[Effect of Intelligent Health Education Based on Health Belief Model on Patients With Kinesophobia After Surgical Treatment of Cervical Spondylosis]. / åŸºäºŽå¥åº·ä¿¡å¿µæ¨¡å¼çš„æ™ºèƒ½å¥åº·æ•™è‚²åœ¨é¢ˆæ¤Žç— æœ¯åŽæåŠ¨ç—‡æ‚£è€ ä¸­çš„æ•ˆæžœç ”ç©¶.

Objective: To explore the application effect of intelligent health education based on the health belief model on patients with postoperative kinesophobia after surgical treatment of cervical spondylosis. Methods: A prospective cohort study was conducted with patients who underwent anterior cervical discectomy, decompression, and fusion surgery with a single central nerve and spine center, and who had postoperative kinesophobia, ie, fear of movement. The patients made voluntary decisions concerning whether they would receive the intervention of intelligent health education. The patients were divided into a control group and an intelligent education group and the intervention started on the second day after the surgery. The intelligent education group received intelligent education starting from the second day after surgery through a WeChat widget that used the health belief model as the theoretical framework. The intelligent health education program was designed according to the concept of patient problems, needs, guidance, practice, and feedbacks. It incorporated four modules, including knowledge, intelligent exercise, overcoming obstacles, and sharing and interaction. It had such functions as reminders, fun exercise, shadowing exercise, monitoring, and documentation. Health education for the control group also started on the second day after surgery and was conducted by a method of brochures of pictures and text and WeChat group reminder messages. The participants were surveyed before discharge and 3 months after their surgery. The primary outcome measure compared between the two groups was the degree of kinesophobia. Secondary outcome measures included differences in adherence to functional exercise (Functional Exercise Adherence Scale), pain level (Visual Analogue Scale score), degree of cervical functional impairment (Cervical Disability Index), and quality of life (primarily assessed by the Quality of Life Short Form 12 [SF-12] scale for psychological and physiological health scores). Results: A total of 112 patients were enrolled and 108 patients completed follow-up. Eventually, there were 53 cases in the intelligent education group and 55 cases in the control group. None of the patients experienced any sports-related injuries. There was no statistically significant difference in the primary and secondary outcome measures between the two groups at the time of discharge. At the 3-month follow-up after the surgery, the level of kinesophobia in the intelligent education group (25.72±3.90) was lower than that in the control group (29.67±6.16), and the difference between the two groups was statistically significant (P<0.05). In the intelligent education group, the degree of pain (expressed in the median [25th percentile, 75th percentile]) was lower than that of the control group (0 [0, 0] vs. 1 [1, 2], P<0.05), the functional exercise adherence was better than that of the control group (63.87±7.26 vs. 57.73±8.07, P<0.05), the psychological health was better than that of the control group (40.78±3.98 vs. 47.78±1.84, P<0.05), and the physical health was better than that of the control group (43.16±4.41 vs. 46.30±3.80, P<0.05), with all the differences being statistically significant. There was no statistically significant difference in the degree of cervical functional impairment between the two groups (1 [1, 2] vs. 3 [2, 7], P>0.05). Conclusion: Intelligent health education based on the health belief model can help reduce the degree of kinesophobia in patients with postoperative kinesophobia after surgical treatment of cervical spondylosis and improve patient prognosis.

Finite element analysis of effects of sagittal cervical manipulation on intervertebral disc and facet joints / 中国组织工程研究

BACKGROUND:Among the pathogenic factors of cervical spondylosis,herniation of the intervertebral disc,dislocation of the facet joint and the stenosis of the intervertebral foramen are important factors leading to symptoms in patients.Moreover,inappropriate manipulation may aggravate the possibility of cervical disc rupture,leading to exacerbation of symptoms in patients. OBJECTIVE:To compare the effect between sagittal cervical manipulation and traditional cervical rotation manipulation on the area of the intervertebral disc,facet joint and intervertebral foramen at the operative segment by the finite element analysis. METHODS:The neck CT data of a male volunteer with a normal neck were selected and imported into Mimics 17.0 three-dimensional reconstruction software.Geo-magic Studio 12.0,Solidworks 2017 and Ansys Workbench 17.0 software were used for the construction of the finite element model of cervical vertebrae(C3-6)including intervertebral disc and articular cartilage.The lower end plate of the C5 vertebral body was fixed.A uniformly distributed vertical downward 50 N load was applied on the upper surface of the upper vertebral body(C3).The stress,deformation and deformation direction of the C4-5 intervertebral disc,joint capsule stress,the displacement of facet joints and the area of bilateral intervertebral foramen were compared between sagittal cervical manipulation and traditional rotation reduction. RESULTS AND CONCLUSION:(1)When using the rotation technique,the maximum normal equivalent stress(von Mises stress)of the C4-5 disc was 8.06 MPa;the total deformation was 1.05 mm,and the fiber ring expanded to the left and outside.When using the sagittal tip lifting technique,the maximum normal equivalent stress(von Mises stress)of the C4-5 disc was 2.60 MPa;the total deformation was 0.90 mm,and the fiber ring expanded to the left and back.Compared with the rotation technique,the pressure of the cervical manipulation technique on the disc was less(about 32.3%of the rotation technique),and the deformation degree of the disc was also light(about 85.7%of the rotation technique).(2)When the rotation technique was used,the maximum stresses of the left and right articular capsule ligaments were 0.37 MPa and 1.69 MPa,respectively.The overall displacement of the facet joint was 2.21 mm.The area of the right intervertebral foramen decreased by about 3.8%and the area of the left intervertebral foramen increased by about 0.9%.When the sagittal end lifting manipulation was performed,the maximum stresses of the left and right articular capsule ligaments were 0.27 MPa and 1.70 MPa,respectively;the overall displacement of the facet joint was 1.63 mm;the area of the right intervertebral foramen increased by about 2.6%,and the area of the left intervertebral foramen decreased by about 0.9%.Compared with rotation manipulation,sagittal end lifting manipulation had fewer changes in the displacement of facet joint,joint capsule stress and intervertebral foramen area,so it was safer to operate.(3)In conclusion,compared with cervical rotation manipulation,sagittal end lifting manipulation has fewer changes in facet joint displacement,intervertebral disc stress/deformation degree,joint capsule stress,and foraminal area.In clinical practice,more appropriate manipulation should be selected based on biomechanical results after an accurate assessment of patients'conditions.

Changes in cervical sagittal balance parameters after anterior cervical decompression and fusion / 中国组织工程研究

BACKGROUND:Some patients with cervical spondylosis have not been fully corrected sagittal position balance after cervical surgery,and this continuous sagittal position imbalance may be an important reason for the poor long-term clinical outcome of patients. OBJECTIVE:To analyze the correlation between the cervical sagittal position balance parameters and their changes and the clinical efficacy of patients in the unbalanced state after anterior cervical decompression and fusion and to explore the necessity of surgical correction of sagittal balance in order to improve the clinical effect in the later stage. METHODS:A retrospective analysis was performed on 125 patients with cervical spondylosis who underwent anterior cervical decompression and fusion in the Department of Spinal Surgery of Affiliated Hospital of Southwest Medical University from July 2019 to July 2022.Follow-up patients had good postoperative recovery(neck disability index score less than 10%one week after surgery)and had complete follow-up data.According to the axial vertical distance(C2-7 SVA)in sagittal position one week after surgery,patients were divided into type I imbalance group(C2-7 SVA loss≤5 mm,n=27),type Ⅱ imbalance group(C2-7 SVA loss>5 mm,and≤10 mm,n=19),and type Ⅲ imbalance group(C2-7 SVA loss>10 mm,n=12),and non-unbalanced group(C2-7 SVA in the normal range,n=67).The changes of visual analog scale score and neck disability index were compared among groups postoperatively and the last follow-up,as well as the changes of imaging sagittal balance parameters C2-7 cobb angle,C2-7 SVA value,neck inclination angle,T1 inclination angle,and thoracic entrance angle.The correlation between the late clinical effect and postoperative cervical sagittal disequilibrium was explored. RESULTS AND CONCLUSION:(1)There was no statistical difference in general data among the four groups(P>0.05).All patients underwent successful surgery without serious complications and postoperative wound infection.The follow-up time was more than 1 year.(2)There was no significant difference in preoperative symptom score and clinical efficacy one week after surgery(P>0.05).At the last follow-up,pain visual analog scale score,neck disability index and C2-7 SVA were lower than those before surgery but higher than those one week after surgery(P<0.05).C2-7 cobb angle was increased compared with those before operation(P<0.05).T1 inclination angle was decreased compared with those before operation(P<0.05).(3)Pearson correlation test showed that the change of neck disability index was positively correlated with the change of C2-7 SVA(P<0.05).(4)It is indicated that anterior cervical decompression and fusion is effective in the treatment of cervical spondylosis,and can effectively relieve the symptoms of patients.Patients with more severe cervical sagittal disequilibrium after surgery had worse curative effect in the later period.Continuous sagittal disequilibrium in patients with cervical spondylosis after surgery is an important cause of poor curative effect in the later stage.Clinicians should pay more attention to the correction of cervical sagittal balance before and during surgery,formulate surgical strategies and plans according to sagittal balance parameters before surgery,and correct C2-7 SVA intraoperatively to the normal range.

Effects of Yi Jin Jing on juvenile cervical spondylopathy in China: A parallel, randomized, assessor-blinded clinical trial.

Background: Cervical spondylopathy is a common musculo-articular disorder, multiple exercises are recommended. Chinese fitness exercises are prevalent and used to treat various diseases. Aim: To explore the efficacy of Chinese fitness exercise Yi Jin Jing exercise in intervening the cervical spondylopathy in adolescents. Patients and Methods: The study was conducted in 60 adolescent patients with cervical spondylopathy, with 30 patients in each group. Methods: The study was conducted in 60 adolescent patients with cervical spondylopathy, with 30 patients in each group. The observation group was required to take Yi Jin Jing exercise, and the control group took the brisk walking exercise. The first week was the preparatory period for the patients, and then the participants were required to do exercises three times a week for at least 30 minutes in the later 3 weeks. Before and after treatment, Neck Disability Index (NDI) scores, pain visual analog scale (VAS) scores, and cervical curvature in both groups were observed, and the incidence of adverse events in both groups was recorded during the trial. Results: The NDI and VAS scores in both groups statistically decreased after intervention and mildly increased at follow-up, while the reduction in scores of the Yi Jin Jing group was more significant. Cervical curvature in both groups improved on day 28 compared to day 0. There were no adverse reactions during the evaluation period. Conclusion: The Chinese health-care qigong Yi Jin Jing exercise is more effective than brisk walking in improving the cervical range of motion and relieving pain in adolescents with cervical spondylopathy. Trial registration/Protocol registration: Clinical Trial Registry (ChiCTR2000030723).

[Mode establishment and preliminary clinical application of anterior cervical surgery in outpatient setting].

Objective: To establish the mode of anterior cervical surgery in outpatient setting, and evaluate its preliminary effectiveness. Methods: A clinical data of patients who underwent anterior cervical surgery between January 2022 and September 2022 and met the selection criteria was retrospectively analyzed. The surgeries were performed in outpatient setting ( n=35, outpatient setting group) or in inpatient setting ( n=35, inpatient setting group). There was no significant difference between the two groups ( P>0.05) in age, gender, body mass index, smoking, history of alcohol drinking, disease type, the number of surgical levels, operation mode, as well as preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale score of neck pain (VAS-neck), and visual analogue scale score of upper limb pain (VAS-arm). The operation time, intraoperative blood loss, total hospital stay, postoperative hospital stay, and hospital expenses of the two groups were recorded; JOA score, VAS-neck score, and VAS-arm score were recorded before and immediately after operation, and the differences of the above indexes between pre- and post-operation were calculated. Before discharge, the patient was asked to score satisfaction with a score of 1-10. Results: The total hospital stay, postoperative hospital stay, and hospital expenses were significantly lower in the outpatient setting group than in the inpatient setting group ( P<0.05). The satisfaction of patients was significantly higher in the outpatient setting group than in the inpatient setting group ( P<0.05). There was no significant difference between the two groups in operation time and intraoperative blood loss ( P>0.05). The JOA score, VAS-neck score, and VAS-arm score of the two groups significantly improved at immediate after operation when compared with those before operation ( P<0.05). There was no significant difference in the improvement of the above scores between the two groups ( P>0.05). The patients were followed up (6.67±1.04) months in the outpatient setting group and (5.95±1.90) months in the inpatient setting group, with no significant difference ( t=0.089, P=0.929). No surgical complications, such as delayed hematoma, delayed infection, delayed neurological damage, and esophageal fistula, occurred in the two groups. Conclusion: The safety and efficiency of anterior cervical surgery performed in outpatient setting were comparable to that performed in inpatient setting. Outpatient surgery mode can significantly shorten the postoperative hospital stay, reduce hospital expenses, and improve the patients' medical experience. The key points of the outpatient mode of anterior cervical surgery are minimizing damage, complete hemostasis, no drainage placement, and fine perioperative management.

[Experimental study of improved sclerotherapy injection in rat model of vertebral arteriocervical spondylopathy].

OBJECTIVE: To improve the rat model of cervical spondylosis of vertebral artery type (CSA) induced by injecting sclerosing agent. To evaluate the efficacy of injecting sclerosing agent to induce CSA. METHODS: Forty Health SPF SD rats(20 males and 20 females), were randomly divided into two groups:the model group (20) and the blank group (20). All the animals were followed up for 4 weeks for the observation of general situation, transcranial Doppler(TCD) detection of blood flow velocity, pulsatility index and resistive index of the vertebral artery, measurement of mental distress by open-field test. RESULTS: One to two days after establish the animal model, rats in the model group appeared apathetic with decreased autonomic activities, trembling, squinting, increased eye excrement, etc., and no rats died during the experiment. The mean blood flow velocity of the model group was lower than that of the blank group (P<0.05), and the pulsatilit index and resistive index of the model group were higher than that of the blank group (P<0.05). The mental distress of the model group was significantly higher than that of the blank group. CONCLUSION: The modified injection of sclerosing agent is a practical method to establish the rat model of CSA, with high success rate, high stability, low mortality and simple operation.

Biomechanical effects of hybrid constructions in the treatment of noncontinuous cervical spondylopathy: a finite element analysis.

BACKGROUND: Hybrid construction (HC) may be an ideal surgical strategy than noncontinuous total disc replacement (TDR) and noncontinuous anterior cervical discectomy and fusion (ACDF) in the treatment of noncontinuous cervical spondylopathy. However, there is still no consensus on the segmental selection for ACDF or TDR in HC. The study aims to analyse the effects of different segment selection of TDR and ACDF on cervical biomechanical characteristics after HC surgery. METHODS: Twelve FEMs of C2-C7 were constructed based on CT images of 12 mild cervical spondylopathy volunteers. Two kinds of HC were introduced in our study: Fusion-arthroplasty group (Group 1), upper-level (C3/4) ACDF, and lower-level TDR (C5/6); Arthroplasty-fusion group (Group 2), upper-level (C3/4) TDR and lower-level ACDF (C5/6). The follow-load technique was simulated by applying an axial initial load of 73.6 N through the motion centre of FEM. A bending moment of 1.0 Nm was applied to the centre of C2 in all FEMs. Statistical analysis was carried out by SPSS 26.0. The significance threshold was 5% (P < 0.05). RESULTS: In the comparison of ROMs between Group 1 and Group 2, the ROM in extension (P = 0.016), and lateral bending (P = 0.038) of C4/5 were significantly higher in Group 1 group. The average intervertebral disc pressures at C2/3 in all directions were significantly higher in Group 1 than those in Group 2 (P < 0.005). The average contact forces in facet joints of C2/3 (P = 0.007) were significantly more than that in Group 2; however, the average contact forces in facet joints of C6/7 (P < 0.001) in Group 1 group were significantly less than that in Group 2. CONCLUSIONS: Arthroplasty-fusion is preferred for intervertebral disc degeneration in adjacent upper segments. Fusion-arthroplasty is preferred for patients with lower intervertebral disc degeneration or lower posterior column degeneration. TRIAL REGISTRATION: This research was registered in Chinese Clinical Trial Registry (ChiCTR1900020513).

Mode establishment and preliminary clinical application of anterior cervical surgery in outpatient setting / 中国修复重建外科杂志

OBJECTIVE@#To establish the mode of anterior cervical surgery in outpatient setting, and evaluate its preliminary effectiveness.@*METHODS@#A clinical data of patients who underwent anterior cervical surgery between January 2022 and September 2022 and met the selection criteria was retrospectively analyzed. The surgeries were performed in outpatient setting ( n=35, outpatient setting group) or in inpatient setting ( n=35, inpatient setting group). There was no significant difference between the two groups ( P>0.05) in age, gender, body mass index, smoking, history of alcohol drinking, disease type, the number of surgical levels, operation mode, as well as preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale score of neck pain (VAS-neck), and visual analogue scale score of upper limb pain (VAS-arm). The operation time, intraoperative blood loss, total hospital stay, postoperative hospital stay, and hospital expenses of the two groups were recorded; JOA score, VAS-neck score, and VAS-arm score were recorded before and immediately after operation, and the differences of the above indexes between pre- and post-operation were calculated. Before discharge, the patient was asked to score satisfaction with a score of 1-10.@*RESULTS@#The total hospital stay, postoperative hospital stay, and hospital expenses were significantly lower in the outpatient setting group than in the inpatient setting group ( P<0.05). The satisfaction of patients was significantly higher in the outpatient setting group than in the inpatient setting group ( P<0.05). There was no significant difference between the two groups in operation time and intraoperative blood loss ( P>0.05). The JOA score, VAS-neck score, and VAS-arm score of the two groups significantly improved at immediate after operation when compared with those before operation ( P<0.05). There was no significant difference in the improvement of the above scores between the two groups ( P>0.05). The patients were followed up (6.67±1.04) months in the outpatient setting group and (5.95±1.90) months in the inpatient setting group, with no significant difference ( t=0.089, P=0.929). No surgical complications, such as delayed hematoma, delayed infection, delayed neurological damage, and esophageal fistula, occurred in the two groups.@*CONCLUSION@#The safety and efficiency of anterior cervical surgery performed in outpatient setting were comparable to that performed in inpatient setting. Outpatient surgery mode can significantly shorten the postoperative hospital stay, reduce hospital expenses, and improve the patients' medical experience. The key points of the outpatient mode of anterior cervical surgery are minimizing damage, complete hemostasis, no drainage placement, and fine perioperative management.

Experimental study of improved sclerotherapy injection in rat model of vertebral arteriocervical spondylopathy / 中国骨伤

OBJECTIVE@#To improve the rat model of cervical spondylosis of vertebral artery type (CSA) induced by injecting sclerosing agent. To evaluate the efficacy of injecting sclerosing agent to induce CSA.@*METHODS@#Forty Health SPF SD rats(20 males and 20 females), were randomly divided into two groups:the model group (20) and the blank group (20). All the animals were followed up for 4 weeks for the observation of general situation, transcranial Doppler(TCD) detection of blood flow velocity, pulsatility index and resistive index of the vertebral artery, measurement of mental distress by open-field test.@*RESULTS@#One to two days after establish the animal model, rats in the model group appeared apathetic with decreased autonomic activities, trembling, squinting, increased eye excrement, etc., and no rats died during the experiment. The mean blood flow velocity of the model group was lower than that of the blank group (P<0.05), and the pulsatilit index and resistive index of the model group were higher than that of the blank group (P<0.05). The mental distress of the model group was significantly higher than that of the blank group.@*CONCLUSION@#The modified injection of sclerosing agent is a practical method to establish the rat model of CSA, with high success rate, high stability, low mortality and simple operation.

Clinical efficacy of suboccipital muscle massage in the treatment of cervical spondylosis in 32 patients / 中国基层医药

Objective:To investigate the clinical efficacy of suboccipital muscle massage in the treatment of cervical spondylosis.Methods:The clinical data of 70 patients with cervical spondylosis who received treatment in Zichang People's Hospital from July 2020 to June 2021 were retrospectively analyzed. These patients were divided into a control group ( n = 38) and an observation group ( n = 32) according to different treatments. The control group was treated with conventional massage, while the observation group was treated with suboccipital muscle massage based on conventional massage, once a day, 6 times a week, for a total of 2 weeks. Neck disability index (NDI), visual analogue scale (VAS), range of motion (ROM) of cervical point, and clinical efficacy were compared between the two groups. Results:Before treatment, there were no significant differences in NDI, VAS score, or range of motion of cervical point at each dimension between the two groups (all P > 0.05). After 2 weeks of treatment, NDI, VAS score, cervical flexion, cervical extension, and cervical left and right rotation in the observation group were (7.36 ± 9.47)%, 1 (1, 2) point, (39.65 ± 3.41) °, (37.12 ± 2.45) °, (47.28 ± 3.78) °, and (48.34 ± 4.36) °, respectively, which were significantly superior to those in the control group [(12.77 ± 8.74)%, 3 (2, 3) points, (33.41 ± 2.32) °, (32.93 ± 3.72) °, (42.65 ± 4.36) ° and (43.52 ± 3.98) ° in the control group ( t = 2.48, Z = 4.75, t = 9.07, 5.45, 4.70, 4.83, all P < 0.05). The total effective rate in the observation group was 93.8% (30/32), which was significantly higher than 81.6% (31/38) in the control group ( Z = 2.44, P = 0.015). Conclusion:Conventional massage combined with suboccipital muscle massage can greatly alleviate pain, improve cervical function, and thereby improve clinical efficacy in patients with cervical spondylosis.

Relationship between prevalence of cervical spondylosis and occupational stress among employees in community health service centers in Shanghai / 中华全科医师杂志

Objective:To investigate the relationship between the prevalence of cervical spondylosis and occupational stress among employees in Jing 'an community health service centers in Shanghai. Methods:A concise occupational stress questionnaire was developed based on the pay return imbalance model. The prevalence of cervical spondylosis and the incidence of occupational stress were investigated with the questionnaire survey among employees of all 15 community health service centers in a district of Shanghai from September 2020 to November 2020. Multiple logistic regression was used to analyze the relationship between occupational stress factors and prevalence of cervical spondylosis.Results:Of total 1 816 employees in the community health service centers in the district, 1 515 independently completed the questionnaire (83.4%). The average age of responders was 39 years old. The prevalence of cervical spondylosis was 34.7% (526/1 515); and the incidence of occupational stress was 11.6% (175/1 515). The average score of pay factor in the sick group was higher than that in the non-sick group ( t=-8.04, P<0.001), the average score of return factor was lower than that of the non-sick group ( t=6.06, P<0.001), and the average score of internal input factor was higher than that of the non-sick group ( t=-8.39, P=0.004). Multivariate regression analysis showed that occupational stress ( OR=1.57, 95% CI: 1.05-2.36), medium investment ( OR=1.42, 95% CI: 1.02-2.00), high investment ( OR=1.93, 95% CI: 1.27-2.93) were the risk factors of cervical spondylosis (all P<0.05). Conclusions:Cervical spondylosis is associated with occupational stress among employees of community health service centers. To prevent the prevalence of cervical spondylosis, it is necessary to reduce occupational tension, alleviate the imbalance of pay and return, and prevent individuals from excessive internal investment.

Long-term Effect of Sling-massage Exercise on Cervical Spondylopathy / 中国康复理论与实践

Objective:To explore the effect of sling-massage exercise on neck type cervical spondylopathy (NTCS). Methods:From June, 2020 to February, 2021, 68 patients with NTCS from the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control group (n = 34) and observation group (n = 34). The control group accepted routine massage, while the observation group accepted sling exercise and massage based on weak link test, for four weeks. They were assessed with McGill Pain Qusetionnaire (MPQ) and Neck Disability Index (NDI) before and after treatment, and measured median frequency (MF) of the upper trapezius muscle on the affected side with electromyography biofeedback before treatment, after treatment, two weeks after treatment and 4 weeks after treatment. Results:Four cases in the control group and three cases in the observation group dropped down. The scores of MPQ and NDI decreased in both groups after treatment (|Z| > 4.879, P < 0.001), while MF increased (P < 0.001). There was no significant difference in scores of MPQ and NDI between the two groups after treatment (|Z| < 1.100, P > 0.05), while MF was less in the control group than in the observation group (t = 2.184, P < 0.05). MF decreased more in the control group than in the observation group, and was continually less in the control group than in the observation group after treatment (t > 3.770, P < 0.001). Conclusion:Sling-massage exercise is as effective as massage on NTCS immediately, and for more time.

Upper endplate nonunion after transcorporeal percutaneous endoscopic cervical discectomy: A case report.

BACKGROUND: Transcorporeal percutaneous endoscopic cervical discectomy (TcPECD) destroys the integrity of the vertebral body. We herein discuss its long-term risks and avoidance measures. Case presentation: A 44-year-old woman underwent TcPECD. Although her upper limb symptoms were relieved after the operation, the bone channel did not heal and the endplate of the segment was altered. She consequently developed chronic neck and shoulder discomfort. CONCLUSION: Careful preoperative planning is needed to avoid non-healing of the bone channel following TcPECD. The diameter of the bony channel should be as small as possible and the channel should be opened at the posterior edge of the upper endplate to avoid collapse.

Somatosensory evoked potentials in Hirayama disease: A Brazilian study.

BACKGROUND: Hirayama's disease (HD) is characterized by an insidious onset asymmetric weakness and atrophy of the forearm and hand. Taking as a premise, the etiopathogenesis of the disease is attributed to forward displacement of posterior wall of lower cervical dural canal in neck flexion causing marked compression and flattening of lower spinal cord. This may result in compression of the posterior column of the spinal cord and seems likely to result in somatosensory evoked potentials (SSEPs) abnormalities. In the present study, we studied the possible involvement of the lemniscal dorsal pathway in patients with HD. METHODS: SSEPs in upper and lower extremities were prospectively performed in eight patients with HD. All the patients were recruited from the outpatient clinic of a neuromuscular disorder center from South Brazil. SSEPs were obtained by transcutaneous electrical stimulation of the median and posterior tibial nerves, on both sides. We collected the amplitude and the latency of the different components obtained in each channel. The interpretation was based on Brazilian study standards. RESULTS: We evaluated seven men and one woman (mean age 27). The data obtained were compared to a control group consisting of eight patients with spondylotic cervical myelopathy, 6 men and 2 women with mean age of 59 years. The measurements of obtained by the SSEP were also compared between the groups and no significant difference was found for any of them. CONCLUSION: SSEP did not turn out to be an electrophysiological marker in our HD patients.

Microscope-assisted versus traditional anterior cervical approach for cervical spondylopathy: A meta-analysis / 中国组织工程研究

BACKGROUND: In China, although microscope-assisted anterior cervical decompression has been performed by many spine surgeons in recent years, the application of microscope still needs to be further promoted in China. Therefore, it is necessary to systematically evaluate and analyze the clinical efficacy of cervical spondylopathy by comparing patients under microscope-assisted anterior cervical approach to traditional anterior cervical approach. As a result, it can provide the evidence for clinical decision in these cervical spondylopathy patients. OBJECTIVE: To systematically evaluate the effect between microscope-assisted anterior cervical approach and traditional anterior cervical approach in cervical spondylopathy patients. METHODS: Databases such as Medline, Embase, PubMed, Web of science, CBM, Wangfang databases, VIP, and CNKI were searched from inception to July 2019 to find literature related to microscope-assisted anterior cervical approach and traditional anterior cervical approach in treatment of cervical spondylopathy. Two investigators evaluated the researches independently and compared the operative time, intraoperative blood loss, the preoperative and postoperative Japanese Orthopedic Association score, neurological success rate, the preoperative and the postoperative visual analogue scale score, and the complication rates between two groups. The quality of the included literature was evaluated by the modified Jadad scale, the modified Newcastle Ottawa score and the methodological index for non-randomized-studies. The correlative clinical outcome in inclusive research was analyzed systematically by using Stata 12.0 Software. RESULTS AND CONCLUSION: (1) Twelve studies were accorded with the inclusion criteria, containing 892 cases (438 cases in the microscope-assisted group, while 454 cases in the traditional group). (2) There were no significant differences in the preoperative Japanese Orthopedic Association score (WMD=-0.100, 95%C/(-0.459, 0.259), P=0.585), operative time (WMD=6.852, 95%C/(-0.446, 14.149), P=0.066), the preoperative and postoperative visual analogue scale score (WMD=0.293, 95%C/(-0.023, 0.608), P=0.069; WMD=-0.T\8, 95%C/(-1.495, 0.059), P=0.070) between two groups. (3) Postoperative Japanese Orthopedic Association score (WMD= 1.310, 95%C/(0.621, P < 0.001), the rate of neurological success (WMD-4.639, 95%C/(0.294, 8.984), P=0.036) in the microscope-assisted group were higher than those in the traditional group. The intraoperative blood loss (l/MMD=-18.068, 95%C/(-24.504, -11.632), P< 0.001) and the rate of complication (RR=1.068, 95%C/(1.012,1.126), P=0.002) in the microscope-assisted group were significantly lower than those in the traditional group. (4) Performing anterior cervical approach under microscope has a better clinical effect than using traditional anterior cervical approach in the treatment of cervical spondylopathy, but more high-quality clinical studies are needed to verify it.

Clinical study of thumb-tack needle therapy for cervical radiculopathy based onmeridian differentiation / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy and eligibility of thumb-tack needle therapy based on meridian differentiation in treating cervical radiculopathy. Methods: A total of 70 patients with cervical radiculopathy were randomized into an observation group and a control group, with 35 cases in each group. Patients in the control group received thumb-tack needle based on conventional point selection, while those in the observation group received thumb-tack needle according to meridian differentiation. The visual analog scale (VAS) and clinical symptom scores in the two groups were compared before and after treatment, and the clinical efficacy of the two treatments was observed. Results: After treatment, the VAS score in both groups dropped significantly (both P<0.01), and the VAS score in the observation group was lower than that in the control group (P<0.01). The clinical symptoms score in both groups dropped significantly (all P<0.01), and the clinical symptoms score in the observation group was lower than that in the control group (P<0.01). The total effective rate in the observation group was higher than that in the control group (P<0.05). Conclusion: Thumb-tack needle therapy based on meridian differentiation can reduce pain score, improve clinical symptoms in patients with cervical radiculopathy, and produce more significant efficacy compared with conventional thumb-tack needle therapy.

[Advances in research of cervical spondylotic amyotrophy].

Cervical spondylotic amyotrophy (CSA) has attracted more and more attention in recent years, according to early studies, it is based on cervical degeneration, and mainly characterized by segmental, asymmetric and stable muscular atrophy of upper extremities, with or without mild sensory abnormalities and spinal cord lesions (manifested as lower extremity symptoms and gait abnormalities), also known as Keegan's cervical spondylosis. This review will focusing on recent research progress of CSA, and summarize and analyze the definition, pathogenesis, clinical manifestations, diagnosis and treatment of cervical spondylosis muscular atrophy.

Advances in research of cervical spondylotic amyotrophy / 中华外科杂志

Cervical spondylotic amyotrophy (CSA) has attracted more and more attention in recent years, according to early studies, it is based on cervical degeneration, and mainly characterized by segmental, asymmetric and stable muscular atrophy of upper extremities, with or without mild sensory abnormalities and spinal cord lesions (manifested as lower extremity symptoms and gait abnormalities), also known as Keegan′s cervical spondylosis. This review will focusing on recent research progress of CSA, and summarize and analyze the definition, pathogenesis, clinical manifestations, diagnosis and treatment of cervical spondylosis muscular atrophy.

Clinical observation on warm needling moxibustion plus acupoint sticking therapy for cervical radiculopathy / 针灸推拿医学（英文版）

Objective:To observe the clinical effect of warm needling moxibustion plus acupoint sticking therapy for cervical radiculopathy.Methods:A total of 120 cases were allocated into an observation group,a warm needling group and an acupoint sticking group according to the random number table,with 40 cases in each group.Cases in the observation group received warm needling moxibustion plus acupoint sticking therapy;cases in the warm needling group received the same warm needling moxibustion in the observation group;cases in the acupoint sticking group received the same acupoint sticking therapy in the observation group.The scores of Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) were recorded before and after treatment.Results:The total effective rate was 95.0％ in the observation group,versus 77.5％ in the warm needling group and 75.0％ in the acupoint sticking group (both P＜0.05).Inter-group differences in JOA and VAS between the observation group and the other two groups were statistically significant (all P＜0.05).Conclusion:Warm needling moxibustion plus acupoint sticking therapy is effective in treating cervical radiculopathy,and it can significantly alleviate pain and enhance clinical efficacy,and thus is worth clinical popularization.

Treatment of neck type cervical spondylopathy with Zheng's Jin Gou Diao Yu (gold-hook-fishing) acupuncture method: a randomized controlled trial / 针灸推拿医学（英文版）

Objective: To observe the clinical effect of Zheng's Jin Gou Diao Yu (gold-hook-fishing) acupuncture method versus ordinary acupuncture on superficial fascia for treating neck type cervical spondylopathy in Kyrgyz. Methods:A total of 64 Kyrgyz patients conforming to the diagnostic criteria of neck type cervical spondylopathy were included. The patients were randomized into a Zheng's Jin Gou Diao Yu (gold-hook-fishing) acupuncture group and a conventional acupuncture group, with 32 cases in each group. Patients in the Zheng's Jin Gou Diao Yu (gold-hook-fishing) acupuncture group were treated with Zheng's Jin Gou Diao Yu (gold-hook-fishing) acupuncture method to stimulate the superficial fascia, the stimulation sites were primarily located at bilateral sides of the cervical vertebra as well as the trigger points in shoulder-neck region; patients in the conventional acupuncture group were punctured at the same acupoints, with twirling reducing method, and the depth of insertion was determined by the treated region. Patients in both groups received treatment every day for a succession of 5 d as a course, with a 2-day interval between 2 courses, and the whole treatment lasted for 3 courses. After 3 courses of treatment, the McGill pain questionnaire (MPQ) and neck disability index (NDI) were measured to compare the clinical effect between the two groups. Results: After treatment, scores of MPQ and NDI scale dropped when compared with those before treatment, and the differences showed statistical significance (allP<0.05); scores of MPQ and NDI in the Jin Gou Diao Yu (gold-hook-fishing) acupuncture group were substantially lower than those in the conventional acupuncture group, and the differences showed statistical significance (allP<0.05). The total effective rate was 96.9％ in the Jin Gou Diao Yu (gold-hook-fishing) acupuncture group and the cured rate was 78.1％, which were higher than 81.3％ and 40.6％ in the conventional acupuncture group, and the differences showed statistical significance (bothP<0.05). Conclusion: Zheng's Jin Gou Diao Yu (gold-hook-fishing) acupuncture method by stimulating superficial fascia to treat cervical spondylopathy in Kyrgyz can produce a better clinical effect than conventional acupuncture treatment, and is effective in improving pain and stiffness in patients, and thus is worth clinical popularization.