Translation, Cross-Cultural Adaptation, and Validation of the Traditional Chinese Version of the VISA-P Questionnaire.

Background: The Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire is a widely accepted instrument for measuring the severity of symptoms and pain in patients having sustained patellar tendinopathy. Purpose: To adapt the VISA-P questionnaire cross-culturally to a traditional Chinese version (VISA-P-Ch) and validate its psychometric properties. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The VISA-P questionnaire was adapted to a traditional Chinese version following international recommended guidelines, including translation, synthesis, back translation, revision by expert committee, pretesting, and validation. The psychometric properties were tested in 15 healthy controls and 15 participants with patellar tendinopathy. Face validity was judged by the authors and participants. Known-groups validity was tested by comparing the VISA-P-Ch scores between symptomatic and asymptomatic participants using an independent t test. Concurrent validity was determined by comparing the Blazina classification of the participants against VISA-P-Ch scores using the Spearman correlation coefficient. Test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC) following a 24- to 48-hour interval. Internal consistency was determined by the Cronbach alpha. Results: The expert committee and participants reported good face validity of the VISA-P-Ch. Significantly higher scores were found in the control group than in the patellar tendinopathy group (98.47 ± 3.04 vs 65 ± 11.9; P < .001). Concurrent validity showed a high correlation between VISA-P-Ch and the Blazina classification system (r = -0.899; P < .01). The test-retest reliability was excellent (ICC = 0.964). Internal consistency was found to be good for both the first and second assessments (Cronbach α = 0.834 and 0.851). Conclusion: The VISA-P-Ch was proven to be a reliable and valid questionnaire with similar psychometric properties as the original VISA-P.

Effects of pilates exercises on radiographic lumbo-pelvic alignment and range of motion in non-specific low back pain patients.

OBJECTIVES: To determine the effects of Pilates exercises on lumbo-pelvic alignment in non-specific low back pain (NSLBP) patients. METHODS: Twenty-two patients (Male:7; Female:15) with NSLBP aged 20-65 years were recruited and classified based on a modified O'Sullivan's classification system into flexion pattern (FP) or active extension pattern (EP) groups. Oswestry Disability index (ODI), Roland-Morris Disability Questionnaire (RMDQ) as well as radiographic lumbar global range of motion (ROM) and lumbo-pelvic alignment were measured Pre- and immediately post-intervention and at 6- and 12-month. The intervention included supervised six-weeks Pilates program with 60 min per session and up to two sessions per week. RESULTS: Lumbar lordosis, sacral slope and sacral inclination were found to be significantly different between the FP and EP groups based on the O'Sullivan's classification system. However, despite the significant changes in RMDQ (p = 0.001), no significant changes were found for any of the alignment parameters (p > 0.05) post intervention for both groups. For lumbar global ROM, a statistically significant change was observed for the EP group (p = 0.028) but not for the FP group (p = 0.249). No significant correlations were identified between any of the self-reported outcomes, radiographic alignment and ROM parameters. CONCLUSIONS: Patients self-perceived long-term functional improvements based on responding to questionnaires after Pilates exercises were not reflected in significant changes in lumbo-pelvic alignment or lumbar ROM. This may be due to the current cohort demonstrating within normal ranges due to the lesser severity of their condition, but further research is needed for clarification.

ASIC3 roles in mechanosensitive elongation of nucleus pulposus cells.

Morphological changes of the nucleus pulposus (NP) cells occur concomitantly as part of the intervertebral disc (IVD) degeneration and excessive mechanical loading has been speculated as a significant key factor for contributing to such morphological changes. Therefore, we hypothesize that stress exerted on NP cells can cause a deformity of nucleus in response. The changes of cell morphology is observed in degenerative nucleus pulposus. One of the reasons for degeneration of NP is due to overloading of NP especially in the obese population. So the nucleus deformity caused by stress/force is of our study interest. To delineate the effects and role of mechanical stress, we developed a 3D assay using hydrogel cultures with a circular hole generated with needle indentation to simulate a local stress concentration along the edge of the hole. A stressed zone, encompassing 100 µm of range from the circular edge, is defined based on stress concentration calculation to enable quantitative analysis against the control zone. Our results demonstrated that the circular hole produces stress-induced morphological changes in NP cells. The tangential elongation of NP cells and their nucleus shape changes in the stressed zone are significantly increased compared to the non-stressed control zone. It is proposed that the cell elongation is a direct response to elevated stress within the stressed zone. Subsequently we found the stress induced morphological changes of the NP cells can be significantly reduced by inhibiting ASIC3. This suggests ASIC3 plays an important role of play in mechano-signaling of NP cells.

Optimizing Narrowband UVB Phototherapy: Is It More Challenging for Your Older Patients?

Narrowband UVB (NB-UVB) phototherapy remains versatile, safe, and efficacious for multiple dermatologic conditions even with recent pharmacologic treatment advances. Polypharmacy contributes to prescribers pursuing phototherapy as a nonpharmacologic treatment, but some wonder if it is as effective and safe for older patients. This study aimed to determine if NB-UVB is equally effective in both older and younger adults treated with the same protocol and to examine the association between photosensitizing medications, clearance, and erythema rates in older vs younger adults.

Activation of Mechanosensitive Ion Channels by Ultrasound.

Mechanosensitive channels (MSCs) play an important role in how cells transduce mechanical stimuli into electrical or chemical signals, which provides an interventional possibility through the manipulation of ion channel activation using different mechanical stimulation conditions. With good spatial resolution and depth of penetration, ultrasound is often proposed as the tool of choice for such therapeutic applications. Despite the identification of many ion channels as mechanosensitive in recent years, only a limited number of MSCs have been reported to be activated by ultrasound with substantial evidence. Furthermore, although many therapeutic implications using ultrasound have been explored, few offered insights into the molecular basis and the biological effects induced by ultrasound in relieving pain and accelerate tissue healing. In this review, we examined the literature, in particular studies that provided evidence of cellular responses to ultrasound, with and without the target ion channels. The ultrasound activation conditions were then summarized for these ion channels, and these conditions were related to their mode of activation based on the current biological concepts. The overall goal is to bridge the results relating to the activation of MSCs that is specific for ultrasound with the current knowledge in molecular structure and the available physiological evidence that may have facilitated such phenomena. We discussed how collating the information revealed by available scientific investigations helps in the design of a more effective stimulus device for the proposed translational purposes. Traditionally, studies on the effects of ultrasound have focused largely on its mechanical and physical interaction with the targeted tissue through thermal-based therapies as well as non-thermal mechanisms including ultrasonic cavitation; gas body activation; the direct action of the compressional, tensile and shear stresses; radiation force; and acoustic streaming. However, the current review explores and attempts to establish whether the application of low-intensity ultrasound may be associated with the activation of specific MSCs, which in turn triggers relevant cell signaling as its molecular mechanism in achieving the desired therapeutic effects. Non-invasive brain stimulation has recently become an area of intense research interest for rehabilitation, and the implication of low-intensity ultrasound is particularly critical given the need to minimize heat generation to preserve tissue integrity for such applications.

Auditory independent low-intensity ultrasound stimulation of mouse brain is associated with neuronal ERK phosphorylation and an increase of Tbr2 marked neuroprogenitors.

Transcranial ultrasound stimulation is an emerging technique for the development of a non-invasive neuromodulation device for the treatment of various types of neurodegenerations and brain damages. However, there are very few studies that have quantified the optimal ultrasound dosage and the long-term associated effects of transcranial ultrasound treatments of brain diseases. In this study, we used a simple ex vivo hippocampal tissues stimulated by different dosages of ultrasound in combination with different chemical treatments to quantify the required energy for a measurable effect. After determining the most desirable ex vivo stimulation conditions, it was then replicated for the in vivo mouse brains. It was discovered that transcranial ultrasound promoted the increase of Tbr2-expressing neural progenitors in an ASIC1a-dependent manner. Furthermore, such effect was observable at least a week after the initial ultrasound treatments and was not abolished by auditory toxicity.

Phototherapy: Safe and Effective for Challenging Skin Conditions in Older Adults.

Identifying safe, effective, and affordable evidence-based dermatologic treatments for older adults can be challenging because of age-related changes. Few studies have examined the effectiveness of phototherapy in older adults. Our retrospective study of patients 65 years and older who were treated with narrowband UVB(NB-UVB) phototherapy aimed to (1) identify the most common dermatologic conditions treated with phototherapy in older adults, (2) examine the effectiveness and safety of phototherapy in older adults, and (3) compare the outcomes to 2 similar studies in the United Kingdom and Turkey.

Ultrasound Acupuncture for Oxaliplatin-induced Peripheral Neuropathy in Patients With Colorectal Cancer: A Pilot Study.

BACKGROUND: Oxaliplatin is frequently used in the treatment of metastatic colorectal cancer. However, peripheral neuropathy is a severe adverse effect of oxaliplatin that may persist and impact quality of life. OBJECTIVE: To assess the potential effects of ultrasound acupuncture for the alleviation of symptoms related to oxaliplatin-induced peripheral neuropathy (OIPN) among patients with metastatic colorectal cancer. DESIGN: Prospective cohort pilot study. SETTING: Education and research hospital. PARTICIPANTS: Patients with a diagnosis of stage II-IV colorectal cancer undergoing oxaliplatin-based treatment regimens who experienced OIPN symptoms (n = 17). INTERVENTIONS: Pulsed therapeutic ultrasound (1 MHz) at bilateral acupuncture points of PC6, PC7, BL60, and KI1 was administered for 5 minutes per point daily for 12 days. MAIN OUTCOME MEASUREMENTS: Pain Quality Assessment Scale (PQAS), Chemotherapy-induced Neurotoxicity Questionnaire (CINQ), quantitative touch-detection threshold, cold-trigger pain withdrawal latency, and quality of life (EORTC QLQ-C30) were measured at baseline (day 0), pre-intervention (day 12, post wash-out period), post-intervention (day 24), and final follow-up (day 54). A P value of less than .05 was considered statistically significant. RESULTS: Scores of PQAS and CINQ significantly improved after ultrasound acupuncture at post-intervention and follow-up compared to both baseline and pre-intervention. Similar trends were also observed for the quantitative sensory testing, where touch-detection threshold significantly decreased and cold-trigger pain withdrawal latency significantly increased after ultrasound acupuncture. Patients also showed an improvement on quality of life outcomes as measured by QLQ-C30 post-intervention and at follow-up. CONCLUSIONS: Ultrasound acupuncture could be an effective intervention for OIPN symptoms for patients with colorectal cancer. However, larger and randomized clinical trials with placebo controls are needed to confirm such effects.

Upright Balance Control in Individuals with Cervical Myelopathy Following Cervical Decompression Surgery: A Prospective Cohort Study.

Patients with cervical myelopathy may manifest impairments in functional activities and balance control caused by compression of the spinal cord. The objective of the current study was to determine long-term changes in the upright balance control of patients with cervical myelopathy who had undergone cervical decompression surgery. This is a prospective cohort study from the preoperative phase to 3 months, 6 months, and 1 year postsurgery. Fifty-three patients with cervical myelopathy were recruited for the cervical myelopathy group and 22 age-matched healthy controls were recruited for the control group. Functional assessments including Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire-Lower Extremity Function (JOACMEQ-LEF) and 10-second step test; as well as balance assessments including postural sway (center-of-pressure: COP) were performed for both groups. The JOACMEQ-LEF (p = 0.036) scores of the myelopathy group improved postoperatively, and a significant decrease in COP variables of postural sway was observed. The upright posture was less stable in the myelopathy group than in the control group (p < 0.05) both before and after surgery. The effect size and standard response mean of the COP variables ranged from -0.49 to 0.03 at 3 months, 6 months, and 1 year postsurgery. The upright balance control had improved significantly 6 months after decompression surgery. However, the balance control of the patients who had undergone decompression surgery remained less stable than that of the age-matched healthy controls. Balance training should be initiated before 6 months postsurgery to accelerate balance control recovery in patients with cervical myelopathy.

Perturbation-Based Balance Training in Postoperative Individuals With Degenerative Cervical Myelopathy.

Degenerative cervical myelopathy (DCM) is a common aging condition caused by spinal cord compression. Individuals with DCM often presented with residual balance and functional impairments postoperatively. Perturbation-based balance training (PBT) has been shown to have positive effects on populations with neurological disorders but has yet to be investigated in DCM. The objective of this study was therefore to evaluate the effects of PBT on balance and functional performance in postoperative individuals with DCM. Fifteen postoperative individuals with DCM (DCM group) and 14 healthy adults (healthy control group) were recruited. The DCM group received a 4-weeks PBT using a perturbation treadmill. The outcome measures included mean velocity of center of pressure (COP) during quiet standing; center of mass (COM) variance and reaction time to balance perturbation during standing with forward and backward perturbation; gait speed during level ground walking; Timed Up and Go Test (TUG) and disability questionnaire scores including Visual Analog Scale, Neck Disability Index, and Lower Extremity Function of Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. The assessments were conducted pre- and post-training postoperatively for the DCM group but only once for the healthy control group. Significant improvements were observed in the mean velocity of COP, COM variance, reaction time, gait speed, and TUG in the DCM group. Disability questionnaire scores were not significantly different after training in DCM group. For between-group comparisons, significant differences that were observed pre-training were not observed post-training. The 4-weeks PBT is a potential rehabilitation strategy for addressing balance and functional impairment in postoperative individuals with DCM. In addition, the post-training performance in the DCM group exhibited trends comparable to those of age-matched healthy controls. Furthermore, the training regimens offer a practical reference for future studies on populations with balance disorders. Future studies complemented with neurophysiological assessments could reveal more information of the underlying mechanisms of PBT.

Heterogeneous influences of emotional disturbances on multi-domain quality of life after anterior cervical spine surgery: A prospective study.

OBJECTIVE: Quality of life (QoL) has been identified as one of the most important outcome measurements following cervical spine surgery. The contributing factors to post-operative QoL remain limited. This study thus aimed to prospectively examine the QoL and related pre-operative emotional factors in patients who underwent anterior cervical spine surgery. PATIENTS AND METHODS: A total of 124 patients who underwent anterior cervical spine surgery were recruited. All participants were prospectively evaluated for their QoL and 2 aspects of emotion, depression and anxiety, before and after surgery, respectively. RESULTS: Pre-operatively, 13% of patients showed signs of depression and 31% of patients reported symptoms of anxiety. Post-operatively 14% of patients reported depression, but 41% reported symptoms of anxiety. A significant association between depression, anxiety and different domains of QoL were identified, and specific cut-off points of pre-operatively depressive and/or anxiety levels to predict unfavorable post-operative QoL were further established. CONCLUSIONS: This prospective study demonstrated specific emotional factors, specifically depression and anxiety, influence patients' QoL following surgery. These results suggest clinicians should also monitor patients' emotional adjustments with their physical conditions.

Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery.

BACKGROUND: Cervical spondylotic myelopathy (CSM) is a degenerative cervical disease in which the spinal cord is compressed. Patients with CSM experience balance disturbance because of impaired proprioception. The weighting of the sensory inputs for postural control in patients with CSM is unclear. Therefore, this study investigated the weighting of sensory systems in patients with CSM. METHOD: Twenty-four individuals with CSM (CSM group) and 24 age-matched healthy adults (healthy control group) were analyzed in this observational study. The functional outcomes (modified Japanese Orthopaedic Association Scale [mJOA], Japanese Orthopaedic Association Cervical Myelopathy Questionnaire [JOACMEQ], Nurick scale) and static balance (eyes-open and eyes-closed conditions) were assessed for individuals with CSM before surgery, 3 and 6 months after surgery. Time-domain and time-frequency-domain variables of the center of pressure (COP) were analyzed to examine the weighting of the sensory systems. RESULTS: In the CSM group, lower extremity function of mJOA and Nurick scale significantly improved 3 and 6 months after surgery. Before surgery, the COP mean velocity and total energy were significantly higher in the CSM group than in the control group for both vision conditions. Compared with the control group, the CSM group exhibited lower energy content in the moderate-frequency band (i.e., proprioception) and higher energy content in the low-frequency band (i.e., cerebellar, vestibular, and visual systems) under the eyes-open condition. The COP mean velocity of the CSM group significantly decreased 3 months after surgery. The energy content in the low-frequency band (i.e., visual and vestibular systems) of the CSM group was closed to that of the control group 6 months after surgery under the eyes-open condition. CONCLUSION: Before surgery, the patients with CSM may have had compensatory sensory weighting for postural control, with decreased weighting on proprioception and increased weighting on the other three sensory inputs. After surgery, the postural control of the patients with CSM improved, with decreased compensation for the proprioceptive system from the visual and vestibular inputs. However, the improvement remained insufficient because the patients with CSM still had lower weighting on proprioception than the healthy adults did. Therefore, patients with CSM may require balance training and posture education after surgery. TRIAL REGISTRATION: Trial Registration number: NCT03396055 Name of the registry: ClinicalTrials.gov Date of registration: January 10, 2018 - Retrospectively registered Date of enrolment of the first participant to the trial: October 19, 2015.

Emergency Department Visits and Disease Burden Attributable to Ambulatory Care Sensitive Conditions in Elderly Adults.

Many countries worldwide are aging rapidly, and the complex care needs of older adults generate an unprecedented demand for health services. Common reasons for elderly emergency department (ED) visits frequently involve conditions triggered by preventable infections also known as ambulatory care sensitive conditions (ACSCs). This study aims to describe the trend and the associated disease burden attributable to ACSC-related ED visits made by elderly patients and to characterize their ED use by nursing home residence. We designed a population-based ecological study using administrative data on Taiwan EDs between 2002 and 2013. A total of 563,647 ED visits from individuals aged 65 or over were examined. All elderly ED visits due to ACSCs (tuberculosis, upper respiratory infection, pneumonia, sepsis, cellulitis and urinary tract infection (UTI)) were further identified. Subsequent hospital admissions, related deaths after discharge, total health care costs and disability-adjusted life years (DALYs) were compared among different ACSCs. Prevalence of ACSCs was then assessed between nursing home (NH) residents and non-NH residents. Within the 12-year observation period, we find that there was a steady increase in both the rate of ACSC ED visits and the proportion of elderly with a visit. Overall, pneumonia is the most prevalent among six ACSCs for elderly ED visits (2.10%; 2.06 to 2.14), subsequent hospital admissions (5.77%; 5.59 to 5.94) and associated mortality following admission (17.37%; 16.74 to 18.01). UTI is the second prevalent ACSC consistently across ED visits (2.02%; 1.98 to 2.05), subsequent hospital admissions (2.36%, 2.25 to 2.48) and mortality following admission (10.80%; 10.28 to 11.32). Sepsis ranks third highest in the proportion of hospitalization following ED visit (2.29%; 2.18 to 2.41) and related deaths after hospital discharge (7.39%; 6.95 to 7.83), but it accounts for the highest average total health care expenditure (NT$94,595 ± 120,239; ≈US$3185.02) per case. When examining the likelihood of ACSC-attributable ED use, significantly higher odds were observed in NH residents as compared with non-NH residents for: pneumonia (adjusted odds ratio (aOR): 5.01, 95% confidence interval (CI) 4.50-5.58); UTI (aOR: 4.44, 95% CI 3.97-4.98); sepsis (aOR: 3.54, 95% CI 3.06-4.10); and tuberculosis (aOR: 2.44, 95% CI 1.63-3.65). Here we examined the ACSC-related ED care and found that, among the six ACSCs studied, pneumonia, UTI and sepsis were the leading causes of ED visits, subsequent hospital admissions, related mortality, health care costs and DALYs in Taiwanese NH elderly adults. Our findings suggest that efficient monitoring and reinforcing of quality of care in the residential and community setting might substantially reduce the number of preventable elderly ED visits and alleviate strain on the health care system.

Effect of pedicle screw diameter on screw fixation efficacy in human osteoporotic thoracic vertebrae.

The selection of an ideal screw size plays a crucial role in the success of spinal instrumentation as larger diameter screws are thought to provide better fixation strength but increase the risk of pedicle failure during insertion. On the other hand, smaller diameter screws are with lesser risk of pedicle breakage but are thought to compromise the stability of the instrumentation. By investigating the relationship between screw diameter and the pullout strength of pedicle screws after fatigue loading, this study seeks to find quantitative biomechanical data for surgeons in determining the most ideal diameter size screws when performing surgical implementations on osteoporotic vertebrae. Twenty-seven osteoporotic (BMD ranged: 0.353-0.848 g/cm2) thoracic vertebrae (T3-T8) were harvested from 5 human cadavers. Two sizes of poly-axial screws (5.0 mm × 35 and 4.35 mm × 35) were implanted into each pedicles of the vertebrae by an experienced surgeon. Specimens were randomly distributed into control group, fatigue group of 5000 and 10,000 cycles with peak-to-peak loadings of 10-100 N at 1 Hz. Each specimen was then axial pullout tested at a constant rate of 5 mm/min. The ultimate pullout strength (N) & stiffness (N/mm) were obtained for analysis. The results showed that although the larger diameter screws achieved superior pullout strength immediately after the implantation, both sizes of screws exhibited comparable pullout strengths post fatigue loading. This indicates that the smaller diameter screws may be considered for surgical techniques performed on osteoporotic vertebrae for reduced risk of pedicle breakage without sacrificing fixation strength.

Association between Lithium Use and Melanoma Risk and Mortality: A Population-Based Study.

Laboratory studies show that lithium, an activator of the Wnt/ß-catenin signaling pathway, slows melanoma progression, but to our knowledge no published epidemiologic studies have explored this association. We conducted a retrospective cohort study of adult white Kaiser Permanente Northern California members (n = 2,213,848) from 1997-2012 to examine the association between lithium use and melanoma risk. Lithium exposure (n = 11,317) was assessed from pharmacy databases, serum lithium levels were obtained from electronic laboratory databases, and incident cutaneous melanomas (n = 14,056) were identified from an established cancer registry. In addition to examining melanoma incidence, melanoma hazard ratios and 95% confidence intervals for lithium exposure were estimated using Cox proportional hazards models, adjusted for potential confounders. Melanoma incidence per 100,000 person-years among lithium-exposed individuals was 67.4, compared with 92.5 in unexposed individuals (P = 0.027). Lithium-exposed individuals had a 32% lower risk of melanoma (hazard ratio = 0.68, 95% confidence interval = 0.51-0.90) in unadjusted analysis, but the estimate was attenuated and nonsignificant in adjusted analysis (adjusted hazard ratio = 0.77, 95% confidence interval = 0.58-1.02). No lithium-exposed individuals presented with thick (>4 mm) or advanced-stage melanoma at diagnosis. Among melanoma patients, lithium-exposed individuals were less likely to suffer melanoma-associated mortality (rate = 4.68/1,000 person-years) compared with the unexposed (rate = 7.21/1,000 person-years). Our findings suggest that lithium may reduce melanoma risk and associated mortality.

Investigation of the Differential Contributions of Superficial and Deep Muscles on Cervical Spinal Loads with Changing Head Postures.

Cervical spinal loads are predominately influenced by activities of cervical muscles. However, the coordination between deep and superficial muscles and their influence on the spinal loads is not well understood. This study aims to document the changes of cervical spinal loads and the differential contributions of superficial and deep muscles with varying head postures. Electromyography (EMG) of cervical muscles from seventeen healthy adults were measured during maximal isometric exertions for lateral flexion (at 10°, 20° and terminal position) as well as flexion/extension (at 10°, 20°, 30°, and terminal position) neck postures. An EMG-assisted optimization approach was used to estimate the muscle forces and subsequent spinal loads. The results showed that compressive and anterior-posterior shear loads increased significantly with neck flexion. In particular, deep muscle forces increased significantly with increasing flexion. It was also determined that in all different static head postures, the deep muscle forces were greater than those of the superficial muscle forces, however, such pattern was reversed during peak efforts where greater superficial muscle forces were identified with increasing angle of inclination. In summary, the identification of significantly increased spinal loads associated with increased deep muscle activation during flexion postures, implies higher risks in predisposing the neck to occupationally related disorders. The results also explicitly supported that deep muscles play a greater role in maintaining stable head postures where superficial muscles are responsible for peak exertions and reinforcing the spinal stability at terminal head postures. This study provided quantitative data of normal cervical spinal loads and revealed motor control strategies in coordinating the superficial and deep muscles during physical tasks.

Comparison of Cervical Kinematics, Pain, and Functional Disability Between Single- and Two-level Anterior Cervical Discectomy and Fusion.

STUDY DESIGN: A prospective, time series design. OBJECTIVE: The purpose of this study is two-fold: firstly, to investigate the impact of altered cervical alignment and range of motion (ROM) on patients' self-reported outcomes after anterior cervical discectomy and fusion (ACDF), and secondly, to comparatively differentiate the influence of single- and two-level ACDF on the cervical ROM and adjacent segmental kinematics up to 12-month postoperatively. SUMMARY OF BACKGROUND DATA: ACDF is one of the most commonly employed surgical interventions to treat degenerative disc disease. However, there are limited in vivo data on the impact of ACDF on the cervical kinematics and its association with patient-reported clinical outcomes. METHODS: Sixty-two patients (36 males; 55.63 ±â€Š11.6 yrs) undergoing either a single- or consecutive two-level ACDF were recruited. The clinical outcomes were assessed with the Pain Visual Analogue Scale (VAS) and the Neck Disability Index (NDI). Radiological results included cervical lordosis, global C2-C7 ROM, ROM of the Functional Spinal Unit (FSU), and its adjacent segments. The outcome measures were collected preoperatively and then at 3, 6, and 12-month postoperatively. RESULTS: A significant reduction of both VAS and NDI was found for both groups from the preoperative to 3-month period (P < 0.01). Pearson correlation revealed no significant correlation between global ROM with neither VAS (P = 0.667) nor NDI (P = 0.531). A significant reduction of global ROM was identified for the two-level ACDF group at 12 months (P = 0.017) but not for the single-level group. A significant interaction effect was identified for the upper adjacent segment ROM (P = 0.024) but not at the lower adjacent segment. CONCLUSION: Current study utilized dynamic radiographs to comparatively evaluate the biomechanical impact of single- and two-level ACDF. The results highlighted that the two-level group demonstrated a greater reduction of global ROM coupled with an increased upper adjacent segmental compensatory motions that is independent of patient-perceived recovery. LEVEL OF EVIDENCE: 3.

Identification of head control deficits following anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy.

PURPOSE: To investigate the presence of head control deficits and its course of recovery after anterior cervical discectomy and fusion (ACDF) surgery in cervical spondylotic myelopathy (CSM) patients. METHODS: Thirty-seven CSM patients were assessed for their C2-C7 cervical lordosis, neck Range of Motion (ROM), repositioning accuracy, neck strength as well as surface electromyography of the neck muscle activities during slow head motions. Assessments were performed preoperatively and then at 3- and 6-month postoperatively. RESULTS: No significant difference was found for the C2-C7 cervical lordosis postoperatively at 6-month. ROM was restricted immediately after surgery but recovered over time, however, neck strength remained significantly reduced postoperatively. Reposition accuracy improved immediately after surgery but declined again at 6-month follow-up. In addition, muscle activities required to control head motions showed a continuous reduction postoperatively. CONCLUSIONS: Adequate C2-C7 cervical lordosis was maintained in the current study with improvement of slow head motion control and ROM at 6-month. However, improvement in head position sense was not maintained and neck strength showed continuous declination overtime. Assessment and monitoring of head control deficits should be routinely considered in CSM patients.

Exercise training for non-operative and post-operative patient with cervical radiculopathy: a literature review.

[Purpose] Cervical radiculopathy is a clinical condition associated with pain, numbness and/or muscle weaknesses of the upper extremities due to a compression or irritation of the cervical nerve roots. It is usually managed conservatively but surgical intervention is sometimes required for those who fail to respond adequately. This study performed a literature review to determine the effects of exercise on non-operative and post-operative cervical radiculopathy patients. [Methods] The PubMed, MEDLINE, CINAHL and Scopus databases were searched to identify relevant articles published from January 1997 to May 2014, which explicitly stated that an exercise program was employed as an intervention for cervical radiculopathy. The therapeutic effectiveness and outcomes were then classified based on the International Classification of Functioning, Disability and Health (ICF) model. [Results] Eleven studies were identified and included in the final analysis. In these studies, the main forms of exercise training were specific strengthening and general stretching exercises. Levels of evidence were graded as either I or II for all studies according to the Oxford Centre for Evidence-based Medicine. The PEDro Scale score of these studies ranged from 5 to 8. [Conclusion] A review of eleven high-level evidence and high-quality studies revealed that, based on the ICF model, exercise training is beneficial for improving the body function as well as activity participation of cervical radiculopathy patients.

Responsiveness of the Chinese versions of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire and Neck Disability Index in postoperative patients with cervical spondylotic myelopathy.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To evaluate the postoperative responsiveness of the Chinese versions of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and the Neck Disability Index (NDI) in a cohort of patients with cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: We have recently completed the translation and cross-cultural adaptation of a Chinese version of JOACMEQ. However, the postoperative responsiveness of the Chinese JOACMEQ and how it compares with the more commonly used NDI remain undetermined. METHODS: Forty-five patients with cervical spondylotic myelopathy undergoing surgical decompression were recruited. All patients completed the Chinese JOACMEQ and the NDI preoperatively and again at 3-month follow-up together with an 11-point Global Rating of Change scale. Patients were dichotomized either as "Improved" or "Stable" on the basis of Global Rating of Change. Paired t test, standardized effect sizes, and Guyatt responsiveness index were used to determine internal responsiveness. External responsiveness was evaluated by the area under the receiver operating characteristic curve and the minimal clinically important change was determined as the optimal cutoff point for patient discrimination anchor-based on Global Rating of Change classification. RESULTS: Bladder function and quality of life (QOL) domains (P < 0.03) of the JOACMEQ and the NDI (P = 0.004) reached statistically significant difference with the paired t test. After the dichotomization, the standardized effect size was strong for the QOL domain in the improved group (0.85) and the Cervical spine function (0.97) in the stable group, respectively. Based on the Guyatt responsiveness index, strong responsiveness was found for the Bladder function (0.88) and QOL (0.76) domains of the JOACMEQ and moderate responsiveness (0.55) for the NDI. The Bladder function (area = 0.82; minimal clinically important change = 6) and QOL (0.83; minimal clinically important change = 8.5) also produced largest area under the receiver operating characteristic curve. CONCLUSION: Bladder function and QOL domains of the JOACMEQ seem to demonstrate the strongest postoperative responsiveness and thus may be more appropriate than NDI when attempting to determine treatment efficacy in cervical spondylotic myelopathy. LEVEL OF EVIDENCE: 3.