Análisis del impacto ergonômico asociado a la manipulación de cargas en trabajadores de equipos de perforación del sector petrolero / Analysis of the ergonomie impact associated with cargo handling in drilling equipment workers in the oil sector

Resumen El mundo actual y las tendencias de universalización de procesos que se dan a través de la globalización, la apertura de mercados, la internacionalización, la competencia y todas las nuevas situaciones que el desarrollo empresarial trae día a día hacen que los procesos empresariales deban ser más eficientes y eficaces, con lo cual existen riesgos asociados con las actividades que implican un sobre esfuerzo físico y por ende una posible lesión osteomuscular. Objetivo. Analizar las relaciones existentes entre las tareas de impacto negativo y las variables ergonómicas asociadas a la manipulación de cargas, a través del uso de las herramientas de evaluación REBA y RULA de manera que se identifiquen los factores de riesgo por parte de los trabajadores de Drilling & Well Services, especialmente cuñeros y encuelladores de una empresa petrolera. Materiales y métodos. La investigación es de tipo descriptivo, pues representa un análisis experimental que tiene como objetivo establecer las condiciones iniciales y determinar la manera como se manifiesta una determinada circunstancia particular identificando los rasgos característicos de la operación. Resultados. Se evidenciaron actividades como el levantar y posicionar la cuña, trasladar la tubería de perforación, soltar o ajustar las llaves de potencia y ajustar los brazos de los elevadores para cerrarlos y con ello asegurar la tubería de perforación, como las acciones de riesgo más importantes en las operaciones de los cuñeros y operadores.

Abstract The current world and the tendencies of universalization of processes that occur through globalization, the opening of markets, internationalization, competition and all the new situations that business development brings every day make processes must be more efficient and risks, with which there are risks associated with activities that involve physical exertion and therefore a possible musculoskeletal injury. Objective. Analyze the relationships identified between the negative impact tasks and the ergonomic variables associated with cargo handling, by using the REBA and RULA assessment tools so that risk factors are identified by Drilling & Well workers Services, especially wedges and pollsters of an oil company. Materials and methods. The research is descriptive, since it represents an experimental analysis that aims to establish the initial conditions and determine the way in which a particular circumstance is manifested by identifying the characteristic features of the operation. Results. There were activities such as lifting and positioning the wedge, moving the drill pipe, releasing or adjusting the power keys and adjusting the arms of the elevators to close and with it controlling the drill pipe, as the most important risk actions in the operations of the wedges and operators.

An Evaluation of the Disaster Medical System after an Accident which Occurred after a Bus fell off the Incheon Bridge

PURPOSE: Field triage, medical care, and transportation are important and life-saving medical tasks performed at the site of a mass-casualty incident (MCI). We experienced a mass-casualty incident when an express bus fell off the Incheon bridge and conducted an evaluation of problems. We are willing to provide information for equipping an local disaster planning. METHODS: We surveyed the local emergency medical system response time, transportation time, and patients' clinical data using paramedics' records and medical records. We evaluated the adequacy of the order of priority of transportation by field triage used using the simple triage and rapid treatment (START) method. We evaluated field medical care, as well preponderance of transportation. RESULTS: Twenty four people who were on the bus were evacuated, and 2 persons were dead on the scene. Two persons died within one week. There was a transport delay for patients who would benefit significantly from medical intervention because dead persons were transported early. Neither advanced airway nor fluid resuscitation was provided. Sixteen patients (66.7%) were transported to one hospital. CONCLUSION: When we reviewed this mass-casualty incident, there was no appropriate medical control, such as triage, field medical care, and transportation. In construction of the emergency medical service system for preparation for MCI or disasters, we suggest integration and unification of 119 rescue services and emergency medical information centers for effective medical control. Disaster drills should be performed according to guidelines for local emergency medical services.

Single Center Experiences to Landslides on Woo-myun Mountain: Preparedness, Response, and Lessons Learned

PURPOSE: On July 27, 2011, landslides occurred on Woomyun Mountain, resulting in development of mass casualties. Seoul St. Mary's Hospital was the primary recipient of patients. This experience prompted the drafting of a formal disaster plan. Therefore, we outline the Emergency Management External Disaster Plan of Seoul St. Mary's Hospital and discuss the time course of presentation and medical characteristics of the patients. METHODS: We conducted a retrospective review of medical records of patients who visited Seoul St. Mary's Hospital from Woo-myun Mountain landslides. In addition, we reviewed the time course of hospital disaster response. RESULTS: A total of 33 patients participated in this study. Mean age was 40.2 (+/-21.8) years; eight patients died at the time of admission and cardiopulmonary resuscitation was performed in one patient. Mean Injury Severity Score (ISS) was 9.19 and four patients were ISS above 15. Six patients were admitted to our hospital and two patients underwent an emergency operation. Overall, the emergency disaster management was appropriate due to the formal disaster plan and experiences in conduct of disaster drills. However, there were also several problems. The major problems of our disaster response were as follows: delayed activation of external disaster, difficulties in securing a treatment section, and absence of a decontamination facility. CONCLUSION: We observed several problems from our experience with Woo-myun Mountain landslides. Reassessment of the disaster plan and additional planning for other possibilities are needed.

Ureteral Penetration Caused by Drilling During Internal Pelvic Bone Fixation: Delayed Recognition / 대한배뇨장애요실금학회지

A 49-year-old man was referred to our department with profuse serous fluid discharge from a Penrose drain after undergoing internal fixation with metal screws for multiple pelvic bone fractures. A definite ureteral penetration was identified that was orientated from the lateral to the medial aspect of the right distal ureter. The patient was surgically treated with excision of the 2-cm injured ureteral segment, end-to-end ureteroureterostomy, and double J ureteral stent placement. To our knowledge, a penetrating ureteral injury caused by bone drilling has not been reported previously in the published literature. This case shows that surgeons who do pelvic surgery, including orthopedic surgeons, should be familiar with the anatomical relationship of the ureter and its potential injuries.

Clinical Significance of beta-Tricalcium Phosphate and Polyphosphate for Mastoid Cavity Obliteration during Middle Ear Surgery: Human and Animal Study

OBJECTIVES: Mastoid obliteration is used to obliterate the mastoid cavity following a mastoidectomy or to prevent the formation of a retraction pocket. This study evaluated the effectiveness of beta-tricalcium phosphate and polyphosphate (beta-TPP) for mastoid obliteration in middle ear surgeries in prospective human and animal studies. METHODS: Twenty patients with chronic otitis media underwent mastoid obliteration using beta-TPP after a intact canal wall mastoidectomy or simple mastoidectomy. The clinical data were prospectively evaluated including: the diagnosis, temporal bone computed tomography (TBCT), otoscopic findings, pure tone audiogram, and complications. In the animal experiment, beta-TPP was applied into the right bulla in five rats, and the opposite bulla was used as the control in the non-obliterated state. The skulls of five other rats were drilled out and the holes were obliterated with beta-TPP. TBCT were obtained at 3, 6, and 9 months after the obliteration and histologic analysis was done at 3 and 9 months after surgery. RESULTS: In the human study, fourteen TBCTs were obtained at 12 months after the surgery. All demonstrated no bone resorption in the obliterated mastoids. Among the 15 cases displaying retracted tympanic membranes preoperatively, 11 showed no retraction, 2 showed retraction postoperatively, 1 was lost to follow-up and 1 was a case of postoperative wound infection. Among 20 cases, one case developed a postoperative infection that necessitated a second operation. Sixteen underwent ossiculoplasty; hearing improvements were obtained in 15 cases and 1 case showed decreased hearing. In the animal study, new bone formation without significant bone resorption in the radiologic and histologic findings were noted in both the skull and bulla groups. CONCLUSION: Although beta-TPP is a foreign material having the possibility of infection, mastoid obliteration with it can be a treatment option in middle ear surgeries to prevent retraction pockets or the recurrence of diseases.

The effect of guided flapless implant procedure on heat generation from implant drilling / 대한치과보철학회지

PURPOSE: The aim of this study was to evaluate the heat generation in bone in vitro during the guided flapless drilling procedure and the effect of drilling methods on the heat generation. MATERIALS AND METHODS: A model that has missing the first and second mandibular molars bilaterally was used. In group A, classical flap implant surgery was performed. In group B, flapless implant surgery using surgical guide was performed. In group C, flapless implant surgery using surgical guide without up-and-down pumping motion was performed. Temperature was measured with k-type thermocouple and a real-time digital thermometer. The thermocouples were placed at 0.5 mm away from the osteotomy area at the depths of 3 mm and 6 mm. The measured values were evaluated with independent t-test. RESULTS: The mean temperature generated was 27.2degrees C (SD +/- 2.1degrees C) and 27.5degrees C (SD +/- 2.3degrees C) for groups A and B, respectively. These differences were not statistically significant. In group C, the mean temperature was 37.0degrees C (SD +/- 3.4degrees C). There were statistically significant differences between groups B and C with respect to the mean temperature. CONCLUSION: These findings suggest that guided flapless drilling with up-and-down pumping motion may not significantly increase the bone temperature.

Bone apposition on implants coated with calcium phosphate by ion beam assisted deposition in oversized drilled sockets: a histologic and histometric analysis in dogs

PURPOSE: The purpose of this study was to evaluate the osseointegration of calcium phosphate (CaP)-coated implants by ion beam assisted deposition with a lack of primary stability. METHODS: A total of 20 CaP-coated implants were bilaterally placed in the mandible of five dogs. In the rotational implant group, the implants were inserted in oversized drilled sockets without mechanical engagement, while the conventional surgical protocol was followed in the control group. Each group was allowed to heal for 4 and 8 weeks. The bone-to-implant contact (BIC, %) was measured by a histometric analysis. RESULTS: All of the implants were well-maintained and healing was uneventful. In the histologic observation, all of the implants tested were successfully osseointegrated with a high level of BIC at both observation intervals. There was no significant difference in BIC among any of the groups. CONCLUSIONS: Within the limitation of this study, successful osseointegration of CaP-coated implants could be achieved in unfavorable conditions without primary stability.

Evaluation of the correlation between insertion torque and primary stability of dental implants using a block bone test

PURPOSE: Implant stability at the time of surgery is crucial for the long-term success of dental implants. Primary stability is considered of paramount importance to achieve osseointegration. The purpose of the present study was to investigate the correlation between the insertion torque and primary stability of dental implants using artificial bone blocks with different bone densities and compositions to mimic different circumstances that are encountered in routine daily clinical settings. METHODS: In order to validate the objectives, various sized holes were made in bone blocks with different bone densities (#10, #20, #30, #40, and #50) using a surgical drill and insertion torque together with implant stability quotient (ISQ) values that were measured using the Osstell Mentor. The experimental groups under evaluation were subdivided into 5 subgroups according to the circumstances. RESULTS: In group 1, the mean insertion torque and ISQ values increased as the density of the bone blocks increased. For group 2, the mean insertion torque values decreased as the final drill size expanded, but this was not the case for the ISQ values. The mean insertion torque values in group 3 increased with the thickness of the cortical bone, and the same was true for the ISQ values. For group 4, the mean insertion torque values increased as the cancellous bone density increased, but the correlation with the ISQ values was weak. Finally, in group 5, the mean insertion torque decreased as the final drill size increased, but the correlation with the ISQ value was weak. CONCLUSIONS: Within the limitations of the study, it was concluded that primary stability does not simply depend on the insertion torque, but also on the bone quality.

The Clinical Usefulness of Ultrasound-Aided Fixation Using an Absorbable Plate System in Patients with Zygomatico-Maxillary Fracture

BACKGROUND: Ultrasound-aided fixation is a recently developed alternative method of treatment of zygomatico-maxillary (ZM) fracture, and it can resolve the problems of excessive torsion force and subsequent fractures of screws. We conducted this study to evaluate the clinical usefulness of ultrasound-aided fixation as compared with the conventional fixation method using a drill and an expander in patients with ZM fracture. METHODS: We conducted a retrospective study in 35 patients with ZM fracture who had been treated at our hospital during a period ranging from March of 2008 to December of 2010. We divided them into two groups: an ultrasound-aided fixation group, comprising 13 patients who underwent ultrasound-aided fixation (SonicWeld Rx, KLS Martin), and a conventional group, comprising 22 patients who underwent conventional fixation (Biosorb FX, Linvatec Biomaterials Ltd.). We compared such variables as sex, direction, age at operation, follow-up period, operation duration, number of fixed holes, and time to discharge between the two groups. RESULTS: The ultrasound-aided fixation reduced the operation duration by about 30 minutes as compared with that of conventional fixation. There was no significant difference in follow-up period, number of fixed holes, or time to discharge between the two groups. Furthermore, there were no complications in either group. CONCLUSIONS: The ultrasound-aided fixation of fractured ZM bone using an absorbable implant system is safe and effective in promptly reducing the bone fracture and providing satisfactory cosmetic outcomes over time.

Painful Accessory Navicular / 대한족부족관절학회지

Accessory navicular is a congenital anomaly of the tuberosity of the navicular from a secondary ossification center. The accessory navicular is occasionally the source of pain and local tenderness over the medial side of midfoot. If conservative treatment fails for the painful accessory navicular, surgical treatment is required. There are several surgical option for accessory navicular, which vary from simple excision, percutaneous drilling, modified Kidner procedure and osteosynthesis of the accessory ossicle to the navicular body. In addition, symptomatic flatfoot deformity should be addressed concomitantly.

Outcomes of preimplantation genetic diagnosis using either zona drilling with acidified Tyrode's solution or partial zona dissection / 대한생식의학회지

OBJECTIVE: To review the outcomes of preimplantation genetic diagnosis (PGD) using zona drilling with acid Tyrode's solution (chemical zona pellucida drilling, chemical ZD) and those of partial zona dissection (PZD). METHODS: Clinical outcomes of seventy-one couples undergoing 85 PGD cycles from January 2005 to December 2010 were included. Blastocyst formation and the hatching rate, clinical pregnancy rate, ongoing pregnancy rate, implantation rate, and fetal gender ratio of the PZD and chemical ZD groups were compared. RESULTS: Application of PZD resulted in a significantly higher rate of clinical pregnancy (40.7% vs. 15.4%, p=0.022), ongoing pregnancy (35.6% vs. 11.5%, p=0.023), and implantation (18.1% vs. 5.7%, p=0.007) compared with chemical ZD. Among non-transferred embryos, the rate of blastocyst formation on day 5 (49.1% vs. 39.5%, p=0.016) and hatching on day 6 (47.2% vs. 26.5%, p<0.001) were also significantly higher in the PZD group. CONCLUSION: The mechanical zona dissection method showed better outcomes than chemical ZD in terms of the blastocyst development and pregnancy rate. In this study, the fact that chemical ZD was conducted in different period from mechanical method should be considered in interpreting the result.

Construction of High-Density Tissue Microarrays at Low Cost by Using Self-Made Manual Microarray Kits and Recipient Paraffin Blocks

BACKGROUND: Advances of tissue microarray (TMA) technology have enabled simultaneous in situ analysis of biomarker expression in a large number of archived pathology specimens. However, the relatively high cost of TMA construction may hamper many researchers from using this essential tool of modern pathology research. We discuss methods for making TMA kits and recipient blocks for manual construction of high-density TMAs at low cost. METHODS: Ordinary cannula piercing needles, hypodermic needles, bone marrow biopsy needles, metallic ink cartridges of ballpoint pens, and disposable skin biopsy punches were used to construct self-made manual TMA kits. The recipient blocks were manufactured by boring holes in the conventional bare paraffin blocks. A mini electric hand drill and a microcompound table assembled on a drill stand were used to maximize the capacity of the recipient blocks. RESULTS: By using TMA kits made from cannula piercing needles (16- and 18-gauge), it was possible to construct TMAs with 1 mmx140 cores, 0.6 mmx320 cores, 2 mmx70 cores, 3 mmx35 cores, and 5 mmx12 cores. The capacity of the recipient blocks could be dramatically increased by drilling holes. CONCLUSIONS: Construction of TMAs using self-made TMA kits is an inexpensive alternative to construction of TMAs using commercial devices.

Percutaneous Pedicle Screw Fixation of a Hangman's Fracture Using Intraoperative, Full Rotation, Three-dimensional Image (O-arm)-based Navigation: A Technical Case Report

Surgical treatment of a hangman's fractures is technically demanding, even when using the standard open procedure. In this case report, a type II hangman's fracture was treated by percutaneous posterior screw fixation, without a midline incision, using intraoperative, full rotation, three-dimensional (3D) image (O-arm)-based navigation. A 48-year-old woman was injured in a motor vehicle accident and diagnosed with a unilateral hangman's fracture associated with subluxation of the C2 vertebral body on C3. After attaching the reference arc of the 3D-imaging system to the headholder, the cervical spine was screened using an O-arm without anatomical registration. Drilling and screw fixation were performed using a guide tube while referring to the reconstructed 3D-anatomical views. The operation was successfully completed without technical difficulties or neurovascular complications. This percutaneous procedure requires less dissection of normal tissue, which may allow earlier recovery. However, further validation of this procedure for its effectiveness and safety is required.

Osteochondral Lesions of the Talus / 대한족부족관절학회지

Osteochondral lesions of the talus are isolated cartilage and/or bone lesions that are known cause of chronic ankle pain. They can occur as the result of a single acute ankle injury or from repetitive loading of the talus. Technical development in radiologic imaging and ankle arthroscopy have improved diagnostic capabilities for detecting osteochondral lesions. Characteristics which are important in assessing an osteochondral lesions include: the size, the type (chondral, subchondral, cystic), the stability, the displacement, the location, and the containment of lesion. Nonoperative treatment involving period of casting and non-weight-bearing is recommended for acute, non-displaced osteochondral lesions in select pediatric and adolescent patients. Operative treatment is recommended for unstable lesions or failed conservative management. Marrow stimulation techniques (abrasion chondroplasty, multiple drilling, microfracture), osteochondral autograft or allograft, autologous chondrocyte implantation, are frequently employed. The purpose of this article is to review the historical background, etiology, classification systems, diagnostic strategies, and to describe a systematic approach to management of osteochondral lesions of the talus.

Histologic effects of intentional-socket-assisted orthodontic movement in rabbits / 대한치과교정학회지

OBJECTIVE: This study aimed to evaluate the effect of an intentionally created socket on bone remodeling with orthodontic tooth movement in rabbits. METHODS: Eighteen male rabbits weighing 3.8 - 4.25 kg were used. An 8-mm deep and 2-mm wide socket was drilled in the bone 1 mm mesial to the right mandibular first premolar. The left first premolar was extracted to serve as an extraction socket. A traction force of 100 cN was applied to the right first premolar and left second premolar. Sections were obtained at the middle third of the moving tooth for both the drilled and extraction sockets and evaluated with hematoxylin and eosin staining and immunohistochemical analyses. The amount of tooth movement and tartrate-resistant acid phosphatase (TRAP)-positive cell count were compared between the 2 groups using the Mann-Whitney U test. RESULTS: At week 2, the distance of tooth movement was significantly higher in the intentional socket group (p < 0.05) than in the extraction socket group. The number of TRAP-positive cells decreased in week 2 but increased in week 3 (p < 0.05). However, there were no significant differences between the groups. Furthermore, results of transforming growth factor (TGF)-beta staining revealed no significant differences. CONCLUSIONS: The intentional socket group showed greater distance of tooth movement than did the extraction socket group at week 2. Osteoclast counts and results of immunohistochemical analyses suggested elevated bone remodeling in both the groups. Thus, osteotomy may be an effective modality for enhancing tooth movement in orthodontic treatment.

In-vitro study on the accuracy of a simple-design CT-guided stent for dental implants

PURPOSE: An individual surgical stent fabricated from computed tomography (CT) data, called a CT-guided stent, would be useful for accurate installation of implants. The purpose of the present study was to introduce a newly developed CT-guided stent with a simple design and evaluate the accuracy of the stent placement. MATERIALS AND METHODS: A resin template was fabricated from a hog mandible and a specially designed plastic plate, with 4 metal balls inserted in it for radiographic recognition, was attached to the occlusal surface of the template. With the surgical stent applied, CT images were taken, and virtual implants were placed using software. The spatial positions of the virtually positioned implants were acquired and implant guiding holes were drilled into the surgical stent using a specially designed 5-axis drilling machine. The surgical stent was placed on the mandible and CT images were taken again. The discrepancy between the central axis of the drilled holes on the second CT images and the virtually installed implants on the first CT images was evaluated. RESULTS: The deviation of the entry point and angulation of the central axis in the reference plane were 0.47+/-0.27 mm, 0.57+/-0.23 mm, and 0.64+/-0.16degrees, 0.57+/-0.15degrees, respectively. However, for the two different angulations in each group, the 20degrees angulation showed a greater error in the deviation of the entry point than did the 10degrees angulation. CONCLUSION: The CT-guided template proposed in this study was highly accurate. It could replace existing implant guide systems to reduce costs and effort.

Stem Cell Therapy in Articular Cartilage Injury

The natural history after articular cartilage injury is unclear. However, it is generally accepted that once articular cartilage is injured, its ability to regenerate is limited and that injury progresses to arthritis with time. Over the years various treatments have been developed and are used, such as arthroscopic debridement, microfracture, multiple drilling, osteochondral transfer, and Autologous Chondrocyte Implantation (ACI). These can be divided into treatment methods which apply cells and those which apply tissue. The former include abrasion chondroplasty, microfracture, multiple drilling, and ACI. The latter include osteochondral transfer and allograft. Combination treatments using both cells and tissues are new-generation ACI and microfracture with biomaterials. The clinical applications of stem cell therapy is still at an early stage, but shows much promise, particularly in the management of cartilage defects.

Implant overdenture using a locator bar system by drill and tapping technique in a mandible edentulous patient: a case report

Various options have been introduced for the selection of implant overdenture attachments. Attachment wear due to the repeated insertion and removal of dentures has caused problems such as decreased retention and the requirement for suprastructure remanufacturing. In these cases, a Locator bar system was applied using the drill and tapping technique to achieve total retrievability. In a 55-year-old female patient who showed three degrees of mobility in most of her teeth due to severe alveolar bone loss, a complete denture in the maxilla and an implant supported type overdenture in the mandible were planned after extracting all the remaining teeth. Six implants were placed from canine region to the distal molar region, and the locator was connected to the milled bar using the drill and tapping technique. For a 61-year-old female edentulous patient who complained of poor retention with old denture, a complete denture in the maxilla and an implant-tissue supported type overdenture in the mandible were planned. Four implants were placed in front of mental foramen, and the Locator was also connected to the Hader bar using the drill and tapping technique. With this technique, female parts can be easily replaced, and retention can be continuously maintained.

Risk and crisis management in intraoperative hemorrhage: Human factors in hemorrhagic critical events / 대한마취과학회지

Hemorrhage is the major cause of cardiac arrest developing in the operating room. Many human factors including surgical procedures, transfusion practices, blood supply, and anesthetic management are involved in the process that leads to hemorrhage developing into a critical situation. It is desirable for hospital transfusion committees to prepare hospital regulations on 'actions to be taken to manage critical hemorrhage', and practice the implementation of these regulations by simulated drills. If intraoperative hemorrhage seems to be critical, a state of emergency should immediately be declared to the operating room staff, the blood transfusion service staff, and blood bank staff in order to organize a systematic approach to the ongoing problem and keep all responsible staff working outside the operating room informed of events developing in the operating room. To rapidly deal with critical hemorrhage, not only cooperation between anesthesiologists and surgeons but also linkage of operating rooms with blood transfusion services and a blood bank are important. When time is short, cross-matching tests are omitted, and ABO-identical red blood cells are used. When supplies of ABO-identical red blood cells are not available, ABO-compatible, non-identical red blood cells are used. Because a systematic, not individual, approach is required to prevent and manage critical hemorrhage, whether a hospital can establish a procedure to deal with it or not depends on the overall capability of critical and crisis management of the hospital.

Posterior Cervical Inclinatory Foraminotomy for Spondylotic Radiculopathy Preliminary

Posterior cervical foraminotomy is an attractive therapeutic option in selected cases of cervical radiculopathy that maintains cervical range of motion and minimize adjacent-segment degeneration. The focus of this procedure is to preserve as much of the facet as possible with decompression. Posterior cervical inclinatory foraminotomy (PCIF) is a new technique developed to offer excellent results by inclinatory decompression with minimal facet resection. The highlight of our PCIF technique is the use of inclinatory drilling out for preserving more of facet joint. The operative indications are radiculopathy from cervical foraminal stenosis (single or multilevel) with persistent or recurrent root symptoms. The PCIFs were performed between April 2007 and December 2009 on 26 male and 8 female patients with a total of 55 spinal levels. Complete and partial improvement in radiculopathic pain were seen in 26 patients (76%), and 8 patients (24%), respectively, with preserving more of facet joint. We believe that PCIF allows for preserving more of the facet joint and capsule when decompressing cervical foraminal stenosis due to spondylosis. We suggest that our PCIF technique can be an effective alternative surgical approach in the management of cervical spondylotic radiculopathy.