Cervical Disc Herniation Research Articles

Anterior transcorporeal approach combined with posterior translaminar approach in percutaneous endoscopic cervical discectomy for two-segment cervical disc herniation treatment: a technical report and early follow-up

ObjectiveFull endoscopic techniques are being gradually introduced from single-segment cervical disc herniation surgery to two-segment cervical disc herniation surgery. However, there is no suitable full endoscopic treatment for mixed-type two-segment cervical disc herniation (MTCDH) in which one segment herniates in front of the spinal cord and the other segment herniates behind the spinal cord. Therefore, we introduce a new full endoscopic technique by combining an anterior transcorporeal approach and a posterior translaminar approach. In addition, we provide a brief description of its safety, efficacy, feasibility, and surgical points.MethodsThirty patients with MTCDH were given full endoscopic surgical treatment by a combined transcorporeal and transforaminal approach and were followed up for at least 12 months.ResultsClinical assessment scales showed that the patient’s symptoms and pain were significantly reduced postoperatively. Imaging results showed bony repair of the surgically induced bone defect and the cervical Cobb angle was increased. No serious complications occurred.ConclusionThis technique enables minimally invasive surgery to relieve the compression of the spinal cord by MTCDH. It avoids the fusion of the vertebral body for internal fixation, preserves the vertebral motion segments, avoids medical destruction of the cervical disc to the greatest extent possible, and expands the scope of adaptation of full endoscopic technology in cervical surgery.

Determination of Paraoxonase 1 Activity and Phenotype Distribution in Cervical Disk Herniation Patients

Determination of Paraoxonase 1 Activity and Phenotype Distribution in Cervical Disk Herniation Patients
 
 Abstract
 Objectives: Cervical disk herniation (CDH) is a common disease that usually develops as a result of intervertebral disk degeneration (IVDD) or trauma, which can cause pain or neurological deficiency by nevre root or spinal cord compression. Paraoxonase 1 (PON1) has antioxidant qualities, and its function may vary based on genetic variations and ethnic background. This study aims to compare PON1 activity and phenotype distribution in CDH patients and individuals without the condition.
 Materials and Methods: This study involved 70 CDH patients and 70 individuals in good health. Spectrophotometric tests were conducted to measure the serum PON1 and arylesterase (ARE) activities. The PON1 ratio, which indicates the salt-stimulated PON/ARE level, showed a three-peak distribution. This ratio was utilized to determine the various phenotypes; QQ, QR, and RR for each participant.
 Results: The PON1 activity was lower in CDH patients compared to the healthy individuals (p < 0.05). CDH patients exhibited a statistically significant QQ phenotype in comparison to the healthy participants (p < 0.05).
 Conclusion: Patients with CDH exhibited significantly reduced PON1 activity, indicating that low PON1 activity and the PON1 QQ phenotype could potentially be a risk factor for the development of CDH.
 Keywords: Cervical disk herniation, Paraoxonase, Phenotype, PON1

Clinical Demonstration of the Relationship Between Cervical Subcutaneous Fat Tissue Thickness and Obesity

ABSTRACT Objective Neck pain is an important complaint in neurosurgery practice and is observed with a frequency of 30-50% throughout life. The most common complaint of working women who apply to the doctor is neck pain. Obesity is known as a common disease in recent years and traditional measurements are used in its evaluation in practice. In this research, we aimed to show the relationship between obesity in patients with neck pain that may accompany cervical disc herniation. We examined the usability of neck circumference measurement in indicating obesity. Materials and Methods This study was made on 100 patients aged between 20 and 70, after determining the Sample Size with Power Analysis. The presence of cervical disc herniation and the thickness of the cervical subcutaneous adipose tissue were measured and recorded on Magnetic Resonance Imaging. Neck circumference measurements of the patients were compared with waist circumference measurements. The data collected for the study were recorded using the SPSS 22 program and analysed in the same program. Results 55% of the patients had disc herniation and 38% had an additional chronic disease. Individuals with a cervical herniated disc had higher waist circumference and subcutaneous asymptote tissue values than those without (p<0.01). BMI values of individuals with a cervical herniated disc were found to be higher than those without (respectively, 30.47±4.93, 27.77±4.60, p=0.023). A positive linear correlation was found between the BMI values of the patients, neck circumference, waist circumference and subcutaneous adipose tissue (p<0.05 core coefficient 0.676&0.750&0.463, respectively). Conclusion Neck circumference measurement, which is a simple and fast method, we can diagnose obesity. We saw that in our study, as in many cases, obesity was observed more frequently with cervical disc herniation, especially in women.

Prevalence of cervicogenic dizziness in patients with neck pain and effectiveness of cervicogenic dizziness rehabilitation

Objective: This study aims to determine the frequency of cervicogenic dizziness in patients suffering from neck pain and observe the efficacy of cervicogenic dizziness (CGD) rehabilitation. Material and Method: It was a retrospective study. The patients aged between 18 and 65 who attended the physical medicine and rehabilitation outpatient clinic and suffered from neck pain were included in the study. Pregnants and patients with a history of cervical surgery, missing data, or attending the rehabilitation program irregularly were excluded. Demographic data, treatment protocols, laboratory and radiology results, and Dizziness Handicap Inventory Scores in the 1st and 3rd month after rehabilitation were obtained from the health database. The frequency and reasons for cervicogenic dizziness and the efficacy of the rehabilitation program were observed. P < 0.05 was considered statistically significant. Results: Totally, 443 patients were analyzed. 288 patients were female, and 155 were male. The mean age was 50.31 ± 14.06. Cervical disc herniation was determined in 40% (n = 178) of the patients, cervical spondylosis was observed in 11.5% (n = 51) of patients, 45.5% (n = 202) of patients had myofascial pain syndrome and 1.5% (n = 6) of patients defined trauma. Neck pain was associated with dizziness in 8.57% (n = 38). Cervicogenic dizziness was determined in 8.1% of the patients, and the most common reasons were myofascial trigger points and cervical disc hernia. Patients who accepted the cervicogenic rehabilitation program had a better Dizziness Handicap Inventory Score in the 1st and 3 rd month controls. Conclusion: Cervicogenic dizziness was determined in 8.1% of patients suffering from neck pain. It was detected that the most common reason was cervical pathologies, and the patients benefited from rehabilitation program.

Assessment of Spine MED® Traction Effect on Cervical Disc Herniation: Correlation Between MRI and ODI/VAS Score: A Randomized Study

Assessment of Spine MED® Traction Effect on Cervical Disc Herniation: Correlation Between MRI and ODI/VAS Score: A Randomized Study

Posterior cervical decompression in patients with cervical disc herniation and cervical canal stenosis using unilateral biportal endoscopy

Posterior cervical decompression in patients with cervical disc herniation and cervical canal stenosis using unilateral biportal endoscopy

Examination of annulus fibrosus and nucleus pulposus in cervical and lumbar intervertebral disc herniation patients by scanning acoustic microscopy, scanning electron microscopy and energy dispersive spectroscopy.

Intervertebral disc herniation (IVDH) is observed in humans as a result of the alteration of annulus fibrous (AF) and nucleus pulposus (NP) tissue compositions in intervertebral discs. In this study, we studied the feasibility of scanning acoustic microscopy (SAM), scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) in characterizing the herniated segments of AF and NP tissues from male and female patients. SAM determined the acoustic property variations in AF and NP tissues by calculating the acoustic impedance values of samples of 15 patients. SEM obtained higher resolution images and EDS made elemental analysis of the specimen. Consequently, we suggest that these techniques have the potential to be combined for the investigation and removal of the disrupted AF and NP tissues with micrometer resolution in clinics.

Cervical disc herniation disguised as spontaneous intracranial hypotension: a case report

Cervical disc herniation disguised as spontaneous intracranial hypotension: a case report

Finite element modeling and analysis of effect of preexisting cervical degenerative disease on the spinal cord during flexion and extension.

Recent studies have emphasized the importance of dynamic activity in the development of myelopathy. However, current knowledge of how degenerative factors affect the spinal cord during motion is still limited. This study aimed to investigate the effect of various types of preexisting herniated cervical disc and the ligamentum flavum ossification on the spinal cord during cervical flexion and extension. A detailed dynamic fluid-structure interaction finite element model of the cervical spine with the spinal cord was developed and validated. The changes of von Mises stress and maximum principal strain within the spinal cord in the period of normal, hyperflexion, and hyperextension were investigated, considering various types and grades of disc herniation and ossification of the ligamentum flavum. The flexion and extension of the cervical spine with spinal canal encroachment induced high stress and strain inside the spinal cord, and this effect was also amplified by increased canal encroachments and cervical hypermobility. The spinal cord might evade lateral encroachment, leading to a reduction in the maximum stress and principal strain within the spinal cord in local-type herniation. Although the impact was limited in the case of diffuse type, the maximum stress tended to appear in the white matter near the encroachment site while compression from both ventral and dorsal was essential to make maximum stress appear in the grey matter. The existence of canal encroachment can reduce the safe range for spinal cord activities, and hypermobility activities may induce spinal cord injury. Besides, the ligamentum flavum plays an important role in the development of central canal syndrome.Significance.This model will enable researchers to have a better understanding of the influence of cervical degenerative diseases on the spinal cord during extension and flexion.

Traumatic Anterior Cervical Disc Herniation Presenting as Severe Dysphagia.

Due to the anatomical characteristics of the cervical spine, few cases of traumatic anterior cervical disc herniation have been reported in the literature. Here, we present a rare case of a traumatic anterior cervical disc herniation presenting as severe dysphagia. A 75-year-old male patient presented with severe dysphagia following an accident three days prior when he fell from a height of stairs. Cervical magnetic resonance (MR) imaging revealed a 1.3 × 1.0 cm extruded disc in the anterior aspect of the C4 level with the base at the C3-4 disc, which displaced the esophagus anteriorly. Esophagography revealed an extrinsic esophageal lesion that was considered to be responsible for the obstruction of the airway at the same level. He underwent a ruptured disc removal via the anterior approach. Preoperative dysphagia was resolved gradually after surgery, and he remained asymptomatic six months after surgery.

Surgical Essentials and 2-Year Follow-Up Results of Channel Repair in Endoscopic Transcorporeal Discectomy for Cervical Disc Herniation

To evaluate long-term outcomes and surgical essentials of channel repair in endoscopic transcorporeal discectomy for cervical disc herniation. From October 2019 to March 2020, 24 patients with cervical disc herniation underwent channel repair after percutaneous full-endoscopic anterior transcorporeal cervical discectomy. Five interventions were performed at C3-C4, 11 were performed at C4-C5, and 8 were performed at C5-C6. Clinical outcomes were evaluated by Neck Disability Index, Japanese Orthopaedic Association, and visual analog scale scores. Radiologic changes were evaluated with intervertebral disc height and drilled vertebral height. All procedures were completed with a mean operating time of 86.40 ± 8.19 minutes. Swollen neck was observed in 5 patients, which resolved within 2 hours. At the final follow-up, Neck Disability Index, Japanese Orthopaedic Association, and visual analog scale scores were improved significantly compared with preoperative assessments (P < 0.05); intervertebral disc height was decreased significantly (P < 0.05); and loss of drilled vertebral height was not significant (P > 0.05). All 24 bony channels disappeared by 3 months postoperatively. No other complications were observed. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy with channel repair offers a minimally invasive and effective treatment option for patients with cervical disc herniation. This technique demonstrates favorable clinical outcomes, including preservation of cervical spine mobility and minimal complications. Although there was a significant loss of intervertebral disc height, no vertebral collapse occurred. Strict adherence to surgical indications and precautions is crucial for successful outcomes. Further research and long-term studies are required to validate the efficacy and safety of this approach in a larger patient population.

Evaluation of the effectiveness of complex physical therapy and SIS-therapy in the treatment of cervical disc herniation in the cervical spine

This article provides a review of the literature evaluating treatments for cervical disc herniation.&#x0D; As the most common cause of neck pain and even disability, cervical disc herniation often requires a multifaceted approach to treatment. The author examines the effectiveness of complex exercise therapy, including a number of therapeutic exercises and methods of manual therapy and SIS-therapy, using a high-intensity magnetic field. The review contains a description of various clinical trials, and also presents comparative functional characteristics of these methods to assess the effectiveness, safety and effectiveness of treatment. The author conducted a comparative analysis of the SIS-therapy method with the exercise therapy method in the treatment of herniated discs of the cervical spine based on consideration of such aspects of their impact as the mechanism of action, effectiveness, safety, accessibility and convenience, time and cost, and overall impact on health. The results show that complex exercise therapy and SIS-therapy are the most promising non-invasive treatment methods that can significantly improve the degree of pain relief, mobility and overall quality of life of patients with cervical disc herniation. The article provides recommendations for the implementation of these treatment methods in clinical practice and suggestions for further directions of research.

Cervical Angina as a Neglected Symptom of Cervical Spine Pathologies: Retrospective Observational Study

Objective: The objective is to assess the incidence of cervical angina as presentation of cervical spine pathologies. Materials and Methods: Data were collected retrospectively from patients’ medical records from January 2018 to December 2022 who presented to our pain clinic with chest pain, neck pain, upper extremity pain and tingling numbness. A total of 168 patients with cervical spine pathologies were identified. Those having chest pains were analyzed subsequently treated with pharmacotherapy, intramuscular stimulation (IMS). Cervical epidural adhesiolysis was performed depending on spine pathology based on clinical picture, severity of symptoms and radiological findings. Results: Among 168 patients 25 had chest pain. Out of 25 patients, 18 (72%) had chest pain as presenting symptom and 7 (28%) patients had associated chest pain. All 25 patients had cervical radiculopathy with or without nerve compression. Nerve root involved were C4 in 4 patients, C5 in 16 patients, C6 in 22 patients, and C7 in 8 patients, commonly involved were C5 and C6 with C4-C5 and C5-C6 prolapsed intervertebral disc. Thirteen patients (52%) were treated with pharmacotherapy and physiotherapy; seven (28%) patients had 2–3 sessions of IMS with pharmacotherapy. Five patients (20%) had undergone cervical epidural adhesiolysis, where conservative management failed. Conclusions: Even though cervical angina is an underdiagnosed disease, pain physicians and spine surgeons should be familiar with it for diagnosis and treatment. Cervical angina is associated with broad range of cervical spinal pathologies; the most common is cervical disc herniation. It can be easily diagnosed with high level of suspicion and treated with pharmacotherapy, IMS, and cervical epidural adhesiolysis.

Anterior transvertebral endoscopic treatment of calcified cervical disc herniation.

Anterior transvertebral endoscopic treatment of calcified cervical disc herniation.

CT-Guided Radiofrequency Ablation Targeting the Herniation Edge of the Cervical Disc for the Treatment of Neck Pain: A Retrospective Study.

Sinuvertebral nerve overactivation is one of the mechanisms of neck pain caused by cervical disc herniation. Radiofrequency ablation (RFA) of sinuvertebral nerves has shown efficacy for the treatment of discogenic low back pain. However, relatively few studies evaluated the efficacy of RFA of sinuvertebral nerves for the treatment of chronic neck pain caused by cervical disc herniation. Clinical data were retrospectively collected from 168 patients diagnosed with cervical disc herniated neck pain from January 1, 2019, to September 1, 2022, who were treated with computed tomography (CT)-guided cervical disc RFA of at the Pain Medicine Center of Zhejiang Provincial People's Hospital. A 22-G RFA needle (Inomed, Emmendingen, Germany) was inserted between the carotid artery and trachea to the intervertebral disc under the direction of CT the scanner. Depending on the position of the protruding nucleus pulposus or the rupture of the annulus fibrosus, the needle was inserted into the posterior side of the intervertebral disc until the tip of the needle reached the target position. The numeric rating scale (NRS) score, pain relief and appearance of complications after RFA were evaluated. A total of 168 patients underwent CT-guided RFA for cervical disc herniation. The average duration of pain was 67.07 ± 70.42months. At 6months of follow-up, the median preoperative NRS score decreased significantly from preoperative 5.41 ± 1.08 to postoperative 1.341 ± 1.25 at 1month, 1.4 ± 1.38 at 3months and 1.72 ± 1.41 at 6months after RFA (p < 0.01). The numbers of patients with ≥ 50% of their neck pain relieved were 84% (141/168), 87% (147/168), 87% (147/168) and 79% (133/168) at 1day, 1month, 3months and 6months after RFA, respectively. No serious complications related to treatment or long-term complications were observed. This study highlights that CT-guided RFA targeting the edge of cervical disc herniation to destroy the sinuvertebral nerves can effectively relieve neck pain, and the computed tomography (CT)-guided RFA treatment strategy has the advantages of having few complications.

Reliability of ultrasonography to measure cervical multifidus, semispinalis cervicis and longus colli muscles dimensions in patients with unilateral cervical disc herniation: An observational cross-sectional test-retest study

BackgroundUltrasonography (US) has been suggested to assess the morphology and function of cervical muscles; but little is known about the reliability of the US measures in patients with cervical disc herniation (CDH). The purpose of this study was to evaluate within-day inter and intra-rater and between-day intra-rater reliability of US to measure dimensions of deep cervical muscles in patients with unilateral CDH. MethodsThirty patients with unilateral CDH participated. Anterior-posterior and lateral dimension of longus colli (LC), multifidus (MF) and semispinalis cervicis (SC) were measured using B-mode ultrasound. The measurements were repeated by rater A 1 h (for within-day reliability) and one week (for between-day reliability) later. For inter-rater reliability, rater B performed all muscles measurements like rater A. ResultsWithin-day reliability measurement for all muscles was good to excellent with IntraClass Correlation Coefficients (ICC) ranging from 0.82 to 0.96, standard error of measurement (SEM) from 0.18 to 0.46 and minimal detectable changes (MDC) from 0.43 to 1.09. Between-day reliability was good for all muscle dimensions with ICC ranging from 0.75 to 0.89, SEM from 0.30 to 0.64 and MDC from 0.71 to 1.52. Inter-rater reliability was also good with ICC ranging from 0.75 to 0.89, SEM from 0.34 to 0.65 and MDC from 0.81 to 1.55. ConclusionsUS was demonstrated to have high within-day inter and intra-rater and between-day intra-rater reliability to measure muscles dimensions in patients with unilateral CDH. It can be used to assess deep cervical muscles or to monitor the effects of interventions.

Association of selected inflammatory markers and risk factors with pain in patients undergoing cervical or lumbar disc herniation

Introduction&#x0D; Studies have suggested that radicular pain following disc herniation may be associated with local or systemic inflammatory responses produced in the vicinity of the herniated disc rather than compression of the nerve. Present study assessed the association of serum interleukin-6 (IL-6) levels, high-sensitivity C-reactive protein (hs-CRP) and related risk factors in patients undergoing discectomy following cervical disc herniation (CDH) or lumbar disc herniation (LDH).&#x0D; Methods&#x0D; Study recruited 77 patients undergoing discectomy for LDH and CDH. An interviewer administered questionnaire was used to obtain sociodemographic, behavioral and occupational data. IL-6 and hs-CRP levels were measured in each individual. IL-6 was analyzed by ELISA method and hs-CRP was determined using auto analyzer. Results were analyzed by using SPSS version 25.0.&#x0D; &#x0D; Results&#x0D; Significant correlation was not found with serum IL-6 and hs-CRP levels (r=0.02, p˃0.05) for acute and chronic CDH and LDH. Patients with chronic neck or back pain showed significantly (p=0.043) higher IL-6 level compared to patients with acute neck or back pain. Serum hs-CRP level was significantly higher (p=0.048) in patients with acute neck or back pain compared to patients with chronic neck or back pain. Significant association was not observed between; level of physically demanding nature of occupation (p=0.542), duration of occupation (p=0.446), type of exercise (p=0.371), type of sports (p=0.339) and CDH or LDH.&#x0D; Conclusion&#x0D; Though significant correlation was not observed between inflammatory markers IL-6, hs-CRP and CDH or LDH. The mean IL-6 was higher in chronic back pain and neck pain patients with LDH and CDH whereas mean hs-CRP mean was higher in acute back pain and neck pain patients. Significant association was not reported between selected known risk factors (behavioral, occupational) and CDH or LDH.

Effectiveness of a Nonoperative Tailored Treatment and Return to Sport of a Rugby Union Player After a Cervical Spine Disc Herniation: A Case Report

BACKGROUND: This case report aims to illustrate the nonoperative rehabilitation of a rugby union player following a cervical spine disc herniation with neck pain and radicular pain. CASE PRESENTATION: A 23-year-old male rugby player presented with neck pain and radicular pain and was evaluated using clinical and neck-motor control assessments, self-report questionnaires, neck-strength, and magnetic resonance imaging. OUTCOME AND FOLLOW-UP: A well-structured rehabilitation program was followed to ensure early recovery and optimal functional outcome. The player was able to participate in full rugby training sessions without limitation. He returned to his previous level of performance, playing in the first team. DISCUSSION: This is the first case report of a rugby union player with an isolated disc herniation managed with nonoperative treatment. The treatment objectives, interventions, and assessments are provided in detail. JOSPT Cases 2023;3(4):260-266. Epub 25 September 2023. doi:10.2519/josptcases.2023.11886

Degenerative Cervical Disc Herniation: Prevalence of Affected Cervical Level in a Hispanic Population in Puerto Rico

BackgroundIn the literature, degenerative cervical disc herniation is considered to occur more frequently at the C5-C6 and C6-C7 levels. This study aimed to evaluate the operated cervical level prevalence among patients with degenerative cervical disc herniation in a Hispanic Puerto Rico population. MethodsThe University of Puerto Rico Neurosurgery database was used to identify patients who underwent anterior cervical discectomy for degenerative cervical disc herniation during a 15-year period from January 1, 2006 until December 31, 2020. Operated cervical levels for each patient were analyzed. ResultsDuring the study period, 409 patients were operated on for degenerative cervical disc herniation. Two hundred-eight patients (50.8%) had disc herniations at more than one cervical level for 663 treated levels. The most prevalent cervical levels in this Hispanic population were C5-C6 (34.8%) and C4-C5 (28.1%). The C6-C7 level was involved in 18.9% of the operated levels, and the C3-C4 level in 17.3%. The C7-T1 level was involved in only 0.6% of the operated levels, and the C2-3 level in 0.3%. The cohort included 51.3% of men and 48.7% of women, with a men-to-women ratio of 1.05:1. The median age of females was 56.5 (range 26 - 82) and 59.0 (range 31 - 85) for males. Operated cervical discs were most common between the ages of 48 and 66 years for either sex. ConclusionIn a Hispanic Puerto Rico population, the most prevalent operated degenerative cervical disc levels were C5-C6 and C4-C5.

Non-Traumatic Cervical Disc Herniation Presented as Sudden Paralysis of the Limbs: Two Case Reports

We report two uncommon cases of non-traumatic, acute cervical disc herniation presented with sudden paralysis of the limbs. First, a 61-year-old man presented with sudden quadriplegia while resting on the bed 2 hr ago. He had motor weakness of grade 3 in the upper arms and grade 0 in the lower legs. Magnetic resonance imaging (MRI) of the cervical spine showed severe spinal cord compression caused by huge soft central disc herniation at the C6-7 level. After surgery, the paralysis of the upper arms improved, but the paralysis of the lower legs and sphincter functions did not improve. Second, a 65-year-old woman presented with acute right hemiparesis just after waking up in the morning 3 hr ago. She had motor weakness of grade 3 of the right upper arm and grade 2 of the right lower leg. MRI of the cervical spine showed severe cord compression by the right-sided, superiorly migrated soft disc herniation at the C6-7 level. After surgery, she recovered completely and could walk independently.