Cervical Intervertebral Disc Research Articles

Outcomes in Dogs with Multiple Sites of Cervical Intervertebral Disc Disease Treated with Single Ventral Slot Decompression.

In dogs with acute myelopathy but showing multiple sites of spinal compression from intervertebral disc disease (IVDD) on imaging, one approach is surgical decompression of the single acute disc extrusion while ignoring other previously extruded or protruded discs. However, little is known regarding the outcomes of this approach. This study described the outcomes and investigated prognostic factors in 40 dogs with multiple sites of cervical disc extrusion or protrusion on MRI who underwent ventral slot decompression for the single acute disc. The overall recovery rate was 97.5%. The median recovery time was seven days. The number of affected discs (including disc extrusion and protrusion) and the presence and number of the affected discs causing severe spinal compression did not influence the 30-day outcome. Compared with 23 dogs with single disc extrusion treated surgically, the recovery time and outcomes were similar between the two groups. The total number of affected discs was not associated with recovery time or outcomes. In conclusion, if an acute disc could be identified, ventral slot decompression targeting the single acute disc is a viable management approach for dogs with an acute presentation but diagnosed with multiple sites of spinal cord compression from IVDD.

Cervical intervertebral disc disease in 60 Yorkshire terriers.

Intervertebral disc extrusion (IVDE) is a common neurological condition in many dog breeds. This study aimed to describe this condition in Yorkshire terriers (YT) and calculate the prevalence of this condition amongst the YTs with neurological diseases. This is a double-centre retrospective study which was conducted in two arms. The first part of the study, describing the clinical features and prognosis of cervical (C) IVDE in YTs, is based on data from 2005 to 2021. The second part of the study calculated the prevalence of C IVDE amongst the YTs with neurological diseases based on data from 2016 to 2021. A retrospective search through the medical records was conducted. YTs with C IVDE diagnosed with MRI and confirmed surgically were eligible for inclusion in this study. Sixty YTs were included in the first part of the study. There were 48 (80%) dogs with acute onset and 12 (20%) with chronic onset with acute deterioration. Ambulation was preserved in 31 (51.7%) dogs on admission, and the remaining 29 (48.3%) dogs were non-ambulatory. No significant association was found between ambulation on admission and recovery status (p = 0.547). Seventy-three intervertebral spaces were treated during the surgical intervention. Relapses were seen in seven (11.7%) dogs. Forty-nine (81.7%) dogs were ambulatory at discharge. A complete recovery was observed in 46 (76.7%) dogs; the remaining dogs (14, 23.3%) were classified as incomplete recovery. A significant difference was found in time to ambulation (p = 0.0238) and time to discharge (p = 0.0139) between the on-admission ambulatory and non-ambulatory dogs. Three hundred and eight YTs were diagnosed with neurological diseases between 2016 and 2021 in one referral centre. C IVDE was diagnosed in 31 (10.06%) dogs. This is the first study explicitly describing the C IVDE in YTs and establishing the prevalence of this condition amongst YTs with other neurological disorders.

Characteristics of cervical intervertebral disc signal intensity: an analysis of T2-weighted magnetic resonance imaging in 5843 asymptomatic Chinese subjects.

The study aimed to observe cervical intervertebral discs (IVDs) in asymptomatic subjects and to explore the factors associated with cervical intervertebral disc degeneration (IVDD). Cervical spine MRI of 5843 subjects was retrospectively analyzed. On the sagittal T2-weighted MR images, the mean signal intensities of the nucleus pulposus were obtained. Standard signal intensity (SSI) of intervertebral discs was defined as the ratio of mean disc signal intensity to mean CSF signal intensity. In subjects under 70years old, the SSI of IVD was lowest at the C5/6 level. In those over 70, the SSI of IVD was similar among the disc levels from C2/3 to C7/T1. The disc SSI decreased significantly with age in both genders. In subjects under 70 years old, the SSI of the discs at each level was higher in females than in males. In those over 70years old, no difference was found in disc SSI between two genders at most disc levels. Logistic regression analysis showed that kyphotic and straight cervical spine, obesity and older age were associated with higher risk of having lower disc SSI. To our knowledge, this is the largest cross-sectional study using MRI-based quantitative assessment to characterize cervical IVDD in asymptomatic subjects. Cervical IVDD was shown to progress with age and significantly correlated with gender, BMI and cervical alignment. Early intervention of related factors may help delay cervical IVDD and prevent future neck and shoulder pain.

Cervical jerks as a sign of cervical pain or myelopathy in dogs.

To describe and classify cervical muscle jerks associated with cervical pain or myelopathy and evaluate their clinical and diagnostic relevance. 20 dogs with a history of unilateral or bilateral cervical jerks associated with cervical pain or myelopathy. A retrospective study. Detailed history, complete clinical and neurological examinations, CT studies, and outcome were available for each dog. All dogs received a treatment adapted to each diagnosis. The presence or absence of jerks was evaluated at short- and long-term recheck examinations. An immediate postoperative CT scan was obtained for all cases that were treated surgically. 20 dogs were selected for the study, 13 of which were French Bulldogs. Jerks all presented as focal repetitive rhythmic contractions on the lateral aspect of the neck (on one or both sides). All dogs had a diagnosis of cervical intervertebral disk extrusion (IVDE), half of them at the C2-C3 level. No dogs presented with extrusion caudal to the C4-C5 intervertebral disk space. The prevalence of myoclonia among all dogs diagnosed with IVDE was 3.77% (20/530) in our hospital. Cervical jerk associated with cervical pain or myelopathy may represent myoclonus and was exclusively secondary to cranial cervical IVDE in this study. Full recovery was observed following medical or surgical treatment of IVDE. The exact origin and classification of this involuntary movement has yet to be established.

Developing an Individual Neurosurgical Strategy in Patients With a Two-Level Cervical Degenerative Disc Disease

Background: Little is written about substantiated clinical and biometric indications for dynamic stabilization, rigid fixation, and their combinations in patients with two-level degenerative disease of the cervical intervertebral discs (IVD).Objective: To study the risk factors for poor outcomes of two-segment interventions (total disk arthroplasty, TDA; anterior cervical discectomy and fusion, ACDF; and their combination) in patients with two-level degenerative diseases of the cervical IVD; to develop a custom clinical and instrumental assessment strategy for future interventions.Materials and methods: We retrospectively analyzed the outcomes in 118 patients with a two-level degenerative disease of the cervical IVD, who underwent TDA (n = 37), ACDF (n = 41), and their combination (n = 40) from 2005 to 2015. After this analysis, we built a mixed effects logistic regression model to identify and assess the impact of various risk factors on poor clinical outcomes in each intervention.Results: TDA correlated with favorable outcomes in patients with cervical lordosis over 12 °; I–III grade IVD changes according to Pfirrmann scale; I–II grade facet joints (FJ) changes according to Pathria criteria; no FJ tropism; segmental movements amplitude > 8 °; interbody space height ≤ 6 mm, and with no central spinal stenosis/spine interventions. Favorable ACDF outcomes may be achieved in patients with cervical lordosis ≥ 7 °; more than III grade IVD changes according to Pfirrmann scale; more than II grade changes in FJ according to Pathria criteria; segmental movements amplitude ≤ 8 °; interbody space height < 6 mm. FJ tropism, central spinal stenosis, and history of spine interventions do not affect ACDF outcomes.Conclusions: An individual approach to TDA, ACDF, and their combination as well as comprehensive preoperative clinical and instrumental assessment in patients with a two-level degenerative IVD disease contribute to the effective resolution of existing neurological symptoms, which reduced the pain severity in the cervical region and upper limbs, improve the patients’ functional status and quality of life in the late postoperative period, and reduce the number of postoperative complications and reinterventions.

Melatonin restores endoplasmic reticulum homeostasis to protect injured neurons in a rat model of chronic cervical cord compression.

Cervical spondylotic myelopathy (CSM) refers to a chronic injury of the cervical cord caused by cervical intervertebral disc degeneration. Endoplasmic reticulum (ER) homeostasis is essential to counteract neuronal apoptosis. ER stress, an integral part of ER homeostasis, was observed in a rat model of chronic cervical cord compression in our previous study. However, the correlation between ER homeostasis and CSM remains unknown. The antioxidant melatonin is known to exert therapeutic effects in acute spinal cord injury, but the specific effects and their potential mechanisms in the pathological processes of CSM require further exploration. The present study hypothesized that ER homeostasis is essential for neuronal apoptosis in the CSM and that melatonin maintains this homeostasis. The results showed that ER stress led to neuronal apoptosis in rats with chronic cervical cord compression. Conversely, melatonin attenuates protein kinase R-like ER kinase-eukaryotic initiation factor 2α-C/EBP-homologous protein, inositol-requiring enzyme 1, and transcription factor 6 signaling pathways to release ER stress and prevents Bax translocation to the mitochondrion, thereby promoting motor recovery and protecting neurons in vivo. It also rescued primary rat cortical neurons from ER stress-induced glutamate toxicity in vitro. Moreover, melatonin remodels the ER morphology and restores homeostasis via ER-phagy in injured neurons. FAM134B, CCPG1, RTN3, and Sec. 62 are four known ER-phagy receptors. In this study, Sec. 62 was identified as a key melatonin factor in promoting ER-phagy and restoring ER homeostasis in damaged neurons in vivo and in vitro. In conclusion, melatonin suppresses neuronal apoptosis by reducing ER stress and promoting ER-phagy to restore ER morphology and homeostasis. The current results suggested that melatonin is a promising treatment for CSM owing to its restorative effect on ER homeostasis; however, well-designed randomized controlled trials must be carried out to further investigate its clinical effects.

Material science and biomechanical interactions in cervical disc arthroplasty

Historically, anterior cervical discectomy and fusion (ACDF) has been the preferred surgical technique to address myelopathy and radiculopathy due to cervical spine intervertebral disc disease. Continued design improvements and theoretical biomechanical advantages to cervical disc arthroplasty over the last decade have made cervical disc arthroplasty an appealing alternative to ACDF, especially in younger patient populations without significant spondylosis who may wish to preserve neck motion. This narrative review will discuss the recent advances in cervical disc arthroplasty in regard to material composition, overall design and resultant degrees of freedom of the devices, the potential sparing of neck range of motion, and the theoretical biomechanical advantages of an arthroplasty compared to an ACDF.

Comparative analysis of clinical efficacy between posterior percutaneous endoscopic discectomy and anterior cervical discectomy and fusion in the treatment of cervical spondylotic radiculopathy

To explore the clinical efficacy of posterior percutaneous endoscopic discectomy(PPECD) in the treatment of cervical spondylotic radiculopathy. A total of 56 patiens with single segment cervical spondylotic radiculopathy from December 2017 to October 2020, were randomly divided into observation group and control group. In observation group, there were 16 males and 11 females, including 8 cases of C4,5, 13 cases of C5,6 and 6 cases of C6,7 performed posterior percutaneous endoscopic discectomy, aged from 34 to 61 years old with an average of (51.15±6.29) years old. In control group, there were 19 males and 10 females with single segment cervical spondylotic radiculopathy including 10 cases of C4,5, 14 cases of C5,6 and 5 cases of C6,7 performed anterior cervical discectomy and fusion, aged from 40 to 65 years old with an average of (53.24±5.31) years old. The operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were recorded. Visual analogue scale(VAS) and neck disability index(NDI) were used to evaluate the clinical efficacy. Cervical plain films or MRIs, CTs were taken for re-visiting patients. All patients were followed up more than 2 years. The observation group patients were followed up, the duration ranged from 24 to 42 months with an average of (30.48±4.91) months. The control group patients were followed up, the duration ranged from 25 to 47 months, with an average of (32.76±4.53) months. Compared with control group, operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were decreased(P<0.05). Compared with pre-operation, VAS of neck and upper limb and NDI at the latest follow-up between two groups were significantly improved(P<0.05). Compared with control group, VAS of neck and upper limb at 1 day after operation in observation group were significantly reduced(P<0.05). There was no significant difference in VAS of neck and upper limb and NID at 1, 3 months and the latest follow-up after operation between two groups(P>0.05). In the observation group, one patient's deltoid muscle strength was weakened to grade 4 after operation, and returned to normal after 12 weeks of conservative treatment. In control group, there was 1 case of postoperative adjacent spondylosis with symptoms of spinal compression after 2 years operation, then underwent cervical artificial intervertebral disc replacement. And there was 1 case of dysphagia after operation in control group and improved after 1 year. There was no significant difference in incidence of complications between two groups. PPECD has advantages of shortening operative time, decreasing intraoperative blood loss, reducing postoperative time of lying in bed and length of postoperative hospital stay. However, applicable age range of patients and long-term clinical efficacy needs further study.

Association between spinal cord compression ratio in magnetic resonance imaging, initial neurological status, and recovery after ventral slot in 57 dogs with cervical disc extrusion.

This retrospective, unblinded, single rater study evaluated images obtained from magnetic resonance imaging (MRI) of dogs with cervical intervertebral disc extrusion before being submitted to ventral slot decompression (VSD). Dogs were re-evaluated systematically at 10 and 30 days after VSD. The objectives of this study were to investigate the associations between the following parameters: (1) The maximal spinal cord compression ratio (SCCR) as seen on transverse MRI and pre-surgical neurological status (NS) grade; we hypothesized that dogs with greater SCCR will have worse pre-surgical NS grade at presentation; (2) Pre-surgical NS grade and postoperative recovery; we hypothesized that worse pre-surgical NS grade will be associated with longer postoperative recovery time; (3) SCCR and postoperative recovery; we hypothesized that dogs with higher SCCR will have longer recovery time; (4) Location of extrusion (cranial vs. caudal) and initial NS grade and outcomes; we hypothesized that caudal cervical extrusion will have worse NS grade and longer time to recovery; (5) Longitudinal extension of ventral CSF signal loss on HASTE pulse sequence and NS grade and time to recovery; we hypothesized that dogs with longer HASTE CSF attenuation will have higher NS grade and longer time to recovery. There was no significant association between SCCR and NS grade, suggesting that this relationship in the cervical region is similar to what is observed in the thoracolumbar region, rejecting our first hypothesis. There was a significant difference between ambulatory tetraparesis dogs versus non-ambulatory tetraparesis dogs regarding complete recovery at 10 days: dogs with NS grade 1, 2, or 3 overall recovered faster than dogs with NS grade 4. However, there was no significant difference between these groups regarding complete recovery at 30 days, thereby accepting our second hypothesis at 10 days and rejecting it at 30 days. There was no correlation between SCCR and recovery time, rejecting our third hypothesis. Caudal cervical extrusion did not show higher NS grade or longer recovery time than cranial extrusion, rejecting our fourth hypothesis. CSF attenuation length ratio on HASTE images was not significantly correlated with NS grade but weakly correlate with post-surgical recovery time, partially accepting our fifth hypothesis.

Spontaneous regression of a traumatic cervical prolapsed intervertebral disc with myelopathy

We report the case of a 60-year-old male, who presented to us with a 6-month-old quadriparesis (upper limbs 3/5; lower limbs 0/5), secondary to a posttraumatic C5-C6/C6-C7 prolapsed intervertebral disc (PIVD), and a D4-D5 fracture-dislocation, resulting in a physiological dorsal cord transection. The patient had been managed conservatively outside. In view of the insignificant neurological recovery over the past 6 months, the patient consulted for a second opinion. At the time, the patient also had an infected decubitus ulcer. Due to the significant thecal compression at the C5-C6 level, and the partial improvement in upper limbs power, we suspected a possible ongoing dynamic cord injury. The patient was planned for an anterior cervical discectomy and fusion at the C5-C6 level once the decubitus ulcer was managed. After a month, with the patient's pressure sore healed, a repeat magnetic resonance imaging cervico-dorsal spine showed a near-complete spontaneous regression of the C5-C6 PIVD.

Effect of Selected Group of Asanas on the Patients with Cervical Vertigo

One of the most prevalent issues among patients in their middle years is vertigo. The existence of so-called cervical vertigo among the different causes of dizziness is still debatable. Based on the research of cervical vertigo was once believed to be caused by aberrant input from cervical sympathetic nerves. Later studies discovered that sympathetic stimulation has no effect on cerebral blood flow. Some studies made the hypothesis that diseases of vertigo of cervical origin can be associated to aberrant sensory input from the damaged joint receptors of upper cervical areas. Additional research revealed that cervical intervertebral disc disease appears to be the source of cervical vertigo. According to recent studies, vertigo of cervical origin may be associated to the in growth of many Ruffini corpuscles into degenerative cervical discs. Generally, the symptoms of Vertigo are not visible at the initial time, some time people consider it as epilepsy or brain related disease, first of all, it is necessary to diagnose and treat it properly. Yoga is an alternative therapy for any kind of cervical related problems, in which some special Asanas like Bhujangasana, Dhanurasana, Makarasana, Ardhamatsyendrasana, Akaranadhanurasana and Pranayama such as NadiShodhan, Bhramari, and Udgeetha. Which is helpful in this type of pain, it has been seen from many studies that yoga may work as a shield for spinal card related problems.

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.

SeUneter: Channel attentive U-Net for instance segmentation of the cervical spine MRI medical image.

In recent years, cervical spondylosis has become one of the most common chronic diseases and has received much attention from the public. Magnetic resonance imaging (MRI) is the most widely used imaging modality for the diagnosis of degenerative cervical spondylosis. The manual identification and segmentation of the cervical spine on MRI makes it a laborious, time-consuming, and error-prone process. In this work, we collected a new dataset of 300 patients with a total of 600 cervical spine images in the MRI T2-weighted (T2W) modality for the first time, which included the cervical spine, intervertebral discs, spinal cord, and spinal canal information. A new instance segmentation approach called SeUneter was proposed for cervical spine segmentation. SeUneter expanded the depth of the network structure based on the original U-Net and added a channel attention module to the double convolution of the feature extraction. SeUneter could enhance the semantic information of the segmentation and weaken the characteristic information of non-segmentation to the screen for important feature channels in double convolution. In the meantime, to alleviate the over-fitting of the model under insufficient samples, the Cutout was used to crop the pixel information in the original image at random positions of a fixed size, and the number of training samples in the original data was increased. Prior knowledge of the data was used to optimize the segmentation results by a post-process to improve the segmentation performance. The mean of Intersection Over Union (mIOU) was calculated for the different categories, while the mean of the Dice similarity coefficient (mDSC) and mIOU were calculated to compare the segmentation results of different deep learning models for all categories. Compared with multiple models under the same experimental settings, our proposed SeUneter's performance was superior to U-Net, AttU-Net, UNet++, DeepLab-v3+, TransUNet, and Swin-Unet on the spinal cord with mIOU of 86.34% and the spinal canal with mIOU of 73.44%. The SeUneter matched or exceeded the performance of the aforementioned segmentation models when segmenting vertebral bodies or intervertebral discs. Among all models, SeUneter achieved the highest mIOU and mDSC of 82.73% and 90.66%, respectively, for the whole cervical spine.

Impact of extracellular matrix and collagen network properties on the cervical intervertebral disc response to physiological loads: A parametric study

Current intervertebral disc finite element models are hard to validate since they describe multi-physical phenomena and contain a huge number of material properties. This work aims to simplify numerical validation/identification studies by prioritizing the sensitivity of intervertebral disc behavior to mechanical properties. A 3D fiber-reinforced hyperelastic model of a C6-C7 intervertebral disc is used to carry out the parametric study. 10 parameters describing the extracellular matrix and the collagen network behaviors are included in the parametric study. The influence of varying these parameters on the disc response is estimated during physiological movements of the head, including compression, lateral bending, flexion, and axial rotation. The obtained results highlight the high sensitivity of the disc behavior to the stiffness of the annulus fibrosus extracellular matrix for all the studied loads with a relative increase in the disc apparent stiffness by 67% for compression and by 57% for axial rotation when the annulus stiffness increases from 0.4 to 2MPa. It is also shown that varying collagen network orientation, stiffness, and stiffening in the studied configuration range have a noticeable effect on rotational motions with a relative apparent stiffness difference reaching 6.8%, 10%, and 22%, respectively, in lateral bending. However, the collagen orientation does not affect disc response to axial load.

Disc Space Involvement in Cervical Spondylotic Myelopathy: A Prospective Study

Introduction: Cervical spondylotic myelopathy (CSM) most frequently occur in old age because of degenerative change in the cervical vertebrate, intervertebral disc, and hypertrophy of ligamentum flava that create pressure on the spinal cord. Cervical spondylotic myelopathy manifests as long-tract clinical findings in the upper and lower extremities caused by spinal cord compression. Cervical myelopathy is a clinical syndrome that may result from cervical spondylosis. When cervical myelopathy is a result of spondylosis, it is referred to as cervical spondylotic myelopathy. The study aimed to analyze the involvement of the disc space of the vertebral column in cervical spondylotic myelopathy. Methods: This study was carried out at the department of orthopaedics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study was conducted on 30 participants from March 2012 to September 2014. Result: Among the 30 cases, 24 (80%) cases were male and 6 (20%) cases were female. The age range was from 31-60 years. 15(50%) were manual workers, 12(40%) were sedentary workers and 3(10%) were housewives. the majority of the patients 15(50%) had suffered from the symptoms for 10 to 12 months. The most common level of myelopathy was the C5/6 level 13 (44.44%). Among the 30 patients, 27 (90%) cases were presented with myelopathy and the other 3(10%) cases were presented with myeloradiculopathy. Conclusion: Cervical spondylotic myelopathy is a progressive neurological disease that requires surgical intervention in most cases. In terms of interspace disc involvement, C5 C6 was the most frequent space which is 66.7%. C4 C5 and C6 C7 had the same frequency of involvement which was 10% indicating the second most common spaces concurrently.

Effect of "nape seven needles" on expression of hypoxia inducible factor-1α and Notch1 in cervical intervertebral disc degeneration rats

To observe the effect of "nape seven needles" on the expressions of hypoxia inducible factor-1α (HIF-1α) and Notch1 in cervical intervertebral disc of cervical disc degeneration (CDD) rats, so as to reveal its underlying mecha-nisms in improving CDD. SD male rats were randomly divided into normal, model, non-acupoint and nape seven needles groups, with 10 rats in each group. Staticdynamic imbalance method was used to establish CDD model. Rats in the nape se-ven needles group were treated with acupuncture at "Fengfu"(GV16), and bilateral "Fengchi"(GB20), "Wangu"(GB12) and "Tianzhu"(BL10), and rats in the non-acupoint group received acupuncture at the sham acupoints at the caudal tip and armpit, both for 20 min, 6 days a week for 4 weeks. After intervention, tilted plane test and spiral CT were used to assess the neck movement function and cervical degeneration degree of rats; immunohistochemistry was used to observe the protein expression levels of HIF-1α and Notch1 in cervical discs tissue; Western blot and real-time quantitative PCR were used to detect the protein and mRNA expression levels of HIF-1α and Notch1 in cervical discs tissue, respectively. After modeling, the cervical curvature was straightened, with narrowed intervertebral space, rough and hardened articular surface, osteophytes, and blurred articular space and articular process, which was relatively milder in the nape seven needles group. Compared with the normal group, the angle of tilted plane was significantly reduced (P<0.05), while cervical scores, HIF-1α mRNA expression level in cervical intervertebral disc tissue were significantly increased (P<0.05) in the model group. Compared with the model and the non-acupoint groups, cervical scores were significantly reduced (P<0.05), while the angle of tilted plane, HIF-1α and Notch1 positive expressions, HIF-1α mRNA expression level, Notch1 protein and mRNA expression levels in cervical intervertebral disc tissue were significantly increased (P<0.05) in the nape seven needles group. Acupuncture of "nape seven needles" can reduce the degree of cervical degeneration in rats, which was possibly associated with its effects in up-regulating the expressions of HIF-1α and Notch1 in cervical intervertebral disc tissue, promoting the proliferation and recovery of endogenous cells in nucleus pulposus.

The relationship between the flexor and extensor muscle areas and the presence and degree of intervertebral disc degeneration in the cervical region.

Background:This study aimed to investigate the relationship between the presence and degree of cervical intervertebral disc degeneration (IVDD) and the cervical region muscle areas.Methods:The magnetic resonance imaging (MRI) examination of the patients who were sent to our clinic for investigation of neck pain between 2019 and 2020 years were evaluated retrospectively. 143 Turkish women patients between 30 and 40 ages were examined in the study. The presence and degree of IVDD was evaluated for each patient. The areas of the cervical flexor and extensor paravertebral muscles were measured.Results:No cervical disc degeneration was present in 44 (30.76%) patients (grade 1). The cervical intervertebral disc degeneration was grade 2 in 28 (19.58%), grade-3 in 41 (28.67%), and grade 4 in 30 (20.97%) patients. In early stage degeneration (grade 2), an increase was observed in the area of all cervical paravertebral flexor and extensor muscles examined. As the degree of degeneration increased (grades 3 and 4), a decrease was observed in the areas of all muscles. Statistical significance was found for musculus (m) sternocleidomastoideus, m. levator scapulae, m. splenius capitis, m. semispinalis capitis, and m. multifidus muscles (P = .009, r = −0.261; P = .014, r = −0.248; P = .008, r = −0.267; P = .002, r = −0.307; P = .028, r = −0.222, respectively).Conclusions:IVDD is common in middle-aged females with neck pain. An increase in muscles areas is observed in the early stages of cervical disc degeneration but progressive decrease develops in all cervical paraspinal muscles areas as the degree of disc degeneration increases.

Early Locomotor Training in Tetraplegic Post-Surgical Dogs with Cervical Intervertebral Disc Disease.

Simple SummaryAcute cervical disk disease may result in tetraplegic dogs without the ability of sternal posture, which could result in aspiration pneumonia, hypoventilation and other complications. The main treatment approach is surgical, depending on the clinical sign’s severity, and early post-operative rehabilitation may also be considered, including in dogs with spinal hyperesthesia, through the implementation of locomotor training with specific guidelines in the first days after surgery. Locomotor training (LT) is task-specific repetitive training, with sensorimotor stimulation and intensive exercises that promote neuromuscular reorganization. This study aimed to observe if LT could be initiated safely in the first 3–15 days after surgery in tetraplegic C1–C5 IVDD—Hansen type I dogs. This prospective blinded clinical study was conducted at two rehabilitation centers in Portugal, with 114 grade 1 (MFS/OFS) dogs, divided by the presence of spinal hyperesthesia into the SHG (spinal hyperesthesia group) (n = 74) and the NSHG (non-spinal hyperesthesia group) (n = 40), evaluated in each time point for two weeks according to a neurorehabilitation checklist by three observers for inter-agreement relation. LT was safely applied with 62.3% of the OFS ≥ 11 within 15 days and of these, 32.4% achieved a OFS ≥ 13. There were no new cases of hyperesthesia in the NSHG and from the SHG all recovered. Comparing groups, a significant difference was observed in their ability to achieve ambulatory status (p < 0.001), between the presence of hyperesthesia and days until ambulation (p < 0.006) and in each time point (p < 0.001; R2 = 0.809). Early LT may be a safe treatment to be applied in the first 3 days on these dogs and spinal hyperesthesia should be important to the rehabilitation team. This study should be continued.

Biomechanical effect of age-related structural changes on cervical intervertebral disc: A finite element study.

Previous literature has investigated the biomechanical response of healthy and degenerative discs, but the biomechanical response of suboptimal healthy intervertebral discs received less attention. The purpose was to compare the biomechanical responses and risk of herniation of young healthy, suboptimal healthy, and degenerative intervertebral discs. A cervical spine model was established and validated using the finite element method. Suboptimal healthy, mildly, moderately, and severely degenerative disc models were developed. Disc height deformation, range of motion, intradiscal pressure, and von Mises stress in annulus fibrosus were analyzed by applying a moment of 4 Nm in flexion, extension, lateral bending, and axial rotation with 100 N compressive loads. Disc height deformation in young healthy, suboptimal healthy, mildly, moderately, and severely degenerative discs was 40%, 37%, 21%, 12%, and 8%, respectively. The decreasing order of the range of motion was young healthy spine > suboptimal healthy spine > mildly degenerative spine > moderately degenerative spine > severely degenerative spine. The mean stress of annulus ground substance in the suboptimal healthy disc was higher than in the young healthy disc. The mean stress of inter-lamellar matrix and annulus ground substance in moderately and severely degenerative discs was higher than in other discs. Age-related structural changes and degenerative changes increased the stiffness and reduced the elastic deformation of intervertebral discs. Decreased range of motion due to the effects of aging or degeneration on the intervertebral disc, may cause compensation of adjacent segments and lead to progressive degeneration of multiple segments. The effect of aging on the intervertebral disc increased the risk of annulus fibrosus damage from the biomechanical point of view. Moderately and severely degenerative discs may have a higher risk of herniation due to the higher risk of damage and layers separation of annulus fibrosus caused by increased stress in the annulus ground substance and inter-lamellar matrix.

Variability of Intradiscal Pressure During Cervical Spine Posterior-Anterior Mobilization: A Cadaveric Investigation

ObjectivesThe purpose of this study was to investigate in cadaveric specimens the reliability of measuring cervical intradiscal pressure (CIDP) and if posterior-anterior (PA) mobilizations targeting the cervical spine were associated with CIDP changes. MethodsCervical PA mobilizations were performed on the spinous processes of 7 (3 men, 4 women) cadaveric specimens using a servo-controlled linear actuator to provide 25N and 45N forces. CIDP measurements were performed at C4-5, C5-6, C6-7, and C7-T1 intervertebral discs (IVDs) using a fiberoptic catheter system that recorded CIDP for each IVD cervical segment. To assess CIDP measurement reliability, the intraclass correlation coefficient (ICC [3,k]) was calculated. Repeated measures Friedman analysis of variance assessed effect of cervical mobilizations on CIDP for before, during, and immediately after mobilization at 25N and 45N forces for each cervical IVD segment. ResultsAll CIDP measurements demonstrated excellent reliability (ICC >0.98). During the 25N mobilizations, the median CIDP varied from -0.12 to 0.91 (interquartile range, 5.22-5.36), while for 45N mobilizations the median ranged from -0.94 to 1.21 (interquartile range, -7.74 to 43.49). These changes were not statistically significant (P > .40) during 25N and 45N PA mobilizations, with the exception of C5-6 CIDP at 25N and 45N (P = .05 and .018, respectively). ConclusionThere was high CIDP variability between cadavers during and after mobilization. Mobilizations of 1 cervical vertebra resulted in both CIDP increase or decrease at adjacent and remote cervical IVD segments that were not consistent. Cervical PA mobilizations produced variable CIDP changes at adjacent and remote cervical segments in cadavers.