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Brachioradial pruritis (BRP) is a rare form of dermatomal pruritis that appears to be caused both by cervical radiculopathy and exposure to ultraviolet-light, although the exact pathophysiology for the manifestation of these symptoms remains to be determined. A diagnosis of BRP is typically confirmed with the ice-pack test and evidence of cervical spine pathology using magnetic resonance imaging. Treatment options consist of application of ice, reduction in sun exposure, and topical capsaicin, antiepileptics, or tricyclic antidepressants. Patients with refractory symptoms and cervical spine pathology may be candidates for surgical decompression, particularly at the C5 and C6 levels. However, there are currently no established guidelines to treat BRP, or surgical procedures that have shown to be superior. Here, we report two cases of cervical disc herniations after traumatic events that presented as BRP. Both cases were successfully treated with anterior cervical discectomy and fusion with complete resolution of symptoms.

BACKGROUND: Cervical neutral position magnetic resonance imaging is widely used for the diagnosis and treatment of cervical spondylotic myelopathy. However, it is not possible for patients to maintain the exact same position of the head and neck during repeated cervical magnetic resonance imaging examinations. The cervical spine undergoes minor flexion and extension movements in the sagittal plane, and the head may have a certain degree of variation in flexion and extension. Whether these changes in the neutral position of the cervical spine affect the volume of cervical discs herniation and cervical curvature is unclear. OBJECTIVE: Using artificial intelligence-assisted measurement, this study aimed to analyze the accuracy and reliability of magnetic resonance imaging examinations for measuring the volume of cervical discs herniation and cervical curvature in patients with cervical spondylotic myelopathy undergoing two consecutive cervical neutral positions in the short term. METHODS: A retrospective study was conducted on patients with cervical spondylotic myelopathy who underwent conservative treatment and underwent two consecutive cervical magnetic resonance imaging examinations within three months between June 2012 and June 2023. We proposed the use of occipitalthoracic distance and occipital-thoracic angle to evaluate the variation in flexion and extension of the head in the neutral position of the cervical spine. Based on the changes in occipital-thoracic angle, patients were divided into occipital-thoracic angle increase group and occipital-thoracic angle decrease group. Cervical discs herniation volume, C2-6 Cobb angle, and cervical (C3-C7) curvature were measured using artificial intelligence-assisted measurement software. Normal distribution data were represented by mean±SD, while non-normal distribution data were represented by the median (interquartile range). Spearman’s rank correlation coefficient was used to analyze the correlation between changes in Cobb angle, cervical (C3-C7) curvature, and cervical discs herniation volume. RESULTS AND CONCLUSION: (1) A total of 104 patients and 326 cervical discs herniation were included in the study. There were 47 patients in the occipitalthoracic angle increase group and 57 patients in the occipital-thoracic angle decrease group. (2) Extension and flexion index of the head: There were no significant differences in occipital-thoracic distance and occipital-thoracic angle during the initial diagnosis and follow-up examination. The variation of occipitalthoracic distance was 0.035 (3.23) mm, and the variation of occipital-thoracic angle was -0.31 (3.28)°. The deviation range of occipital-thoracic distance and occipital-thoracic angle was small, and there was no significant correlation. (3) Cervical curvature index: There were no significant differences in C2-6 Cobb angle and C3-C7 curvature during the initial diagnosis and follow-up examination. There were no significant differences in C2-6 Cobb angle and C3-C7 curvature between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group. (4) There was no significant difference in volume of cervical discs herniation during the initial diagnosis and follow-up examination. There was no significant difference in volume of cervical discs herniation between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group. There was no significant correlation between the change of cervical discs herniation volume and the change of C2-6 Cobb angle and the cervical (C3-C7) curvature. (5) These results indicate that in the neutral position of the cervical spine, there were negligible minor flexion and extension movements in the sagittal plane, and the head was limited to a specific position. Although the head has a certain range of flexion and extension variation, it does not affect the accuracy and reliability of parameters including cervical discs herniation volume, C2-6 Cobb angle, and cervical (C3-C7) curvature. [ABSTRACT FROM AUTHOR]

Rationale: Cervical radiculopathy is initially typically managed conservatively. Surgery is indicated when conservative management fails or with severe/progressive neurological signs. Personalised multimodal physiotherapy could be a promising conservative strategy. However, aggregated evidence on the (cost‐)effectiveness of personalised multimodal physiotherapy compared to surgery with/without post‐operative physiotherapy is lacking. Aim/Objectives: To systematically summarise the literature on the (cost‐)effectiveness of personalised multimodal physiotherapy compared to surgery with or without post‐operative physiotherapy in patients with cervical radiculopathy. Methods: PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched from inception to 1st of March 2023. Primary outcomes were effectiveness regarding costs, arm pain intensity and disability. Neck pain intensity, perceived recovery, quality of life, neurological symptoms, range‐of‐motion, return‐to‐work, medication use, (re)surgeries and adverse events were considered secondary outcomes. Randomised clinical trials comparing personalised multimodal physiotherapy versus surgical approaches with/without post‐operative physiotherapy were included. Two independent reviewers performed study selection, data‐extraction, and risk of bias assessment using the Cochrane RoB 2 and Consolidated Health Economic Evaluation Reporting Standards statement. Certainty of the evidence was determined using Grading of Recommendations, Assessment, Development and Evaluations. Results: From 2109 records, eight papers from two original trials, with 117 participants in total were included. Low certainty evidence showed there were no significant differences on arm pain intensity and disability, except for the subscale 'heavy work' related disability (12 months) and disability at 5–8 years. Cost‐effectiveness was not assessed. There was low certainty evidence that physiotherapy improved significantly less on neck pain intensity, sensory loss and perceived recovery compared to surgery with/without physiotherapy. Low certainty evidence showed there were no significant differences on numbness, range of motion, medication use, and quality of life. No adverse events were reported. Conclusion: Considering the clinical importance of accurate management recommendations and the current low level of certainty, high‐quality cost‐effectiveness studies are needed. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective single-center study. Objectives. To evaluate the results of surgical treatment in patients with double crush syndrome associated with cervical radiculopathy and upper limb peripheral nerve compression after staged and simultaneous operations. Summary of Background Data. Currently, choosing the optimal diagnostic and therapeutic modalities for treating patients with double crush syndrome remains unresolved. Methods. The study included 79 patients with double crush syndrome (cervical radiculopathy and syndrome of Guyon's canal or Carpal tunnel syndrome). Two independent groups were studied: In the Staged Group (n= 35), we performed a cervical decompression with stabilization and peripheral nerve decompression at separate days due to ongoing clinical symptoms (average interval between interventions being 22 (18;26) days). In the simultaneous group (n=33), we performed both the cervical spine surgery as well as the peripheral nerve procedures in one surgical session. Total operative time, estimated blood loss, length of hospitalization, complications, and clinical data (NDI score, SF-36, VAS neck pain score, VAS arm pain score, Disabilities of Arm, Shoulder, and Hand (DASH) score, and Macnab scale) were compared. We used the Mann-Whitney (MW) test for intergroup comparisons, the Wilcoxon criterion for dependent samples, and the Fisher exact test for binomial parameters. Results. There was a significantly lower operative time, duration of inpatient treatment, and temporary disability in the simultaneous group (P= 0.01, P=0.04, and P=0.006, respectively). Comparative analysis did not reveal significant intergroup differences using NDI, VAS, and DASH (P> 0.05), whereas, at discharge, significantly better clinical parameters were appreciated for the simultaneous group using SF-36 and Macnab scores (P= 0.04 and P=0.03, respectively). At the last follow-up, an intra-group analysis revealed comparable clinical effectiveness between the two approaches (P>0.05). Conclusion. Comparison of the effectiveness of simultaneous and staged surgery revealed comparable long-term clinical outcomes. However, simultaneous surgery conveys clinically important advantages in terms of surgical time, anesthesia duration, length of hospitalization, and patient disability. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cervical disc herniation can cause pain in the neck and shoulder area, as well as radiating pain in the upper limbs. The incidence rate is increasing year by year and tends to affect younger individuals. Fully understanding the biomechanical characteristics of the cervical spine in adolescents is of great significance for preventing and delaying the onset of cervical disc herniation in this age group. OBJECTIVE: To reconstruct cervical spine models for both healthy adolescents and adolescent patients with cervical disc herniation utilizing finite element analysis techniques, to analyze the motion range of the C1-T1 cervical vertebrae as well as the biomechanical characteristics of the annulus fibrosus, nucleus pulposus, endplates, and the cartilage of the small joints. METHODS: A normal adolescent's cervical spine and an adolescent patient with cervical disc herniation were selected in this study. The continuous scan cervical spine CT raw image data were imported into Mimics 21.0 in DICOM format. The C1-T1 vertebrae were reconstructed separately. Subsequently, the established models were imported into the 3-Matic software for disc reconstruction. The perfected models were then imported into Hypermesh software for meshing of the vertebrae, nucleus pulposus, annulus fibrosus, and ligaments, creating valid geometric models. After assigning material properties, the final models were imported into ABAQUS software to observe the joint motion range of the C1-C7 cervical vertebrae segments under different conditions, and to analyze the biomechanical characteristics of the annulus fibrosus, nucleus pulposus, endplates, and small joint cartilage of each cervical spine segment. RESULTS AND CONCLUSION: (1) In six different conditions, the joint motion range of the C1 vertebra in the cervical spine models of both normal adolescent and adolescent patient with cervical disc herniation was higher than that of the other vertebrae. Additionally, the joint motion range of each cervical spine segment in normal adolescent was greater than that in adolescent patient with cervical disc herniation. (2) In the cervical spine model of normal adolescent, the maximum stress values in the annulus fibrosus and nucleus pulposus were found on the left side during C2-3 flexion conditions (0.43 MPa and 0.17 MPa, respectively). In the cervical spine model of adolescent patient with cervical disc herniation, the maximum stress values were found on the left side during C7- T1 flexion conditions (0.54 MPa and 0.18 MPa, respectively). (3) In the cervical spine model of normal adolescent, the maximum stress value on the endplate was found on the left side of the upper endplate of C3 during flexion conditions (1.46 MPa). In the model of adolescent patient with cervical disc herniation, the maximum stress value on the endplate was found on the left side of the lower endplate of C7 during flexion conditions (1.32 MPa). (4) In the cervical spine model of normal adolescent, the maximum stress value in the small joint cartilage was found in the C2-3 left rotation conditions (0.98 MPa). In adolescent patient with cervical disc herniation, the stress in the small joint cartilage significantly increased under different conditions, especially in C1-2, with the maximum stress found during left flexion (3.50 MPa). (5) It is concluded that compared to normal adolescent, adolescent patient with cervical disc herniation exhibits altered cervical curvature and a decrease in overall joint motion range in the cervical spine. In adolescent with cervical disc herniation, there is a significant increase in stress on the annulus fibrosus, nucleus pulposus, and endplates in the C7-T1 segment. The stress on the left articular cartilage of the C1-2 is notable. Abnormal cervical curvature may be the primary factor causing these stress changes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Vibration therapy approaches are an effective and safe treatment option for musculoskeletal disorders. This study examines the effects of vibration therapy using a percussion massage gun (PMG) on joint position sense, range of motion, pain, functionality, and kinesiophobia in individuals with cervical disc herniation (CDH). Methods: This single-blind randomized controlled trial involved 44 CDH patients divided into a Vibration Group (VG) and a Conventional Group (CG). The CG underwent a standard physiotherapy treatment heat application, Transcutaneous Electrical Nerve Stimulation (TENS), and exercises for range of motion and strengthening. VG received conventional therapy augmented with vibration therapy (VT) via a PMG. Joint position sense (JPS) using the Laser Pointer Assisted Angle Repetition Test; pain intensity with the Visual Analog Scale, kinesiophobia with the Tampa Scale for Kinesiophobia, and cervical dysfunction with the Neck Disability Index were assessed. Results: Both groups showed statistically significant improvements in pain, kinesiophobia, disability, and proprioception after treatment (p < 0.05). When comparing the difference values between groups, the VG was found to be more effective than the CG in the parameters of VAS activity (p = 0.013). The CG had more improvement in JPS neck left rotation than the VG (p = 0.000). Conclusions: VT, when combined with conventional physiotherapy, is effective in improving pain, proprioception, and functionality in individuals with CDH. These findings support the inclusion of VT as a beneficial adjunct therapy. Further research with larger sample sizes and longer follow-ups is recommended to validate these results and explore the long-term effects of VT on CDH. [ABSTRACT FROM AUTHOR]

Objectives: Cervical disc herniation (CDH) leads to pain, numbness, and potential disability. Percutaneous endoscopic cervical discectomy (PECD) offers an anterior or posterior approach. This study aims to compare postoperative disc height and angle changes one year after PECD, considering both approaches. Methods: We retrospectively reviewed the data from patients with CDH who underwent PECD from October 2017 to July 2022. Cervical disc height was measured using the preoperative and one-year postoperative magnetic resonance imaging (MRI) examinations. Lordotic angle (LA), global alignment angle (GAA), segmental alignment angle (SAA), and slippage distance (SD) at the surgical level were measured on radiographs in the neutral, flexion, and extension positions. Results: Thirty-eight patients who underwent posterior PECD (PPECD) and five patients who underwent anterior PECD (APECD) were included in the evaluation. The mean age of the patients was 47.4 years (range: 29–69 years). There was a significant difference in the preoperative and one-year postoperative GAA and SAA in extension in the PPECD group (p = 0.003 and 0.031, respectively). The mean decreased disc height one-year postoperative was 1.30 mm in the APECD group and 0.3 mm in the PPECD group by MRI. A significant disc height decrease was observed in the APECD group (p < 0.001). Conclusions: Treating CDH with PPECD or APECD is feasible, as it can relieve symptoms and reduce disability. Stability remained unaffected during the first year after surgery, even though there was an increase in angulation during extension. Despite a significant decrease in disc space following APECD, patients reported significant symptom improvement and no new symptoms. [ABSTRACT FROM AUTHOR]

Aim: Neck pain is an important complaint in neurosurgery practice and is observed with a frequency of 30-50% throughout life. The most common complaint of working women who apply to the doctor is neck pain. Obesity is known as a common disease in recent years and traditional measurements are used in its evaluation in practice. In this research, we aimed to show the relationship between obesity in patients with neck pain that may accompany cervical disc herniation. We examined the usability of neck circumference measurement in indicating obesity. Materials and Methods: This study was made on 100 patients aged between 20 and 70, after determining the Sample Size with Power Analysis. The presence of cervical disc herniation and the thickness of the cervical subcutaneous adipose tissue were measured and recorded on Magnetic Resonance Imaging. Neck circumference measurements of the patients were compared with waist circumference measurements. The data collected for the study were recorded using the SPSS 22 program and analysed in the same program. Results: 55% of the patients had disc herniation and 38% had an additional chronic disease. Individuals with a cervical herniated disc had higher waist circumference and subcutaneous asymptote tissue values than those without (p<0.01). BMI values of individuals with a cervical herniated disc were found to be higher than those without (respectively, 30.47±4.93, 27.77±4.60, p=0.023). A positive linear correlation was found between the BMI values of the patients, neck circumference, waist circumference and subcutaneous adipose tissue (p<0.05 core coefficient 0.676&0.750&0.463, respectively). Conclusion: Neck circumference measurement, which is a simple and fast method, we can diagnose obesity. We saw that in our study, as in many cases, obesity was observed more frequently with cervical disc herniation, especially in women. [ABSTRACT FROM AUTHOR]

Background: We aimed to analyze the clinical outcomes and effectiveness of cervical biportal endoscopic spine surgery (C-BESS) and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic cervical disc herniation. Methods: This study was a retrospective chart review of four-year clinical data involving 318 cases of symptomatic cervical disc herniation, with 156 patients undergoing the ACDF and 162 patients receiving the C-BESS. Preoperative and postoperative one-year data were collected. Results: The numeric rating scale and neck disability index showed statistically significant improvement for both ACDF and C-BESS groups. While showing a longer operation time and more blood loss during surgery compared to the ACDF group, the C-BESS group demonstrated a learning effect as the surgeon's proficiency increased with more cases. There was no significant difference in the postoperative length of hospitalization between the two methods. The subgroup with predominant arm pain revealed the statistical difference in arm pain intensity changes between the two groups (p < 0.001). The rates of complication were 2.6% for the ACDF group and 1.9% for the C-BESS group. Conclusions: C-BESS and ACDF are effective surgical treatments for patients with symptomatic single-level cervical disc herniation in relieving relevant pain intensities and pain-related disabilities. [ABSTRACT FROM AUTHOR]

Introduction: Neck pain is one of the most common complaints in clinical practice and can be caused by a wide variety of conditions. While cervical spine surgery is a well-accepted option for radicular pain and myelopathy, surgery for isolated neck pain is controversial. The identification of the source of pain is challenging and subtle, and misdiagnosis can lead to inappropriate treatment. Materials and methods and results: We conducted a thorough literature review to discuss and compare different causes of neck pain. We then supplemented the literature with our senior author's expert analysis of treating cervical spine pathology. Conclusions: This study provides an in-depth discussion of neck pain and its various presentations, as well as providing insight into treatment strategies and diagnostic pearls that may prevent mistreatment of cervical spine pathology. [ABSTRACT FROM AUTHOR]

To evaluate long-term outcomes and surgical essentials of channel repair in endoscopic transcorporeal discectomy for cervical disc herniation. From October 2019 to March 2020, 24 patients with cervical disc herniation underwent channel repair after percutaneous full-endoscopic anterior transcorporeal cervical discectomy. Five interventions were performed at C3-C4, 11 were performed at C4-C5, and 8 were performed at C5-C6. Clinical outcomes were evaluated by Neck Disability Index, Japanese Orthopaedic Association, and visual analog scale scores. Radiologic changes were evaluated with intervertebral disc height and drilled vertebral height. All procedures were completed with a mean operating time of 86.40 ± 8.19 minutes. Swollen neck was observed in 5 patients, which resolved within 2 hours. At the final follow-up, Neck Disability Index, Japanese Orthopaedic Association, and visual analog scale scores were improved significantly compared with preoperative assessments (P < 0.05); intervertebral disc height was decreased significantly (P < 0.05); and loss of drilled vertebral height was not significant (P > 0.05). All 24 bony channels disappeared by 3 months postoperatively. No other complications were observed. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy with channel repair offers a minimally invasive and effective treatment option for patients with cervical disc herniation. This technique demonstrates favorable clinical outcomes, including preservation of cervical spine mobility and minimal complications. Although there was a significant loss of intervertebral disc height, no vertebral collapse occurred. Strict adherence to surgical indications and precautions is crucial for successful outcomes. Further research and long-term studies are required to validate the efficacy and safety of this approach in a larger patient population. [ABSTRACT FROM AUTHOR]

Cervical total disc replacement (TDR) aims to maintain normal cervical kinematics after surgery. This study investigates the relation between shifted location of centre of rotation (COR) and subsequent surgical outcomes after multilevel cervical TDR (MCTDR) and identifies radiological parameter that corresponded to this change of COR after MCTDR. The study included a consecutive 24 patients treated with MCTDR following the diagnosis of multilevel cervical disc herniation or stenosis. Numeric Rating Scale (NRS), range of motion (ROM) at both C2-7 segment and TDR implanted levels, and location of COR at TDR level were evaluated at pre- and post-MCTDR. These parameters were compared between patients who experienced successful and unsuccessful pain relief. The inherent CORs relatively at ventro-cranial coordinates have demonstrated significant migrations to dorso-caudal location, more prominent shifts for the successful group, after MCTDR switch. The unsuccessful group showed markedly reduced C2-7 ROM and reduced angular improvement at C2-7 as well as MCTDR level in comparison with the successful group. Postoperative C2-7 ROM was related to postoperative COR along the X axis. The determinant for clinical success after MCTDR, other than mere preservation of the ROM both at C2-7 and TDR levels, was restoration of COR from ventro-cranial location close to normal coordinates by posterior and inferior shifts. The position of COR along the X axis after MCTDR was important factor to determine maintenance of C2-7 ROM. [ABSTRACT FROM AUTHOR]

Introduction: Sinuvertebral nerve overactivation is one of the mechanisms of neck pain caused by cervical disc herniation. Radiofrequency ablation (RFA) of sinuvertebral nerves has shown efficacy for the treatment of discogenic low back pain. However, relatively few studies evaluated the efficacy of RFA of sinuvertebral nerves for the treatment of chronic neck pain caused by cervical disc herniation. Methods: Clinical data were retrospectively collected from 168 patients diagnosed with cervical disc herniated neck pain from January 1, 2019, to September 1, 2022, who were treated with computed tomography (CT)-guided cervical disc RFA of at the Pain Medicine Center of Zhejiang Provincial People's Hospital. A 22-G RFA needle (Inomed, Emmendingen, Germany) was inserted between the carotid artery and trachea to the intervertebral disc under the direction of CT the scanner. Depending on the position of the protruding nucleus pulposus or the rupture of the annulus fibrosus, the needle was inserted into the posterior side of the intervertebral disc until the tip of the needle reached the target position. The numeric rating scale (NRS) score, pain relief and appearance of complications after RFA were evaluated. Results: A total of 168 patients underwent CT-guided RFA for cervical disc herniation. The average duration of pain was 67.07 ± 70.42 months. At 6 months of follow-up, the median preoperative NRS score decreased significantly from preoperative 5.41 ± 1.08 to postoperative 1.341 ± 1.25 at 1 month, 1.4 ± 1.38 at 3 months and 1.72 ± 1.41 at 6 months after RFA (p < 0.01). The numbers of patients with ≥ 50% of their neck pain relieved were 84% (141/168), 87% (147/168), 87% (147/168) and 79% (133/168) at 1 day, 1 month, 3 months and 6 months after RFA, respectively. No serious complications related to treatment or long-term complications were observed. Conclusions: This study highlights that CT-guided RFA targeting the edge of cervical disc herniation to destroy the sinuvertebral nerves can effectively relieve neck pain, and the computed tomography (CT)-guided RFA treatment strategy has the advantages of having few complications. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate and compare the clinical efficacy of patients with cervical disc herniation (CDH) treated by low-temperature plasma radiofrequency ablation (LTP-RFA) as day surgery with traditional inpatients. Methods: According to the selection criteria, single-segment mild to moderate CDH patients who received LTP-RFA from January 2020 to December 2021 were divided into day surgery procedure (DSP) group and a traditional inpatient procedure (TIP) group. The visual analogue score (VAS) and modified Japanese Orthopedic Association score (mJOA) of neurological function of patients in the two groups were recorded at the time of preoperative, and one day, three months, six months after surgery and the last follow-up respectively. The gender, age, responsible segment, surgical complications, hospitalization time, hospitalization expenses, and patient satisfaction were recorded and analyzed for both groups. The modified Macnab standard was used to evaluate the postoperative efficacy at one month and six months after operation. Results: A total of 127 patients (75 in DSP;52 in TIP) with complete data were enrolled and completed six month follow-up. There were no statistically significant pre-treatment VAS scores and mJOA scores in the two groups (P>0.05). The postoperative VAS and mJOA scores in both groups were improved after surgery (P<0.05). However, there was no significant difference in VAS scores and mJOA scores between the two groups in the same postoperative period (all P > 0.05). The efficacy of MacNab was similar one month and six months after operation (P > 0.05). The hospitalization time and hospitalization cost were significantly lower in DSP group (all P<0.05). As the treatment effects were comparable, patients in both groups were similarly satisfied at discharge. Conclusion: LTP-RFA is an effective method for the treatment of mild to moderate CDH. We suggest that the application of LTP-RFA in DSP for mild to moderate CDH is worthy of wide application. [ABSTRACT FROM AUTHOR]

Anterior cervical discectomy and fusion (ACDF) is the leading surgical treatment for cervical radiculopathy. However, ACDF surgery has been suggested for to accelerate the degeneration of the adjacent cervical discs, which causes so-called adjacent segment disease (ASD). Over the past 2 decades, total disc replacement (TDR)/cervical disc arthroplasty (CDA) has become an increasingly common method for treating degenerative cervical diseases. The rationale is that a synthetic disc prosthesis may preserve motion at the operated level, which is expected to lead to reduced stress on the other cervical levels and thus decrease the risk of developing ASD. However, since the method was first introduced in the early 2000s, the long-term outcome after it is still not completely understood. Our goal was to compare the long-term outcomes of TDR and ACDF procedures. Retrospective case-control study. All patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 (38 patients) and matched control patients who underwent ACDF during this period (76 patients) for degenerative disc disease. The primary outcome measure was the rate of reoperations and further cervical surgeries. Secondary outcome measures included neck symptoms (Neck Disability Index, or NDI), health-related quality of life (EQ-5D-3L), satisfaction with the surgery, radiological outcomes, and employment status. The medical records of all patients who underwent TDR due to degenerative cervical disease at Helsinki University Hospital between 2006 and 2012 and those of the matched control patients were analyzed retrospectively. Questionnaires were sent to all available patients at the end of the follow-up (median 14 years) to evaluate their employment status, levels of satisfaction with the surgery, current neck symptoms, and health-related quality of life. Radiological outcomes were evaluated from the cervical plain radiographs, which were taken either at the end of the follow-up as a part of the present study or earlier on for other clinical reasons, but at least 2 years after index surgery. The total rate of reoperations and further cervical surgeries during the follow-up of a median of 14 years was 7/38 (18%) in the TDR group and 6/76 (8%) in the ACDF group (p=.096, ns.). Total disc replacement patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group (11% vs 1.3%, p=.026). None of the TDR patients underwent further cervical surgery more than 6 years after index surgery, whereas 5/6 (83%) of the reoperated ACDF patients were reoperated after that time. There were no significant differences in the NDIs between the patient groups. The employment rate and health-related quality of life were slightly higher in the TDR group, but the differences were statistically nonsignificant. TDR was significantly better at maintaining the angular range of motion at the operated level, and the fusion rate was significantly lower among this group. There were no significant differences in the long-term outcomes of ACDF and TDR when measured by reoperation rates, employment status, NDI, EuroQoL, and satisfaction with surgery. Reoperation rate and, on the other hand, employment rate and health-related quality of life, were higher in the TDR group, but the differences were statistically nonsignificant. However, TDR patients were reoperated earlier, and the 5-year reoperation rate was significantly higher in the TDR group. Randomized long-term studies in which these methods are compared are needed to further clarify the differences between them. [ABSTRACT FROM AUTHOR]

Abstract Introduction Sinuvertebral nerve overactivation is one of the mechanisms of neck pain caused by cervical disc herniation. Radiofrequency ablation (RFA) of sinuvertebral nerves has shown efficacy for the treatment of discogenic low back pain. However, relatively few studies evaluated the efficacy of RFA of sinuvertebral nerves for the treatment of chronic neck pain caused by cervical disc herniation. Methods Clinical data were retrospectively collected from 168 patients diagnosed with cervical disc herniated neck pain from January 1, 2019, to September 1, 2022, who were treated with computed tomography (CT)-guided cervical disc RFA of at the Pain Medicine Center of Zhejiang Provincial People’s Hospital. A 22-G RFA needle (Inomed, Emmendingen, Germany) was inserted between the carotid artery and trachea to the intervertebral disc under the direction of CT the scanner. Depending on the position of the protruding nucleus pulposus or the rupture of the annulus fibrosus, the needle was inserted into the posterior side of the intervertebral disc until the tip of the needle reached the target position. The numeric rating scale (NRS) score, pain relief and appearance of complications after RFA were evaluated. Results A total of 168 patients underwent CT-guided RFA for cervical disc herniation. The average duration of pain was 67.07 ± 70.42 months. At 6 months of follow-up, the median preoperative NRS score decreased significantly from preoperative 5.41 ± 1.08 to postoperative 1.341 ± 1.25 at 1 month, 1.4 ± 1.38 at 3 months and 1.72 ± 1.41 at 6 months after RFA (p

Highlights • The presence of preoperative Modic changes tends not to affect clinical outcomes after ACDF due to degenerative pathology, including disc herniation. • Preoperative Modic changes are correlated with a worse preoperative picture. Abstract Background: Modic Change (MC) is a phenomenon that can be found in Magnetic Resonance Imaging (MRI) of patients with degenerative spinal diseases and in the cervical region. The effect of Modic change on the clinical outcome of postoperative patients has not been fully established. Anterior Cervical Discectomy and Fusion (ACDF) is a procedure that has become the gold standard in treating cervical disc herniation because it is able to eliminate pathological lesions and prevent the recurrence of nerve compression. Objective: This study aimed to determine the effect of MC on the clinical outcome of patients undergoing ACDF therapy due to degenerative disc pathology, including cervical disc herniation. Material and Method: This was a systematic review using filtered literature based on PICOs. The variables examined in this study were "modic change", "ACDF", and "clinical outcome". Data were collected from three databases, which were then screened based on eligibility criteria, assessed for study quality, and reviewed using a qualitative descriptive method. Result: A total of six articles published between 2017 and 2021 were included in this study. This study was an observational study with a retrospective cohort method. Preoperative Modic changes tend not to affect clinical outcomes after ACDF. Conclusion: The presence of preoperative Modic changes tends not to affect clinical outcomes after ACDF due to degenerative disc pathology, including disc herniation, but remains a risk factor for postoperative disability and provides a worse preoperative picture.

Background: There is a small level of evidence regarding the alterations in global spine alignment following the restoration of cervical lordosis using anterior cervical discectomy and fusion (ACDF). Different cage types are available to restore cervical lordosis through ACDF. In this study, we evaluate the impact of two types of these cages on local and global spine alignments. Patients and Methods: Thirty-two patients with a mean age of 46 ± 10 who underwent ACDF for cervical disc herniation were included in this retrospective study. Patients were divided according to their cage type into two groups, 17 patients with standalone conventional polyether ether ketone cages and 15 patients with integrated cage and plate (ICP) (Perfect-C®). Cervical alignment and global spine alignment were evaluated on the pre- and post-operative EOS® images. Results: Three months after the ACDF, total cervical lordosis correction was higher in patients with ICP (P = 0.001), while the local cervical lordosis correction was not significantly different between conventional cages and prefect-C cages (P = 0.067). Lumbar lordosis and pelvic tilt change were significantly higher among patients with Perfect-c cages (P = 0.043). Conclusion: In patients undergoing ACDF, alignment of the global spine changes along with the restoration of the cervical spine. Cage type affects this association, mainly through the compensatory alteration of pelvic tilt. [ABSTRACT FROM AUTHOR]

Background: There is a small level of evidence regarding the alterations in global spine alignment following the restoration of cervical lordosis using anterior cervical discectomy and fusion (ACDF). Different cage types are available to restore cervical lordosis through ACDF. In this study, we evaluate the impact of two types of these cages on local and global spine alignments. Patients and Methods: Thirty-two patients with a mean age of 46 ± 10 who underwent ACDF for cervical disc herniation were included in this retrospective study. Patients were divided according to their cage type into two groups, 17 patients with standalone conventional polyether ether ketone cages and 15 patients with integrated cage and plate (ICP) (Perfect-C®). Cervical alignment and global spine alignment were evaluated on the pre- and post-operative EOS® images. Results: Three months after the ACDF, total cervical lordosis correction was higher in patients with ICP (P = 0.001), while the local cervical lordosis correction was not significantly different between conventional cages and prefect-C cages (P = 0.067). Lumbar lordosis and pelvic tilt change were significantly higher among patients with Perfect-c cages (P = 0.043). Conclusion: In patients undergoing ACDF, alignment of the global spine changes along with the restoration of the cervical spine. Cage type affects this association, mainly through the compensatory alteration of pelvic tilt. [ABSTRACT FROM AUTHOR]

Background: Different treatments for discogenic axial back/neck pain or radicular pain to limbs are there from conservative therapies and minimally invasive therapies to open spine surgeries with lots of controversial outcomes. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive therapies which is done under local anesthesia and has been successfully performed in many selected patients for their lumbar and cervical disc herniation problems. In PLDD, a part of the nucleus pulposus is vaporized with the help of laser energy to reduce the intradiscal pressure of the diseased discs causing nerve compression. In this case series after a 1-year follow-up, the clinical effectiveness of PLDD with epidural steroid injection is assessed in selected lumbar and cervical disc herniation cases. Materials and Methods: Ninety-six patients underwent the PLDD procedure at the cervical and lumbar disc with epidural steroid injections for their disc herniation causing radicular pain in the upper and lower limbs, respectively. The patients were followed at 8 weeks, 3 months, 6 months, and 1 year. The main outcome measures were done through the visual analog scores (VASs) and the Oswestry Disability Index (ODI) for upper and lower limb pain. Results: The primary outcome showed that there is a significant clinically relevant difference between the two groups at a 1-year follow-up. VAS and mean disability score based on the ODI were significantly lower in cervical disc herniation patients. The reoperation rate in the cervical group is also much less than the lumbar group. Conclusion: Like all other surgical modalities for disc herniation, PLDD has its own advantages and disadvantages. However, compared to lumbar disc herniation, it may give better results in cervical disc herniation. In selected cases, combined PLDD with epidural steroid injection can be chosen as a "first-choice-minimally-invasive-treatment," when standard conservative therapies do not give satisfactory outcome. [ABSTRACT FROM AUTHOR]

Objective: Anterior cervical discectomy and fusion (is one of the important options for the treatment of cervical disc herniation. The aim of this study was to examine the effects of anterior cervical discectomy and fusion on coronal balance, apart from the reduction in pain intensity, angle difference, and sagittal balance, which has been frequently studied before. Methods: Clinical and radiological follow-up results after anterior cervical discectomy and fusion procedure were evaluated in 41 patients. Standard anterior cervical microdiscectomy, osteophytectomy, and root decompression were performed by the same neurosurgeon. The pre- and postoperative sagittal balances of the patients, the effect of the angulation difference that will be created by the cage and the pain scores (visual analog scale) were determined. C1-C2 angle, C2-C7 lordosis angle, and T1 slope angle were measured on the lateral radiograph of the patients. Number Cruncher Statistical System program was used for statistical analysis. Results: The lordotic increases in the postoperative C1-C2 and C2-C7 angles of the cases compared to the preoperative period were statistically significant (P = .001 and P = .004, respectively). The changes in the T1 slope angles and in the postoperative coronal balance measurements after the operation compared to the preoperative period were not significant (P = .232 and P = .753, respectively). The decrease in the postoperative visual analog scale scores of the cases compared to the preoperation was significant (P = .001). Conclusion: While no significant change was found in the T1 slope angle for lordosis after surgery, significant increases in the C1-C2 and C2-C7 lordosis angles were accompanied by a significant decrease in pain. [ABSTRACT FROM AUTHOR]

Background: The microsurgical anterior approach to the cervical spine is commonplace. Fewer surgeons perform posterior cervical microsurgical procedures on a routine basis for lack of indication, more bleeding, persistent postoperative neck pain, and risk of progressive misalignment. In comparison, the endoscopic technique is preferentially performed through the posterior approach. Many spine surgeons and even surgeons versed in lumbar endoscopy are often reluctant to consider endoscopic procedures in the cervical spine. We report the results of a surgeon survey to find out why. Methods: A questionnaire of 10 questions was sent to spine surgeons by email and chat groups in social media networks including Facebook, WeChat, WhatsApp, and LinkedIn to collect practice pattern data about microscopic and endoscopic spine surgery in the lumbar and cervical spine. The responses were cross-tabulated by surgeons' demographic data. Pearson Chi-Square measures, Kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances using the statistical package SPSS Version 27.0. Results: The survey response rate was 39.7%, with 50 of the 126 surgeons who started the survey submitting a completed questionnaire. Of the 50 surgeons, 56.2% were orthopedic, and 42% neurological surgeons. Most surgeons worked in private practice (42%). Another 26% were university-employed, 18% were in private practice affiliated with a university, and the remaining 14% were hospital employed. The majority of surgeons (55.1%) were autodidacts. The largest responding surgeon groups were between 35–44 years (38%) and between 45–54 years of age (34%). Half of the responding surgeons were routinely performing endoscopic cervical spine surgery. The other half did not perform it for the main hurdle of fear of complications (50%). Lack of appropriate mentorship was listed as second most reason (25.4%). More concerns for not performing cervical endoscopic approaches were the perception of lack of technology (20.8%) and suitable surgical indication (12.5%). Only 4.2% considered cervical endoscopy too risky. Nearly a third (30.6%) of the spine surgeons treated over 80% of their cervical spine patients with endoscopic surgeries. Most commonly performed were posterior endoscopic cervical discectomy (PECD; 52%), posterior endoscopic cervical foraminotomy (PECF; 48%), anterior endoscopic cervical discectomy (AECD; 32%), cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD; 30%), respectively. Conclusion: Cervical endoscopic spine surgery is gaining traction among spine surgeons. However, by far most surgeons performing cervical endoscopic spine surgery work in private practice and are autodidacts. This lack of a teacher to shorten the learning curve as well as fear of complications are two of the major impediments to the successful implementation of cervical endoscopic procedures. [ABSTRACT FROM AUTHOR]

In the treatment of cervical radiculopathy due to a herniated disc, potential surgical treatments include: anterior cervical discectomy (ACD), ACD and fusion using a cage (ACDF), and anterior cervical disc arthroplasty (ACDA). Previous publications yielded comparable clinical and radiological outcome data for the various implants, but research on their comparative costutility has been inconclusive. To evaluate the cost utility of ACD, ACDF, and ACDA. Cost-utility analysis. About 109 patients with cervical radiculopathy randomized to undergo ACD, ACDF, or ACDA as part of the NEtherlands Cervical Kinetics trial. Quality-adjusted life-years (QALYs) estimated from patient-reported utilities using the EuroQol-5D questionnaire and EuroQol Visual Analogue Scale (EQ VAS), measured at baseline, 2, 4, 8, 12, 26, 52, and 104 weeks postprocedure. Societal costs including admissions to hospital (related and otherwise), GP visits, specialist visits, physical therapy, medications, home care, aids, informal care, productivity losses, and out of pocket condition-related expenses. The cost utility of the competing strategies over 1 and 2 years was assessed following a net benefit (NB) approach, whereby the intervention with the highest NB among competing strategies is preferred. Cost effectiveness acceptability curves were produced to reflect the probability of each strategy being the most cost effective across various willingness-to-pay (WTP) thresholds. Five sensitivity analyses were conducted to assess the robustness of results. ACDF was more likely to be the most cost-effective strategy at WTP thresholds of €20,000 to 50,000/QALY in all but one of the analyses. The mean QALYs during the first year were 0.750, 0.817, and 0.807 for ACD, ACDF, and ACDA, respectively, with no significant differences between groups. Total healthcare costs over the first year were significantly higher for ACDA, largely due to the higher surgery and implant costs. The total societal costs of the three strategies were €12,173 for ACD, €11,195 for ACDF, and €13,746 for ACDA, with no significant differences between groups. Our findings demonstrate that ACDF is likely to be more cost-effective than ACDA or ACD at most WTP thresholds, and this conclusion is robust to most sensitivity analyses conducted. It is demonstrated that the difference in costs is mainly caused by the initial surgical costs and that there are only minimal differences in other costs during follow-up. Since clinical data are comparable between the groups, it is to the judgment of the patient and surgeon which intervention is applied. [ABSTRACT FROM AUTHOR]

Background: Different treatments for discogenic axial back/neck pain or radicular pain to limbs are there from conservative therapies and minimally invasive therapies to open spine surgeries with lots of controversial outcomes. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive therapies which is done under local anesthesia and has been successfully performed in many selected patients for their lumbar and cervical disc herniation problems. In PLDD, a part of the nucleus pulposus is vaporized with the help of laser energy to reduce the intradiscal pressure of the diseased discs causing nerve compression. In this case series after a 1-year follow-up, the clinical effectiveness of PLDD with epidural steroid injection is assessed in selected lumbar and cervical disc herniation cases. Materials and Methods: Ninety-six patients underwent the PLDD procedure at the cervical and lumbar disc with epidural steroid injections for their disc herniation causing radicular pain in the upper and lower limbs, respectively. The patients were followed at 8 weeks, 3 months, 6 months, and 1 year. The main outcome measures were done through the visual analog scores (VASs) and the Oswestry Disability Index (ODI) for upper and lower limb pain. Results: The primary outcome showed that there is a significant clinically relevant difference between the two groups at a 1-year follow-up. VAS and mean disability score based on the ODI were significantly lower in cervical disc herniation patients. The reoperation rate in the cervical group is also much less than the lumbar group. Conclusion: Like all other surgical modalities for disc herniation, PLDD has its own advantages and disadvantages. However, compared to lumbar disc herniation, it may give better results in cervical disc herniation. In selected cases, combined PLDD with epidural steroid injection can be chosen as a “first-choice-minimally-invasive-treatment,” when standard conservative therapies do not give satisfactory outcome.

Background: There is a small level of evidence regarding the alterations in global spine alignment following the restoration of cervical lordosis using anterior cervical discectomy and fusion (ACDF). Different cage types are available to restore cervical lordosis through ACDF. In this study, we evaluate the impact of two types of these cages on local and global spine alignments. Patients and Methods: Thirty-two patients with a mean age of 46 ± 10 who underwent ACDF for cervical disc herniation were included in this retrospective study. Patients were divided according to their cage type into two groups, 17 patients with standalone conventional polyether ether ketone cages and 15 patients with integrated cage and plate (ICP) (Perfect-C®). Cervical alignment and global spine alignment were evaluated on the pre- and post-operative EOS® images. Results: Three months after the ACDF, total cervical lordosis correction was higher in patients with ICP (P = 0.001), while the local cervical lordosis correction was not significantly different between conventional cages and prefect-C cages (P = 0.067). Lumbar lordosis and pelvic tilt change were significantly higher among patients with Perfect-c cages (P = 0.043). Conclusion: In patients undergoing ACDF, alignment of the global spine changes along with the restoration of the cervical spine. Cage type affects this association, mainly through the compensatory alteration of pelvic tilt.

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.

Brown-Sequard syndrome (BSS) is an uncommon condition caused by a localized injury to one side of the spinal cord. It is rarely reported to present because of cervical disc herniation (CDH), especially as a result of 2 consecutive discs prolapse, with only 8 cases reported worldwide, 4 of which have the cervical disc levels of C5-C6, C6-C7 being affected just like the case we are presenting. A 45 years male had complained of left-sided body pain and numbness following a fall, his symptoms progressing over two weeks to left side hemiparesis and impaired sensation; MRI of C spine revealed C5-C6, C6- C7 disc prolapse with cord compression resulting in BSS. The patient was treated surgically by anterior cervical discectomy and fusion (ACDF) followed by physiotherapy. The patient showed complete recovery in terms of sensory and motor deficits in both the right and left upper and lower limbs. We are stressing the role of detailed history, comprehensive neurological examination, and proper imaging in the early diagnosis of BSS. Treatment with anterior surgical intervention is the recommended approach in most reported cases and is associated with an excellent prognosis. [ABSTRACT FROM AUTHOR]

This study aims to investigate the effectiveness of Artcure Diffusional Transdermal Patch treatment on pain and functional status in patients with cervical disc herniation. A total of 48 patients (15 males, 33 females; mean age 48 years; range 20 to 60 years) who were diagnosed with cervical disc herniation were included in this double-blind, randomized, placebo-controlled study. Participants were randomized into 2 groups. Artcure Transdermal Patch was implemented in the 1st Group, and a placebo transdermal patch was given to the 2nd Group. Artcure and placebo patches were applied once to both patient groups, remaining for 24 hours as was recommended in their usages. All individuals were examined at the onset, in the 4th week, and the 12th week. Visual Analog Scale (VAS) was used to evaluate pain, neuropathic pain intensity was measured using the Leeds Assessment of Neuropathic Symptoms and Signs Scales (LANSS), and the functional level was measured by the Neck Pain and Disability Scale (NPDS). It was determined that the pain level decreased, neuropathic symptoms reduced, and functional level improved compared to initial parameters in the diffusional transdermal patch group. There were significant differences among the groups in the 4th and 12th weeks concerning pain, neuropathic symptoms, and functional status, and it was also determined that this difference was conspicuous in the transdermal diffusional patch group. Based on these data, Artcure Diffusional Patch may be an alternative for conservative treatment of patients with cervical disc herniation. [Med-Science 2022; 11(2.000): 502-6]

Background: Cervical spine injuries are considered common in athlete populations, especially in those involved in high-contact sports. In some cases, surgical treatment can be necessary, and, therefore, return-to-play (RTP) after surgery represent a notable issue. Methods: We performed a systematic review of literature according to the PRISMA statement guidelines using the following search algorithm: (("ACDF") OR ("cervical spine surgery") OR ("neck surgery") OR ("cervical discectomy") OR ("foraminotomy") OR ("cervical disc replacement")) AND (("return to play") OR ("athlete") OR ("contact sports") OR ("martial arts")). The search was performed on 21 October 2022. We included only articles in which operative treatment for the cervical spine was performed and return to martial art activity was declared in the text. Results: Eight articles were selected, including 23 athletes who practice wrestling (n = 16), kickboxing (n = 1), sumo (n = 1) or other unspecified martial arts (n = 5). We also included the case of a young judoka who underwent anterior cervical discectomy and fusion (ACDF) at our hospital. About 88% (21 of 24 cases) of martial arts practitioners returned to play after cervical spine surgery, and no major complications were reported after RTP. Four patients (16.7%) returned in 0–3 months; 41.7% (10 of 24) returned in 3–6 months; 29.2% (7 of 24) returned after a period longer than 6 months. ACDF is the most used procedure. The level of evidence in the included articles is low: only case reports are available, including some single-case studies. Moreover, a small number of cases have been reported, and the examined data are very heterogeneous. Conclusions: Return to martial arts within one year after cervical spine surgery is generally safe, even if case-by-case evaluation is, however, necessary. Further studies are necessary to corroborate the present findings in a larger population. [ABSTRACT FROM AUTHOR]

Study Design: Prospective non-randomized single-center cohort study. Objectives: To analyze the quality of postoperative magnetic resonance imaging of 2 structurally different cervical disc arthroplasty devices at the index and adjacent levels. Methods: A non-randomized, comparative, prospective, single-center study included 40 patients (23 men and 17 women) aged 32 (26-40) years. Two study groups were utilized: in the first (n = 20), a titanium prosthesis was used; in the second (n = 20), a cobalt-chromium implant was used. Evaluation of MRI studies before and after surgery was performed using sagittal and axial T2 weighted images by 2 specialists who were blinded to the prosthesis that was used. To determine the quality of an MRI image, the classification of Jarvik 2000, the radiological and orthopedic scales for assessing artifacts were used. Results: There was good-to-excellent inter-observer agreement for all of the MR parameters used for the titanium and satisfactory-to-good for the cobalt chromium group. The analysis of the quality of postoperative imaging using the Jarvik 2000 scale showed a statistically significant deterioration in MR images in the cobalt chromium group (P < 0.001), compared to the titanium (P = 0.091). Following a single-level total arthroplasty, the titanium group had better MRI images according to radiological and orthopedic scales (P < 0.001). Conclusion: Titanium cervical disc arthroplasty devices result in superior postoperative MR imaging, as compared to cobalt chromium prostheses, as the latter significantly reduces image quality due to the pronounced ferromagnetic effect. [ABSTRACT FROM AUTHOR]

Study Design Retrospective observational study. Purpose We investigated the correlation between T2 relaxation times and clinical symptoms in patients with cervical radiculopathy caused by cervical disk herniation. Overview of Literature There are currently no imaging modalities that can assess the affected cervical nerve roots quantitatively. Methods A total of 14 patients with unilateral radicular symptoms and five healthy subjects were subjected to simultaneous apparent T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement signaling (SHINKEI-Quant) using a 3-Tesla magnetic resonance imaging. The Visual Analog Scale (VAS) score for neck pain and upper arm pain was used to evaluate clinical symptoms. T2 relaxation times of the cervical dorsal root ganglia of the brachial plexus were measured bilaterally from C4 to C8 in patients with radicular symptoms and from C5 to C8 in healthy controls. The T2 ratio was calculated as the affected side to unaffected side. Results When comparing nerve roots bilaterally at each spinal level, no significant differences in T2 relaxation times were found between patients and healthy subjects. However, T2 relaxation times of nerve roots in the patients with unilateral radicular symptoms were significantly prolonged on the involved side compared with the uninvolved side (p

Objective To describe the surgical technique of cervical transdural discectomy with laminoplasty (CTDL) for the treatment of multi‐segment cervical spinal stenosis (CSS) accompanied with cervical disc herniation (CDH) and investigate its surgical outcomes and complications. Methods This was a clinical study. Between 2012 and 2018, 31 patients (13 males and 18 females) with multi‐segment CSS (over two cervical segments) accompanied with huge CDH and underwent CTDL were enrolled in this study. The details of CTDL technique with general anesthesia was described by the authors. The average follow‐up period of patients was 65.03 months (range from 24 to 126 months). Perioperative parameters such as age, sex, operative level, operative time, estimated blood loss, ambulation time, and operative complications were recorded. The results of clinical metrics such as the visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) scores in the preoperative and during the follow‐up period were obtained and used to evaluate clinical outcomes. Radiographic improvement was evaluated by the compression ratio, sagittal maximum spinal cord compression (SMSCC), and cervical range of motion (ROM). The preoperative and postoperative follow‐up parameters (VAS, JOA, Compression ratio, SMSCC, and ROM) were assessed with paired t test. A P‐value

Objective To quantitively characterize the morphology of cervical disc herniation (CDH) causing cervical spondylotic radiculopathy (CSR) and investigate whether the morphological features of CDH are associated with clinical outcomes in CSR patients treated by posterior percutaneous full‐endoscopic cervical discectomy (PPECD). Methods This is a single‐center retrospective study. Eighty‐seven PPECD‐treated patients meeting the inclusion criteria were included between May 2017 and May 2019. Based on preoperative T2‐weighted magnetic resonance imaging (MRI), we designed and measured six morphological parameters of CDH for all patients to reflect its relative position to cervical spinal cord and protruding degree: DC‐SC distance from the center of disc (DC) and the center of spinal cord (SC); DC‐DP distance from the center of cervical disc (DC) to the peak of herniation (DP); internal diameter of the disc; axial length of CDH; central angle of CDH formed by central axes of CDH and spinal cord; the modified index of CDH. We recorded general information, neck disability index (NDI) scores, visual analog scale (VAS) scores of neck and arm of all patients preoperatively and postoperatively at 1‐year follow‐up. The association of preoperative general variables and morphological parameters with clinical outcomes were explored by utilizing logistic regression and receiver operating characteristic curve (ROC) analysis. Results The preoperative neck‐VAS, arm‐VAS, and NDI were significantly decreased after PPECD and remained at a low value at follow‐up. In regards to the morphological parameters of CDH, the mean value of DC‐SC distance, DC‐DP distance, internal diameter of the disc, axial length of CDH, central angle of CDH, and modified index of CDH were 1.61 ± 0.30 cm, 1.66 ± 0.32cm, 1.04 ± 0.21 cm, 0.63 ± 0.19cm, 39.38° ± 11.94°, and 0.39 ± 0.24, respectively. For patients grouped by difference in the recovery rate of NDI and arm‐VAS (excellent improved group, EI; and limited improved group, LI), there were no differences in the age, gender, surgical segments, and morphological parameters, except for the central angle of CDH. According to binary logistic regression analysis, only the preoperative central angle of CDH was significantly associated with postoperative NDI recovery (odds ratio: 0.873; 95% confidence interval: 0.819–0.931, P = 0.002). ROC analysis showed the optimal cut‐off value of the central angle of CDH for predicting the postoperative improvement of functional outcomes is 33.788°. Conclusion Preoperative morphology of CDH is related to the outcomes of CSR patients after PPECD. Patients with a large central angle of CDH (>33.788°) have more likelihood of ameliorating neurological symptoms of CSR. There is the potential to select the central angle of CDH as a predictor for outcomes of PPECD in treating CSR.

Hiroshi Kobayashi, Koji Otani, Takuya Nikaido, Kazuyuki Watanabe, Kinshi Kato, Junichi Handa, Shoji Yabuki, Shin-Ichi Konno Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, JapanCorrespondence: Hiroshi Kobayashi 1-Hikarigaoka, Fukushima, 960-1295, JapanTel +8124-547-1276Fax +81 24-548-5505Email hiroshik@fmu.ac.jpPurpose: Early diagnosis of degenerative cervical spondylosis (DCM) is desirable because late treatment can lead to irreversible sequelae. No screening method has yet been established. Grip strength is commonly used in primary care settings to evaluate disease activity and diagnose sarcopenia. This single-center, cross-sectional study aimed to determine the diagnostic accuracy of grip strength for cervical myelopathy (DCM) and cutoff values for primary care DCM screening using area under the curve (AUC) and sensitivity values.Patients and Methods: The DCM group comprised 249 consecutive participants (165 males, 84 females; mean age, 65.1 years) with DCM who had undergone surgery at the affiliated hospital. The control group comprised 735 (280 males, 455 females; mean age, 65.8 years) participants undertaking a local government health checkup. Stratifying by age and sex, receiver operating characteristic (ROC) analyses were constructed for each group using minimum grip strength values for both hands. Based on ROC analysis, cut-off values were established so that the screening sensitivity would be 90% for either sex or age group, respectively.Results: According to age group and sex (males/females [M/F]), AUC values for a diagnosis of DCM in M/F were as follows: 40– 59 years, 0.92/0.87; 60– 69 years, 0.94/0.89; 70– 79 years, 0.89/0.91; and 80– 89 years, 0.97/0.97. Calculated M/F cutoff values were 41/24.5, 27/16, 27/15, and 20/10 kg, which were similar to cutoff scores for sarcopenia in M/F patients aged 60– 69 and 70– 79 years. M/F sensitivities in each age groups were 0.94/0.91, 0.92/0.90, 0.95/0.96, and 0.92/0.93. M/F specificities were 0.62/0.59, 0.84/0.83, 0.61/0.71, and 0.83/0.88.Conclusion: Grip strength had moderate-to-high diagnostic accuracy for DCM between participants in the control and DCM groups. We developed easily applicable cutoff values for primary care DCM screening with ≥ 90% sensitivity. In patients with sarcopenia, DCM should be differentially diagnosed in primary care.Keywords: degenerative cervical myelopathy, cervical spondylotic myelopathy, ossification of posterior longitudinal ligament, cervical disc herniation, primary care, early detection, sarcopenia

Purpose: Cervical disc herniation (CDH) is one of the most common spinal diseases in modern society; intervertebral disc degeneration (IVDD) has long been considered as its primary cause. However, the mechanism of intervertebral disc degeneration is still unclear. The aim of the study is to examine the components and structures of proteoglycan and collagen in cervical disc herniated nucleus pulposus (NP) using a validated and convenient Raman spectra technique and histological methods to further elucidate the mechanism of IVDD at the microscopic level. Methods: Our study used a burgeoning technique of Raman spectroscopy combined with in vitro intervertebral disc NP to characterize the above mentioned research purposes. Firstly, we collected cervical disc NP samples and imaging data by certain inclusion and exclusion criteria. Then, we graded the NP of the responsible segment according to the patient's preoperative cervical magnetic resonance imaging (MRI) T2-weighted images by Pfirrmann grading criteria while measuring the T2 signal intensity value of NP. In addition, the structure of the NP samples was evaluated by histological staining (H&E staining and Safranin-O staining). Finally, the samples were scanned and analyzed by Raman spectroscopy. Results: A total of 28 NP tissues from 26 patients (two of these patients were cases that involved two segments) with CDH were included in this study. According to the Raman spectroscopy scan, the relative content of proteoglycans which is characterized by the ratio of the two peaks (I1,064/I1,004) in the NP showed a significantly negative correlation with Pfirrmann grade (P < 0.001), while the collagen content and the NP intensity value showed a positive correlation (P < 0.001). For the microstructural characterization of collagen, we found that it may have an essential role in the degenerative process of the intervertebral disc. Moreover, histological staining (H&E staining and Safranin-O staining) showed the general structure of the NP and the distribution of macromolecules. Conclusion: The present study demonstrated the possibility of characterizing the macromolecular substances inside the cervical disc NP tissue by Raman spectroscopy. It also confirmed that macromolecular substances such as proteoglycans and collagen have some degree of alteration in content and structure during degeneration, which has a further positive significance for the elucidation of CDH's mechanism. [ABSTRACT FROM AUTHOR]

Early diagnosis of degenerative cervical myelopathy (DCM) is desirable, as delayed treatment can cause irreversible spinal cord injury and subsequent activity of daily living (ADL) impairment. We attempted to develop a straightforward and accurate diagnostic tool for DCM by combining the grip and release test (GRT) and grip strength. As a pilot study, we measured the GRT and grip strength of patients with DCM (n = 247) and a control group (n = 721). Receiver operating characteristic analysis was performed using the lower left and right. The Youden index was used to set cutoff values by sex and age group. The diagnostic performance of each test varied by sex and age, and a diagnostic support tool was created to determine any abnormal results in a test. The calculated M/F cutoff values for GRT were as follows: 40–59 years, 21/18; 60–69 years, 17/17; 70–79 years, 15/15; and 80–89 years, 11/12. The calculated M/F cutoff values for grip strength 32/20, 29/13, 21/15, and 19/10. When either GRT or grip strength was judged as positive, the overall sensitivity was 88.2%, specificity was 78.1%, positive likelihood ratio was 4.03, and the negative likelihood ratio was 0.15. This novel diagnostic support tool was superior to using GRT and grip strength alone in the early DCM diagnosis. Future research to obtain age- and sex-specific data is necessary to validate and further improve the tool. [ABSTRACT FROM AUTHOR]

Introduction: In 2018, the first Mobi-CⓇ total disk replacement (TDR) case was performed in Japan. In this study, we examined the preliminary clinical outcome of Mobi-CⓇ for degenerative cervical spine disease. Methods: We examined 24 consecutive patients who underwent 1-level TDR after 2018 and followed up for more than 6 months after surgery. The evaluation criteria included age, gender, diagnosis, follow-up period, surgical level, implant size, surgery time, intraoperative bleeding volume, complications, revision surgery, imaging findings, JOA score, and various questionnaires. Results: The mean age was 52.7 years, 13 males and 11 females. There were 15 cases of cervical disk herniation and 9 cases of cervical spondylosis. The mean follow-up period was 17.4 months. Surgical levels were C3/4 in 4 cases, C4/5 in 2 cases, C5/6 in 16 cases, and C6/7 in 2 cases. The mean operation time was 138.5 minutes, the amount of intraoperative bleeding was 32.1 ml, and there were no serious intraoperative complications. The range of motion of the affected level increased significantly, from 6.6 degrees preoperatively to 12.2 degrees at final follow-up. No patients required revision surgery at final follow-up, and there were no cases of heterotopic ossification or adjacent segment disease. One patient exhibited radiculopathy due to mild subsidence 1 year after surgery, and 1 had asymptomatic contact of device plates. Preoperative and final JOA scores improved from 11.7 to 15.8 points, and NRS improved from 4.3 to 1.3 points for neck pain and 4.3 to 1.7 points for arm pain. Preoperative and final NDI improved from 39.7% to 14.0%, and EQ-5D improved from 0.602 to 0.801. Conclusions: The short-term treatment outcomes of Mobi-CⓇ TDR were generally favorable. Spine surgeons should comply with guidelines when introducing this procedure and strive to adopt this new technology in Japan.

Study Design: An algorithm was developed with MATLAB platform to automatically quantify the volume of cervical disc herniation (CDH) based on the sagittal magnetic resonance images. This automated program was used for CDH data set, and then compared with manual measurement results confirming its reliability.Objective: The aim was to develop a new software for automated CDH volume measurement.Summary Of Background Data: CDH compresses the spinal cord, regarding as the leading cause of cervical myelopathy. However, the CDH volume, of great value to clinical symptoms, can be only manually measured with no-excellent but acceptable interobserver reliability. This was due to the manual error of outlining CDH area and inclusion of structure posterior vertebra. No studies has proposed such an automated algorithm of CDH volume quantification which is standardised to quantify the accurate volume of CDH thus helping doctors easily evaluate CDH progressing.Methods: The algorithm of CDH volume measurement was proposed. This program was then tested for 490 CDHs data set, from 185 patients with two repeated magnetic resonance imaging detections. Three individual observers manually measured the volumes of these CDHs, to justify the accuracy of this software. CDH volume was either in the classic way or the revised way excluding the influence of structure posterior vertebra.Results: The automated software was successfully developed on MATLAB platform, with no difference found with manual measurements (average level) in CDH volume measurement. The change ratios in CDH volumes were profoundly consistent with manual observation, showing the error of 5.8% in median. The revised method elevated the absolute value of ratio by amplifying the percentage change.Conclusion: Our developed automated volumetry system was an standardized and accurate way, with selective removal module of structure posterior vertebra, replaceable for manual volume measurement of CDH, which was useful for spinal surgeons diagnosing and treating CDH disease. [ABSTRACT FROM AUTHOR]

Objective: Neutrophil/lymphocyte ratio (NLR) is currently used as a marker for the diagnosis, follow-up and treatment of many diseases. It has been shown immunohistochemically that interleukins and cytokines are released in the disc herniation region. Our aim was to compare visual analog scale (VAS) and NLR values in the patients who have a cervical disc herniation, whom we frequently encounter and operate in neurosurgery practice. Materials and Methods: This study was conducted retrospectively by scanning the files of 24 cervical disc herniation patients that we operated approximately 2018-2020. Magnetic resonance imaging was used for the diagnosis. Patients with a single level cervical disc herniation requiring surgical intervention according to the clinical and radiological findings at the level of C4-5/C5-6/C6-7 were included in the study. Preoperative and postoperative 6th month VAS values were recorded. The neutrophil and lymphocyte ratios were calculated and recorded by taking routine preoperative morning blood samples before surgery. The relationship between VAS and NLR values was examined. Results: Preoperative neutrophil values ranged from 1.77 to 9.35, with a mean of 4.97±1.81. Preoperative lymphocyte values ranged from 1.06 to 4.86, with a mean of 2.54±0.88. NLR values ranged from 0.53 to 4.31, with a mean of 2.12±0.92. A statistically significant decrease in the VAS values was found in the postoperative 6th month compared to the preoperative values (p=0.000; p<0.05). There was a positive (47.7%) and statistically significant correlation between the NLR and preoperative VAS values (p=0.018; p<0.05). Conclusion: The relationship between the NLR and VAS scores in the spinal surgery cases has been evaluated in many series. In our study, we found a positive and significant relationship between the preoperative VAS score and the NLR values, which is consistent with the literature. [ABSTRACT FROM AUTHOR]