Arm Pain Research Articles

A Comparison of Clinical Outcomes Between Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Laminoplasty for Multilevel Cervical Myelopathy.

Retrospective Cohort. To compare patient-reported outcomes and surgical outcomes after anterior cervical discectomy and fusion (ACDF) versus cervical laminoplasty for multilevel cervical spondylotic myelopathy. Treatment options for multilevel cervical spondylotic myelopathy include ACDF and cervical laminoplasty. Given that the literature has been mixed regarding the optimal approach, especially in patients without kyphosis, there is a need for additional studies investigating outcomes between ACDF and cervical laminoplasty. A retrospective review was conducted of adult patients undergoing 3 or 4-level surgery. Patients with preoperative kyphosis based on C2-C7 Cobb angles were excluded. The electronic medical record and institutional databases were reviewed for baseline characteristics, surgical outcomes, and patient-reported outcomes. A total of 101 patients who underwent ACDF and 52 patients who underwent laminoplasty were included in the study. The laminoplasty cohort had a higher overall Charlson Comorbidity Index (3.10 ± 1.43 vs 2.39 ± 1.57, P = 0.011). Both groups had a comparable number of levels decompressed, C2-C7 lordosis, and diagnosis of myelopathy versus myeloradiculopathy. Patients who underwent laminoplasty had a longer length of stay (2.04 ± 1.15 vs 1.48 ± 0.70, P = 0.003) but readmission, complication, and revision rates were similar. Both groups had similar improvement in myelopathy scores (∆modified Japanese Orthopedic Association: 1.11 ± 3.09 vs 1.06 ± 3.37, P = 0.639). ACDF had greater improvement in Neck Disability Index (∆Neck Disability Index: -11.66 ± 19.2 vs -1.13 ± 11.2, P < 0.001), neck pain (∆Visual Analog Scale-neck: -2.69 ± 2.78 vs -0.83 ± 2.55, P = 0.003), and arm pain (∆Visual Analog Scale-arm: -2.47 ± 3.15 vs -0.48 ± 3.19, P = 0.010). These findings persisted in multivariate analysis except for Neck Disability Index. ACDF and cervical laminoplasty appear equally efficacious at halting myelopathic progression. However, patients who underwent ACDF had greater improvements in arm pain at 1 year postoperatively. Longitudinal studies evaluating the efficacy of laminoplasty to mitigate adjacent segment disease are indicated to establish a robust risk-benefit assessment for these 2 procedures. III.

Cost-effectiveness of posterior versus anterior surgery for cervical radiculopathy: results from a multicentre randomised non-inferiority trial (FACET)

PurposeFor cervical nerve root compression, anterior cervical discectomy with fusion (anterior surgery) or posterior foraminotomy (posterior surgery) are safe and effective options. Posterior surgery might have a more beneficial economic profile compared to anterior surgery. The purpose of this study was to analyse if posterior surgery is cost-effective compared to anterior surgery.MethodsAn economic evaluation was performed as part of a multicentre, noninferiority randomised clinical trial (Foraminotomy ACDF Cost-effectiveness Trial) with a follow-up of 2 years. Primary outcomes were cost-effectiveness based on arm pain (Visual Analogue Scale (VAS; 0–100)) and cost-utility (quality adjusted life years (QALYs)). Missing values were estimated with multiple imputations and bootstrap simulations were used to obtain confidence intervals (CIs).ResultsIn total, 265 patients were randomised and 243 included in the analyses. The pooled mean decrease in VAS arm at 2-year follow-up was 44.2 in the posterior and 40.0 in the anterior group (mean difference, 4.2; 95% CI, − 4.7 to 12.9). Pooled mean QALYs were 1.58 (posterior) and 1.56 (anterior) (mean difference, 0.02; 95% CI, − 0.05 to 0.08). Societal costs were €28,046 for posterior and €30,086 for the anterior group, with lower health care costs for posterior (€12,248) versus anterior (€16,055). Bootstrapped results demonstrated similar effectiveness between groups with in general lower costs associated with posterior surgery.ConclusionIn patients with cervical radiculopathy, arm pain and QALYs were similar between posterior and anterior surgery. Posterior surgery was associated with lower costs and is therefore likely to be cost-effective compared with anterior surgery.

Opening Side of Unilateral Open-Door Laminoplasty Does Not Impact Improvement in Arm Pain or Space Available for the Spinal Cord.

Background/Objectives: There exists limited data guiding open-door laminoplasty. The objective of this study is to determine if open-door laminoplasty affects radiographic decompression or arm pain outcomes. Methods: Adult patients who underwent unilateral open-door laminoplasty cervical myelopathy were included. The side opened was dependent on surgeon discretion. We recorded preoperative side of symptoms, side of radiographic compression, arm pain scores, and canal diameter. Patients with open-side ipsilateral or contralateral to dominant symptoms or compression were compared to determine any effect on arm pain outcomes or spinal canal diameter. If the symptoms were equal bilaterally, patients were neutral. Results: A total of 167 patients were included, with an average age of 64 ± 11 years and average follow-up time of 64.5 ± 72 weeks. The average preoperative arm pain visual analog score (VAS) was 2.13 ± 2.86, and the average arm VAS after 6 months was 1.52 ± 2.68. For dominant symptoms, the ipsilateral, contralateral, and neutral groups had a significant improvement in arm VAS at >6 months postoperatively. For dominant compression, the ipsilateral and contralateral groups had a significant improvement in both arm VASs and canal diameter at >6 months postoperatively. No differences were seen between groups for either. We observed a significant correlation between size of plate and change in canal diameter; however, no differences were noted for arm pain. Conclusions: Laminoplasty may be effective in addressing radicular arm pain by increasing the spinal canal's diameter and space available for the cord. The laterality of open-door laminoplasty did not affect arm pain improvement or canal expansion.

The patient outcomes with EGFR-mutated advanced non-small-cell lung cancer receiving aumolertinib as first-line treatment.

e20619 Background: As a novel third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), aumolertinib demonstrated superior progression-free survival and a well-tolerated toxicity profile to gefitinib in front-line treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) in the AENEAS trial. However, the real-world impact of aumolertinib in the first-line treatment on patients' HRQoL still remains unclear. Methods: Advanced NSCLC patients with sensitizing EGFR mutations treated with aumolertinib 110 mg daily in the first-line treatment were prospectively enrolled and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) and EORTC Quality of Life lung cancer-specific module (QLQ-LC13) information were collected. Efficacy evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.0 was also recorded here. Prespecified key symptoms were cough, hemoptysis, dyspnea, sore mouth or tongue, dysphagia, hair loss, tingling hands or feet, chest pain, arm or shoulder pain and pain of other sites. Results: Totally, 33 patients in the first-line treatment were included and 23 patients had efficacy information up to Jan 2024. The median follow-up time was 264 days (interval: 36-491 days). The objective response rate (ORR) and disease control rate (DCR) was 65.2% and 91.3%, respectively. All the patients haven’t reached the time to deterioration and the progression free survival(PFS) and overall survival is not reach. EORTC QLQ-LC30 showed general health status scale and functional scales increased and symptom scales decreased during aumolertinib treatment. Symptom scales assessed by EORTC QLQ-LC13 showed cough, sore mouth or tongue, chest pain, arm or shoulder pain and pain of other sites, were improved significantly after aumolertinib treatment (P &lt; 0.05). Conclusions: General health status, functional status and key symptoms improved from baseline in patients with advanced NSCLC receiving aumolertinib as first-line treatment. The ORR and DCR in our study was comparable in those showed the AENEAS trial.

Cervical Disc Arthroplasty (CDA) versus Anterior Cervical Discectomy and Fusion (ACDF) for Two-Level Cervical Disc Degenerative Disease: An Updated Systematic Review and Meta-Analysis.

Background: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are both considered to be efficacious surgical procedures for treating cervical spondylosis in patients with or without compression myelopathy. This updated systematic review and meta-analysis aimed to compare the outcomes of these procedures for the treatment of cervical degenerative disc disease (DDD) at two contiguous levels. Methods: The PubMed, EMBASE, and Cochrane CENTRAL databases were searched up to 1 May 2023. Studies comparing the outcomes between CDA and ACDF in patients with two-level cervical DDD were eligible for inclusion. Primary outcomes were surgical success rates and secondary surgery rates. Secondary outcomes were scores on the Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, as well as the Japanese Orthopaedic Association (JOA) score for the severity of cervical compression myelopathy and complication rates. Results: In total, eight studies (two RCTs, four retrospective studies, and two prospective studies) with a total of 1155 patients (CDA: 598; ACDF: 557) were included. Pooled results revealed that CDA was associated with a significantly higher overall success rate (OR, 2.710, 95% CI: 1.949-3.770) and lower secondary surgery rate (OR, 0.254, 95% CI: 0.169-0.382) compared to ACDF. In addition, complication rates were significantly lower in the CDA group than in the ACDF group (OR, 0.548, 95% CI: 0.326 to 0.919). CDA was also associated with significantly greater improvements in neck pain VAS than ACDF. No significant differences were found in improvements in the arm VAS, NDI, and JOA scores between the two procedures. Conclusions: CDA may provide better postoperative outcomes for surgical success, secondary surgery, pain reduction, and postoperative complications than ACDF for treating patients with two-level cervical DDD.

Prevalence and Risk Factors of Musculoskeletal Complaints Among Clinical Healthcare Workers

This study investigated the prevalence and risk factors of musculoskeletal complaints among health workers in clinical wards, examining the relationship between these complaints and various work-related and personal variables. Conducted between December 2022 and April 2023, this descriptive study utilized a non-probability, voluntary sample of 100 health workers. Results indicated that 26% of participants reported lower back pain, 49% arm or neck complaints, 44% regular back pain, and 51% leg complaints. Key risk factors included extended work hours without breaks (67%), time pressure (33%), lifting (45%), and stooping (54%). Despite high medium-risk exposure (85%), no participants reported high-risk levels. This study highlights the significant burden of WMSDs among clinical healthcare workers and underscores the need for interventions to reduce duce these risks and improve occupational health. Highlight: Prevalence: A significant portion of healthcare workers reported musculoskeletal complaints, with 51% experiencing leg pain and 49% arm or neck pain. Risk Factors: Key risk factors identified include prolonged work hours without breaks (67%), time pressure (33%), lifting (45%), and stooping (54%). Implications: The study underscores the need for targeted interventions to mitigate WMSDs and improve the occupational health of clinical healthcare workers. Keywords: Musculoskeletal Disorders, Healthcare Workers, Risk Factors, Occupational Health, Clinical Wards

Адаптация русскоязычной версии детского опросника соматических симптомов на выборке детей-сирот и детей, оставшихся без попечения родителей

&lt;p&gt;This study was aimed to adapt the Russian version of the Children&amp;rsquo;s Somatic Symptoms Inventory-8 (CSSI-8). The participants were 160 orphans and children and adolescents left without parental care, including 80 girls and 80 boys aged 9 to 17 years (M=14,51; Me=15 years; SD=1,79). All participants completed CSSI-8 and the Revised Child Anxiety and Depression Scale-30 (RCADS-30). The Russian version of the inventory was reliable and valid: firstly, it has a high Cronbach&amp;rsquo;s &amp;alpha;, showing its internal reliability; secondly, it has a one-factor structure, indicating its factor validity; thirdly, the relationship of somatic symptoms with anxiety and depressive symptoms proves convergent validity. Thus, 76,2% of children and adolescents had at least one specific somatic symptom, 44,4% complained of pain in stomach or abdomen, 58,7% of headaches, 30,6% of pain in lower back, 19,4% of faintness or dizziness, 29,4% of pain in arms or legs, 28,7% of heart palpitations, nausea or upset stomach, 47,5% of weakness in some parts of the body. In conclusion, it is important to make future psychometric examinations of the adapted questionnaire, which allow us to recommend it for school diagnosis and psychological counseling of children and adolescents, as well as screening and monitoring of somatoform disorders.&lt;/p&gt;

Impact of low-level laser therapy on upper limb lymphoedema secondary to breast cancer: a systematic review and meta-analysis

IntroductionThis review analysed the efficiency of low-level laser therapy in treating breast cancer-related lymphedema (BCRL) in women.Material and methodsDatabases such as Scopus, PEDro, PubMed, Cochrane, and Web of Science were searched for RCTs using low-level laser therapy (LLLT) or photo-bio modulation therapy (PBMT) on BCRL published between 2010 and August 2023. Primary outcomes were arm circumference, volume, and hand grip strength, while secondary outcomes were pain, shoulder mobility, and quality of life.ResultsEleven RCTs with a total of 379 patients were analysed, and 8 studies were included for meta-analysis. We found no significant difference between laser-treated and control groups in any of the trials in terms of arm circumference, arm volume, grip strength, and quality of life post-intervention, and a significant difference between the groups in terms of pain intensity and shoulder mobility.ConclusionsThis review revealed that low-level laser therapy (photobiostimulation) was successful in reducing arm circumference, volume, and pain, as well as enhancing grip strength, life quality, and mobility. However, the meta-analysis did not show any improvement except in pain and shoulder mobility. Further trials are required to assess the long- and short-term efficacy of LLLT in managing lymphoedema secondary to breast cancer.

The Positive Side Effect of Anterior Cervical Decompression and Fusion on Axial Neck Pain.

Observational Cohort Study. This study aims to comprehensively assess the outcomes of anterior cervical spine surgery in patients who have undergone surgical intervention for radiculopathy or myelopathy, with a specific focus on the surgery's impact on axial neck pain. Data from an institutional spine surgery registry were analyzed for patients who underwent anterior cervical spine surgery between January 2016 and March 2022. Patient demographics, clinical variables, and outcome measures, including the Neck Disability Index (NDI), numeric rating scales for neck and arm pain (NRS-Neck and NRS-Arm), and 36-Item Short Form Health Survey (SF-36) scores, were collected. Statistical analysis included paired t-tests, chi-squared tests, and multivariate linear regression. Of 257 patients, 156 met the inclusion criteria. Patients showed significant improvement in NDI, NRS-Neck, NRS-Arm, SF-36 (Physical and Mental components), and all changes exceeded the minimum clinically important difference. Multivariate regression revealed that lower preoperative physical and mental component scores and higher preoperative NRS-Neck predicted worse NDI scores at follow-up. This study underscores that anterior cervical fusion not only effectively alleviates arm pain and disability but also has a positive impact on axial neck pain, which may not be the primary target of surgery. Our findings emphasize the potential benefits of surgical intervention when neck pain coexists with neurologic compression. This contribution adds to the growing body of evidence emphasizing the importance of precise diagnosis and patient selection. Future research, ideally focusing on patients with isolated neck pain, should further explore alternative surgical approaches to enhance treatment options.

A Case of Cervical Chordoma

A 48 year old male presented with neck pain and left arm pain that worsened with movement alongside left arm weakness, numbness, and tingling. The differential diagnosis for a patient with symptoms of a neck mass includes benign tumors like neurofibromas, malignant tumors like chordomas, and non-neoplastic conditions like cervical spondylitis. A magnetic resonance imaging (MRI) study of the cervical spine with and without contrast identified a T1 hypointense, T2 hyperintense, heterogeneously enhancing prevertebral mass with parapharyngeal extension. A direct laryngoscopy with biopsy was performed and revealed a paraspinal tumor. The patient’s diagnosis of cervical chordoma was confirmed upon detection of Brachyury, a gene that encodes a transcription factor which promotes epithelial mesenchymal transition (EMT) in chordoma pathogenesis. Chordomas are slow-growing tumors located within the body’s midline and they are associated with poorer outcomes because of neurovascular encasement at time of presentation. Chordomas are rare, with an incidence of 1 in 1,000,000. Approximately 6% of chordomas are located in the cervical spine. They are typically treated with surgery followed by radiation therapy. The patient underwent anterior resection for the prevertebral mass in the C2-C6 section of the cervical spinal cord. Surgery achieved subtotal resection and involved removal of the spinous processes of C3-C5 and reconstruction of the cervical spine with implants. The patient will be starting proton beam radiotherapy for his adjuvant treatment. Although rare, it is important to keep chordomas in the differential diagnosis when evaluating a patient with a neck mass.

Is the cardioprotective effect of pre-infarction angina blunted by age?

Abstract Funding Acknowledgements None. Background Pre-infarct angina (PIA) has been demonstrated to reduce infarct size and improve prognosis in ST-elevation myocardial infarction (STEMI). However, the effects of ischemic preconditioning with aging are still controversial. Purpose We aimed at comparing the effect of pre-infarction angina (PIA) on infarct size between two age groups. Methods We retrospectively studied consecutive STEMI patients treated by primary percutaneous coronary intervention (PCI) from January 2008 to December 2017. PIA was diagnosed if a patient had arm, jaw, or chest pain in the preceding eight days. Peak creatine kinase (CK) concentration was used as a surrogate of infarct size. Patients were divided into two groups, based on the median age: ≤62 years and &amp;gt;62 years. Multiple linear regression was used to identify independent predictors for infarct size that included total ischemic time and classic cardiovascular risk factors (hypertension, diabetes, dyslipidaemia, and smoking). Interaction between age and PIA was evaluated by 2-way factorial ANOVA. Results From the 1131 patients included in the study, 590 (52,2%) had ≤62 years and 541 (47,8%) had &amp;gt;62 years. Older patients were more often women (17.2% vs 8.6%, p&amp;lt;0.001) and had longer total ischemic time [4.6(3.0-9.0) vs 3.5(2.3-6.0) hours, p&amp;lt;0.001]. They also had higher prevalence of hypertension (32.8% vs 22.8%, p&amp;lt;0.001), diabetes (30.7% vs 18.7%, p&amp;lt;0.001) and were less likely to be smokers (26.9% vs 71.4%, p&amp;lt;0.001). The prevalence of PIA was similar across age groups (≤62Y 31.2% vs &amp;gt;62Y 32.0%, p=0.668). In older patients, PIA was associated with smaller infarct size [1.29(0.72-2.33) vs. 1.76(0.97-2.91) U/Lx103, p&amp;lt;0.001]. This difference was not observed for younger patients [1.72(0.95-3.40) vs. 1.81(0.94-3.37) U/Lx103, p=0.392]. There was no significant interaction between the existence of PIA and age on peak CK (p=0.280 for interaction) (Figure 1). In multivariate analysis, overall, PIA was associated with reduced peak CK (β=-0,320, p=0.011). On subgroup group analysis, PIA was a predictor of infarct size only in the older patients (β=-0,459, p=0.005), but not in the younger group (β=-0,182, p=0.394). Conclusion Older patients with PIA had significantly lower infarct size compared to patients in the same age group without PIA. After adjustment for risk factors and total ischemic time, PIA was a predictor of lower infarct size only for the older patients. These results suggest that the effect of pre-ischemic conditioning is not blunted by age, indicating that older patients should not be excluded from clinical trials investigation of cardioprotective strategies in STEMI patients.

Bone morphogenetic protein in subaxial cervical arthrodesis: a meta-analysis of 5828 patients.

Use of bone morphogenetic protein (BMP)-an osteoinductive agent commonly used in lumbar arthrodesis-is off-label for cervical arthrodesis. This study aimed to identify the effect of BMP use on clinical and radiological outcomes in instrumented cervical arthrodesis. A comprehensive systematic review of the literature was performed to identify studies directly comparing outcomes between cervical arthrodeses with and without using BMP. Outcomes were analyzed separately for cases of anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF). A total of 20 studies with 5828 patients (1948 with BMP and 3880 without BMP) were included. In the ACDF cases, BMP use was associated with higher fusion rates (98.9% vs 93.6%, risk difference [RD] 8%; risk ratio [RR] 1.12, p = 0.02), lower reoperation rates (2.2% vs 3.1%, RD 3%; RR 0.48, p = 0.04), and higher risk of dysphagia (24.7% vs 8.1%, RD 11%; RR 1.93, p = 0.02). No significant differences in the Neck Disability Index, neck pain, or arm pain scores were associated with the use of BMP. On subgroup meta-analysis of ACDF cases, older age (≥ 50 years) and higher BMP dose (≥ 0.9 mg/level) were associated with significantly higher fusion rates and relatively lower risk for dysphagia, whereas arthrodesis of fewer segments (< 2 levels) showed significantly higher dysphagia rates without a significant increase in fusion rates. In the PCF cases, the use of BMP was not associated with significant differences in fusion (p = 0.38) or reoperation (p = 0.61) rates but was associated with significantly higher blood loss during surgery (mean difference 146.7 ml, p ≤ 0.01). Use of BMP in ACDF offers higher rates of augmented fusion and lower rates of all-cause reoperation but with an increased risk of dysphagia. The benefit of fusion outweighs the risk of dysphagia with a higher BMP dose in older patients being operated on for < 2 levels. The use of BMP in PCF seems to have a less important effect on clinical and radiological outcomes.

Peripheral Nerve Stimulation for Arm Pain in an Adolescent Girl with Ewing Sarcoma as Bridge Therapy to Chemotherapy: A Case Report

BACKGROUND: Cancer commonly presents discomfort from abnormal cell growth in healthy tissue and is often inadequately managed. Peripheral nerve stimulation (PNS), mainly for non-cancer chronic pain, has emerged as a minimally invasive option for neuropathic cancer-related pain when conventional methods fail. Limited research, primarily in adults, has focused on PNS in the non-oncological population. CASE REPORT: A 14-year-old adolescent girl with a history of obesity, diabetes, and Ewing sarcoma in her left proximal humerus experienced severe pain, initially rated at 10/10. After undergoing ultrasound-guided left suprascapular PNS as a 60-day bridge therapy to chemotherapy, her pain improved to 3/10 at lead removal and remained at 4/10 at 3 months postremoval. CONCLUSION: PNS is a promising and less invasive neuromodulation approach for managing tumor-related bone pain. Our case study illustrates the effectiveness of PNS placement for significant pain reduction, although limitations, such as delayed response and the need for further randomized-controlled studies, are acknowledged. KEY WORDS: Neuromodulation, peripheral nerve stimulation, Ewing sarcoma, arm pain, bone pain, chemotherapy, teen, adolescent

Temporal Dynamics of Adverse Effects across Five Sessions of Transcranial Direct Current Stimulation.

(1) Background: Transcranial direct current stimulation (tDCS) is a safe intervention, only producing mild and transient adverse effects (AEs). However, there is no detailed analysis of the pattern of adverse effects in an application transferable to the clinic. Therefore, our objective is to describe the AEs produced by tDCS and its temporal evolution. (2) Methods: A total of 33 young volunteers were randomized into a tDCS or sham group. Participants performed a hand dexterity task while receiving the tDCS or sham intervention (20 min and 1 mA), for five consecutive days. AEs were assessed daily after each intervention and classified as somatosensory, pain, or other effects. (3) Results: The number of AEs was generally increased by tDCS intervention. Specifically, tDCS led to more frequent somatosensory discomfort, characterized by sensations like itching and tingling, alongside painful sensations such as burning, compared to the sham intervention. Additionally, certain adverse events, including neck and arm pain, as well as dizziness and blurry vision, were exclusive to the tDCS group. Interestingly, tDCS produced similar AEs across the days; meanwhile, the somatosensory AEs in the sham group showed a trend to decrease. (4) Conclusions: tDCS produces mild and temporary somatosensory and pain AEs during and across sessions. The different evolution of the AEs between the tDCS and sham protocol could unmask the blinding protocol most used in tDCS studies. Potential solutions for improving blinding protocols for future studies are discussed.

Evaluating the Impact of Smoking and Hyperlipidemia in Patients with Atherosclerotic Cardiovascular Disease

Hyperlipidemia and Smoking are risk factors of atherosclerotic cardiovascular disease in Pakistani community. Objectives: To determine whether smoking and hyperlipidemia were associated with atherosclerotic cardiovascular disease. Methods: A comparative, cross-sectional study was conducted upon a sample of 200 male and female participants with different cardiac complications were selected and divided them into different groups like Group A and Group B. The individuals with medical complications such as severe chest pain, unexpected numbness or weakness in arms or legs and loss of vision were placed in Group A. While in Group-B 70 male and 30 female individuals with mild chest pain were include. BMI, Cholesterol, Triglyceride, LDL and HDL levels and other demographics such as age, smoking habits were measured respectively. Results: In Group A (severe disease group) there were 75 males and 25 females while in Group B (mild disease group) 70 male and 30 female individuals were listed. The mean age in Group A (59.09 ± 0.01) and Group B (59.09 ± 0.01). The results showed significant difference in Group A and B mean cholesterol (279.9 ± 0.04 vs. 239.09 ± 0.04), Triglycerides (187.02 ± 0.01 vs. 127.02 ± 0.01), LDL (153.01 ± 0.02 vs. 123.01 ± 0.02), HDL (49.04 ± 0.01 vs. 40.01 ± 0.01) and (p value&lt;0.05). Conclusions: It was concluded that hyperlipidemia and smoking were significant (p≤0.05) risk factors for atherosclerotic cardiovascular disease, as seen by increasing levels of cholesterol, Triglycerides and LDL in cardiovascular patients.

Os odontoideum with progressive symptoms: case report

A 53-year-old male patient was admitted to the neurosurgery outpatient clinic with neck pain. He had difficulty performing fine manual skills, had numbness in his hands, and felt as if he was stepping on a space while walking. He declared that his head occasionally fell forward involuntarily. He had no urinary or fecal incontinence or neurogenic claudication. On neurologic examination, there was no loss of muscle strength and no pathologic reflex. He was skillful in cerebellar tests. He declared no history of falls, impacts, or accidents. From the patient's hospital digital records, it was seen that he was admitted to the neurosurgery outpatient clinic with right arm and neck pain before, and surgical treatment was recommended to him due to the os odontoideum, but he refused this treatment. As the patient became symptomatic in the following period, atlantoaxial instability was found on cervical dynamic X-rays. For all these reasons, he was advised to undergo surgical treatment, but he re-refused the operation. In conclusion, it was considered that close follow-up with conservative treatment in asymptomatic os odontoideum patients may be appropriate. However, it was suggested that the possibility of AAI should be considered in patients who become symptomatic.

P111 Reliability of quantitative sensory testing, disease activity score 28, ultrasound and central aspects of pain questionnaire in individuals with rheumatoid arthritis

Abstract Background/Aims Disease Activity Score 28 (DAS28), ultrasound, quantitative sensory testing (QST) and central aspect of pain (CAP) questionnaire measure disease activity and pain hypersensitivity. We investigated their inter-rater and test-retest reliability in Central Aspects of Pain in Rheumatoid Arthritis (CAP-RA) participants. Methods Participants who attended the CAP-RA study visit and agreed to one or more reliability assessments were included. The same two raters completed all assessments, including clinical examination for DAS28, using a single blood sample per participant. QST modalities in the sequence: Pressure Pain detection Threshold (PPT) at the medial joint line of the most painful knee, tibialis anterior and contralateral brachioradialis, Temporal Summation (TS) at rectus femoris of the most painful knee and Conditioned Pain Modulation (CPM), with ischaemic arm pain conditioning and PPT at tibialis anterior. Ultrasound followed the Backhaus 7 protocol, plus the knee. Two trained sonographers scored each joint scan for grey scale (GS), power Doppler and a combined score (PDUS) using EULAR-OMERACT methodology. Joint scores were summated to give an overall score for GS, Doppler and PDUS. Participants could complete questionnaires at invitation, prior to and at baseline, 1-week post-baseline, prior to and at follow-up visit. Any combination of questionnaires completed within 7 days of each other assessed repeatability. Data were assessed for normality, interclass correlation coefficients, and Bland and Altman plots in R studio. Results 196 people were recruited into CAP-RA (median (IQR)) age 66 (58-75) y, 139 (75%) female, 190 (98%) white. 97 (49%) undertook study visits. Characteristics of the 66 people undertaking reliability did not significantly differ from the total population. Measurements are shown in Table 1. Moderate to excellent reliability was found across all measures except CPM (Table 1). The swollen joint count was the least reliable of the DAS28 components. Conclusion Measures of inflammatory disease activity and pain sensitivity are at least moderately reliable within a research context. Only low reliability for CPM might indicate imprecision, or reflect fluctuations in symptoms or pain sensitivity. High reliability of DAS28 and US might reflect relative stability of clinical signs of inflammation. Suppressing day-to-day fluctuations could reduce the unpredictability of rheumatoid arthritis. Disclosure S.L. Smith: None. V. Georgopoulos: None. O. Ifesemen: None. E. Ferguson: None. R.J. Wakefield: None. D. Wilson: None. P. Buckley: None. D. Platts: None. S. Ledbury: None. D.F. McWilliams: Grants/research support; Eli Lilly, Pfizer, GSK, Orion, UCB. D.A. Walsh: Grants/research support; Eli Lilly, Pfizer, GSK, Orion, UCB.

Pancoast-Tobias Syndrome Due to a High-Grade Fibrous Histiocytoma: A Case Report

Bronchogenic cancers account for an overwhelming majority of all malignancies responsible for Pancoast syndrome. However, the spectrum of non-bronchogenic malignant causes is broad and although less frequent, they are characterized by late diagnosis at advanced disease stage with a poor prognosis. The clinical presentation of Pancoast tumors can be polymorphic based on the etiology and anatomic extent, leading to considerable delays in the request of appropriate investigative techniques. Chest radiography may be helpful in first-line imaging but the cross-sectional modalities are more sensitive for diagnosis, staging and follow-up of treatment. Early reporting of symptoms and increased clinical vigilance could lead to an early diagnosis and improved 5-year survival. We report the case of a 40-year-old male with worsening left shoulder and arm pain over the course of a few months and a left neck swelling.

Disability and pain after anterior cervical decompression and fusion: A group-based trajectory analysis.

This study aimed to identify the clusters of patients with different developmental trajectories of pain and disability after anterior cervical decompression and fusion (ACDF). Group-based trajectory analysis among 318 patients undergoing the ACDF. Three developmental trajectories of disability were identified: "Steadily good functioning," "Improved functioning," and "Steadily poor functioning." Three developmental trajectories of neck pain were identified: "Worsened pain," "Pain relief," and "Steadily severe pain." Two developmental trajectories of arm pain were identified: "Decreased arm pain" and "Severe arm pain with only short-term relief." No associations were found between sex, preoperative pain duration, or body weight and probability to be classified into a particular disability trajectory group. Female sex (relative risk ratio (RRR) 1.78) and longer history of preoperative pain (RRR 2.31-2.68) increased the probability to be classified into a group with steadily severe neck pain. Longer history of preoperative pain increased the probability to be classified into group with severe arm pain with only short-term pain relief (RRR 2.68). After the ACDF, dissimilar developmental trajectories of pain and disability were identified between the patient clusters. While sex, preoperative pain duration, and body weight were not associated with differences in improvement in disability level, female sex and longer duration of preoperative pain were correlated with more severe neck and arm pain after surgery.

Evaluation of Cervical Vertebral Motion and Foraminal Changes During the Spurling Test Using Zero Echo Time Magnetic Resonance Imaging and Computed Tomography-Based Micromotion Analysis.

Clinical experimental diagnostic study. The objective of the study was to investigate cervical spine dynamics including changes in the cervical foramina in patients experiencing intermittent arm radiculopathy. Cervical foraminal stenosis is a frequent cause of radicular arm pain. The Spurling test, while specific, lacks the precision to identify symptomatic nerve roots. The relationship among vertebral motion, foraminal changes, and radiculopathy during a Spurling test remains underexplored. Ten patients with positive Spurling tests and magnetic resonance imaging (MRI) confirmed 1 or 2-level cervical foraminal stenosis were scanned using the Dynamic MRI Compression System enabling a simulated Spurling test inside the MRI gantry of a 3T MRI scanner with a dedicated neck coil. First, a relaxed image acquisition was undertaken, followed by slowly applying the Spurling test until the patient reported aggravation of radiculopathy or discomfort, where the next image series was taken. Zero echo time MRI was employed to obtain computed tomography (CT)-like images. The images were thereafter analyzed using the Sectra® CT-based Micromotion Analysis software for motion analysis. The C4/C5 level exhibited the most significant movements both in translation and rotation, with less movements observed in C5 to C6 and C6 to C7 levels. No uniform pattern emerged that differentiated suspected stenotic levels from nonsuspected levels. Despite relatively small vertebral movements, 9/10 of patients reported arm pain during provocation, indicating extremely narrow margins of tolerance. This study demonstrates the utility of zero echo time MRI and CT-based Micromotion Analysis in detecting subtle yet clinically relevant vertebral motions influencing the foramina in the cervical spine during the Spurling maneuver. These findings could lead to a better understanding and potentially improved diagnostic strategies for cervical foraminal stenosis, although further research with a larger cohort is necessary to confirm these results.