Background Cervical disc herniation with radiculopathy is a common cause of neck and arm pain. While anterior cervical discectomy and fusion (ACDF) remains the standard treatment, it sacrifices motion and may cause adjacent segment degeneration. Uniportal non-coaxial spinal endoscopic surgery (UNSES) offers a motion-preserving alternative. This case presents the first application of UNSES with endoscopic annular suture repair and ligamentum flavum suspension in the cervical spine, demonstrating its technical feasibility. Case presentation A 54-year-old male presented with progressive neck and right right arm pain, numbness and triceps weakness, due to right paracentral C6/C7 disc herniation compressing the C7 nerve root. The patient underwent full-endoscopic posterior cervical discectomy using a uniportal non-coaxial endoscopic system, with ligamentum flavum preservation via suture suspension. The annular defect was repaired intraoperatively using an endoscopic annular suture device under direct visualization. Postoperative imaging confirmed complete neural decompression and successful annular closure without residual disc or dural compromise. Postoperative MRI confirmed complete decompression and annular closure. At 3 months, visual analog scale (VAS) improved from 7 to 1, the Japanese Orthopaedic Association (JOA) score increased from 13 to 16, and the Neck Disability Index (NDI) decreased from 42% to 14%, with no recurrence or instability. Conclusions UNSES combined with annular suture repair enables safe, motion-preserving decompression for cervical disc herniation. This novel approach may enhance biomechanical integrity, reduce recurrence, and represent a minimally invasive alternative to fusion in selected patients.

The "prone stretching and adjusting cervical manipulation", known for its therapeutic benefits in treating cervical spondylotic radiculopathy (CSR), has demonstrated notable clinical success. However, understanding its mechanism of action remains an underexplored area. This study aimed to elucidate the biomechanical impact of this technique on the cervical spine using three-dimensional finite element analysis. Leveraging detailed CT scan data from a healthy adult female, we constructed a comprehensive three-dimensional finite element model encompassing the seven cervical vertebrae and five intervertebral discs. The model was validated by comparing its predicted segmental range of motion with experimental data from the literature under flexion, extension, lateral bending, and axial rotation. We simulated the manipulation process on this model, applying relevant mechanical parameters, and measured the stresses and foraminal areas across the cervical vertebrae and discs before and after the simulated manipulation. Post-simulation analysis revealed a marked reduction in overall stress within the cervical spine's vertebral bodies, with the maximum stress dropping from 123.31MPa to 29.637MPa. Similarly, the intervertebral discs exhibited a substantial decrease in overall stress, plummeting from 36.859MPa to 8.4136MPa. Additionally, the intervertebral foramen area on the contralateral side to the manipulation expanded, with the most substantial increase reaching 0.75mm². These findings suggest that the"prone stretching and adjusting cervical manipulation"may biomechanically reduce stress on the vertebral bodies and intervertebral discs while expanding the intervertebral foraminal area, providing a biomechanical basis for the symptomatic relief in CSR. The study was approved by the Ethics Committee of Gannan Medical University, China (no.2019806). (Clinical trial number: not applicable).

Spontaneous vocalisation is a common reason for dogs to be presented to veterinary practices. However, the cause can be unclear, making prioritisation of investigations challenging. Although vocalisation has been associated with syringomyelia, and anecdotally with cervical disc disease, the most common causes are not reported. The medical records of dogs presented at a single institution with spontaneous vocalisation between 2016 and 2022 were retrospectively analysed. A total of 115 dogs were included. The most common breeds were crossbreeds (n = 23), Cavalier King Charles Spaniels (n = 10) and French Bulldogs (n = 9). Patients were most frequently referred to the neurology department (n = 93). Cervical myelopathy was most prevalent (n = 41), with a further 14 neurologically normal dogs with cervical hyperaesthesia. The most frequent diagnoses were intervertebral disc extrusion (n = 41), neoplasia (n = 9), intervertebral disc protrusion (n = 7), steroid-responsive meningitis arteritis (n = 7) and meningoencephalitis/myelitis of unknown origin (n = 6). This was a retrospective analysis of patients within a single institution identified using terms within patient records, relying on comprehensive recording of information by the clinician at the time of presentation. In this cohort, spontaneous vocalisation most frequently localised to the cervical spine, with intervertebral disc extrusion as the most common diagnosis. This information may aid in clinical decision making, especially when advanced imaging is unavailable.

Retrospective cohort study. To identify factors associated with heterotopic ossification (HO) formation following cervical disc arthroplasty (CDA), including postoperative non-steroidal anti-inflammatory drug (NSAID) use. CDA preserves segmental motion in treating cervical degenerative disc disease but is susceptible to HO formation, which may compromise surgical outcomes. While NSAID prophylaxis is well-established in total hip arthroplasty to reduce HO risk, its role in CDA remains underexplored. A retrospective review was conducted at a single academic center using a maintained surgical registry. Patients undergoing CDA with at least 1-2 years of radiographic follow-up were included. Demographic variables, BMI, implant type, operative levels, and NSAID use (any reason vs. specifically for HO prophylaxis) within 48 hours postoperatively were collected. Radiographs were graded for HO severity using the McAfee classification. Two logistic regression analyses assessed associations between variables and HO formation. Patient-reported outcome measures (PROMs) and rates of complications and reoperations were compared between HO-positive and HO-negative groups. Among 140 patients, 43.6% developed HO. HO presence was associated with higher age (P=0.025), higher BMI (P=0.002), and lower NSAID use both overall (P=0.018) and specifically for HO prophylaxis (P=0.005). Logistic regression confirmed that higher BMI was associated with increased HO risk, while postoperative NSAID use was associated with reduced risk. Clinical outcomes and PROMs improved significantly over time in both HO+ and HO- groups, with no significant differences in outcomes, complications, or reoperations. Following multivariate analysis, higher BMI is associated with increased risk of HO following CDA, while early postoperative NSAID use is associated with a lower incidence. Clinical outcomes were similar between HO presence and absence groups. These findings support the potential role of NSAID prophylaxis in reducing HO development and guiding postoperative management following CDA. 3.

Study DesignRetrospective Database Study.ObjectivesAnterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are common procedures performed for cervical spondylosis. Sparse data exists comparing the utilization and reimbursement rates associated with these procedures. This study seeks to compare Medicare utilization of single- and multilevel ACDF to CDA between 2011 and 2021. Additionally, this study evaluates Medicare reimbursement rate changes for ACDF with structural allograft, ACDF with cage, and CDA between the years 2016 and 2021.MethodsThis study used the publicly available Medicare National Summary Data Files to aggregate annual utilization and reimbursement rates for ACDF procedures as well as CDA procedures based on Current Procedural Terminology codes. Reimbursement rates were adjusted for inflation through use of the U.S. Bureau of Labor Statistics' 2021 Consumer Price Index. Changes in reimbursement rates and utilization were calculated and compared between procedures.ResultsIn 2011, 27974 single-level ACDF procedures were performed on Medicare Part B patients compared to 34683 performed in 2021. This represents a growth in procedure utilization of 24% over the study period. Over the course of the same study period CDA procedures grew by 1087.3%, from 118 in 2011 to 1401 in 2021. Throughout the reimbursement study period, Medicare reimbursements per case for single-level CDAs had an average annual percent change of 9.96%, rising from $1636 in 2016 to $2779 in 2021. Reimbursement per case for single-level ACDF with allograft had an average annual change of -1.25%, falling from $3408 in 2016 to $3206 in 2021. Medicare reimbursement per case for single-level ACDF with cage had an average annual change of 1.19%, from $3379 in 2017 to $3547 in 2021.ConclusionAll procedures saw an increase in utilization throughout the study period, with CDAs showing significant growth within the Medicare population. While the reimbursement for ACDFs remained relatively constant, the reimbursement for CDAs demonstrated a moderate increase.

This is a retrospective study. To evaluate and compare the clinical efficacy and fusion outcomes of allograft versus hydroxyapatite (HA) as bone graft materials in anterior cervical discectomy and fusion (ACDF) surgery. ACDF is used for cervical disc herniation treatment; however, there is no consensus on the optimal bone graft material, particularly between allograft and hydroxyapatite. This retrospective study included patients who underwent ACDF at the Third Affiliated Hospital of Southern Medical University between January 2015 and December 2019. A total of 63 patients met the inclusion criteria and were divided into 2 groups: the allograft group (n=39) and the HA group (n=24). Clinical outcomes were assessed using the Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) score, and Neck Disability Index (NDI). Cervical spine radiographs were utilized to evaluate fusion status, intervertebral height, and sagittal alignment parameters. Both groups demonstrated significant postoperative improvement in VAS, JOA, and NDI scores compared with preoperative values. The magnitude of improvement was similar between the 2 groups, the allograft group exhibited superior final VAS, JOA, and NDI scores relative to the HA group. Radiographic analysis revealed a significantly lower fusion rate and score in the HA group. The incidence of cage subsidence was higher in the HA group, although no significant difference in intervertebral height was observed between groups. Notably, 6 patients (25.0%) in the HA group experienced fusion failure requiring revision surgery, of whom 3 underwent reoperation. No fusion failure or revision surgery was reported in the allograft group. ACDF remains a widely accepted and effective treatment for cervical disc herniation. While both graft types provide symptomatic relief and functional recovery, the allograft demonstrates superior performance in terms of fusion rate, structural integrity, and lower revision risk.

Study DesignSystematic Literature Review.ObjectiveThe aim of this literature review is to examine the results of total disc arthroplasty in the setting of cervical myelopathy.MethodsA systematic review of the relevant literature examining the efficacy of cervical disc arthroplasty (CDA) in patients with cervical myelopathy was conducted using the Medline database.ResultsOur query identified 288 potentially relevant articles. After eliminating duplicate articles and screening by title and abstract 115 articles underwent full-text review. Of these, 15 were deemed relevant to the research questions posed. Evaluation of references identified 2 additional relevant articles.ConclusionEvaluation of outcomes measures, radiographic analysis, and failure due to implant related complications is equivalent in comparing CDA to Anterior Cervical Discectomy and Fusion (ACDF). From the literature available, the outcomes in patients undergoing cervical disc arthroplasty are at least equal to those of ACDF. The concern for persistent symptoms in patients treated with CDA due to the dynamic component on myelopathy is theoretic and not supported by the available literature.

Posterior cervical surgery blindness (PCSB) is a rare but serious complication with significant implications for affected patients. Herein, we retrospectively analyzed two cases of postoperative blindness. Case 1: A 51-year-old with basilar invagination, atlantoaxial dislocation, and syringomyelia. Blindness, caused by central retinal artery occlusion, occurred after atlantoaxial decompression and fusion in the prone position. After the arterial thrombolytic therapy, the vision gradually improved. Case 2: A 58-year-old with radiculopathy-type cervical spondylosis. Blindness, caused by vitreous hemorrhage, occurred after dual-channel endoscopic cervical disc nucleotomy in the prone position. Vision did not recover after 1 year. PCSB is linked to the prone position and use of a horseshoe headrest. Early intra-arterial thrombolysis can significantly promote visual recovery. Preoperative counseling, careful intraoperative management, and active postoperative care are essential to reducing the risk.

Retrospective case-control study. To evaluate whether patients from highly deprived neighborhoods, as defined by the Area Deprivation Index (ADI), undergoing one-level cervical disc arthroplasty (CDA) experience differences in (1) postoperative medical complications, (2) lengths of stay (LOS), emergency department (ED) visits, and readmissions compared with less disadvantaged patients. The ADI measures neighborhood-level deprivation at the national level. Little is known about the role of neighborhood deprivation on outcomes after CDA. A national insurance claims database was used to identify patients who underwent single-level CDA between 2010 and 2022. Patients from less disadvantaged neighborhoods (ADI <90th percentile) were matched in a 1:5 ratio with patients from more deprived areas (ADI >90th percentile) using propensity score matching on age, sex, and Elixhauser Comorbidity Index (ECI), yielding a final cohort of 25,975 patients: 4331 in the low ADI group and 21,644 in the high ADI group. Multivariable logistic regression models were used to assess odds of 90-day complications, readmissions, and ED visits. t tests compared LOS. P-values<0.05 were significant. High ADI patients experienced significantly higher odds of total 90-day medical complications compared with less disadvantaged patients (3.54% vs. 2.67%; OR: 1.37; 95% CI: 1.12-1.70; P=0.003). High ADI patients had longer mean hospital stays (1.75 vs. 1.66 d; P<0.01). Ninety-day readmission (1.54% vs. 1.36%; OR: 1.13; P=0.379) and ED visits (1.64% vs. 1.43%; OR: 1.14; P=0.330) were similar between groups. Neighborhood deprivation is associated with increased lengths of stay and a higher overall rate of medical complications after CDA, despite similar readmission and ED visit rates. These findings emphasize the importance of incorporating socioeconomic context into perioperative care and resource planning. Level III.

This letter to the editor critiques the study “Postoperative Functional Outcomes in Patients with Highly Migrated Cervical Disc Prolapse” by Periyasamy et al., highlighting its contributions and limitations. While the study provides valuable insights into a rare and complex spinal condition and supports anterior cervical corpectomy and fusion (ACCF) as a treatment option, several methodological issues are noted. These include the small retrospective sample, absence of a comparative surgical arm, omission of patient-reported outcome measures, insufficient follow-up for late complications, and lack of subgroup analysis. Additionally, minimally invasive alternatives receive limited discussion despite potential advantages. The letter emphasizes the need for prospective, controlled studies incorporating PROMs, stratified analyses, and extended follow-up to better define optimal surgical strategies for highly migrated cervical disc prolapse.

Dysphagia is a common postoperative complaint following anterior cervical discectomy and fusion (ACDF), with incidence rates ranging from 1.7% to 71%. The variability in incidence rates raises the question of whether dysphagia warrants clinical concern or represents a transient, expected symptom. The aim of this study was to characterize the time course and impact of dysphagia following anterior cervical surgery for degenerative pathology with use of both subjective and objective measures. Patients undergoing either lumbar or cervical spine surgery from 2023 to 2024 were prospectively enrolled. Lumbar cases were limited to 1 to 2-level, decompression-only procedures, whereas cervical cases included up to 3-level ACDF and/or cervical disc replacement (CDR). Dysphagia was assessed using the Eating Assessment Tool (EAT-10) and the Yale Swallow Protocol at 5 time points: preoperatively and on postoperative days (PODs) 0, 3, 7, and 30. Postoperative responses were collected electronically. Retropharyngeal radiographic measurements at C3-C7 were obtained preoperatively, immediately postoperatively, and at the first follow-up. Measurements were taken from the vertebral midbody to the posterior airway space. A total of 134 patients (67 in the cervical group and 67 in the lumbar group) were included. The groups were demographically similar, although the cervical group had a longer mean operative time (86.7 versus 62.2 minutes; p < 0.001). Dysphagia was more prevalent in the cervical group across all postoperative time points: POD0 (70.1% versus 13.4%), POD3 (64.2% versus 10.4%), POD7 (40.3% versus 6.0%), and POD30 (35.8% versus 4.5%) (all p ≤ 0.001). EAT-10 scores correlated strongly across postoperative time points and modestly with procedure duration. Male sex was associated with lower EAT-10 scores through POD7 (p < 0.001). Intraoperative steroid use trended toward reduced EAT-10 scores but was not significant after correction. Retropharyngeal measurements increased immediately postoperatively (notably at C3, C4, C5, and C7), but swelling resolved by the time of follow-up, except at C3 and C4. Dysphagia was frequent after anterior cervical surgery, peaking early and partially resolving by 1 month. These findings support its characterization as a common, self-limited postoperative symptom rather than a true complication in most cases. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Study DesignSystematic Review.ObjectivesCervical disc arthroplasty (CDA) is a motion-preserving alternative to fusion for degenerative cervical disc disease. Implant dislocation, though rare, can lead to severe complications. Despite growing CDA adoption, no systematic synthesis of dislocation risk factors exists, leaving clinicians without evidence-based guidelines. To our knowledge, our study is the first detailed systematic review on CDA-related implant migrations. Our study aims to synthesize literature on CDA-related migration, identify risk factors and evaluate overall management outcomes.MethodsA structured literature review was conducted, identifying 16 relevant studies through PubMed. Data were extracted on study design, patient demographics, prosthesis type, migration direction and timing, risk factors, management approaches, and clinical outcomes.ResultsAmong 40 dislocation cases, anterior migration predominated (70.0%), linked to trauma, hyperlordosis, or poor osseointegration. Posterior migration (17.5%) was associated with polyethylene wear or osteolysis. 5 cases were of unspecified direction (12.5%). 62.5% of the patients underwent revision surgery, with anterior cervical discectomy and fusion (ACDF) making up 88% of these revision surgeries. Two deaths occurred due to postoperative complications.ConclusionsCareful patient selection, optimal implant sizing, and adherence to surgical technique are critical to minimizing dislocation. Surgeons should avoid CDA in kyphotic patients and consider constrained designs in high-risk cases. Early recognition and prompt surgical intervention lead to favourable outcomes.

Rationale:Adefovir dipivoxil (ADV)-induced Fanconi syndrome associated with hypophosphatemic osteomalacia is an extremely rare disease. Owing to its rarity, it is easily misdiagnosed as cervical spondylotic myelopathy. Here, we present the case of a patient with Fanconi’s syndrome associated with hypophosphatemic osteomalacia that was misdiagnosed as having cervical spondylotic myelopathy.Patient concerns:A 44-year-old Chinese man with a 10-year history of ADV therapy for chronic hepatitis B presented with progressive bilateral lower extremity weakness for more than 6 months. Cervical magnetic resonance imaging revealed disc herniations at C4/5, C5/6, and C6/7, accompanied by spinal cord compression. Laboratory evaluations revealed glucosuria, proteinuria, hypophosphatemia, and impaired renal function. He was misdiagnosed with cervical spondylotic myelopathy and underwent anterior cervical corpectomy decompression and fusion. However, his lower limb weakness failed to improve 10 months after surgery.Diagnosis:On the basis of the patient’s clinical symptoms, along with his long history of oral ADV use, hypophosphatemia, and renal insufficiency, he was diagnosed with adefovir dipivoxil-induced Fanconi syndrome.Interventions:ADV was replaced with entecavir, and the patient was prescribed oral calcitriol 0.25 μg daily and oral calcium carbonate with vitamin D₃ (300 mg calcium and 60 IU vitamin D₃ per tablet) once daily.Outcomes:The patient’s lower limb muscle strength returned to normal after 6 months.Lessons:Fanconi syndrome with hypophosphatemic osteomalacia induced by low-dose adefovir dipivoxil (10 mg/d) is extremely rare. The condition may present with pain, muscle weakness, or numbness, and its nonspecific manifestations can easily lead to a misdiagnosis of cervical spondylotic myelopathy. For patients receiving long-term ADV therapy who develop such symptoms, especially in the presence of cervical disc herniation with spinal cord compression, clinicians should carefully evaluate laboratory findings and physical examination results to exclude the possibility of ADV-induced Fanconi syndrome.

Background/Objectives: The extent to which compression or inflammation contribute to the development of cervical radiculopathy and its associated symptoms remains unclear. This study aimed to evaluate whether herniated disc size correlates with baseline symptom severity and/or clinical outcome in patients with cervical radiculopathy, treated surgically or conservatively. Methods: This multi-centre retrospective cohort study included 206 patients with cervical radiculopathy due to a herniated disc. MRI scans from 108 patients in the NECK trial (surgical treatment, evaluating disc replacement) and 98 from the CASINO trial (surgical versus conservative treatment), were used to classify herniation size. Clinical outcome was assessed using the Visual Analogue Scale for arm and neck pain, the Neck Disability Index and the EuroQol VAS at baseline and one year after treatment. Binary logistic regression models were used to evaluate associations between herniation size and clinical outcome, adjusting for treatment type, gender, Body Mass Index and age. Results: A total of 107 patients presented with a small herniation, and 99 had a large herniation. Baseline mean NDI scores were 39.1 ± 15 (surgical group, n = 165) and 32.9 ± 16 (conservative group, n = 41). No association was observed between herniation size and clinical condition (OR 1.010, p = 0.323). After one year, mean NDI scores were 16.2 ± 15 (surgical group) versus 19.6 ± 22 (conservative group), with no significant associations between herniation size and outcome in either group. Similar findings were found for VAS arm and neck pain and EQ-VAS. Conclusions: Disc herniation size on baseline MRI showed no correlation with symptom severity or one-year clinical outcomes, suggesting that inflammatory mechanisms, rather than mechanical compression alone, play a key role in cervical radiculopathy.

Cervical total disc replacement (TDR) is intended to preserve motion and reduce adjacent segment degeneration compared to anterior cervical discectomy and fusion (ACDF). The Simplify Cervical Disc (Globus Medical, Audubon, Pennsylvania), a polyetheretherketone (PEEK)-on-ceramic device with titanium-coated endplates, was approved following encouraging short-term outcomes. However, emerging registries and the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) reports suggest an increase in device failures and revision surgeries, raising concerns about the device's long-term durability and biological compatibility. We reviewed publicly available FDA MAUDE adverse event reports related to the Simplify disc replacement and the published literature on PEEK-on-ceramic wear mechanisms and titanium coating delamination. Representative clinical cases revised to ACDF procedures were also examined. Device bench testing data from the FDA summary were compared with real-world failure modes. Reported complications were categorized into wear, subsidence, migration, osteolysis, and revision outcomes. Analysis of 96 MAUDE reports revealed diverse complications: osteolysis, device migration, persistent or worsening pain, and intraoperative retrieval difficulties. Histological evaluation of revision specimens demonstrated benign bone and fibrocartilage with foreign material, consistent with PEEK, titanium, and zirconia wear debris, an associated inflammatory reaction, and osteolysis. In vitro data confirm that PEEK-on-ceramic couples generate volumetric wear rates of 0.7-2.1mm³/Mc, with titanium coating delamination further contributing to particulate load. Bench testing demonstrated mechanical adequacy under idealized conditions. However, retrieval findings highlight wear, coating failure, and osteolysis as potential failure pathways in real-world applications. Clinical outcomes after ACDF revision were favorable, suggesting effective salvage treatment. Despite promising early trial results, the Simplify disc demonstrates concerning failure mechanisms, including PEEK wear, titanium coating delamination, and subsequent osteolysis. The discrepancy between bench testing and retrieval analysis underscores the limitations of preclinical simulation in predicting in vivo wear. Vigilant post-market surveillance, independent registry reporting, and further long-term outcome studies are essential. Until durability is confirmed, cautious patient selection and readiness for revision remain critical in clinical practice.

The main objective of this study was to investigate the causal association between genetic susceptibility of lifestyle, psychosocial factors, socioeconomic status, and various spinal disorders by using bidirectional Mendelian randomization (MR). We used a bidirectional MR analysis to explore the association between 28 lifestyle, psychosocial factors, socioeconomic status, and a wide range of spinal disorders. We primarily adopted the inverse variance weighting method as the main effect estimate and used additional methods to evaluate the reliability of the results. Genetically predicted smoking and alcohol intake increased the risks of cervical spondylosis and intervertebral disc degenerative disease (IVDD). Longer education was associated with reduced risks of cervical spondylosis, IVDD, spinal stenosis, and spondylolisthesis/spondylolysis. Time spent watching TV increased the risks of cervical spondylosis, IVDD, and spinal stenosis. Sleeplessness elevated the risks of spinal stenosis and IVDD. Higher Townsend deprivation index was linked to cervical spondylosis and spondylolisthesis/spondylolysis, while neuroticism and higher household income increased IVDD risk. Depression was associated with cervical spondylosis. Sensitivity and reverse MR analyses supported robust and unidirectional causal relationships. The results of the study emphasize the importance of addressing certain modifiable risk factors to reduce the burden of spinal diseases and improve the health status of the population. Key messages What is already known on this topic: Several retrospective and epidemiological studies have demonstrated associations between certain lifestyle, psychiatric, socioeconomic factors, and the risk of developing spinal disorders. However, there are no studies that have verified a positive causal relationship between these associations. What this study adds: This study employed a rigorous Mendelian randomization strategy to confirm and quantify the causal effects of known risk factors, thereby confirming the directionality of causality. How this study might affect research, practice, or policy: This study provides a scientific foundation for developing precise prevention strategies and public health policies targeting modifiable risk factors.

Neck pain is one of the 4 most reported musculoskeletal disorders in the medical field. This condition can lead to functional limitations and can have negative economic and social impacts on the patient's life in addition to the medical repercussions. Approximately half of the population experiences cervical pain or cervicobrachial syndrome at some point in their lives, making it a common complaint. This study was conducted on a total of 10 participants who had been diagnosed with cervical disc disease and consecutive neck pain in the subacute or chronic phase of the disease. The patients selected for this study were assigned to a single group and underwent a complex rehabilitation treatment including physical-kinetic therapy (medical gymnastics, kinesio-prophylaxis, electrotherapy, massage, thermotherapy). The treatment protocol was adapted and individualized for each patient. The statistical results obtained from the study emphasize the importance and effectiveness of the physio-kinesiotherapy protocol in improving the clinical status, functional abilities and consequently the quality of life of patients with cervical pain caused by cervical disease.

Artificial disc replacement (ADR) has become an evidence-based alternative to traditional fusion surgery. Current guidelines for safe return-to-activity (RTA) levels following surgery have yet to be determined. This Modified Delphi study aimed to establish expert-sourced consensus for safe and optimized RTA recommendations following cervical disc arthroplasty. Ten expert spine surgeons with an average of 15 years of surgical experience participated in a 3-round Modified Delphi Method. The first round presented experts with 11 clinical cases and 19 multiple-choice questions regarding recommendations for patient RTA following surgery for 1-, 2-, or 3-level arthroplasty. First-round responses were analyzed and presented in second-round surveys to the experts, who repeated 19 multiple-choice questions. The third round presented consensus recommendation statements derived from the second round for the final assessment of the expert agreement. Experts agreed on 19 of 22 (86.4%) postarthroplasty RTA recommendations. Eight recommendations achieved unanimous agreement; the most robust consensus (95%-100% agreement) included recommendations that patients may return to basic activities such as walking, social activities, sedentary work, air travel, and sexual activity within 2 weeks of arthroplasty surgery and that arthroplasty patients will have a shorter recovery, resuming normal activities sooner than fusion patients. Experts agreed that patients may return to light and heavy physical activity (strong consensus) earlier for 2- and 3-level ADR compared to hybrid constructs. Experts also agreed that ADR patients can resume light physical activity at 4 to 6 weeks and engage in intense conditioning and sport-specific training at 6 weeks. However, a weaker consensus was achieved for returning to physically demanding work at 4 to 6 weeks and high-intensity physical activity/sports at 6 weeks, indicating that individual patient factors and the specific nature of the activity should be considered. This study provides the first consensus-based recommendations for RTA following cervical disc arthroplasty.

Neurocysticercosis (NCC), a parasitic infection of the central nervous system caused by Taenia solium larvae, is a leading cause of acquired epilepsy in endemic regions. This case describes a 40-year-old male who presented with chronic headache, dizziness, and a recent seizure episode. He had no prior history of systemic illness, tuberculosis, or neurological disorders. Magnetic Resonance Imaging (MRI) of the brain revealed multiple ring-enhancing lesions with an eccentric scolex in the cerebral and cerebellar hemispheres, accompanied by surrounding edema, confirming the diagnosis of neurocysticercosis. Additional lesions in extraocular, facial, and tongue muscles were consistent with myocysticercosis, an uncommon but clinically significant manifestation that may mimic inflammatory or neoplastic processes.Spinal imaging demonstrated degenerative changes, including diffuse cervical disc bulges at multiple levels (C3–C7) and lumbar disc pathology at L4–L5, causing anterior thecal sac indentation but without cord compression or myelomalacia. While the spinal findings were incidental, they were clinically relevant as contributors to chronic pain and potential neurological deficits.The coexistence of disseminated neurocysticercosis with muscular involvement and early degenerative spinal disease highlights the importance of comprehensive evaluation in patients presenting with seizures and persistent headache. Treatment included albendazole-based antiparasitic therapy, corticosteroids to reduce perilesional edema, antiepileptic medications, and conservative management for disc disease.This case underscores the role of MRI in identifying pathognomonic features of cysticercosis, emphasizes the need for systemic evaluation, and demonstrates the significance of recognizing coexisting pathologies for tailored multidisciplinary management.

Study Design: Network meta-analysis of randomized controlled trials (RCTs) and comparative cohort studies. Objective: To compare different cervical disc prostheses based on sagittal alignment parameters, motion preservation, clinical results, and adverse events. Summary of Background Data: Despite the growing adoption of cervical disc replacement (CDR) as an alternative to ACDF, surgeons currently lack evidence-based guidance for selecting among different CDR devices. Methods: PubMed, Cochrane Library, and Google Scholar searches were conducted for all published eligible studies till December 31, 2024. Surface under the cumulative ranking curve (SUCRA) values were used to rank implant performance. Meta-regression was used to examine correlations between radiographic and clinical parameters. Results: Twenty-six studies (20 RCTs and 6 cohort studies) comprising 2892 CDR patients and 2638 ACDF patients with ACDF were analyzed. SUCRA analysis ranked M6-C as the top device with 66% overall performance across the alignment and clinical domains, followed by SECURE-C (58%) and Mobi-C (56%). ProDisc-C and Activ-C best maintain C2–7 lordosis. Prestige-LP best maintained the range of motion (MD 11.40°, 95% CI: 5.43–17.37). Clinical outcomes varied, with the best improvement in neck Oswestry index (NDI) for Simplify (MD: −9.40, 95% CI: −15.15 to −3.65). Meta-regression revealed significant correlations between C2 and 7 lordosis improvement and Japanese orthopedic association (JOA) scores ( t =8.446, P &lt;0.001) and index level angle lordosis with reduced ASD ( t =5.601, P =0.030) and subsidence ( t =4.364, P =0.022). Conclusions: M6-C, prestige-LP, simplify, and ACDF showed a trend of better overall performance compared with other devices across parameters of sagittal alignment, preservation of motion, clinical outcomes, and adverse events, respectively. However, the recent M6-C reported complications, and the performance of SECURE-C and Mobi-C suggests that semi-constrained designs may provide a better balance, circumventing issues found in both unconstrained and constrained devices. These findings emphasize the importance of individualized device selection and long-term safety monitoring.