Cervical Spondylosis Patients Research Articles

Meta-analysis of resting-state fMRI in cervical spondylosis patients using AES-SDM.

Resting-state functional magnetic resonance imaging (rs-fMRI) reveals diverse neural activity patterns in cervical spondylosis (CS) patients. However, the reported results are inconsistent. Therefore, our objective was to conduct a meta-analysis to synthesize the findings from existing rs-fMRI studies and identify consistent patterns of neural brain activity alterations in patients with CS. A systematic search was conducted across PubMed, Web of Knowledge, Embase, Google Scholar, and CNKI for rs-fMRI studies that compared CS patients with healthy controls (HCs), up to January 28, 2024. Significant cluster coordinates were extracted for comprehensive analysis. We included 16 studies involving 554 CS patients and 488 HCs. CS patients demonstrated decreased brain function in the right superior temporal gyrus and left postcentral gyrus, and increased function in the left superior frontal gyrus. Jackknife sensitivity analysis validated the robustness of these findings, and Egger's test confirmed the absence of significant publication bias (p > 0.05). Meta-regression showed no significant impact of age or disease duration differences on the results. This meta-analysis confirms consistent alterations in specific brain regions in CS patients, highlighting the potential of rs-fMRI to refine diagnostic and therapeutic strategies. https://www.crd.york.ac.uk/prospero/, identifier CRD42024496263.

Efficacy Comparison of Osteopathic Muscle Energy Techniques and Cervical Mobilization on Pain, Disability, and Proprioception in Cervical Spondylosis Patients.

BACKGROUND Cervical spondylosis (CS) is a degenerative disease of the cervical spine characterized by persistent neck pain. Cervical facet joint mobilization (CM) and the osteopathic muscle energy technique (MET) are effective manual procedures for the treatment of neck pain. In this study, we compared the efficacy of the MET and CM techniques on pain, disability, and proprioception in 76 patients with CS. MATERIAL AND METHODS A total of 96 participants with a diagnosis of CS were randomized into an electro-thermal therapy (ET) group (control group, n=32), ET+MET group (experiment I, n=32), and ET+CM group (experiment II, n=32). All patients received 3 treatment sessions per week for 4 consecutive weeks. Pain intensity, functional disability and cervical position sense were measured using the visual analog scale (VAS), Copenhagen Neck Functional Disability Scale (CNFDS), and cervical range of motion (CROM) device. RESULTS The study was completed by 76 participants. VAS and CNFDS scores decreased significantly after treatment in all 3 groups (P<0.001); however, there was no significant difference between the groups (P>0.05). Between-group analysis showed a significant difference in extension joint position error in favor of MET (P<0.001), while there was no significant difference between the groups in other movement directions (P>0.05). CONCLUSIONS MET and CM have similar effects on improving pain and disability in individuals with CS and chronic neck pain. However, the results of this study show that MET combined with ET is a more effective method for improving cervical position sense.

Comparative Evaluation of Neck Length, Relative Neck Length and Total Body Height in Cervical Spondylosis Affected and Non-Affected Individual

Anthropometric measurements, including neck length, relative neck length and total body height, have been proposed as potential indicators of cervical spine health, yet their association with cervical spondylosis remains relatively understudied. Objective: To compare neck length, relative neck length, and total body height between individuals affected by cervical spondylosis and a non-affected control group. Methods: This case-control study was conducted at Department of Anatomy Multan Medical and Dental College (MMDC), Multan from April 2023 to September 2023. Cases were diagnosed with cervical spondylosis and controls were selected from the same population without a history of cervical spine pathology or symptoms. The collected data were analyzed using IBM SPSS, version 27.0. Results: Gender distribution revealed females in both cases (63, 60.6%) and controls (59, 56.7%). The age of participants ranged from 25 to 75 years. The mean age for cases was 49.2 ± 12.93 years and for controls was 49.7 ± 13.19 years. The mean neck length among cases and controls was 105.2 ± 17.22 mm and 107.7 ± 20.02 mm, respectively. Regarding relative neck length, cases and controls exhibited measurements of 6.41 ± 1.07 mm and 6.42 ± 1.27 mm, respectively. Height-wise, cases measured 164.4 ± 10.27 cm, while controls measured 168.3 ± 8.53 cm. Conclusions: In conclusion, while no significant differences were observed in neck length or relative neck length between cervical spondylosis patients and controls, a notable disparity in height was noted.

Zero-profile implant system versus novel plate systems after ACDF for comparison of sagittal balance parameters and clinical efficacy analysis

BackgroundThe zero-profile implant system (Zero-P) and conventional plates have been widely used in anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis. The purpose of this study was to compare the effects of the application of Zero-P and new conventional plates (ZEVO, Skyline) in ACDF on the sagittal imaging parameters of cervical spondylosis patients and to analyze their clinical efficacy.MethodsWe conducted a retrospective study on 119 cervical spondylosis patients from January 2018 to December 2021, comparing outcomes between those receiving the Zero-P device (n = 63) and those receiving a novel conventional plate (n = 56, including 46 ZEVO and 10 Skyline plates) through ACDF. Cervical sagittal alignment was assessed pre- and postoperatively via lateral radiographs. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were recorded at baseline, after surgery, and at the 2-year follow-up to evaluate patient recovery and intervention success.ResultsThere were significant differences in the postoperative C0-C2 Cobb angle and postoperative sagittal segmental angle (SSA) between patients in the novel conventional plate group and those in the Zero-P group (P < 0.05). Postoperatively, there were significant changes in the C2‒C7 Cobb angle, C0‒C2 Cobb angle, SSA, and average surgical disc height (ASDH) compared to the preoperative values in both patient groups (P < 0.05). Dysphagia in the immediate postoperative period was lower in the Zero-P group than in the new conventional plate group (0% in the Zero-P group, 7.14% in the novel conventional plate group, P = 0.046), and the symptoms disappeared within 2 years in both groups. There was no statistically significant difference between the two groups in terms of complications of adjacent spondylolisthesis (ASD) at 2 years postoperatively (3.17% in the Zero-P group, 8.93% in the novel conventional plate group; P = 0.252). According to the subgroup analysis, there were significant differences in the postoperative C2‒C7 Cobb angle, C0‒C2 Cobb angle, T1 slope, and ASDH between the ZEVO group and the Skyline group (P < 0.05). Compared with the preoperative scores, the JOA, NDI, and VAS scores of all groups significantly improved at the 2-year follow-up (P < 0.01). According to the subgroup analysis, the immediate postoperative NDI and VAS scores of the ZEVO group were significantly better than those of the Skyline group (P < 0.05).ConclusionIn ACDF, both novel conventional plates and Zero-P can improve sagittal parameters and related scale scores. Compared to the Zero-P plate, the novel conventional plate has a greater advantage in correcting the curvature of the surgical segment, but the Zero-P plate is less likely to produce postoperative dysphagia.

Prediction of additional hospital days in patients undergoing cervical spine surgery with machine learning methods

Background Machine learning (ML), a subset of artificial intelligence (AI), uses algorithms to analyze data and predict outcomes without extensive human intervention. In healthcare, ML is gaining attention for enhancing patient outcomes. This study focuses on predicting additional hospital days (AHD) for patients with cervical spondylosis (CS), a condition affecting the cervical spine. The research aims to develop an ML-based nomogram model analyzing clinical and demographic factors to estimate hospital length of stay (LOS). Accurate AHD predictions enable efficient resource allocation, improved patient care, and potential cost reduction in healthcare. Methods The study selected CS patients undergoing cervical spine surgery and investigated their medical data. A total of 945 patients were recruited, with 570 males and 375 females. The mean number of LOS calculated for the total sample was 8.64 ± 3.7 days. A LOS equal to or <8.64 days was categorized as the AHD-negative group (n = 539), and a LOS > 8.64 days comprised the AHD-positive group (n = 406). The collected data was randomly divided into training and validation cohorts using a 7:3 ratio. The parameters included their general conditions, chronic diseases, preoperative clinical scores, and preoperative radiographic data including ossification of the anterior longitudinal ligament (OALL), ossification of the posterior longitudinal ligament (OPLL), cervical instability and magnetic resonance imaging T2-weighted imaging high signal (MRI T2WIHS), operative indicators and complications. ML-based models like Lasso regression, random forest (RF), and support vector machine (SVM) recursive feature elimination (SVM-RFE) were developed for predicting AHD-related risk factors. The intersections of the variables screened by the aforementioned algorithms were utilized to construct a nomogram model for predicting AHD in patients. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve and C-index were used to evaluate the performance of the nomogram. Calibration curve and decision curve analysis (DCA) were performed to test the calibration performance and clinical utility. Results For these participants, 25 statistically significant parameters were identified as risk factors for AHD. Among these, nine factors were obtained as the intersection factors of these three ML algorithms and were used to develop a nomogram model. These factors were gender, age, body mass index (BMI), American Spinal Injury Association (ASIA) scores, magnetic resonance imaging T2-weighted imaging high signal (MRI T2WIHS), operated segment, intraoperative bleeding volume, the volume of drainage, and diabetes. After model validation, the AUC was 0.753 in the training cohort and 0.777 in the validation cohort. The calibration curve exhibited a satisfactory agreement between the nomogram predictions and actual probabilities. The C-index was 0.788 (95% confidence interval: 0.73214–0.84386). On the decision curve analysis (DCA), the threshold probability of the nomogram ranged from 1 to 99% (training cohort) and 1 to 75% (validation cohort). Conclusion We successfully developed an ML model for predicting AHD in patients undergoing cervical spine surgery, showcasing its potential to support clinicians in AHD identification and enhance perioperative treatment strategies.

Effects of Shoulder Exercises with and Without Cervical Exercises on Pain and Function in the Patients with Cervical Spondylosis: Randomized Controlled Trial

Background: Cervical spondylosis is a chronic, degenerative, progressive disease of osteocartilagenous component of cervical spine that is usually age related and more common in men than in women, with a peak incidence between the ages of 40 and 60 years for both men and women.Objective: The aim of the study is to determine effects of shoulder exercises with and without cervical exercises on pain and function in patients with cervical spondylosis.Methods: Sixty eight diagnosed cervical spondylosis patients with 30-60 years of age were selected and randomly allocated in experimental and control groups, 34 in each group. The study was conducted in the physical therapy department of WAPDA hospital, Lahore. All participants were following the 6 weeks supervised exercise program, 4 sessions per week. Experimental group received shoulder exercises with cervical exercises while the control group received cervical exercises. Clinical outcomes were measured with visual analog scale for pain and neck disability index for function.Results: Analysis of final 61 patients were included, 31 in experimental and 30 in control (3 and 4 patients did not follow the study completely). Mean aged for experimental and control group was 49.39 ±7.022 and 49.23 ±6.704 respectively. Results showed that there was statically and clinically significance difference that as observed in from of reduction of pain P=0.001 and improvement of function P= 0.01Conclusion: Overall improvement was observed in both groups, results of study shows that shoulder exercises with cervical isometric exercises were more beneficial for outcomes of pain and function in experimental group. So we can conclude that shoulder exercise should be an integral part of treatment for cervical spondylosis patients.

A COMPARATIVE CLINICAL STUDY ON AGNIKARMA, NIRGUNDYADI UPANAHA, AND SHEPHALIKA KWATHA IN MANAGING GREEVA SANDHI-GATA VATA WITH RESPECT TO CERVICAL SPONDYLOSIS.

Greevasandhigata Vata is a form of Vata Vyadhi caused by the interference or entrance of vitiated Vata in Greeva Sandhi, leading to symptoms like Sandhishoola (pain in joint), Sandhishopa (sweeling in joint), Prasaran Aakunchnayo Pravariticha Savedana (restricted movement of joint) etc. Cervical Spondylosis is one of the leading disorders in older adults caused by degenerative changes in cervical spine vertebrae and causing symptoms like pain &amp; restricted joint movement, etc., in the neck, which further leads to the struggle of the patients to fulfil their daily routine work. Patients of Cervical spondylosis, are bound to choose analgesics, anti-inflammatory drugs, steroid injections and physiotherapy as conservative treatments to improve their quality of life. In the advanced stage, surgical treatments like spinal fusion, spinal decompression, etc., are the only options. However, these procedures do not fulfil the goal of patients because of the very high cost and therapeutic limitations. Even after surgery, patients have to take analgesics for longer duration. These drugs are also not free from adverse effects like gastritis, hyperacidity, nephrotoxicity, etc. Treatment modalities like Agnikarma, Nirgundyadi Upanaha and Shephalika Kwatha are the non-pharmacological and result oriented therapies, recommended in Ayurveda for such type of disease condition. These are proven to be Vatashamaka &amp; Vedanashamaka in various contexts.

Standardizing Continuous Physical Activity Monitoring in Patients with Cervical Spondylosis.

Prospective cohort study. To use a commercial wearable device to measure real-life, continuous physical activity in patients with CS and to establish age-adjusted and sex-adjusted standardized scores. Patients with cervical spondylosis (CS) often present with pain or neurologic deficits that result in functional limitations and inactivity. However, little is known regarding the influence of CS on the patient's real-life physical activity. This study included 100 English-speaking adult patients with cervical degenerative diseases undergoing elective spine surgery at Stanford University who owned iPhones. Patients undergoing surgery for spine infections, trauma, tumors, or lumbar degenerative disease were excluded. Activity two weeks before surgery was expressed as raw daily step counts. Standardized z-scores were calculated based on age-specific and sex-specific values of a control population. Responses to patient-reported outcome measures (PROMs) surveys assessed convergent validity. Functional impairment was categorized based on predetermined z-score cut-off values. Thirty CS with a mean (±SD) age of 56.0 (±13.4) y wore an Apple Watch for ≥8 hours/day in 87.1% of the days. The mean watch wear time was 15.7 (±4.2) hours/day, and the mean daily step count was 6400 (±3792). There was no significant difference in activity between 13 patients (43%) with myelopathy and 17 (57%) without myelopathy. Test-retest reliability between wearable step count measurements was excellent (ICC β=0.95). Physical activity showed a moderate positive correlation with 36-Item Short Form Survey Physical Component Summary, EuroQol-5-dimension visual analog scale, and Patient-Reported Outcomes Measurement Information System Physical Function Subscale. Activity performance was classified into categories of "no impairment" [step count=9640 (±2,412)], "mild impairment" [6054(±816)], "moderate impairment" [3,481 (±752)], and "severe impairment" [1,619 (±240)]. CS patients' physical activity is significantly lower than the general population or the frequently stated goals of 7000 to 10,000 steps/day. Standardized, continuous wearable physical activity monitoring in CS is a reliable, valid, and normalized outcome tool that may help characterize functional impairment before and after spinal interventions.

Abnormalities of brain structure and function in cervical spondylosis: a multi-modal voxel-based meta-analysis.

Previous neuroimaging studies have revealed structural and functional brain abnormalities in patients with cervical spondylosis (CS). However, the results are divergent and inconsistent. Therefore, the present study conducted a multi-modal meta-analysis to investigate the consistent structural and functional brain alterations in CS patients. A comprehensive literature search was conducted in five databases to retrieve relevant resting-state functional magnetic resonance imaging (rs-fMRI), structural MRI and diffusion tensor imaging (DTI) studies that measured brain functional and structural differences between CS patients and healthy controls (HCs). Separate and multimodal meta-analyses were implemented, respectively, by employing Anisotropic Effect-size Signed Differential Mapping software. 13 rs-fMRI studies that used regional homogeneity, amplitude of low-frequency fluctuations (ALFF) and fractional ALFF, seven voxel-based morphometry (VBM) studies and one DTI study were finally included in the present research. However, no studies on surface-based morphometry (SBM) analysis were included in this research. Due to the insufficient number of SBM and DTI studies, only rs-fMRI and VBM meta-analyses were conducted. The results of rs-fMRI meta-analysis showed that compared to HCs, CS patients demonstrated decreased regional spontaneous brain activities in the right lingual gyrus, right middle temporal gyrus (MTG), left inferior parietal gyrus and right postcentral gyrus (PoCG), while increased activities in the right medial superior frontal gyrus, bilateral middle frontal gyrus and right precuneus. VBM meta-analysis detected increased GMV in the right superior temporal gyrus (STG) and right paracentral lobule (PCL), while decreased GMV in the left supplementary motor area and left MTG in CS patients. The multi-modal meta-analysis revealed increased GMV together with decreased regional spontaneous brain activity in the left PoCG, right STG and PCL among CS patients. This meta-analysis revealed that compared to HCs, CS patients had significant alterations in GMV and regional spontaneous brain activity. The altered brain regions mainly included the primary visual cortex, the default mode network and the sensorimotor area, which may be associated with CS patients' symptoms of sensory deficits, blurred vision, cognitive impairment and motor dysfunction. The findings may contribute to understanding the underlying pathophysiology of brain dysfunction and provide references for early diagnosis and treatment of CS. https://www.crd.york.ac.uk/PROSPERO/, CRD42022370967.

Changes of regional brain activity following Tuina therapy for patients with painful cervical spondylosis: a resting-state fMRI study.

The effectiveness of Tuina therapy has been confirmed in treating pain of patients with cervical spondylosis (CS), however, its therapeutic mechanism is still unclear. This study aimed to observe the changes of regional brain activity following Tuina therapy in patients with painful CS based on resting-state functional magnetic resonance imaging (rs-fMRI) data. A total of 27 patients with CS and 27 healthy subjects (HCs) were enrolled in this study. All patients received Tuina therapy every 2 days for 2 weeks. The clinical manifestations of patients were evaluated by the Visual Analog Scale (VAS) and Neck Disability Index (NDI) before and after treatment. In addition, rs-fMRI data were collected and preprocessed in all patients before and after treatment, as well as HCs. HCs underwent a 1-time rs-fMRI scan, whereas CS patients underwent 2-times of rs-fMRI scan. The measure of regional homogeneity (ReHo) was calculated and compared between groups. Finally, relationships between altered brain regions and clinical characteristics were evaluated by Pearson's correlation analysis. After Tuina therapy, VAS and NDI scores of patients decreased. Before treatment, CS patients showed higher ReHo values in the left middle temporal gyrus, left thalamus, right anterior and posterior cingulate gyrus, left inferior parietal gyrus and lower ReHo values in the right gyrus rectus when compared with HCs. After treatment, CS patients exhibited higher ReHo values in the left inferior temporal gyrus, right anterior and posterior cingulate gyrus, left inferior parietal gyrus and lower ReHo values in the right rectus gyrus when compared with HCs. CS patients after treatment demonstrated higher ReHo values in the left inferior occipital gyrus when compared with those before treatment. Positive correlations were found between ReHo values of the right rectus gyrus and VAS, NDI scores in CS patients before treatment. Differences of VAS scores between before and after treatment were negatively correlated with ReHo values of the left inferior temporal gyrus in CS patients after treatment. This study demonstrated the presence of asynchronous activity in certain brain regions in CS patients, which might be associated with pain and cervical spine dysfunction. Tuina therapy might modulate asynchronous activity of abnormal brain regions, which might contribute to the effectiveness of Tuina therapy in alleviating pain and cervical spine dysfunction in CS patients.

Prevalence of Cervical Spondylotic Myelopathy Among Patients with Cervical Spondylosis

Purpose: To calculate the prevalence of cervical spondylotic myelopathy among patients with cervical spondylosis.&#x0D; Methodology: The cross-sectional study was conducted in district Gujrat and Gujranwala on patients with cervical spondylosis in order to evaluate the prevalence of cervical spondylotic myelopathy among them. Data (n=186) was collected through non-probability convenient sampling using a Japanese orthopedic association cervical myelopathy evaluation questionnaire with the reliability of 0.89–0.96 by making a personal visit to different clinics and hospitals in Gujrat.&#x0D; Findings: The prevalence of cervical spondylotic myelopathy in patients with cervical spondylosis was 62.37%. The prevalence among different age group varied with the highest prevalence among age group 61-65 years old (30.2%). Moreover, it was higher in males than in females (52.6% vs 47.4%). The study also observed significant association between age and prevalence of cervical spondylotic myelopathy as they have p-value (0.000). This study concluded that the prevalence of cervical spondylotic myelopathy is high in cervical spondylosis patients. It appears that advance age may be the factor responsible for cervical spondylotic myelopathy, as cervical spondylosis is more prevalent in older individuals.&#x0D; Recommendations: There is a need to investigate the impact of lifestyle factors such as physical activity and posture on the frequency and severity of cervical spondylotic myelopathy. Both clinical assessment and imaging techniques should be considered to accurately diagnose and evaluate the severity of CSM. To explore potential correlation between the duration and progression of cervical spondylosis and development of CSM further studies should be conducted.

EFFECTIVENESS OF KALTENBORN MOBILIZATION TECHNIQUE VERSUS CONVENTIONAL EXERCISE FOR SUBJECTS WITH CERVICAL SPONDYLOSIS

BACKGROUND &amp; AIM: The application of joint mobilization to the upper thoracic spine has been reported to have an positive effect, sometimes immediately, on cervical spine dysfunction, in conjunction with the provision of pain relief. However, previous including joint mobilization, have been ineffective in a busy clinical setting because they involve the direct and passive intervention of therapists. So the purpose of this study is to evaluate the effectiveness of kaltenborn mobilization technique among cervical spondylosis. OBJECTIVE: • To determine the effectiveness of kaltenborn mobilization technique on reducing pain by using VAS • To evaluate the effectiveness of kaltenborn mobilization technique on improving cervical spine range of motion (ROM) by using goniometer. METHOD: STUDY DESIGN: experimental study SAMPLING TECHNIQUE: Convenient sampling technique SAMPLE SIZE: 30 RESULT: Statistical study revealed that among 30 individuals, The test shows that the subjects received kaltenborn mobilization along with interferential therapy have improved reduction in pain and increased in ROM among cervical spondylosis. CONCLUSION: From this results it has been concluded that there was a definite and positive effect of Kaltenborn mobilization technique along with Interferential therapy for cervical spondylosis patients. KEYWORDS: kaltenborn mobilization, goniometer, cervical spondylosis, isometric exercises.

Correlation between cervical proprioception with the neck length and neck pain in patients of cervical spondylosis

Background: Cervical proprioception has been a major source of attention among the population of cervical spondylosis as it is associated with neck pain, whereas it can lead to alteration in physiological manifestations which enhance neck pain as a consequence of disturbed proprioception. Objective: To determine the correlation between cervical proprioception with neck length and neck pain in patients with cervical spondylosis. Methodology: It is a cross-sectional correlational study conducted at Innovative Health Concepts (IHC) and Pakistan Society for Rehabilitation for Differently-abled Lahore, in the duration of six months from November 2021 to March 2022. The sample size of n=130 participants was recruited and data was collected through non-probability purposive sampling. Patients diagnosed with cervical spondylosis aged 25 to 50 years with neck pain, decreased neck range of motion, and osteophytes formation were included. Whereas, vestibule basilar artery insufficiency or any systemic illness was excluded. Joint Position Error Test (JPET) for cervical proprioception assessment, Numeric Pain Rating Scale (NPRS) was used for neck pain, and lateral view X-rays were taken for neck length measurement. Data was analyzed using Statistical Package for Social Sciences (IBM-SPSS) version 22. Results: There was no significant association between proprioception except for left rotation (r=0.21, p=0.016) which showed a weak positive correlation. On the other hand, neck pain showed a significant strong positive correlation with flexion (r=0.88, p=0.002), moderate with extension (r=0.39, p=0.004), strong with right rotation (r=0.81, p=0.001) and left rotation (r=0.61,p=0.001) respectively. Conclusion: It was concluded that the population of cervical spondylosis has no correlation between cervical proprioception and cervical length. Whereas, a positive strong correlation was found between cervical proprioception and neck pain. Keywords: Joint position error test, Neck pain, Proprioception.

Cost-utility Analysis of Anterior Cervical Discectomy and Fusion for Cervical Spondylosis Patients Comparing Polyetheretherketone Versus Tricortical Iliac Crest Bone Graft.

Prospective cohort study. To perform a cost-utility analysis and to investigate the clinical outcomes and patient's quality of life after anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis compared between fusion with polyetheretherketone (PEEK) and fusion with tricortical iliac bone graft (IBG) in Thailand. ACDF is one of the standard treatments for cervical spondylosis. The fusion material options include PEEK and tricortical IBG. No previous studies have compared the cost-utility between these 2 fusion material options. Patients with cervical spondylosis who were scheduled for ACDF at Siriraj Hospital (Bangkok, Thailand) during 2019-2020 were prospectively enrolled. Patients were allocated to the PEEK or IBG fusion material group according to the patient's choice of fusion material. EuroQol-5 dimensions 5 levels and relevant costs were collected during the operative and postoperative periods. A cost-utility analysis was performed using a societal perspective. All costs were converted to 2020 United States dollars (USD), and a 3% discount rate was used. The outcome was expressed as the incremental cost-effectiveness ratio. Thirty-six patients (18 ACDF-PEEK and 18 ACDF-IBG) were enrolled. Except for Nurick grading, there was no significant difference in patient baseline characteristics between groups. The average utility at 1 year after ACDF-PEEK and ACDF-IBG were 0.939 ± 0.061 and 0.798 ± 0.081, respectively ( P < 0.001). The total lifetime cost of ACDF-PEEK and ACDF-IBG was 83,572 USD and 73,329 USD, respectively. The incremental cost-effectiveness ratio of ACDF-PEEK when compared with that of ACDF-IBG showed a gain of 4468.52 USD/quality-adjusted life-years, which is considered cost-effective at the Thailand willingness-to-pay threshold of 5115 USD/quality-adjusted life-year gained. ACDF-PEEK was found to be more cost-effective than ACDF-IBG for treating cervical spondylosis in Thailand. Level II.

Evaluation of Genetic and Nongenetic Risk Factors for Degenerative Cervical Myelopathy.

Cohort study. We aimed to evaluate the associations of genetic and nongenetic factors with degenerative cervical myelopathy (DCM). There is mounting evidence for an inherited predisposition for DCM, but uncertainty remains regarding specific genetic markers involved. Similarly, nongenetic factors are thought to play a role. Using diagnosis codes from hospital records linked to the UK Biobank cohort, patients with cervical spondylosis were identified followed by the identification of a subset with DCM. Nongenetic variables evaluated included age, sex, race, Townsend deprivation index, body mass index, occupational demands, osteoporosis, and smoking. Genome-wide association analyses were conducted using logistic regression adjusted for age, sex, population principal components, and follow-up. A total of 851 DCM cases out of 2787 cervical spondylosis patients were identified. Several nongenetic factors were independently associated with DCM including age [odds ratio (OR)=1.11, 95% CI=1.01-1.21, P =0.024], male sex (OR=1.63, 95% CI=1.37-1.93, P <0.001), and relative socioeconomic deprivation (OR=1.03, 95% CI=1.00-1.06, P =0.030). Asian race was associated with lower DCM risk (OR=0.44, 95% CI=0.22-0.85, P =0.014). We did not identify genome-wide significant (≤5×10 -8 ) single-nucleotide polymorphisms (SNPs) associated with DCM. The strongest genome-wide signals were at SNP rs67256809 in the intergenic region of the genes LINC02582 and FBXO15 on chromosome 18 ( P =1.12×10 -7 ) and rs577081672 in the GTPBP1 gene on chromosome 22 ( P =2.9×10 -7 ). No SNPs reported in prior DCM studies were significant after adjusting for replication attempts. Increasing age, male sex, and relative socioeconomic deprivation were identified as independent risk factors for DCM, whereas Asian race was inversely associated. SNPs of potential interest were identified in GTPBP1 and an intergenic region on chromosome 18, but these associations did not reach genome-wide significance. Identification of genetic and nongenetic DCM susceptibility markers may guide understanding of DCM disease processes, inform risk, guide prevention and potentially inform surgical outcomes. Prognostic level III.

Exploring the latest advancements in physical therapy techniques for treating cervical spondylosis patients: A narrative review.

Cervical spondylosis is a widespread medical condition that significantly impacts patients' quality of life. Treatment options include surgical and conservative approaches, with conservative treatment often being the preferred choice. Rehabilitation therapy is an essential component of conservative treatment, and advancements in technology have the way to the development of new physiotherapy techniques. The effectiveness of treatment largely hinges on the patient's ability to improve their dysfunction. This study aims to provide valuable insights into the use of new physical therapy techniques, such as Sling Exercises Training (SET), fascia manipulation, muscle energy technique (MET), and proprioceptive neuromuscular facilitation (PNF), that aid the rehabilitation of cervical spondylosis. By scrutinizing the current research status of these techniques, this study aims to present innovative ideas enhancing the rehabilitation process and outcomes for patients suffering from cervical spondylosis.

Chunky yarn sign: A screening marker for brachial plexus hypertrophy on axial cervical spine MRI

AbstractBackgroundNerve hypertrophy is one of the characteristic features of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The brachial plexus runs along the gap between the anterior and medial scalene muscles (interscalene gap), and its enlargement sometimes appears as widening of the interscalene gap on conventional axial cervical spine MRI.MethodsTo determine whether the screening of nerve hypertrophy in CIDP is available via conventional cervical spine MRI, we reviewed the medical records of 29 patients with CIDP who underwent cervical MRI, and imaging features were compared with 50 patients with cervical spondylosis who underwent nerve conduction study and were confirmed to have no neuropathies. The maximum diameter of the interscalene gap at the 6th or 7th cervical vertebra level on axial‐slice T2 weighted imaging was measured by two observers independently.ResultsThe maximum diameter of the interscalene gap was significantly larger in the CIDP patients (range, 1.7–11.58; median, 3.64 mm; interquartile range [IQR], 1.79) than in the cervical spondylosis patients (range, 0.87–4.71; median, 1.96 mm; IQR, 0.88) (p &lt; 0.001).ConclusionThe enlarged interscalene gaps were analogous to chunky yarn, with a continuous thick structure along the gaps. Attention to interscalene gaps on routine MRI can contribute to the screening of hypertrophic neuropathies without additional costs or procedures.

The impact of disease time, cervical alignment and range of motion on cervical vertebral Hounsfield unit value in surgery patients with cervical spondylosis

Study designThis study was a retrospective review.ObjectiveBone mineral density (BMD) at the surgical site is associated with complications of surgical internal fixation, and it is very important to study the cervical BMD of patients with cervical spondylosis who need surgery and the related factors that affect cervical BMD. It is still unclear about the age-related influence of disease time, cervical alignment and range of motion (ROM) on cervical vertebral Hounsfield unit (HU) value.MethodsThis retrospective study was conducted on patients who underwent cervical surgery at one institution between January 2014 and December 2021. Age, sex, body mass index (BMI), disease type, comorbidities, neck pain, disease time, C2-7 Cobb angle (CA), cervical ROM and the C2-C7 vertebral HU value were recorded. The association between cervical HU value and each parameter of interest was assessed using the Pearson correlation coefficient. Multivariable linear regression analysis was performed to examine the relative influence of the multiple factors on cervical vertebral HU value.ResultsAmong patients younger than 50 years old, the HU value of the cervical vertebral in females was higher than that of males, but after the age of 50 years, the value of females was lower than that of males and decreased significantly after 60 years old. In addition, cervical HU value was significantly correlated with the disease time, flexion CA and ROM. Our age-related subgroup of multivariate linear regression analyses shows that disease time and flexion CA negatively affected the C6-7 HU value in more than 60-year-old males and in more than 50-year-old females.ConclusionsDisease time and flexion CA were negatively affecting the C6-7 HU values in more than 60-year-old males and in more than 50-year-old females. More attention should be paid to bone quality in cervical spondylosis patients with longer disease time and larger convex of flexion CA.

The association between unilateral high-riding vertebral artery and atlantoaxial joint morphology: a multi-slice spiral computed tomography study of 396 patients and a finite element analysis

Background ContextA high-riding vertebral artery (HRVA) can deviate too medially, too posteriorly, or too superiorly to allow the safe insertion of screws. However, it is unknown whether the presence of a HRVA is associated with morphological changes of the atlantoaxial joint. PurposeTo investigate the association between HRVA and atlantoaxial joint morphology in patients with and without HRVA. Study DesignA retrospective case–control study and finite element (FE) analysis. Patient SampleA total of 396 patients with cervical spondylosis underwent multi-slice spiral computed tomography (MSCT) of cervical spine at our institutions from 2020 to 2022. Outcome MeasuresA series of atlantoaxial joint morphological parameters, including C2 lateral mass settlement (C2 LMS), C1–2 sagittal joint inclination (C1–2 SI), C1–2 coronal joint inclination (C1–2 CI), atlanto-dental interval (ADI), lateral atlanto-dental interval (LADI), and C1–2 relative rotation angle (C1–2 RRA) were measured, and lateral atlantoaxial joints osteoarthritis (LAJs-OA) was recorded. The stress distribution on the C2 facet surface under different torques of flexion-extension, lateral bending, and axial rotation was analyzed by FE models. A 2-Nm moment was applied to all models to determine the range of motion (ROM). MethodsA total of 132 consecutive cervical spondylosis patients with unilateral HRVA were enrolled in the HRVA group, and 264 patients without HRVA matched for age and sex were enrolled in the normal (NL) group. Atlantoaxial joint morphological parameters were compared between two sides of C2 lateral mass within HRVA or NL group, and between HRVA and NL groups. A 48-year-old woman with cervical spondylosis without HRVA was selected for cervical MSCT. A three-dimensional (3D) FE intact model of the normal upper cervical spine (C0-C2) was created. We established the HRVA model by simulating atlantoaxial morphological changes of unilateral HRVA with FE method. ResultsThe C2 LMS was significantly smaller on the HRVA side than that on the non-HRVA side in the HRVA group, but C1–2 SI, C1–2 CI, and LADI on HRVA side were significantly larger than those on non-HRVA side. There was no significant difference between left and right sides in the NL group. The difference in C2 LMS (d-C2 LMS) between HRVA side and non-HRVA side in the HRVA group was larger than that in the NL group (P < 0.05). Meanwhile, the differences in C1–2 SI (d-C1/2 SI), C1–2 CI (d-C1/2 CI), and LADI (d-LADI) in the HRVA group were significantly larger than those in the NL group. The C1–2 RRA in the HRVA group was significantly larger than that in the NL group. Pearson correlations showed that d-C1/2 SI, d-C1/2 CI, and d-LADI were positively associated with d-C2 LMS (r=0.428, 0.649, 0.498, respectively, p<.05 for all). The incidence of LAJs-OA in the HRVA group (27.3%) was significantly larger than that in the NL group (11.7%). Compared with the normal model, the ROM of C1-2 segment declined in all postures of the HRVA FE model. We found a larger distribution of stress on the C2 lateral mass surface of the HRVA side under different moment conditions. ConclusionsWe suggest that HRVA affects the integrity of the C2 lateral mass. This change in patients with unilateral HRVA is associated with the nonuniform settlement of the lateral mass and an increase in the lateral mass inclination, which may further affect the degeneration of the atlantoaxial joint because of the stress concentration on the C2 lateral mass surface.

Role of diffusion kurtosis imaging in evaluating microstructural changes in spinal cord of patients with cervical spondylosis.

Analytical cross-sectional study. To study the role of diffusion kurtosis imaging (DKI) in evaluating microstructural changes in patients with cervical spondylosis. Cervical spondylosis is a common progressive degenerative disorder of the spine. Conventional magnetic resonance imaging (MRI) can only detect the changes in the spinal cord once there are visual signal changes; hence, it underestimates the extent of the injury. Newer imaging techniques like Diffusion Tensor and Kurtosis Imaging can evaluate the microstructural changes in cervical spinal cord before the obvious signal changes appear. Conventional MRI, diffusion tensor imaging (DTI), and DKI scans were performed for 90 cervical spondylosis patients on 1.5-T MR Siemens Magnetom aera after obtaining informed consent. Eight patients were excluded due to poor image quality. Fractional anisotropy (FA) colour maps and diffusion kurtosis (DK) maps corresponding to spinal cord cross sections at C2-C3 intervertebral disc level (control) and at the most stenotic levels were obtained. Modified Japanese Orthopaedic Association (mJOA) scoring was used for clinical assessment of the spinal cord function. The changes in DTI and DKI parameters and their correlation with mJOA scores were analysed by SPSS 23 software. In our study, mean FA and mean kurtosis (MK) values at the stenotic level (0.54, 1.02) were significantly lower than values at the non-stenotic segment (0.70, 1.27). The mean diffusivity (MD) value at the stenotic segment (1.25) was significantly higher than in the non-stenotic segment (1.09). We also observed a strong positive correlation between mJOA score and FA and MK values and a negative correlation between mJOA score and MD values, suggesting a correlation of FA, MK, and MD with the clinical severity of the disease. Addition of DTI and DKI sequences helps in early identification of the disease without any additional cost incurred by the patient.