI scores and perceived work ability. This warrants future research trialing work-related fear avoidance interventions in conservatively managed patients with cervical radiculopathy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Allan Abbott
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia.,Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Michael Allard
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia
| | - Marie Kierkegaard
- Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.,Academic Specialist Center, Stockholm Health Services, SE-113 65, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Åsa Dedering
- Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
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Vučinić N, Erić M, Tomašević-Todorović S, Milekić B. Application of algometry in patients with cervical and lumbar radiculopathy. J Back Musculoskelet Rehabil 2018. [PMID: 29526842 DOI: 10.3233/bmr-170965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Algometry, as a highly sensitive method, provides an objective insight into the degree of pain, while the use of questionnaires can estimate the patient's psychological status in a simple way. OBJECTIVE This study was conducted in order to measure the pressure pain threshold in patients with cervical and lumbar radiculopathy and to find a possible association of pain with the anxiety and depression. METHODS The study examined 60 hospitalized patients with cervical radiculopathy and 60 patients with lumbar radiculopathy before starting and after finishing kinesitherapy. The research was conducted using the digital algometry device and Hospital Anxiety and Depression Scale. RESULTS There was no statistically significant difference in algometric values between the patients with cervical radiculopathy and the patients with lumbar radiculopathy. The program of rehabilitation did not lead to significant improvement in the level of pain. Females have a lower pressure pain threshold than males. Psychological factors greatly affect the pain. CONCLUSIONS The applied methods will provide the implementation of appropriate therapy and would achieve better verification of the results in a rehabilitation program. Radiculopathy in conservative therapy should be treated in cervical-thoracic and lumbar region together. Rehabilitation period for patients with radiculopathy have to be longer.
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Affiliation(s)
- Nikola Vučinić
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Mirela Erić
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Snežana Tomašević-Todorović
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Novi Sad, Clinic for Medical Rehabilitation, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Bojana Milekić
- Department of Dentistry, Faculty of Medicine, University of Novi Sad, Dental Clinic of Vojvodina, Novi Sad, Serbia
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Kartha S, Weisshaar CL, Philips BH, Winkelstein BA. Pre-treatment with Meloxicam Prevents the Spinal Inflammation and Oxidative Stress in DRG Neurons that Accompany Painful Cervical Radiculopathy. Neuroscience 2018; 388:393-404. [PMID: 30086368 PMCID: PMC6132222 DOI: 10.1016/j.neuroscience.2018.07.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/15/2018] [Accepted: 07/30/2018] [Indexed: 12/14/2022]
Abstract
Painful neuropathic injuries are accompanied by robust inflammatory and oxidative stress responses that contribute to the development and maintenance of pain. After neural trauma the inflammatory enzyme cyclooxygenase-2 (COX-2) increases concurrent with pain onset. Although pre-treatment with the COX-2 inhibitor, meloxicam, before a painful nerve root compression prevents the development of pain, the pathophysiological mechanisms are unknown. This study evaluated if pre-treatment with meloxicam prior to painful root injury prevents pain by reducing spinal inflammation and peripheral oxidative stress. Glial activation and expression of the inflammatory mediator secreted phospholipase A2 (sPLA2) in the spinal cord were assessed at day 7 using immunohistochemistry. The extent of oxidative damage was measured using the oxidative stress marker, 8-hydroxyguanosine (8-OHG) and localization of 8-OHG with neurons, microglia and astrocytes in the spinal cord and peripherally in the dorsal root ganglion (DRG) at day 7. In addition to reducing pain, meloxicam reduced both spinal microglial and astrocytic activation at day 7 after nerve root compression. Spinal sPLA2 was also reduced with meloxicam treatment, with decreased production in neurons, microglia and astrocytes. Oxidative damage following nerve root compression was found predominantly in neurons rather than glial cells. The expression of 8-OHG in DRG neurons at day 7 was reduced with meloxicam. These findings suggest that meloxicam may prevent the onset of pain following nerve root compression by suppressing inflammation and oxidative stress both centrally in the spinal cord and peripherally in the DRG.
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Affiliation(s)
- Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 415 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104, USA
| | - Christine L Weisshaar
- Department of Bioengineering, University of Pennsylvania, 415 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104, USA
| | - Blythe H Philips
- University Laboratory Animal Resources, University of Pennsylvania, 3800 Spruce Street, Old Vet Quad, Suite 177E, Philadelphia, PA 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 415 Skirkanich Hall, 210 S. 33rd Street, Philadelphia, PA 19104, USA; Department of Neurosurgery, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, 3 Silverstein, Philadelphia, PA 19104, USA.
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Diagnostic Accuracy of Zero-Echo Time MRI for the Evaluation of Cervical Neural Foraminal Stenosis. Spine (Phila Pa 1976) 2018; 43:928-933. [PMID: 29095415 DOI: 10.1097/brs.0000000000002462] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cohort study. OBJECTIVE The aim of this study was to evaluate the clinical utility of Zero-Echo-Time (ZTE) magnetic resonance imaging (MRI) for the assessment of cervical neural foraminal stenosis (CNFS) through the comparison of inter-modality [computed tomography (CT) and ZTE-MRI] CNFS grade severity agreements. SUMMARY OF BACKGROUND DATA Conventional MRI limited in its ability to provide direct visualization of cortical bone. The highly organized tissue structure of cortical bone results in very short T2 values that preclude acquisition of sufficient signal intensity and positive image contrast. ZTE imaging permits visualization of tissues with very short transverse relaxation times, and is capable of displaying images with CT-like contrast. METHODS Thirty-four subjects were recruited from a clinical cohort of patients undergoing standard of care MRI and CT imaging for evaluation of CNFS. Standard of care CT imaging studies were obtained on all subjects within 6 months of their ZTE-MRI acquisition (mean time interval: 25.3 ± 54.1 days; median: 0 days). ZTE-MRI and CT imaging studies were evaluated and severity of CNFS was graded on a scale from 0 to 5 (0 = none; 5 = severe). Weighted-kappa statistics were used to assess agreement between ZTE and CT grades of CNFS on both sides (right and left) of each motion segment. Ordinal logistic mixed-effects regression analyses evaluated the effects of inter-modality position differences (flexion-extension curvature) on inter-modality differences in CNFS grade. RESULTS Substantial agreement (κ = 0.72) was found between ZTE- and CT-based grades of CNFS. Significant inter-modality differences in cervical spine curvature were found for all motion segments, except C2-3 and C3-4 (P < 0.05). However, no significant relationship was found between inter-modality differences in curvature, and inter-modality differences in CNFS grade for any motion segment (P = 0.28). CONCLUSION Results of the current study suggest that ZTE-MRI is well-suited for the evaluation of CNFS and may have the potential to obviate the need for concurrent CT scans in some cases. LEVEL OF EVIDENCE 2.
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Manabe H, Sakai T, Tezuka F, Yamashita K, Takata Y, Chikawa T, Sairyo K. Hemidiaphragmatic Paralysis Due to Cervical Spondylosis: A Case Report. Spine Surg Relat Res 2018; 3:183-187. [PMID: 31435573 PMCID: PMC6690080 DOI: 10.22603/ssrr.2018-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/26/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction C4 radiculopathy due to cervical spondylosis has rarely been reported as a cause of hemidiaphragmatic paralysis. Case Report A 70-year-old man presented with hemidiaphragmatic paralysis due to right C3-C4 foraminal stenosis. The diagnosis was made preoperatively from findings on plain chest radiographs, respiratory function tests, and electrophysiologic tests. All the patient's test results and symptoms improved immediately after surgical treatment for cervical spondylosis. Conclusions Although it may be difficult to make a correct diagnosis based only on radiological findings at the cervical spine, we should be aware of the existence of this entity and pay close attention to chest radiographs.
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Affiliation(s)
- Hiroaki Manabe
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Takashi Chikawa
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Kim MS, Lee DG, Chang MC. Outcome of Transforaminal Epidural Steroid Injection According to Severity of Cervical Foraminal Stenosis. World Neurosurg 2018; 110:e398-e403. [PMID: 29138074 DOI: 10.1016/j.wneu.2017.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cervical transforaminal epidural steroid injection (TFESI) is considered one of the most effective treatments for radicular pain induced by cervical foraminal stenosis. PURPOSE AND DESIGN We sought to evaluate the treatment outcome of TFESI according to the severity of cervical foraminal stenosis. In our retrospective study there were 53 patients with cervical radiculopathy due to cervical foraminal stenosis. OUTCOME MEASURES Pain intensity was evaluated using a numeric rating scale (NRS) at pretreatment, 2 weeks, and 1, 2, and 3 months after TFESI. METHODS Patients were divided into 2 groups according to the severity of stenosis by cervical axial magnetic resonance imaging findings. Twenty-two patients were assigned to group A (nonsevere stenosis), and 31 patients were assigned to group B (severe stenosis). RESULTS Thirty-seven (69.8%) of 53 patients showed successful treatment outcome (>50% reduction in the NRS score at 3 months). The patients in both groups showed a significant decrease in NRS scores at 2 weeks and at 1, 2, and 3 months after TFESI. However, the effect of TFESI was not significantly different between patients with nonsevere cervical foraminal stenosis and those with severe cervical foraminal stenosis. CONCLUSIONS The treatment outcome of cervical TFESI did not different according to the severity of cervical foraminal stenosis. However, on the basis of our results, we suggest that TFESI can be a beneficial clinical option for managing radicular pain due to cervical foraminal stenosis.
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Affiliation(s)
- Min Son Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea.
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Nakanishi K, Tanaka N, Kamei N, Kotaka S, Ochi M, Adachi N. Evidence that impaired motor conduction in the bilateral ulnar and tibial nerves underlies cervical spondylotic amyotrophy in patients with unilateral deltoid muscle atrophy. Spine Surg Relat Res 2018; 2:23-29. [PMID: 31440642 PMCID: PMC6698543 DOI: 10.22603/ssrr.2017-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/02/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction The clinical entity of cervical spondylotic amyotrophy (CSA) is characterized by severe muscle atrophy in the upper extremities with insignificant sensory deficits in patients with cervical spondylosis. However, the pathogenesis of CSA is still unclear. Methods We assessed electrophysiological motor conduction through the corticospinal tract and ulnar and tibial nerves, which do not supply the deltoid or biceps muscles, of 18 patients with CSA, 12 patients with compressive cervical myelopathy, and 18 control subjects with cervical spondylotic radiculopathy. Motor evoked potentials following transcranial magnetic stimulation and M-waves and F-waves following electrical stimulation were measured from the bilateral abductor digiti minimi muscles (ADMs) and abductor hallucis muscles (AHs). The peripheral conduction time (PCT) was calculated from the latencies of the CMAPs and F-waves as follows: (latency of CMAPs + latency of F-waves - 1) / 2. The central motor conduction time (CMCT) was calculated by subtracting the PCT from the onset latency of the MEPs. Results The M-wave (M) latency and minimum F-wave (Fmin) latency from the ADM, and Fmin-M latency from the ADM/AH were significantly longer in the CSA group than in the other groups, on both the affected (p = 0.000-0.007) and unaffected sides (p = 0.000-0.033). F-wave persistence from the bilateral ADMs was significantly lower in the CSA group than in the other groups (p = 0.000-0.002). Among the CSA patients, there were no significant differences in these parameters between the affected and unaffected sides. The CMCT showed no significant differences between the CSA and control groups, but significant differences between the CSA and CCM groups (p = 0.000-0.004). Conclusions CSA patients with unilateral deltoid muscle atrophy had subclinical impairments of lower motor neurons and/or peripheral axons in the ulnar nerve, and subclinical impairments of peripheral axons in the tibial nerve. These motor impairments may have originally existed in these individuals before the onset of CSA.
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Affiliation(s)
- Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Division of Medicine, Biomedical Sciences Major, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, Division of Medicine, Biomedical Sciences Major, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Division of Medicine, Biomedical Sciences Major, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kotaka
- Department of Orthopaedic Surgery, Division of Medicine, Biomedical Sciences Major, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Division of Medicine, Biomedical Sciences Major, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Division of Medicine, Biomedical Sciences Major, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Investigation of the effectiveness of therapeutic ultrasound with high-resolution ultrasonographic cross-sectional area measurement of cervical nerve roots in patients with chronic cervical radiculopathy: a prospective, controlled, single-blind study. J Med Ultrason (2001) 2018; 45:479-486. [DOI: 10.1007/s10396-017-0855-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
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Choi AR, Shin JS, Lee J, Lee YJ, Kim MR, Oh MS, Lee EJ, Kim S, Kim M, Ha IH. Current practice and usual care of major cervical disorders in Korea: A cross-sectional study of Korean health insurance review and assessment service national patient sample data. Medicine (Baltimore) 2017; 96:e8751. [PMID: 29145327 PMCID: PMC5704872 DOI: 10.1097/md.0000000000008751] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 10/19/2017] [Accepted: 10/25/2017] [Indexed: 01/18/2023] Open
Abstract
Neck pain is a highly common condition and is the 4th major cause of years lived with disability. Previous literature has focused on the effect of specific treatments, and observations of actual practice are lacking to date. This study examined Korean health insurance review and assessment service (HIRA) claims data to the aim of assessing prevalence and comparing current medical practice and costs of cervical disorders in Korea.Current practice trends were determined through assessment of prevalence, total expenses, per-patient expense, average days in care, average days of visits, sociodemographic characteristics, distribution of medical costs, and frequency of treatment types of high frequency cervical disorders (cervical sprain/strain, cervical intervertebral disc displacement [IDD], and cervicalgia).Although the number of cervical IDD patients was few, total expenses, per-patient expense, average days in care, and average days of visits were highest. The proportion of women was higher than men in all 3 groups with highest prevalence in the ≥50s middle-aged population for IDD compared to sprain/strain. Primary care settings were commonly used for ambulatory care, of which approximately 70% chose orthopedic specialist treatment. In analysis of medical expenditure distribution, costs of visit (consultation) (22%-34%) and physical therapy (14%-16%) were in the top 3 for all 3 disorders. Although heat and electrical therapies were the most frequently used physical therapies, traction use was high in the cervical IDD group. In nonnarcotics, aceclofenac and diclofenac were the most commonly used NSAIDs, and pethidine was their counterpart in narcotics.This study investigated practice trends and cost distribution of treatment regimens for major cervical disorders, providing current usage patterns to healthcare policy decision makers, and the detailed treatment reports are expected to be of use to clinicians and researchers in understanding current usual care.
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Affiliation(s)
- A Ryeon Choi
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
| | - Joon-Shik Shin
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
| | - Jinho Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
| | - Me-riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
| | - Min-seok Oh
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Dae-Jeon University, Daejeon
| | - Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Dae-Jeon University, Daejeon
| | - Sungchul Kim
- ALS & MND Center at Wonkwang University Korean Medicine Hospital in Gwangju, Gwangju
| | - Mia Kim
- Department of Cardiovascular and Neurological Diseases (Stroke Center), College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul
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Kartha S, Yan L, Weisshaar CL, Ita ME, Shuvaev VV, Muzykantov VR, Tsourkas A, Winkelstein BA, Cheng Z. Superoxide Dismutase-Loaded Porous Polymersomes as Highly Efficient Antioxidants for Treating Neuropathic Pain. Adv Healthc Mater 2017; 6:10.1002/adhm.201700500. [PMID: 28671302 PMCID: PMC5591629 DOI: 10.1002/adhm.201700500] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/15/2017] [Indexed: 01/27/2023]
Abstract
A highly efficient antioxidant is developed by encapsulating superoxide dismutase (SOD) within the aqueous interior of porous polymersomes. The porous polymersomes provide a permeable membrane that allows free superoxide radicals to pass into the aqueous interior and interact with the encapsulated antioxidant enzyme SOD. In vivo studies in the rat demonstrate that administration of SOD-encapsulated porous polymersomes can prevent neuropathic pain after nerve root compression more effectively than treatment with free antioxidant enzyme alone.
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Affiliation(s)
- Sonia Kartha
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, 240 Skirkanich Hall, Philadelphia, PA, 19104, USA
| | - Lesan Yan
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, 240 Skirkanich Hall, Philadelphia, PA, 19104, USA
| | - Christine L Weisshaar
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, 240 Skirkanich Hall, Philadelphia, PA, 19104, USA
| | - Meagan E Ita
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, 240 Skirkanich Hall, Philadelphia, PA, 19104, USA
| | - Vladimir V Shuvaev
- Department of Systems Pharmacology and Translational Therapeutics, Center for Translational Targeted Therapeutics and Nanomedicine of the Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Vladimir R Muzykantov
- Department of Systems Pharmacology and Translational Therapeutics, Center for Translational Targeted Therapeutics and Nanomedicine of the Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Andrew Tsourkas
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, 240 Skirkanich Hall, Philadelphia, PA, 19104, USA
| | - Beth A Winkelstein
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, 240 Skirkanich Hall, Philadelphia, PA, 19104, USA
| | - Zhiliang Cheng
- Department of Bioengineering, University of Pennsylvania, 210 South 33rd Street, 240 Skirkanich Hall, Philadelphia, PA, 19104, USA
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Shoulder pain due to cervical radiculopathy: an underestimated long-term complication of herpes zoster virus reactivation? INTERNATIONAL ORTHOPAEDICS 2017; 42:157-160. [PMID: 28798978 DOI: 10.1007/s00264-017-3593-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate if herpes zoster virus (HZV) reactivation may be considered in the aetiology of cervical radiculopathy. METHODS The study group was composed of 110 patients (52 M-58F;mean age ± SD:46.5 ± 6.12; range:40-73) with a clinical diagnosis of cervical radiculopathy. Patients with signs of chronic damage on neurophysiological studies were submitted to an X-ray and to an MRI of the cervical spine in order to clarify the cause of the cervical radiculopathy and were investigated for a possible reactivation of HZV; HZV reactivation was considered as "recent" or "antique" if it occurs within or after 24 months from the onset of symptoms, respectively. Data were submitted to statistics. RESULTS Thirty-eight patients (34,5%,16 M-22F) had a history of HZV reactivation: four (2 M-2F) were "recent" and 34 (14 M-20F) were "antique". In 68 of 110 participants (61,8%,30 M-38F), pathological signs on X-ray and/or MRI of the cervical spine appeared; in the remaining 42 (38,2%,22 M-20F) X-ray and MRI resulted as negative. Among patients with HZV reactivation, seven (18,4%) had a "positive" X-ray-MRI while in 31 (81,6%) the instrumental exams were considered as negative. The prevalence of "antique" HZV reactivations was statistically greater in the group of patients with no pathological signs on X-ray/MRI of the cervical spine with respect to the group with a pathological instrumental exam (p < 0.01). CONCLUSIONS It may be useful to investigate the presence of a positive history of HZV reactivation and to consider it as a long-term complication of a cervical root inflammation especially in patients in which X-ray and MRI of the cervical spine did not show pathological findings.
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Kim W, Ahn KS, Kang CH, Kang WY, Yang KS. Comparison of MRI grading for cervical neural foraminal stenosis based on axial and oblique sagittal images: Concordance and reliability study. Clin Imaging 2017; 43:165-169. [DOI: 10.1016/j.clinimag.2017.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/27/2017] [Accepted: 03/10/2017] [Indexed: 10/20/2022]
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Dynamic measurements of cervical neural foramina during neck movements in asymptomatic young volunteers. Surg Radiol Anat 2017; 39:1069-1078. [DOI: 10.1007/s00276-017-1847-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
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