Expert consensus for Jingtong Granules in treatment of cervical radiculopathy in clinical application / 中国中药杂志

With the effects of activating blood and resolving stasis, and moving Qi to relieve pain, Jingtong Granules is widely used in the treatment of cervical radiculopathy in China. Long-term clinical application and related evidence have shown that the prescription has ideal effect in alleviating the pain in neck, shoulder, and upper limbs, stiffness or scurrying numbness, and scurrying pain caused by this disease. However, there is a lack of consensus on the clinical application of Jingtong Granules. Therefore, clinical first-line experts and methodology experts from all over the country were invited to compile this expert consensus. This expert consensus is expected to guide clinicians to use Jingtong Granules in a standardized and reasonable way, improve clinical efficacy, reduce medication risks, and benefit patients. First, according to the clinical experience of experts and the standard development procedures, the indications, syndrome characteristics, clinical advantages, and possible adverse reactions of Jingtong Granules were summarized. Then, through face-to-face interview of clinical doctors in traditional Chinese medicine and western medicine and survey of the clinical application, the clinical problems were summed up, and the consensus was reached with the nominal group method to form the final clinical problems. Third, evidence retrieval was carried out for the clinical problems, and relevant evidence was evaluated. The GRADE system was employed to rate the quality of evidence. Fourth, 5 recommendation items and 3 consensuses items were summarized with the nominal group method. Opinions and peer reviews on the consensus content were solicited through expert meetings and letter reviews. The final consensus includes the summary of evidence on the clinical indications, effectiveness, and safety of Jingtong Granules, which can serve as a reference for clinicians in hospitals and primary health institutions.

A Case of Cervical Radiculopathy Related to a Cervical Manual Therapy Course

ABSTRACT Neck pain is a common problem associated with considerable comorbidities, disability and cost to society. Spinal manual therapy is commonly used to treat this condition, and some countries recommend it as a treatment option in their clinical guidelines, since it is generally believed to be a safe and effective method for physicians to use to relieve neck pain. However, the non-invasive and frequently medication-free manipulation manoeuvres can potentially lead to severe adverse effects. This study presents a case of cervical radiculopathy related to cervical manual therapy applied during a training course.

The role of motor nerve conduction: in cervical radiculopathy patients

Background: Cervical radiculopathy is the clinical description of when a nerve root in the cervical spine becomes inflamed or damaged, resulting in a change in neurological function. Neurological deficits, such as numbness, altered reflexes, or weakness, may radiate from the neck into the shoulder, arm, hand, or fingers. Patient also complains of tingling, numbness or loss of sensation along with the nerve root dermatome. It is a substantial cause of disability and morbidity, and its cost-effective evaluation and treatment are crucial so there is a definite need to establish a cost effective, reliable, and accurate means for establishing the diagnosis of cervical radiculopathy. Electrodiagnostic tests are the closest to fulfil these criteria out of which nerve conduction tests are one of the electrodiagnostic test.Methods: In this study motor nerve conduction of ulnar and median nerve done in 30 clinically proven cervical radiculopathy patientsResults: There are significant decrease in the conduction velocity of both nerve (median nerve (51.60±7.5), Ulnar nerve (50.60±5.6)) and significantly increased in the mean latency of both nerve (median nerve (6.02±2.4), ulnar nerve (5.8±1.8)).Conclusions: Authors concluded that MNC is the specific test for the diagnosis of cervical radiculopathy. At least the MNC of both nerves included in diagnostic criteria of cervical radiculopathy.

Effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis

Background: Cervical Spondylitis (CS) is a common term that denotes degenerative changes that develop with of trauma-centre patients, specific age groups, and head injury patients. A study done on Indian population reported 78% of radiological changes of CS at C5-C6 and C6-C7 levels in asymptomatic individuals. These degenerative changes in the cervical spine may remain asymptomatic or can present as pure axial neck pain, cervical radiculopathy, cervical myelopathy, or cervical myeloradiculopathy. So, the aim of the study was to check the effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis. Materials and methods: 60 patients were included in the study which was divided into two groups ; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group A pre-test measurement with the help of two measures - Northwick Park Neck Pain Questionnaire (NPNPQ) for disability and Visual Analog Scale (VAS) Inclinometer for a range of Sreenivasu Kotagiri, Anup Kumar Songa, Mayuri Vijay Gad, Nazz Sulthan. Effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis. IAIM, 2018; 5(5): 146-155. Page 147 motion cervical spine movements was done in each group. Subjects in Group-A were given Mulligan Mobilization with Upper Limb Movement for cervical regain for 45 minutes 4 days for one week in four weeks subject were sitting Subjects in Group-B was given McKenzie Exercises with Neural Mobilization for 45 minutes 4 days for one week in four weeks subject were in supine position and remains relaxed with the feet uncrossed. Result analysis was done by Wilcoxon Sum Rank Test (Mann Whitney U Test). Results: On comparing Group A and Group B for post-treatment VAS score and NPNPQ score, results showed a significant difference (p=0.001) in improvement in terms of VAS and NPNPQ. The overall study proved that both Mulligan mobilization with upper limb movement and McKenzie exercises with neural mobilization were effective in improving Pain and decreasing the disability level in cervical radiculopathy subjects. Conclusion: McKenzie exercise with neural mobilization is better than mulligan mobilization with upper limb movements in cervical radiculopathy. Results supported that McKenzie exercise with neural mobilization was more effective than mulligan mobilization to improve pain and disability in a patient with cervical radiculopathy.

Clinical Application of Chinese Patent Medicine Treating Cervical Radiculopathy in Real-world Study / 世界科学技术-中医药现代化

Objective: Analyze the clinical application rule of Chinese patent medicine in cervical radiculopathy (CR) .Method: The clinical real-world data of CR were extracted by using information sharing system of traditional Chinese medicine and clinical research. Six hundred and twenty-eight inpatients and out patients with CR were enrolled from December 2012 to July 2014 in the information system database of Wangjing Hospital. The correlation analyses and mutual information value were recorded for Chinese patent medicine therapy application of all patients by using liquorice software. Complex network diagrams were generated. Result: Yuxuebi capsule and Jingshu granule is the highest frequency in application of Chinese patent medicine. Jingshu granule and Cobamamide for injection were the highest frequency in combined application of Chinese patent medicine and western medicine. Association frequency was 822, mutual information value was 268.07. Biqi capsule and Daiwenjiu cream were the highest frequency in combined application of Chinese patent medicine and topical drugs. Association frequency was 384, mutual information value was1754.76. Conclusion: The basic treating principle for CR was promoting blood circulation and removing blood stasis. The efficacy and safety of combined Chinese patent medicine with other medicine need further research

Application of Non-pharmacotherapy Treating Cervical Radiculopathy in Real-world Study / 世界科学技术-中医药现代化

This study was aimed to analyze the application of non-pharmacotherapy in treating cervical radiculopathy (CR) in real-world,and to provide clinical reference for CR non-pharmacotherapy.The clinical real-world data of CR was extracted by using information sharing system of traditional Chinese medicine (TCM) and clinical research.Six hundred and twenty-eight inpatients and outpatients with CR were enrolled from December 2012 to July 2014 in the information system database of Wangjing Hospital.Basic characteristics of the non-pharmacotherapy groups were analyzed by statistical description method.The node degree and mutual information value were recorded for non-pharmacotherapy application of all patients by using liquorice software.Complex network diagrams were generated.The results showed that 47％ of CR patients received non-pharmacotherapy (294/628),including 67 males and 227 females.The average age of patients was 49 years old,and the prevalence of the disease was the highest from 45 to 65 years old.In all patients,the usage of manipulation and cervical traction was higher,and the combination of manipulation and acupuncture was the most.Within outpatients,the proportion of cervical traction was higher,and the combination of manipulation and acupuncture was the most frequently.Within inpatients,the proportion of manipulation and cervical traction was higher,and the combination of comprehensive physical therapy and exercise therapy was the most frequently.It was concluded that non-pharmacotherapy has been commonly used in clinical treatment of CR.Cervical traction and manipulation was the widest applications.The combination treatment was in wide application.Future studies should increase the sample size of CR patients from different regions,and enhance gradually the level of evidence of clinical research for non-pharmacotherapy treating CR.

Clinical Outcomes of a Zero Profile Implant for Single-Level Anterior Cervical Discectomy and Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate and compare the clinical results of a zero profile implant with a conventional stand-alone cage. SUMMARY OF LITERATURE REVIEW: A new zero-profile interbody fusion implant named Zero-P was developed in order to avoid plate-related complications. MATERIALS AND METHODS: Twenty-three patients with cervical degenerative disc disease were enrolled. Twelve of these were implanted with a stand-alone cage, and 11 patients received a Zero-P. The mean follow-up time was 16.7 months, ranging from 12 to 34 months. Intraoperative parameters, clinical outcomes (Korean Neck Pain Disability Index [K-NDI], visual analog scale [VAS] score for neck/arm pain), dysphagia scores, and device-related complications were recorded. RESULTS: At the 6-week, 3-month, 6-month, and 12-month follow up, the K-NDI and VAS scores significantly improved in both groups. Dysphagia scores in both groups have no significant differences (p>0.05). However, the cage subsidence rate was significantly higher in the stand-alone cage group (p<0.05). CONCLUSIONS: Clinical outcomes of ACDF with the Zero-P were satisfactory. The incidence of cage subsidence was lower than with the conventional stand-alone cage.

Effectiveness of Selective Nerve Root Block on the Need for Surgical Treatment of Patients with Cervical Radicular Pain: A Minimum 5 Years Follow-Up / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to assess the 5-year outcome of patients considering surgery for complaint of cervical and radiating pain treated by selective nerve root block (SNRB). MATERIALS AND METHODS: Between January 2001 and December 2007, 39 cases were selected from patients who underwent SNRB before the operation and were followed-up for more than five years. The mean follow-up period was 64.3 months and the mean age was 57.7 years. The patients were divided into the operation group and the only cervical SNRB group. The groups were compared for gender, age, duration, disease, single or multi-level, and root compression rate on magnetic resonance imaging. The clinical results were analyzed using the neck disability index (NDI) and the visual analogue scale (VAS) score. RESULTS: Among the 39 cases scheduled for the operation, 20 cases (51.3%) did not proceed to the operation and 13 cases among them were treated with additional conservative treatment. The average VAS score for the operation group and the cervical SNRB group was 8.1 points and 7.5 points at the preoperative state and the pre-injection state. After surgical treatment and cervical nerve root block, the scores were 3.0 points for all. The NDI for the operation group was 11.3 points at the last follow-up. The NDI for the cervical nerve root block group was 13.6 at the last follow-up. There was no significant difference between the two groups. Shorter duration and younger age tended to show a higher operation rate. At the last follow-up, 7 cases (17.9%) after cervical SNRB had persistent symptom relief without other treatment. CONCLUSION: Cervical SNRB is considered an effective treatment for patients with cervical disease with radiating pain and who are scheduled for an operation.

Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy

OBJECTIVE: Anterior cervical microforaminotomy (ACMF) is a motion-preserving surgical procedure. The purpose of this study is to assess radiologic changes of operated and adjacent segments after ACMF. METHODS: We retrospectively reviewed 52 patients who underwent ACMF between 1998 and 2008. From X-ray film-based changes, disc height and sagittal range of motion (ROM) of operated and adjacent segments were compared at preoperative and last follow-up periods. Radiological degeneration of both segments was analyzed as well. RESULTS: The mean follow-up period was 48.2 months. There were 78 operated, 52 upper adjacent, and 38 lower adjacent segments. There were statistically significant differences in the ROM and disc height of operated segment between preoperative and last follow-up periods. However, there were no statistically significant differences in the ROM and disc height of adjacent segment between both periods. Radiological degenerative changes of operated segments were observed in 30%. That of adjacent segments was observed in 11 and 11% at upper and lower segments, respectively. CONCLUSION: After mean 4-year follow-up periods, there were degenerative changes of operated segments. However, ACMF preserved motion and prevented degenerative changes of adjacent segments.

Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography?

Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA.

Mini Open Foraminotomy for Cervical Radiculopathy: A Comparison of Large Tubular and TrimLine Retractors

STUDY DESIGN: Retrospective chart review. PURPOSE: A comparison of mini open foraminotomy (MOF) for cervical radiculopathy using either large tubular (LT) or TrimLine (TL) retractors. OVERVIEW OF LITERATURE: Posterior foraminotomy relieves compression of the cervical nerve root in radiculopathy patients. However, invasion of the paravertebral muscle may cause major problems in these patients. To address these problems, we performed MOF. METHODS: Twenty cervical radiculopathy patients (16 male and 4 female) who underwent MOF between May 2004 and August 2011 were assigned to LT and TL groups. Each group contained 10 subjects. Surgical and clinical outcomes were compared. RESULTS: The average operating time in the TL group was significantly shorter than that in the LT group. The final follow-up mean neck disability indices significantly improved compared to the preoperative values (LT group, 12.0+/-7.8 vs. 28.0+/-9.4; TL group, 6.0+/-5.9 vs. 21.9+/-10). The final follow-up neck pain visual analog scale (VAS) scores also decreased significantly from the preoperative of 8.0+/-1.5 and 2.5+/-2.5 to the final follow-up values of 2.2+/-2.2 and 1.0+/-2.5 in the LT and TL groups, respectively. The recovery rate for the neck pain VAS score was 70.0+/-31.9 in the LT group and 87.0+/-32.0 in the TL group, thus suggesting no significant difference between the two groups. CONCLUSIONS: MOF with the TL retractor is an easy and safe procedure. Furthermore, the use of the TL retractor allows for a minimally invasive and effective surgical treatment of cervical radiculopathy patients.

Feasibility of Early and Repeated Low-dose Interscalene Brachial Plexus Block for Residual Pain in Acute Cervical Radiculopathy Treated with NSAIDS

BACKGROUND: To improve residual pain management in acute cervical radiculopathy treated with NSAIDs, the feasibility of early and repeated low-dose interscalene brachial plexus block (IS-BPB) needs to be assessed. METHODS: This was a prospective study on patients receiving NSAIDs (loxoprofen) for cervical radiculopathy of or = 70 (severe pain; SE group) were compared to the controls receiving NSAIDs. RESULTS: A total of 316 IS-BPBs were performed in the intervention group. There was a significant difference in the decline in the VAS from week 0 to week 3 in the MM and SE groups (P < 0.05); however, from week 3 to week 4, the therapeutic effect exhibited no significant difference. Thirteen patients at week 2 (15.5%; MM: 27.7%; SE: 0%), 43 at week 3 (51.2%; MM: 83.0%; SE: 10.8%), and 47 at week 4 (56.0%; MM: 85.1%; SE: 18.9%) achieved a VAS score of < or = 20. Patient satisfaction was high, and the decrease in VAS scores in both groups was significant (P < 0.05) compared to the controls. CONCLUSIONS: Weekly, low-dose, USG-guided IS-BPB can be implemented for early pain relief in acute cervical radiculopathy, with high patient satisfaction.

Treatment Effects of Ultrasound Guide Selective Nerve Root Block for Lower Cervical Radicular Pain: A Retrospective Study of 1-Year Follow-up

OBJECTIVE: To compare the long-term effects and advantages of ultrasound (US)-guided selective cervical nerve root block with fluoroscopy (FL)-guided transforaminal block. METHODS: From March 2009 to November 2012, 162 patients received steroid injections for lower cervical radicular pain. A total of 114 patients fulfilled the inclusion criteria. All procedures were performed by using US or FL. We compared the intravascular injections during the procedure with the effects and functional scales at 3, 6, and 12 months after the procedure between the two groups. Successful treatments occurred when patients obtained significant pain reliefs (as measured by >50% improvements in the verbal numerical scale [VNS] score and >40% improvements in the neck disability index [NDI] score) and reported a patient satisfaction score of 3 or 4 points at 12 months after the injection. Image analysis of intravascular injection and chart review were performed. Logistic regression was performed to reveal the correlations between successful treatments and variables (patient's age, gender, duration of the disease, cause, injection method, and radiologic finding). RESULTS: The VNS and NDI improved 3 months after the injection and continued to improve until 12 months for both groups. But there were no statistical differences in changes of VNS, NDI, and effectiveness between these two groups. The proportion of patients with successful treatment is illustrated as 62.5% in US-guided group and 58% in FL-guided group at 12 months. There were no significant differences between the groups or during follow-up periods. Three cases of the intravascular injections were done in FL-guided group. CONCLUSION: The US-guided selective cervical nerve root blocks are facilitated by identifying critical vessels at unexpected locations relative to the foramen and to protect injury to such vessels, which is the leading cause of reported complications from FL-guided transforaminal blocks. On treatment effect, significant long-term improvements in functions and pain reliefs were observed in both groups after the intervention. However, significant differences were not observed between the groups. Therefore, the US-guided selective cervical nerve root block was shown to be as effective as the FL-guided transforaminal block in pain reliefs and functional improvements, in addition to the absence of radiation and protection vessel injury at real-time imaging.

Cervical Foraminal and Discal Height after Dynamic Rotational Plating in the Cervical Discectomy and Fusion

STUDY DESIGN: This is a retrospective study. PURPOSE: To evaluate the effect of the dynamic rotational plate to the intervertebral foraminal and discal height after anterior cervical discectomy and fusion. OVERVIEW OF LITERATURE: There is no report regarding the changes of foraminal and discal height following cervical dynamic rotational plating. METHODS: We reviewed the outcomes of 30 patients (36 levels), who were followed-up for an average of 15 months (range, 12-57 months) after undergoing fusions with anterior cervical dynamic rotational plating for cervical radiculopathy, from March 2005 to February 2009. The changes of foraminal and intervertebral discal height of the operated levels were observed on oblique and lateral radiographs obtained at the preoperative, postoperative and follow-up examinations. RESULTS: The foraminal and discal height increased sufficiently, immediately following the operation. However, follow-up results showed gradual decrease in the foraminal and discal height. After 6 months of the surgery, they showed little difference compared with the preoperative heights. However, clinically, patients showed improvements in radiating pain during the follow-up period. CONCLUSIONS: Anterior cervical dynamic rotational plating was an effective treatment modality for cervical radiculopathy without the deterioration of the foraminal and intervertebral discal height.

Does the Size of Anterior Microforaminotomy Affect the Surgical Outcome? / 이화의대지

OBJECTIVES: Anterior microforaminotomy (AMF) is an alternative procedure to treat unilateral cervical pathology. Although the results have been reported favorable in the previous studies, postoperative degeneration may occur. We analyze long-term outcome to determine the critical size of AMF. METHODS: A retrospective study was performed. Clinical data with chart review, radiologic data with picture archiving and communication system (PACS) images were obtained. Long-term clinical outcomes were accessed by a questionnaire, including visual analogue scale (VAS) and neck disability index (NDI). Various clinical, radiological data were statistically analyzed. RESULTS: Eight-two patients were enrolled in this study. Main pathology was spondylotic spur (53.7%), soft disc herniation (36%). Mean age was 49 years old. There was no surgery-related complication. Mean follow-up was 6.1 years. 90.3% showed favorable clinical outcome. Mean VAS score was decreased from 8.2 to 2.9, and NDI score was decreased from 24.5 to 6.7 (P<0.05). 88.7% showed decrease of disc height (DH), and mean change was 1 mm. DH change was correlated positively with the disc invasion and AMF diameter (P<0.05). Mean diameter of AMF was 5.2 mm. According to statistical analysis, the critical diameter of AMF was 4.7 mm, directly affecting DH decrease. Any radiological parameters did not affect the clinical outcome. CONCLUSION: AMF was an effective procedure to treat unilateral cervical pathology. Critical DH decreases and/or disc invasion may be the trigger of sequential degeneration. To preserve DH, AMF diameter should be small and disc invasion should be avoided.

Radiculopatía cervical / Cervical radiculopathy

La patología cervical traumática y su relación con el quehacer de la medicina legal tiene gran importancia y vigencia, principalmente cuando se hace necesario realizar valoraciones a pacientes con alteraciones cervicales y se debe definir si estas están en relación a un trauma determinado o repetitivo en el tiempo como puede ocurrir en algunos casos de riesgo de trabajo. El médico forense debe estar muy bien preparado, conocer la anatomía cervical y de los miembros superiores, realizar un interrogatorio y un examen físico neurológico exhaustivo para orientar las posibilidades diagnósticas; es fundamental además el análisis de los estudios diagnósticos. En este caso en particular se realizar una revisión de la radiculpatía cervical, su fisiopatología, mecanismos de producción y las implicaciones médico legales al realizar la valoración en pacientes con cervicobraquialgia...

The Efficacy and Persistence of Selective Nerve Root Block under Fluoroscopic Guidance for Cervical Radiculopathy

STUDY DESIGN: Retrospective study. OBJECTIVES: To investigate the outcomes of fluoroscopically guided selective nerve root block as a nonsurgical treatment for cervical radiculopathy. OVERVIEW OF LITERATURE: Only a few studies have addressed the efficacy and persistence of cervical nerve root block. METHODS: This retrospective study was conducted on 28 consecutive patients with radicular pain due to cervical disc disease or cervical spondylosis. Myelopathy was excluded. Cervical nerve root blocks were administered every 2 weeks, up to 3 times. Outcomes were measured by comparing visual analogue scale (VAS) scores, patient satisfaction, and medication usage before the procedure and at 1 week and 3, 6, and 12 months after the procedure. In addition, complications associated with the procedure and need for other treatments were evaluated. RESULTS: The average preoperative VAS score was 7.8 (range, 5 to 10), and this changed to 2.9 (range, 1 to 7) at 3 months and 4.6 (range, 2 to 7) at 12 months. Patient satisfaction was 71% at 3 months and 50% at 12 months. Five patients used medication at 3 months, whereas 13 used medication at 12 months. Average symptom free duration after the procedure was 7.8 months (range, 1 to 12 months). Two patients were treated surgically. Only two minor complications were noted; transient ptosis with Horner's syndrome and transient causalgia. CONCLUSIONS: Although selective nerve root block for cervical radiculopathy is limited as a definitive treatment, it appears to be useful in terms of providing relief from radicular pain in about 50% of patients at 12 months.

Dropped Shoulder Syndrome: A Cause of Lower Cervical Radiculopathy

BACKGROUND AND PURPOSE: Cervical radiculopathy is a pathological process involving a nerve root of the cervical spine. The most common causes of radiculopathy are cervical disc herniation followed by cervical spondylosis. The aim of this study was to determine the effect of dropped shoulder as a cause of lower cervical radiculopathy. METHODS: In total, 132 patients, comprising 105 women (79.5%) and 27 men (20.5%; female : male ratio of 4 : 1) and a mean age of 36.7 years (range 18-58 years), were included in this study. All of the patients presented with shoulder pain, and were investigated by cervical X-ray, cervical magnetic resonance imaging, serum muscle enzymes, and electromyography (EMG)/nerve-conduction studies. RESULTS: Ninety six patients (72.7%) exhibited visually detectable dropped shoulder. The lateral view X-ray of the cervical region revealed eight or more vertebrae. In 119 patients (90.2%), the EMG revealed a mild-to-moderate or moderate denervation patterns in the abductor digiti minimi, first dorsal interosseous, and flexor carpi ulnaris muscles, while the abductor pollicis brevis, extensor carpi radialis, and triceps brachii were denervated in 102 patients (77.3%). All of the patients had lower cervical paraspinal muscles with a denervation pattern. CONCLUSIONS: Three criteria for diagnosing dropped shoulder syndrome have been suggested: pain with consistent anatomical distribution, X-ray abnormalities, and EMG abnormalities. Compression of the cervical roots by muscle spasm has been proposed as the cause of dropped shoulder syndrome; this possibility is discussed herein.

Reference Data of Cervical Dermatomal Somatosensory Evoked Potentials Using Low Intensity Stimulation and Report of 2 Cases

OBJECTIVE: To establish reference data for dermatomal somatosensory evoked potentials (DSEP) using a stimulation intensity lower than what is conventionally utilized. METHOD: Fifty subjects (25 older adults>48 years old; 25 younger adults<32 years old) without history of neck pain or cervical spine surgery were enrolled. The DSEP study was performed with stimulation intensities of 1.0, 1.5, and 2.5 times sensory threshold (ST) on right arms for C5, C6, C7, and C8 dermatomes. RESULTS: The mean latencies of DSEP stimulating C5, C6, C7, and C8 dermatomes with 1.5 times ST intensity were 17.6+/-1.7 ms, 22.2+/-2.1 ms, 22.8+/-1.4 ms, and 22.6+/-1.8 ms, respectively. The mean amplitude (N1P1) of DSEP stimulating C5, C6, C7, and C8 dermatomes with 1.5 times ST intensity were 0.9+/-0.4 microV, 0.9+/-0.5 microV, 1.0+/-0.6 microV, and 1.1+/-0.8 microV, respectively. The C5, C6, C7, and C8 DSEP were evoked in 84%, 98%, 100%, and 96% of cases with 2.5 times ST compared to 64%, 56%, 60%, and 62% with 1.5 times ST, respectively. When one DSEP was not evoked, the DSEP of the opposite side was evoked only in 2 subjects. CONCLUSION: This study provides the reference data of DSEP with lower stimulation intensities than are conventionally utilized. Additionally, two cases of clinical significance were reported.

Current concept on the operative treatment for degenerative cervical disc disease

Degenerative changes in the cervical spinal column are common in the adult population. Although most patients respond well to initial nonsurgical management, those who continue to have symptoms or patients with clinically evident myelopathy are candidates for surgical intervention. The objective of this article is to review and discuss the surgical treatment for degenerative cervical spine disease. Anterior cervical spine surgery is commonly used to treat numerous pathologic entities and is expected to increase with the development of surgical techniques and instruments. Autogenous tricortical iliac crest struts are the best option for anterior fusion, but they are associated with donor site morbidity. Equivalent fusion rates have been reported after allografting and autografting, combined with the use of anterior plates. Artificial disc replacement, one of the emerging motion-sparing technologies, is currently used and has shown excellent results. However, longer follow-up is needed to determine whether these devices can function well over time. Surgical treatments in degenerative cervical disease have shown excellent results. Appropriate methods that take into account the pathologic status of the patient and the surgeon's surgical experience can prevent complications and lead to excellent surgical outcomes.