Cervical Spondylosis Patients Research Articles

Acupuncture and cupping combined with chiropractic massage in the treatment of 36 cervical spondylosis patients

ObjectiveTo observe the clinical efficacy of treatment of cervical spondylosis with acupuncture and cupping combined with chiropractic massage. MethodsThirty-six patients with cervical spondylosis were treated with acupuncture, cupping, and massage. Body acupuncture was taken as the principle, combining with balance acupuncture. Acupuncture was mainly applied at C1–C7 Jiāj▪ with balance acupuncture at J▪ngtòng (▪) to stimulate them by needle sticking. When cupping was applied, flash cupping was applied first, then sliding-cupping, and retention cupping was applied finally. Eventually, chiropractic massage was applied. The treatment course lasted for 10 days, and the whole treatment lasted for one to three courses. ResultsTwenty patients were cured, 14 were improved, and ineffectiveness was seen in 2 cases. The total effective rate was 94.4%(34/36). ConclusionThe curative effect of cervical spondylosis treated with acupuncture and cupping combined with chiropractic massage was definite.

Correlation between degree of subvoxel spinal cord compression measured with super-resolution tract density imaging and neurological impairment in cervical spondylotic myelopathy.

OBJECT The purpose of this study was to explore the use of super-resolution tract density images derived from probabilistic diffusion tensor imaging (DTI) tractography of the spinal cord as an imaging surrogate for microstructural integrity and functional impairment in patients with cervical spondylosis. METHODS Structural MRI and DTI images were collected for 27 patients with cervical spondylosis with (n= 21) and without (n= 6) functional impairment as defined by the modified Japanese Orthopaedic Association Scale (mJOA). DTI was performed axially through the site of compression in a total of 20 directions with 10 averages. Probabilistic tractography was performed at 0.5-mm isotropic spatial resolution using the streamline technique combined with constrained spherical deconvolution. The following measurements were calculated for each patient: maximum tract density at the site of compression, average tract density in rostral normal-appearing spinal cord, and the ratio of maximum density to normal density. RESULTS Compared with normal tissue, the site of compression exhibited elevated fiber tract density in all patients, and a higher fiber tract density was also noted in focal areas at the site of compression in patients with functional impairment. There was a strong negative correlation between maximum tract density and mJOA score (R(2)= 0.6324, p < 0.0001) and the ratio of maximum tract density to normal tract density (R(2)= 0.6647, p < 0.0001). When grouped according to severity of neurological impairment (asymptomatic, mJOA score of 18; mild, mJOA score of 15-17; moderate, mJOA score of 11-14; and severe, mJOA score < 11), the results showed a significant difference in the ratio between severe and both no impairment (p= 0.0009) and any impairment (p= 0.036). A ratio of maximum fiber tract density at the site of compression to fiber tract density at C-2 greater than 1.45 had 82% sensitivity and 70% specificity for identifying patients with moderate to severe impairment (ROC AUC= 0.8882, p= 0.0009). CONCLUSIONS These results support the use of DTI as a surrogate for determining spinal cord integrity in patients with cervical spondylosis. Probabilistic tractography provides spinal cord microstructural information that can help discern clinical status in cervical spondylosis patients with varying degrees of neurological impairment.

Subaxial cervical spine involvement in symptomatic rheumatoid arthritis patients: Comparison with cervical spondylosis

ObjectiveTo investigate the frequency, location, characteristics, and clinical significance of subaxial involvement (below C1–C2) in a series of patients with rheumatoid arthritis (RA) and symptomatic involvement of the cervical spine. MethodsA total of 41 patients with RA were examined via cervical spine magnetic resonance imaging (MRI). A comparative analysis of the incidence of the different types of subaxial lesions was performed between these patients and 41 age- and sex-matched patients with symptomatic cervical spondylosis. ResultsStenosis of the spinal canal was found at the subaxial level in 85% of RA patients, and at the atlantoaxial level in 44%. Comparative analysis between these patients and the cervical spondylosis patients revealed significant differences in the types and frequencies of subaxial lesions. For both conditions, signs of discopathy and end-plate osteophytosis were the most common abnormalities observed on magnetic resonance imaging (MRI). However, in the RA patients these abnormalities coincided with subchondral bone and ligamentous acute inflammatory changes and with secondary destruction (vertebral instability) or repair (vertebral ankyloses).Only evidence of subaxial myelopathy was significantly associated with an increased risk of neurological dysfunction among the RA patients [Ranawat class II or III; P = 0.01; odds ratio (OR) = 11.43], although subaxial cord compression tended toward a significant association with the risk of neurological dysfunction (P = 0.06; OR = 3.95). ConclusionSubaxial stenosis seems to be the consequence of both the inflammatory process and mechanical-degenerative changes. Despite its frequency, it was not usually related to the occurrence of myelopathy symptoms, not even in cases with MRI evidence of spinal cord compression.

A clinical study based observation on prevalence of neck pain among patients attending National Institute of Unani Medicine, India

Aim:Waja ul Unuq (Neck/ Cervical pain) is one of the most common reasons for medical consultation, but it is usually short lived and responds to symptomatic measures. As reported about 26 71% of the adult population can experience and recall an episode of neck pain in their lifetime. Most patients with acute neck pain, with or without radicular symptoms have musculoskeletal or degenerative disorders. It is estimated that every year more than 50% of adults experience some degree of cervical pain due to faulty posture and 60–80% of older adults experience cervical pain due to degenerative changes. This study was conducted as a clinical trial to assess the efficacies of certain regimens from which the data on prevalence of neck pain among the study participants were collected and compiled to generate data for future epidemiological studies. Methods: As part of single-centred clinical trial, prevalence study was conducted over a period of 13 months in patients of cervical spondylosis (neck pain). A total of 250 patients between the age group of 20-70 years, both gender, having neck pain with or without radicular symptoms were screened for cervical spondylosis from the musculoskeletal OPD, IPD and radiological unit of National Institute of Unani Medicine Hospital, Bangalore. Results & Conclusion: This study revealed that neck pain is more prevalent among the middle aged individuals, with the body mass index ranges between 26-30, belongs to middle class and occupationally engaged manual works with axial loading, faulty posture adaptation, and slightly higher in females and highest among Balgami mizaj (temperamentally phlegmatic) people. The prevalent morbidities in patients of neck pain were cervical spondylosis without and with complication like Vertebro basilar insufficiency, myelopathy, and the others nonspecific conditions includes history of trauma, cervical rib, ankylosing spondylosis, and psoriatic arthropathy.

Efficacy analysis of small needle knife treatment of cervical spondylosis

Objective To compare the clinical effect of needle knife therapy and traction for treatment of cervical spondylosis .Methods 156 patients with nerve root type of cervical spondylosis patients definitely diag -nosed,randomly divided into two groups ,the treatment group of 78 cases,with small needle knife therapy;the control group of 78 cases,the cervical traction therapy ,combined with traditional Chinese medicine .The clinical efficacy was compared between the two groups .Results The treatment group 70 cases were cured（89.6%）,the total efficiency of 96.9%;control group 44 cases were cured（56.7%）,the total efficiency of 83.3%.The cure rate and total effective rate was significantly better than the control group （χ2 =22.02,11.57,all P<0.05）.Conclusion The needle knife therapy to treat cervical vertebra disease is better than that of cervical traction ,has good clinical curative effect . Key words: Cervical spondylosis; Small needle knife therapy; Traction

Sympathetic nerve innervation in cervical posterior longitudinal ligament as a potential causative factor in cervical spondylosis with sympathetic symptoms and preliminary evidence

Sympathetic symptoms associated with cervical disorders, such as vertigo, headache, dizziness, etc., are common clinical disorders bewildering both clinicians and patients. In our clinical practice we observed that sympathetic symptoms associated with cervical disorders were apparently relieved in some patients after undergoing routine anterior cervical decompression and fusion plus posterior longitudinal ligament (PLL) resection. This study was designed to investigate the sympathetic nerve innervations in the cervical PLL and its potential correlation with cervical sympathetic symptoms such as vertigo. MethodIn animal research, cervical PLLs of 9 adult rabbits were harvested and stained with sucrose–phosphate–glyoxylic acid (SPG), which is a specific fluorescence staining method for sympathetic postganglionic fibers. In human research, cervical PLL of 8 patients of cervical spondylosis with sympathetic symptoms were harvested during surgery and stained with SPG. All sections were observed under fluorescence microscope. Sympathetic symptoms were evaluated using the sympathetic symptom 20-point score preoperatively and at 1week, 2-month, and 6-month postoperatively. ResultsIn rabbit specimens, a large number of sympathetic postganglionic fibers were distributed in the cervical PLL of every segment. The density of sympathetic fibers distributed in the intervertebral portion of PLL was more than that in the vertebral portion. Compared with deep layer section, the nerve fibers in the superficial PLL layer section were thicker and more densely populated. Existence of sympathetic postganglionic fibers was also confirmed in human specimens. Those nerve fibers were mostly short and isolated in areatus form, with non-interwoven branches. The mean sympathetic symptoms score decreased significantly from 6.6±2.6 before surgery to 2.0±1.9 at 6months postoperatively after anterior cervical decompression and fusion with PLL removed. ConclusionAccording to the experimental result and clinical practice, we hypothesized that sympathetic nerve fibers distributed in PLL may represent a pathologic basis of stimulation induced by cervical vertebral degenerative changes and thus are susceptible to being a potential causative factor in cervical spondylosis with sympathetic symptoms.

Diffusion tensor imaging predicts functional impairment in mild-to-moderate cervical spondylotic myelopathy

Background contextMagnetic resonance imaging (MRI) is the standard imaging modality for the assessment of cervical spinal cord; however, MRI assessment of the spinal cord in cervical spondylotic myelopathy patients has not demonstrated a consistent association with neurologic function or outcome after surgical or medical intervention. Thus, there is a need for sensitive imaging biomarkers that can predict functional impairment in patients with advanced cervical spondylosis. PurposeTo implement diffusion tensor imaging (DTI) as an imaging biomarker for microstructural integrity and functional impairment in patients with cervical spondylosis. Study designNonrandomized, single institution study. Patient sampleForty-eight cervical spondylosis patients with or without spinal cord signal change underwent DTI of the spinal cord along with functional assessment. Outcome measuresFunctional measures of neurologic function via modified Japanese Orthopedic Association (mJOA) score. MethodsA zoomed-echoplanar imaging technique and two-dimensional spatially selective radiofrequency excitation pulse were used for DTI measurement. Fractional anisotropy (FA), mean diffusivity (MD), radial and axial diffusion (AD) coefficient, AD anisotropy, ψ, defined as AD-MD, and the standard deviation (SD) of primary eigenvector orientation were evaluated at the site of compression. ResultsResults suggest average FA, transverse apparent diffusion coefficient, ψ, and SD of primary eigenvector orientation at the spinal level of highest compression were linearly correlated with mJOA score. Receiver-operator characteristic analysis suggested FA and ψ could identify stenosis patients with mild-to-moderate symptoms with a relatively high sensitivity and specificity. ConclusionsThe results of this study support the potential use of DTI as a biomarker for predicting functional impairment in patients with cervical spondylosis.

Proton magnetic resonance spectroscopy of human cervical spondylosis at 3T

Study DesignA single center magnetic resonance imaging and spectroscopic study involving twenty-one patients with advanced cervical spondylosis and eleven healthy controls.ObjectiveWe assessed the utility of MR spectroscopy to quantify biochemical changes within the spinal cord and serve as a potential biomarker in patients with cervical spondylosis with or without T2 hyperintensity within the cord.SettingLos Angeles, California, USAMethodsTwenty-one patients with cervical spondylosis and eleven healthy controls were evaluated. Single voxel MR spectroscopy was performed in the cervical cord. Morphometry of the spinal canal space was measured. NAA, choline, myo-inositol, glutamine-glutamate complex and lactate metabolite concentration ratios with respect to total creatine were quantified using an LC model algorithm and compared between healthy controls and spondylosis patients. Correlation of MRS metabolites with mJOA score was also performed.ResultsThe spinal canal space was significantly different between patients and controls (ANOVA, P<0.0001). Total choline-to creatine-ratio was significantly elevated in patients with spondylosis and T2-hyperintensity compared with healthy controls (ANOVA, P<0.01). A significantly higher choline-to-NAA ratio was observed in spondylosis patients compared with healthy controls (ANOVA, P<0.01). Slightly elevated glutamine-glutamate complex and myo-inositol was encountered in patients with stenosis without T2 hyperintensity. A linear correlation between Cho-NAA ratio and mJOA was also observed (P<0.01).ConclusionMRS appears sensitive to biochemical changes occurring in advanced cervical spondylosis patients. The choline/NAA ratio was significantly correlated with the mJOA score, providing a potentially clinical useful radiographical biomarker for the management of advanced cervical spondylosis patients.

Effect of Grīvā Vasti in management of Grīvā Asthi Sandhi Gata Vāta (Cervical Spondylosis)

Introduction:Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in the neck. Keeping in view the increasing incidence of this problem in modern society a study was conducted with following.Aims and Objectives:The aim of the following study is to assess the efficacy of Grīvā Vasti in the management of cervical spondylosis.Materials and Methods:The study was conducted on 10 clinically, pathologically, and radiologically diagnosed patients of cervical spondylosis, selected from outpatient department/In -patient department wing of P.G. Department of Kāya Chikitsā, N.I.A., Jaipur, satisfying the inclusion criteria. Patients were treated with Grīvā Vasti with Daśamūla Tailam for 35-45 min duration, for 14 days. Assessments were performed with regard to neck disability index before and after treatment.Statistical Analysis:Statistical analysis was done with the help of Instat GraphPad 3 using Wilcoxon matched-pairs signed ranks test.Result:Relief in neck disability index was 65.70%, which was statistically significant (P < 0.01).Conclusion:Result indicates that Grīvā Vasti is an effective treatment in cervical spondylosis.

The Correlation Study of C5 Nerve Root Palsy and Common Body Position in Posterior Total Laminectomy Decompression and Instrumentation.

To compare both the clinical characteristics and incidence of postoperative cervical nerve root palsy in cervical spondylosis patients treated by posterior total laminectomy, decompression and instrumentation with two different common body positions, traction bed and plaster bed. One hundred and thirty-three patients, with a mean age of 49.5 years suffering from multilevel cervical spondylosis and treated by laminectomy from 2007 to 2009, were reviewed. Overall 30 of 133 (22.56%) patients had C5 palsy, of which 14 (19.44%) out of 72 patients were in the plaster bed group, while 16 of 61 (26.23%) patients were in the traction bed group. The difference was statistically significant (P < 0.05). The cervical curvature index (CCI) reflected both the change of cervical height and the change of the overall cervical curvature. CCI was related with the incidence of C5 nerve root palsy postoperatively. The patients in the traction bed group had a higher nerve root palsy rate and change in cervical alignment because of over traction.

Effect of tailored cervical pillow on the neck muscle strength balance of cervical spondylosis patients

Objective To study the effect of tailored cervical pillow on the neck muscle strength balance of patients with cervical spondylosis.Methods Totals of 60 cases of cervical spondylosis patients were randomly divided into experimental group and control group,with 30 cases each group,the patients of the two groups were treated with conventional treatment and nursing,while experimental group used the tailored cervical pillow for 8 hours every day and one month (1 course ). Two groups were being respectively received the isometric muscle strength and movement of the cervical spine assessment with the symptoms and functional assessment scales,clinical assessment and multifunctional cervical vertebra rehabilitation system (MCU).Results Experimental group were significantly improved than that of the control group in symptoms and functional assessment scale score[ (24.84 ± 2.341 ) vs ( 20.65 ± 2.134 ) ; t =3.024,P ＜0.05 ],The overall clinical curative effect,difference has statistical significance [ 60.0％ vs 30.0％ ; x2=5.455,P ＜ 0.05 ] ; the position of each isometric muscle strength and movement of the cervical spine were statistically significant( P ＜0.05).Conclusions The tailored cervical pillow can promote the neck muscle balance of patients with cervical spondylosis,strengthen the stability of cervical spine and improve symptoms,which is one of value auxiliary treatment for cervical spondylosis. Key words: Cervical spondylosis; Tailored cervical pillow; Neck muscles; Balance

Clinical effects of innovative tuina manipulations on treating cervical spondylosis of vertebral artery type and changes in cerebral blood flow

ObjectiveTo determine the clinical effect, treatment times, and rheoencephalogram changes in vertebral artery type cervical spondylosis patients treated with innovative Tuina manipulations. MethodsOne hundred and twenty six cervical spondylosis patients (vertebral artery type) were randomly divided into test and control groups. Patients in the test group were treated with innovative Tuina manipulations, while those in the control group were treated with the routine Tuina manipulations according to the textbook of Chinese Massage for Acupuncture and Moxibustion majors. The clinical effects, treatment times, clinical symptoms, and cerebral blood flow were measured. ResultsThe response to the treatment was 100% in the test group and 88.71% in the control group. Patients in the test group required (7 ± 4) treatments before recovery, while those in the control group required (15 ± 7) treatments before recovery (P<0.05). The clinical symptoms exhibited greater improvement in the test group compared to the control group (P<0.05). There were no differences in cerebral blood flow between the two groups. ConclusionBoth innovative Tuina manipulations and routine Tuina manipulations produced satisfactory therapeutic results in vertebral artery type cervical spondylosis patients. However, the innovative manipulation was more effective in improving the functional symptoms, although there were no changes in the cerebral blood flow.

Three-dimensional kinematic analysis of the cervical spine after anterior cervical decompression and fusion at an adjacent level: a preliminary report

Development of adjacent segment degeneration following anterior cervical decompression and fusion (ACDF) is still controversial, as adjacent-level kinematics is poorly understood. This study reports preliminary data from a high-accuracy 3D analysis technique developed for in vivo cervical kinematics. From nine cervical spondylosis patients, four underwent single-level ACDF, and five underwent two-level ACDF using cylindrical titanium cage implant(s). Pre- and post-surgical CT scans were taken in flexion, neutral and extended positions, allowing us to compute segmental ranges of motion for rotation and translation, and 3D disc-height distributions. Differences in segmental motions and disc-height between fused and adjacent levels were analyzed with a Wilcoxon signed-rank test. Results are presented as mean ± SEM. The flexion/extension angular-ROM at the fusion level decreased after surgery (7.46 ± 1.17° vs. 3.14 ± 0.56°, p < 0.003). The flexion/extension angular-ROM at one caudal adjacent level to the fusion level (3.97 ± 1.29°) tended to be greater post-operatively (6.11 ± 1.44°, p = 0.074). Translation in the anterior-posterior direction during flexion/extension at the fusion level decreased after surgery (1.22 ± 0.20 mm vs. 0.32 ± 0.11 mm, p < 0.01). No differences were found in adjacent-level disc heights between both study time-points. This study showed increased segmental motion in flexion/extension angular-ROM at one level adjacent to ACDF. However, increases in the rotational angular-ROM were not statistically significant when cranial/caudal adjacent levels were analyzed separately. This preliminary study highlighted the capabilities of a 3D-kinematic analysis method to detect subtle changes in kinematics and disc height at the adjacent levels to ACDF. Thus, reliable evidence related to ACDF's influence on adjacent-level cervical kinematics can be collected.

Application of traditional Chinese medicine clinical nursing pathway on cervical spondylosis patients

Objective To explore the application effects of traditional Chinese medicine (TCM) clinical nursing pathway on cervical spondylosis patients of vertebroarterial. Methods 100 cases of cervical spondylosis from July 2008 to July 2010 were selected and randomly divided into control group and observation group, with 50 cases for each group. Both groups were treated based on cervical spondylosis conventional care. TCM clinical nursing pathway was used in the observation group, TCM sentiment and dietary regulating were also fully used, combined with TCM characteristic treatment measures such as internal and external therapy. The length of hospital stay, hospital charge,nursing adverse events occurrence rate, degree of satisfaction, and the understanding level of cervical health care knowledge were all compared in both groups. Results The length of hospital stay and hospital expenses were less than those in control group (P＜0.05). The rate of nursing adverse events was also less than that in the control group (P＜0.01),the degree of satisfaction and understanding level of cervical health care knowledge were higher than those in the control group (P＜0.05). Conclusion The application of TCM clinical nursing pathway on cervicai spndylosis patients of vertebroarterial can reduce the length of hospital stay, hospital expenses and the rate of nursing adverse events, improve degree of satisfaction and understanding level of cervical health care knowledge. Key words: Cervical spondylopathy of vertebroarterial; Traditional Chinese medicine nursing; Clinical pathway

Vertigo is associated with advanced degenerative changes in patients with cervical spondylosis

Since vascular risk factors that predispose to vertebrobasilar ischemia are common findings in elderly, cervical spondylosis-which is also common in such age group-as a cause of vertigo is sometimes considered as a myth. The purpose of this study is to investigate the effect of cervical spondylosis on blood flow velocity of VAs during cervical rotation and to identify the possible association of vertigo with the decreased blood flow velocity through VAs during head rotation in these patients. The incidence of cervical spondylosis was estimated in patients with and without vertigo. Patients with vertigo proved to have spondylosis are further compared with patients having spondylosis but not complaining of vertigo and patients who neither have spondylosis nor complain of vertigo who served as controls. Plain cervical radiography was used to evaluate cervical degenerative changes using cervical degenerative index. Color duplex sonography was used to measure vertebral artery blood flow with the cervical spine in the neutral position then with 60° rotation and 30° extension to measure the opposite vertebral artery. A significantly higher prevalence of cervical spondylosis was found among patients complaining of vertigo than those in non-vertigo group (71.4% vs. 32.9%, respectively). Furthermore, among patients with cervical spondylosis, patients having vertigo showed significantly more evident degenerative changes (P = 0.003). Despite Doppler ultrasound examination with head in neutral position was similar in all groups; cervical spondylosis patients with vertigo had statistically significant lower blood flow parameters with contralateral head rotation in the left and right vertebral arteries than cervical spondylosis patients without vertigo and controls. The decreased vertebral artery blood flow that occurs with cervical rotation can be observed in patients with cervical spondylosis. In patients with high-grade cervical spondylosis with more extensive osteophyte formation, the decreased blood flow becomes prominent and symptomatic presenting as vertigo.

Nursing and studies on fumigation with Chinese medicine treatment of cervical 9 step in cervical spondylosis patients

Objective To observe effects on fumigation with Chinese medicine treatment of cervical 9 step in cervical spondylosis patients. Methods 136 patients were randomly divided into 56 cases in the observation group and 80 cases in control group. The control group was treated with conventional methods, the observation group on this basis with fumigation with Chinese medicine treatment of cervical 9 steps. After three treatments periods, the effects between the two groups were compared. Results The efficacy rate in observation and control group were 93.75% and 78.57% respectively and the difference has reached the statistical significance (u = 8. 658 ,P < 0. 05) ; Three months after treatment, The efficacy rate in observation and control group were 91.25% and 76.78% respectively and the observation group was better than control group ( u =7. 232,P < 0. 05 ). Conclusions Fumigation with Chinese medicine treatment of cervical 9 step in cervical Spendylosis was an effective method. Key words: Chinese herbal medicine; Nerve root type cervical spendylosis; Fumigation; Cervical9 step exercises; Nursing

Anterior Cervical Discectomy and Fusion to Treat Cervical Spondylosis With Sympathetic Symptoms

Retrospective study. To investigate the clinical effectiveness of polytheretherketone (PEEK) cages-assisted anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis with sympathetic symptoms. The diagnosis and treatment of cervical spondylosis with sympathetic symptoms has remained controversial. To date, few reports have focused on the surgical efficacy of cervical spondylosis with sympathetic symptoms. Retrospective analysis was undertaken for 39 patients who were diagnosed as cervical spondylosis with sympathetic symptoms and underwent ACDF with PEEK cages. They were followed up for at least 1 year. The mean follow-up was 15.6 months. Radiographs obtained before surgery, after surgery, and at the final follow-up were assessed for quality of fusion. The sympathetic symptoms including vertigo, headache, tinnitus, nausea and vomiting, heart throb, hypomnesia, and gastroenterologic discomfort were scored by 20-point system preoperatively, 2 months postoperatively, and at the final follow-up. The recovery rate and clinical satisfaction rate were also evaluated. Surgical complications were also assessed. Radiographs of the cervical spine at the last follow-up revealed a solid fusion with no signs of a pseudoarthrosis in 36 cases. In 2 patients delayed union and bony fusion were achieved at 9 and 11 months. Pseudoarthrosis was found in 1 case but the patient had no symptoms. The sympathetic symptoms improved in all patients and the score was significantly improved after surgery. There was one patient who had cerebral spinal fluid leakage but he recovered 1 week after surgery. Two patients felt a mild swallowing discomfort, but it disappeared within 1 month after surgery. Subcutaneous hematoma occurred in one patient due to obstructed drainage. It was cleared 2 days after surgery. Cervical spondylosis patients with sympathetic symptoms may be managed successfully with ACDF using PEEK cages. Successful clinical results regarding symptom improvement and general satisfaction with the surgical procedure depend on obtaining successful decompression and radiographic fusion.

Comparing anterior cervical fusion using titanium cage with hydroxyapatite and with autograft

Abstract Background: Anterior cervical discectomy and fusion using autogenous iliac bone graft may lead to donor site pain. This has led some surgeons to use hydroxyapatite but it has greater rates of complications. Objective: Analyze results of the treatment of cervical spine spondylosis by anterior cervical discectomy, and to compare fusion using titanium cage with hydroxyapatite and with autograft. Methods: We evaluated eighty patients (at 146 cervical levels) that had been treated by anterior cervical discectomy and fusion with hydroxyapatite or autograft. In a prospective study, patients were divided into two groups: 1) 77 levels of anterior cervical fusion from in 40 patients who were treated with cage and hydroxyapatite, and 2) 69 levels of anterior cervical fusions in 40 patients who were treated with cage and autograft. Results were evaluated using the Japanese Orthopedic Association (JOA) scoring system before and after surgery, subsidence, non-union and complication. Results: According to JOA score, the first group (hydroxyapatite) had improved from 9.8 preoperation to 14.5 postoperation. The subsidence rate was 26.0%, the non-union rate was 10.4%, and there was no intra and post-operative complication. In the other group (autograft), the preoperative JOA score had improved from 9.3 to 14.1. The subsidence rate was 11.6%, and there were no non-union and complications. Statistical significance was found in non-union and subsidence aspect between groups, but the clinical outcome of JOA score was not significantly different. Conclusion: Anterior cervical discectomy and fusion in cervical spondylosis patients, titanium cage implantation with hydroxyapatite is a highly useful alternative to autograft.

Three-level anterior cervical discectomy: radiographic and clinical results analysis.

Objective Retrospective study of radiographic and clinical results for cervical spondylo-sis patients treated with three-level anterior cervical discectomy. Methods From October 2002 to January 2007, 23 cervical spondylosis patients (including 15 males, 8 females, with the mean age of 51.4 years) un-derwent three-level anterigr cervical discectomy, iliae crest autograft fusion and titanium plate fixation. Pa-tients wore collar braces for a period of 6 to 8 weeks post surgery. Radiographic and clinic follow-up data were collected respectively. Study parameters include the JOA score and its improvement rate, results were graded from excellent to poor using the Odom criteria and post operative assessment of neck symptoms. The sagittal segmental alignment of fusion levels were measured using the Cobb method before and after surgery. Adjacent level degeneration and graft fusion rate were observed upon final follow up. Results All patients were followed up for 11-48 months, with the average of 19.8 months. The JOA score in 20 patients was 11.1±1.0 preoperatively, and 14.6±1.0 three months postoperatively. The mean JOA score improvement rate was 62%. Three patients with radiculopathy: one patient presenting with deltoid muscle weakness improved from grade 2 before surgery to grade 4 after surgery, symptoms of the other two patients were alleviated. Sur-gical results graded according to Odom criteria: 15 excellent, 4 good, 4 fair. Remnant neck symptoms inci-dence was 17.4%(4/23). Graft fusion rate was 100%. Radiograph analysis indicated preoperative mean seg-mental lordosis 3.7°, mean segmental lordosis 10.8° upon one week follow up, and segmental lordosis was 10.4° upon final follow up. No detectable adjacent level disease incidence was noted. No neurological and instrumentation-related complications occurred. Conclusion Three-level anterior cervical discectomy, iliac crest autograft fusion, and titanium plate fixation, present high fusion rates with positive clinic outcomes in the treatment of multilevel cervical spondylosis. Key words: Cervical spondylosis; Diskectomy; Spinal fusion

Decreased sympathetic outflow to muscles in patients with cervical spondylosis.

To clarify the pathogenesis of neurologic symptoms of a vascular nature that may accompany cervical spondylosis (CS), we measured the sympathetic outflow to muscles (muscle sympathetic nerve activity: MSNA) in 8 ambulatory patients with CS and 10 healthy volunteers (controls). The burst rate and incidence of MSNA at rest were significantly lower in patients with CS than in controls (P < 0.01). There were no differences between the 2 groups in either resting heart rate or blood pressure. During a head-up tilting, the changes in MSNA were slightly greater in CS patients than controls due to reduced baseline levels of MSNA in CS patients. The burst incidence of MSNA in CS was significantly negatively correlated with the severity of pyramidal tract symptoms (P < 0.05). The decreased MSNA at rest in CS patients may be due to a spinal cord compression resulting from posterior spondylotic changes in the cervical spine.