Renal Artery Dissection in a Patient With Degenerative Scoliosis: A Rare Complication Caused by Lumbar Vertebra Osteophyte.

Isolated spontaneous renal artery dissection (RAD) without known trauma is rare, and its etiology has not been determined. However, notable risk factors including hypertension, strenuous exercise, connective tissue disorders, atherosclerosis, extracorporeal shock wave lithotripsy, and cocaine abuse have been reported. To the best of our knowledge, isolated RAD caused by lumbar vertebra osteophytes in patients with degenerative lumbar scoliosis has not been reported in the literature. In this article, we present a case of RAD caused by lumbar vertebra osteophyte in a patient with degenerative scoliosis and discuss the management of the disease.

Anterior Cervical Osteophyte Presenting as a Pharyngeal Mass / Osteofito cervical anterior que se presenta como una masa faríngea

No disponible

Vertebral spinal osteophytes.

Osteoarthritis is a common complication in the elderly and is often associated with osteophyte growth on vertebral bodies. The clinical presentation of vertebral osteophytes is related to anatomical structures adjacent to the spinal column. For instance, cervical osteophytes potentially involve the pharynx and esophagus, leading to dysphagic symptoms that may be accompanied by food aspiration, vocal fold paralysis and obstructive sleep apnea. In addition to anterior cervical osteophytes, posterior and uncinate process osteophytes may form, compressing the spinal cord and vertebral artery blood supply, respectively. Cervical osteophytes have also been shown to form an accessory median atlanto-occipital joint when the relationship between the atlas, dens and basiocciput is involved. In the thorax, the esophagus is often affected by osteophytes and may result in dysphagia. Traumatic and non-traumatic thoracic aorta pseudoaneurysm formation has been attributed to sharp osteophytes lacerating the aorta, a direct complication of the relationship between the aorta anterior vertebral column. Additionally, aspiration pneumonia was reported in patients with compression of a main stem bronchus, due to mechanical compression by thoracic osteophytes. In the lumbar spinal region, the two major structures in close proximity to the spine are the inferior vena cava and abdominal aorta, both of which have been reported to be affected by osteophytes. Treatment of osteophytes is initially conservative with anti-inflammatory medications, followed by surgical removal. Increasing obesity and geriatric populations will continue to result in an array of osteoarthritic degenerative changes such as osteophyte formation.

The role of oligodendrocytes in the molecular pathobiology and potential molecular treatment of cervical spondylotic myelopathy.

Cervical spondylotic myelopathy (CSM) is a very common and debilitating disease; however, its underlying pathocellular process remains uncertain. Attempts have been made to reproduce CSM in experimental animal models in order to deepen the knowledge on the molecular pathobiology of this disease. The up-to-date observations have established the apoptosis of oligodendrocytes (OLGs) as the principal pathocellular process of CSM. Since favorable neurological recovery cannot be obtained in afflicted patients, even after the decompression surgery, elucidation of the apoptotic cascade in OLGs may unveil possible molecular treatments which could inhibit demyelination and ameliorate the neurological deficits. Moreover, additional therapeutic benefits may include improvement of myelin self-repair capability by stimulating OLG progenitor cells to become mature and finally, myelinating OLGs. This review focuses on the factors and mechanisms of crucial importance for developing antiapoptotic treatments. Critical evaluations of the role of OLGs in molecular pathobiology of CSM as well as strategies for potential remyelination of CSM are also provided. The analyses and evaluations of the experimental findings can possibly lead to treatment of CSM as well as to development of novel biopharmacenticals.

[Lumbar spinal stenosis--claudicatio spinalis. Pathophysiology, clinical aspects and treatment]. / Lumbale Spinalkanalstenose - Claudicatio spinalis. Pathophysiologie, Klinische Aspekte und Therapie.

The lumbar spinal stenosis (LSS) is defined as a narrowing of the spinal canal together with neuronal and vascular structures via circumjacent bone and soft tissue. In patients aged over 65 years, the LSS is among the most frequent causes of lumbago, either with or without sciatica. The prevalence will continue to augment because of the increased life expectancy. The leading symptom is neurogenic claudicatio with lumbogluteal or sciatic pain, which occurs while walking and leads to a limitation of the walking distance. Its typical constellation of symptoms including subjective leg weakness is leading to the tentative diagnosis. Nowadays, the imaging technique of choice for the diagnosis is magnetic resonance imaging. A conservative treatment is initially sufficient in most cases. The indication for surgery is given, if the pain and limitation of walking distance are not tolerable any more. Additional fusion should be taken into account, when degenerative spondylolisthesis or other pathomorphological alterations result in an instability. Conservative and surgical therapeutic goals imply pain relief, amelioration of the physical functionality, mobility and general quality of life.

Systematic review and meta-analysis of the efficacy of tuina for cervical spondylosis.

AIMS AND OBJECTIVES: This study performed a meta-analysis of seven parallel-group comparison studies evaluating the efficacy of tuina in treating cervical spondylosis. BACKGROUND: Tuina is a form of Chinese manipulative therapy. It has been used as a modality for the treatment of symptoms associated with such a musculoskeletal condition as cervical spondylosis. However, evidence regarding the efficacy of tuina for cervical spondylosis has yet to be determined. DESIGN: Systematic review. METHODS: Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words: tuina, tuinaology, manual medicine, massotherapy, cervical spondylopathy, cervical spondylosis and cervical vertebrae. Chinese research papers were searched through the Chinese electronic periodical services and Wangfane database. The publication date was limited from 1996-2007. Studies were selected if they were written in English or Chinese, used tuina as a stand-alone modality, used a parallel-group comparison design and explicated raw data regarding symptoms relief. Two independent reviewers reviewed the selected studies based on the evidence rating system of the US Preventive Services Task Force. Studies with an evidence rating of II-2 fair or above were included in this review. RESULTS: The direction of the effect size for the improvement of blood flow velocity of vertebral artery and basilar artery was not consistent across studies. Moreover, the pooled effect size was negligible. No evidence supported that tuina could improve headache and vertigo. A small effect of tuina on the viscosity of blood and plasma was found. CONCLUSION: Based on the results of this systematic review, a definitive conclusion regarding the effects of tuina on cervical spondylosis remains to be determined. RELEVANCE TO CLINICAL PRACTICE: The efficacy of tuina is not supported by parallel-group comparison studies.

[Cervicogenic headache]. / Szyjnopochodny ból glowy.

In 2004 cervicogenic headache was introduced into ICD-10 classification. The reasons of cervicogenic headache are changes within bones, soft tissue and nervous structures of cervical spine section. The pain may spread to the neck, occipital area of skull, area of jaw and eyeballs, and arms. There are many theories trying to explain spreading of the pain outside the area innervated by C1, C2 and C3 cervical roots. Their common denominator is communication between fibres running in those roots and neurons of trigeminal nerve. Many authors describe a possibility of such connection through the jelly-like nucleus of the trigeminal nerve located in the back funiculi of spinal cord. In this mechanism, the pain conducted via occipital nerves may affect activity of neurons of the trigeminal nerve and influence areas innervated by the trigeminal nerve. In general case history and physical examination are sufficient to make a diagnosis. Additional radiological and imaging examinations support this diagnosis. According to some authors, the necessary condition to make a diagnosis of cervicogenic headache is finding the changes of spondylosis nature of the cervical spine section in additional examinations. In doubtful cases, diagnostic blockade of greater occipital nerve, resulting in headache relief, supports finally a diagnosis. Any treatment includes pharmacotherapy, rehabilitation, psychotherapy and surgical methods. The purpose of the study is to view literature on cervicogenic headache which causes many diagnostic problems and hence makes it difficult to choose effective treatment.

Cervical spondylotic myelopathy: proposal of a surveillance algorithm.

The review of the publications concerning cervical spondylotic myelopathy (CSM) suggests that it has not been achieved a clear consensus about the treatment of this pathology. In this paper an algorithm of surveillance, conceived as an assistant tool to decide the best indications of treatment is presented. The algorithm permits a clear separation of the symptomatic patients on the base of the presence or the absence of neurologic damage resulting at the evoked potentials examination. The negativity of the evoked potentials, that means neurologic integrity, excludes any type of surgical treatment. In case of proved neurologic damage, the algorithm permits a further differentiation in subgroups according to the degree of clinical disability. If evoked potentials are positive, a surgical decompression should be always performed in patients affected by a severe clinical disability. The group of patients affected by a mild degree of clinical disability but with positive evoked potentials represents the most challenging for the spinal surgeons. Actually, several studies support either surgical and non surgical treatment for these patients. Although the Authors think that a surgical decompression has to be always performed in case of proved neurologic damage, only further randomized studies based on accurate algorithms could elucidate the outcome of the CSM and could permit to choose the best treatment according to the degree of the disease.

Cervical spinal cord injury without bony injury: a multicenter retrospective study of emergency and critical care centers in Japan.

BACKGROUND: To demonstrate the clinical characteristics of patients with cervical cord injury (CCI) without bony injury in Japan. METHODS: Retrospective review of 127 patients with CCI without bony injury treated between January 2003 and October 2005 at 11 institutions. RESULTS: Prevalence of CCI without bony injury was 32.2% among all CCIs and 0.81% among all blunt traumas. Mean age was 60.4 years (range, 19-90 years), with 104 patients (82%) > or = 46 years old (older group). The major mechanism of injury among younger patients (< 46 years) was traffic injuries (39%), whereas minor falls (44%) predominated in older patients. High-energy mechanisms of injury were significantly more common for younger patients (35% versus 15%, p = 0.041). Mean injury severity score, abbreviated injury score for the head and Glasgow coma scale on admission were 17.2 +/- 4.7, 0.6 +/- 0.9, and 14.2 +/- 2.1, respectively. Incomplete CCI occurred in 88.7%. On plain cervical spine radiography, spinal canal stenosis and spondylosis or ossification of the posterior longitudinal ligament were more frequent in older patients than in younger patients (43% vs. 13%, p = 0.008; 54% vs. 17%, p = 0.002, respectively). No abnormal findings were seen in 52% of younger patients. CONCLUSION: CCI without bony injury occurred more frequently in this study population than previously reported. Degenerative changes and spinal canal stenosis represent important risk factors for developing CCI without bony injury and the present results suggest that this injury may occur in younger adults during high-energy injuries in the absence of pre-existing cervical spine disease.

[The evidence-based occupational health paradigm in managing back pain: identifying the problem and evaluation of the decision]. / Il paradigma dell'evidence based occupational health nella gestione della rachialgia in operatori sanitari: dalla formulazione del quesito alla valutazione della decisione.

BACKGROUND: Occupational health professionals must rely on the best available evidence in support of the appropriateness of diagnostic tests and preventive or clinical interventions. This study aims at comparing the decisions made in respect of health care personnel with the decisions made on the basis of the evidence and evaluating the effectiveness of these decisions. MATERIALS AND METHODS: Five female nurses with back problems exposed to health risk mostly associated with patient handling and movement were considered. The diagnostic results and the interventions following the decisions made in 2002 were evaluated and compared with the medical data during the years 2004-2005. To assess health changes occurring after the intervention, an indicator of impact was used. During 2006 the health problems were reviewed by means of the multi-step evidence-based occupational health paradigm: starting from identification of the problem and search for evidence (with a new and validated search string and the database Medline) followed by evaluation of performance. Professional performance was assessed by comparing the medical decisions made in 2002 with the decision supported by the evidence. RESULTS: All the medical decisions were in agreement with the decisions inferred from scientific evidence. Furthermore, all subjects showed an improvement in both perceived and objective health conditions after the intervention, together with increased acceptability of working conditions. CONCLUSION: Given that no gold standard exists and that guidelines for the management of back pain need to be assessed for their effectiveness, this study shows that the occupational health professional should be aware of the availability of up-to-date scientific evidence which can provide appropriate solutions to the commonly encountered problems. This perspective will be a challenge for professionals aware of the need to adopt practices related to the concept of quality in occupational health care.

[Observation on therapeutic effect of shu-needling therapy as main on cervical spondylosis of nerve root type].

OBJECTIVE: To explore a better method for treatment of cervical spondylosis of nerve root type. METHODS: One hundred and two cases were randomly divided into an observation group and a control group, 51 cases in each group. The observation group were treated with Shu-needling, i. e. the needles were deeply inserted into the cervical vertebrae of corresponding Jiaji (EX-B 2), and the control group were treated with routine needling method. Electroacupuncture was used in the two groups. RESULTS: The cured rate and the total effective rate were 68.6% and 98.0% in the observation group and 47.1% and 84.3% in the control group, with significant differences between the two groups (both P<0.05). CONCLUSION: Shu-needling therapy as main has a better therapeutic effect on cervical spondylosis of nerve root type.

[Clinical observation on Jiquan (HT 1) for treatment of cervical spondylosis of nerve root type].

OBJECTIVE: To observe acupuncture at Jiquan (HT 1) with different manipulations for improvement of abnormal sensation of the upper limb induced by cervical spondylosis of nerve root type. METHODS: One hundred and seven cases were randomly divided into 3 groups. The lifting-thrusting group (n = 37) were treated with acupuncture at Jiquan (HT 1) with lifting-thrusting manipulation, the twirling group (n = 36) with acupuncture at Jiquan (HT 1) with twirling manipulation and the routine needling group (n = 34) with acupuncture at C4 - T1 Jiaji (EX-B 2), Quchi (LI 11). RESULTS: The total effective rate of 91.9% in the lifting-thrusting group was significantly better than 58.3% in the twirling group (P < 0.005) and 76.5% in the routine needling group (P < 0.05), and the therapeutic effect of the twirling group was similar to that in the routine needling group CP > 0.05). CONCLUSION: Acupuncture at Jiquan (HT 1) with lifting-thrusting manipulation can obviously improve abnormal sensation of the upper limb induced by cervical spondylosis of nerve root type.

[Survey and prospects of mini-acupuncture system therapy for cervical spondylosis].

The article introduces resent 10 years' application survey of ear acupuncture, abdominal acupuncture, scalp acupuncture, hand acupuncture and other mini-acupuncture system therapies in clinical treatment of cervical spondylopathy, finding out that unique advantages and problems of this therapy in treatment of cervical spondylopathy, and it prospects for clinical application of mini-acupuncture system.

[Observation on therapeutic effect of acupuncture at "cervical three points" combined with cake-separated moxibustion on cervical hyperosteogeny].

OBJECTIVE: To compare therapeutic effects of acupuncture at "cervical three points" combined with cake-separated moxibustion and routine acupuncture at Jiaji (EX-B 2) on cervical hyperosteogeny. METHODS: Single blind, randomized and controlled methods were used and 91 cases were divided into an observation group of 46 cases and a control group of 45 cases. The observation group was treated by acupuncture at "cervical three points" combined with cake-separated moxibustion, i.e. acupuncture at Chonggu (EX), Dazhui (GV 14), Taodao (GV 13) and moxibustion at pain points with cake made by Rhizoma Atractylodis Macrocephalae and Radix Paeoniae Alba; the control group was treated with acupuncture at Jiaji (EX-B 2). Changes of sourness and pain of the neck, the shoulder and back, pressure pain and cervical activity scores were used for assessment of therapeutic effects. RESULTS: The markedly cured rate of 76.1% in the observation group was better than 42.2% in the control group (P<0.05). After treatment, the scores of all the items were significantly improved in the two groups (all P<0.05), and the observation group in sourness and pain of the neck, the shoulder and back, and cervical activity were better than the control group (all P<0.05). CONCLUSION: The therapeutic effect of acupuncture at "cervical three points" combined with cake-separated moxibustion on cervical hyperosteogeny is superior to routine acupuncture at Jiaji (EX-B 2).

Prognostic factors for deterioration of patients with cervical spondylotic myelopathy after nonsurgical treatment.

STUDY DESIGN: A prospective study involving 56 patients with cervical spondylotic myelopathy (CSM) was conducted. OBJECTIVE: To investigate the outcomes and prognostic factors for CSM after nonsurgical treatment. SUMMARY OF BACKGROUND DATA: The superiority of surgical treatment over nonsurgical treatment has not been confirmed in mild forms of CSM. Outcomes and prognostic factors for nonsurgical treatment of mild forms of CSM are not well understood. METHODS: Clinical signs and symptoms of CSM were assessed by Japanese Orthopedic Association (JOA) scores. Nonsurgical treatment was selected for patients with mild forms of CSM (JOA >or=13 patients). Seventy patients with mild forms of CSM were enrolled in the study between 1995 and 2003. The follow-up rate was 80.0%. Prognostic factors that exacerbate clinical symptoms of CSM were examined, such as age, gender, follow-up period, developmental or dynamic factors on plain lateral radiograph, high signal intensity area on T2-weighted sagittal MRI, and the extent of maximum cord compression; partial or circumferential spinal cord compression, on axial MRI. Univariate and multivariate logistic regression analysis were carried out to test for significant prognostic factors. RESULTS: There was, on average, no statistically significant deterioration in JOA scores after nonsurgical treatment. However, 11 of 56 patients deteriorated after nonsurgical treatment. The only factor that significantly exacerbated clinical symptoms of CSM was circumferential spinal cord compression in the maximum compression segment on axial MRI. Indeed, 10 of 33 CSM patients with circumferential spinal cord compression on axial MRI deteriorated after nonsurgical treatment. CONCLUSION: Outcomes of mild forms of CSM during nonsurgical treatment were generally good as shown by average JOA scores. The only prognostic factor for mild forms of CSM was circumferential spinal cord compression in the maximum compression segment on axial MRI. Surgical treatment can be considered for patients with this prognostic factor.

[Clinical observation on distinctive water-medicine cup therapy for treatment of cervical spondylopathy of cervical type].

OBJECTIVE: To use distinctive water-medicine cup therapy for treatment of cervical spondylopathy of cervical type as a sample to provide a more effective cupping method for clinic. METHODS: One hundred and forty cases were randomly divided into a medicine cup group (n = 47), a water cup group (n = 47) and a empty cup group (n = 46). The medicine cup group were treated by cupping therapy with a self-made medicine cup with 45 degrees C Chinese herb solution; the water cup group were treated with a cup with 45 degrees C water, and the empty cup group with a cup with nothing. Clinical symptoms and signs were observed for comparison of therapeutic effects. RESULTS: Clinically cured was 39 cases, and markedly effective was 8 cases in the medicine cup group; 20 cases were clinically cured, 22 cases were markedly effective and 5 cases were effective in the water cup group; 12 cases were clinically cured, 19 cases were markedly effective and 15 cases were effective in the empty cup group. There were significant differences in the ratio of cases of different therapeutic effects and the difference of pain score before and after treatment between the medicine cup group and the water cup group (P < 0.05), between the water cup group and the empty cup group (P < 0.05), and between the medicine cup group and the empty cup group (P < 0.01). CONCLUSION: The therapeutic effect of the distinctive medicine cup is better than the water cup group, and the water cup group is better than the empty cup group.

[Effects of acupuncture at Dazhui (GV 14) on brain stem auditory evoked potentials in the patient with cervical spondylosis of vertebral artery type].

OBJECTIVE: To study on the mechanism of Dazhui (GV 14) in treatment of cervical spondylosis of vertebral artery type, and to explore the feasibility of regarding hrain stem auditory evoked potential (BAEP) as the objective criterion for assessment of the therapeutic effect. METHODS: Fifty-two cases of cervical spondylosis of vertebral artery type were treated with acupuncture at Dazhui (GV 14), their therapeutic effect and changes of BAEP before and after treatment were investigated. RESULTS: Seventeen cases were cured, 26 cases improved and 9 cases were ineffective, with an effective rate of 82.7%. In BAEP, V PL, I-III IPL, III-V IPL had significant changes after treatment (P < 0.05), with a significant difference between the clinically effective group (cured and improved) as compared with the ineffective group (P < 0.05, P < 0.01). CONCLUSION: Acupuncture at Dazhui (GV 14) improves blood supply of the vertebrabssilar artery, eliminates or alleviates clinical symptoms of cervical spondylosis of vertebral artery type. BAEP can be used as the criterion for assessment of the therapeutic effect.

[Clinically randomized controlled study on abdominal acupuncture for treatment of cervical spondylosis].

OBJECTIVE: To compare clinical therapeutic effects of abdominal acupuncture and traditional acupuncture on cervical spondylosis (CS). METHODS: Sixty-two cases of neck or nerve-root type CS were randomly divided into an observation group (n=32) treated by abdominal acupuncture at Zhongwan (CV 12), Guanyuan (CV 4) and others, and a control group (n=30) treated by traditional acupuncture at Fengchi (GB 20) and cervical Jiaji (EX-B 2), etc.. Simplified McGill Pain Questionnaire (MPQ) and clinical therapeutic effects were served as the objective indexes. Their clinical therapeutic effects were compared after the first session of treatment, at the end of therapeutic course and 3 months after the end of treatment. RESULTS: The two groups had a same effective rate of 100.0%. All items of MPQ in these two groups after treatment and 3 months after the end of treatment significantly improved, and in the observation group the differences in the PRI feeling score before and after the first treatment, and the difference of the total PRI scores after the first treatment, at the end of therapeutic course and 3 months after the end of treatment significantly improved as compared with the control group (P < 0.05). CONCLUSION: Abdominal acupuncture can better reduce the pain of the patient caused by CS, with transient pain-alleviating effect, but whether or not the clinical therapeutic effect of abdominal acupuncture is better than the traditional acupuncture still can not be proved.

[Observation on therapeutic effect of long-time needle retention at Baihui (GV 20) on vertebroarterial cervical spondylopathy].

OBJECTIVE: To compare therapeutic effects of long-time needle retention at Baihui (GV 20) and routine needle retention on vertebroarterial cervical spondylopathy. METHODS: One hundred and twenty cases of vertebroarterial cervical spondylopathy were randomly divided into a treatment group and a control group, 60 cases in each group. The treatment group were treated with needle retention at Baihui (GV 20) for 8 h and electroacupuncture at local points, and the control group with needle retention at Baihui (GV 20) for 30 min and electroacupuncture at local points. RESULTS: The cured rate and the total effective rate were 70.0% and 98.3% in the treatment group and 45.0% and 86.7 in the control group with very significant difference or significant difference in the cured rate and the total effective rate between the two groups (P < 0.01, P < 0.05). CONCLUSION: Long-time needle retention at Baihui (GV 20) has a better therapeutic effect on vertebroarterial cervical spondylopathy.