Minimally invasive percutaneous procedure for the treatment of a contained cervical disc herniation - a preliminary prospective study.

The aim of this study was to compare the patient-reported outcome measures Neck Disability Index (NDI) and visual analog scale (VAS) with the Patient Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) measures, respectively, and to determine their correlations in a surgical population longitudinally.Legacy outcome measures such as NDI and VAS are essential for analyzing treatments in spine surgery for cervical disc herniations with radiculopathy. Despite their usefulness, administrative burdens impose limits on completion of these measures. PROMIS was developed as a patient outcome measure in order to improve reporting of patient symptoms and function and to reduce administrative burden. Despite early positive results of PROMIS in orthopedics, NDI and VAS scores have not been compared with PROMIS scores in patients with cervical disc herniations with radiculopathy. Eighty patients undergoing surgery for cervical disc herniations with radiculopathy were included. All patients were treated at the same tertiary spine center. Patients were seen and PROMIS PF and PI, NDI, and VAS arm and neck pain scores were collected preoperatively and at 1 year postoperatively. Correlations between NDI, VAS, and PROMIS PF and PI were quantified using Pearson correlation coefficients. Two-tailed Student t-tests were used to demonstrate correlation significance, with alpha = 0.05. All 80 (100%) patients completed all preoperative questionnaires. Fifty-seven (72%) and 75 (94%) patients completed all questionnaires at baseline and at the 6-month and 1-year follow-ups, respectively. PROMIS PF and NDI scores demonstrated a strong negative correlation, with Pearson r values of -0.81, -0.77, and -0.75 at baseline, 6 months, and 1 year. PROMIS PI and VAS neck pain scores demonstrated a moderately positive correlation, with Pearson r values of 0.51, 0.61, and 0.6. PROMIS PI and VAS arm pain scores demonstrated a moderately positive correlation, with Pearson r values of 0.46, 0.47, and 0.45. PROMIS PF scores have a strong negative correlation with NDI scores at baseline and in the postoperative course in patients undergoing surgery for cervical disc herniations with radiculopathy. PROMIS PI scores have a moderately positive correlation with VAS neck and arm pain scores at baseline and in the postoperative course. Surgeons may factor these correlation results into the interpretation of patient-reported outcome measures in patients with cervical radiculopathy. Use of PROMIS PF and PI for this patient population may reduce administrative burden while providing reliable outcomes data.

The impact of mental health on patient-reported outcomes in cervical radiculopathy or myelopathy surgery

Background: The gold standard for treating cervical spondylotic myelopathy and single or multi-segmental cervical spondylotic radiculopathy is ACDF, a safe and dependable procedure. However, as far as we are aware, there aren't many reports on using ACDF to treat cervical disc herniation. This study presents the outcomes of 50 cervical disc herniation patients who received ACDF treatment. Methodology: This descriptive study included 50 male and female patients, aged 20 to 80, who were admitted to Mardan Medical Complex in the Department of Neurosurgery, for the duration from May 2024 to November 2024. These patients had been undergoing Anterior Cervical Discectomy and Fusion (ACDF) for cervical disc herniation. The same team of surgeons carried out every surgery. The Neck Disability Index (NDI), Japanese Orthopedic Association (JOA), and visual analogue scale (VAS) were used to evaluate how well ACDF treated CDH illness. Three days, three months following surgery, as well as during the pre-surgery outpatient visit, the VAS, NDI, and JOA were assessed and analyzed. Results: Three days following surgery, all patients were able to move and take care of themselves, and their neck pain had significantly decreased. Three days post-surgery, the mean VAS score decreased from 7.3 ± 1.4 to 3.1 ± 1.2 (P < 0.001). The NDI scores changed in the same way. Three days after surgery, the average NDI score went down from 43.6 ± 12.1 to 24.1 ± 7.2, and at the last follow-up, it went down to 16.2 ± 4.1. The average JOA score was 6.9 ± 2.1 before surgery. Three days after surgery, it rose to 13.9 ± 1.1 (P < 0.001), and at the last follow-up, it was 15.4 ± 0.8, which was not substantially different from the score right after surgery. Conclusion: According to this investigation, ACDF helped with functional recovery, enhanced neurological function, and dramatically decreased discomfort. The therapy reduces severe symptoms and enhances quality of life, as evidenced by the high neurological recovery rate and notable VAS and NDI reductions.

Introduction Conventional anterior cervical discectomy and fusion (ACDF) operation is the treatment of choice for cervical radiculopathies caused by herniated cervical disc (HCD) or foraminal stenosis (FS) when surgery is indicated. But neck motion limitation and axial neck pain after multilevel ACDF and/or corpectomy and reconstruction would be considerable. For preserving the motion of spinal motion segment, artificial disc transplantation was revolutionary developed, but all of these prosthesis still did not reach to normal angular and sliding range of motion segment, and cause many complications such as prosthesis loosening and migration, subsidence, postoperative kyphosis, progression of facet arthrosis (PFA), heterotopic ossification (HO), and not so much as spontaneous fusion. These device-related failures are still of concern for motion-sparing devices, and moreover, the benefit of these devices in preventing adjacent level degeneration still requires further confirmation. Then anterior cervical microforaminotomy (ACM) which is one of nonfusion surgical technique is applicable method in combination with fusion surgery in other levels for decreasing the numbers of fusion levels on multilevel cervical radiculopathy. The purpose of this study is to introduce alternative surgical technique for minimizing fusion surgery on cases of multilevel cervical radiculopathies as possible. Patients and Methods Patients with bilateral or unilaterally dominant upper extremity radiculopathies, who was defined multilevel pathologies such as HCD or FS on image studies, and underwent ACM combined with ACDF or corpectomy and reconstruction in other levels between December 2010 and May 2012 were included. There were two females and eight males with mean age of 56.86 years. Total number of fusions were15 disc levels including ACDF (13 disc levels) and corpectomy and reconstruction (two disc levels) and total number of ACM were 11 disc levels. Combination surgical techniques were1 level ACDF and 1 level ACM is six cases, 2 level ACDF and 1 level ACM is one case, 3 level ACDF and 1 level ACM is one case, 2 level ACDF and 2 level ACM in one case, and 1 level corpectomy and 1 level ACM is one case. Pre- and postoperative arm, shoulder, and neck pain were evaluated by Visual Analogue Scale (VAS). Functional outcomes were evaluated using Neck Disability Index (NDI). Results Arm and shoulder pain relief was assessed by VAS postoperative immediately and 2, 4, 6 months after procedure. Early postoperatively, there was significant improvement in VAS arm pain ( p < 0.0001). After 1 year, there was also significant improvement in VAS neck pain ( p = 0.001), and VAS arm pain ( p < 0.0001, p = 0.001, respectively). The functional outcome was measured by NDI and relatively good in almost. Major complications such as recurrence of HCD, instrumental failure, or fusion failure were not found and related reoperations were absent in all the cases at this study periods. Conclusion Anterior cervical microforaminotomies are an effective technique for treatment of radiculopathies because of the multilevel degenerative pathologies to minimize the need for fusion.

Lumbar and cervical disc herniations are medical problems that affect the quality of life. The purpose of this study was to compare the quality of life in patients with lumbar and cervical disc herniations. The degree of pain in all patients was assessed by the Million visual analogue scale, disability in patients with lumbar disc herniation by the Oswestry low back pain disability questionnaire, disability in patients with cervical disc herniation by the neck disability index, quality of life by functional limitation profile, occupational handicap in all patients by the occupational handicap scales of the World Health Organization and status of depression in all patients by the Zung depression scale. Quality of life was lower and occupational handicap was greater in the patients with lumbar disc herniation than in those with cervical disc herniation. Intensity of pain and depression and disability were not significantly different in the two groups.

Aim: Neck pain is one of the most prevalent medical complaints. Chronic pain conditions can lead to depression, anxiety and sleep problems in individuals. Thus, both the pain itself and the psychiatric problems it causes impair the quality of life of the patient. Depression and anxiety can also cause changes in the perception of pain. In this study, we aimed to investigate the effects of cervical disc herniation (CDH), which causes chronic neck pain, on the level of neck disability, sleep quality, anxiety and depression. Material and Methods: Patients’ pain intensity, neck disability indexes, depression and anxiety status, and sleep quality were evaluated using a visual analog scale (VAS), the neck disability index (NDI), Beck Depression Inventory (BDI), beck anxiety inventory (BAI) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Results: We found a statistically significant relationship between CDH and anxiety, depression and sleep quality. In addition, we found higher levels of pain, anxiety and depression in the group with poor sleep quality. Conclusion: For optimal treatment approaches of patients with chronic neck pain, accompanying sleep disorder, depression and anxiety should also be evaluated.

ObjectiveTo quantitively characterize the morphology of cervical disc herniation (CDH) causing cervical spondylotic radiculopathy (CSR) and investigate whether the morphological features of CDH are associated with clinical outcomes in CSR patients treated by posterior percutaneous full‐endoscopic cervical discectomy (PPECD).MethodsThis is a single‐center retrospective study. Eighty‐seven PPECD‐treated patients meeting the inclusion criteria were included between May 2017 and May 2019. Based on preoperative T2‐weighted magnetic resonance imaging (MRI), we designed and measured six morphological parameters of CDH for all patients to reflect its relative position to cervical spinal cord and protruding degree: DC‐SC distance from the center of disc (DC) and the center of spinal cord (SC); DC‐DP distance from the center of cervical disc (DC) to the peak of herniation (DP); internal diameter of the disc; axial length of CDH; central angle of CDH formed by central axes of CDH and spinal cord; the modified index of CDH. We recorded general information, neck disability index (NDI) scores, visual analog scale (VAS) scores of neck and arm of all patients preoperatively and postoperatively at 1‐year follow‐up. The association of preoperative general variables and morphological parameters with clinical outcomes were explored by utilizing logistic regression and receiver operating characteristic curve (ROC) analysis.ResultsThe preoperative neck‐VAS, arm‐VAS, and NDI were significantly decreased after PPECD and remained at a low value at follow‐up. In regards to the morphological parameters of CDH, the mean value of DC‐SC distance, DC‐DP distance, internal diameter of the disc, axial length of CDH, central angle of CDH, and modified index of CDH were 1.61 ± 0.30 cm, 1.66 ± 0.32cm, 1.04 ± 0.21 cm, 0.63 ± 0.19cm, 39.38° ± 11.94°, and 0.39 ± 0.24, respectively. For patients grouped by difference in the recovery rate of NDI and arm‐VAS (excellent improved group, EI; and limited improved group, LI), there were no differences in the age, gender, surgical segments, and morphological parameters, except for the central angle of CDH. According to binary logistic regression analysis, only the preoperative central angle of CDH was significantly associated with postoperative NDI recovery (odds ratio: 0.873; 95% confidence interval: 0.819–0.931, P = 0.002). ROC analysis showed the optimal cut‐off value of the central angle of CDH for predicting the postoperative improvement of functional outcomes is 33.788°.ConclusionPreoperative morphology of CDH is related to the outcomes of CSR patients after PPECD. Patients with a large central angle of CDH (>33.788°) have more likelihood of ameliorating neurological symptoms of CSR. There is the potential to select the central angle of CDH as a predictor for outcomes of PPECD in treating CSR.

Objective: To evaluate the long-term efficacy of cervical artificial disc replacement for patients with cervical disc herniation and degenerative cervical canal stenosis. Methods: Total of sixty-eight patients underwent single-level Bryan artificial disc replacement in Beijing Jishuitan Hospital from December 2003 to December 2007 with a minimum 10-year follow-up were retrospectively analyzed. There were 43 males and 25 females with a mean age of (46±8) years. According to preoperative CT and MRI, the patients were divided into two groups: 27 patients in cervical disc herniation group and 41 patients in degenerative cervical canal stenosis group. The evaluation indexes before surgery and at last follow-up were compared between two groups. The clinical indexes included Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) and Odom's grade; and the radiological indexes included the global and segmental range of motion (ROM), Cobb's angle at operated level. The continuous variable data were analyzed by independent sample t test. Results: In cervical disc herniation group, the improvement rate of JOA score was 83%±22%, NDI% decreased by 14%±9%, and Odom's grade was excellent in 17 patients, good in 10 patients. In degenerative cervical canal stenosis group, the improvement rate of JOA was 68%±34%, NDI% decreased by 11%±7%, and Odom's grade was excellent in 19 patients, good in 18 patients, fair in 4 patients. The segmental ROM was 10°±4° and 7°±6° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (t=2.284, P=0.026). The global ROM was 50°±9° and 44°±14° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (t=2.112, P=0.038). Conclusions: Cervical artificial disc replacement has a favorable long-term efficacy in treating cervical degenerative diseases. The postoperative global and segmental ROM in patients with cervical disc herniation are better than those in patients with degenerative cervical canal stenosis.

Introduction : Cervical discogenic pain, which is characterized by a stiffness or pain in neck movement, generally occurs as a result of disc degeneration. On the other hand; vascular pathologies of the cervical region, especially vertebrobasilar insufficiency, may give rise to similar findings in patients; it can also be detected simultaneously with cervical disc pathologies. . In this study, it was aimed to investigate whether the circulatory properties of the vertebral arteries have an effect on the neck pain and functional status of the patients. Material and Method: Based on the participants’ medical history, physical examination and radiological examination, sixty five patients were diagnosed with cervical disc herniation. Twenty patients who met the inclusion criteria were completed the study. Vertebral artery and carotid artery doppler ultrasonography was performed in these patients, thus any stenosis or insufficiency in vascular systems of the neck was evaluated. Additionally; vertebral blood flow rate (ml / min),vessel diameter(mm), minimum blood flow velocity (Vmin) and maximum blood flow velocity (Vmax) parameters was measured by doppler ultrasonography. The obtained findings compared with patients' level of pain measured with the "VAS (Visual Analog Scale)" and the level of daily life activities measured by the "Neck Disability Index ". Results: It was detected a statistically significant negative correlation between the VAS score and right vertebral artery diameter (p=0.019, r=-0.518). A significant reverse correlation between the VAS score and right vertebral arterial blood flow rate (p=0.011, r=-0.556) was also observed. No correlation was found between other vertebral artery parameters and VAS score or Neck Disability Index (p>0.05). Conclusion: The findings of this study revealed that there is a correlation between the vertebral artery flow rate and pain level. Clinicians must take into consideration vertebral pathologies in patients with neck pain because of this vital condition may accompany with various musculoskeletal pathologies such as cervical disc herniation.

Background/Objectives: Vibration therapy approaches are an effective and safe treatment option for musculoskeletal disorders. This study examines the effects of vibration therapy using a percussion massage gun (PMG) on joint position sense, range of motion, pain, functionality, and kinesiophobia in individuals with cervical disc herniation (CDH). Methods: This single-blind randomized controlled trial involved 44 CDH patients divided into a Vibration Group (VG) and a Conventional Group (CG). The CG underwent a standard physiotherapy treatment heat application, Transcutaneous Electrical Nerve Stimulation (TENS), and exercises for range of motion and strengthening. VG received conventional therapy augmented with vibration therapy (VT) via a PMG. Joint position sense (JPS) using the Laser Pointer Assisted Angle Repetition Test; pain intensity with the Visual Analog Scale, kinesiophobia with the Tampa Scale for Kinesiophobia, and cervical dysfunction with the Neck Disability Index were assessed. Results: Both groups showed statistically significant improvements in pain, kinesiophobia, disability, and proprioception after treatment (p < 0.05). When comparing the difference values between groups, the VG was found to be more effective than the CG in the parameters of VAS activity (p = 0.013). The CG had more improvement in JPS neck left rotation than the VG (p = 0.000). Conclusions: VT, when combined with conventional physiotherapy, is effective in improving pain, proprioception, and functionality in individuals with CDH. These findings support the inclusion of VT as a beneficial adjunct therapy. Further research with larger sample sizes and longer follow-ups is recommended to validate these results and explore the long-term effects of VT on CDH.

ABSTRACTBackground:Inherent complications associated with surgery and limited success of percutaneous minimally invasive procedures make researches wanting for an ideal treatment for cervical disc herniation.Objective:We prospectively study the role of ozone disc nucleolysis in cervical intervertebral disc herniation.Patients and Methods:From January 2008 to December 2020, we prospectively study 246 consecutive patients of cervical disc herniation treated by a single session of intradiscal injection of ozone–oxygen mixture (ozone disc nucleolysis). There were 55% of females and 45% of males. Age ranged from 28 to 68 years with a mean of 47. The outcome was measured on visual analog scale (VAS) scale and neck disability index (NDI) along with Mcnab method.Results:The mean baseline VAS score was 7.87 which became 3.09 at 1 month, 1.42 at 3 months, 1.40 at 6 months, and 1.35 at 1 year. The mean NDI was 36.27 at baseline which improved to 9.24 at 1 month, 6.25 at 3 months, 6.20 at 6 months, and 6.22 at 1 year. This was found to be significant with P < 0.05. Modified McNab criterion showed excellent recovery in 138 (56.10%), good recovery in 50 (20.32%), and fair recovery in 22 (8.94%), resulting in a successful rate of 85.36%. Mediocre recovery was seen in the remaining 36 patients amounting to a 14.64% failure rate.Conclusion:This study showed that ozone disc nucleolysis significantly reduces the pain related to cervical disc herniation along with a significant reduction in disability.

Objective To investigate the effect of combination of cervical manipulation with cervical conditioning exercise for the treatment of cervical spondylosis of neck type or nerve root type. Methods Seventy-two patients were randomly divided into a treatment group （37 patients） or a control group （35 patients） by using a random number table. Patients in the treatment group and in the control group were treated with combination of cervical manipulation or cervical manipulation only, respectively. At the end of treatment and 3 months, treatment effects were assessed by Neck Disability Index （NDI） and Visual Analog Scale （VAS）. Results NDI scores in both of the treatment group and the control group after treatment were significantly lower han those before treatment （t=4.471 in the treatment group, t=3.599 in the control group, all P〈0.05）, and NDI score in the treatment group were significantly lower than that in the control group after treatment （t=-2.085,P〈0.05）. Follow-up at 3 months, NDI score in the treatment group was significantly lower than that in the control group （t=-4.549, P〈0.05）. Proportions of improved patients, as assessed by NDI items, including pain intensity, personal care, lifting, reading, headaches, concentration, work, sleeping, driving and recreation in＆amp;nbsp;the treatment group were significantly higher than those in the control groups （Z=-3.521,-3.331,-3.003,-3.001,-3.265,-3.198,-3.016,-3.000,-2.102,-2.971, respectively, all P〈0.05）. VAS scores in both of the treatment group and the control group after treatment were significantly lower than those before treatment （t=7.986 in the treatment group, t=6.507 in the control group, all P〈0.05）, and VAS score in the treatment group were significantly lower than that in the control group after treatment （t=-2.426,P〈0.05）. Follow-up at 3 months, the VAS score in the treatment group was significantly lower than that in the control group （t=-7.065, P〈0.05）. Proportions of improved patients in the treatment group was significantly higher than that in the control group （91.89% vs 74.29%; χ2=4.014, P=0.045）. Conclusion Combination of cervical manipulation with cervical conditioning exercise may be superior to cervical manipulation only for the treatment of cervical spondylosis of neck type or nerve root type. Key words: Manipulation; Conditioning Exercise; Cervical Spondylosis

Informed patient selection and counseling is key in improving surgical outcomes. Understanding the impact that certain baseline variables can have on postoperative outcomes is essential in optimizing treatment for certain symptoms, such as radiculopathy from cervical spine pathologies. The aim was to identify baseline characteristics that were related to improved or worsened postoperative outcomes for patients undergoing surgery for cervical spine radiculopathic pain. Retrospective review of prospectively collected data. Patient Sample: Surgical cervical spine patients with a diagnosis classification of "degenerative." Diagnoses included in the "degenerative" category were those that caused radiculopathy: cervical disc herniation, cervical stenosis, and cervical spondylosis without myelopathy. Baseline variables considered as predictors were: (1) age, (2) body mass index (BMI), (3) gender, (4) history of cervical spine surgery, (5) baseline Neck Disability Index (NDI) score, (6) baseline SF-36 Physical Component Summary (PCS) scores, (7) baseline SF-36 Mental Component Summary (MCS) scores, (8) Visual Analog Scale (VAS) Arm score, and (9) VAS Neck. Outcome Measures: Improvement in NDI (≥50%), VAS Arm/Neck (≥50%), SF-36 PCS/MCS (≥10%) scores at 2-years postoperative. An arm-to-neck ratio (ANR) was also generated from baseline VAS scores. Univariate and multivariate analyses evaluated predictors for 2-year postoperative outcome improvements, controlling for surgical complications and technique. Three hundred ninety-eight patients were included. Patients with ANR ≤ 1 (n = 214) were less likely to reach improvements in 2-year NDI (30.0% vs 39.2%, P = .050) and SF-36 PCS (42.4% vs 53.5%, P = .025). Multivariate analysis for neck disability revealed higher baseline SF-36 PCS (odds ratio [OR] 1.053) and MCS (OR 1.028) were associated with over 50% improvements. Higher baseline NDI were reduced odds of postoperative neck pain improvement (OR 0.958). Arm pain greater than neck pain at baseline was associated with both increased odds of postoperative arm pain improvement (OR 1.707) and SF36 PCS improvement (OR 1.495). This study identified specific symptom locations and health-related quality of life (HRQL) scores, which were associated with postoperative pain and disability improvement. In particular, baseline arm pain greater than neck pain was determined to have the greatest impact on whether patients met at least 50% improvement in their upper body pain score. These findings are important for clinicians to optimize patient outcomes through effective preoperative counseling.

Cervical epidural injections are frequently applied in the treatment of radicular pain caused by cervical disc herniation. This study aimed to investigate and compare the effectiveness of cervical epidural steroid injection and cervical epidural steroid + bupivacaine injection using Neck Disability Index (NDI) and Visual Analog Scale (VAS) scores. A total of 91 patients were included in the study. Patients who received cervical epidural steroid and cervical epidural steroid + bupivacaine were classified as Group I and Group II, respectively. Demographic characteristics, pain duration, and baseline VAS (VAS0) and NDI (NDI0) scores were recorded. Patients were also evaluated at the first and sixth months, and VAS1, NDI1, VAS6, and NDI6 scores were assessed. Demographic characteristics and mean pain durations of the groups were similar, and VAS and NDI scores did not differ significantly at baseline, the first, and sixth months. Within each group, the VAS6 score was significantly lower than VAS0 (p=0.01) and VAS1 (p=0.01) scores, while the NDI6 score was also significantly lower than NDI0 (p=0.01) and NDI1 (p=0.01) scores in Group I. Similarly, the VAS3 score was significantly lower than VAS0 (p=0.01) and VAS1 (p=0.01) scores, and the NDI3 score was significantly lower than NDI0 (p=0.01) and NDI1 (p=0.01) scores in Group II. Our findings showed that the combination of epidural steroid + bupivacaine in cervical interlaminar epidural injections yields similar clinical effects to those of steroid alone, providing comparable improvement in functional status.

This study examines the changes in segmental and global cervical sagittal parameters after single-level anterior cervical discectomy and fusion (ACDF) in patients with cervical radiculopathy or myelopathy. We also investigate whether these changes have any relation with postoperative pain and functional outcome of the patients. Sixty patients (37 females and 23 males) with a mean age of 45.9 ± 9.5 years who were candidates of single-level ACDF due to cervical myelopathy or radiculopathy participated in the study. At baseline, 1 month, and 6 months after ACDF, outcomes of the study including sagittal balance parameters, pain intensity, and Neck Disability Index (NDI) were measured among the patients. Intensity of pain and neck disability were measured using the visual analog scale (VAS) and validated version of NDI, respectively. Using a standard lateral cervical radiography, the Cobb angle for occiput-C2, C1-C2, and C2-C7 as well as operation-level angle (OA; Cobb's angle at the level of discopathy), the thoracic inlet angle, and C7 and T1 slope angles were measured. The intensity of pain and neck disability of patients improved significantly during the follow up of the study comparing with baseline measurements (P < .001). There was a significant correlation between the increase of C2-C7 angle, C1-C2 angle, and OA and improvement in neck pain and NDI at 1- and 6-month follow ups. We found that changes at C2-C7 angle, C1-C2 angle, and OA have positive significant correlation with clinical outcome including pain improvement and decrease of disability in patients who undergo ACDF. 3. The results of this study might be beneficial in selection of cervical cages with appropriate size during ACDF surgery, as our findinds showed that larger cages could lead to better functional outcome in patients.