Arm Pain Research Articles

Post-procedural Brachial Neuritis: Clinical, Electrodiagnostic and Neuroimaging features.

Brachial neuritis is a monophasic condition affecting the brachial plexus and its branches, manifesting as acute shoulder and upper arm pain, followed by weakness and paresthesias. It can be triggered by antecedent events, including procedures such as surgery. Misdiagnosis and delay in diagnosis is common. Imaging is important to confirm the diagnosis of post-procedural brachial neuritis and exclude other etiologies. Clinical, electrodiagnostic, and neuroimaging features of patients with post-procedural brachial neuritis from a single quaternary care institution were identified and analyzed. Six (2 female) patients were identified with median age 62 (range 49-70) years. Antecedent procedures included 4 cervical spine surgeries, 1 rotator cuff repair, and 1 central venous catheter placement. Time to symptom onset ranged from 1-day to 2-weeks. The initial symptom for 5/6 patients was severe upper extremity pain followed by weakness. All patients had electrodiagnostic tests and MR neurography consistent with brachial neuritis. MR neurogram showed plexus and/or terminal branch abnormalities with associated muscular denervation edema. The C5 or C6 root, and/or upper trunk were always involved. The most common branches affected were the suprascapular, long thoracic, and axillary nerves. Hourglass constrictions of these nerves were seen in 3/6 patients. The average time to diagnosis was 3.4 (range 1.5-5) months. Post-procedural brachial neuritis is an underrecognized cause of acute upper extremity pain and weakness. MR neurography can exclude iatrogenic causes and document the presence of hourglass constrictions in affected nerves. Diagnostic neuroradiologists should be aware of this clinical entity and associated neuroimaging findings. HGC = hourglass constriction; EDX = electrodiagnostic; IRB = Institutional Review Board; ACDF = anterior cervical discectomy and fusion; NRS = Numerical Rating Scale; MUAP = motor unit action potential.

Factors Associated With Return to Work Following Laminoplasty for Degenerative Cervical Myelopathy.

Retrospective cohort study. To identify factors predictive of returning to work within 90 days of laminoplasty for degenerative cervical myelopathy (DCM). DCM is a debilitating condition resulting from spinal canal stenosis and spinal cord compression. One surgical option for cord decompression is cervical laminoplasty. Factors influencing return to work (RTW) postsurgery are unknown. This study included adult patients previously employed, undergoing primary elective laminoplasty for DCM, and with documented RTW status. Variables included demographic information, medical history, illness characteristics, and baseline patient-reported outcomes. The primary outcome of interest was RTW status at 90 days. Statistical analyses were conducted to identify predictors. Forty-six patients (67.6%) returned to work within 90 days, whereas 22 (32.3%) either RTW between 90 and 365 days (n = 3) or did not RTW within 365 days (n = 19). Significantly more patients who RTW within 90 days worked full-time (90.9% vs 64.3%, P = 0.030). Patients who RTW within 90 days had significantly lower preoperative Neck Disability Index scores (23.7 ± 17.5 vs 35.6 ± 14.3, P = 0.008) and higher preoperative modified Japanese Orthopedic Association scores (13.7 ± 2.5 vs 12.2 ± 2.7, P = 0.018) compared with those who did not RTW. No differences were found in other baseline patient-reported outcomes. Patients who RTW within 90 days had significantly lower postoperative 3-month neck pain (2.0 ± 2.1 vs 3.8 ± 2.6, P = 0.007), 3-month arm pain (1.3 ± 1.9 vs 3.6 ± 2.8, P < 0.001), 12-month neck pain (1.4 ± 1.6 vs 3.1 ± 2.4, P = 0.019) and 12-month arm pain (1.1 ± 1.8 vs 2.4 ± 2.4, P = 0.048) compared with those who did not RTW within 90 days. Higher preoperative modified Japanese Orthopedic Association scores were significantly associated with truncated time to RTW (HR: 1.14, 95% CI: 1.01-1.29, P = 0.034). Patients with better preoperative neck and arm pain and functional scores were more likely to RTW within 90 days postlaminoplasty. Preoperative functional status plays an important role in assessing RTW postlaminoplasty. This information is valuable for preoperative patient counseling.

Relationship Between Pain, Muscle Strength, Function, and Quality of Life in Overhead Players With Chronic Internal Shoulder Impingement

Background and Objectives: This study aims to determine the relationship between pain, muscle strength, function, and quality of life (QoL) in overhead players with chronic shoulder internal impingement syndrome. Methods: Forty-seven overhead players consisting of 15 men, 32 and women (mean age 32.45±7.2) with chronic shoulder internal impingement were enrolled. The pain was measured by a visual analogue scale (VAS). Disabilities of the arm, shoulder, and hand (DASH) and shoulder pain and disability index (SPADI) questionnaires were used to measure pain and function, and a short form (SF)-36 questionnaire to measure QoL. Muscle strengths were evaluated in both hands with a hand-held dynamometer and players were asked to hold the maximal voluntary isometric contraction (MVIC) in the middle range for 3 s and rest for 30 s between each test and each contraction was repeated three times on both affected and healthy side and the average of contractions was considered for each side. Results: The study showed a significant relationship between pain, the strength of shoulder muscle groups (-0.354), function (-0.935), and QoL (-0.861) in overhead throwers with chronic shoulder internal impingement syndrome and the strength of internal rotators of the affected shoulder decreased more than others. (P&lt;0.05) Conclusions: This correlational study showed a significant relationship between pain and strength of shoulder muscles and function and QoL in overhead throwers with this syndrome.

Overloaded Vertebral Body Following Consecutive Three-Level Hybrid Surgery Comparing with Anterior Cervical Discectomy and Fusion.

Based on the varying number and relative positions of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF) procedures, three-segment hybrid surgery (HS) presents a diverse structural approach. Currently, the potential differential effects of HS with different segment combinations and surgical procedures on overloaded vertebral body (OVB) occurrence remain unexplored. The purpose of this retrospective study is to compare the clinical and radiological outcomes of HS and ACDF in treating cervical degenerative disc disease (CDDD), aiming to provide further insights into OVB. This study included patients with three-level CDDD who underwent ACDF or HS at our institution. Eligible patients were divided into three groups: Type I (one-level CDR and two-level ACDF), Type II (two-level CDR and one-level ACDF), and ACDF (three-level ACDF). For radiographic analysis, patients were further divided into the Replacement Segment Group and the Nonreplacement Segment Group based on the presence of replacement segments above and below the OVB. Clinical outcomes were evaluated using visual analog scale (VAS) scores for neck and arm pain, Japanese Orthopedic Association (JOA) scores, and neck disability index (NDI) scores. The cervical radiological parameters assessed included (1) vertebral cross-sectional area (CSA), (2) wedge angle (WA), (3) anterior vertebral height (AH), (4) posterior vertebral height (PH), and (5) Hounsfield unit (HU) values. Statistical methods included paired t-test, ANOVA test, and chi-square test. Independent samples t-test, Mann-Whitney U test, and Wilcoxon signed-rank test were used to compare the differences between two groups according to the results of normal distribution test. A total of 123 patients, evenly distributed among three groups, were included and were well matched in terms of demographic characteristics. The likelihood of vertebral body collapse (VBC) was notably higher in the ACDF group (41.5%) compared with the Type I (17.9%) and Type II (8.9%) groups (p < 0.01). Following surgery, both at 3 and 6 months, the ACDF group demonstrated higher VAS neck scores and NDI scores compared with the Type I and Type II groups (p < 0.01). Additionally, the WA and AH values of the upper and lower adjacent OVB were consistently lower in the ACDF group than in the Type I and Type II groups at 6 and 12 months and at the final follow-up (p < 0.01). Notably, in the Nonreplacement Segment Group, WA significantly decreased at 12 months postoperatively and at the final follow-up compared with the Replacement Segment Group (p < 0.01). Three levels of HS appear to reduce stress concentrations and alleviate morphological changes in OVB. The occurrence of more VBC patients with OVB was associated with the use of Zero-P or Zero-P VA implants.

Prevalence of lateral epicondylitis among housewives in Lahore: a cross-sectional study

BackgroundLateral epicondylitis (LE) is characterized by pain, inflammation and local tenderness over the bony prominence of the lateral epicondyle and is exacerbated under stressful and repetitive movements such as prolonged supination and pronation movements, twisting (wringing, turning) and rolling activities (stirring and mixing). Lateral Epicondylitis ranks as the second most commonly diagnosed musculoskeletal condition. Females, especially housewives, are more affected by LE. It can lead to persistent elbow pain, reduced grip strength, limited arm movement, and difficulty performing daily tasks.ResultsAll of our 150 participants were women aged 25–50 + years. We found that 86% of housewives reported some level of pain (mild, moderate and severe) according to the PRTEE questionnaire but 39.33% (59/150) showed positive lateral epicondylitis cases assessed physically by special test (Cozen, Mills, Maudsley’s test). Among the individuals diagnosed with lateral epicondylitis, a significant majority, 71.19% (42 out of 59), reported pain in their right arm while only 16.95% were experiencing pain in their left arm, however, 11.86% (7 out of 59) reported pain in both arms. The odds ratio estimates of age groups suggested that the 25–30 years group had higher odds of getting LE about 0.95 than the reference group. Among the individuals with lateral epicondylitis, 59.32% (35 out of 59) were experiencing chronic pain, while 40.67% (24 out of 59) were dealing with acute pain. 54.24% (32/59) of individuals with lateral epicondylitis experienced functional disability in specific activities, while 28.81% (17/59) reported functional disability in routine activities.ConclusionWe found a high prevalence of 39.33% lateral epicondylitis among housewives. There is a dire need to raise awareness among housewives for changing their lifestyle and activities regimen in order to avoid any such disorders like L.E. Robust studies with larger sample sizes are needed to establish conclusive evidence.

Arm Pain, Dysesthesias, And Pallor In A High School Soccer Athlete

Arm Pain, Dysesthesias, And Pallor In A High School Soccer Athlete

Development and implementation of a physiotherapy exercise intervention with tailored support for exercise adherence for people with vertebral fragility fractures (OPTIN trial)

ObjectivesThe OsteoPorosis Tailored exercise adherence INtervention (OPTIN) trial is a two-arm, multi-centre randomised controlled trial. It compares the effectiveness of physiotherapy exercise rehabilitation with integrated support for exercise adherence, to physiotherapy exercise rehabilitation alone, for people with vertebral fragility fracture (VFF) and back pain. This paper describes the development of the physiotherapist-led adherence enhanced intervention. MethodsWe used an intervention mapping approach and followed Medical Research Council guidelines for developing complex interventions. We co-created the intervention involving expert clinicians, service managers, researchers, and adults with long-term musculoskeletal conditions, including osteoporosis. We identified a theoretical framework, reviewed the evidence, used a feasibility study, and considered clinical practice and deliverability within UK National Health Service (NHS) outpatient physiotherapy secondary care. Through a collaborative workshop, we refined the intervention, involved patients again and re-tested the intervention. Finally, we manualised the intervention, produced patient and physiotherapist materials and trained physiotherapists for delivery. ResultsThe OPTIN intervention uses a motivational interviewing approach and captures information about patient goals, barriers, and facilitators to exercise. Physiotherapists assess exercise capability, opportunities and motivation and utilise at least three behaviour change approaches, selecting from an intervention toolkit of nine approaches to support exercise behaviour. Ninety minutes of additional physiotherapy are provided to deliver the intervention, integrated within the assessment and six follow-up visits. ConclusionsA theory-informed intervention to support exercise adherence was developed and delivered by physiotherapists trained in the intervention to older adults with VFF and back pain in the intervention arm (n = 63) of the OPTIN trial. Trial Registration numberISRCTN 14465704. Contribution of Paper•Describes the development of an intervention to support adherence to physiotherapy exercise for people with vertebral fragility fracture.•Reports in detail the intervention for replication.

Could indirect decompression occur for cord compression by the ligamentum flavum with anterior cervical discectomy and fusion?

Cord compression by the ligamentum flavum (CCLF) has been reported to adversely affect the clinical outcomes of anterior cervical discectomy and fusion (ACDF). While indirect decompression does occur for foraminal stenosis with ACDF, whether ACDF could improve CCLF with the distraction of disc space remains unclear. This study aimed to identify 1) whether indirect decompression occurs for CCLF with ACDF, and 2) risk factors that hinder the improvement of CCLF. This retrospective cohort study included 119 patients who underwent ACDF for the treatment of cervical myelopathy and CCLF was detected on preoperative MRI. Patients who demonstrated improvement in CCLF grade after ACDF were included in the improved group, while those who did not show improvement were classified as the unimproved group. Patient characteristics, cervical sagittal parameters, neck and arm pain visual analog scale score, and Japanese Orthopaedic Association (JOA) score were assessed. A comparison between the improved and unimproved groups was performed. Regression analyses were performed to identify factors associated with CCLF grade improvement. Overall, 58.0% (69/119) of patients showed improvement in CCLF grade after ACDF. CCLF grade did not improve in the remaining 42.0% (50/119) of patients, and 3.4% (4/119) of patients experienced aggravation of CCLF after ACDF. Preoperative spondylolisthesis (OR 0.252, 95% CI 0.090-0.711; p = 0.009) and greater segmental lordosis 3 months postoperatively (OR 0.835, 95% CI 0.731-0.953; p = 0.008) were the factors that hindered the improvement of CCLF after ACDF. Furthermore, patients with higher pre- or postoperative CCLF grades showed significantly less improvement in JOA score 2 years postoperatively. Indirect decompression for CCLF with ACDF is not reliable because 42.0% of patients did not demonstrate improvement in CCLF grade after the operation. Preoperative spondylolisthesis and postoperative increased segmental lordosis were risk factors for failure of CCLF improvement. Both pre- and postoperative higher CCLF grades were associated with poor neurological recovery 2 years postoperatively.

Neutralizing antibody titers after COVID-19 vaccination

BackgroundMonitoring COVID-19 and evaluating the effectiveness of prevention and control strategies are considered critical priorities in public health. As a result, the administration of COVID-19 vaccines has been widely approved around the world. In the current study, we investigated the level of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) neutralizing antibody (NAb) among individuals who received different COVID-19 vaccines. MethodsThis cross-sectional study recorded demographical data and clinical characteristics of 168 individuals who received COVID-19 vaccines from 2021 to 2022. Vaccination data of participants, including type and times of vaccine and any complications and symptoms after vaccination, were also recorded. SARS-CoV-2 NAb level was assessed by performing an ELISA test, and all data was analyzed using SPSS version 21. The significant level was set at 0.05. ResultsThe mean age of the participants was 40.4 ± 16 years, and 109 were females. About 18.4% of participants had the underlying diseases, of which thyroid diseases were the most frequent. The mean SARS-CoV-2 NAb level was 31.6 ± 39.78 ng/ml. Sinopharm was the common vaccine in our population, and AstraZeneca represented a high level of Nab 47.18 ng/ml. Among the participants, 96 had mild to severe complications after vaccination, with the most complaining of arm pain. Significant differences of NAb levele were observed only between types of vaccine and gender (P<0.05). ConclusionDue to our findings, all employed vaccines demonstrated efficacy in generating NAb. The levels of Nab were different among genders, age groups, and different types of vaccine receivers.

Pitcher’s Predicament: Left Arm Pain In Youth Baseball

Pitcher’s Predicament: Left Arm Pain In Youth Baseball

Clinical and Radiographic Outcomes of Cervical Disc Replacement Versus Posterior Endoscopic Cervical Decompression: A Matched-Pair Comparison Analysis.

To compare clinical and radiographic outcomes between 2 motion preservation surgeries, cervical disc replacement (CDR) and posterior endoscopic cervical decompression (PECD), for unilateral cervical radiculopathy. Between February 2018 and December 2020, 60 patients with unilateral cervical radiculopathy who underwent either CDR or PECD were retrospectively recruited as matched pairs. Clinical outcomes included visual analogue scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and satisfaction rates. The radiographic outcome was index level motion. Intraoperative data, complications, and hospital stay were collected. Preoperative and postoperative outcomes were compared. Patients undergoing CDR or PECD were included, with 30 cases in each group. Matched pairs were compared in terms of demographic data and preoperative measurements. CDR was associated with shorter operative times, whereas PECD resulted in less intraoperative blood loss. The total complication rate was 5%. NDI and VAS for neck and arm were significantly improved in both groups, with no significant differences between the 2 groups. Satisfaction rates of good and excellent exceeded 87% in both groups. CDR was superior to PECD in the restoration of disc height. Early postoperative follow-up showed no significant difference in terms of index level motion. PECD demonstrated significantly shorter hospital stays and quicker return-to-work times (p<0.05). PECD achieved equivalent clinical and radiologic outcomes compared with CDR when the certain criteria for surgery were met. Both techniques demonstrated the potential to maintain index level motion. Additionally, PECD resulted in less blood loss, shorter hospital stays, and faster return-to-work times. Conversely, CDR offered shorter operative times and better restoration of disc height.

Clinical Outcomes and Complications of Unilateral Biportal Endoscopic Posterior Cervical Foraminotomy: A Systematic Review and Meta-Analysis With a Comparison to Full-Endoscopic Posterior Cervical Foraminotomy.

The unilateral biportal endoscopic posterior cervical foraminotomy (UBE-PCF) has been recently adopted for unilateral radiating arm pain due to cervical herniated intervertebral disc or foraminal stenosis. We systematically meta-analyzed clinical outcomes and complications of the UBE-PCF and compared them with those of full-endoscopic PCF (FE-PCF). We systematically searched the PubMed, Embase, and Web of Science until February 29, 2024. Clinical outcomes and complications of the UBE-PCF and FE-PCF were collected and analyzed using the fixed-effect or random-effects model. Clinical outcomes of the UBE-PCF were compared with minimal clinically important difference (MCID) following PCF to evaluate the efficacy of UBE-PCF. Ten studies were included in the meta-analysis. In the random-effects meta-analysis, the Neck Disability Index (NDI), visual analogue scale (VAS) neck, and VAS arm were significantly decreased after the UBE-PCF (p<0.001). The improvement of NDI, VAS neck, and VAS arm were significantly higher than MCID (p<0.05). The improvement of NDI, VAS neck, and VAS arm were not significantly different between the UBE-PCF and FE-PCF (p>0.05). Overall incidence of complications of the UBE-PCF was 6.2% (24 of 390). The most common complication was dura tear (2.1%, 8 of 390). The incidence in overall complications was not significantly different between the UBE-PCF and FE-PCF (p=0.813). We found that the UBE-PCF significantly improved clinical outcomes. Regarding clinical outcomes and complications, the UBE-PCF and FE-PCF were not significantly different. Therefore, the UBE-PCF would be an advantageous surgical option comparable to FE-PCF for unilateral radiating arm pain.

Surgery on the C3-4 Level and the Presence of Ligamentum Flavum Hypertrophy Increases the Risk of 30-Day Reoperation Rate After Anterior Cervical Discectomy and Fusion

BACKGROUND AND OBJECTIVES: Cervical myelopathy caused by C3-4 level degeneration often exhibits different characteristics after anterior cervical discectomy and fusion (ACDF) than other cervical levels. This study compared the outcomes of C3-4 ACDF with surgeries at other levels and identified risk factors of 30-day reoperation after ACDF. METHODS: We retrospectively analyzed patients who underwent ACDF for degenerative cervical disease from 2018 to 2023. The patients were divided into 2 groups based on the level of surgery: C3-4 and non–C3-4 groups. Radiological outcomes, including cervical alignment and range of motion (ROM), were analyzed. Clinical outcomes were assessed with patient-reported outcomes and the rates of 30-day reoperation and complications after ACDF. Patient-reported outcomes included visual analog scale for neck pain, visual analog scale for arm pain, and modified Japanese Orthopedic Association scores. Risk factors of 30-day reoperation were assessed. RESULTS: Of 259 patients, 74 (28.6%) and 185 (71.4%) were in the C3-4 and non–C3-4 groups, respectively. The C3-4 group exhibited lower C2-7 ROM (P = .019), higher C3-4 ROM (P = .015), and greater C3-4 %ROM (P = .014). The C3-4 group demonstrated lower preoperative and 1-month postoperative modified Japanese Orthopedic Association scores (P &lt; .001; P &lt; .001, respectively). The rate of 30-day reoperation was significantly higher in the C3-4 group (9.5%) compared with the non–C3-4 group (2.2%) (P = .014). In addition, C3-4 surgical level (odds ratio = 4.99, P = .034) and ligament flavum hypertrophy (odds ratio = 5.84, P = .018) were identified as independent risk factors of 30-day reoperation after ACDF. CONCLUSION: Surgery on C3-4 level showed a higher risk of 30-day reoperation than other levels. It is likely due to C3-4 surgical level, and ligament flavum hypertrophy contributes to cord compression, particularly in the unstable early postoperative period.

Preoperative Factors on Loss of Range of Motion after Posterior Cervical Foraminotomy.

Background and Objectives: Posterior cervical foraminotomy (PCF) aims to resolve cervical radiculopathy while preserving range of motion (ROM). However, its effectiveness in maintaining ROM is uncertain. This study investigates the changes in ROM after PCF and identifies preoperative factors that influence ROM reduction post surgery. Materials and Methods: This retrospective cohort study included patients treated at our hospital from August 2016 to September 2021. Clinical outcomes were assessed using the visual analog scale (VAS) for neck and arm pain and the neck disability index (NDI). Radiological outcomes included the segmental angle (SA), cervical angle (CA), C2-C7 SVA, Pfirrmann grade, extent of facetectomy, foraminal stenosis, and ROM. Patients were categorized into two groups based on segmental ROM changes: decreased (Group D) and maintained (Group M). Radiological and clinical outcomes were compared between the groups. Univariate and multivariate regression analyses were performed to identify risk factors for ROM loss after PCF. Results: 76 patients were included: 34 in Group D and 42 in Group M, with no demographic differences. Preoperatively, Group D had significantly larger flexion segmental and cervical angles than Group M (segmental, p < 0.001; cervical, p = 0.001). Group D also had a higher Pfirrmann grade (p = 0.014) and more bony bridge formations (p = 0.004). While no significant differences were observed in arm pain VAS and NDI scores, Group D exhibited worse neck pain VAS at the last follow-up (p = 0.03). Univariate linear regression indicated that preoperative segmental ROM (p < 0.001, B = 0.82) and bony bridge formation (p = 0.046, B = 5.33) were significant predictors of ROM loss post PCF. Conclusions: Patients with higher preoperative flexion angles and Pfirrmann grades at the operative level are at an increased risk for ROM loss and neck pain and often exhibit bony bridge formation. Accounting for these factors can improve surgical planning and patient outcomes.

Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy

BACKGROUND CONTEXTAnterior cervical discectomy and fusion (ACDF) combined with uncinate process resection and laminoplasty combined with foraminotomy (LPF) have been used to achieve cervical cord and root decompression in patients with combined cervical myeloradiculopathy (CMR). PURPOSETo compare the clinical and radiographic outcomes of ACDF with those of LPF for the treatment of CMR. STUDY DESIGN/SETTINGPropensity score-matched retrospective cohort study. PATIENT SAMPLEPatients with CMR who underwent ACDF or LPF and were followed up for at least 2 years. OUTCOME MEASURESC2–C7 lordosis, C2–C7 sagittal vertical axis, and cervical range of motion (ROM) were determined. The visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and Japanese Orthopedic Association (JOA) scores were analyzed. METHODSThe radiographic and clinical outcomes of the 2 groups were compared. RESULTSEighty-four patients were included (n=42 in each group) after application of the inclusion criteria and propensity score matching. A significant decrease in C2–C7 lordosis (p<.001) and ROM (p<.001) was observed in the LPF and ACDF groups, respectively. LPF was associated with a significant decrease in C2 to C7 lordosis (p<.001), while ACDF caused a significant decrease in cervical ROM (p<.001). ACDF effectively improved neck pain VAS (p<.001) and NDI (p<.001), while neck pain did not significantly improve after LPF (p=.103). Furthermore, neck pain VAS (p=0.026) and NDI (p=.021) at postoperative 6 months, were significantly greater in the LPF group than in the ACDF group, while the difference was not statistically significant at 2 years postoperatively (neck pain VAS, p=.502; NDI, p=.085). Arm pain VAS and JOA score both significantly improved after LPF (p=0.003 and 0.043, respectively) or ACDF (p<.001 and 0.039, respectively), and postoperative results were not significantly different between the 2 groups. CONCLUSIONLPF and ACDF yielded similar outcomes for arm pain and neurological recovery. More immediate neck pain improvement was observed with ACDF, while neck pain after 2 years postoperatively was similar between the LPF and ACDF groups. Furthermore, increased postoperative loss of lordosis was observed in the LPF group, whereas decreased postoperative ROM was observed in the ACDF group. These findings should be considered when deciding the surgical method for patients with CMR. LEVEL Of EVIDENCEIII.

Structural Allograft versus Polyetheretherketone Cage in Anterior Cervical Discectomy and Fusion: A Meta-Analysis

Polyetheretherketone (PEEK) cages and structural allografts (SAs) are commonly used in Anterior Cervical Discectomy and Fusion (ACDF), yet their postoperative results remain uncertain. This meta-analysis was conducted to determine whether there were any differences in outcomes between patients who received these two grafts in ACDF. We comprehensively searched electronic databases up to August 2023. Observational studies or randomized controlled trials reported postoperative outcomes, including fusion, subsidence, reoperation rates, and patient-reported outcomes through the Neck Disability Index (NDI), the Visual Analog Scale (VAS) for neck and arm pain, and the Japanese Orthopedic Association (JOA)/modified JOA score following primary ACDF using SA or PEEK cage. The results are presented in odds ratios (ORs) or mean differences with corresponding 95% confidence intervals (CIs). Eleven studies were included, with 1213 patients (788 receiving SAs and 425 receiving PEEK cages). Patients having SA had significantly higher fusion (OR: 1.84, 95% CI: 1.27-2.67, p = 0.001) and lower subsidence (OR: 0.50, 95%CI: 0.30-0.86, p = 0.01) rates when compared with the PEEK cage. There was no difference in revision rate between SA or PEEK cage (p = 0.88). Two grafts demonstrated similar clinical improvements in NDI (p = 0.31), VAS for the neck (p = 0.77) and arm pain (p = 0.22), and JOA/mJOA score (p = 0.99). SA demonstrates better fusion and lower subsidence rates than the PEEK cage in ACDF. Nevertheless, these two cages resulted in equally successful postoperative clinical performances.

Do class III obese patients achieve similar outcomes and satisfaction to nonobese patients following surgery for cervical myelopathy? A QOD study.

The aim of this study was to compare the rate of achievement of the minimal clinically important difference (MCID) in patient-reported outcomes (PROs) and satisfaction between cervical spondylotic myelopathy (CSM) patients with and without class III obesity who underwent surgery. The authors analyzed patients from the 14 highest-enrolling sites in the prospective Quality Outcomes Database CSM cohort. Patients were dichotomized based on whether or not they were obese (class III, BMI ≥ 35 kg/m2). PROs including visual analog scale (VAS) neck and arm pain, Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA), EQ-5D, and North American Spine Society patient satisfaction scores were collected at baseline and 24 months after cervical spine surgery. Of the 1141 patients with CSM who underwent surgery, 230 (20.2%) were obese and 911 (79.8%) were not. The 24-month follow-up rate was 87.4% for PROs. Patients who were obese were younger (58.1 ± 12.1 years vs 61.2 ± 11.6 years, p = 0.001), more frequently female (57.4% vs 44.9%, p = 0.001), and African American (22.6% vs 13.4%, p = 0.002) and had a lower education level (high school or less: 49.1% vs 40.8%, p = 0.002) and a higher American Society of Anesthesiologists grade (2.7 ± 0.5 vs 2.5 ± 0.6, p < 0.001). Clinically at baseline, the obese group had worse neck pain (VAS score: 5.7 ± 3.2 vs 5.1 ± 3.3), arm pain (VAS score: 5.4 ± 3.5 vs 4.8 ± 3.5), disability (NDI score: 42.7 ± 20.4 vs 37.4 ± 20.7), quality of life (EQ-5D score: 0.54 ± 0.22 vs 0.56 ± 0.22), and function (mJOA score: 11.6 ± 2.8 vs 12.2 ± 2.8) (all p < 0.05). At the 24-month follow-up, however, there was no difference in the change in PROs between the two groups. Even after accounting for relevant covariates, no significant difference in achievement of MCID and satisfaction was observed between the two groups at 24 months. Despite the class III obese group having worse baseline clinical presentations, the two cohorts achieved similar rates of satisfaction and MCID in PROs. Class III obesity should not preclude and/or delay surgical management for patients who would otherwise benefit from surgery for CSM.

Endovascular treatment of contained ruptured internal thoracic artery aneurysm mimicking a tumor in a patient with neurofibromatosis type 1: a case report

BackgroundAn internal thoracic artery aneurysm (ITAA) is an exceedingly rare condition, with approximately two-thirds of reported cases being iatrogenic pseudoaneurysms. The remainder are attributed to various causes, including vasculitis, connective tissue disease, and neurofibromatosis type 1 (NF-1). NF-1 is an autosomal dominant disorder characterized by distinct clinical manifestations that occasionally include life-threatening vascular complications. Although NF-1 patients may develop various vascular abnormalities, ruptured ITAA is rarely reported, with only seven published cases.Case presentationA 32-year-old man with NF-1 consulted for a three-day history of persistent left back and upper arm pain. Initial chest radiography indicated left pleural effusion and an opacity at the left lung apex. Computed tomography scan revealed a mass in the left upper mediastinum that was initially suspected to be a tumor. Subsequent contrast-enhanced computed tomography revealed the mass to be a subclavian artery aneurysm. Detailed contrast-enhanced computed tomography with 1-mm slices was performed for surgical planning, identifying the mass as a left ITAA with contained rupture. Given the risk of re-rupture, emergency angiography was performed, which confirmed rupture of the left ITAA without extravasation. The ITAA was successfully treated with multiple microcoils at the proximal and distal ends. The patient had an uneventful recovery and was discharged on the fourth postoperative day.ConclusionsThis case highlights the importance of considering vascular lesions in NF-1 patients who present with pleural effusion. It also emphasizes the challenges in diagnosing ITAA and the effectiveness of thin-slice contrast-enhanced computed tomography scans and endovascular treatment.

Unveiling workplace safety and health empowerment: Unraveling the key elements influencing occupational injuries

Introduction: Millions of workers globally experience work-related injuries, leading to fatalities, injuries, job loss, and wider societal implications. This study utilizes both the U.S. database and the General Social Survey (GSS) to delve into the factors linked to occupational injuries. Methods: In this study, 30 questions from the GSS between 2002 and 2014 were used. The sample included 5,914 workers from various sectors, distributed between both female and male, and were of 18 years and above. The analysis encompasses several dimensions: demographics, job-related characteristics, administrative factors, and health and safety measures. The study particularly focuses on assessing the prevalence of three common work-related injuries: nonfatal injuries, back pain and arm pain. Logistic regression models were constructed to gauge the effects of identified factors. Results: Significant insights emerge from the analysis. Factors such as age, gender, race, working hours, overtime work, trust in management, coworker support, and workflow smoothness were identified as having notable impacts on work-related injuries. For each model, the study quantifies these impacts through odds ratio and relative effects. For example, in the nonfatal injuries model, the relative effects of age showed that workers aged 65 years or older experience a 2.56% decrease in the frequency of nonfatal injuries compared to younger workers. Furthermore, in the back pain model, the estimated odds of having back pain in males are 0.90 lower than that in females. Moreover, in the arm pain model, workers who have sufficient time to complete their tasks have estimated odds of experiencing arm pain that are 0.85 lower than those who don’t have adequate time, etc. Conclusions: Understanding the intricate interplay of various factors influencing workers’ safety and health is vital for addressing occupational injuries. By addressing these factors, there’s potential for reducing work-related injuries, enhancing work environment, and minimizing costs. Practical Applications: Organizations can use the study’s findings for reducing work related injuries. Flexible work arrangements, tailored training programs, and ergonomic improvements might highlight factors such as age, gender, and working hours. Enhancing communication, fostering a positive work culture, and prioritizing safety and health measures could reduce risks associated with trusting management and coworker support. Cost-benefit analysis and continuous monitoring ensure these interventions’ effectiveness, reduce back and hand pain incidents, minimize cost, and create safer workplaces, thereby boosting the overall well-being of workers and organizational success.

Penerapan Metode Bayes untuk Mendiagnosa Penyakit Saraf Kejepit

A pinched nerve is a condition where certain nerves are compressed by tissues around the body, such as bones, cartilage and muscles. This causes the nerve to become damaged with symptoms of severe pain, tingling, and numbness during activity. Nerve pain can spread throughout the body. For example, patients with radiculopathy type spinal cord disease make the patient numb, and the nerve pain can spread to the feet and hands. Sylvani General Hospital also provides expert doctors who treat various diseases, including pinched nerve disease suffered by patients. However, there are several problems that often occur to patients when going for direct consultation due to time constraints, long queues, long waits, long distances to the hospital, and lack of costs. Because agencies need to have a system that can manage existing symptom data on pinched nerve disease and make it an online expert substitute information by utilizing technological developments to get maximum diagnostic results, and patients can find out the initial symptoms of one of them numbness, leg pain, arm pain, back pain, muscle weakness in the type of pinched nerve disease, namely radiculopathy, carpal tunnel syndrome, pinched nerves in the waist, piriformis syndrome, radial tunnel syndrome and treatment first by consulting through a system that has been created using the Bayes method. From the calculation process using the Bayes method above, it is known that the diagnosis of pinched nerve disease is diagnosed with nerve root syndrome (Radiculopathy) (P01) with a percentage of 72.55%.