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STUDY DESIGN: Multicenter double-blind randomized sham-controlled trial. OBJECTIVE: To assess the efficacy of radiofrequency (RF) denervation of the cervical facet joints in chronic cervical facet joint pain. SUMMARY OF BACKGROUND DATA: One randomized controlled trial showed efficacy of RF denervation in whiplash-associated disease. There are no randomized controlled trials on RF denervation in patients with chronic cervical facet joint pain. METHODS: Patients were randomized to receive RF denervation combined with bupivacaine (intervention group) or bupivacaine alone (control group). In the intervention group, an RF thermal lesion was made at the cervical medial branches after the injection of bupivacaine. The primary outcome was measured at 6 months and consisted of pain intensity, self-reported treatment effect, improvement on the Neck Disability Index, and the use of pain medication. Duration of effect was determined using telephone interviews. RESULTS: We included 76 patients. In the intervention group, 55.6% showed >â30% pain decrease versus 51.3% in the control group (P = 0.711); 50.0% reported success on the Patients' Global Impression of Change in the intervention group versus 41.0% (Pâ=â0.435); the Neck Disability Index was 15.0â±â8.7 in the intervention group compared with 16.5â±â7.2 (Pâ=â0.432), the need for pain medication did not differ significantly between groups (Pâ=â0.461). The median time to end of treatment success for patients in the RF group was 42 months, compared with 12 months in the bupivacaine group (Pâ=â0.014). CONCLUSIONS: We did not observe significant differences between RF denervation combined with injection of local anesthesia compared with local anesthesia only at 6 months follow-up. We found a difference in the long-term effect after 6 months follow-up in favor of the RF treatment.Level of Evidence: 2.
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Artralgia/terapia , Bupivacaína/administración & dosificación , Vértebras Cervicales/patología , Desnervación/métodos , Dolor de Cuello/terapia , Articulación Cigapofisaria/patología , Anciano , Anestésicos Locales/administración & dosificación , Artralgia/diagnóstico , Vértebras Cervicales/efectos de los fármacos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor de Cuello/diagnóstico , Factores de Tiempo , Resultado del Tratamiento , Articulación Cigapofisaria/efectos de los fármacosRESUMEN
OBJECTIVE: Using a longitudinal observational cohort of ankylosing spondylitis (AS) patients, we sought to identify progression rates and factors predictive of spinal progression. As a secondary aim, we analyzed the effect of tumor necrosis factor inhibitor (TNFi) treatment on radiographic progression. METHODS: AS patients who had baseline and follow-up cervical and lumbar radiographs were included in the study. Radiographic damage was assessed by the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). A change of 2 mSASSS units in 2 years was defined as progression. The characteristics of the study group such as demographic, clinical, laboratory, and treatment history were collected. RESULTS: There were 350 patients in the study. The mean ± SD mSASSS increased from 9.3 ± 15.8 units at baseline to 17.7 ± 21.7 units by the sixth year. Mean ± SD changes in mSASSS between the years 0 to 2, 2 to 4, and 4 to 6 were 1.23 ± 2.68, 1.47 ± 2.86, and 1.52 ± 3.7 units, respectively. Overall, 24.3% of the group progressed over 2 years. Male sex (hazard ratio [HR] 2.46 [95% confidence interval (95% CI) 1.05, 5.76]), the presence of baseline damage (HR 7.98 [95% CI 3.98, 16]), increased inflammatory markers (log C-reactive protein level HR 1.35 [95% CI 1.07, 1.70]), and TNFi use (HR 0.82 [95% CI 0.70, 0.96]) were predictive of radiographic progression. There was a 20% reduction in the rate of progression with TNFi. CONCLUSION: Male sex, the presence of baseline damage, active disease state, and higher inflammatory markers confer a high risk for disease progression. Treatment with TNFi showed a disease-modifying effect by slowing the rate of radiographic progression.
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Vértebras Cervicales/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Espondilitis Anquilosante/diagnóstico por imagen , Adulto , Vértebras Cervicales/efectos de los fármacos , Progresión de la Enfermedad , Femenino , Humanos , Estudios Longitudinales , Vértebras Lumbares/efectos de los fármacos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de Riesgo , Factores Sexuales , Espondilitis Anquilosante/tratamiento farmacológico , Factores de Tiempo , Inhibidores del Factor de Necrosis Tumoral/uso terapéutico , Adulto JovenRESUMEN
STUDY DESIGN: Osmoviscoelastic behavior of cyclically loaded cervical intervertebral disc. OBJECTIVE: The aim of this study was to evaluate in vitro the effects of physiologic compressive cyclic loading on the viscoelastic properties of cervical intervertebral disc and, examine how the osmoviscoelastic coupling affects time-dependent recovery of these properties following a long period of unloading. SUMMARY OF BACKGROUND DATA: The human neck supports repetitive loadings during daily activities and recovery of disc mechanics is essential for normal mechanical function. However, the response of cervical intervertebral disc to cyclic loading is still not very well defined. Moreover, how loading history conditions could affect the time-dependent recovery is still unclear. METHODS: Ten thousand cycles of compressive loading, with different magnitudes and saline concentrations of the surrounding fluid bath, are applied to 8 motion segments (composed by 2 adjacent vertebrae and the intervening disc) extracted from the cervical spines of mature sheep. Subsequently, specimens are hydrated during 18 hours of unloading. The viscoelastic disc responses, after cyclic loading and recovery phase, are characterized by relaxation tests. RESULTS: Viscoelastic behaviors are significantly altered following large number of cyclic loads. Moreover, after 18-hour recovery period in saline solution at reference concentration (0.15âmol/L), relaxation behaviors were fully restored. Nonetheless, full recovery is not obtained whether the concentration of the surrounding fluid, that is, hypo-, iso-, or hyper-osmotic conditions. CONCLUSION: Cyclic loading effects and full recovery of viscoelastic behavior after hydration at iso-osmotic condition (0.15âmol/L) are governed by osmotic attraction of fluid content in the disc due to imbalance between the external load and the swelling pressure of the disc. After removal of the load, the disc recovers its viscoelastic properties following period of rest. Nevertheless, the viscoelastic recovery is a chemically activated process and its dependency on saline concentration is governed by fluid flow due to imbalance of ions between the disc tissues and the surrounding fluid. LEVEL OF EVIDENCE: 3.
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Vértebras Cervicales/fisiología , Fuerza Compresiva/fisiología , Elasticidad/fisiología , Disco Intervertebral/fisiología , Presión Osmótica/fisiología , Soporte de Peso/fisiología , Animales , Fenómenos Biomecánicos/efectos de los fármacos , Fenómenos Biomecánicos/fisiología , Vértebras Cervicales/efectos de los fármacos , Fuerza Compresiva/efectos de los fármacos , Elasticidad/efectos de los fármacos , Disco Intervertebral/efectos de los fármacos , Presión Osmótica/efectos de los fármacos , Presión/efectos adversos , Solución Salina/farmacología , OvinosRESUMEN
PURPOSE OF REVIEW: Cervical interlaminar epidural steroid injection is a common intervention in the management of cervical radiculitis. Given the large number of injections done annually, it is important to assess the potential complications associated with this procedure. RECENT FINDINGS: Based on current published studies, the overall complication rate varies. The vast majority are minor complications. However, this review also identified potentially catastrophic complications following cervical interlaminar epidural steroid injections. Based upon our review, cervical epidural steroid injection is considered a safe intervention. Nevertheless, catastrophic complications such as spinal cord injuries from needle placement, infections, and epidural hematoma can occur. It is prudent to take appropriate measures to minimize these complications.
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Vértebras Cervicales/efectos de los fármacos , Vértebras Cervicales/cirugía , Inyecciones Epidurales/efectos adversos , Esteroides/uso terapéutico , Fluoroscopía/métodos , Humanos , Inyecciones Epidurales/métodos , Traumatismos de la Médula Espinal/etiología , Esteroides/administración & dosificación , Esteroides/efectos adversos , Resultado del TratamientoRESUMEN
The hollow cylindrical nanohydroxyapatite/polyamide 66 strut (n-HA/PA66) has been used clinically for anterior cervical reconstruction. However, rates of occurrence of a "radiolucent gap" between the dense strut and adjacent endplates were reported. The aim of this in vivo study was to evaluate the viability and advantages of the novel porous n-HA/PA66 strut. The goat C3/4 partial discectomy and fusion model was built, and two groups of n-HA/PA66 struts were implanted into C3/4: group 1, porous n-HA/PA66 strut; and group 2, hollow cylindrical n-HA/PA66 strut filled with autogenous cancellous bone. CT evaluation was performed to assess the fusion status after 12 and 24 weeks. The cervical spines were harvested. Histomorphological analysis was performed to determine new bone formation. Biomechanical testing was performed to determine range of motion (ROM). CT confirmed the disappearance of the boundary of the porous strut and host bone, while the radiolucent gap remained clearly discernible in the dense strut group. The mean CT fusion scores of the porous group were significantly higher. Histologic evaluation showed that the porous struts promoted better osteointegration. Calcein fluorochrome labelling indicated faster bone ingrowth in the porous struts. Biomechanical tests revealed that the porous struts had significantly reduced micromotion. The porous n-HA/PA66 strut could offer interesting potential for cervical reconstruction after corpectomy.
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Vértebras Cervicales/efectos de los fármacos , Vértebras Cervicales/cirugía , Durapatita/farmacología , Nanopartículas/administración & dosificación , Nylons/farmacología , Enfermedades de la Columna Vertebral/cirugía , Animales , Huesos/efectos de los fármacos , Huesos/cirugía , Discectomía/métodos , Femenino , Cabras , Osteogénesis/efectos de los fármacos , Porosidad , Prótesis e Implantes , Fusión Vertebral/métodosRESUMEN
BACKGROUND: Cervical vertigo commonly concurs in patients with neck pain, but the concurrent mechanism of these 2 symptoms still remains unclear. We previously reported a bidirectional segmental nerve fiber connection between cervical spinal and sympathetic ganglia, which provided a hypothesis that this connection between the 2 ganglia may be the anatomic basis for the concurrence of neck pain and cervical vertigo. However, this concurrent mechanism needs biochemical and functional evidence. OBJECTIVES: This study aimed to investigate a possible noradrenergic pathway between cervical spinal and sympathetic ganglia. STUDY DESIGN: We performed both clinical and laboratory research. Clinical observation was a prospective case-control study. SETTING: Clinical study took place in our hospital; laboratory study was in an orthopedic laboratory. METHODS: Cervical lamina block therapy used in patients with cervical vertigo was clinically evaluated; norepinephrine (NE) expressions in cervical sympathetic ganglia were analyzed using immunohistochemical staining after electrical stimulation to the cervical spinal ganglia; the influence of phentolamine local injection to the vertebrobasilar artery flow was experimentally measured. RESULTS: Cervical lamina block therapy could significantly shorten the clinical hospital stays of patients with cervical vertigo (P = 0.000) and improve vertebral artery flow (P < 0.05). NE expressions in superior cervical sympathetic ganglia (SCG) or inferior cervical sympathetic ganglia (ICG) increased significantly when ipsilateral C2 to C3 or C6 to C8 spinal ganglia were electrically stimulated, respectively. Adrenergic receptor block with phentolamine significantly inhibited the decrease of basilar artery (BA) flow induced by electrical stimulation of the cervical spinal ganglia. The change range of BA flow caused by stimulations of C2 to C3 and C6 to C8 spinal ganglia was more than that of C4 and C5. LIMITATIONS: The inpatients observed in this clinical study might be influenced by some factors including emotion, diet, sleep, and others. The limitations of the laboratory study included animal species and small sample size. CONCLUSIONS: Adrenergic system could play a part in cervical spinal ganglia altering the vertebrobasilar artery system. It could provide a neurochemical foundation between neck pain and vertigo, and that segmental functional connections exist between cervical spinal and sympathetic ganglia. KEY WORDS: Cervical vertigo, neck pain, cervical sympathetic ganglia, cervical spinal ganglia, noradrenaline.
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Bloqueo Nervioso Autónomo/métodos , Ganglios Espinales/fisiología , Ganglios Simpáticos/fisiología , Dolor de Cuello/tratamiento farmacológico , Vértigo/tratamiento farmacológico , Adulto , Animales , Estudios de Casos y Controles , Vértebras Cervicales/efectos de los fármacos , Vértebras Cervicales/inervación , Vértebras Cervicales/fisiología , Femenino , Ganglios Espinales/efectos de los fármacos , Ganglios Simpáticos/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Dolor de Cuello/epidemiología , Dolor de Cuello/fisiopatología , Estudios Prospectivos , Conejos , Distribución Aleatoria , Vértigo/epidemiología , Vértigo/fisiopatologíaRESUMEN
Sleep-disordered breathing (SDB) is very common after spinal cord injury (SCI). The present study was designed to evaluate the therapeutic efficacy of adenosine A1 receptor blockade (8-cyclopentyl-1,3-dipropylxanthine, DPCPX) on SDB in a rodent model of SCI. We hypothesized that SCI induced via left hemisection of the second cervical segment (C2Hx) results in SDB. We further hypothesized that blockade of adenosine A1 receptors following C2Hx would reduce the severity of SDB. In the first experiment, adult male rats underwent left C2Hx or sham (laminectomy) surgery. Unrestrained whole body plethysmography (WBP) and implanted wireless electroencephalogram (EEG) were used for assessment of breathing during spontaneous sleep and for the scoring of respiratory events at the acute (~1 wk), and chronic (~6 wk) time points following C2Hx. During the second experiment, the effect of oral administration of adenosine A1 receptor antagonist (DPCPX, 3 times a day for 4 days) on SCI induced SDB was assessed. C2Hx animals exhibited a higher apnea-hypopnea index (AHI) compared with the sham group, respectively (35.5 ± 12.6 vs. 19.1 ± 2.1 events/h, P < 0.001). AHI was elevated 6 wk following C2Hx (week 6, 32.0 ± 5.0 vs. week 1, 42.6 ± 11.8 events/h, respectively, P = 0.12). In contrast to placebo, oral administration of DPCPX significantly decreased AHI 4 days after the treatment (159.8 ± 26.7 vs. 69.5 ± 8.9%, P < 0.05). Cervical SCI is associated with the development of SDB in spontaneously breathing rats. Adenosine A1 blockade can serve as a therapeutic target for SDB induced by SCI.NEW & NOTEWORTHY The two key novel findings of our study included that 1) induced cervical spinal cord injury results in sleep-disordered breathing in adult rats, and 2) oral therapy with an adenosine A1 receptor blockade using DPCPX is sufficient to significantly reduce apnea-hypopnea index following induced cervical spinal cord injury.
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Médula Cervical/metabolismo , Médula Cervical/fisiopatología , Receptor de Adenosina A1/metabolismo , Síndromes de la Apnea del Sueño/metabolismo , Síndromes de la Apnea del Sueño/fisiopatología , Traumatismos de la Médula Espinal/metabolismo , Traumatismos de la Médula Espinal/fisiopatología , Animales , Médula Cervical/efectos de los fármacos , Vértebras Cervicales/efectos de los fármacos , Vértebras Cervicales/metabolismo , Vértebras Cervicales/fisiopatología , Masculino , Antagonistas de Receptores Purinérgicos P1/farmacología , Ratas , Ratas Sprague-Dawley , Respiración/efectos de los fármacos , Sueño/efectos de los fármacos , Sueño/fisiología , Síndromes de la Apnea del Sueño/tratamiento farmacológico , Traumatismos de la Médula Espinal/tratamiento farmacológico , Xantinas/farmacologíaRESUMEN
INTRODUCTION: The leading cause of pyogenic vertebral osteomyelitis is Staphylococcus aureus, and its incidence is rising, particularly in the elderly. We report an unusual case of cervical spondylodiscitis and epidural abscess mimicking Pott's disease. CASE REPORT: A 67-year-old man was admitted to our institution with a 15-day history of neck pain radiating to the head, shoulders and left arm that was associated with weakness and paresthesia. Laboratory tests showed a mild leucocytosis and high levels of inflammatory markers. The MRI showed contrast enhancement of C6-C7 with an abscess infiltration extending to the intervertebral disc, the anterior epidural space, and the medullary cord. The patient had a medical history of a positive Mantoux tuberculin skin test 25 years prior, and the interferon-gamma release assay (IGRA) was positive for the identification of latent tuberculosis infection. All other examinations for diagnosis of spinal tuberculosis were inconclusive. Intravenous antibiotic therapy was initiated with teicoplanin 800 mg and levofloxacin 750 mg daily with a fast recovery of symptoms. CONCLUSIONS: Cervical spondylodiscitis can be an unusual cause of severe neck pain with a challenging differential diagnosis. Conservative treatment should always be considered for patients without neurological symptoms as long as close follow-up evaluations are performed.
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Vértebras Cervicales/diagnóstico por imagen , Discitis/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Tuberculosis de la Columna Vertebral/diagnóstico por imagen , Anciano , Antibacterianos/uso terapéutico , Vértebras Cervicales/efectos de los fármacos , Discitis/tratamiento farmacológico , Humanos , Levofloxacino/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Infecciones Estafilocócicas/tratamiento farmacológico , Teicoplanina/uso terapéutico , Tuberculosis de la Columna Vertebral/tratamiento farmacológicoRESUMEN
PURPOSE: CT-guided periradicular infiltration of the cervical spine is an effective symptomatic treatment in patients with radiculopathy-associated pain syndromes. This study evaluates the robustness and safety of a low-dose protocol on a CT scanner with iterative reconstruction software. MATERIALS AND METHODS: A total of 183 patients who underwent periradicular infiltration therapy of the cervical spine were included in this study. 82 interventions were performed on a new CT scanner with a new intervention protocol using an iterative reconstruction algorithm. Spot scanning was implemented for planning and a basic low-dose setup of 80 kVp and 5âmAs was established during intermittent fluoroscopy. The comparison group included 101 prior interventions on a scanner without iterative reconstruction. The dose-length product (DLP), number of acquisitions, pain reduction on a numeric analog scale, and protocol changes to achieve a safe intervention were recorded. RESULTS: The median DLP for the whole intervention was 24.3 mGy*cm in the comparison group and 1.8 mGy*cm in the study group.âThe median pain reduction was -3 in the study group and -2 in the comparison group.âA 5âmAs increase in the tube current-time product was required in 5 patients of the study group. CONCLUSION: Implementation of a new scanner and intervention protocol resulted in a 92.6â% dose reduction without a compromise in safety and pain relief. The dose needed here is more than 75â% lower than doses used for similar interventions in published studies. An increase of the tube current-time product was needed in only 6â% of interventions. KEY POINTS: · The presented ultra-low-dose protocol allows for a significant dose reduction without compromising outcome.. · The protocol includes spot scanning for planning purposes and a basic setup of 80 kVp and 5âmAs.. · The iterative reconstruction algorithm is activated during fluoroscopy.. CITATION FORMAT: · Elsholtz FH, Kamp JE, Vahldiek JL etâal. Periradicular Infiltration of the Cervical Spine: How New CT Scanner Techniques and Protocol Modifications Contribute to the Achievement of Low-Dose Interventions. Fortschr Röntgenstr 2019; 191: 54â-â61.
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Vértebras Cervicales/efectos de los fármacos , Manejo del Dolor/métodos , Radiculopatía/tratamiento farmacológico , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Raíces Nerviosas Espinales/efectos de los fármacos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Algoritmos , Vértebras Cervicales/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dosis de Radiación , Radiculopatía/diagnóstico por imagen , Estudios Retrospectivos , Raíces Nerviosas Espinales/diagnóstico por imagen , Escala Visual AnalógicaRESUMEN
BACKGROUND: Posterior atlantoaxial fusion is an important armamentarium for neurosurgeons to treat several pathologies involving the craniovertebral junction. Although the potential advantages of recombinant human bone morphogenetic protein-2 (rhBMP-2) are well documented in the lumbar spine, its indication for C1-C2 fusion has not been well characterized. In our institution, we apply rhBMP-2 to the C1-C2 joint either alone or with hydroxyapatite, locally harvested autograft chips, and/or morselized allogenic bone graft for selected cases-without conventional posterior structural bone graft. We report the clinical outcomes of the surgical technique to elucidate its feasibility. METHODS: We performed a single-center, retrospective review of data from 2008 to 2016 and identified 69 patients who had undergone posterior atlantoaxial fusion with rhBMP-2. The clinical records of these patients were reviewed, and the baseline characteristics, operative data, and postoperative complications were collected and statistically analyzed. RESULTS: The average age of the 69 patients was 60.8 ± 4.5 years, and 55.1% were women. With an average follow-up period of 21.1 ± 4.2 months, the C1-C2 fusion rate was 94.3% (65 of 69), and the average time to fusion was 11.4 ± 2.6 months (range, 5-23). The overall reoperation rate was 10.1% (7 of 69), with instrumentation failure in 7 patients (10.1%), adjacent segment disease in 2 (2.9%), and postoperative dysphagia and dyspnea in 2 patients (2.9%). No ectopic bone formation or soft tissue edema developed. CONCLUSIONS: Although retrospective and from a single center, our study has shown that rhBMP-2 usage at the C1-C2 joint without posterior structural bone grafting is a safe and reasonable surgical option.
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Articulación Atlantoaxoidea/anomalías , Conservadores de la Densidad Ósea/uso terapéutico , Proteína Morfogenética Ósea 2/uso terapéutico , Vértebras Cervicales/efectos de los fármacos , Vértebras Cervicales/cirugía , Anomalías Congénitas , Factor de Crecimiento Transformador beta/uso terapéutico , Trasplante Óseo , Vértebras Cervicales/diagnóstico por imagen , Protocolos Clínicos , Durapatita/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Proteínas Recombinantes/uso terapéutico , Reoperación , Estudios Retrospectivos , Trasplante Autólogo , Trasplante HomólogoRESUMEN
STUDY DESIGN: This was a retrospective study. OBJECTIVE: To radiographically demonstrate the distinct fusion pattern of recombinant human bone morphogenetic protein-2 (rhBMP-2) in the setting of anterior cervical discectomy and fusion. SUMMARY OF BACKGROUND DATA: Studies investigating spinal fusion assisted with rhBMP-2 have yielded promising results, suggesting rhBMP-2 is an efficacious alternative to iliac crest autografts. rhBMP-2-assisted spinal fusion both hastens healing and eliminates patient morbidity from iliac crest autograft. Unique to rhBMP-assisted spinal fusion is its distinct radiographic fusion pattern as fusion is achieved. Despite promising results and increased clinical use of rhBMP-2, there remains a paucity of literature documenting this radiographic process. MATERIALS AND METHODS: This study included 26 patients who underwent single-level anterior cervical discectomy and fusion using rhBMP-2. All data used for this study was collected from a prior FDA Investigational Device Exemption study. RESULTS: A polyetheretherketone cage was used as an interbody disk spacer in all 26 patients. Patients were evaluated between 2 and 6 weeks after surgery and subsequently at 3, 6, 12, and 24 months postoperative. All patients underwent plain radiography at every follow-up visit, and computed tomograhy evaluation was performed at 3, 6, 12, and 24 months as part of the study protocol. Earliest fusion was observed at 3 months in 38% of patients. Likely fusion was observed in all patients by 12 months postoperative. CONCLUSIONS: rhBMP-2 leads to both successful interbody fusion and an enhanced fusion rate with unique imaging characteristics. Additional characteristics of BMP observed in 100% of patients included prevertebral soft-tissue swelling and early endplate resorption. Other common features included polyetheretherketone cage migration, heterotopic bone formation and cage subsidence.
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Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Fusión Vertebral , Tomografía Computarizada por Rayos X , Artefactos , Proteína Morfogenética Ósea 2 , Vértebras Cervicales/efectos de los fármacos , Humanos , Osificación Heterotópica/diagnóstico por imagen , Proteínas Recombinantes , Factor de Crecimiento Transformador betaRESUMEN
BACKGROUND: Biologic agents (BAs) enabled not only a reduction of disease activity but also a slowing down of structural damage to the joints in patients with rheumatoid arthritis (RA). However, the incidence of cervical lesions in patients with RA is still high. PURPOSE: To elucidate the predictors for the progression of two different cervical lesions in patients with RA under BA treatment. METHODS: Of 151 subjects who received more than two years of continuous BA treatment, 101 subjects who had cervical X-ray images taken at baseline and final visit were enrolled. The mean disease duration and mean radiography interval were 10.6 years and 4.4 years, respectively. The existence and progression of cervical lesions (atlanto-axial subluxation [AAS], vertical subluxation [VS], and subaxial subluxation [SS]) were investigated. And predictors for the AAS or VS progression were analyzed by multivariate logistic regression analysis. RESULTS: The incidence of cervical lesions at baseline were no pre-existing cervical lesion (none) in 50 cases (50%), AAS only in 32 (32%), both AAS and VS in 12 (12%), and VS only in 7 cases (7%). In the none group, only 4 cases of AAS progression (8%) was observed during the follow-up. In contrast, in the groups with pre-existing cervical lesions, a high incidence of VS progression was observed (63% in the AAS only group, 58% in the AAS + VS group, and 71% in the VS only group). Multivariate regression analysis demonstrated that the DAS-CRP value at baseline (odds ratio [OR] = 9.23) and matrix metaloprotease-3 level at baseline (OR = 1.01) were significant predictors for the progression of AAS, and pre-existing AAS (OR = 18.38) was a sole significant predictor for the progression of VS. CONCLUSIONS: Cervical lesions progressed irrespective of disease activity after AAS development. Strict disease control before the development of AAS is crucial for preventing further progression and development of cervical lesions.
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Artritis Reumatoide/tratamiento farmacológico , Factores Biológicos/uso terapéutico , Vértebras Cervicales/efectos de los fármacos , Progresión de la Enfermedad , Inestabilidad de la Articulación/diagnóstico por imagen , Absorciometría de Fotón/métodos , Adulto , Anciano , Artritis Reumatoide/diagnóstico , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/efectos de los fármacos , Articulación Atlantoaxoidea/fisiopatología , Factores Biológicos/farmacología , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/tratamiento farmacológico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Dolor de Cuello/diagnóstico , Dolor de Cuello/tratamiento farmacológico , Dolor de Cuello/etiología , Dimensión del Dolor , Valor Predictivo de las Pruebas , Rango del Movimiento Articular/efectos de los fármacos , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
To observe and analyze the clinical effect of cervical paravertebral nerve block combined with Mailuoning and Angelica sinensis injection in treatment of nerve-root type cervical spondylosis. 120 patients who have been accepted by our hospital for nerve-root type cervical spondylosis were selected as research objects. They were randomly divided into a research group and a control group, each containing 60 patients. The control group was applied with glucocorticoid nerve block therapy, while the research group was treated by cervical paravertebral nerve block combined with Mailuoning and Angelica sinensis injection. The total therapeutic response rates of two groups were compared. The total therapeutic response rate of the research group was relatively higher,P<0.05. Through comparing various clinical effect scores between two groups, the research group also had advantages over control group, P<0.05. The treatment satisfaction degree of the research group was also higher than that of control group, P<0.05. The application of cervical paravertebral nerve block combined with Mailuoning and Angelica sinensis injection can achieve better medical results and achieve higher treatment satisfaction degree.
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Angelica sinensis , Vértebras Cervicales/efectos de los fármacos , Medicamentos Herbarios Chinos/uso terapéutico , Bloqueo Nervioso , Espondilosis/tratamiento farmacológico , Adulto , Anciano , Betametasona/uso terapéutico , Terapia Combinada/métodos , Quimioterapia Combinada/métodos , Femenino , Glucocorticoides/uso terapéutico , Humanos , Lidocaína/uso terapéutico , Masculino , Persona de Mediana EdadRESUMEN
Lidocaine effects in the spinal cord have been extensively investigated over the years. Although the intrathecal route is usually used to treat insults occurring in the spinal cord, the local delivery drug via intraparenchymal infusions has gained increasing favor for the treatment of some neurodegenerative disorders. The aim of the present study was to evaluate the behavioral and tissue effects of the intraparenchymal injection of different concentrations of lidocaine into the rat cervical spinal cord. Young male Sprague-Dawley rats were intraparenchymally injected with 0.5%, 1% or 2% lidocaine at the C5 segment of the spinal cord. Other rats were injected with saline solution (sham group). Hot plate test was determined at 0, 1, 2, 3, 7 and 14 post-injection (pi) days. Rats of each experimental group were euthanized either at 1, 2, 3, 7 or 14 pi days. Intact animals were used as controls. Sections of the C5 segment were used for histological, immunohistochemical or immunofluorescence analysis. Injection of 0.5% lidocaine did not affect neuronal counting, did not evoke an inflammatory reaction, nor induce astrocyte activation. Therefore, a concentration of 0.5% lidocaine is suggested to promote anti-inflammatory effects after injury.
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Vértebras Cervicales/efectos de los fármacos , Lidocaína/farmacología , Neuronas/efectos de los fármacos , Médula Espinal/efectos de los fármacos , Anestésicos Locales , Animales , Modelos Animales de Enfermedad , Inyecciones Espinales/métodos , Lidocaína/administración & dosificación , Masculino , Ratas Sprague-DawleyAsunto(s)
Angiografía de Substracción Digital/métodos , Vértebras Cervicales/diagnóstico por imagen , Inyecciones Epidurales/métodos , Fantasmas de Imagen , Esteroides/administración & dosificación , Vértebras Cervicales/efectos de los fármacos , Fluoroscopía/métodos , Humanos , Posicionamiento del Paciente , Seguridad del PacienteRESUMEN
AIM: To evaluate the effect of tumor necrosis factor α inhibitors (TNFi) on spinal radiographic progression in patients with ankylosing spondylitis (AS). METHODS: Subjects were selected from patients at a single tertiary hospital between 1995 and 2014. Patients who used TNFi with baseline and paired follow-up radiographic data with a minimum interval of 2 years were included. Time to start TNFi was defined as the time from symptom onset to the start of TNFi use. TNFi index was defined as the ratio of the period of TNFi use to the entire period of disease. Radiographic damage was assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Univariable and multivariable linear regression analyses were used to identify factors associated with radiographic progression. RESULTS: A total of 151 patients were included in the analysis. Seventeen (11.3%) patients were female and mean ΔmSASSS/year was 1.01 units/year. Mean X-ray follow-up duration was 102.9 ± 54.9 months. Mean time from symptom onset to start of TNFi use was 104.8 ± 83.6 months (median 84 months) and mean TNFi index was 42.9 ± 23.8% (median 40.9%). In multivariable analysis, initial mSASSS, initial C-reactive protein, body mass index, current smoker, and delayed start of TNFi use were associated with radiographic progression. Presence of peripheral arthritis and the TNFi index were negatively associated with radiographic progression. CONCLUSIONS: A delay in starting TNFi use and low TNFi index were associated with radiographic progression. Early and long-term use of TNFi appear to reduce spinal radiographic progression in patients with AS.
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Productos Biológicos/uso terapéutico , Vértebras Cervicales/efectos de los fármacos , Vértebras Lumbares/efectos de los fármacos , Espondilitis Anquilosante/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto , Productos Biológicos/efectos adversos , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/inmunología , Progresión de la Enfermedad , Femenino , Humanos , Modelos Lineales , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/inmunología , Masculino , Análisis Multivariante , Inducción de Remisión , Estudios Retrospectivos , Factores de Riesgo , Espondilitis Anquilosante/diagnóstico por imagen , Espondilitis Anquilosante/inmunología , Centros de Atención Terciaria , Factores de Tiempo , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/inmunología , Adulto JovenRESUMEN
Although rheumatoid arthritis (RA) is most commonly associated with peripheral joints, cervical spine involvement can be seen in almost 80% of patients in the presence of long-term disease, joint erosion, and risk factors such as male sex and rheumatoid factor positivity. It is very rare to have cervical involvement in the initial period of RA. If a patient has isolated cervical spine involvement without peripheral arthritis, it is highly likely that inappropriate investigations and delayed treatment may occur. Any damage that occurs in cervical spine may cause symptoms varying from slight instability to atlantoaxial subluxation, spinal cord and brain stem compression and even death. Therefore, physician should be aware that there may be isolated cervical involvement, albeit rare, in patients with RA. In this report, we presented a case of RA presenting with cervical spine involvement without peripheral arthritis to underline the importance of this kind of involvement in clinical practice. We also briefly reviewed other cases similar to ours in light of literature.
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Artritis Reumatoide/complicaciones , Vértebras Cervicales/fisiopatología , Dolor de Cuello/etiología , Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/fisiopatología , Fenómenos Biomecánicos , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/efectos de los fármacos , Quimioterapia Combinada , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Dolor de Cuello/diagnóstico , Dolor de Cuello/tratamiento farmacológico , Dolor de Cuello/fisiopatología , Dimensión del Dolor , Valor Predictivo de las Pruebas , Recuperación de la Función , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate the effect of interlaminar epidural steroid injection (ESI) for management of central cervical spinal stenosis-induced posterior neck pain. METHODS: This retrospective study recruited 45 patients with posterior neck pain caused by central cervical spinal stenosis. For the ESI procedure, a 21-gauge Touhy needle was inserted into the epidural space between C7 and T1, and 20 mg (40 mg/mL) of dexamethasone with 4 mL of normal saline was injected. The effect of the procedure was evaluated using a numerical rating scale at 1, 2, and 3 months after the procedure. Successful pain relief was defined as reduction in numerical rating scale score of ≥50% compared with before treatment. At 3 months after treatment, patient satisfaction levels were examined; patients who reported very good (score = 7) or good results (score = 6) were considered to be satisfied with the procedure. RESULTS: Posterior neck pain was significantly reduced at follow-up evaluation 1, 2, and 3 months after ESI (P < 0.001, repeated measures 1-factor analysis). At 3 months after the procedure, 58% of the patients achieved a successful response (≥50% pain reduction), and 56% were satisfied with treatment results. CONCLUSIONS: Cervical interlaminar ESI appears to be a good treatment method for managing chronic posterior neck pain induced by central cervical spinal stenosis, especially when pain is refractory to oral medication.
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Corticoesteroides/administración & dosificación , Vértebras Cervicales/diagnóstico por imagen , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/tratamiento farmacológico , Adulto , Anciano , Vértebras Cervicales/efectos de los fármacos , Espacio Epidural/diagnóstico por imagen , Espacio Epidural/efectos de los fármacos , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Epidurales/métodos , Masculino , Persona de Mediana Edad , Dolor de Cuello/diagnóstico por imagen , Dolor de Cuello/tratamiento farmacológico , Dolor de Cuello/etiología , Estudios Retrospectivos , Estenosis Espinal/complicaciones , Resultado del TratamientoRESUMEN
Cervical radiculopathy has become an increasing problem worldwide. Conservative treatment options have been recommended in many reviews on cervical radiculopathy, ranging from different types of physiotherapy to waiting for remission by natural history. No multimodal pain management concept (MPM) on an inpatient basis has been evaluated. This study aimed at showing the positive short-term effects of an inpatient multimodal pain management concept with focus on cervical translaminar epidural steroid injection for patients with cervical radiculopathy. 54 patients who had undergone inpatient MPM for 10 days were evaluated before and after 10-days treatment. The NRS (0-10) value for arm pain could be reduced from 6.0 (IQR 5.7-6.8) to 2.25 (IQR 2.0-3.1) and from 5.9 (IQR 4.8-6.0) to 2.0 (IQR 1.7-2.6) for neck pain. Neck pain was reduced by 57.4% and arm pain by 62.5%. 2 days after epidural steroid injection, pain was reduced by 40.1% in the neck and by 43.4% in the arms. MPM seems to be an efficient short-term approach to treating cervical radiculopathy. Cervical translaminar epidural steroid injection is an important part of this concept. In the absence of a clear indication for surgery, MPM represents a treatment option.
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Vértebras Cervicales/efectos de los fármacos , Manejo del Dolor/métodos , Radiculopatía/tratamiento farmacológico , Esteroides/administración & dosificación , Adulto , Brazo/fisiopatología , Vértebras Cervicales/fisiopatología , Femenino , Humanos , Inyecciones Epidurales , Masculino , Persona de Mediana Edad , Dolor de Cuello/tratamiento farmacológico , Dolor de Cuello/fisiopatología , Manejo del Dolor/estadística & datos numéricos , Dimensión del Dolor/métodos , Dimensión del Dolor/estadística & datos numéricos , Estudios Prospectivos , Radiculopatía/fisiopatología , Resultado del TratamientoRESUMEN
Objective. The aim of this study was to compare the efficacy of ultrasound-guided deep cervical plexus block with fluoroscopy-guided deep cervical plexus block for patients with cervicogenic headache (CeH). Methods. A total of 56 patients with CeH were recruited and randomly assigned to either the ultrasound-guided (US) or the fluoroscopy-guided (FL) injection group. A mixture of 2-4 mL 1% lidocaine and 7 mg betamethasone was injected along C2 and/or C3 transverse process. The measurement of pain was evaluated by patients' ratings of a 10-point numerical pain scale (NPS) before and 2 wks, 12 wks, and 24 wks after treatments. Results. The blocking procedures were well tolerated. The pain intensity, as measured by NPS, significantly decreased at 2 wks after injection treatment in both US and FL groups, respectively, compared with that of baseline (P < 0.05). The blocking procedures had continued, and comparable pain relieving effects appeared at 12 wks and 24 wks after treatment in both US and FL groups. There were no significant differences observed in the NPS before and 2 wks, 12 wks, and 24 wks after treatment between US and FL groups. Conclusions. The US-guided approach showed similar satisfactory effect as the FL-guided block. Ultrasonography can be an alternative method for its convenience and efficacy in deep cervical plexus block for CeH patients without radiation exposure.