Cervical Discopathy Research Articles

The level of pain intensity vs sleep quality and functioning of patients with cervical and lumbar disc disease

Discopathy have wide variety of clinical symptoms. The main issue, destabilizing patients’ life is pain, especially when sleep quality is influenced. The aim of the study was to assess the influence of pain severity on sleep and everyday life quality in patients with cervical and lumbar discopathy. The study was performed on 52 cervical herniation and 59 lumbar herniation patients qualified to surgical intervention. In the study, Athens Insomnia Scale, Oswestra Questionnaire, NRS were used. The majority of patients (70,3%) experienced constant pain and it’s severity what is higher in group of patients with lumbar herniation (Me: 8 vs 7; p=0,036). In a 41% of patients pain lasted for more than two years. Analgesics were applayed by patients (73%) most temporarily, when the level of pain was 8 (relief of pain Me: 5). The pain intensity is correlated with insomnia (r=0,32; p=0,000) and degree of disability (r=0,60; p=0,000). Patients with lumbar herniation have significantly higher degree of disability in comparison to patients with cervical herniation (49,9% vs 37,4%; p=0,000). In majority of patients experienced pain was constant and its intensity was high. Moreover pain was responsible for lowering the quality of sleep and everyday life regardless of the patient’s age. Patients with lumbar herniation experienced significantly higher pain intensity and had higher degree of disability. The pain treatment was not effective enough however it’s effectiveness can be modified by many factors, not by disease process itself.

RESULTS OF TREATMENT OF CERVICAL DISCOPATHY WITH PEEK INTERBODY CAGES AT THREE LEVELS WITHOUT PLATE FIXATION

ABSTRACT Objective: To present the results of treatment of patients with cervical discopathy by anterior cervical approach, discectomy and placement of a PEEK interbody cage without anterior plate fixation. Methods: Retrospective, cross-sectional study from March 2013 to March 2015. Sixteen patients with radiculopathy or clinical signs of myelopathy were included; all patients underwent cervical surgery through anterior approach, discectomy, and placement of PEEK cages on three levels. Decompression levels were determined according to the correlation between preoperative radiological and clinical findings. Results: Sixteen patients predominantly male were included, with mean age of 50 years at the onset of the condition. Ten patients had involvement of C4-C5, C5-C6, C6-C7 levels, and six patients C3-C4, C4-C5 and C5-C6. Fourteen patients had cervicobrachialgia and two myelopathy. The preoperative visual analog scale average was 8/10 and the average postoperative value at 6 months was 3/10. At 6 months, there was no radiological evidence of recurrence. One patient had non-fatal complications. Conclusions: The treatment of cervical discopathy by anterior approach with interbody fusion with PEEK cage on three levels, with no plate fixation seemed to be safe and effective with better long-term results in terms of pain and myelopathy. The clinical results compare favorably with other similar series and, most importantly, the complications associated with anterior fixation plate are avoided.

STOP-Bang Test Results of a Randomly Selected Group of Fibromyalgia Patients

Except for diffuse musculoskeletal pain and pain at tender points, the symptoms reported by patients with Obstructive sleep apnea syndrome (OSAS) are similar to those of patients with fibromyalgia syndrome (FMS). Patients with OSAS can also present FMS. STOP-Bang test is an effective scale which was developed to identify the patients with OSAS. The aim of this study was to evaluate the probable correlation between symptom severity of FMS and STOP-Bang test. Thirty one patients were included in the study. Demographic data including gender, age, body mass index and concomitant diseases are recorded. Musculoskeletal and neurologic examination, measurement of neck circumference and limitation of cervical range of motion were performed. Also MRI findings were recorded as decreased cervical lordosis, spondylosis and discopathy. STOP-Bang test was applied. Beside this test presence of snoring and fatigue were asked again separately. Fibromyalgia Impact Questionnaire (FIQ) was applied. Results of FIQ including total score, visual analog scale for pain (VAS pain) and fatigue (VAS fatigue) were recorded. Twenty five patients (80,6%) were female and 6 patients (19,4%) were male. Neck circumference of male patients was significantly higher than the females (p<0,05). All patients were complaining of fatigue, and 61,3% reported snoring. According to the STOP-Bang test high risk of OSAS was found in 54,8% of the patients (5 males and 12 females). There was significant and positive correlation between snoring and VAS pain, VAS fatigue, FIQ score and high risk of OSAS (p<0,01). Correlations between high risk of OSAS and VAS pain, VAS fatigue and FIQ score (p<0,01) were significant, as well as the correlations between high risk of OSAS and limitation of cervical rotation, and presence of cervical discopathy and decreased cervical lordosis (p<0,05). Although it does not imply a cause and effect relationship, the association between FMS and OSAS is clear. Physicians should keep in mind the presence of OSAS among patients with FMS, especially in male patients. STOP-Bang test is an effective co-examination to predict the risk level of OSAS which is correlated with snoring. Only asking presence of snoring can substitute for STOP-Bang test to refer these patients for the examination of upper airways.

Wpływ leczenia operacyjnego na zgłaszane dolegliwości i stan neurologiczny chorych z dyskopatią kręgosłupa

Introduction. Treatment of patients with spine discopathy is the subject of interest in numerous medical disciplines and includes non-invasive as well as invasive methods. Both therapeutic ways aim to resolve the disc-root conflict. The clinical picture and the incidence of neurological complications depend on the location of herniated nucleus pulposus. Aim. To determine the influence of surgical treatment on reported ailments and neurological status of patients with spine discopathy. Material and Methods. The study was conducted twice (before and after the surgery) among 188 patients treated surgically due to cervical or lumbosacral spine discopathy. The analysis included: clinical and intraoperative diagnosis, the level of operation, BMI, and neurological status: Laseque’s sign, muscle strength, pain, dysesthesia, sphincter disorders. The results were analyzed by means of Microsoft Excel spreadsheet and Statistica 6.0, assuming a significance level of p≤ 0.05. Results. While assessing pain, in the case of L-S discopathy, the majority of patients belonged to group III (34%) and group IV (33.5%). After the operation, 37.8% of patients were classified as group II; in cervical discopathy this percentage was 12.2%. The positive Laseque’s sign before the operation was observed in 68.1% of the subjects; after the surgery in 56%. Dysesthesia in the case of the upper discopathy occurred in 72.9% of the patients, after the surgery in 30.3% (p &lt;0.05). Conclusions. Performed surgery significantly results in reducing pain in patients. The improvement was also noticed in neurological status. (JNNN 2015;4(3):109–116)

Neurosurgical Approaches in Demyelinating Disorders; Where are We Now?

Demyelinating diseases of the central nervous system (CNS) are a group of autoimmune disorders affecting the myelin sheets of CNS neurons resulting in different neurological deficits and disability. Multiple sclerosis (MS), Devic’s disease, progressive multifocal leukoencephalopathy, acute disseminated encephalomyelitis (ADEM), and neuromyelitis optica (NMO) are among the most common types of demyelinating disorders. Currently MS is the leading cause of neurological disability in young population after trauma . The incidence and prevalence of MS is increasing worldwide primarily due to increase the incidence in female population. Globally, the median estimated incidence of MS is 5.2 (range: 0.5-20.6) per 100,000 p-yrs, the median estimated prevalence of MS is 112.0 (with a range of 5.2-335) per 100,000 p-yrs, and the average disease duration is 20.2 years (range: 7.6-36.2). In Iran, the prevalence and incidence of MS is estimated to be 54.51 and 5.87 per 100,000. Diagnosis of demyelinating disorders is a controversial issue and several criteria has been introduced for the aforementioned subject. Diagnostic criteria for clinically definite MS require documentation of two or more episodes of symptoms and two or more signs that reflect pathology in anatomically noncontiguous white matter tracts of the CNS. The second may be documented by abnormal paraclinical tests such as MRI or evoked potentials (EPs).&#x0D; The standard treatment for patients with demyelinating disorders and especially MS is the medical management. Recent large placebo-controlled trials in relapsing-remitting multiple sclerosis have shown efficacy of new oral disease-modifying drugs, teriflunomide and dimethyl fumarate, with similar or better efficacy than the injectable disease-modifying drugs, IFN-β and glatiramer acetate. In addition, the new oral drugs seem to have a favorable safety profile. Further, the monoclonal antibody alemtuzumab, which in clinical trials has shown superiority to subcutaneous IFN-β 1a, has been approved in Europe. In acute exacerbation and flare up of the disease, methylprednisolone pulse is the only approved treatment.&#x0D; Although the standard of treatment of MS and other demyelinating disorders is medical, but neurosurgical procedures especially the functional neurosurgical interventions has found their way in management of patients with demyelinating disorders. These interventions are used to treat the complications of MS and demyelinating disorders such as tremor, trigeminal neuralgia, movement disorders and neuropathic pains. Most of these interventions are stereotactic in order to obtain precise targeting of a special deep brain nucleus. The first application of deep brain stimulation (DBS) in patients with MS was for treatment of tremor. Recently it has been demonstrated that DBS of ventral intermediate (VIM) nucleus of thalamus results in alleviation of severe, disabling tremor in patients with MS. Other experiments have also demonstrated decreased tremor and improved quality of life in MS patients responsive to DBS.&#x0D; Neuropathic pain and trigeminal neuralgia are among the other complications of demyelinating disorders which are associated with disability and decreased quality of life. Several investigations have shown that DBS of thalamic nuclei would be effective in treatment of neuropathic pain in patients with MS, although the results are controversial and need further investigations. The trigeminal neuralgia is often treated by microsurgical decompression of the trigeminal nerve. However this approach is not effective in patients with demyelinating disorders as they have different pathology. Case series have shown that Gamma Knife surgery (GKS) is an effective and safe treatment for trigeminal neuralgia in patients with MS. No clinical trial is available for comparing the results and outcome between GKS and microsurgical approach. However results of case series are favorable.&#x0D; There are still other field that could be approached surgically in patients with demyelinating disorders. Recent bodies of evidence have demonstrated a link between cervical cord plaques and discopathy in those with MS which needs further investigation. Tumefactive demyelinating lesions (TDL) are another issues observed in patients with MS which have unknown course and pathology. The link between demyelinating disorders and brain tumors is also another issues which deserves further investigation. To take a long story short, although the role of functional neurosurgical procedures in management of patients with demyelinating disorders especially MS is still limited, but there is optimistic horizons for growing role of neurosurgical procedures in management of different complications of demyelinating disorders refractory to medical therapy.Â

Kinesiophobia in pre-operative patients with cervical discopathy and coexisting degenerative changes in relation to pain-related variables, psychological state and sports activity.

BackgroundNo research group has ever investigated the level of kinesiophobia in a well defined group of preoperative patients treated due to cervical discopathy and degenerative spine disease, confirmed by X-ray and magnetic resonance imaging (MRI) examinations. We aimed to investigate the degree of kinesiophobia and the differences in pain-related and psychosocial characteristics between patients with high and low levels of kinesiophobia, in relation to factors commonly associated with neck pain.Material/MethodsSixty-five consecutive patients with cervical discopathy and coexisting degenerative changes were assessed pre-surgically. The mean pain duration was 31.7 SD 34.0 months. Patients completed the Polish versions of the Tampa Scale for Kinesiophobia (TSK-PL) on 2 occasions, and the following once: Neck Disability Index (NDI-PL), State-Trait Anxiety Inventory (STAI-PL), Coping Strategies Questionnaire (CSQ-PL), and the Visual Analogue Scale (VAS-PL).ResultsA high level of kinesiophobia was indicated in 81.5% and 87.7% of patients in first and second completion, respectively. Patients with high and low kinesiophobia differ in regards to the recreation section of NDI-PL (p=0.012), gender (p=0.043), and sports activity (p=0.024). Correlations were identified between TSK-PL and marital status (p=0.023) and sports activity (p=0.024).ConclusionsKinesiophobia levels are higher in patients with chronic cervical pain before surgical treatment. Fear of movement tends to be higher in women and among patients avoiding sports recreation before surgical treatment. Although sports activity and socio-demographic data are predictors of kinesiophobia, psychological, pain-related, and clinical data are not. These findings should be considered when planning rehabilitation after surgical treatment of cervical discopathy and coexisting degenerative changes.

Concomitance of fibromyalgia syndrome and cervical disc herniation.

[Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C2–3, 16.6% C5–6, 16.6% C6–7, 33.3% C4–5, C5–6 (two levels in two patients) and 16.6% C4–5, C5–6, C7–1 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population.

Występowanie zaburzeń odżywiania wśród pacjentów hospitalizowanych z powodu udaru i dyskopatii na oddziale neurologicznym

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Sierżantowicz R, Jakimiuk L, Lewko J, Stępień R, Trochimowicz L, Zimnoch R. Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department. Medical Studies/Studia Medyczne. 2015;31(3):187-193. doi:10.5114/ms.2015.54758. APA Sierżantowicz, R., Jakimiuk, L., Lewko, J., Stępień, R., Trochimowicz, L., & Zimnoch, R. (2015). Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department. Medical Studies/Studia Medyczne, 31(3), 187-193. https://doi.org/10.5114/ms.2015.54758 Chicago Sierżantowicz, Regina, Lucyna Jakimiuk, Jolanta Lewko, Renata Stępień, Lech Trochimowicz, and Ryszard Zimnoch. 2015. "Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department". Medical Studies/Studia Medyczne 31 (3): 187-193. doi:10.5114/ms.2015.54758. Harvard Sierżantowicz, R., Jakimiuk, L., Lewko, J., Stępień, R., Trochimowicz, L., and Zimnoch, R. (2015). Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department. Medical Studies/Studia Medyczne, 31(3), pp.187-193. https://doi.org/10.5114/ms.2015.54758 MLA Sierżantowicz, Regina et al. "Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department." Medical Studies/Studia Medyczne, vol. 31, no. 3, 2015, pp. 187-193. doi:10.5114/ms.2015.54758. Vancouver Sierżantowicz R, Jakimiuk L, Lewko J, Stępień R, Trochimowicz L, Zimnoch R. Prevalence nutritional disorders among patients hospitalised for stroke and discopathy in the neurology department. Medical Studies/Studia Medyczne. 2015;31(3):187-193. doi:10.5114/ms.2015.54758.

Observation of vertebral artery damage using angioscopy in autopsy cases.

The vertebral arteries are important blood vessels that supply the cerebral circulation in conjunction with the internal carotid arteries. In cases of subarachnoid hemorrhage, it is necessary to examine the vertebral arteries as potential sources of bleeding due to blunt trauma (head and neck) or of cerebral embolism that originated on the surface of the damaged intima as a result of hyperflexion or hyperextension. However, a considerable part of the vertebral arterial surface is surrounded by bone, resulting in challenges during examination in a routine autopsy. In this study, angioscopy was used to inspect the vertebral artery intima for damage in cases of neck injury, head injury, or neck strangulation. Intimal damage was detected in 34 out of the total 75 cases. Of the 28 cases with cervical discopathy or fracture, 61% had intimal damage. In addition, postmortem application of computed tomography angiography was performed to identify the injured vessel in a case with traumatic subarachnoid hemorrhage, and a perforated hole was detected using angioscopy, which did not introduce autopsy-related artifacts. Therefore, angioscopy may be a useful and nondestructive method to identify intimal damage in the vertebral arteries during an autopsy.

Health of Danish seafarers and fishermen 1970-2010: What have register-based studies found?

This study aimed to review Danish register-studies on seafarers' and fishermen's health and safety. Register-based or register-linked studies from 1970 until 2012 were identified and reviewed. Four categories of studies were included: mortality, hospitalization, specific diagnoses and conditions and accidents. Standardized risks estimates were typically calculated by comparison with the total Danish working population. Elevated rates were found in all four categories. For mortality male seafarers had excess rates of accidents, cirrhosis of the liver, cancer, and suicides, and fishermen of accidents and cardiovascular disorders. Female seafarers in male-dominated occupations also had increased mortality rates. Elevated hospitalization rates for male seafarers were particularly prominent for endocrine/nutritional conditions, cervical discopathy, gastrointestinal and cardiovascular diseases, cancers, hearing impairment, and injuries, and for female seafarers cancers, circulatory and genitourinary diseases and injuries. Fishermen had increased hospitalization rates for cardiovascular diseases, bronchitis, emphysema, lung cancer, gonarthrosis, thoracolumbar discopathy, rotator cuff syndrome, carpal tunnel syndrome, injuries and hearing impairment. Specific diagnoses and conditions: There was an elevated risk of tuberculosis, hepatitis B and certain cancers for male seafarers, and of obesity and occupational accidents for both fishermen and seafarers. In spite of safety measures and significant structural changes in the Danish merchant and fishing fleet, the spectrum of health indicators continues to indicate considerable risk factors in the maritime environment and/or the lifestyle of seafarers and fishermen. Future monitoring of fishermen's and seafarers' health will remain essential for implementing appropriate preventive measures.

Is there any relation between cervical cord plaques and discopathy in patients with multiple sclerosis?

IntroductionMultiple sclerosis (MS) is the most common chronic autoimmune demyelinating disease of the central nervous system. The purpose of this study is to determine the relationship between the site of the cervical discopathy and cervical spinal cord plaque in MS patients. MethodsThis retrospective study included all patients with a definite diagnosis of MS who were treated at an outpatient clinic between September 2004 and September 2011. All patients underwent cervical magnetic resonance imaging (MRI) for primary investigation of the disease. Cervical MRI scans were evaluated for detection of any evidence of cervical discopathy and cervical MS plaques. Any correlation between the site of the MS lesions and discopathy was recorded. ResultsFrom 536 patients who were involved in the study, 214 patients had both cervical discopathy and cervical cord plaques. In this group 148 (69.1% of patients) had cervical plaque at the same site of cervical discopathy. The number of patients with cervical cord plaque and discopathy at same site was significantly higher than those with plaque and discopathy at different sites (P<0.05). ConclusionThe study data suggests a possible correlation between cervical discopathy and cervical MS plaque.

Patient satisfaction with nursing after surgery due to cervical or lumbar discopathy

BackgroundRelationships between patient satisfaction with nursing and patient clinical data have not been fully resolved in a Polish sample. Our objectives were to determine clinical factors associated with patient satisfaction with nursing and investigate differences between patients treated surgically for cervical or lumbar discopathy and degenerative changes.Material/MethodsThis prospective and cross-sectional study included 63 consecutively selected patients treated surgically for lumbar discopathy and degenerative spine disease and 41 patients undergoing surgery for cervical discopathy and degenerative spine disease from 1st June 2009 to 31st September 2010 in the Department of Neurosurgery and Neurotraumatology of Poznan University of Medical Sciences. In the first stage of this study, socio-demographic data, medical history, and clinical patient characteristics were collected. A minimum 12-month follow-up formed the second part. Nineteen patients with lumbar discopathy were excluded because they were unable to answer the questionnaire. Finally, 44 consecutively selected patients treated surgically for lumbar discopathy and 41 patients undergoing surgery due to cervical discopathy were evaluated with the Polish version of the Newcastle Satisfaction with Nursing Scale (NSNS-PL).ResultsIn patients with cervical and lumbar discopathy, the average Experiences of Nursing Care Subscale (ENCS) scores were 82.0 (SD 15.1) and 79.0 (SD 13.5), respectively, whereas the average Satisfaction with Nursing Care Subscale (SNCS) scores were 75.6 (SD 18.1) and 74.4 (SD 16.8), respectively. The study groups did not differ in regards to NSNS subscales. Associations between ENCS and SNCS scores were confirmed in both patient groups (rS=.73, p<0.001 and rS=.73, p<0.001, respectively).ConclusionsOur study highlights the importance of assessing the association between patient characteristics and patient perception of quality of nursing care. Satisfaction with treatment outcome and conviction about undergoing the same treatment affected experiences and satisfaction with nursing in the cervical group only.

Artificial Cervical Disc Arthroplasty (ACDA): Tips and Tricks

Background: Anterior cervical discectomy and fusion (ACDF) is currently treatment of choice for managing medical therapy refractory cervical degenerative disc disease. Numerous studies have demonstrated the effectiveness of ACDF; patients generally experience rapid recoveries, and dramatic improvement in their pain and quality of life. However, as several studies reported symptomatic adjacent segment disease attributed to fusions’ altered kinematics, cervical disc arthroplasty emerged as a new motion-sparing alternative to fusion. Fusion at one level increases motion at adjacent levels along with increased intradiscal pressures. This phenomenon can result in symptomatic adjacent level degeneration, which can necessitate reoperation at these levels. The era of cervical arthroplasty began in Europe in the late 1990s. In recent years, artificial cervical disc arthroplasty (ACDA) has been increasingly used by spine surgeons for degenerative cervical disc disease. There have been several reports of safety, efficacy and indications of ACDA. Cervical arthroplasty offers several theoretical advantages over anterior cervical discectomy and fusion (ACDF) in the treatment of selected patients with medically refractory cervical radiculopathy. Preserving motion at the operated level, Cervical TDR has the potential to decrease the occurrence of adjacent segment Degeneration. There are a few studies on the efficacy and effectiveness of ACDA compared to cervical fusion. However, the true scenery of cervical arthroplasty yet to be identified. Objective: This study is intended to define patients' characteristics and outcomes of ACDA by a single surgeon in Iran. Methods: This retrospective study was performed in two general Hospitals in Tehran, Iran from 2005 To 2010. All patients were operated by one senior neurospine surgeon. One hundred fifty three patients were operated in this period. All patients signed the informed consent form prior to surgery. All patients presented with cervical discopathy who had myelopathy or radiculopathy and failed conservative management, undergoing cervical disc arthroplasty by ACDA were included, consecutively. Patients were followed for at least 2 years. Exclusion criteria was age >60 years, non compliance with the study protocol, osteoporosis, infection, congenital or post traumatic deformity, malignancy metabolic bone disease, and narrow cervical canal (

Effectiveness of Acupuncture with NSAID Medication in the Management of Acut Discogenic Radicular Pain: A Randomised, Controlled Trial

Aim: To evaluate potential benefit of acupuncture in the treatment of acute discogenic radicular pain and compare it with nonsteroidal anti-inflammatory drug (NSAID) therapy. Method: Eighty patients, referring with acute radicular pain with no or with minimal neurologic deficits and without any indications for surgery were informed about the study with treatment choices. Patients willing to participate, were also randomly assigned into two treatment subgroups as NSAID and acupuncture. Tenoxicam was used as analgesic drug in each NSAID sub-group. Acupuncture groups received classical filiform needle and ear needle applications. Pain intensities of cases who were well-informed about the procedure were assessed before and after treatment - and also on third and twelfth months - on a 100 mm visual analogue scale. All patients were informed about daily activity modifications relevant to their illness. Result: It was determined that short and long term pain relieving effects of acupuncture in the management of radiculopathy secondary to lumbar disc herniations were similar to NSAID therapy (p>0.05). The pain relieving effects of acupuncture in cases with cervical discopathy were rather similar to NSAID administrations in the long term but in short period it was significantly more effective (p<0.01). Conclusion: Acupuncture is a promising therapeutic option in the management of the radiculopathy of discogenic origin.

Pseudomeningeal syndrome of Dupre associated with cervical discopathy—case report

The below publication presents a case of a 51-year-old patient with cervical discopathy of unusual clinical course. The symptoms of the disease suddenly became aggravated and took a form of meningeal syndrome without inflammation of cerebrospinal fluid. The authors emphasize the symptomatology and diagnostic difficulties connected to unusual clinical course of cervical discopathy at the level of VC3/VC4. Both medical and neurosurgical approaches to clinical history of cervical discopathic patient were presented in details. The patient underwent anterior cervical interbody fusion and the operative procedure was very effective for a few years up till now.

The effects of weightbath traction hydrotherapy as a component of complex physical therapy in disorders of the cervical and lumbar spine: a controlled pilot study with follow-up

The therapeutic modalities available for the conservative management of chronic cervical and lumbar pain include underwater traction, the usefulness of which is not universally acknowledged. No reports have been published on clinical trials evaluating underwater traction. This study was intended to ascertain any beneficial impact of weightbath therapy on the clinical parameters and quality of life of patients with cervical/lumbar discopathy. The study population comprised 72 subjects. Two groups of 18 patients each received underwater traction therapy of the cervical or lumbar spine with add-on McKenzie exercises and iontophoresis. The remaining two groups, treated with exercises and iontophoresis, served as controls. VAS and SF36 scores, range of motion were monitored to appraise therapeutic efficacy in cervical discopathy, whereas these parameters were supplemented by the Oswestry index in lumbar discopathy. A MRI scan was done at baseline and after 3 months of follow-up. Underwater cervical or lumbar traction therapy for discopathy achieved significant improvement of all study parameters, which was still evident 3 months later. Among the controls, significant improvement of just a single parameter was seen in patients with lumbar, and of two parameters in those with cervical discopathy. Underwater traction therapy effectively mitigates pain, enhances joint flexibility, and improves the quality of life of patients with cervical or lumbar discopathy. The equipment required to administer weightbath therapy is simple to install and treatment technique is straightforward.

Acute ECG Changes and Chest Pain Induced by Neck Motion in Patients with Cervical Hernia

We report two cases of acute cervical angina and ECG changes induced by anteflexion of the head. Cervical angina is defined as chest pain that resembles true cardiac angina but originates from cervical discopathy with nerve root compression. In these patients, Prinzmetal's angina, valvular heart disease, congenital heart disease, left ventricular aneurysm, and cardiomyopathy were excluded. After all, the patient's chest pain was reproduced by anteflexion of head, at this time, their ECGs showed nonspecific ST-T changes in the inferior and anterior leads different from the basal ECG. ECG changes returned to normal when the patient's neck moved to the neutral position. To our knowledge, these are the first cases of cervical angina associated with acute ECG changes by neck motion.

Nystagmus in syncopal vertebro-basilar fit syndrome

Based upon our clinical observations and the results of repeated control-examinations of 21 patients (head injury, traumatic lesions of the cervical spine, postoperative disorders following surgery of cervical discopathy), the characteristic nystagmus features of this particular vestibular syndrome termed as ‘syncopal vestibular fit syndrome’ may be explained as follows: Four different phases may be distinguished which are regularly observed in all the cases, but showing individual variations of their course of development. The main pathogenetic factor of this syndrome is probably a severe impairment of blood circulation within the vertebral <i>and</i> carotid arteries. Neurological and particularly vestibular findings must be interpreted mainly as the symptoms of an ischemic lesion of the dorsolateral corner of the medulla, whereas pathological alterations of the cervical spine and neuronal factors seem to be of minor importance with respect to the origine of this syndrome.

On the Results of Cervical Anterior Interbody Fusion for Cervical Discopathy

In our hospital, cervical interbody fusion has been performed on 23 patients of cervical discopathy (including cervical spondylosis and cervical trauma) during the last 8 months. Discussing the cases, we noticed it to be very difficult to diagnose exactly the symptomatic level of cervical disc for reason of its miscellaneous neurologic symptoms due to multiple degenerative lesions, inspite of many diagnostic procedures. Therefore, we should not neglect that the involved disc exists even in the asymptomatic level except the level diagnosed through the systematic examination. In conclusion, it is recommended that the spinal fusion should be performed even in the suspected level adjacent to the symptomatic disc.It is reported that the pathogenesis of neuropathy in cervical spondylosis is the compression due to instability of the cervical spine or the posterior protrusion of its vertebral ridge and disc. We should remove these pathogenic causes. In some cases, we encounter the difficulties in the complete removal of osteophytes encroaching upon the nerve roots or the spinal cord by Cloward's method. Recently, we have obtained the good results by the modified Robinson's method that aligns the local kyphotic curvature of the cervical spine and eliminates the compression upon the nerve roots and the spinal cord by means of the insertion of the wedgeshaped bone plug into the intervertebral space.

Transient hyperlipemia following myocardial infarction associated with inhibition of heparin clearing activity

A thirty-eight year old woman with hypertension is described who exhibited marked hypertriglyceridemia on four occasions following acute stressful events (two attacks of myocardial infarction, acute cholecystitis and cervical discopathy). Subnormal or normal blood lipid values were observed between and after the acute episodes for a period of about six years. The triglyceride level began to rise six to twelve days after the acute events, reached a peak after two to six weeks and subsided after seven to fourteen weeks. None of the disease processes known to be associated with hyperlipemia were present in the patient, and there was no familial hyperlipemia. The blood lipid levels were entirely unrelated to the dietary fat intake. The hyperlipemia was shown to be accompanied by a transient absence of lipoprotein lipase activity in the blood after heparin therapy and associated with the presence of a plasma inhibitor. Nevertheless, exogenous triglyceride clearance was not impaired during the period of hyperlipemia and seemed to be increased during the periods of hypolipemia and normolipemia. An enormous increase in liver size, due to fatty infiltration, preceded the hypolipemic and normolipemic periods. The term “stress hyperlipemia” is suggested, and its possible mechanism is discussed.