Cervical Root Compression Research Articles

CLINICAL CHARACTERISTICS AND MAGNETIC RESONANCE IMAGING IN CERVICAL CANAL STENOSIS

Objectives: This article aimed to evaluate the changes of magnetic resonance imaging in cervical canal stenosis and the concordance between clinical characteristics and magnetic resonance imaging results of cervical canal stenosis. Materials and methods: Descriptive cross-sectional studies of 55 consecutive patients with cervical canal stenosis on magnetic esonance imaging in Radiology department of Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital. Results: The mean age of the patients was 49.6 ± 11.2, the male:female ratio is 1.6:1. Age group 40-60 was highest ratio (67.3%). The cervical spine pain was the most common symptom of cervical canal stenosis. Abnormal reflexes of upper limb tendons were one of the more common symptoms (72.7%). The combined presentation of all three syndromes: cervical spine pain, cervical root compression, and cervical cord compression that were 54.5%. The cervical herniated disc (92.7%) is the most common cause of acquired cervical spinal stenosis. According to the Kang classification in 2011, grade 1 stenosis is 50.9%, grade 2 stenosis is 36.4% and grade 3 stenosis 12.7%. Patients with Kang’s grade 1 mostly present clinical characteristics of grade 0 myelopathy (66.7%). On the other hand, half of those with grade 2 stenosis had Nurick’s Grade 1, and all with grade 3 stenosis had Nurick’s Grade ≥ 2. Conclusion: The concordance between the cervical canal stenosis by Kang grading system and clinical symptoms by Nurick-score were more than average with Kappa = 0.58. Key words: magnetic resonance imaging, cervical spine pain, cervical canal stenosis.

THE ROLE OF MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS AND TREATMENT ORIENTATION OF CERVICAL SPINAL STENOSIS SYNDROMES

Objectives: To study on the magnetic resonance imaging (MRI) to diagnose the causes of cervical spinal stenosis and contribution to therapeutic orientations in cervical spinal stenosis patients. Materials and methods: Descriptive cross-sectional studies of 55 consecutive patients with cervical canal stenosis on magnetic resonance imaging in Radiology department of Hue University Hospital of Medicine and Pharmacy. Results: The mean age of the patients was 49.6 ± 11.2, and 61.8% of cases were males. Age group 40-60 was highest ratio (67.3%). The cervical spine pain was the most common symptom of cervical canal stenosis. Abnormal reflexes of upper limb tendons were one of the more common symptoms (72.7%). The combined presentation of all three syndromes: cervical spine pain, cervical root compression, and cervical cord compression that were 54.5%. The cervical herniated disc (92.7%) is the most common cause of acquired cervical spinal stenosis. According to classical classification of cervical spinal stenosis, 52.7% of patients with absolute stenosis and 47.3% of patients with relative stenosis. According to the Kang classification in 2011, grade 1 stenosis is 50.9%, grade 2 stenosis is 36.4% and grade 3 stenosis 12.7%. Conclusion: There was a concordance between the clinical presentation and imaging manifestation of cervical canal stenosis. The concordance between the cervical canal stenosis by Kang grading system and clinical symptoms by Nurickscore were more than average with Kappa = 0.58. Therefore, it is necessary to determine the grade of injury on magnetic resonance imaging in combination with clinical symptoms to choose a reasonable treatment method for patients with acquired cervical spinal stenosis. Key words: Magnetic resonance imaging, cervical spine pain, cervical canal stenosis

Arthroplasty-CervicalP001 - Double Crush Syndrome of the Vertebral Artery Loop and Foraminal Stenosis Causing Monoparesis

Introduction:To report a case of monoparesis caused by a vertebral artery (VA) anomaly and foraminal stenosis treated with microvascular decompression by the posterior approach.Material and Methods:A 51-year-old man was referred because of a 4-year history of progressive left shoulder pain refractory to other forms of treatment and a 7-month history of arm weakness. Clinical and radiologic evaluation showed an abnormally tortuous loop of left C5-6 cervical foramina with foraminal stenosis causing direct C6 nerve root compression.Results:Left posterior cervical C5-6 facetectomy and fusion was done to decompress the nerve root. The C6 nerve root was identified and well decompressed. The patient’s symptoms resolved after surgery, supporting the posterior decompression of a cervical nerve root compressed by a vertebral artery loop and stenosis for the relief of pain and weakness.Conclusion:Cervical root compression by an anomalous extracranial VA accompanied with foraminal stenosis is a rare cause of radiculopathy and weakness. The best management of such lesions combined with arterial compression and stenosis, is the posterior approach with bony and nerve root decompression.

Randomized Controlled Study of Percutaneous Epidural Neuroplasty Using Racz Catheter and Epidural Steroid Injection in Cervical Disc Disease

Background: The efficacy of lumbar percutaneous epidural neuroplasty (PEN) as a minimally invasive technique has been relatively well investigated, but the clinical effectiveness of cervical PEN (C-PEN) has yet to be established. Objective: The purpose of this study was to compare clinical outcomes between C-PEN and cervical epidural steroid injection (C-ESI). Study Design: Randomized control study. Setting: University hospital center. Methods: Eighty patients with neck pain from single level cervical disease with and without radiculopathy were included in this study. Patients were randomly assigned into 2 groups: C-PEN or C-ESI. Clinical outcomes were assessed according to Neck Disability Index (NDI) score and Visual Analog Scale (VAS) score for arm pain until 12 months after treatment. Results: All C-PEN and C-ESI groups showed better NDI recovery and greater reduction in VAS score at postoperative 6 months (P < 0.001). The C-PEN group demonstrated better NDI score at postoperative 6 months than the C-ESI group (P = 0.014), while there were no differences at 2, 4, and 12 months. Additionally, the C-PEN group showed lower VAS scores at all follow-up intervals compared to the C-ESI group (P < 0.050). Symptom relief was sustained for a significantly longer duration in the C-PEN group than in the C-ESI group (23.4 vs. 20.5 weeks, P < 0.001). Limitations: The follow-up period was relatively short with a small sample size, and the grade of cervical disc disease, root compression, and disc degeneration grade were could not considered in this study. Conclusions: C-PEN was superior to C-ESI in terms of better NDI recovery (at 6 months) and greater reduction in VAS score (until 12 months) in treating single level cervical disc herniation. Better outcomes with C-PEN may have been achieved via a more localized selective block in the epidural space closer to the dorsal root ganglion and ventral aspect of the nerve root. Key words: Cervical, cervical disc disease, pain management, percutaneous epidural neuroplasty, percutaneous adhesiolysis, epidural steroid injection

Sensory axonal dysfunction in cervical radiculopathy

ObjectiveThe aim of this study was to evaluate changes in sensory axonal excitability in the distal nerve in patients with cervical radiculopathy.MethodsThe patients were classified by the findings of cervical...

Clinical Predictors of EMG-confirmed Cervical and Lumbosacral Radiculopathy

Electromyography (EMG) for suspected cervical or lumbosacral root compression is often negative, producing expense and physical discomfort that could have been avoided. To improve patient selection for testing, we sought to identify clinical features that would accurately predict presence of radiculopathy on EMG. Adult patients consecutively evaluated for suspected cervical or lumbosacral root compression at an academic clinical neurophysiology laboratory were prospectively enrolled. Presence of clinical features suggesting root disease (neck or back pain, dermatomal pain or numbness, myotomal weakness, segmental reflex loss, and straight leg-raising) was recorded prior to testing. EMG examination to confirm root compression was conducted per standard protocols. Analysis was based on computation of sensitivity, specificity, predictive values, and accuracy. A total of 200 patients (55% male; mean age 46.4 years; 38% suspected of cervical and 62% of lumbosacral disease) were included. EMG evidence of root disease was detected in 31% of cervical and 62% of lumbosacral referrals. Dermatomal pain was the most sensitive, and segmental reflex loss and myotomal weakness the most specific individual predictors of root disease. Combined presence of dermatomal pain or numbness with segmental reflex loss and myotomal weakness approached specificities of 78% (lumbosacral disease) and 99% (cervical disease). In all cases, myotomal weakness was the most accurate predictor of root disease. The diverse symptoms and signs of cervical and lumbosacral root compression predict a positive electrodiagnosis of radiculopathy with varying degrees of accuracy, and may be used to guide patient selection for EMG testing.

Cervical Nucleoplasty Using Coblation Technology; Clinical Outcome

Background Although the standard treatment for cervical disc herniation is open discectomy with or without fusion, nucleoplasty offers a new technique with encouraging results in well-selected cases. Nucleoplasty is a minimally invasive technique that manages intradiscal herniation through energy-based removal of part of the nucleus pulposus. Objective To assess the safety and clinical outcome of nucleoplasty procedure in well-selected cases. Methods Coblation technology was used in 47 cases that had symptoms of cervical root compression or pain owing to contained disc herniation or focal protrusion. Clinical outcome was assessed through visual analogue scale and neck disability index questionnaire for 24 months. The procedure was carried out through an anterior approach and in most cases with local anesthesia. Results According to visual analogue scale, 72% of patients had complete resolution of symptoms 1 month postoperatively. After 3 months, 83% of patients had complete resolution and at 6 month, 79% of patients had complete resolution and this result was the same during follow-up. Regarding neck disability index questionnaire, 30 patients (63.8%) showed significant improvement, whereas (19%) showed moderate improvement at 1 month. Five patients (10.6%) did not show improvement, whereas 6.3% showed deterioration of their abilities. At 3 months, 76.6% showed significant improvement. Conclusion Nucleoplasty does not require general anesthesia, offers less morbidity and shortens recovery time. Contained herniated disc or focal protrusion is the most important inclusion criteria. This technique is a promising tool in well-selected cases.

Intracranial iohexol-distribution following cervical myelography, postmyelographic registration of adverse effects, psychometric assessment and electroencephalographic recording

Cervical myelography (CM) was taken from 14 cases with cervical root-compression symptoms. Prior to myelography, there was complete cranial CT registration to assess the subarachnoid, intraventricular, subcortical and periventricular densities. Control scans at 3,6,24 and 48 h following myelography disclosed intracranial contrast medium at level of basal cisterns, the fourth ventricle and fissura Sylvii. Nine and 11 patients, respectively, had enhancement in the third and lateral ventricles. All patients had subcortical enhancement, and 9 patients had periventricular enhancement; at the 3-h control CT after myelography a minor subcortical edema was disclosed, which declined during the following hours. Two days after myelography, a minimal residual contrast was disclosed subcortically at the level of fissura Sylvii and in the subarachnoid space at the level of fissura Sylvii and the convexity. Hence, we recommend, that diagnostic cranial CT is performed before or postponed until 3 days after cervical myelography. The patients were questioned about adverse effects, and they underwent psychometric assessment and EEG-recordings: 11 had adverse effects, chiefly mild and exclusively transient, without sequelae. Three patients had no side effect. The psychometric assessment, however, disclosed pronounced deterioration in all patients at test 28 h after myelography, especially marked in the verbal paired associates test, however these disturbances were totally absent at retest one week later. No EEG-abnormalities developed; consistently, no patient had seizures. In conclusion, following CM iohexol is taken up by the brain parenchyma, gradually disappearing within 48 h, during which time a brain CT will be disturbed. During the same period some deterioration of psychometric tests may be found.

Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review

Degenerative cervical radiculopathy: clinical diagnosis and conservative treatment. A review. To provide a state-of-the-art assessment of diagnosis and non-surgical treatment of degenerative cervical radiculopathy a literature search for studies on epidemiology, diagnosis including electrophysiological examination and imaging studies, and different types of conservative treatment was undertaken. The most common causes of cervical root compression are spondylarthrosis and disc herniation. Diagnosis is made mainly on clinical grounds, although there are no well-defined criteria. Provocative tests like the foraminal compression test are widely used but not properly evaluated. The clinical diagnosis of degenerative cervical radiculopathy can be confirmed by magnetic resonance imaging. The role of electromyography is mainly to rule out other conditions. Cervical radiculopathy is initially treated conservatively, although no treatment modality has been evaluated in a randomized controlled trial. Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review.

Is It Useful to Stimulate Roots in the Diagnosis of Cervical Root Compression?

Electrophysiology can be very important in diagnosing root pathologies, but the classic electrophysiologic methods lack an objective measurement tool. In this study, diagnostic validity of cervical spinal root stimulation (CRS) was evaluated in patients with suspected cervical radiculopathy. CRS, conventional needle electromyography, and magnetic resonance imaging were performed in 14 patients. The control group included 10 healthy individuals. A monopolar needle electrode was used for the CRS. Compound muscle action potentials were recorded from biceps, triceps, and abductor digiti minimi muscles. Thirty root pairs in the control group and 40 root pairs in the patient group were stimulated. Latencies and amplitudes of the compound muscle action potentials were found abnormal in 5 (35.7%) and 10 (71.4%) patients, respectively. Electromyographic findings of root compression were seen in 10 patients (71.4%). The CRS results were positive in 7 out of 10 patients with positive electromyography findings of root dysfunction. Our results suggest that CRS may be a complementary diagnostic tool. Technical difficulties and lack of reference data make its use difficult as a routine electrophysiologic test for diagnosing nerve root dysfunction.

Assessment of Forearm Pronation Strength in C6 and C7 Radiculopathies

Consecutive case series of patients with C6 and C7 radiculopathies. To explore the clinical utility and reliability of manual muscle testing of forearm pronation strength in C6 and C7 radiculopathies. EMG evidence of denervation of the pronator teres was the most common finding in C6 radiculopathies, and frequently present in C7 radiculopathies. Clinical evaluation of the pronator teres through manual muscle testing of forearm pronation has never been explored; therefore, its clinical utility is unknown as compared with the muscle groups that are traditionally evaluated. Fifty-five subjects with diagnostic imaging evidence of either C6 (n = 25) or C7 (n = 30) cervical root compression and clinical symptoms consistent with cervical radiculopathy were recruited for this study. These subjects underwent manual muscle testing of forearm pronation, wrist extension, elbow flexion, and elbow extension. The frequency of impaired strength was recorded and compared for C6 and C7 radiculopathies. A second examiner evaluated each subject, with his or her findings compared with the first examiner only for the determination of interrater reliability. In C6 radiculopathy subjects, forearm pronation weakness was present in 72%, was twice as common as wrist extension weakness, was present in all cases where elbow flexion or wrist extension weakness was noted, and was found in all but 2 subjects where elbow extension weakness was present. In C7 radiculopathy subjects, forearm pronation weakness accompanies elbow extension weakness in 23% of subjects and was the only weakness in 10% of subjects. Manual muscle testing demonstrated adequate interrater reliability. Forearm pronation weakness is the most frequent motor finding in C6 radiculopathies and may be noted is some cases of C7 nerve root compression.

Headache in patients with cervical radiculopathy: a prospective study with selective nerve root blocks in 275 patients.

Since many years we routinely use diagnostic selective nerve root blocks (SNRB) at our department when evaluating patients with cervical radiculopathy. Frequently patients who also presented with headache reported that the headache disappeared when the nerve root responsible for the radicular pain was blocked with local anaesthetics. Headache has been described as a companioning symptom related to cervical radiculopathy but has never before been evaluated with SNRB performed in the lower cervical spine. For this reason we added to our routine an evaluation of the response from the SNRB on headache in patients with cervical radiculopathy. The aim was to describe the frequency of headache in patients with cervical radiculopathy and its response to a selective nerve root block of the nerve root/roots responsible for the radiculopathy. Can nerve root compression in the lower cervical spine produce headache? In this consecutive series of 275 patients with cervical radiculopathy, 161 patients reported that they also suffered from daily or recurrent headache located most often unilaterally on the same side as the radiculopathy. All patients underwent a careful clinical examination by a neurosurgeon and a MRI of the cervical spine. The significantly compressed root/roots, according to the MRI, underwent SNRB with a local anaesthetic. The effect of the nerve root block on the radiculopathy and the headache was carefully noted and evaluated by a physiotherapist using visual analogue scales (VAS) before and after the SNRB. All patients with headache had tender points in the neck/shoulder region on the affected side. Patients with headache graded significantly more limitations in daily activities and higher pain intensity in the neck/shoulder/arm than patients without headache. After selective nerve root block, 59% of the patients with headache reported 50% or more reduction of headache and of these 69% reported total relief. A significant correlation was seen between reduced headache intensity and reduced pain in the neck, shoulder and arm. The result indicates that cervical root compression from degenerative disease in the lower cervical spine producing radiculopathy might also induce headache.

Distress triggered cervical root compression pain by looped vertebral artery

Distress triggered cervical root compression pain by looped vertebral artery

Minimally Invasive Cervical Microendoscopic Foraminotomy: An Initial Clinical Experience

We have previously reported the feasibility of using the microendoscopic foraminotomy (MEF) technique in a cadaveric study. We now report our initial clinical experience with this novel technique. From March 1998 to January 2001, we prospectively used the MEF technique in 25 patients with cervical root compression from either foraminal stenosis or disc herniation. The patients' demographic, clinical presentation, surgical, and outcome data were recorded. Another 26 patients treated via open cervical laminoforaminotomy were used for comparison. MEF cases involved less blood loss (138 versus 246 ml per level). MEF patients recovered more rapidly, had a shorter postoperative stay (20 versus 68 hours), and needed fewer narcotics (11 versus 40 equivalents). There were two durotomies after MEF. Overall, our initial experience with the MEF procedure yielded symptomatic improvement for approximately 87 to 92% of patients, depending on which symptom was analyzed. After MEF (mean follow-up, 16 mo; minimum follow-up, 1 year), patients with radiculopathy experienced resolution of their symptoms in 54%, improvement in 38%, and no change in 8% of cases. For open surgery, radiculopathy resolved in 48%, improved in 40%, and remained unchanged in 12%. For neck pain, the MEF results were 40% resolved, 47% improved, and 13% unchanged. Open results for neck pain were 33% resolved, 56% improved, and 11% unchanged. Overall, there was no significant difference in outcomes between the groups. The MEF technique yielded clinical results equivalent to those of the open surgical group as well as to those described in the literature. MEF patients, however, had less blood loss, shorter hospitalizations, and a much lower postoperative pain medication requirement.

The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine.

An anatomic study of the cervical intervertebral foramina, nerve roots, and intradural rootlets performed using a surgical microscope. To investigate the anatomy of cervical root compression, and to obtain the anatomic findings related to cervical foraminotomy for the treatment of cervical radiculopathy. Cervical foraminotomy is a procedure performed frequently for the management of cervical radiculopathy. However, anatomic studies of cervical foraminotomy have not been fully elucidated. In this study, 18 cadavers were obtained for the study of the cervical spine. All the soft tissues were dissected from the cervical spine. Thereafter, laminectomy and facetectomy were performed on C4 through T1 using a surgical microscope. The nerve roots and surrounding anatomic structures, including intervertebral discs and foramina, were exposed. In addition, the intradural rootlets and their intersegmental connections were observed. The shape of the intervertebral foramina approximated a funnel, the entrance zone being the most narrow part and the root sleeves conical, with their takeoff points from the central dural sac being the largest part. Therefore, compression of the nerve roots occurred at the entrance zone of the intervertebral foramina. Anteriorly, compression of the nerve roots was caused by protruding discs and osteophytes of the uncovertebral region, whereas the superior articular process, the ligamentum flavum, and the periradicular fibrous tissues affected the nerve posteriorly. The C5 nerve roots were found to exit over the middle aspect of the intervertebral disc, whereas the C6 and C7 nerve roots were found to traverse the proximal part of the disc. The C8 nerve roots had little overlap with the C7-T1 disc in the intervertebral foramen. The C6 and C7 rootlets passed two disc levels in the dural sac. Also, a high incidence of the intradural connections between the dorsal rootlets of C5, C6, and C7 segments was found. This study demonstrated the anatomy of the nerve roots, rootlets, and intervertebral foramina, and may aid in understanding the pathology of cervical radiculopathy. The presence of intradural connections between dorsal nerve roots and the relation between the course of the nerve root and the intervertebral disc may explain the clinical variation of symptoms resulting from-nerve root compression in the cervical spine. To perform cervical foraminotomy for cervical radiculopathy, it is necessary to understand the detailed anatomy of the intervertebral foramina thoroughly.

Cervical root compression monitoring by flexor carpi radialis H-reflex in healthy subjects.

One-group, pretest-postest experimental research with repeated measures. To determine the effect of head postural modification on the flexor carpi radialis H-reflex in healthy subjects. H-reflex testing has been reported to be useful in evaluating and treating patients with lumbosacral and cervical radiculopathy. The idea behind this technique is that postural modification can cause further H-reflex inhibition, indicating more compression of the impinged nerve root, or recovery, indicating decompression of the root. Such assumptions cannot be supported unless the influence of normal head postural modification on the H-reflex in healthy subjects is studied. Twenty-two healthy subjects participated in this study (14 men, 8 women; mean age, 39 +/- 9 years). The median nerve of the subjects at the cubital fossa was electrically stimulated (0.5 msec; 0.2 pulses per second [pps] at H-max), whereas the flexor carpi radialis muscle H-reflex was recorded by electromyography. The H-reflexes were recorded after the subject randomly maintained the end range of head-forward flexion, backward extension, rotation to the right and the left, lateral bending to the right and the left, retraction and protraction. These were compared with the H-reflex recorded during comfortable neutral positions. Data were recorded after the subject maintained the position for 30 seconds, to avoid the effect of dynamic postural modification on the H-reflex. Four traces were recorded in each position. During recording, the H-reflex was monitored by the M-response to avoid any changes in the stimulation-recording condition. Repeated multivariate analysis of variance was used to evaluate the significance of the difference among the H-reflex, amplitude, and latency, in various head positions. The H-reflex amplitude showed statistically significant changes (P < 0.001) with head postural modification. All head positions, except flexion, facilitated the H-reflex. Extension, lateral bending, and rotation toward the side of the recording produced higher reflex facilitation than the other positions. These results indicate that H-reflex changes may be caused by spinal root compression-decompression mechanisms. It may also indicate that relative spinal root decompression occurs in most head-neck postures except forward flexion. Head postural modification significantly influences the H-reflex amplitude but not the latency. This indicates that the H-reflex is a more sensitive predictor of normal physiologic changes than are latencies. The H-reflex modulation in various head positions may be-caused by relative spinal root compression-decompression mechanisms.

NECK RETRACTION INCREASED CERVICAL H-REFLEX AND DECREASED NECK PAIN.

1392 Neck exercises are the central treatment protocol for patients with neck pain. Extension, flexion or retraction movements have been prescribed based on patients self report of pain. The purpose of this study was to evaluate the use of the flexor carpi radialis (FCR) H-reflex in determining cervical root compression and decompression during neck retraction and correlate the finding with neck pain. Twelve subjects (20-40y) with confirmed symptoms of neck pain for more than 6 months volunteered for the study. The FCR H-reflex was elicited by electrical stimulation of the median nerve at the cubital fossa(0.5 ms., 0.2 pps at H-max) using bipolar surface electrodes. Signal was recorded from the FCR muscle using 500-2000 gain and 10-10,000 Hz bandpass. Pain intensity of the neck (evaluated by visual analog scale) and the H-reflex were recorded before and after A-upright sitting, B- 20min of reading and C- 20 repetitions of neck retractions. The peak to peak amplitude and the deflection latency were measured and averaged for 4 reflex representations. One way ANOVA and Spearman correlation were used for statistics. Results showed significant decrease in the H-reflex amplitude after reading and significant increase after neck retractions (p<0.001). No measurable changes were recorded in the H-reflex latency (p<0.34). Neck pain intensity was significantly increased after reading and decreased after neck retraction(p<0.001). Changes in the H-reflex amplitude and pain intensity during different testing conditions were strongly correlated (r=0.85- -0.82). These results imply a cervical root decompression during neck retractions and suggest it for effective therapy. They also confirm the objective utility of the FCR H-reflex for on line evaluation of patients with neck pain.

Clinical signs in patients with brachialgia and sciatica: A comparative study

The aim of the study was to compare the clinical signs of patients with cervical and lumbar root affections. From January 1994 to January 1995, we performed a prospective study on 395 patients. The study comprised 93 patients with a cervical and 302 patients with a lumbar root affection. 338 patients underwent surgery. General data, case histories, and neurological findings were analyzed. The patients with brachialgia had a nonradicular pain radiation in 67%, the patients with sciatica only in 35%. All other data showed no significant differences. The investigation also shows that a radicular pain radiation is significantly correlated with an unequivocal radicular deficit. In particular, the patients with a cervical radicular pain radiation had a highly significant incidence of a radicular neurological deficit. We could demonstrate in this prospective study that only about one third of the patients with a cervical root affection showed an unequivocal radicular pain radiation. This contradicts the traditional medical textbook concept of a cervical root compression syndrome. This difference in respect of the clinical signs of lumbar and cervical root compressions might be explained by the anatomical variations of cervical root anastomoses. To determine the affected cervical root level, further investigation of the myotomes is recommended.

Effects of Different Treatments on Postural Performance in Patients with Cervical Root Compression1

Patients with cervical root compression were used as a "model" to investigate the possible importance of neck disorders and cervical sensory information in postural control. We assessed postural performance with posturography before and after treatment in 71 consecutive patients with MRI-verified cervical root compression without medullary compression. The patients were randomized to surgery (n = 22), physiotherapy (n = 24) or treatment with cervical collars (n = 25). There were no differences in postural performance or pain intensity between the groups before treatment. After treatment, the surgery group manifested significant improved postural performance and reduced neck pain scores, as compared to the two conservative treatment groups, and their postural performance had improved to the same level manifested by healthy controls. The conservative treatment groups manifested no consistent significant changes in postural performance or pain scores. Decreased muscular tension due to reduction of cervical pain after surgery and normalization of cervical proprioception are suggested as possible explanations of the improved postural control.

Cervical Chymopapain Nucleolysis: MR Imaging Assessment of Chymopapain Efficacy

Soft cervical disc herniations can be treated by minimally invasive procedures with excellent results. Chemonucleolysis with chymopapain is one alternative to surgery that is shown to be innocuous within a strict technical framework. MR imaging allows an accurate diagnosis of the cause of cervical root compression, thus facilitating the choice of conventional surgery or minimally invasive procedures.