Cervical Spondylotic Patients Research Articles

Cerebral White Matter Alterations Revealed by Multiple Diffusion Metrics in Cervical Spondylotic Patients with Pain: A TBSS Study.

The aims of the present study were to investigate white matter alterations and their associations with the clinical variables in cervical spondylotic (CS) patients with pain. Cross-sectional study. Chinese community. Forty-two CS patients with pain and 42 matched healthy participants were ultimately recruited from August 2018 to September 2019. Tract-based spatial statistics (TBSS) analysis was performed to investigate the differences of DTI-derived indices (fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD)) between the patients and healthy controls throughout brain white matter. The relationship of the severity of cervical pain and affective disturbance to aberrant DTI indices in the patients was also examined using spearman correlation analyses. The CS patients with pain showed decreased FA in the genu, body, and splenium portions of corpus callosum (CC), and increased MD and RD along with decreased FA in anterior corona radiata (ACR) compared with healthy controls, whereas no significant difference of AD was observed between groups. Additionally, lower FA of the genu part of CC together with higher MD of the left ACR were statistically correlated with the pain severity in the patient group. Decreased FA coupled with increased MD and RD was detected in multiple white matter regions, and several DTI metrics in certain white matter tracts had moderate relationships with the pain severity in the CS patients with pain. These observations may provide alternative imaging clues for the evaluation of the pathophysiological characteristics of CS pain.

The relationship between changes of cervical sagittal alignment after anterior cervical discectomy and fusion and spino-pelvic sagittal alignment under roussouly classification: a four-year follow-up study

BackgroundAnterior cervical discectomy and fusion (ACDF) is widely used in the treatment of cervical degenerative disease; however, the variation of cervical sagittal alignment changes after ACDF has been rarely explored. The purpose of this study is to determine the relationship between changes of cervical sagittal alignment after ACDF and spino-pelvic sagittal alignment under Roussouly classification.MethodsA cohort of 133 Chinese cervical spondylotic patients who received ACDF from 2011 to 2012 was recruited. All patients were categorized with Roussouly Classification. Lateral X-ray images of global spine were obtained, and preoperative and postoperative parameters were measured and analyzed, including C2–C7 angles (C2–C7), C0–C7 angles (C0–C7), external auditory meatus (EAM) tilt, sacral slope (SS), thoracic kyphosis (TK), lumbar lordosis (LL), spinal sacral angles (SSA), Superior adjacent inter-vertebral angle (SAIV), inferior adjacent inter-vertebral angle (IAIV) and et al. The Wilcoxon signed-rank test was used for intragroup comparisons preoperatively and at postoperative 48 months.ResultsAmong the parameters, C2–C7 and C0–C7 showed significant increase, while EAM TK, and IAIV decreased significantly. In type I, EAM and TK decreased significantly, however SS showed a significant increase; in type II, TK showed a significant decrease, but SSA showed a significant increase; in type III, a significant increase of C0–C7 was observed with a significant decrease in EAM, nevertheless, LL, SS and SSA showed significant decreases; and in type IV, C2–C7 showed a significant increase and EAM decreased significantly. The percentage of lordotic alignment in cervical spine increased, which was presenting in type I, III and IV. Nevertheless, the amount of patients with straight cervical alignment increased in type II.ConclusionThe backward movement of head occurs is the compensatory mechanism in cervical sagittal alignment modifications after ACDF. The compensatory alteration of spino-pelvic sagittal alignment varied in different Roussouly type.

Analysis of cervical and global spine alignment under Roussouly sagittal classification in Chinese cervical spondylotic patients and asymptomatic subjects.

To explore the relationship between cervical spine and the global spine alignment and to postulate the hypotheses that a lordotic alignment of cervical spine is not the only standard to identify asymptomatic subjects, and the degenerative modification of cervical curves depends primarily on their spinal-pelvic alignment. A cohort of 120 cases of Chinese asymptomatic subjects and a cohort of 121 cases of Chinese cervical spondylotic patients were recruited prospectively from 2011 to 2012. Roussouly Classification was utilized to categorize all subjects and patients according to their thoracic spine, lumbar spine and pelvic alignment. The cervical alignments were evaluated as lordosis, straight, sigmoid or kyphosis. Through the lateral X-ray images of neutral cervical and global spine, a number of parameters were measured and analyzed, including pelvic incidence, pelvic tilt, sacral slope, thoracic kyphosis (TK), lumbar lordosis, global cervical angles (angles between two lines parallel with posterior walls of C2 and C7), practical cervical angles (the addition of different cervical end plate angles from C3 to C7, and inter-vertebral angles from C23 to C67), T1 slope, spinal sacral angles (SSA), Hip to C7/Hip to Sacrum and C0-C2 angle. The percentages of cervical lordosis were 28.3% and 36.4% in asymptomatic and spondylotic group, respectively. The cervical spine alignments correlated with Roussouly types of global spine alignment in both asymptomatic and cervical spondylotic group (P < 0.001). And there were significant differences between Roussouly Type 2 and 4, Type 3 and 4, Type 1 and 3 in cervical angles in spondylotic group (P < 0.05). In the comparison of the two cohorts, significant differences were found in both general and practical cervical angles in Roussouly Type 4 (P = 0.00 and 0.01, respectively), and there were significant differences in inter-vertebral angle in Roussouly Type 2 at C4-5 and C5-6 levels (P = 0.04 and 0.04, respectively), and in Roussouly Type 3 at C6-7 level (P = 0.01). The SSA showed significant difference between Roussouly Type 2 and 4 in asymptomatic subjects (P = 0.00), and between Type 1 and 3, 1 and 4, 2 and 3, 2 and 4 in cervical spondylotic patients (P = 0.01, 0.02, 0.00 and 0.01, respectively). The T1 slope was significantly different among Roussouly types (P = 0.04) with its largest value in Type 1 in cervical spondylotic group. There are significant differences in C0-C2 angles in all Roussouly types (P = 0.01, 0.02, 0.00 and 0.01, respectively), as well as in the ratio of Hip to C7/hip to sacrum in Type 2 (P = 0.01), and Type 3 (P = 0.00) in the comparison of the two cohorts. The multiple linear regression of all parameters showed both general and practical cervical angles were significantly related to TK, C0-C2 and T1 slope (P = 0.01, 0.00 and 0.00, respectively). The cervical alignment correlates with their global spine and pelvic curves. And lordosis is not the only presentation in asymptomatic subjects. The degenerative modification of cervical disc angles was the compensation of global spine degeneration for horizontal gaze. Cervical angles are influenced by their TK angles, occipital-C2 joint and the tilt of T1 vertebral body. The occipital-C2 joint has a compensating mechanism in all Roussouly types in cervical spondylosis.

Comparison of Surgical and Medical Treatments for Cervical Spondylosis

Objective: Cervical spondylosis can lead to static and dynamic compression of the cord and severe disabilities especially in patients with cervical spondylotic myelopathy (CSM). We planned a study to determine the best approach to treat CSM. Materials and Methods: Many cases with CSM, who needed operation, refused to do surgery and treated medically. We determined the score of each patient at first and 6 months later based on Japanese Orthopedic Association scores. Then we compared the results. Results: We approached posteriorly in 43%, anteriorly in 35%, and circumferential in 22%. In cases treated surgically, 23% had excellent results, 47% good, 28% no changes, and 2% poor results; however, in cases treated medically, 0% had excellent results, 7% good, 67% no changes, and 26% poor results. Conclusion: In cervical spondylotic patients with severe neurological findings, especially as myelopathy, the results of surgery versus conservative approach is preferred in most cases (P<0.001).

Clinical Results of Median Corpectomy in Cervical Spondylotic Patients with Myelopathy.

To determine the factors in choosing the right surgical technique for patients with cervical spondylotic myelopathy. 60 patients were operated with anterior median corpectomy and anterior fusion for cervical myelopathy in Ankara Atatürk Education and Research Hospital between the years 2006-2011. All data were obtained from patient files retrospectively. Patients were evaluated in the preoperative and early postoperative stages and 45 days after discharge by referring to their neurological examinations, Japanese Orthopaedic Association (JOA) and Nurick scores and radiological findings. The average age of the patients was 53.8 ± 9.9 years (38-78) and 45 were male (75%) and 15 were female (25%). Diabetics made up 16.7% (n=10) of the group and nondiabetics 83.3% (n=50). Of the nondiabetic patients, the Nurick score on the first month after surgery was statistically lower than the preoperative and after 24 hours Nurick score (p < 0.001). In the patients in the group that had 1 or 2 myelopathic findings, the Nurick score on the first month after surgery was statistically lower than the preoperative and after 24 hours Nurick score (p < 0.001). The JOA score one month after surgery was statistically lower in patients with myelomalacia than in patients without myelomalacia (p=0.002). Median corpectomy and anterior fusion technique had better scores in patients that had few and early myelopathic symptoms, no myelomalacia on MRI, and no systemic disease.

Myelographic Evaluation of Cervical Spondylosis: Patient Tolerance and Complications

Retrospective chart review of documented adverse events in 637 consecutive patients after computed tomogram myelography and follow-up interview of the most recent 100 of these patients. This study assessed documented prevalence of adverse events after diagnostic myelography in cervical spondylotic patients and compared with perceived adverse events and satisfaction in a subset of the same cohort of patients. There are some data that suggest complimentary benefits of myelography to magnetic resonance imaging. However, given the invasive nature of myelography, there are little data documenting the adverse events and patient experience with myelography to guide informed consent and physician choice of this study. We analyzed the records of 637 consecutive patients (364 males and 273 females) after myelography. Five hundred forty-four patients (group 1) had a cervical approach and 93 (group 2) had a lumbar approach. The last 100 consecutive patients (85 in group 1 and 15 in group 2) were asked questions that addressed patient perceived adverse reactions, pain levels, and satisfaction. There was a 4.4% (28/637) prevalence of documented abnormal reactions. Group 1 had a 4.9% (25/506) prevalence of adverse reactions compared with 3.4% (3/89) in group 2. Overall 6.6% (42/637) had to have their myelographic procedures converted. Group 1 had 7% (38/544) converted to the lumbar approach group 2 had 4.3% (4/93) converted to the cervical approach. Thirty percent of the 100 patients interviewed felt they had an unexpected reaction (28 group 1 and 2 group 2). When interviewed, 14% of patients had maximum pain scores of 10 during the procedure and 8% (all group 1) felt worse pain after the procedure was completed. Six group 1 and 2 group 2 patients would not have the procedure again even when recommended by the surgeon. There was no statistically significant difference between complication rates, conversion rates, or patient perceived unexpected reactions between the 2 groups (beta=0.90). This paper demonstrated the discrepancy between documented adverse events with computed tomogram myelography and patient reported tolerance as recorded by telephone follow-up. The cervical approach had a greater degree of patient perceived discomfort and a trend toward higher documented and patient reported adverse events and rate of approach conversion to a lumbar approach (P>0.5). When choosing myelography to evaluate patients with cervical spondylosis, the surgeon should consider the low patient tolerance and frequent adverse reactions that often go undocumented.