Objective To study the cl inical appl ication of Mobi-C prosthesis in treatment of anterior cervical discectomy and artificial disc replacement (ADR). Methods Between January 2009 and June 2009, 20 cases of degenerative cervical disease were treated with anterior discectomy and ADR by Mobi-C prosthesis, including 13 cases of cervical disc herniation and 7 cases of cervical spondylotic radiculopathy, and 25 Mobi-C prosthesis were implanted. There were 8 males and 12 females, aged 29-54 years (mean, 45.2 years). The disease duration was from 4 days to 5 years (mean, 1.2 years). Affected segments of process included C3, 4 in 1 case, C4, 5 in 2 cases, C5, 6 in 7 cases, C6, 7 in 5 cases, C4, 5 and C5, 6 in 2 cases, and C5, 6 and C6, 7 in 3 cases. Radiographs were taken regularly, and cervical range of motion (ROM) on segments of disc replacements were measured. The functions of cervical spinal cord were evaluated by “40 score” system (COA) preoperatively, immediately postoperatively, and at follow-up. The qual ity of l ife was evaluated by neck disabil ity index (NDI) and visual analogue scale (VAS) score. Results All incisions healed by first intention. No perioperative compl ication was found. All cases were followed up 16.5 months on average (range, 14-18 months). There was no significant difference in cervical ROM of operatied segment between preoperation and follow-up duration (t=0.808，P=0.440). No heterotopic ossification was found at follow-up. COA score at last follow-up (38.20 ± 1.14) was significantly higher than preoperative one (32.10 ± 2.96) , (t=9.278，P=0.000) , and the improvement rate at last follow-up was 77.2% ± 5.4%. VAS score at last follow-up (3.20 ± 1.23) had significant difference when compared with preoperative one (5.10 ± 1.29), (t=10.585，P=0.000). NDI score at last follow-up (29.40 ± 4.55) had significant difference when compared with preoperative one (39.20 ± 3.80), (t=16.039, P=0.000). Conclusion A satisfactory short-term curative effect can be obtained by using Mobi-C prosthesis in treatment of anterior cervical discectomy and ADR.
Objective To summarize the recent minimally invasive approach for cervical spondylotic radiculopathy (CSR). Methods The recent l iterature at home and abroad concerning minimally invasive approach for CSR was reviewed and summarized. Results There were two techniques of minimally invasive approach for CSR at peresent: percutaneous puncture techniques and endoscopic techniques. The degenerate intervertebral disc was resected or nucleolysis by percutaneouspuncture technique if CSR was caused by mild or moderate intervertebral disc herniations. The cervical microendoscopicdiscectomy and foraminotomy was an effective minimally invasive approach which could provide a clear view. The endoscopy techniques were suitable to treat CSR caused by foraminal osteophytes, lateral disc herniations, local l igamentum flavum thickening and spondylotic foraminal stenosis. Conclusion The minimally invasive procedure has the advantages of simple handl ing, minimally invasive and low incidence of compl ications. But the scope of indications is relatively narrow at present.
Objective To investigate the effect and safety of the anterior uncovertebral joint resection in treatment of cervical spondylotic myelopathy accompanied by radiculopathy. Methods From March 2002 toJuly 2004, 9 patients (5 males, 4 females; aged 38-66) with cervical spondylotic myelopathy accompanied by radiculopathy underwent the anterior uncovertebral joint resection and discectomy using the titanium cage implantation. There were 6 unilateral and 3 bilateral compressed nerve roots. Results During the follow-up for 3-16 months, CT scanning or X-ray films revealed thatall the patients improved with an enlargement of the intervertebral foramen, and MRI demonstrated that compression of the spinal cord and nerve roots vanished.Seven patients had a relief in the radicular pain although the other 2 still had a residual pain. All the patients improved to some extent in symptoms of myelopathy. No patient suffered vertebral artery injury during the operation. Conclusion The uncovertebral joint resection can directly decompressthe nerve roots. The key to avoidance of an injury to the vertebral artery is agood understanding of the regional anatomy and a good performance of the operation.
ObjectiveTo probe into the clinical value of supine cervical vertebra traction with neck flexion in treating cervical spondylotic radiculopathy. MethodsFrom August 2011 to December 2013, 71 patients were divided randomly into a treatment group of 36 cases and a control group of 35 cases. They were treated respectively with supine cervical vertebra traction with neck flexion, and cervical vertebra traction on a sitting position. Both groups had acupuncture, moxibustion, massage and medium frequency electrotherapy. The period of observation was 15 days. We evaluated the results by surveying physiological curvature of the cervical spine on lateral radiograph, and visual analogue scale (VAS), neck disability index (NDI), criteria of diagnosis and therapeutic effect of syndromes in traditional Chinese medicine syndrome and clinical assessment scale for cervical spondylosis (CASCS) were also used. ResultsPhysiological curvature of cervical spine was much improved in both groups after treatment (P<0.05). The distance of cervical vertebra arc between vertebral anterior edge sequences in treatment group before treating was (4.07±3.63) mm and it was (9.03±4.31) mm after treatment. For the control group, those two numbers were respectively (4.13±3.02) and (8.87±3.97) mm. There was no significant difference in the distance of cervical vertebra arc and its increase between vertebral anterior edge between the two groups after treatment. There was significant difference in the efficiency rate between the two groups (P<0.05) (treatment group 100.00%, control group 97.14%). When cured rate and cured-markedly effective rate were added, the treatment group (80.56%) was much better than the control group (51.43%) (P<0.01). As to VAS score, NDI and CASCS scores, both groups got much better after treatment (P<0.01). For VAS, the treatment group decreased from 8.43±0.75 before treatment to 1.40±0.61 after treatment, while the control group from 8.35±0.78 before treatment to 2.55±0.59 after treatment. For NDI, the treatment group decreased from 54.13±7.44 before treatment to 10.78±4.55 after treatment, while the control group from 55.85±8.72 to 12.66±5.48. For CASCS, the treatment group rose from 34.88±5.39 before treatment to 74.65±6.73 after treatment, while the control group from 34.77±4.89 to 69.03±6.21. After treatment, VAS score of the treatment group was much lower than the control group (P<0.01). There was no difference between the two groups on NDI (P>0.05). CASCS score of the treatment group was significantly higher than the control group after the treatment (P<0.01). There was no significant difference in the increase of CASCS score between the two groups after treatment (P>0.05). ConclusionVertebra traction combined with acupuncture, moxibustion, massage and medium frequency electrotherapy is therapeutic for cervical spondylotic radiculopathy and traction at a supine and flexing position is better.
ObjectiveTo investigate the influence of uncovertebral joint foraminal part excision on the motion response, stability and clinical outcomes after single-level cervical disc replacement. MethodsThe clinical data of 57 patients with cervical spondylotic radiculopathy, who underwent single-level Prestige LP cervical disc replacement in West China Hospital of Sichuan University from January 2012 to January 2015, were retrospectively analyzed.According to whether to have the uncovertebral joint foraminal part excision in the process of operation, two groups were divided, named excision group and non-excision group.The Japanese Orthopedic Association score (JOA), neck disability index (NDI) and visual analogue score (VAS) were used to evaluate the clinical outcomes pre-and post-operatively.The stability, overall cervical alignment, range of motion of treated levels in flexion-extension and lateral bending, and the transverse and longitudinal diameter of intervertebral foramen were measured by X-ray and CT-3D examination.The complications and reoperations were also recorded. ResultsThere were statistically significant improvement in the JOA, NDI, neck VAS and arm VAS scores in both of the two groups after the surgery (P < 0.05).The improvement of the NDI and the arm VAS scores were more obvious after the surgery in excision group.The overall cervical alignment, the range of motion of treated levels in flexion-extension and lateral bending were well maintained post-operatively (P > 0.05), and the differences between the two groups were not significant (P > 0.05).The transverse diameter of intervertebral foramen was significantly increased in excision group post-operatively (P < 0.05) while the longitudinal diameter was not (P > 0.05);both of the transverse and longitudinal diameter of intervertebral foramen didn't differ much post-operatively in the non-excision group (P > 0.05).All the prostheses showed a good stability.No prostheses shift, dislocation or unfixed prostheses were found. ConclusionUncovertebral joint foraminal part excision can be used in single-level Prestige LP cervical disc replacement, which is safe and reliable.
ObjectiveTo provide an overview of systematic reviews on the efficacy and safety of massage for the treatment of cervical spondylotic radiculopathy.MethodsCNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library and EMbase databases were electronically searched to collect the systematic reviews on the efficacy and safety of massage for the treatment of cervical spondylotic radiculopathy from inception to December 30th, 2018. Two reviewers independently screened the literature and extracted the data, applied the AMSTAR2 scale to evaluate its methodological quality, and GRADE to evaluate the quality of the evidence.ResultsA total of 7 systematic reviews/meta-analysis were included. The AMSTAR2 scale evaluation showed that the quality of the included studies was extremely low. The GRADE evidence grading results showed that the quality of the VAS score outcome index of the two literatures was intermediate, and the quality of the OASCSR outcome index of one literature was intermediate. The quality of the remaining outcome indicators reported is low or very low.ConclusionThe available evidence shows that the efficacy and safety of manual treatment of cervical spondylotic radiculopathy is acceptable, but the overall methodological quality of the systematic review is extremely low, and the quality level of evidence is generally low. The future clinical trials and systematic reviews should be strictly followed. The scientific research design of the medical science provides high-quality evidence and provides reference for clinical practice.
Objective To investigate whether an internet-based neck-specific training program can alleviate pain and disability in participants with cervical spondylotic radiculopathy (CSR). Methods Patients diagnosed with CSR at West China Hospital of Sichuan University between March 2022 and September 2022 were randomly allocated to either an telehabilitation group or a traditional treatment group. The primary outcome measures included Visual Analogue Scale, Neck Disability Index, and patient satisfaction. Secondary outcome measures included the Euroqol group’s 5-Domain questionnaire, Fear-Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, Tanaka Jingjiu cervical spondylosis symptom scale (20 points) and satisfaction. Quantitative outcome measures were collected at baseline, 12th and 24th weeks after the first intervention, while qualitative outcome measures were collected at 24th weeks after the first intervention. Results A total of 90 patients were included, with 45 in each group. There was no statistically significant difference between the two groups in terms of age, gender and other demography characteristics and general data (P>0.05). There is no interaction effect (group × time) for the Tanaka Jingjiu cervical spondylosis symptom scale (20 points) (P>0.05), the interaction effects (group × time) for other quantitative outcome measures were statistically significant (P<0.05). The time effect showed significant statistical differences across all quantitative outcome measures (P<0.001), while the group effect did not exhibit any significant statistical differences (P>0.05). The comparison results within the group showed that at different time points, the differences between the two groups were statistically significant (P<0.001). There were no significant statistical differences between the two groups in terms of qualitative outcome measures (P>0.05) . Conclusions An internet-based neck-specific training program or traditional treatment for 12 weeks can effectively reduce pain and disability among CSR patients, with significant long-term effects. There was no significant difference in treatment effectiveness between the two groups.