Establishment and evaluation of anterior cervical discectomy fusion model in small-tailed Han sheep model / 中国实验动物学报

Objective Cervical disc herniation(CDH)is one of the common orthopaedic diseases.With the in-depth study of it and the development of cervical implants,the establishment of cervical fusion animal models has become an indispensable part.Notably however,studies of the establishment and evaluation of cervical fusion animal models in China are currently lacking.This study aimed to provide a suitable animal model and evaluation scheme for implants for cervical spine-related research.Methods Small-tailed Han sheep were chosen for anterior cervical discectomy fusion(ACDF)after modified surgery,and a polyetheretherketone(PEEK)interbody fusion cage(Cage)(control group),3D-printed Ti6Al4V Cage(group 1),and new method Ti6Al4V Cage(group 2)were implanted in different cervical segments(C2/3～C4/5)in each sheep,respectively.Hematology and histopathological analyses were carried out after surgery to evaluate recovery of sheep and the biosafety of the materials.Bone in-growth and bone fusion were assessed by X-ray,computed tomography(CT),Micro-CT and quantitative analysis,hard tissue section staining,and biomechanical tests.Results The modified ACDF ovine model was established successfully.There were no significant differences in important hematology indexes(P＞0.05)and histopathological analysis showed no pathological changes,such as inflammatory cell infiltration.The implants had good biosafety.Furthermore,X-ray and CT examinations showed that the position of internal fixation and the interbody fusion were good.Micro-CT and quantitative analysis at 3 and 6 months after operation showed that compared with PEEK Cage group,the bone volume/total volume and trabecular number were significantly increased(P＜0.01)while the trabecular spacing was significantly decreased in the new method Ti6Al4V and 3D-printed Ti6Al4V groups compared with the PEEK Cage group(P＜0.01).Moreover,the new method new method Ti6Al4V Cage group had more bone growth(P＜0.01).Hard tissue section staining demonstrated that the pores of the new method Ti6Al4V Cage and 3D-printed Ti6Al4V Cage had obvious bone growth and relatively dense pores in the new method Ti6Al4V and 3D-printed Ti6Al4V groups,and the combination was slightly better than that of PEEK Cage.Biomechanical evaluation indicated that the new method Ti6Al4V Cage and 3D-printed Ti6Al4V Cage reduced the range of cervical flexion-extension,lateral bending,and axial rotation(P＜0.05)compared with the PEEK cage,as well as enhancing the stability of the cervical vertebra,and the new method Ti6Al4 V Cage was more advantageous(P＜0.05).Conclusions After the establishment of the modified ACDF ovine model,reasonable and effective assessment method were used to demonstrate the suitability and effectiveness of the model and the good biosecurity of all three Cage materials.Compared with the PEEK Cage,the new method Ti6Al4V Cage and 3D-printed Ti6Al4V Cages showed better performances in terms of bone growth and bone fusion,which could enhance the stability of the cervical vertebrae.The new method Ti6Al4V Cage was particularly advantageous.

Effect of neutral position magnetic resonance imaging on cervical discs herniation volume and cervical curvature / 中国组织工程研究

BACKGROUND:Cervical neutral position magnetic resonance imaging is widely used for the diagnosis and treatment of cervical spondylotic myelopathy.However,it is not possible for patients to maintain the exact same position of the head and neck during repeated cervical magnetic resonance imaging examinations.The cervical spine undergoes minor flexion and extension movements in the sagittal plane,and the head may have a certain degree of variation in flexion and extension.Whether these changes in the neutral position of the cervical spine affect the volume of cervical discs herniation and cervical curvature is unclear. OBJECTIVE:Using artificial intelligence-assisted measurement,this study aimed to analyze the accuracy and reliability of magnetic resonance imaging examinations for measuring the volume of cervical discs herniation and cervical curvature in patients with cervical spondylotic myelopathy undergoing two consecutive cervical neutral positions in the short term. METHODS:A retrospective study was conducted on patients with cervical spondylotic myelopathy who underwent conservative treatment and underwent two consecutive cervical magnetic resonance imaging examinations within three months between June 2012 and June 2023.We proposed the use of occipital-thoracic distance and occipital-thoracic angle to evaluate the variation in flexion and extension of the head in the neutral position of the cervical spine.Based on the changes in occipital-thoracic angle,patients were divided into occipital-thoracic angle increase group and occipital-thoracic angle decrease group.Cervical discs herniation volume,C2-6 Cobb angle,and cervical(C3-C7)curvature were measured using artificial intelligence-assisted measurement software.Normal distribution data were represented by mean±SD,while non-normal distribution data were represented by the median(interquartile range).Spearman's rank correlation coefficient was used to analyze the correlation between changes in Cobb angle,cervical(C3-C7)curvature,and cervical discs herniation volume. RESULTS AND CONCLUSION:(1)A total of 104 patients and 326 cervical discs herniation were included in the study.There were 47 patients in the occipital-thoracic angle increase group and 57 patients in the occipital-thoracic angle decrease group.(2)Extension and flexion index of the head:There were no significant differences in occipital-thoracic distance and occipital-thoracic angle during the initial diagnosis and follow-up examination.The variation of occipital-thoracic distance was 0.035(3.23)mm,and the variation of occipital-thoracic angle was-0.31(3.28)°.The deviation range of occipital-thoracic distance and occipital-thoracic angle was small,and there was no significant correlation.(3)Cervical curvature index:There were no significant differences in C2-6 Cobb angle and C3-C7 curvature during the initial diagnosis and follow-up examination.There were no significant differences in C2-6 Cobb angle and C3-C7 curvature between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group.(4)There was no significant difference in volume of cervical discs herniation during the initial diagnosis and follow-up examination.There was no significant difference in volume of cervical discs herniation between the occipital-thoracic angle increase group and occipital-thoracic angle decrease group.There was no significant correlation between the change of cervical discs herniation volume and the change of C2-6 Cobb angle and the cervical(C3-C7)curvature.(5)These results indicate that in the neutral position of the cervical spine,there were negligible minor flexion and extension movements in the sagittal plane,and the head was limited to a specific position.Although the head has a certain range of flexion and extension variation,it does not affect the accuracy and reliability of parameters including cervical discs herniation volume,C2-6 Cobb angle,and cervical(C3-C7)curvature.

Evaluación del desempeño de una nueva prótesis de disco intervertebral cervical mediante el método de los elementos finitos / Evaluation of a new cervical intervertebral disc prosthesis using the finite element method

Introducción: El tratamiento inicial de la cervicalgia por degeneración de los discos intervertebrales es conservador, pero en caso de fallo la discectomía es la opción quirúrgica habitual, sustituyendo el disco por un injerto óseo u otra estructura que cumpla total o parcialmente las funciones del primero. El Servicio de Neurocirugía del Hospital General Camilo Cienfuegos de Cuba ha diseñado un nuevo modelo de prótesis de disco intervertebral cervical para tratar esta enfermedad. Objetivo: Evaluar el desempeño mecánico de la prótesis diseñada a través del método de los elementos finitos bajo las cargas habituales de la columna cervical. Material y Métodos: Se realizó un estudio experimental mediante la simulación numérica, según el método de los elementos finitos, sometiendo la prótesis a las cargas axiales recomendadas por las normas ASTM F2423-11e ISO 18192-1.2011 mediante el software Free CAD 0.18. Resultados: Los mayores esfuerzos soportados por la prótesis en la posición neutral, flexión anterior y flexión lateral fueron de 28.79 MPa, 52.29 MPa y 55.59 MPa respectivamente. La prótesis no sufrió ninguna fractura al no sobrepasar los valores anteriores al límite elástico del material que la constituye. La mayor deformación descrita fue de 1 m. Conclusiones: La mayor concentración de esfuerzos en la prótesis se ubicó en el punto de contacto de la cavidad prismática de la pieza superior al hacer contacto con el prisma de la pieza inferior. El dispositivo diseñado no sufrió ninguna deformación significativa ni se fracturó ante las cargas aplicadas(AU)

Introduction: The initial treatment of cervicalgia due to degeneration of the intervertebral discs is conservative, but in case of failure, discectomy is the usual surgical option, replacing the disc with a bone graft or another structure that fully or partially fulfills the functions of the former. The Neurosurgery Service of the Camilo Cienfuegos General Hospital in Cuba has designed a new cervical intervertebral disc prosthesis model to treat this disease. Objective: To evaluate the mechanical performance of the prosthesis designed through the finite element method under the usual loads of the cervical spine. Material and Methods: An experimental study was carried out using numerical simulation according to the finite element method, subjecting the prosthesis to the axial loads recommended by ASTM F2423-11e ISO 18192-1.2011 standards using Free CAD 0.18 software. Results: The greatest efforts supported by the prosthesis in the neutral position, anterior flexion and lateral flexion were 28.79 MPa, 52.29 MPa and 55.59 MPa, respectively. The prosthesis did not suffer any fracture as it did not exceed the values ​prior to the elastic limit of the material that constitutes it. The greatest deformation described was 1 956;m. Conclusions: The highest concentration of efforts in the prosthesis was located at the point of contact of the prismatic cavity of the upper part when making contact with the prism of the lower part. The designed device did not undergo any significant deformation or fracture at the applied loads(AU)

Tratamiento de la hernia discal cervical. Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus / Cervical disc herniation treatment at Camilo Cienfuegos General Provincial Hospital in Sancti Spíritus

RESUMEN Fundamento: La enfermedad degenerativa cervical produce una variedad de síntomas clínicos que pueden ser tratados de forma no quirúrgica, sin embargo en ocasiones la cirugía es necesaria. La técnica quirúrgica más empleada para tratar esta enfermedad es la discectomía con artrodesis. El tratamiento adecuado de la hernia discal cervical depende de una adecuada selección de la técnica quirúrgica y su correcta realización. Objetivo: Caracterizar el tratamiento quirúrgico de la hernia discal cervical en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus en el período: enero de 2015 a diciembre de 2018. Metodología: Se realizó un estudio prospectivo en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus de enero 2015 a diciembre 2018. La población de estudio: todos los pacientes que acudieron a la consulta externa de neurocirugía del hospital refiriendo cervicalgia o cervicobraquialgia; la muestra: 51 pacientes diagnosticados por resonancia magnética nuclear de hernia discal cervical y que se les realizó al menos una discectomía cervical. Resultados: De los pacientes el 62.8 % eran mujeres y el 33.3 % tenía una edad comprendida entre 51-60 años. El espacio intervertebral más afectado fue C5-C6 (43.7 %). La técnica quirúrgica que predominó fue la discectomía con colocación de injerto autólogo (79.7 %). La complicación más frecuente fue la expulsión del injerto (3.9 %). Conclusiones: El comportamiento de la hernia discal en cuanto al sexo, edad y nivel afectado fue similar al descrito en la bibliografía. La técnica quirúrgica más empleada fue la artrodesis con injerto autólogo de cresta ilíaca. Las complicaciones presentadas fueron infrecuentes.

ABSTRACT Background: Cervical degenerative disease produces a variety of clinical symptoms that can be treated by a non-surgical way, however sometimes surgery is necessary. The most widely used surgical technique to treat this disease is discectomy with arthrodesis. The proper treatment of cervical disc herniation depends on an adequate selection of the surgical technique and its correct performance. Objective: To characterize the surgical treatment of cervical disc herniation at Camilo Cienfuegos General Provincial Hospital in Sancti Spíritus in the period: January 2015 to December 2018. Methodology: A prospective study was carried out at Camilo Cienfuegos General Provincial Hospital in Sancti Spíritus from January 2015 to December 2018. The study population: all the patients who attended the hospital outpatient neurosurgery consultation referring cervicalgia or cervicobraquialgia; the sample: 51 patients diagnosed with cervical disc herniation and performed at least one cervical discectomy. Results: Of the patients, 62.8 % were women and 33.3 % were between 51-60 years old. The most affected intervertebral space was C5-C6 (43.7 %). The predominant surgical technique was discectomy with autologous graft placement (79.7 %). The most frequent complication was the expulsion of the graft (3.9 %). Conclusions: The behavior of the herniation disc concerning sex, age and affected level was similar to that described in the literature. The most widely used surgical technique was arthrodesis with an autologous iliac crest graft. The complications presented were infrequent.

Percutaneous endoscopic Key-Hole technology for treatment of paracentral cervical disc herniation / 中国修复重建外科杂志

Objective: To investigate the effectiveness of percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation in the treatment of paracentral cervical disc herniation. Methods: Between December 2015 and October 2018, 29 cases of paracentral cervical disc herniation were treated with percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation. There were 16 males and 13 females, with an average age of 49.7 years (range, 39-78 years). The disease duration was 3.5-15.0 months (mean, 6.2 months). The herniated disc located at C 3, 4 in 2 cases, C 4, 5 in 5 cases, C 5, 6 in 9 cases, C 6, 7 in 12 cases, and C 7, T 1 in 1 case. The main symptoms were radiculopathy symptom. The operation time, intraoperative blood loss, hospital stay, and complications were observed and recorded. Visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, cervical range of motion (ROM), Macnab standard, and cervical segment stability were used to evaluate the efficacy and safety of the operation. Results: All patients were followed up 11-43 months, with an average of 19.4 months. The operation time was 67-89 minutes (mean, 73.3 minutes); the intraoperative blood loss was 18-30 mL (mean, 22.9 mL); the hospital stay was 5-10 days (mean, 7.3 days). All the incisions healed by first intention. There was 1 case of hypodynia and hyperalgesia in the affected limb after operation,1 case of decreased limb muscle strength. The VAS scores and JOA scores at each time point after operation were superior to those before operation ( P0.05). At last follow-up, the effectiveness was rated according to the Macnab standard as excellent in 11 cases, good in 15 cases, fair in 2 cases, and bad in 1 case, with an excellent and good rate of 89.7%. The CT and MRI showed the decompression of spinal canal and nerve canal. There was no significant difference in cervical ROM between pre- and post-operation ( t=1.427, P=0.165), and no surgical segment instability occurred by X-ray films of flexion and extension of cervical vertebrae. Conclusion: For the paracentral cervical disc herniation with simultaneous compression of nerve roots and spinal cord, percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation has the advantages of small trauma, quick recovery, and satisfactory effectiveness, and can be used as a safe and effective minimally invasive procedure.

Clinical study of single-level cervical disc herniation treated by full-endoscopic decompression via anterior transcorporeal approach / 中国修复重建外科杂志

Objective: To investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach. Methods: According to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C 3, 4 in 2 cases, C 4, 5 in 8 cases, C 5, 6 in 9 cases, and C 6, 7 in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated. Results: Full-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation ( P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one ( t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation ( t=0.881, P=0.421). Conclusion: Full-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results.

Observation of herniated cervical intervertebral disc volume based on quantitative volume measurement “monitoring” based on PACS software / 中国组织工程研究

BACKGROUND: Herniated cervical intervertebral disc volume measurement is an important parameter for quantitative evaluation of cervical disc degeneration, but it faces a lot of problems such as different measurement standards and the undefined measurement error range. OBJECTIVE: To investigate the accuracy of PACS software in measuring cervical disc volume, provide reliable measurement methods and accurate data support for clinical observation and research on cervical disc volume change and degeneration. METHODS: The error rate was obtained by repeated measurements of the normal saline with a known volume of 5.0 mL by means of PACS software. With reference to this error rate, volume changes of cervical disc herniation before and after cervical microendoscopic laminoplasty were “monitored” and analyzed in 30 cases. This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University (approval No. 2019-KY-274) on September 26, 2019. RESULTS AND CONCLUSION: (1) For the measurement of normal saline with known volume, it was found that the error rate of measurement by PACS software was ±5%, suggesting that the measurement of cervical disc volume by PACS software is a simple and accurate method. (2) After cervical microendoscopic laminoplasty, there were 70 patients with reduced cervical disc volume reduction absorption rate of 5%-100%, and the absorption ratio was 76.1% (70/92). The volume increased by 11, but the increase was not more than 5% in the patients with cervical disc herniation after treatment. (3) The spontaneous disappearance or reduction of the herniated cervical disc after cervical microendoscopic laminoplasty was as early as 7 days, and the longest was 76 months. (4) The effects were excellent in 11 cases, good in 15 cases, and fair in 4 cases. The excellent and good rate was 86.7%.

Effect of Xianlu Qige Decoction combined with acupuncture on improvement of cervical intervertebral disc symptoms and serum p-P38MAPK level / 中草药

Objective To study the effects of Xianlu Qige Decoction combined with acupuncture on the improvement of cervical intervertebral disc symptoms (CIDS) and serum phosphorylation-P38 mitogen-activated protein kinase (p-P38MAPK). Methods A total of 156 patients with CIDS admitted to our hospital from April 2016 to September 2018 were enrolled. The patients were randomly divided into two groups, 78 cases for each. The control group was given conventional Western medicine treatment. The observation group was given the combination of Xianlu Qige Decoction and acupuncture. The acupuncture therapy was supervised, by comparing the total effective rate of the two groups before and after treatment. The Tianzhong Jingjiu cervical spondylosis symptom scale 20 points score, serum immunoinflammatory factors [immunoglobulin G (IgG), IgA, IgM, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-1, p-P38 MAPK pathway protein expression [vascular endothelial growth factor (VEGF), matrix metalloproteinase-3 p-P38MAPK, MMP-9], serum pain medium [nitrogen monoxide (NO), serotonin (5-HT), and prostaglandin E2 (PEG2)] levels were compared. Results The total effective rate of the experimental group was 94.87% higher than that of the control group of 76.92% (P < 0.001). After treatment the scores of symptoms, signs, work and life ability and hand function of the two groups were higher than those before treatment, and the scores of pain were lower than those before treatment (P < 0.05). After treatment, the scores of symptoms, signs, work and life ability and hand function in the experimental group were higher than those in the control group, and the scores of pain were lower than those in the control group (P < 0.001); the levels of IgG, IgA, IgM, TNF-α, IL-1 and IL-6 in the two groups were lower than those before treatment (P < 0.001); the levels of IgG, IgA, IgM, TNF-α, IL-1 and IL-6 in the experimental group were lower than those in the control group (P < 0.001). After treatment, the levels of vascular endothelial growth factor (VEGF) in both groups were lower than those before treatment, and the levels of MMP-3, p-P38MAPK and MMP-9 were higher than those before treatment (P < 0.001); after treatment, the levels of VEGF in the experimental group were lower than those in the control group, and the levels of MMP-3, p-P38MAPK and MMP-9 were higher than those in the control group (P < 0.001). After treatment, the levels of NO, PEG2 and 5-HT in the two groups were lower than those before treatment (P < 0.05); After treatment, the levels of NO, PEG2 and 5-HT in the experimental group were lower than those in the control group (P < 0.05). Conclusion Xianlu Qige Decoction combined with acupuncture in the treatment of CIDS can reduce the release of serum pain media, significantly improve the clinical symptoms such as pain, and inhibit the inflammatory response of body, and its curative effect is significant. The mechanism may be related to the regulation of p-P38MAPK signaling pathway.

Cervical Disc Herniation and Central Horner Syndrome

Central Horner syndrome is a rare condition, comprising a unique pathophysiological phenomenon. It results from vascular lesions, head or thoracic trauma. We describe a case of Horner syndrome associated to cervical disc herniation, and first-order neuron compression. To our knowledge, this is the second case reported to date in the literature.

A síndrome de Horner central é uma condição rara, que compreende um fenómeno fisiopatológico singular. Resulta de lesões vasculares, trauma cerebral ou torácico. Descrevemos um caso de síndrome de Horner associado a hérnia de disco cervical, com lesão de primeiro neurónio. De acordo com a revisão, é o segundo caso reportado na literatura.

The preliminary clinical study about the effectiveness of selective treatment for traumatic cervical disc herniation with stand alone RIO-C / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the efficacy of a new double plate self locking interbody fusion device(ROI-C) in the anterior cervical discectomy and fusion(ACDF) to treat traumatic cervical disc herniation(TCDH) without segmental instability, fracture or dislocation.</p><p><b>METHODS</b>ACDF with stand alone ROI-C was performed in 17 selective TCDH patients between December 2011 and December 2013. There were 12 males and 5 females, aged from 24 to 41 years old with a mean of 32.9 years, including 11 patients with single segment, 4 patients with double segments and 2 patients with three segments. Japanese Orthopaedics Assiciation (JOA), visual analogue scale(VAS) score and the Neck Disability Index(NDI) were recorded before and after operation in order to evaluate the clinical outcome, meanwhile, the preoperative and postoperative X ray films were collected to measure the intervertebral space height and whole cervical curvature. According to Vaccraro criteria to observe the bone fusion. The clinical effects were assessed according to Odom criteria.</p><p><b>RESULTS</b>All patients were followed up from 12 to 33 months with an average of 18.5 months. JOA score was increased significantly from preoperative 4.3±3.8 to 13.9±2.5 at final follow up (<0.05). VAS, NDI were decreased from preoperative (6.5±2.2) scores and (38.2±11.7) % to (1.0±0.9) scores and (8.7±3.4) % in final follow up, respectively (<0.05). Intervertebral space height and cervical curvature were increased from preoperative (5.2±1.7) mm and (5.1±7.5) ° to (7.8±0.6) mm and (10.5±5.1) °, respectively(<0.05). Hoarseness occurred in one patient and dysphagia occurred in 2 patients and they recovered spontaneously in 2 weeks and 3 months after operation, respectively. All the segments (25 levels) of the 17 cases achieved bony fusion in 6 months after operation. No displacement, subsidence and failure of ROI-C were found during follow up. According to Odom's criteria to evaluate clinical effects at the last follow up, 13 cases got excellent results, 3 good, and 1 fair.</p><p><b>CONCLUSIONS</b>ACDF with stand alone ROI-C is an effective, minimally invasive and reliable method in treating TCDH without segmental instability, fracture or dislocation, it can obtain satisfactory clinical outcomes and has advantage of less complications, high fusion rate.</p>

Cervical Footprint Anthropometry in Indian Population: Implications on Design of Artificial Disc Replacement Devices

STUDY DESIGN: Cross-sectional study. PURPOSE: To accurately measure the dimensions of cervical endplates based on computed tomography (CT) scans in Indian population and assess accuracy of match with currently available cervical disc prostheses. OVERVIEW OF LITERATURE: The dimensions of currently available cervical disc replacement implants are based on early published geometrical measurements of vertebrae endplates for Caucasian population. To author's knowledge, similar study has not been published for patients from Indian subcontinent. METHODS: CT scans of cervical spine of patients from Indian subcontinent were collected and reviewed. Seventy patients (54 men and 16 women; aged 18-56 years with average of 37 years) who underwent CT scans of cervical spine were included in study. 3D CT scans of sub axial cervical spine (C3 to C7) were analyzed. The anterior-posterior (AP) and central mediolateral (CML) dimensions of superior and inferior endplates from C3 to C7 were measured using digital measuring system. RESULTS: A total of 560 endplates of 70 patients were included in the study. The AP diameter of cervical endplates ranged from 0.87 to 2.47 cm. The CML diameters ranged from 0.84 to 2.98 cm. For levels C3/C4 and C4/C5 for AP dimension Prestige-LP (90.5%) and Prodisc-C (89%) discs showed higher percentage of matching than Discover discs (58.5%). For CML diameter, Prestige-LP (69.5%), Prodisc-C (70%) and Discover (39.5%) discs showed almost similar matching with measured endplates. For levels C5/C6 and C6/C7 for AP dimension, Prestige-LP (67.25%), Prodisc-C (49.35%) and Discover (51.5%) discs showed similar matching. For CML diameter Prestige-LP (32%), Prodisc-C (27.5%) and Discover (42.2%) discs showed poor matching with measured endplates. CONCLUSIONS: This study indicates need for redesign of cervical disc prostheses to match Indian patients. The collected anthropometric dimensions from this study may be used to design and develop indigenous artificial total disc replacement prosthesis and even cervical cages in India. With the present study being a small pilot study, the authors recommend anthropometric CT measurements in larger number of Indian patients in order to validate footprint dimensions for designing better-matched prosthesis.

Thalamic Pain Misdiagnosed as Cervical Disc Herniation

Thalamic pain is a primary cause of central post-stroke pain (CPSP). Clinical symptoms vary depending on the location of the infarction and frequently accompany several pain symptoms. Therefore, correct diagnosis and proper examination are not easy. We report a case of CPSP due to a left acute thalamic infarction with central disc protrusion at C5-6. A 45-year-old-male patient experiencing a tingling sensation in his right arm was referred to our pain clinic under the diagnosis of cervical disc herniation. This patient also complained of right cramp-like abdominal pain. After further evaluations, he was diagnosed with an acute thalamic infarction. Therefore detailed history taking should be performed and examiners should always be aware of other symptoms that could suggest a more dangerous disease.

Prognostic Factors for Postsurgical Recovery of Deltoid Palsy due to Cervical Disc Herniations

STUDY DESIGN: Retrospective multicenter study. PURPOSE: We aimed to investigate prognostic factors affecting postsurgical recovery of deltoid palsy due to cervical disc herniation (CDH). OVERVIEW OF LITERATURE: Little information is available about prognostic factors affecting postsurgical recovery of deltoid palsy due to CDH. METHODS: Sixty-one patients with CDH causing deltoid palsy (less than grade 3) were included in this study: 35 soft discs and 26 hard discs. Average duration of preoperative deltoid palsy was 11.9 weeks. Thirty-two patients underwent single-level surgery, 22 two-level, four three-level, and three four-level. Patients with accompanying myelopathy, shoulder diseases, or peripheral neuropathy were excluded from the study. RESULTS: Deltoid palsy (2.4 grades vs. 4.5 grades, p<0.001) and radiculopathy (6.4 points vs. 2.1 points, p<0.001) significantly improved after surgery. Thirty-six of 61 patients (59%) achieved full recovery (grade 5) of deltoid palsy, with an average time of 8.4 weeks. Longer duration of preoperative deltoid palsy and more severe radiculopathy negatively affected the degree of improvement in deltoid palsy. Age, gender, number of surgery level, and disc type did not affect the degree of improvement of deltoid palsy. Contrary to our expectations, severity of preoperative deltoid palsy did not affect the degree of improvement. Due to the shorter duration of preoperative deltoid palsy, in the context of rapid referral, early surgical decompression resulted in significant recovery of more severe grades (grade 0 or 1) of deltoid palsy compared to grade 2 or 3 deltoid palsy. CONCLUSIONS: Early surgical decompression significantly improved deltoid palsy caused by CDH, irrespective of age, gender, number of surgery level, and disc type. However, longer duration of deltoid palsy and more severe intensity of preoperative radiating pain were associated with less improvement of deltoid palsy postoperatively.

Clinical effect of ozone combined with radiofrequency thermocoagulation for the treatment of cervical interver-tebral disc herniation / 局解手术学杂志

Objective To analyze the treatment effects of cervical disc herniation treated by ozone combined with radiofrequency ther-mocoagulation. Methods Ninety cases of cervical intervertebral disc herniation were collected from our hospital in July 2009 to December 2013,who were treated by ozone combined with radiofrequency thermocoagulation. The patients were followed up for at least 3~6 months and the improvement rate was calculated according to the Macnab improved standard. Results All the patients were followed up for at least 3~6 months,according to the Macnab standard improved,50 cases were excellent,good in 25 cases,in 10 cases and poor in 5 cases,the improve-ment rate was 94. 4%. Conclusion The treatment of cervical disc herniation by ozone combined with radiofrequency thermocoagulation is one of the interventional therapy methods,which is minimally invasive and relatively safe. The treatment method has the following advantages, such as,satisfactory effect,accurate operation safety,less complications and without destroying the stability of the spinal structure.

Traumatic extrusion of C5-C6 intervertebral disc associated to mielopathy without bone lesion: report of 2 cases and review

The authors reports two cases of cervical disc herniation caused by trauma without osseous lesions in articular facets, vertebral bodies or dislocations. It constitutes uncommon lesions in spinal cord injury. The literature is reviewed.

Cervical Spinal Epidural Hematoma Following Cervical Posterior Laminoforaminotomy

A 65-year-old man who had lateral cervical disc herniation underwent cervical posterior laminoforaminotomy at C5-6 and C6-7 level right side. During the operation, there was no serious surgical bleeding event. After operation, he complained persistent right shoulder pain and neck pain. Repeated magnetic resonance image (MRI) showed diffuse cervical epidural hematoma (EDH) extending from C5 to T1 level right side and spinal cord compression at C5-6-7 level. He underwent exploration. There was active bleeding at muscular layer. Muscular active bleeding was controlled and intramuscular hematoma was removed. The patient's symptom was reduced after second operation. Symptomatic postoperative spinal EDH requiring reoperation is rare. Meticulous bleeding control is important before wound closure. In addition, if patient presents persistent or aggravated pain after operation, rapid evaluation using MRI and second look operation is needed as soon as possible.

Clinical Outcomes of Epidural Neuroplasty for Cervical Disc Herniation

Cervical disc herniation is a common disorder characterized by neck pain radiating to the arm and fingers as determined by the affected dermatome. This condition has a favorable prognosis, but pain can have a serious detrimental impact on daily activities. Epidural neuroplasty has been applied as a treatment option for cervical disc herniation; however, no study has addressed the clinical outcomes. This retrospective study evaluated the clinical outcomes of epidural neuroplasty on 128 patients for the treatment of cervical disc herniation. To measure pain-related disabilities over time, the changes of pain scores in neck and arm were evaluated using a numerical rating scale (NRS) and the neck disability index (NDI). Compared with preprocedural values, the pain NRS of neck and arm demonstrated significant improvement at day 1, and 1, 3, 6, and 12 months after the procedure (P < 0.001). Likewise, the NDI was significantly reduced at 3, 6, and 12 months after the procedure (P < 0.001). There were no serious complications. Cervical epidural neuroplasty shows good clinical outcomes in the treatment of cervical disc herniation and can be considered a treatment modality for cervical disc herniation refractory to conservative treatment.

Clinical study on the treatment of cervical disc herniation with radiofrequency thermocoagulation and Chinese medicine / 国际中医中药杂志

Objective To explore the effects and security of traditional Chinese medicine combined with radiofrequency thermocoagulation in the treatment of lumbar disc herniation.Methods A total of 116 cases with lumbar disc herniation were randomly divided into a treatment group and a control group.The control group (56 cases) was treated with radiofrequency thermocoagulation,while the treatment grouP (60 cases)was treated with Chinese medicine on the basis of the control group.Clinical effect was evaluated by VAS score and JOA score standard analysis before therapy,and 24 hours,1 month,3 month and 6 months after the therapy.Results Thee was no significant differences(x2=0.19,P＞0.05)in VAS and JOA score between the two groups before therapy and 24 hours after the therapy.While after 1 months,3 months and 6 months after the therapy,there was significant difference between the two groups (F value of the control grouP was 168.50、97.80、109.10,F value of the treatment group was 286.50、165.34、75.82,P＜0.01).The therapeutic effects comparison between the two group after 6 months therapy:the recovery rate was 76.7％ and 90.0％ in the control group and the treatment group respectively,showing significant differences (x2=4.568,P＜0.05).Conclusion Chinese medicine combined with radiofrequency thermocoagulation was an effective method for cervical disc herniation.

A Case of Cervical Disc Herniation with Paresthesia in Both Arms and Tic Mimicking Motions / 대한소아신경학회지

Intervertebral disc herniation is rare in children and is reportedly related with disc calcification and traumatic injury. We report an 8 years old girl, who complained of tingling sensation in both arms and intentional tic like neck stretching for about 1 month. She had got unnoticed whiplash Injury 2 weeks before symptoms. She also had been taking lessons for taekwondo for one and half year. Physical examination was unremarkable. Her symptoms got aggravated over the next 4 weeks. Plain vertebral x-ray showed no abnormalities, but cervical spinal MRI revealed disc central herniations at C 5-6 and C 6-7 levels. We concluded that her paresthesia and tic like motion were related with cervical disc herniation from hyperflexion neck injury.

Early anterior approach operation with internal fixation in treatment of acute multilevel cervical disc herniation patients with cervical spinal cord injury / 中华神经医学杂志

Objective To evaluate the clinical effect of early anterior approach operation with internal fixation in treating traumatic cervical disc herniation patients with cervical spinal cord injury.Methods Twenty-three patients with spinal cord injury caused by acute cervical disc herniation,admitted to our hospital from January 2010 to January 2011,were chosen in our study; all patients underwent anterior cervical surgery with the application of titanium mesh plate and cage to perform decompression and reconstruction; 14 patients received surgery within 72 h of injury and other 9 adopted surgery after 72 h of injury.The clinical data and postoperative recovery degree of the spinal cord injury were retrospectively analyzed.Results All patients were followed up for 6 to 13 months (averaged 11 months).X-ray examination showed bony fusion in the fusion segments without loosening/breakage of internal fixation or interbody fusion sinking.Except for 1 patient having grade A according to American Spinal Injury Association (ASIA) criteria enjoyed no recovery after the operation,the remaining patients enjoyed good improvement.The postoperative average Japanese Orthopedic Association (JOA) scale scores were significantly higher than those before surgery; the postoperative average JOA scale scores and recovery ratio of JOA in patients received surgery within 72 h of injury were obviously higher than those in patients received surgery over 72 h of injury (P＜0.05).Conclusion Early anterior titanium mesh combined with cage and locking plate operation can make acute cervical disc herniation patients with spinal cord injury get rapid improvement and restoration; the earlier the operation time,the better the recovery degree; surgery can make cervical operation section obtain immediate stability,fusion and clinical effects are satisfied.