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1.
J Clin Neurosci ; 95: 9-19, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34929658

RESUMO

We present our experience with Camille's cervical transarticular screw fixation technique. During the period June 2012 to April 2020, 2422 screws were implanted in 321 patients by Camille's transarticular cervical spinal screw fixation technique. The indications of screw implantation were radiculopathy/myelopathy related to cervical spondylosis in 258 cases, cervical OPLL in 54 cases and Hirayama disease in 9 cases. The follow-up ranged from 6 to 92 months. In the entire series, there were no nerve or vessel injury or any other intraoperative 'complications' related to screw implantation. There was no instance of screw pull out or screw failure. There was no metal implant related infection. Satisfactory arthrodesis of all the treated spinal segments was observed on investigations done at a minimum follow-up of 6 months. Camille's transarticular screw fixation technique is a relatively simple surgical procedure and provides a safe, strong and reliable arthrodesis at the fulcrum of spinal movements.


Assuntos
Radiculopatia , Fusão Vertebral , Espondilose , Parafusos Ósseos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Resultado do Tratamento
2.
Pain Res Manag ; 2021: 3960553, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34956433

RESUMO

Objective: The current study aimed to explore the efficacy of Zero profile intervertebral fusion system (Zero-P) and traditional anterior plate cage system (PC) in the treatment of cervical spondylotic myelopathy (CSM). Further, the present study evaluated effects of the treatments on medical security, height of intervertebral disc, adjacent-level ossification development (ALOD), and adjacent segmentation disease (ASD) through a systematic retrospective analysis. Methods: Studies on Zero-P system and traditional anterior plate cage system for ACDF in the treatment of CSM were searched in PubMed, Web of Science, Ovid, Embase, and Cochrane Library databases. Two independent researchers screened articles, extracted data, and evaluated the quality of the articles based on the inclusion and exclusion criteria of the current study. RevMan5.3 software was used for meta-analysis following the guidelines of Cochrane collaboration network. Cervical curvature, interbody fusion rate, preoperative and postoperative disc height index (DHI), fusion cage sinking rate, postoperative dysphagia, ASD, ALOD, and loosening of screw were compared between the two groups. Results: A total of 17 literatures were included in the present study, including 6 randomized controlled trials and 11 observational studies. The studies comprised a total of 1204 patients with CSM, including 605 patients in the Zero-P system group (Zero-P group) and 599 patients in the traditional animal plate cage group (PC group). Results of this meta-analysis showed that postoperative dysphagia [OR = 0.40, CI (0.28, 95% 0.58), P < 0.00001], ALOD [OR = 0.09, CI (0.02, 95% 0.39), P = 0.001], ASD [OR = 0.42, CI (0.20, 95% 0.86), P = 0.02], and screw loosening [OR = 0.20, CI (0.08, 95% 0.52), P = 0.0009] of the Zero-P group were significantly lower compared with the PC group. On the other hand, preoperative cervical curvature [WMD = -0.23, CI (-1.38, 95% 0.92), P = 0.69], postoperative cervical curvature [WMD = -0.38, CI (-1.77, 95% 1.01), P = 0.59], cage sinking rate [OR = 1.41, CI [0.52, 95% 3.82], P = 0.50], intervertebral fusion rate [OR = 0.76, CI (0.27, 95% 2.48), P = 0.38], preoperative DHI [WMD = -0.04, CI (-0.14, 95% 0.22), P = 0.65], and postoperative DHI [WMD = 0.06, CI (-0.22, 95% 0.34), P = 0.675] were not significantly different between the two groups. Conclusion: It was evident that the Zero-P system used in ACDF is superior compared with the traditional anterior plate cage system in postoperative dysphagia, avoiding ALOD, ASD, and screw loosening.


Assuntos
Fusão Vertebral , Espondilose , Vértebras Cervicais/cirurgia , Discotomia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Espondilose/cirurgia , Resultado do Tratamento
3.
Zhongguo Zhen Jiu ; 41(12): 1313-6, 2021 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-34936266

RESUMO

OBJECTIVE: To verify the superiority of Fu's acupuncture for cervical spondylosis of vertebral artery type (CSA) based on Cheng's Tongtuo method. METHODS: A total of 150 patients with CSA were randomly divided into a Tongtuo Fu's acupuncture group, a Tongtuo acupuncture group and a conventional Fu's acupuncture group, 50 cases in each group. Under the guidance of the theory of Tongtuo method, the Tongtuo Fu's acupuncture group was treated with Fu's acupuncture, the distal Tong method was performed at the distal myofascial trigger point (MTrP) of the dorsal forearm, and then the Tuo method was performed at the proximal MTrP of the cervical muscle group. In the Tongtuo acupuncture group, acupuncture was given at distal acupoints (Neiguan [PC 6], Quchi [LI 11], Taichong [LR 3], Xingjian [LR 2], etc.), and then at proximal acupoints (Fengchi [GB 20] and Baihui [GV 20]). In the conventional Fu's acupuncture group, Fu's acupuncture was only performed at the MTrP of cervical muscle group. Each group was treated once a day, 3 days were taken as one course, and 2 courses were given. The score of cervical vertigo symptoms and function evaluation scale, peak systolic velocity (PSV) and resistance index (RI) of vertebral artery were observed before and after treatment in the 3 groups. RESULTS: After treatment, the scores of cervical vertigo symptoms and function evaluation scale and PSV in each group were higher than those before treatment (P<0.01), and the RI was lower than that before treatment (P<0.01). The score of cervical vertigo symptoms and function evaluation scale and PSV in Tongtuo Fu's acupuncture group were higher than those in the other two groups (P<0.01), and the RI was lower than that in the other two groups (P<0.01). CONCLUSION: Fu's acupuncture based on Tongtuo method could improve the symptoms of cervical vertigo and the blood flow state of vertebral artery in patients with CSA, and the curative effect is better than Tongtuo acupuncture and conventional Fu's acupuncture.


Assuntos
Terapia por Acupuntura , Espondilose , Pontos de Acupuntura , Humanos , Pescoço , Espondilose/terapia , Resultado do Tratamento , Artéria Vertebral
4.
Zhonghua Yi Xue Za Zhi ; 101(43): 3594-3599, 2021 Nov 23.
Artigo em Chinês | MEDLINE | ID: mdl-34808754

RESUMO

Objective: To analyze the correlation between the parameters of diffusion tensor imaging (DTI) and the clinical function scores before and 5 years after anterior cervical discectomy and fusion (ACDF) by measuring the DTI signal of the maximum compression level (MCL) of the cervical spinal cord in patients with cervical spondylotic myelopathy (CSM). Methods: A prospective study was conducted and clinical data of 37 patients with CSM treated by ACDF in Beijing Chaoyang Hospital from February 2014 to February 2020 were analyzed. The MCL was studied with diffusion tensor imaging (DTI) of MRI. The changes of diffusion indexes (fractional anisotropy (FA)), and clinical function score including Modified Japanese Orthopedic Association (mJOA), neck disability index (NDI) and visual analog scale (VAS) of pain were compared among each follow-up point. The FA value and clinical function score were collected and the data was analyzed to determine whether the high signal intensity could be observed in T2-weighted imaging (T2WI) at each follow-up point. The changes of preoperative and postoperative data were compared, and the correlation between FA value and other two clinical function score were analyzed at each follow-up point. Results: There were 14 males and 23 females with a mean age of (55±10) years in this study. All patients received the surgery and the medullary symptoms improved significantly postoperatively. After 3 months, the mJOA and FA value were improved by 2.62±1.41 and 0.14±0.11 on average, respectively (both P<0.05); and there were significant differences in these two indexes between each follow-up point in two years after the operation (all P<0.05). At the MCL, there were strong correlations between the FA value and mJOA score pre-and postoperatively (rs=0.770, 0.729, both P<0.01). There was no significant correlation between mJOA, NDI and VAS (both P>0.05). Conclusions: The DTI sensitively reflects the improvement of spinal cord function and can be used as an important tool to predict and evaluate the state of spinal cord dysfunction in patients with CSM.


Assuntos
Doenças da Medula Espinal , Espondilose , Idoso , Vértebras Cervicais/diagnóstico por imagem , Imagem de Tensor de Difusão , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Espondilose/diagnóstico por imagem , Espondilose/cirurgia
5.
Cir Cir ; 89(5): 657-663, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34665178

RESUMO

OBJECTIVE: To determine the association of Depression with clinical outcomes in patients treated surgically for cervical spondylotic myelopathy (CSM) using an anterior approach. METHOD: An observational study was conducted in patients with ECM. The Beck scale, modified scale of the Japanese Orthopedic Association (mJOA), neck disability index (NDI) and the Visual Analogue Scale (VAS) were used preoperatively, one month and 3 months after surgery. RESULTS: Initial VAS showed more severe degrees in patients with depression. At one month and third month after surgery, there was a significant decrease in pain in the group without depression (p = 0.03). The mJOA at one month and three months was observed that the degree of severity decreased in both groups, being more noticeable in the group without depression (p = 0.02). Presurgical NDI was higher in the group with depression. At three months in both groups the improvement was noticeable with respect to the degree of preoperative disability. CONCLUSIONS: There is a favorable relationship in patients with ECM undergoing surgical treatment in the absence of depression prior to surgery and clinical evolution, with the possibility of promoting multidisciplinary management prior to surgery in patients with depression.


Assuntos
Doenças da Medula Espinal , Espondilose , Vértebras Cervicais/cirurgia , Depressão/epidemiologia , Depressão/etiologia , Humanos , Medição da Dor , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/cirurgia , Espondilose/complicações , Espondilose/cirurgia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(37): e26643, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34664825

RESUMO

BACKGROUND: Guiqi huoxue capsule (GQHXC) is a patented Chinese medicine used for treating a liver and kidney deficiency and blood stasis syndrome due to qi deficiency. It is caused by cervical spondylosis (cervical spondylotic radiculopathy (CSR), mixed cervical spondylosis mainly composed of nerve root type). Its underlying mechanisms need, however, to be further clarified. METHODS: In this study, collecting compounds, predicting therapeutic targets, constructing networks, and analyzing biological functions and pathways were based on network pharmacology analysis. In addition, molecular docking verification was engaged to assess the binding potential of selected target-compound pairs. RESULTS: We established 5 networks: compound-putative target network of GQHXC, protein-protein interaction (PPI) network related to CSR, compound-CSR target network, potential therapeutic targets PPI network, and herb-compound-target-pathway network. Network analysis indicated that 7 targets (tumor necrosis factor [TNF], interleukin 6 [IL6], nitric oxide synthase 3 [NOS3], Interleukin-8 [CXCL8], prostaglandin-endoperoxide synthase 2 [PTGS2], vascular endothelial growth factor A [VEGFA], and AP-1 transcription factor subunit [JUN]) might be the therapeutic targets of GQHXC in CSR. Moreover, molecular docking verification showed that TNF, IL6, NOS3, CXCL8, PTGS2, VEGFA, and JUN had a good is interaction with the corresponding compounds. Furthermore, enrichment analysis indicated that GQHXC might exert a curative role in CSR by regulating some important pathways, such as TNF signaling pathway, NF-kappa B signaling pathway, AGE-RAGE signaling pathway in diabetic complications, and so on. CONCLUSION: Our study preliminarily explained the underlying mechanisms of GQHXC for treating CSR, and molecular docking verification was adopted as an additional verification. These findings laid a valuable foundation for experimental research and further application of GQHXC in the clinical treatment of CSR.


Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Espondilose/tratamento farmacológico , Administração Oral , Medicamentos de Ervas Chinesas/uso terapêutico , Humanos , Simulação de Acoplamento Molecular/métodos , Farmacologia/métodos
7.
Medicine (Baltimore) ; 100(36): e26220, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516486

RESUMO

BACKGROUND: Laminectomy with lateral mass screw fixation (LCS) is considered an effective surgical procedure for cervical spondylotic myelopathy. However, varying degrees of loss of the cervical curvature were noted in some patients postoperatively. The aim of this study was to observe the relationship between cervical curvature and spinal drift distance after LCS and to determine its effect on neurological function, axial symptoms, and C5 palsy. METHODS: A total of 117 consecutive cervical spondylotic myelopathy patients with normal cervical curvature underwent LCS from April 2015 to May 2017 in our institution. Of these patients, 90 patients who accepted to undergo an integrated follow-up were enrolled in this study. The patients were divided into 3 groups based on their postoperative cervical curvature. In group A (28 patients), the cervical curvature became straight postoperatively (0°≤cervical spine angle≤5°); in group B (36 patients), the cervical curvature decreased (5°16.5°). Spinal drift distance, neurological recovery, axial symptoms, and C5 palsy in the patients were recorded and analyzed. RESULTS: Postoperative measurements showed that there was no significant difference in laminectomy width between the groups (P > .05). The cervical spine angle was 2.7°â€Š±â€Š0.5° in group A, 11.2°â€Š±â€Š2.6° in group B, and 20.8°â€Š±â€Š4.1° in group C (P < .05), while the spinal drift distance was 1.2 ±â€Š0.2 mm, 1.8 ±â€Š0.4 mm, and 3.0 ±â€Š0.5 mm, respectively (P < .05). The postoperative Japanese Orthopedic Association score was significantly increased in all groups (P < .05), and there was no significant difference between the groups at different time points (P > .05). However, significant differences were noted between the groups in axial symptoms (P < .05), which were analyzed via the visual analog scale score. The occurrence of C5 palsy in groups A, B, and C was 7.1% (2/28), 8.3% (3/36), and 11.5% (3/26), respectively (P > .05). CONCLUSION: In LCS, the cervical curvature should be maintained at the normal angle to obtain a good spinal cord drift distance and a lower incidence of axial symptoms.


Assuntos
Parafusos Ósseos , Vértebras Cervicais/cirurgia , Medula Espinal/fisiopatologia , Espondilose/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Laminectomia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Resultado do Tratamento
8.
J Clin Neurosci ; 92: 75-77, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34509266

RESUMO

Spinal cord compression may lead to pain that is sometimes directed to areas far below the compression level. In certain cases, it may present as sciatica pain, knee pain or low back pain (LBP). These types of pain are called tract pain or funicular pain. Tract pain because of cervical spondylotic myelopathy (CSM) may lead to delays in the diagnosis and treatment of CSM in some cases, and sometimes unnecessary medical and surgical treatments. This study evaluated the results of four patients who presented to the outpatient clinic with complaints of LBP accompanying CSM findings. This study aims to present the improvement in low back pain as a result of anterior cervical microdiscectomy and cage procedure in four patients who presented with tract pain because of CSM, which is a rare condition.


Assuntos
Compressão da Medula Espinal , Doenças da Medula Espinal , Osteofitose Vertebral , Espondilose , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Dor , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Espondilose/complicações , Espondilose/cirurgia , Resultado do Tratamento
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1147-1154, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523280

RESUMO

Objective: To evaluate the effectiveness of three-dimensional (3D) printing artificial vertebral body and interbody fusion Cage in anterior cervical disectomy and fusion (ACCF) combined with anterior cervical corpectomy and fusion (ACDF). Methods: The clinical data of 29 patients with multilevel cervical spondylotic myelopathy who underwent ACCF combined with ACDF between May 2018 and December 2019 were retrospectively analyzed. Among them, 13 patients were treated with 3D printing artificial vertebral body and 3D printing Cage as 3D printing group and 16 patients with ordinary titanium mesh Cage (TMC) and Cage as TMC group. There was no significant difference in gender, age, surgical segment, Nurick grade, disease duration, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, and Cobb angle of fusion segment between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospitalization stay, complications, and implant fusion at last follow-up were recorded and compared between the two groups; JOA score was used to evaluate neurological function before operation, immediately after operation, at 6 months after operation, and at last follow-up; VAS score was used to evaluate upper limb and neck pain. Cobb angle of fusion segment was measured and the difference between the last follow-up and the immediate after operation was calculated. The height of the anterior border (HAB) and the height of the posterior border (HPB) were measured immediately after operation, at 6 months after operation, and at last follow-up, and the subsidence of implant was calculated. Results: The operation time of 3D printing group was significantly less than that of TMC group ( t=3.336, P=0.002); there was no significant difference in hospitalization stay and intraoperative blood loss between the two groups ( P>0.05). All patients were followed up 12-19 months (mean, 16 months). There was no obvious complication in both groups. There were significant differences in JOA score, VAS score, and Cobb angle at each time point between the two groups ( P<0.05). There was an interaction between time and group in the JOA score ( F=3.705, P=0.025). With time, the increase in JOA score was different between the 3D printing group and the TMC group, and the increase in the 3D printing group was greater. There was no interaction between time and group in the VAS score ( F=3.038, P=0.065), and there was no significant difference in the score at each time point between the two groups ( F=0.173, P=0.681). The time of the Cobb angle interacted with the group ( F=15.581, P=0.000). With time, the Cobb angle of the 3D printing group and the TMC group changed differently. Among them, the 3D printing group increased more and the TMC group decreased more. At last follow-up, there was no significant difference in the improvement rate of JOA score between the two groups ( t=0.681, P=0.502), but the Cobb angle difference of the 3D printing group was significantly smaller than that of the TMC group ( t=5.754, P=0.000). At last follow-up, the implant fusion rate of the 3D printing group and TMC group were 92.3% (12/13) and 87.5% (14/16), respectively, and the difference was not significant ( P=1.000). The incidence of implant settlement in the 3D printing group and TMC group at 6 months after operation was 15.4% (2/13) and 18.8% (3/16), respectively, and at last follow-up were 30.8% (4/13) and 56.3% (9/16), respectively, the differences were not significant ( P=1.000; P=0.264). The difference of HAB and the difference of HPB in the 3D printing group at 6 months after operation and last follow-up were significantly lower than those in the TMC group ( P<0.05). Conclusion: For patients with multilevel cervical spondylotic myelopathy undergoing ACCF combined with ACDF, compared with TMC and Cage, 3D printing artificial vertebrae body and 3D printing Cage have the advantages of shorter operation time, better reduction of height loss of fusion vertebral body, and maintenance of cervical physiological curvature, the early effectiveness is better.


Assuntos
Fusão Vertebral , Espondilose , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Impressão Tridimensional , Estudos Retrospectivos , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Resultado do Tratamento , Corpo Vertebral
10.
Rev. bras. med. esporte ; 27(5): 476-480, July-Sept. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1288620

RESUMO

ABSTRACT Objective: With the increasing number and youth of patients with cervical spondylosis, people pay more and more attention to the cervical spine. Early diagnosis, intervention and treatment play an important role in the recovery of cervical spondylosis. With the continuous development of computer technology, the improvement of various modeling theories, and the application of image processing methods in orthopedics, new ideas are opened to observe cervical vertebra motion health. Methods: In this paper, the measurement of cervical motion is achieved by machine vision. A method of parameter measurement based on the constraint relationship of lower cervical motion is proposed. Based on image preprocessing, the left edge of the cervical vertebra was extracted and analyzed. Results: With the horizontal coordinate of registration point as the reference line, the changing trend of the angle between the left edge curve and the reference line of C4 and C5 vertebrae in the process of spontaneous flexion and extension of the cervical vertebrae was observed, and the movement rate of the cervical vertebrae was analyzed. Conclusions: It was found that the speed of the cervical vertebrae in the process of movement of the patients with cervical spondylosis showed jumping changes. Level of evidence II; Therapeutic studies - investigation of treatment results.


RESUMO Objetivo: Com o aumento do número e da juventude dos pacientes com espondilose cervical, as pessoas prestam cada vez mais atenção à coluna cervical. O diagnóstico, intervenção e tratamento precoces desempenham um papel importante na recuperação da espondilose cervical. Com o desenvolvimento contínuo da tecnologia computacional, o aprimoramento de várias teorias de modelagem e a aplicação de métodos de processamento de imagens na ortopedia, novas ideias se abrem para observar a saúde do movimento das vértebras cervicais. Métodos: Neste trabalho, a mensuração do movimento cervical é realizada por meio de visão artificial. É proposto um método de medição de parâmetro baseado na taxa de restrição de movimento cervical inferior. Com base no pré-processamento da imagem, a borda esquerda da vértebra cervical foi extraída e analisada. Resultados: Com a coordenada horizontal do ponto de registro como linha de referência, a tendência de mudança do ângulo entre a curva da borda esquerda e a linha de referência das vértebras C4 e C5 foi observada no processo de flexão espontânea e extensão do vértebras, vértebras cervicais e a taxa de movimento das vértebras cervicais. Conclusões: Verificou-se que a velocidade das vértebras cervicais no processo de movimentação de pacientes com espondilose cervical apresentou alterações de salto. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.


RESUMEN Objetivo: Con el número creciente y la juventud de pacientes con espondilosis cervical, las personas prestan cada vez más atención a la columna cervical. El diagnóstico, la intervención y el tratamiento tempranos juegan un papel importante en la recuperación de la espondilosis cervical. Con el desarrollo continuo de la tecnología informática, la mejora de varias teorías de modelado y la aplicación de métodos de procesamiento de imágenes en ortopedia, se abren nuevas ideas para observar la salud del movimiento de las vértebras cervicales. Métodos: En este trabajo, la medición del movimiento cervical se logra mediante visión artificial. Se propone un método de medición de parámetros basado en la relación de restricción del movimiento cervical inferior. Sobre la base del preprocesamiento de imágenes, se extrajo y analizó el borde izquierdo de la vértebra cervical. Resultados: Con la coordenada horizontal del punto de registro como línea de referencia, se observó la tendencia cambiante del ángulo entre la curva del borde izquierdo y la línea de referencia de las vértebras C4 y C5 en el proceso de flexión y extensión espontánea de las vértebras cervicales, y Se analizó la tasa de movimiento de las vértebras cervicales. Conclusiones: Se encontró que la velocidad de las vértebras cervicales en el proceso de movimiento de los pacientes con espondilosis cervical mostró cambios de salto. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.


Assuntos
Humanos , Programas de Rastreamento , Espondilose/diagnóstico por imagem , Atletas , Algoritmos , Diagnóstico Precoce
11.
Clin Spine Surg ; 34(9): 322-330, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34379608

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS), compared with hybrid decompression fixation (HDF). SUMMARY OF BACKGROUND DATA: A retrospective analysis of 94 cases with MCSMSS was carried out. Fifty-four patients were treated with ACAF, whereas 40 patients were treated with HDF. METHODS: The operation time, intraoperative blood loss, postoperative complications, Japanese Orthopedic Association score, Neck Disability Index score, parameters at axial computed tomography, cervical curvature and the Kang grade were compared between 2 groups. RESULTS: The patients were followed up for 12-17 (15.6±1.6) months. Compared with HDF, ACAF group achieved better decompression according to computed tomography measurement and Kang grade (P<0.05), and recovered to a greater cervical Cobb angle (P<0.05). However, Japanese Orthopedic Association score and Neck Disability Index showed no significant difference 1 year after surgery (P>0.05). In addition, ACAF presented longer operation time (P<0.05) and similar intraoperative blood loss (P>0.05), compared with HDF. In terms of complications, ACAF produced less incidences of cerebrospinal fluid leakage, implant complication, epidural hematoma, and C5 palsy compared with HDF. CONCLUSIONS: ACAF is an effective method for the treatment of MCSMSS. In comparison to HDF, ACAF has the advantages of more sufficient decompression, more satisfactory cervical curvature, and lower incidence rates of complications.


Assuntos
Ossificação do Ligamento Longitudinal Posterior , Doenças da Medula Espinal , Fusão Vertebral , Estenose Espinal , Espondilose , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Humanos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Resultado do Tratamento
12.
Ann Palliat Med ; 10(7): 7671-7680, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34353055

RESUMO

BACKGROUND: Cervical spondylotic myelopathy (CSM) can be managed by conservative treatment or surgical treatment. This study aimed to compare the clinical effects of conservative treatment versus surgical treatment for patients with CSM. METHODS: Reports of randomized controlled trials and retrospective cohort studies that compared surgical treatment versus conservative treatment for CSM were collated from medical databases. The following data were extracted from eligible studies: pre- and post-treatment Japanese Orthopedic Association (JOA) scores, recovery rate, American Spinal Injury Association (ASIA) scores, and ASIA grade change. Results were expressed as risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CIs). RESULTS: A total of 10 studies were included in this meta-analysis, with a total of 517 patients. Patients who received surgical treatment had lower pre-treatment JOA scores compared to patients who received conservative treatment (P=0.01). However, there was no difference in the post-treatment JOA scores between the two types of treatment (P=0.70). This demonstrated that the increase in JOA score was greater in the surgical group compared to the conservative group. Additionally, patients in the surgical group had a higher recovery rate than patients in the conservative group (P<0.00001). Although this investigation showed no significant difference in ASIA score between the two groups (P=0.30), there was a definite difference in ASIA grade change after sensitivity analysis. DISCUSSION: This meta-analysis suggested that surgical treatment may be more advantageous than conservative treatment in patients with CSM. However, these findings should be verified with larger, multi-centered, follow-up, controlled trials.


Assuntos
Doenças da Medula Espinal , Espondilose , Vértebras Cervicais/cirurgia , Tratamento Conservador , Humanos , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Resultado do Tratamento
13.
Zhongguo Zhen Jiu ; 41(8): 906-12, 2021 Aug 12.
Artigo em Chinês | MEDLINE | ID: mdl-34369703

RESUMO

OBJECTIVE: To observe the changes of functional connectivity of brain pain-emotion regulation region in patients with cervical spondylosis of cervical type by functional magnetic resonance imaging (fMRI). METHODS: Thirty-two subjects were selected. Of them, 16 patients with cervical spondylosis of cervical type were divided into an observation group and 16 healthy subjects into a control group. The patients in the observation group were treated with acupuncture at Tianzhu (BL 10), Jingbailao (EX-HN 15), Jianzhongshu (SI 15) and ashi points for 30 min. The rest-state fMRI data was collected before and after acupuncture in the observation group. The subjects in the control group received no treatment, and the rest-state fMRI data was collected once. The visual analogue scale (VAS) score before and after treatment and the pain catastrophizing scale (PCS) score before treatment in the observation group were recorded. The resting-state brain functional imaging characteristics between the observation group and control group before treatment, between the observation group before and after treatment, were compared. Based on the brain functional connectivity of region of interest (ROI) the changes of functional connectivity in insula and ventral tegmental area (VTA) in emotional regulation brain region were observed, and the correlation between functional connectivity changes and VAS、PCS scores in patients of the observation group was analyzed. RESULTS: In the observation group, the VAS score was (1.94±1.12) after the treatment, which was lower than (5.62±1.20) before treatment (P<0.05). The PCS score before treatment was (19.18±8.42) in the observation group. Compared with the control group, the areas with increased functional connectivity with insula in the observation group before acupuncture included bilateral dorsolateral prefrontal lobe and right middle cingulate gyrus, and the areas with increased functional connectivity with VTA included right central posterior gyrus and right insula. In the observation group, the connectivity coefficient of left insula and left dorsolateral prefrontal lobe (r=0.438, P<0.05), the connectivity coefficient of right insula and right dorsolateral prefrontal lobe (r=0.483, P<0.05) were positively associated with the VAS score. In the observation group, the connectivity coefficient between the right insula and the right middle cingulate gyrus (r=-0.560, P<0.05), the connectivity coefficient between the right VTA and the right insula (r=-0.525, P<0.05) were negatively associated with the PCS score. After acupuncture, the areas with decreased functional connectivity with insula included bilateral posterior central gyrus, right anterior central gyrus, middle cingulate gyrus and left corpus callosum, while the bilateral suboccipital gyrus and left cerebellum showed increased functional connectivity with right insula. The areas with decreased functional connectivity with VTA included bilateral dorsomedial prefrontal cortex, left anterior cingulate gyrus, right middle temporal gyrus and left anterior cingulate gyrus. After acupuncture in the observation group, the functional connectivity of left VTA left dorsomedial prefrontal cortex and left anterior cingulate cortex (r=-0.548, P<0.05), the functional connectivity of right VTA-bilateral dorsomedial prefrontal cortex and left anterior cingulate cortex (r=-0.547, P<0.05) were negatively associated with the PCS score. CONCLUSION: Pain involves the formation and expression of "pain-emotion-cognition". Acupuncture can systematically regulate the brain functional connections between cognitive regions such as dorsal prefrontal lobe and anterior cingulate gyrus and emotional regions such as insula and VTA in patients with cervical spondylosis of cervical type, suggesting that acupuncture has a multi-dimensional and comprehensive regulation effect on pain.


Assuntos
Terapia por Acupuntura , Espondilose , Encéfalo/diagnóstico por imagem , Emoções , Humanos , Imageamento por Ressonância Magnética , Dor , Espondilose/diagnóstico por imagem , Espondilose/terapia
14.
Medicine (Baltimore) ; 100(31): e26824, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397845

RESUMO

BACKGROUND: Cervical spondylotic radiculopathy (CSR) is one of the most common types of cervical spondylosis, and its treatments are mainly for relieving radicular pain and improving dysfunction. The existing randomized controlled trials (RCTs) suggest that fire needle may be a potential therapy in the treatment of CSR, but there is no evidence-based medical evidence to date. Therefore, this study will systematically evaluate the efficacy and safety of fire needle in the treatment of CSR. METHODS: We will search for 7 electronic databases (PubMed, EMBASE, Cochrane library, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Sinomed, and Wanfang Database) and 2 trial registration platforms (ClinicalTrials.gov and Chinese Clinic Trials.gov) to collect eligible studies. The RCTs related to fire needle for CSR and published up to June 30, 2021 will be included, regardless of language. We will consider the visual analogue scale as the primary outcome and the secondary outcome will include cervical range of motion, assessment of muscle strength, neck disability index, the MOS item short from health survey, activities of daily living, total efficiency, and adverse reactions. We will use the standard proposed in Cochrane Handbook 5.1.0 to assess the quality and bias risk of every RCT, and all analyses will be conducted through RevMan software V5.3 (Copenhagen: Nordic Cochrane Center, Cochrane, Collaborative Organization, 2014). RESULTS: This systematic review and meta-analysis will provide a convincing synthesis of existing evidences on the efficacy and safety of fire needle for CSR, and the results will be submitted to a peer-reviewed journal for publication. CONCLUSION: The results of this study will provide high-quality evidence of fire needle in the treatment of CSR for clinical decision-making. INPLASY REGISTRATION NUMBER: INPLASY202170041.


Assuntos
Terapia por Acupuntura , Radiculopatia , Espondilose/complicações , Terapia por Acupuntura/efeitos adversos , Terapia por Acupuntura/instrumentação , Terapia por Acupuntura/métodos , Humanos , Metanálise como Assunto , Radiculopatia/etiologia , Radiculopatia/terapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
15.
BMJ Case Rep ; 14(8)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433537

RESUMO

A 40-year-old Chinese woman presented with a 4-year history of lower back pain and left lower leg sciatica. The patient had previously tried different modalities of treatments, including massage, acupuncture, ultrasound, alternative Bowen therapy and nonsteroidal anti-inflammatory drugs (NSAIDs), all of which only provided temporary relief. On presentation to a tertiary hospital, careful and comprehensive history taking found that the sciatica pattern of pain always coincided with menstruation. An MRI identified a thickened left sciatic nerve, with surgery confirming sciatic nerve endometriosis. The case highlights the importance of comprehensive history taking in accurately diagnosing a rare aetiology of sciatica with subsequent prompt surgical intervention to avoid severe disability as well as follow-up treatment to prevent recurrence.


Assuntos
Endometriose , Ciática , Espondilose , Adulto , China , Endometriose/complicações , Endometriose/diagnóstico , Feminino , Humanos , Nervo Isquiático , Ciática/diagnóstico , Ciática/etiologia
16.
Zhongguo Gu Shang ; 34(7): 650-4, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34318642

RESUMO

OBJECTIVE: To study the changes of anterior soft tissue swelling after anterior cervical subtotal corpectomy, titanium mesh fusion and internal fixation. METHODS: From November 2015 to July 2018, 151 patients with cervical spondylotic myelopathy were treated with anterior single corpectomy, titanium mesh fusion and internal fixation, including 109 males and 42 females, aged 44 to 81 (59.77±8.34) years. Through postoperative follow up observation, the C2-C7 level of anterior intervertebral space distance was measured to evaluate the changes of anterior soft tissue swelling. RESULTS: All patients were followed up for 15 to 40(28.00±3.52) months. One week after the operation, the swelling of anterior soft tissue reached the peak, and then decreased. At 8 months after the operation, the swelling of anterior soft tissue on C5, C6 and C7 plane returned to normal. At 12 months after the operation, the swelling of anterior soft tissue on C2, C3 and C4 plane returned to normal. CONCLUSION: Anterior subtotal cervical corpectomy, titanium mesh bone graft fusion and internal fixation can cause swelling of the anterior soft tissue. One week after operation, we should pay more attention to the aggravation of the swelling of the anterior soft tissue to avoid the occurrence of dysphagia, respiratory obstruction, asphyxia and other complications.


Assuntos
Doenças da Medula Espinal , Fusão Vertebral , Espondilose , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
17.
Sci Rep ; 11(1): 15399, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34321548

RESUMO

Fusion with a titanium mesh cage (TMC) has become popular as a conventional method after cervical anterior corpectomy, but postoperative TMC subsidence has often been reported in the literature. We designed a novel anatomic cervical TMC to reduce the postoperative subsidence rate. According to the test process specified in the American Society of Testing Materials (ASTM) F2267 standard, three-dimensional finite element analysis was used to compare the anti-subsidence characteristics of a traditional TMC (TTMC) and novel TMC (NTMC). Through analysis, the relative propensity values of a device to subside (Kp) of the TTMC and NTMC were 665.5 N/mm and 1007.2 N/mm, respectively. A higher Kp measurement is generally expected to indicate that the device is more resistant to subsidence into a vertebral body. The results showed that the novel anatomic titanium mesh cage (NTMC) significantly improved the anti-subsidence performance after anterior cervical corpectomy and fusion (ACCF), which was approximately 51.3% higher than that of the traditional titanium mesh cage.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Espondilose/cirurgia , Telas Cirúrgicas/normas , Titânio/uso terapêutico , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Humanos , Próteses e Implantes , Doenças da Medula Espinal/patologia , Doenças da Medula Espinal/cirurgia , Espondilose/patologia , Resultado do Tratamento
18.
J Vis Exp ; (172)2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34279506

RESUMO

As a severe progressive degenerative disease, cervical spondylotic myelopathy (CSM) has a poor prognosis and is associated with physical pain, stiffness, motor or sensory dysfunction, and a high risk of spinal cord injury and acroparalysis. Thus, therapeutic strategies that promote efficient spinal cord regeneration in this chronic and progressive disease are urgently needed. Effective and reproducible animal spinal cord compression models are required to understand the complex biological mechanism underlying CSM. Most spinal cord injury models reflect acute and structural destructive conditions, whereas animal models of CSM present a chronic compression in the spinal cord. This paper presents a protocol to generate a rat spinal cord compression model, which was further evaluated by assessing the behavioral score and observing the compressed spinal cord region. The behavioral assessments showed decreased monitor motor disability, including joint movements, stepping ability, coordination, trunk stability, and limb muscle strength. Hematoxylin and eosin (H&E) staining and immunostaining revealed considerable neuronal apoptosis in the compressed region of the spinal cord.


Assuntos
Pessoas com Deficiência , Transtornos Motores , Compressão da Medula Espinal , Espondilose , Animais , Apoptose , Vértebras Cervicais , Humanos , Ratos , Medula Espinal , Compressão da Medula Espinal/etiologia
19.
J Clin Neurosci ; 90: 244-250, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275557

RESUMO

Although T2-weighted axial magnetic resonance imaging (MRI) has strength in demonstrating morphologic characteristics of the spinal cord in cervical spondylotic myelopathy (CSM), no study has investigated postoperative changes. We aimed to assess postoperative changes on T2-weighted axial MRI using the classification system based on axial imaging in cervical compressive myelopathy (Ax-CCM) and associated impact on outcome in CSM. In total, 250 patients with CSM who underwent decompressive surgery with preoperative and postoperative MRI were included. At first, we investigated the presence of increased signal intensity (SI) in cervical spinal cord on T2-weighted sagittal images. Next, the increased SI was assessed using Ax-CCM on T2weighted axial images. The classifications were type 0, no-signal abnormality; single-level type 1, diffuse; single-level type 2, fuzzy focal; single-level type 3, discrete focal; and two-level. The recovery rates (RRs) of modified Japanese Orthopaedic Association (mJOA) score were evaluated from 5 to 10 months postoperatively. Eighty-seven patients (34.8%) exhibited postoperative changes. Most of postoperative changes were in single-level type 1 and 2. Patterns of changes were resolution, reduced extent, or transition to discrete margin. The most common pattern was resolution in type 1 (23.9%) and transition to discrete margin in type 2 (46.5%). In each group, resolution showed the best RR, but insignificantly (p > 0.05).


Assuntos
Imageamento por Ressonância Magnética/métodos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Medula Cervical/diagnóstico por imagem , Medula Cervical/patologia , Medula Cervical/cirurgia , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/patologia , Espondilose/patologia , Resultado do Tratamento
20.
BMC Musculoskelet Disord ; 22(1): 605, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217257

RESUMO

STUDY DESIGN: This is a prospective case-controlled study. BACKGROUND: To analyze the postoperative axial pain and cage subsidence of patients presenting with cervical spondylotic myelopathy (CSM) after a modified procedure of ACDF (mACDF). METHODS: Ninety patients with CSM were prospectively collected from 2014 to 2018. The patients were divided into spread group and non-spread group (48:42 ratio) according to the cage placement with or without releasing the Caspar cervical retractor after decompression. Spread group received conventional ACDF and non-spread group received mACDF. Patients were followed-up for at least 24 months after surgery. Radiologic data, including height of intervertebral space and Cobb Angle, were collected. Nervous system function was obtained using JOA scores, and level of pain was assessed using VAS scores. RESULTS: A total of 90 patients were enrolled and the patients were divided into spread group (n = 48) and none-spread group(n = 42). Cage subsidence of (spread group vs none-spread group) was (0.82 ± 0.68 vs 0.58 ± 0.81) mm, (0.64 ± 0.77 vs 0.34 ± 0.46) mm, (0.48 ± 0.43 vs 0.25 ± 0.28) mm, and (0.45 ± 0.47 vs 0.17 ± 0.32) mm at 3 months, 6 months, 12 months and 24 months, respectively. The period exhibiting the most decrease of the height of intervertebral space was 3 months postoperatively. However, there was no statistical difference in the height of intervertebral space, JOA or VAS scores at the final follow-up between the two groups. CONCLUSIONS: The mACDF can avoid excessive distraction by releasing the Caspar Cervical retractor, restore the "natural height" of cervical vertebra, relieve immediate pain after surgery, and prevent rapid Cage subsidence and the loss of cervical curvature.


Assuntos
Fusão Vertebral , Espondilose , Vértebras Cervicais/cirurgia , Discotomia , Seguimentos , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Espondilose/cirurgia , Resultado do Tratamento
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