Cervical Disc Herniation Research Articles

Evaluation of Depression, Anxiety and Sleep Quality Scores in Patients with Cervical Disc Herniation: A Study Conducted in Turkey

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.

Full Endoscopic Posterior Cervical Laminoforaminotomy and Discectomy: A Technical Note

Cervical disc herniations affects different age groups especially the young population with habits of a sedentary lifestyle, long working hours over the computer, and poor neck postures who present with acute disc herniations. Cervical radiculopathy commonly presents with pain, paresthesia and motor weakness. Traditional surgical options available are anterior Cervical Discectomy and Fusion (ACDF) and Posterior Cervical Foraminotomy (PCF). However both the procedures have some disadvantages. With evolution of endoscopy in recent times provide better opportunity. Here we mention Full Endoscopic posterior cervical laminoforaminotomy and discectomy technique. It is the most advanced technique for single-level lateral and foraminal disc prolapses causing monoradiculopathy, we found this procedure is safe and effective minimally invasive technique for lateral soft herniations and foraminal stenosis. It has lesser complications and better post-op recovery.

Prospective Study of Percutaneous Ozone Treatment of Cervicobrachial Neuralgia (CBN) Due To Disc Herniation

Introduction: In case of conservative treatment failure in cervical disc herniation, many surgical procedures are offered. Percutaneous surgery seems to have the best benefits. Ozone discolysis is one of the emerging treatments. However, no standardized procedure for this discolysis is yet available. The purpose of this work was to describe our procedure that we have been practicing since 2016 and to assess its results. Methods: From July 2016 to June 2021, we conducted a prospective study in the neurosurgery department of Yalgado Ouedraogo. All consenting patients with cervical disc herniation and conservative treatment failure who have benefited ozone discolysis were included. These patients were reassessed (VAS and neurological examination) at one week, two weeks, one month, three months. Results: Thirty-four cases were retained, representing 39.5% of cervical disc herniation surgeries. Main indications were disabling cervicobrachial neuralgia (CBN) (88.2%) and hyperalgesia CBN (8.8%). Discolysis concerned 1 (52.9%); 2 (29.4%) and 3 (17.6%) levels. At 1 week, 2 weeks, 1 month and 3 months after discolysis were respectively noted 61.8%; 85.3%; 85.3% and 91.2% asymptomatic patients. Pending conventional surgery, discolysis was performed in 1 case (2.9%) of left C5 root plegia resulting in total recovery. No complications were noted. No complications were noted. Conclusion: Cervical discolysis with ozone had very satisfactory results with certain benefits for the patient and his surgeon. It was a good alternative to surgery in our country where the neurosurgeon is the first and only resort in case of cervical disc herniation with failure of conservative treatment.

Anterior Endoscopic Cervical Discectomy: Surgical Technique and Literature Review.

The conventional surgical technique for radiculopathy with cervical disc herniation (CDH) is anterior cervical discectomy and fusion, with a good clinical outcome and fusion rate. However, significant perioperative morbidity related to extensive surgical exposure has been reported. Therefore, anterior endoscopic cervical discectomy (AECD) using a working channel endoscope has been developed to reduce surgical complications and tissue damage. The objective of this study was to describe a cutting-edge technique for AECD of soft CDH. The primary indication is cervical radiculopathy with or without axial neck pain due to soft CDH. The surgical procedure consists of 2 parts: (1) a safe anterior percutaneous approach under fluoroscopic control and (2) selective endoscopic discectomy and foraminal decompression using specialized mechanical tools under endoscopic visualization. The clinical outcomes are comparable to those of conventional surgery and show the benefits of minimally invasive spine procedure. Perioperative data revealed typical minimalism, including reduced muscle damage, blood loss, operative time, and recovery time. With technical advancements in surgical instruments and optics, AECD will become more practical and safer. AECD is effective in selected CDH cases with cervical radiculopathy. However, high-quality clinical studies are needed to verify the effectiveness of this endoscopic cervical spinal procedure.

Biportal Endoscopic Posterior Cervical Foraminotomy for Adjacent 2-Level Foraminal Lesions Using a Single Approach (Sliding Technique).

Endoscopic posterior cervical foraminotomy (PCF) using uniportal or biportal endoscopic approach has been performed for cervical foraminal stenosis or foraminal disc herniation. Two-level PCF is possible using a single biportal endoscopic approach. The purpose of this study was to present a technique of biportal endoscopic PCF for contiguous 2-level foraminal lesions using a single approach and its clinical results. Patients who received 2-level PCF using a single biportal endoscopic approach were enrolled in this study. We analyzed their clinical data including age, sex, complications, and Neck Disability Index (NDI), and visual analogue scale (VAS) of neck and arm. Postoperative magnetic resonance image was taken on the first postoperative day to determine whether there was sufficient decompression. We successfully performed biportal endoscopic PCF for adjacent 2-level foraminal lesions using a single approach (sliding technique) in all 12 patients. There were cervical foraminal disc herniation with foraminal stenosis (5 cases) and 2-level foraminal stenosis (7 cases). Preoperative mean NDI and VAS of arm and neck significantly decreased at 12 months after surgery. Postoperative clinical outcomes were excellent in 5 patients, good in 6 patients, and fair in 1 patient. There was no major complication. Two-level PCF could be performed using a single approach biportal endoscopic surgery with only 2 skin incisions. Clinical outcomes are favorable. This sliding PCF technique using biportal endoscopic approach might be an alternative surgical treatment for contiguous 2-level cervical foraminal pathologic lesions.

Frekans Alanı Öznitelik Çıkarımına Dayalı Makine Öğrenme Teknikleri ile Trapezius Yüzey EMG Sinyallerini Kullanarak Servikal Disk Fıtığı Hastalığının Tahmini

Cervical disk herniation (CDH) is a disease that affects the quality of life of many people due to the neck pain it causes. The aim of this study was to develop an automatic prediction system to aid in diagnosis by evaluating the change in the surface electrical activity of the trapezius muscle in SDH disease in order to find an answer to the question: 'Can the surface electromyogram (sEMG) recorded from the trapezius muscle be an effective indicator for the diagnosis of SDH disease?'. To this end, a dataset will be created using preprocessing and feature extraction methods from sEMG signals from CDH patients and healthy individuals. In the first step, the Savitsky-Golay filter is used to denoise the sEMG signals and the dominant frequency signals between 20 and 150 Hz are included in the study using the Butterworth filter design. Twenty PSD-based features in the frequency domain were then obtained from the signals to which we applied the Burg method. Eleven of the most significant features based on the information gain, gain ratio, and Gini values are selected to be submitted to the classifiers. 80% of all new feature areas are used for classification and the rest for prediction. The best classification accuracy of 91.6% was obtained with the Tree classifier using 10-fold cross-validation for classification. In addition, neural networks and CN2 rule inducer provided 87.5% classification accuracy for prediction using 20% of the remaining data that the classifiers had not seen before. The experimental results demonstrate that the trapezius muscle has different surface electrical activity in CDH patients and healthy subjects and that the frequency domain characteristics of this activity are important for disease prediction.

Epidemiological characteristics of 1,806 patients with traumatic spinal cord injury: A retrospective study.

Traumatic spinal cord injury (TSCI) is a type of highly disabling central nervous system trauma. In this study, we investigated the epidemiological characteristics of 1,806 TSCI patients and compared the characteristics of patients with traumatic cervical spinal cord injury (TCSCI) caused by cervical fracture/dislocation and disc herniation/bulging. We retrospectively reviewed the hospital records of 1,806 TSCI patients. The detailed information included gender, marital status, occupation, age, neurological level of injury, etiology, American Spinal Injury Association (ASIA) grade, combined injuries, complications, treatment, the interval between admission and surgery, intubation/tracheostomy requirement, and the length of hospital stay. Cervical spinal cord injury (CSCI) was the most common injury. Compared to non-CSCI cases, patients with TCSCI were older, and more likely to suffer from tetraplegia and require intubation/tracheostomy, but had fewer other injuries or complications and a shorter length of hospital stay. Compared to patients with cervical fracture/dislocation, those with TCSCI caused by disc herniation/bulging were older and more likely to suffer from paraplegia, but required intubation/tracheostomy less frequently, exhibited fewer other injuries and complications, and required shorter hospitalization. Men, married individuals, manual laborers, and individuals aged 31-75 years had the highest risk of TSCI. Patients with TCSCI tended to have a shorter length of hospital stay than patients with non-CSCI. More attention should be paid to the other injuries and complications of non-CSCI patients, which may increase the length of hospital stay and delay rehabilitation. Compared to patients with cervical disc herniation, the patients with fracture/dislocation tended to be younger, but prognosis was severely compromised by tetraplegia, a greater need for intubation/tracheostomy, additional injuries, and complications.

Comparison of Clinical Effectiveness between the Management of Cervical and Lumbar Disc Herniation with Percutaneous Laser Disc Decompression Followed by Interlaminar Cervical Epidural and Lumbar Transforaminal Epidural Steroid Injection Respectively

Background: Different treatments for discogenic axial back/neck pain or radicular pain to limbs are there from conservative therapies and minimally invasive therapies to open spine surgeries with lots of controversial outcomes. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive therapies which is done under local anesthesia and has been successfully performed in many selected patients for their lumbar and cervical disc herniation problems. In PLDD, a part of the nucleus pulposus is vaporized with the help of laser energy to reduce the intradiscal pressure of the diseased discs causing nerve compression. In this case series after a 1-year follow-up, the clinical effectiveness of PLDD with epidural steroid injection is assessed in selected lumbar and cervical disc herniation cases. Materials and Methods: Ninety-six patients underwent the PLDD procedure at the cervical and lumbar disc with epidural steroid injections for their disc herniation causing radicular pain in the upper and lower limbs, respectively. The patients were followed at 8 weeks, 3 months, 6 months, and 1 year. The main outcome measures were done through the visual analog scores (VASs) and the Oswestry Disability Index (ODI) for upper and lower limb pain. Results: The primary outcome showed that there is a significant clinically relevant difference between the two groups at a 1-year follow-up. VAS and mean disability score based on the ODI were significantly lower in cervical disc herniation patients. The reoperation rate in the cervical group is also much less than the lumbar group. Conclusion: Like all other surgical modalities for disc herniation, PLDD has its own advantages and disadvantages. However, compared to lumbar disc herniation, it may give better results in cervical disc herniation. In selected cases, combined PLDD with epidural steroid injection can be chosen as a “first-choice-minimally-invasive-treatment,” when standard conservative therapies do not give satisfactory outcome.

Ayurvedic management of quadriparesis (Sarvanga roga) due to cervical disc herniation

Cervical disc herniation is most common after lumbar disc herniation. Nerve impingement due to cervical disc herniation causes symptoms that correlate with Sarvanga roga (~quadriparesis). The present case is of a 44-year-old male who reported neck pain, stiffness, and reduced power in bilateral upper and lower limbs, due to which he was unable to walk on his own and unable to perform daily living activities. Ayurveda holds bountiful resources for the management of Vata (~Dosha responsible for movement and cognition) disorders. This patient was treated with oral medicines along with Panchakarma therapy on the line of treatment of Vatavyadhi (~disorders due to Vata). The result was assessed using the Modified Ashworth scale for muscle tone, Medical Research Council scale for muscle power, National Institute for Neurological Disorders and Stroke grading for deep tendon reflex, and Katz Index of Independence in Activities of Daily Living. The result obtained after 45 days of treatment helped the patient to walk and perform activities of daily living independently. Treatment provided relief by reducing pain, stiffness, and cervical cord edema and providing strength to local muscles, bones, tendons, and ligaments. This case provided positive hope for serious cases like this, where patients are left with the only option of surgery.

Correlation Between Cervical Spine Sagittal Alignment and Clinical Outcome After Standalone Intersomatic Titanium Cage CeSPACE for Cervical Anterior Discectomy and Fusion in Cervical Degenerative Disk Diseases.

The aim of this study was to determine the relationship between cervical spine sagittal alignment and clinical outcomes after using a standalone intersomatic titanium cage CeSPACE for anterior cervical discectomy and arthrodesis. We present our clinical experience in a group of 180 patients with a mean follow-up for at least 2 years. Patients were evaluated by clinical and radiological assessment preoperatively, immediately after surgery and at regular follow-up. There were 97 male and 83 female patients (average age: 56.6 years) who were preoperatively affected by cervical radiculomyelopathy that was due to spondylosis or cervical disk herniation and who underwent surgical treatment. All patients underwent an anterior discectomy and interbody fusion through the positioning of one or more levels of the CeSPACE device. Compared with the preoperative scores, improvement was seen in postoperative visual analog scale (VAS) scores and Neck Disability Index (NDI) values. The standalone intersomatic titanium cage CeSPACE for anterior cervical discectomy and arthrodesis improved radiculomyelopathy and increased the probability of cervical kyphotic alignment. However, cervical sagittal alignment after surgery was not significantly associated with clinical outcomes in terms of postoperative improvement in VAS scores and NDI values. Similarly, the change in cervical sagittal alignment was not related to visual analog scale scores or Neck Disability Index values.

Traumatic Cervical Disc Herniation Manifesting as Brown-Sequard Syndrome: A Case Report

Brown-Sequard syndrome (BSS) is an uncommon condition caused by a localized injury to one side of the spinal cord. It is rarely reported to present because of cervical disc herniation (CDH), especially as a result of 2 consecutive discs prolapse, with only 8 cases reported worldwide, 4 of which have the cervical disc levels of C5-C6, C6-C7 being affected just like the case we are presenting. A 45 years male had complained of left-sided body pain and numbness following a fall, his symptoms progressing over two weeks to left side hemiparesis and impaired sensation; MRI of C spine revealed C5-C6, C6- C7 disc prolapse with cord compression resulting in BSS. The patient was treated surgically by anterior cervical discectomy and fusion (ACDF) followed by physiotherapy. The patient showed complete recovery in terms of sensory and motor deficits in both the right and left upper and lower limbs. We are stressing the role of detailed history, comprehensive neurological examination, and proper imaging in the early diagnosis of BSS. Treatment with anterior surgical intervention is the recommended approach in most reported cases and is associated with an excellent prognosis.

Spontaneous cervical intradural disc herniation with cerebrospinal fluid leak

Spontaneous cervical intradural disc herniation with cerebrospinal fluid leak

Association of Cervical Spine Magnetic Resonance Imaging Abnormalities with Chronic Neck Pain in Southern Nigeria.

This study was done to evaluate the relationship between cervical spine magnetic resonance imaging (MRI) findings and clinical features in adults with chronic neck pain (NP) at our tertiary hospital. This was a prospective cross-sectional study of the cervical spine MRI of 90 adult patients with chronic NP. The clinical history, biodata, and cervical spine MRI findings were analysed. Statistical tests were considered significant at P ≤ 0.05. The mean age of the participants was 54.72 (13.51) years (range = 28-79 years). There were 52 (58%) males and 38 (42%) females. Cervical disc desiccation and disc herniation were the most prevalent MRI findings. C4/C5 and C5/C6 disc levels were most commonly affected. Disc height reduction correlated with shoulder pain (r = 0.23, P = 0.030), unsteady gait (r = 0.27, P = 0.010), and lower limb weakness (r = 0.23, P = 0.029). Vertebral collapse correlated with shoulder pain (r = 0.22, P = 0.036), upper limbs burning sensation (r = 0.33, P = 0.001), and loss of dexterity (r = 0.22, P = 0.037). Spondylolisthesis correlated significantly with unsteady gait (r = 0.34, P = 0.001), dizziness/vertigo (r = 0.29, P = 0.005), painful neck movement (r = 0.32, P = 0.002), loss of dexterity (r = 0.37, P < 0.001) and sphincteric dysfunction (r = 0.23, P = 0.031). Modic changes correlated with loss of dexterity (r = 0.39, P < 0.001) and upper limbs burning sensation (r = 0.21, P = 0.048). Cervical canal stenosis did not correlate significantly with any symptom. Cervical disc disease (C4/C5 and C5/C6 levels) was the most prevalent finding on MRI. Disc height reduction, vertebral collapse, spondylolisthesis, and Modic changes correlated with various clinical symptoms.

Hybrid Implants in Anterior Cervical Spine Surgery: The State of the Art and New Trends for Multilevel Degenerative Disc Disease.

Anterior cervical discectomy and fusion (ACDF) still represents the first surgical option in the treatment of cervical degenerative disc disease (DDD) but is still burdened by several complications secondary to the loss of mobility at the treated segment and adjacent segment diseases (ASDs). To overcome those complications, hybrid surgery (HS) incorporating ACDF and cervical disc arthroplasty (CDA) is increasingly performed for DDD. We retrospectively reviewed the clinical, surgical, and outcome data of 85 consecutive patients (M/F, 41/44) harboring cervical disc herniation with or without osteophytes, with radiculopathy and with or without myelopathy, who underwent the anterior approach to a cervical discectomy on two or more levels with at least one disc prosthesis, along with a cage and plate or an O Profile screwed plate. All the patients improved regardless of the cervical construct used. No significant relationship between different kinds of prosthesis and their surgical level; the number of cages; and the site of the cages (screwed and/or plated) was found concerning immediate stability, dynamic prosthesis effectiveness, and clinical improvement in all the patients up to the maximum follow-up time. Although the optimal surgical technique for cervical DDD remains controversial, HS represents a safe and effective procedure in select patients with multilevel cervical DDD, as demonstrated by biomechanical and clinical studies and the present series.

The effect of cage type on local and total cervical lordosis restoration and global spine alignment in single-level anterior cervical discectomy and fusion based on EOS® imaging: A comparison between standalone conventional interbody polyether ether ketone cage and integrated cage and plate (Perfect-C®).

There is a small level of evidence regarding the alterations in global spine alignment following the restoration of cervical lordosis using anterior cervical discectomy and fusion (ACDF). Different cage types are available to restore cervical lordosis through ACDF. In this study, we evaluate the impact of two types of these cages on local and global spine alignments. Thirty-two patients with a mean age of 46 ± 10 who underwent ACDF for cervical disc herniation were included in this retrospective study. Patients were divided according to their cage type into two groups, 17 patients with standalone conventional polyether ether ketone cages and 15 patients with integrated cage and plate (ICP) (Perfect-C®). Cervical alignment and global spine alignment were evaluated on the pre- and post-operative EOS® images. Three months after the ACDF, total cervical lordosis correction was higher in patients with ICP (P = 0.001), while the local cervical lordosis correction was not significantly different between conventional cages and prefect-C cages (P = 0.067). Lumbar lordosis and pelvic tilt change were significantly higher among patients with Perfect-c cages (P = 0.043). In patients undergoing ACDF, alignment of the global spine changes along with the restoration of the cervical spine. Cage type affects this association, mainly through the compensatory alteration of pelvic tilt.

Ozonucleolysis in cervical radiculopathy – Pakistan experience.

BACKGROUND AND PURPOSE&#x0D; Direct injection of Oxygen-Ozone in the cervical discs has proved to be the effective alternative to surgery in patients with cervical disc herniation in many countries around the world. We report our experience with ozonucleolysis with patients effected by pain incervical region (brachialgia)due to disc herniation including post-operative recurrence or disc prolapse.&#x0D; &#x0D; METHODS&#x0D; 6000 patients were treated with single session of Oxygen-Ozone therapy from 2005-2020. All the patients had CT or MRI evidence of cervical disc prolapse with clinical signs of cervical nerve root compression. The procedure was performed under angiofluoroscopy using 22/23 G spinal needle without anesthesia. All the patients received intradiscal injection n of Oxygen-Ozone mixture at Ozone concentration of 30 µgm/ml. Among these patients 4500 were males and 1500 were females between the ages of 20-70 years. Therapeutic outcome was assessed 8 week after treatment by using modified MacNab method.&#x0D; &#x0D; RESULTS&#x0D; A satisfactory therapeutic outcome was obtained. 60% of the patients showed complete recovery with resolution of symptoms. 20% of the patients complained of occasional episodic neck pain and arms pain with no limitation of occupational activity. 5% of cases showed some improvement. 5% of cases had insufficient or noimprovement and went for surgery. 10% of cases never turned up after the first visit.&#x0D; &#x0D; CONCLUSION&#x0D; Intradiscal injection of Ozone for herniated cervical disc has revolutionized percutaneous approach to nerve root diseases making it safer, cheaper and easier to repeat than treatments currently in use.

Radiological and Clinical Follow-up of Alpha-D Cervical Disk Prosthesis.

Fusion surgery is applied to prevent segmental instability after surgery for cervical disk herniation. Motion-sparing surgeries have been developed to prevent adjacent segment disease after fusion surgery. Total disk replacement, one of these methods, has been applied in the cervical region for more than 20years. We aimed to investigate the medium-term radiological and clinical outcomes of patients who had received Alpha-D disk prosthesis after cervical disk surgery, in terms of incidence of heterotopic ossification (HO) and other complications. We included 33 patients (17 women and 16 men) diagnosed with single-level cervical disk herniation and who had received prosthesis after anterior discectomy. The average follow-up period was 36 (18-78) months. The patients were followed up postoperatively at month 4, year 1, and annually thereafter. Patients, who had Alpha-D cervical disk prosthesis (CDP) (Medikon, Turkey), were monitored via radiological (standard and dynamic X-ray) and clinical (visual analog scale [VAS] and neck disability index [NDI]) modalities. Dynamic X-ray images were evaluated by an independent radiologist for HO and prosthesis movement. Mean patient age was 40 ± 6.88years. HO was observed in 7 (21.21%) patients, 6 of which were men. Significant intersex differences were noted for HO and movement rates (p = 0.039). Clinically, the mean preoperative and post-operative NDI levels were 35.4 ± 3.9 and 4 ± 2, respectively, whereas the mean pre- and post-operative VAS levels were 7 ± 1 and 1 ± 1, respectively. There was a clinically significant postoperative improvement in all the patients. However, there was no significant difference between the patients with and without HO in terms of age, operation level, and mean pre- and postoperative VAS, and postoperative NDI levels (p > 0.05). Despite the fact that there was a significant difference (p = 0.038) in favor of patients without HO in terms of mean preoperative NDI levels, this was not considered clinically significant. In the present study, all the patients demonstrated clinically significant improvement following CDP surgery. HO rate after CDP surgery was 21.21% in the medium term, and movement was preserved in 5 of the 7 patients with partial HO. The fact that the CDP design was based on the one-to-one reproduction of the movement segment in the cervical spine, might account for the underlying cause of success. However, these good results in the medium term may change in cases with long-term clinical follow-up.

Effect of acupuncture on the energy metabolism of dogs with intervertebral disk disease and cervical disk herniation: A pilot study

Thirteen dogs with intervertebral disk disease (IVDD) and 3 dogs with cervical disk herniation (CVDH) were examined to determine the effects of acupuncture on energy metabolism. Acupuncture points GV14, GV20-1, BL18, BL23, BL26, GB30, and ST36 were selected for IVDD, while GV14, GV20-1, GB20, and BL23 were selected for CVDH. All dogs except no.13 did not receive medication during acupuncture treatment. Acupuncture effects were evaluated based on the IVDD/CVDH evaluation scales in Oji 2015 and Tanaka and Nakayama 2015. Blood samples were taken before and 30 min after acupuncture treatment. Pyruvate and lactate concentrations, lactate dehydrogenase (LDH) and malate dehydrogenase (MDH) activity, the MDH/LDH ratio (M/L ratio), and LDH isozyme electrophoretic patterns served as energy metabolism markers. In IVDD/CVDH dogs that showed improvements, plasma pyruvate concentrations significantly decreased, the M/L ratio increased, and the plasma LDH isozyme pattern changed from predominantly LDH5 to predominantly LDH1. These data suggest that local redox potential is improved and energy metabolism is increased in dogs with IVDD/CVDH after acupuncture treatment. Acupuncture treatments may activate the citric acid cycle and increase ATP production, followed by improvement of the disease. Future studies with a large sample size are needed to clarify this hypothesis.

Clinical Approach to Diagnosing and Treatment of Neck Pain

Background: Neck pain is one of the most common reasons patients seek treatment in the hospital. The causes of neck pain vary widely, trigger misdiagnosis, and often result in mistreatment. Misdiagnoses and mistreatment-related neck pain diagnoses are often associated with a diagnosis of cervical herniated disc. The implication of the misdiagnosis is the use of excessive investigations and inappropriate therapy. This review aims to determine the causes of neck pain often obtained in daily practice and how to diagnose and treat it. Method: Search relevant articles on clinical diagnosis of neck pain with the keywords neck pain diagnostic therapy using Medline and PubMed databases. Results: Neck pain can be in the form of axial pain, which is mostly related to disorders of the joints and muscles of the neck, or in the form of pain in the roots and spinal cord. Investigations and therapy must be related to the clinical diagnosis of neck pain experienced by patients with a history of neck pain. Conclusion: Neck pain is one of the most common complaints encountered in outpatient department settings, associated with reduced quality of life. Patients may come with differing degrees of pain, various symptoms, and aetiologies making it quite challenging to treat them into complete remission. Despite being frequently encountered, some patients with neck pain are underdiagnosed and undertreated due to failure to understand the clinical symptoms before deciding possible aetiologies.

Analysis of the clinical and radiological outcomes of percutaneous cervical nucleoplasty: A case-control study.

Percutaneous cervical nucleoplasty (PCN) is a simple, safe, and effective treatment for contained cervical herniated intervertebral disc (CHIVD). However, few studies have compared the actual benefits of PCN against conservative treatment (CT), either clinically or radiographically. The present study sought to analyze and to compare the outcomes of symptomatic contained CHIVD treated with PCN or CT. The present study was designed as a case-control comparative study. Patients who indicated for PCN after a failed CT for more than 6 months were recruited. After the exclusion of some patients who did not meet the selection criteria of the study, we finally enrolled 71 patients treated with PCN. In addition, another 21 patients who indicated for PCN but finally chose to receive CT continuously were also enrolled and categorized as the control group. All patients completed the 6-month follow-up. Pain levels and functional outcomes were evaluated pre- and post-operatively by assessing the visual analog scale (VAS), Oswestry Disability Index (ODI), and Neck Disability Index (NDI). Radiographic images of 72 of 104 intervened segments were collected to measure disc height and other cervical spinal alignments, such as range of motion, C2-7 Cobb's angle, and C2-7 sagittal vertical axis. Compared with the CT group, the PCN group showed significantly better outcomes on VAS, ODI, and NDI at the 1-month post-operative follow-up, which continued through at least the 6-month follow-up (P < 0.01 for VAS and P < 0.05 for ODI and NDI). The mean disc height significantly decreased, from 6.04 ± 0.85 mm to 5.76 ± 1.02 mm, 3 months after PCN treatment (P = 0.003). However, the degree of disc height decrease did not correlate with the changes of the substantial VAS improvement. To provide therapeutic benefits for symptomatic contained CHIVD patients after an invalid CT for 6 months, PCN seems to be a better option than CT. The reduced disc heights did not alter the clinical outcomes of PCN.