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1.
PLoS One ; 15(2): e0228628, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097419

RESUMO

We reviewed charts and radiologic studies of 30 patients operated upon by ADR with Mobi-C® in single level since 2006. All patients had healthy cervical facet joints (less than or equal to grade 1 according to grading systems for cervical facet joint degeneration) preoperatively. We assessed clinical outcomes with NDI and VAS on neck and arm over follow-up and also measured ROM at implanted segment on dynamic radiographs during follow-up. The mean follow-up period was 42.4 ± 15.9 months. We then assessed the linearity of changes in ROM at implanted segment through linear mixed model. All patients showed significantly improved clinical outcomes. ROMs at implanted segment were maintained at slightly increased levels until 24 months postoperatively (P = 0.529). However, after 24 months, ROMs at implanted segment decreased significantly until last follow-up (P = 0.001). In addition, the decreasing pattern after 24 months showed a regular regression (P = 0.001). This decline was correlated with decline of extension angle at implanted segment. Based on this regular regression, we estimated that ROMs at implanted segments would be less than 2 degrees at 10.24 years postoperatively. Even though implanted segment maintains its motion for some length of time, we could assume that an artificial disc would have limited life expectancy correlated with the decline of extension angle.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular , Substituição Total de Disco/efeitos adversos , Adulto , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia
2.
Spine (Phila Pa 1976) ; 44(22): 1539-1549, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31689249

RESUMO

STUDY DESIGN: Prospective Cohort Study OBJECTIVE.: The aim of this study was to validate the Patient Reported Outcomes Measurement Information System (PROMIS) against existing patient-reported outcomes in the cervical spine. SUMMARY OF BACKGROUND DATA: Current patient-reported outcomes in cervical spine have substantial limitations. PROMIS offers the potential for improved psychometric properties with reduced questionnaire burden. METHODS: Adult patients undergoing cervical spine surgery at a single institution between 2016 and 2018 were prospectively enrolled. Patients completed questionnaires (36-Item Short Form Health Survey [SF-36], Neck Disability Index (NDI), Visual Analog Scale arm/neck, and PROMIS pain Interference [PI], physical Function [PF], and Upper Extremity [UE]) preoperatively and at 6 months postoperatively. Demographic data, diagnosis, and procedural data were recorded. Validation of the instruments was completed with a Rasch Model as well as measurement of coverage, efficiency, test-retest reliability, responsiveness, and convergent validity. RESULTS: Of 197 patients who completed the preoperative survey, 164 were eligible for 6-month follow-up and 139 completed 6-month postoperative surveys. The most common diagnoses were radiculopathy (37.6%), myeloradiculopathy (30.5%), and myelopathy (28.4%). All studied instruments had acceptable fit to a Rasch model. PROMIS computer adaptive testings (CATs) demonstrated improved average time to completion for PI (39 seconds), PF (47 seconds), and UE (54  seconds), compared to NDI (117 s) and SF-36 PCS (175 seconds). Responsiveness for PROMIS CATs was similar to NDI and SF-36, test-retest reliability was lower for PI (intraclass correlation: 0.68), PF (0.70), and UE (0.59), compared to NDI (0.86) and PCS (0.85). For convergent validity, PI was strongly correlated to NDI and PF to SF-36 PCS. There were no significant floor or ceiling effects for the PROMIS domains, although UE had preoperative clustering (n = 18) at a high score (56.4) and PI had postoperative clustering (n = 27) at a low score (38.7). CONCLUSION: PROMIS CATs demonstrate several advantages, including efficiency and responsiveness, while demonstrating good convergent validity with legacy instruments. Nevertheless, CATs had lower test-retest reliability and had significant clustering at higher levels of function for the PI and UE CATs. These limitations must be considered before broad adoption of CATs in cervical spine patients. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais , Medidas de Resultados Relatados pelo Paciente , Psicometria/normas , Radiculopatia , Doenças da Medula Espinal , Adulto , Vértebras Cervicais/fisiopatologia , Vértebras Cervicais/cirurgia , Humanos , Estudos Prospectivos , Radiculopatia/epidemiologia , Radiculopatia/fisiopatologia , Radiculopatia/cirurgia , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/fisiopatologia , Doenças da Medula Espinal/cirurgia , Inquéritos e Questionários
3.
J Altern Complement Med ; 25(12): 1183-1192, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31634001

RESUMO

Objective: Traditional Chinese Medicines (TCMs), as well as physiotherapy and chemical drugs, are recommended for the treatment of cervical spondylosis by Chinese guidelines for cervical spondylosis diagnosis and treatment. The aim of this study was to evaluate whether TCM Jingshu Granules are cost-effective in patients with cervical radiculopathy in China. Methods: A multicenter, double-blinded, randomized placebo-controlled trial was performed. A total of 480 patients were recruited from 14 tertiary hospitals in China and were randomly divided into an experimental group (Jingshu Granules) or control group (placebo) at a 3:1 ratio. All patients received 4 weeks of treatment. Clinical outcomes and cost data were collected during the trial, including the neck disability index (NDI), visual analog scale (VAS) of pain, VAS of numbness, 36-Item Short Form Health Survey (SF-36) score, willingness to pay (WTP) for VAS of pain, direct medical costs, and transport costs. From a social perspective, a decision-tree model and cost-effectiveness analysis were conducted. Results: The treatment group has a significant advantage in reducing NDI (9.41 ± 10.51 vs. 4.83 ± 8.43, p < 0.05), VAS of pain (22.72 ± 15.08 vs. 12.86 ± 13.45, p < 0.05), and VAS of numbness (16.96 ± 17.53 vs. 11.64 ± 16.54, p < 0.05), respectively, while there was no significant difference in the improvement of quality of life (QoL; SF-36 score, p > 0.05). The expected mean cost of the experimental group was 1144.34 yuan, and the effective rates were 57.9% for NDI and 72.9% for VAS of pain. The expected mean cost of the control group was 767.41 yuan, and the effective rates were 33.3% for NDI and 51.6% for VAS of pain. For the primary indicators (VAS of pain and NDI), the incremental cost-effectiveness ratio was 17.69 and 15.32, respectively. The WTP per efficacy for pain resolution of patients was 19.10 yuan. Setting the WTP as threshold, Jingshu Granules were found to be a cost-effectiveness strategy, and sensitivity analysis showed that the effective rates and inspection fees of both groups had a greater impact on the results of both groups. Conclusions: Jingshu Granules were shown to be effective for treating patients with cervical radiculopathy. This treatment was found to be cost-effective when considering VAS of pain and NDI as clinical outcome indicators compared to no treatment (placebo). A clinical study with longer duration or real world study is needed to determine the impact on QoL of patients in the future.


Assuntos
Vértebras Cervicais/fisiopatologia , Medicamentos de Ervas Chinesas/economia , Medicamentos de Ervas Chinesas/uso terapêutico , Radiculopatia/tratamento farmacológico , Análise Custo-Benefício , Método Duplo-Cego , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Humanos , Masculino , Radiculopatia/fisiopatologia , Resultado do Tratamento
4.
J Clin Neurosci ; 69: 149-154, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31420276

RESUMO

Cervical degenerative disease is a major cause of neck disability, but it has been understudied in patients with cervical spondylotic (CS), largely due to the fact that the neurological impairment associated with this condition tends to be the primary treatment focus. This observational study examined the cerebral functional alterations occurring in advanced cervical spondylosis and myelopathy using resting state functional MRI. Associations between functional connectivity (FC) and neck disability using the Neck Disability Index (NDI) were assessed. Results of the study demonstrated an increase in FC with increasing in neck disability in regions associated with sensorimotor system (both postcentral gyri and precentral gyri, bilaterally, with the SMA; bilateral precentral gyri and the left postcentral gyrus, with the left superior frontal gyrus; bilateral SMA and the left putamen, with the superior frontal gyri). Accounting for the difference in neurological function (mJOA score), strong connectivity between the precentral gyri and the SMA associated with the neck disability. Consistent with studies in chronic pain conditions, these findings suggest neck disability is associated with altered cerebral FC in cervical spondylosis patients.


Assuntos
Encéfalo/patologia , Cervicalgia , Espondilose/complicações , Espondilose/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/fisiopatologia , Estudos Transversais , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Cervicalgia/etiologia
5.
Int J Mol Sci ; 20(15)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31374824

RESUMO

Spinal cord injury (SCI) is associated with an increased susceptibility to infections, such as pneumonia, which is the leading cause of death in these patients. This phenomenon is referred to as SCI immune deficiency syndrome (SCI-IDS), and has been shown to be more prevalent after high-level transection in preclinical SCI models. Despite the high prevalence of contusion SCIs, the effects of this etiology have not been studied in the context of SCI-IDS. Compared to transection SCIs, which involve a complete loss of supraspinal input and lead to the disinhibition of spinally-generated activity, contusion SCIs may cause significant local deafferentation, but only a partial disruption of sympathetic tone below the level of injury. In this work, we investigate the effects of thoracic (T6-7) and cervical (C6-7) moderate-severe contusion SCIs on the spleen by characterizing splenic norepinephrine (NE) and cortisol (CORT), caspase-3, and multiple inflammation markers at 3- and 7-days post-SCI. In contrary to the literature, we observe an increase in splenic NE and CORT that correspond to an increase in caspase-3 after thoracic SCI relative to cervical SCI. Further, we found differences in expression of leptin, eotaxin, IP-10, and IL-18 that implicate alterations in splenocyte recruitment and function. These results suggest that incomplete SCI drastically alters the level-dependence of SCI-IDS.


Assuntos
Vértebras Cervicais/fisiopatologia , Inflamação/etiologia , Traumatismos da Medula Espinal/complicações , Baço/fisiopatologia , Vértebras Torácicas/fisiopatologia , Animais , Vértebras Cervicais/imunologia , Citocinas/imunologia , Modelos Animais de Doenças , Feminino , Inflamação/imunologia , Inflamação/fisiopatologia , Ratos Wistar , Traumatismos da Medula Espinal/imunologia , Traumatismos da Medula Espinal/fisiopatologia , Baço/imunologia , Vértebras Torácicas/imunologia
6.
Turk J Med Sci ; 49(4): 1095-1101, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31385489

RESUMO

Background/aim: In this study, it was aimed to investigate the effects ofpulsed electromagnetic field(PEMF) therapy on pain, disability, psychological state, and quality of life in cervical disc herniation. Materials and methods: Patients were randomly divided into two groups, including Group 1, which received a therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot pack (HP), and PEMF, and Group 2, which received a magnetic field (sham magnetic field) without current flow in addition to TENS and HP therapy. Pain was assessed by a visual analog scale (VAS, 0­10 cm). The other outcome measures were function (Neck Pain and Disability Scale), anxiety-depressive mood (Hospital Anxiety and Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, in the 3rd week, and in the 12th week after treatment. Results: A significant improvement was found in the neck pain, disability, depression, anxiety, and quality of life scores of both groups after treatment when compared to those before treatment. However, in the comparison between changes within groups, significant improvements were determined only in the VAS and Nottingham Health Profile sleep subparameter in the 12th week after treatment compared to those before treatment. Conclusion: PEMF therapy in cervical disc herniation can be used safely in routine treatment in addition to conventional physical therapy modalities.


Assuntos
Dor nas Costas , Depressão , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Terapia de Campo Magnético , Qualidade de Vida , Adulto , Dor nas Costas/etiologia , Dor nas Costas/terapia , Vértebras Cervicais/fisiopatologia , Depressão/etiologia , Depressão/terapia , Avaliação da Deficiência , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
7.
PLoS One ; 14(5): e0217792, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150496

RESUMO

OBJECT: To compare the clinical and radiological outcomes between patients with long posterior cervical fusion (PCF) in which fusion stopped at C7 versus patients in which fusion crossed the cervicothoracic junction (CTJ). METHODS: The patients were divided into 2 groups on the basis of the lower-most instrumented vertebra (LIV); C7 group patients (n = 25) and upper thoracic (UT) group (n = 21). We analyzed the visual analogue scale of arm/neck pain, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI). And we also measured the following parameters: (1) pseudomotion of fused segments; (2) C2-C7 sagittal vertical axis; (3) T1 slope; and (4) C2-C7 lordosis. RESULTS: Arm and neck pain were similar in both groups pre- and postoperatively. Interestingly, mean postoperative NDI score in the UT group was significant worse when compared with the C7 group (9.7±4.6 vs. 14.2±3.7, p = 0.006). Although UT patients had longer fusion levels, the fusion rates were not significantly different between the C7 and UT groups (96.0% vs. 90.5%; p = 0.577). The radiographic parameters did not show any significant differences between the groups at final follow-up. CONCLUSIONS: Our study demonstrates that multi-level PCF stopping at C7 does not negatively affect C7-T1 segment failure, fusion rate, neck pain, neurologic outcomes, and global sagittal alignment of the cervical spine. Hence, it is unnecessary to extend the long PCF levels caudally across the healthy CTJ for fear of development of adjacent segmental disease (ASD) at the C7-T1 segment.


Assuntos
Anquilose/cirurgia , Lordose/cirurgia , Cervicalgia/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Idoso , Anquilose/fisiopatologia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Lordose/diagnóstico por imagem , Lordose/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico por imagem , Cervicalgia/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Período Pós-Operatório , Radiografia , Fusão Vertebral/métodos , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia , Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/fisiopatologia , Vértebras Torácicas/cirurgia
8.
Orthop Surg ; 11(3): 500-509, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31243925

RESUMO

OBJECTIVES: To establish a dynamic three-dimensional (3D) model of upper cervical spine instability and to analyze its biomechanical characteristics. METHODS: A 3D geometrical model was established after CT scanning of the upper cervical spine specimen. The ligament of the specimen was fatigued to establish the upper cervical spine-instability model. A 100-N preloaded stress was applied to the upper surface of the occipital bone, and then a 1.5-Nm moment was applied in the occipital-sagittal direction to simulate upper cervical spine flexion and extension. Subsequently, the 3D dynamic model was established based on trajectory data that were measured using a motion-capture system. The stress on the main ligament and the relative motion angle of the joint were analyzed. RESULTS: The shape of the model grid was regular and the total number of its units was 627 000. After finite-element analysis was conducted, results of the ligament stress and relative movement angle were obtained. After the upper cervical spine instability, the pressure of the alar ligament during the upper cervical spine extension was increased from 2.85 to 8.12 MPa. The pressure of the flavum ligament was increased during the upper-cervical spine flexion, from 0.90 to 1.21 MPa. The pressure of the odontoid ligament was reduced during the upper cervical spine flexion and extension, from 10.46 to 6.67 MPa and 25.66 to 16.35 MPa, respectively. The pressure of the anterior longitudinal ligament and cruciate ligament was increased to a certain degree during upper cervical spine flexion and extension. The pressure of the anterior longitudinal ligament was increased during flexion and extension, from 7.70 to 10.10 MPa and 10.45 to 13.75 MPa, respectively. The pressure of the cruciate ligament was increased during flexion and extension, from 2.29 to 4.34 MPa and 2.32 to 4.40 MPa, respectively. In addition, after upper cervical spine instability, the articular-surface relative-movement angle of the atlanto-occipital joint and atlanto-axial joint had also changed. During upper cervical spine flexion, the angle of the atlanto-occipital joint was increased from 3.49° to 5.51°, and the angle of the atlanto-axial joint was increased from 8.84° to 13.70°. During upper cervical spine extension, the angle of the atlanto-occipital joint was increased from 11.16° to 12.96°, and the angle of the atlanto-axial joint was increased from 14.20° to 17.20°. Therefore, the movement angle of the atlanto-axial joint was most obvious after induction of instability. CONCLUSION: The 3D dynamic finite-element model of the upper cervical spine can be used to analyze and summarize the relationship between the change of ligament stress and the degree of instability in cervical instability. Frequent or prolonged flexion activities are more likely to lead to instability of the upper cervical spine.


Assuntos
Vértebras Cervicais/fisiopatologia , Análise de Elementos Finitos , Imageamento Tridimensional , Instabilidade Articular/fisiopatologia , Modelos Anatômicos , Tomografia Computadorizada por Raios X , Fenômenos Biomecânicos , Vértebras Cervicais/diagnóstico por imagem , Humanos , Instabilidade Articular/diagnóstico por imagem
9.
Australas Emerg Care ; 22(2): 69-75, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31053486

RESUMO

BACKGROUND: In the Emergency Department cervical spine immobilisation precautions are frequently used. There is controversy in regard to the balance of risks and benefits of routine immobilisation in conscious patients. METHODS: A prospective multi-methods evaluation in a tertiary trauma referral centre. The objectives were to investigate current practices and rate of concordance with established international guidelines. A provider survey focused on current knowledge, skills and attitudes and was disseminated to nurses, doctors and paramedics treating trauma patients. Additionally, clinical data were collected on a cohort of immobilised trauma patients. Demographic data were analysed using SPSS and content analysis was completed by manifest coding. RESULTS: The response rate to the survey was 85.2%. Interdisciplinary providers included nurses (n=46), doctors (n=68) and paramedics (n=41). Content analysis revealed a range of themes for improving care. Themes identified included improved application of guidelines, tailored use of equipment in low-risk patients, improved access to radiology results, and staff education. The series of five case vignettes provided to participants revealed a high level of variance in intended approaches to immobilisation. In the cohort of trauma patients (n=54), the median age was 54 years and the most common mechanism of injury was falls (40.7%). Median time spent with immobilisation was 325min. Adherence to a recognised decision tool was 35/54 (64.8%). Precautions were initiated by paramedics in 42/54 (77.8%). CONCLUSIONS: Despite widespread dissemination of guidelines, observed approaches to patient immobilisation appear to be highly variable in this trauma centre. Reducing variation for low-risk patients is likely to improve the patient journey and minimise the risk of prolonged immobilisation. Further assessment of the causes of variation could define goals for targeted translational change.


Assuntos
Vértebras Cervicais/lesões , Imobilização/normas , Ferimentos e Lesões/complicações , Adulto , Idoso , Vértebras Cervicais/fisiopatologia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Imobilização/estatística & dados numéricos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , New South Wales , Estudos Prospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/fisiopatologia , Inquéritos e Questionários , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Triagem/normas , Triagem/estatística & dados numéricos , Ferimentos e Lesões/fisiopatologia
10.
PLoS One ; 14(5): e0216663, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31071162

RESUMO

Head collisions in sport can result in catastrophic injuries to the cervical spine. Musculoskeletal modelling can help analyse the relationship between motion, external forces and internal loads that lead to injury. However, impact specific musculoskeletal models are lacking as current viscoelastic values used to describe cervical spine joint dynamics have been obtained from unrepresentative quasi-static or static experiments. The aim of this study was to develop and validate a cervical spine musculoskeletal model for use in axial impacts. Cervical spine specimens (C2-C6) were tested under measured sub-catastrophic loads and the resulting 3D motion of the vertebrae was measured. Specimen specific musculoskeletal models were then created and used to estimate the axial and shear viscoelastic (stiffness and damping) properties of the joints through an optimisation algorithm that minimised tracking errors between measured and simulated kinematics. A five-fold cross validation and a Monte Carlo sensitivity analysis were conducted to assess the performance of the newly estimated parameters. The impact-specific parameters were integrated in a population specific musculoskeletal model and used to assess cervical spine loads measured from Rugby union impacts compared to available models. Results of the optimisation showed a larger increase of axial joint stiffness compared to axial damping and shear viscoelastic parameters for all models. The sensitivity analysis revealed that lower values of axial stiffness and shear damping reduced the models performance considerably compared to other degrees of freedom. The impact-specific parameters integrated in the population specific model estimated more appropriate joint displacements for axial head impacts compared to available models and are therefore more suited for injury mechanism analysis.


Assuntos
Vértebras Cervicais/lesões , Modelos Biológicos , Traumatismos da Coluna Vertebral/fisiopatologia , Algoritmos , Animais , Fenômenos Biomecânicos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Simulação por Computador , Elasticidade , Futebol Americano/lesões , Futebol Americano/fisiologia , Humanos , Imageamento Tridimensional , Técnicas In Vitro , Masculino , Modelos Animais , Fenômenos Fisiológicos Musculoesqueléticos , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/etiologia , Sus scrofa , Viscosidade , Microtomografia por Raio-X
11.
Complement Ther Med ; 43: 312-318, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30935551

RESUMO

OBJECTIVES: This study aimed to compare the amount of deep tissue pressure and muscle relaxation between a soft inflatable rubber ball (SIRB) and a hard massage ball (HMB). DESIGN: Crossover experimental design study. INTERVENTIONS: Thirty participants with neck pain (age: 65.9 ± 3.4, Neck Disability Index score: 34.0% ± 15.2) pillowed a SIRB or an HMB beneath the suboccipital region in the supine position. For the baseline condition, participants pillowed a foam block without a ball. MAIN OUTCOME MEASURES: To quantify the amount of deep-tissue pressure by a ball, compressed soft tissue thickness was measured with lateral cervical radiographs. To assess muscle relaxation, the amount of muscle tension was determined using electromyography of the sternocleidomastoid and upper trapezius muscles. To monitor the cervical lordosis in each condition, the extension angles of the cervical vertebrae were quantified using the relative rotation angles. RESULTS: The compressed soft tissue thickness in the SIRB condition was significantly lower than that in the HMB condition. The normalised muscle activities exhibited that right sternocleidomastoid muscle activity in the HMB condition was significantly higher than that in the baseline and SIRB conditions. In the SIRB and HMB conditions, Numeric Rating Scale for pain was 0.2 ± 0.5 and 5.2 ± 1.4, respectively. CONCLUSIONS: Our findings demonstrate that a SIRB is more advantageous than an HMB for pressing the soft tissue deeply. This finding would be related to reduced muscle tension and discomfort in the SIRB condition when compared with the HMB condition.


Assuntos
Massagem/métodos , Síndromes da Dor Miofascial/terapia , Cervicalgia/terapia , Idoso , Vértebras Cervicais/fisiopatologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Relaxamento Muscular/fisiologia , Tono Muscular/fisiologia , Músculos do Pescoço/fisiopatologia , Limiar da Dor/fisiologia , Pressão , Amplitude de Movimento Articular/fisiologia , Músculos Superficiais do Dorso/fisiopatologia , Pontos-Gatilho/fisiopatologia
12.
PLoS One ; 14(4): e0215357, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30990826

RESUMO

OBJECTIVE: The aim of this study was to measure the movement of the cervical spine in healthy volunteers and patients with cervical spondylosis (CS) and describe the actual motion of the cervical spine using a three-dimensional (3D) CT reconstruction method. The results can enrich current biomechanical data of cervical spine and help to find the differences between the noted two groups. MATERIALS AND METHODS: 20 healthy volunteers underwent CT examination ranging from the clivus of the occiput (Oc) to the top of first thoracic vertebrae (T1) in a neutral position with left or right maximal axial rotation, while 26 CS patients received the same CT scan procedures in the neutral position with left and right maximum rotation. Subsequently, the three-dimensional images of the occiput and every cervical vertebrae (C1-C7) were reconstructed using medical software. 3 virtual non-collinear markers were placed on the prominent structures of foramen magnum and every cervical vertebrae. Then, the 3D orthogonal spatial coordinates were defined with these anatomical markers to represent the orientation and position of every vertebra. Segmental relative motions were calculated using Cardan angles in the 3D spatial coordinates. Finally, the differences between the two groups were analyzed with statistical software SPSS. RESULTS: The cervical spine exhibited complicated 3D movements, which could be adequately described using the three-dimensional CT reconstruction method. Reliability analysis of the 3D CT reconstruction method showed inter-rater ICC of 0.90-0.99 and intra-rater ICC of 0.91-0.98, suggesting very good consistency. Besides, the rotation at the upper cervical spine (Oc-C2) took up at least 60% of the total cervical rotation. The coupled lateral bending movement of the upper cervical spine was opposite to the major motion, while the movement of the lower cervical spine followed the same direction as that of the major motion. Oc to C5 segments were all coupled with the back-extension movement. The relative translations of all adjacent segments in each direction were minimal. CS patients showed a significant decrease in the movement of the C4-C5 segment compared with healthy volunteers. CONCLUSION: The motion of the cervical spine was complicated and three-dimensional. The CT reconstruction method employed here was good at describing such movement. The 3D CT reconstruction method exhibited high reproducibility when measuring cervical spine movement. CS patients and healthy volunteers showed significant differences in the movement of some segments.


Assuntos
Vértebras Cervicais , Cabeça/fisiopatologia , Rotação , Espondilose , Tomografia Computadorizada por Raios X , Adulto , Idoso , Fenômenos Biomecânicos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Espondilose/diagnóstico por imagem , Espondilose/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/fisiopatologia
13.
Biomed Res Int ; 2019: 2193436, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31001552

RESUMO

Background: Percutaneous DiscoGel® (Gelscom SAS, France), introduced in 2007 as a promising new minimal invasive technique, showed efficacy and safety in lumbar spine surgery, with limited use and scientific reports with regard to the cervical spine. Since the first publication of its use on the cervical spine (2010), less than 100 cases have been published. We introduce an initial experience with this relatively new procedure. We hypothesized that percutaneous DiscoGel® is a safe and effective option for chronic neck pain of cervical discogenic origin. Method: This was a clinical study on 10 patients with chronic discogenic pain operated on for 18 cervical discs with percutaneous DiscoGel®. Inclusion criteria were patients with chronic axial or referred neck pain with MRI showing a cervical disc that is consistent with patient symptoms and failed conservative treatment. Exclusion criteria were clinical myelopathy, motor deficit, severe stenosis or reduced disc height by more than 50%, or previous cervical spine surgery. Results: A total of 10 cases consisting of 6 females and 4 males underwent treatment with percutaneous DiscoGel® for 18 cervical discs. C5/C6 was the most affected level. The mean preoperative VAS score was 8; the postoperative VAS scores at 6 weeks and 3 months were 2.2 and 2.9, respectively. There were no postoperative complications or neurological deficits. Conclusion: The present study has the limitation of the small number of cases; however, with the limited number of studies and less than 100 published cases in the literature, this initial work shows that cervical percutaneous DiscoGel® is an effective minimally invasive bridging option between conservative and open surgical treatment for cervical discogenic pain, with a high success rate. The differentiation of pain types (nociceptive, referred, radicular, and trapezius myalgia) that can coexist is crucial for procedure selection and improving treatment outcome.


Assuntos
Dor Crônica/tratamento farmacológico , Etanol/administração & dosagem , Cervicalgia/tratamento farmacológico , Adolescente , Adulto , Vértebras Cervicais/patologia , Vértebras Cervicais/fisiopatologia , Dor Crônica/patologia , Dor Crônica/fisiopatologia , Feminino , Humanos , Disco Intervertebral/patologia , Disco Intervertebral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Cervicalgia/patologia , Cervicalgia/fisiopatologia
14.
Kaohsiung J Med Sci ; 35(2): 102-110, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30848027

RESUMO

This study intends to investigate the predictive values of plasma Vitamin D-binding protein (VDBP), 25-hydroxyvitamin D [25(OH)D], and glutathione (GSH) levels in the outcome of cervical spondylotic myelopathy (CSM) surgery. Surgery outcomes of 236 CSM patients were determined. Recovery rate was calculated according to Japanese Orthopaedic Association (JOA) scores during follow-up. CSM patients with a recovery rate >50% were assigned with good prognosis and the rest were with fair prognosis. Preoperative and postoperative neurologic function scores were compared among groups. Plasma VDBP and 25(OH)D levels, as well as GSH levels were measured by ELISA and glutathione reductase recycling assay, respectively. Pearson's correlation coefficient was performed to analyze the correlation among plasma VDBP, 25(OH)D, and GSH levels. Receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of plasma VDBP, 25(OH)D, and GSH levels for surgical outcome. Logistic regression model was used to analyze risk factors for surgical outcome. Compared with those with fair prognosis, CSM patients with good prognosis group exhibited higher postoperative neurologic function scores, plasma VDBP, 25(OH)D, and GSH levels, and better improvements in spinal cord compression and motions of the cervical vertebra. Plasma VDBP, 25(OH)D, and GSH levels were favorable prognostic factors for CSM surgical outcome. The sensitivity and specificity of plasma VDBP, plasma 25(OH)D, and plasma GSH were 89.8% and 91.7%, 85.8% and 84.4%, and 79.5% and 91.7%, respectively. Our study provides evidence that higher plasma VDBP, 25(OH)D, and GSH levels may predict better surgical outcome in CSM patients.


Assuntos
Vértebras Cervicais/patologia , Glutationa/sangue , Espondilose/sangue , Proteína de Ligação a Vitamina D/sangue , Vitamina D/análogos & derivados , Estudos de Casos e Controles , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Vértebras Cervicais/cirurgia , Feminino , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Amplitude de Movimento Articular , Fatores de Risco , Espondilose/diagnóstico por imagem , Espondilose/fisiopatologia , Espondilose/cirurgia , Vitamina D/sangue
15.
Mil Med ; 184(Suppl 1): 637-643, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901460

RESUMO

PURPOSE: The objective of this study is to directly compare different types of cervical artificial disc implants using an in vivo model capable of simulating the axial load on a neck that is similar to the human neck. METHODS: Cervical arthroplasty was performed at C3-4 in 14 healthy female adult Alpine goats. The goats were divided into three groups. Group A received Bryan (unconstrained one-piece design); Group B received ProDisc-C (semi-constrained two-piece design); and Group C received Mobi-C (unconstrained three-piece design) artificial discs. The goats were monitored in a veterinary unit for 6 months with radiography at regular intervals. RESULTS: Each goat tolerated cervical arthroplasty well and had satisfactory placement of their implant per intra-operative radiography. Implants monitored in Group A demonstrated no migration. One out of five implants in Group B experienced anterior migration at 3 months. In Group C, anterior migration and disintegration occurred in all four implants, with migration occurring during the first postoperative week in three implants and after 5 weeks in the fourth. CONCLUSIONS: Unconstrained multi-piece artificial cervical discs may be prone to anterior migration and extrusion out of the disc space. This outcome deserves attention in individuals with a hypermobile neck and/or an occupation involving the use of a head-supported mass, such as helmets.


Assuntos
Vértebras Cervicais/cirurgia , Substituição Total de Disco/instrumentação , Animais , Fenômenos Biomecânicos , Vértebras Cervicais/fisiopatologia , Modelos Animais de Doenças , Cabras/lesões , Desenho de Prótese/métodos , Desenho de Prótese/normas , Amplitude de Movimento Articular/fisiologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Fusão Vertebral/veterinária , Substituição Total de Disco/métodos , Substituição Total de Disco/veterinária
16.
J Pediatr Orthop B ; 28(4): 411-414, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30921249

RESUMO

Odontoid synchondrosis fractures are the most common cervical fracture in young children, although their overall incidence is rare. Various strategies have been proposed in the management of injuries with significant displacement or angulation. In this report, we present the long-term functional and radiological outcomes following nonoperative treatment of such a fracture in a 5-year-old female. The patient was referred to our tertiary centre with radiological progression of angulation from 10° to 35° within 5 weeks of the injury, despite wearing a rigid collar. She had no neurological compromise. Although we examined the fracture under general anaesthetic, and subsequently applied halo traction, there was no effect on alignment. The halo device was removed after 11 days and a rigid collar was fitted again. The patient had no pain or neurological symptoms out of the collar at 12 weeks after injury (6 weeks after removal of halo), and a computed tomography scan at 15 weeks confirmed that the fracture had united in malalignment. However, serial radiographs and MRI subsequently have shown that the axis has remodelled completely. At 7 years follow-up, there has been no impact on the patient's functional range of movement or quality of life. This case highlights the preservation of the motion segment and the remarkable remodelling potential of the paediatric cervical spine.


Assuntos
Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Processo Odontoide/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Vértebras Cervicais/fisiopatologia , Pré-Escolar , Feminino , Humanos , Imagem por Ressonância Magnética , Movimento (Física) , Aparelhos Ortopédicos , Qualidade de Vida , Tomografia Computadorizada por Raios X , Tração
17.
Biomed Res Int ; 2019: 9830243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30756087

RESUMO

Purpose: Because Hirayama disease is stereotyped as a self-limited disease in the absence of a definite pathology, we investigated the potential relationship between snake-eyes appearance (SEA) and Hirayama disease to bring a new perspective in the pathological process of Hirayama disease based on relevant radiological and clinical evidence. Methods: A total of 30 cases observed SEA were selected from 293 patients with Hirayama disease to constitute the SEA group, and an equal number of cases were randomly selected from the remaining patients to form the non-SEA group. Cervical magnetic resonance imaging (MRI) was performed and subsequently used to measure the anteroposterior diameter and anterior shifting of the spinal cord. Additionally, clinical data, such as age, sex, duration of symptoms, symptoms, and signs, were collected and analyzed. Results: Of 293 patients, 10.6% appeared with the SEA, which was mainly multisegmental (86.7%), particularly at the C5-6 segment (73.3%), and intense with a well-defined border (70.0%). The SEA group was an older population (p < 0.0001) with a longer duration (p < 0.0001) and a higher incidence of Hoffmann signs and knee hyperreflexia (p < 0.0001, p = 0.0038, respectively). The degree of spinal cord atrophy demonstrated a close association with the SEA, as it was significantly worse in the SEA group and SEA segment (p = 0.0008, p < 0.0001, respectively). The degree of spinal cord atrophy was positively related to both age and duration (p = 0.0095, p = 0.0176, respectively). Conclusions: Confirmed as an irreversible lesion and an indication of poor prognosis, SEA appears during the late stage of Hirayama disease and is closely related to pyramidal signs and spinal cord atrophy.


Assuntos
Olho/diagnóstico por imagem , Prognóstico , Medula Espinal/diagnóstico por imagem , Atrofias Musculares Espinais da Infância/diagnóstico por imagem , Adolescente , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Olho/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pescoço/diagnóstico por imagem , Pescoço/fisiopatologia , Medula Espinal/fisiopatologia , Atrofias Musculares Espinais da Infância/fisiopatologia , Adulto Jovem
18.
Eur J Orthop Surg Traumatol ; 29(5): 975-982, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30737557

RESUMO

BACKGROUND: Posterior stabilization in patients treated with laminectomy for spondylotic cervical myelopathy is still a debate. Despite both being reported in literature by several authors, some controversies still exist. The aim of this study is to compare clinical and radiological outcomes in patients treated with laminectomy or laminectomy with posterior stabilization. MATERIAL AND METHODS: We retrospectively evaluated 42 patients affected by cervical myelopathy (mean age 70.43 ± 5.03 years), 19 treated with laminectomy (group A) and 23 with laminectomy and posterior instrumentation (group B). Neurological status was assessed with Nurick scale, pain with VAS and radiological parameters with C2-C7 SVA, T1 slope and C2-C7 lordosis, clinical function with modified Japanese Orthopaedic Association score (JOA). Also, surgery time and blood loss were recorded. Student's t test was used for continuous variables, while Kruskal-Wallis test was used for categorical values. RESULTS: No differences were found in postoperative Nurick scale (p = 0.587), VAS (p = 0.62), mJOA (p = 0.197) and T1 slope (p = 0.559), while laminectomy with fusion showed better postoperative cervical lordosis (p = 0.007) and C2-C7 SVA (p < 0.00001), but higher blood loss (p < 0.00001) and surgical time (p < 0.00001). Both groups showed better Nurick scale (p = 0.00017 for group A and p = 0.00081 for group B), VAS (p = 0.02 for group A and p = 0.046 for group B) and mJOA (p < 0.00001 for both groups) than preoperative values. CONCLUSIONS: Both treatments are a valuable choice, offering some benefits and disadvantages against each other. Each procedure must be carefully evaluated on the basis of patients' general status, preoperative pain, signs of instability and potential benefits from cervical alignment correction.


Assuntos
Vértebras Cervicais , Laminectomia , Doenças da Medula Espinal , Fusão Vertebral , Espondilose/complicações , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Vértebras Cervicais/cirurgia , Feminino , Humanos , Itália , Laminectomia/efeitos adversos , Laminectomia/métodos , Masculino , Exame Neurológico/métodos , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/fisiopatologia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos
19.
Postgrad Med ; 131(3): 230-238, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30807247

RESUMO

OBJECTIVE: To report on the long-term outcomes for patients receiving paraesthesia-free high-frequency spinal cord stimulation (HF10-SCS) at 10 kHz for the treatment of combined upper and lower body neuropathic/nociplastic pain syndromes including chronic widespread pain/fibromyalgia. MATERIALS AND METHODS: Forty-five patients with widespread (both upper and lower body) neuropathic/nociplastic pain syndromes underwent a trial of combined cervical and thoracic HF10-SCS leads placed over the C2/T2 or C2/T9 vertebral levels, or three leads placed over the C2/T2/T9 vertebral levels. Thirty-eight patients proceeded to permanent implant, resulting in a trial to implant conversion rate of 84.4%. Patients were followed up an average of 2.3 ± 1.7 years post-permanent implant. Patient outcomes were recorded. RESULTS: A statistically significant reduction of 3.5 ± 1.6 on the 10-point numerical rating scale (NRS) at 2.3 ± 1.7 years post-permanent implant was observed (baseline: 7.1 ± 0.8 vs. follow up: 3.7 ± 1.3) (p ≤ 001). Likewise, a reduction in disability (Roland Morris Disability Questionnaire) was also observed; baseline: 12.3 ± 5.1 vs. follow up: 7.8 ± 5.9. Similar trends were observed in a working capacity, with 20/31 (64.5%) of the work eligible patients employed at follow-up, compared with only 8/31 (25.8%) at baseline. Opioid pain medication use reduced and over 90% of patients were satisfied with their treatment outcome. No long-term adverse events were observed. CONCLUSIONS: HF10-SCS at 10 kHz provides long-term widespread pain relief when leads are staggered across the cervical and thoracic spine. The improved return to work outcomes and opiate reductions suggest that cost-effectiveness as well as clinical effectiveness may be achieved with this treatment approach.


Assuntos
Dor Crônica/terapia , Neuralgia/terapia , Estimulação da Medula Espinal/métodos , Adulto , Vértebras Cervicais/fisiopatologia , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/métodos , Satisfação do Paciente/estatística & dados numéricos , Psicometria/métodos , Estudos Retrospectivos , Retorno ao Trabalho/estatística & dados numéricos , Estimulação da Medula Espinal/efeitos adversos , Vértebras Torácicas/fisiopatologia , Resultado do Tratamento
20.
Injury ; 50(3): 657-662, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30765183

RESUMO

INTRODUCTION: Helmet use during motorcycle crashes (MCCs) has been shown to reduce traumatic brain injury and mortality. However, preventive effects of its use on cervical spine injury remain controversial. In this study, we evaluated whether helmet use can reduce cervical spine injury during MCCs. PATIENTS AND METHODS: A case-control study using data from the Emergency Department-based Injury In-depth Surveillance (EDIIS) registry was conducted. Cases were defined as patients with cervical spine injury [≥2 points in the Abbreviated Injury Scale (AIS)] in MCCs from 2011 to 2016. Four controls were matched to one case with strata which included age and sex from the EDIIS registry. Primary outcome was cervical spine injury, secondary outcome was intensive care unit (ICU) admission, and tertiary outcomes was mortality. Multivariable logistic regression analysis was used to calculate odds ratios (OR) with 95% confidence intervals (CIs) to evaluate the associations between helmet use and related outcomes. RESULTS: In total, 2600 patients were analysed; among these, 1145 (44.0%) used helmets at the time of crashes. The helmet group showed lower alcohol consumption and mortality rates than the no helmet group (alcohol: 3.2% vs. 9.2%, respectively, and mortality: 2.4% vs. 7.1%, respectively; p < 0.01). Compared with the no helmet group, the helmet group was less likely to have cervical spine injury [adjusted OR, 0.62 (0.51-0.77)]. In addition, helmet use has been shown to help prevent ICU admission and mortality [adjusted OR, 0.45 (0.36-0.56) and 0.32 (0.21-0.51), respectively]. CONCLUSION: Helmet use was found to have significant preventive effects on cervical spine injury during MCCs.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Vértebras Cervicais/lesões , Dispositivos de Proteção da Cabeça , Motocicletas , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Coluna Vertebral/fisiopatologia , Adulto , Consumo de Bebidas Alcoólicas/mortalidade , Estudos de Casos e Controles , Vértebras Cervicais/fisiopatologia , Feminino , Dispositivos de Proteção da Cabeça/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Traumatismos da Medula Espinal/mortalidade , Traumatismos da Medula Espinal/prevenção & controle , Traumatismos da Coluna Vertebral/mortalidade , Traumatismos da Coluna Vertebral/prevenção & controle , Centros de Traumatologia
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