Symptomatic Cervical Disc Herniation Research Articles

Comparison of Cervical Biportal Endoscopic Spine Surgery and Anterior Cervical Discectomy and Fusion in Patients with Symptomatic Cervical Disc Herniation.

Background: We aimed to analyze the clinical outcomes and effectiveness of cervical biportal endoscopic spine surgery (C-BESS) and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic cervical disc herniation. Methods: This study was a retrospective chart review of four-year clinical data involving 318 cases of symptomatic cervical disc herniation, with 156 patients undergoing the ACDF and 162 patients receiving the C-BESS. Preoperative and postoperative one-year data were collected. Results: The numeric rating scale and neck disability index showed statistically significant improvement for both ACDF and C-BESS groups. While showing a longer operation time and more blood loss during surgery compared to the ACDF group, the C-BESS group demonstrated a learning effect as the surgeon's proficiency increased with more cases. There was no significant difference in the postoperative length of hospitalization between the two methods. The subgroup with predominant arm pain revealed the statistical difference in arm pain intensity changes between the two groups (p < 0.001). The rates of complication were 2.6% for the ACDF group and 1.9% for the C-BESS group. Conclusions: C-BESS and ACDF are effective surgical treatments for patients with symptomatic single-level cervical disc herniation in relieving relevant pain intensities and pain-related disabilities.

The Role of Cervical Disc Arthroplasty in Elite Athletes.

Cervical disc arthroplasty (CDA) for the treatment of symptomatic cervical disc herniations (CDH) is a promising treatment for professional athletes. In recent years, a number of high-profile athletes have returned to professional play within three months after CDA, raising important questions about the potential of this procedure within this patient group. We provide the first comprehensive review of available literature for the safety and efficacy of CDA in professional contact sport athletes. CDA provides theoretical biomechanical advantages over anterior cervical discectomy and fusion (ACDF) and posterior foraminotomy (PF), as CDA is the only operation for treatment of CDH that provides neural decompression, stability and height restoration, with preserved range of motion. While the comparative long-term results from each procedure are unknown, CDA has provided encouraging promise in its use in professional contact athletes. We aim to aid ongoing discussions regarding the controversies in spine surgery for professional athletes by providing a scientific review of the available evidence-based literature involving cervical disc arthroplasty in this population. In general, we believe that CDA is a viable alternative to ACDF and PF for the contact professional athlete who requires full neck range of motion and desires an expedited return to play. For collision athletes, the short- and long-term safety and efficacy profile of this procedure is promising but still unclear.

Exploring macrophage differentiation and its relation to Modic changes in human herniated disc tissue

IntroductionCervical- and lumbosacral radiculopathy symptoms due to disc herniation are likely to be influenced by macrophage infiltration of the herniated disc. Vertebral endplate changes are hypothesized to, at least partially, correlate to the inflammatory condition of the disc and its environment. Research questionThe present study aims to evaluate several immunohistochemical M1-and M2-markers for their suitability to discern pro-inflammatory M1-and anti-inflammatory M2 macrophage differentiation patterns in herniated intervertebral disc tissue. In addition, their associations with Modic changes (MC) of the vertebral endplates will be evaluated. Materials and methodsHerniated disc samples were collected from 45 patients undergoing surgery for cervical- or lumbosacral radiculopathy. Samples were processed for immunohistochemistry and stained for the presence of macrophages: CD68 (macrophage marker), CD40 (M1), iNOS (M1), CD192 (M1), CD163 (M2), Arg1 (M2) and CD209 (M2). T-cells (CD3) and neutrophil (CD15) expressions were studied additionally. ResultsCD68 positive cells were present with a median density of 50/cm2, M2 markers CD163 and CD209 were expressed most dominantly, followed by M1 marker CD192. Other M1/M2 markers, T-cell and neutrophil expression was limited. Lumbar samples showed higher expression of iNOS and Arg1 compared to cervical samples. Presence of Modic changes was associated with higher levels of CD68+ cells (p ​= ​0.046), but no significant differences in M1/M2 markers were found. Discussion and conclusionFor studying M1 macrophages, CD192 is the most suitable marker due to its high expression; whereas for M2 macrophages, this is CD163 due to its high expression and selectivity. Further, the relatively high expression of M2 markers indicates predominance of anti-inflammatory over pro-inflammatory macrophages in symptomatic lumbar and cervical disc herniations. No associations between M1/M2 markers and MC were seen in this limited number of samples. In order to further explore the role of macrophage differentiation and its relation with MC in radiculopathy, a large prospective trial with elaborate clinical follow-up is required.

Motion preservation after cervical total disc replacement surgery-fact or fiction?

Cervical disc replacement surgery aims to preserve cervical motion in younger patients who present with symptomatic degenerative cervical disc herniation and mobile facet joints. We aimed to determine the demographics, pre-operative range of motion, operative parameters, post-operative parameters, range of motion at 2-years post-operatively, in 27 patients who presented to our unit over a 6-year period who underwent cervical total disc replacement surgery. Materials and methodsWe performed a retrospective chart review of 27 patients who presented to our unit with degenerative cervical disc disease, from 01 January 2014 – 31 December 2019, who underwent cervical disc replacement surgery. The data collected included patient age; gender; mechanism of injury; clinical presentation; cervical level/s involved; description and site of the disc herniation; length of preoperative symptomatology; pre-operative cervical range of motion; length of operative procedure; volume of intra-operative blood loss; amount of immediate post-operative radiculopathy pain assessed by the visual analogue scale; complications; length of hospital stay; and cervical range of motion at 2-year follow-up. ResultsThe mean age of our subjects was 45.5 (+/-6.5) years. Regarding gender 11/27 (41%) subjects were female and 16/27 (59%) subjects were male. In terms of number of levels 21/27 (78%) subjects had single level surgery and 6/27 (22%) subjects had double level surgery. Considering age categories, patients in the 4th decade demonstrated a statistically significant increase between their pre-operative segmental range of cervical flexion and their post-operative segmental range of cervical flexion (p = 0.02). ConclusionThrough the results of our study we report that in our 27 subjects cervical total disc replacement surgery was motion preserving in 100% of our subjects at a 2-year study end point. We further report that all our subjects demonstrated some degree of increase in their segmental ranges of motion in all planes, although this was largely insignificant.

Evaluation of Concordance between Degenerative Changes on Neck X-Ray and Symptomatic Cervical Disc Herniation

Objectives: Radiographic assessment of cervical spine can help find the etiology of neck symptoms, however association between these findings is debatable. The aim of this study was to investigate the association between degenerative changes of the cervical spine and symptomatic cervical disc herniation. Patients and Methods: This cross-sectional retrospective study included 160 patients who underwent anterior cervical discectomy and fusion between February 2012 and June 2017 for cervical disc herniation. Demographic data, patients’ symptoms and radiographic findings and indices were evaluated. The Chi-Square (X2) and one-way ANOVA were used to compare the observed data. Results: A total of 160 patients were studied. Among them, 83 (52%) were male and 77(48%) were female. The patients were classified into four groups on the basis of imaging findings: 89(55.6%) with degenerative changes and symptomatic disc herniation at the same level (group 1), 40(25%) with degenerative changes at a level adjacent to symptomatic level (group 2), 23(14.3%) with symptomatic herniation both at the degenerated level and at level immediately adjacent to it (group 3), and 8(5%) symptomatic herniation and degenerative changes at non-adjacent levels (group 4). There were no significant differences among the four groups from the viewpoint of gender, age, symptoms, smoking and sedentary life style. The study also showed no significant differences between groups with respect to Ishihara index, disc height and posterior osteophyte length. Conclusion: Degenerative changes visible on neck X-ray can be useful clues to the symptomatic disc herniation, but disc herniation may also develop at adjacent and non-adjacent levels.

The key hole augmentation with demineralized bone matrix in anterior cervical trans-corporeal discectomy – Preliminary result of a novel technique

ObjectiveThe objective of this study was to evaluate the benefit of key hole augmentation with demineralized bone matrix (DBM) when performing the anteriortrans-corporeal discectomy (ACTD) for the treatment of cervical disc herniation. MethodsOf the 44 patients diagnosed with symptomatic cervical disc herniation, 22 patients were surgically treated by ACTD-alone, and the remaining 22were treated using ACTD with keyhole augmentation using DBM. Clinical outcomes were assessed using a visual analog scale (VAS). Plain radiographs were periodically checked during and up to 1 year postoperatively. The changes in the cervical lordosis angle, functional spinal unit angle, disc height, and anterior/posterior body height were serially measured and compared between the two groups. ResultsIn the ACTD-alone group, the disc height, anterior body height, and posterior body height gradually decreased during 1 year postoperatively, from 6.1 ± 1.00 mm to 4.3 ± 0.94 mm, 14.6 ± 1.60 mm to 12.7 ± 2.19 mm, and 14.6 ± 1.72 mm to 13.1 ± 2.23 mm, respectively; in the ACTD with keyhole augmentation group, these values were relatively stable (6.4 ± 1.02 mm to 4.6 ± 0.93 mm, 15.3 ± 1.27 mm to 13.9 ± 1.32 mm, and 15.8 ± 1.30 mm to 14.5 ± 1.32 mm, respectively). Most significant changes occurred 6 months postoperatively (p < 0.05). ConclusionsThis preliminary result of comparative study suggested that key hole augmentation with DBM could be an effective technique to prevent early height loss of the vertebral body and disc after ACTD and provide better biomechanical stability.

Evaluation of concordance between degenerative changes on neck X-ray and symptomatic cervical disc herniation

ObjectivesRadiographic assessment of cervical spine can help find the etiology of neck symptoms, however association between these findings is debatable. The aim of this study was to investigate the association between degenerative changes of the cervical spine and symptomatic cervical disc herniation. Patients and MethodsThis cross-sectional retrospective study included 160 patients who underwent anterior cervical discectomy and fusion between February 2012 and June 2017 for cervical disc herniation. Demographic data, patients' symptoms and radiographic findings and indices were evaluated. The Chi-Square (X2) and one-way ANOVA were used to compare the observed data. ResultsA total of 160 patients were studied. Among them, 83(52%) were male and 77(48%) were female. The patients were classified into four groups on the basis of imaging findings: 89(55.6%) with degenerative changes and symptomatic disc herniation at the same level (group 1), 40(25%) with degenerative changes at a level adjacent to symptomatic level (group 2), 23(14.3%) with symptomatic herniation both at the degenerated level and at level immediately adjacent to it (group 3), and 8(5%) symptomatic herniation and degenerative changes at non-adjacent levels (group 4). There were no significant differences among the four groups from the viewpoint of gender, age, symptoms, smoking and sedentary life style. The study also showed no significant differences between groups with respect to Ishihara index, disc height and posterior osteophyte length. ConclusionDegenerative changes visible on neck X-ray can be useful clues to the symptomatic disc herniation, but disc herniation may also develop at adjacent and non-adjacent levels.

Differences in the Incidence of Symptomatic Cervical and Lumbar Disc Herniation According to Age, Sex and National Health Insurance Eligibility: A Pilot Study on the Disease's Association with Work.

The aim of this research was to identify the differences in the incidence of symptomatic cervical and lumbar disc herniation according to age, sex, and national health insurance eligibility. We evaluated the hospital documents of patients who received medical treatment for symptomatic cervical and lumbar disc herniation between 2004 and 2010 and excluded those who claimed to have expenses at oriental medical clinics or pharmacies. Furthermore, any duplicate documents from the labor force population aged 20–69 years were excluded from the analysis. The results showed that the number of individuals diagnosed with symptomatic cervical and lumbar disc herniation increased with age, and the incidence of these diseases was higher in women than in men. Additionally, the incidence differed depending on the subject’s qualification for health insurance. The incidence of lumbar disc herniation showed differences depending on the degree of the lumbar burden. The present study findings may help determine whether lumbar disc herniation is associated with tasks performed at the patient’s workplace. Further research is needed to classify the risk of lumbar disk herniation in the workplace into detailed categories such as types of business, types of occupation, and lumbar compression force.

Friday, September 28, 2018 8:00 AM–9:00 AM interdisciplinary spine forum: abstract presentations: 144. Biomechanical effects of lateral bending position on performing cervical spinal manipulation for cervical disc herniation: a three-dimensional finite element analysis

BACKGROUND CONTEXT Most studies report that the common position of cervical spinal manipulation (CSM) for treating symptomatic cervical disc herniation (CDH) is lateral bending to the herniated side. However, the rationality of lateral bending position on performing CSM for CDH is still unclear. PURPOSE The purpose of this study is to investigate the biomechanical effects of lateral bending position on performing CSM for CDH. STUDY DESIGN/SETTING A finite element analysis study. OUTCOME MEASURES Cervical disc displacement, annulus fiber stress (von Mises stress) and facet joint stress (von Mises stress) were observed during the simulation of CSM. METHODS Afinite element (FE) model of CDH (herniated on the left side) was generated in C5–C6 segment based on the normal FE model. The FE model was performed CSM in left lateral bending position, neutral position and right lateral bending position, respectively. Cervical disc displacement, annulus fiber stress and facet joint stress were observed during the simulation of CSM. RESULTS The cervical disc displacement on herniated side moved forward during CSM, and the maximum forward displacements were 0.23, 0.36 and 0.45mm in left lateral bending position, neutral position and right lateral bending position, respectively. As the same trend of cervical disc displacement, the annulus fiber stress on herniated side from small to large were 7.40, 16.39 and 22.75MPa in left lateral bending position, neutral position and right lateral bending position, respectively. However, the maximum facet stresses at left superior cartilage of C6 in left lateral bending position, neutral position and right lateral bending position were 6.88, 3.60 and 0.12MPa, respectively. CONCLUSIONS Compared with neutral position and right lateral bending position, though the forward displacement of cervical disc on herniated side was smaller in left lateral bending position, the annulus fiber stresson herniated sidewas declined by sharing load on the left facet joint. The results suggested that lateral bending to the herniated side on performing CSM tend to protect the cervical disc on herniated side. Future clinical studies are in need to verify that.

Biomechanical Effects of Lateral Bending Position on Performing Cervical Spinal Manipulation for Cervical Disc Herniation: A Three-Dimensional Finite Element Analysis

Background Most studies report that the common position of cervical spinal manipulation (CSM) for treating symptomatic cervical disc herniation (CDH) is lateral bending to the herniated side. However, the rationality of lateral bending position on performing CSM for CDH is still unclear. Objective The purpose of this study is to investigate the biomechanical effects of lateral bending position on performing CSM for CDH. Methods A finite element (FE) model of CDH (herniated on the left side) was generated in C5-6 segment based on the normal FE model. The FE model performed CSM in left lateral bending position, neutral position, and right lateral bending position, respectively. Cervical disc displacement, annulus fiber stress, and facet joint stress were observed during the simulation of CSM. Results The cervical disc displacement on herniated side moved forward during CSM, and the maximum forward displacements were 0.23, 0.36, and 0.45 mm in left lateral bending position, neutral position, and right lateral bending position, respectively. As the same trend of cervical disc displacement, the annulus fiber stresses on herniated side from small to large were 7.40, 16.39, and 22.75 MPa in left lateral bending position, neutral position, and right lateral bending position, respectively. However, the maximum facet stresses at left superior cartilage of C6 in left lateral bending position, neutral position, and right lateral bending position were 6.88, 3.60, and 0.12 MPa, respectively. Conclusion Compared with neutral position and right lateral bending position, though the forward displacement of cervical disc on herniated side was smaller in left lateral bending position, the annulus fiber stress on herniated side was declined by sharing load on the left facet joint. The results suggested that lateral bending to the herniated side on performing CSM tends to protect the cervical disc on herniated side. Future clinical studies are needed to verify that.

The value of short-term pain relief in predicting the long-term outcome of 'indirect' cervical epidural steroid injections.

The predictive value of short-term arm pain relief after 'indirect' cervical epidural steroid injection (ESI) for the 1-month treatment response has been previously demonstrated. It remained to be answered whether the long-term response could be estimated by the early post-interventional pain course as well. Prospective observational study, following a cohort of n = 45 patients for a period of 24months after 'indirect' ESI for radiculopathy secondary to a single-level cervical disk herniation (CDH). Arm and neck pain on the visual analog scale (VAS), health-related quality of life with the Short Form-12 (SF-12), and functional outcome with the Neck Pain and Disability (NPAD) Scale were assessed. Any additional invasive treatment after a single injection (second injection or surgery) defined treatment outcomeas 'non-response'. At 24months, n = 30 (66.7%) patients were responders and n = 15 (33.3%) were non-responders. Non-responders exited the follow-up at 1month (n = 10), at 3months (n = 4), and at 6months (n = 1). No patients were injected again or operated on between the 6- and 24-month follow-up. Patients with favorable treatment response at 24months had significantly lower VAS arm pain (p < 0.05) than non-responders at days 6, 8-11, and at the 3-month follow-up. The previously defined cut-off of > 50% short termpain reduction was not a reliable predictor of the 24-month responder status. SF-12 and NPAD scores were better among treatment responders in the long term. Patients who require a second injection or surgery after 'indirect' cervical ESI for a symptomatic CDH do so within the first 6months. Short-term pain relief cannot reliably predict the long-term outcome.

Anterior cervical discectomy without fusion for a symptomatic cervical disk herniation

BackgroundCervical radiculopathy is characterized by dysfunction of the nerve root usually caused by a cervical disk herniation. The most important symptom is pain, radiating from the neck to the arm. When conservative treatment fails, surgical treatment is indicated to relieve symptoms. During the last decades, multiple fusion techniques have been developed, although without clinical evidence for added value of fusion over non-fusion.MethodsThe surgical procedure of anterior cervical discectomy without fusion is performed step by step, leading to removal of the entire intervertebral disk.ConclusionAnterior cervical discectomy without fusion is a safe and effective treatment for cervical disk herniation.

Management of Symptomatic Cervical Disk Herniation: A Survey Among Dutch Neurosurgeons.

A questionnaire survey. To assess the preferred surgical technique, the optimal timing of surgery, and the expectations of different surgical techniques of neurosurgeons in the Netherlands, regarding patients with cervical disc herniation (CDH). To treat CDH, multiple surgical techniques are performed. Due to the lack of consensus, the daily routine management may vary. All 134 neurosurgeons of the Dutch Association of Neurosurgery were sent a survey, evaluating the operative management as well as the attitude towards different surgical treatments for CDH. Ninety-six (74.4%) of the neurosurgeons treating CDH completed the survey. Anterior cervical discectomy with fusion (ACDF) was the standard procedure for the majority of neurosurgeons (76.3%). ACDF was expected to have the highest effectiveness on arm pain, yet also a higher risk for complications as compared with anterior cervical discectomy (ACD). Approximately, 47.9% of the surgeons regarded a minimal duration of 8 to 12 weeks of radicular arm pain before deciding to perform surgery. Regarding the risk of recurrent CDH, DCF was expected to give the highest risk, whereas ACDF the lowest. Despite the lack of solid evidence in favor for ACDF this survey showed that ACDF is the preferred technique to treat cervical radiculopathy. A minimum duration of 8 to 12 weeks of radicular arm pain was considered the optimal timing to perform surgery for CDH by the majority of the neurosurgeons. Whether to fuse or not remains a controversial subject in degenerative spinal surgery. This study emphasizes the need of high-quality evidence on the optimal surgical management of CDH. N/A.

Can axial pain be helpful to determine surgical level in the multilevel cervical radiculopathy?

Spine surgeons are required to differentiate symptomatic cervical disc herniation with asymptomatic radiographic herniation. Although the dermatomal sensory dysfunction of upper extremity is the most important clue, axial pain including cervicogenic headache and parascapular pain may be helpful to find surgical target level. However, there is no review article about the axial pain originated from cervical spondylotic radiculopathy and relieved by surgical decompression. The purpose is to review the literatures about the axial pain, which can be utilized in determining target level to be decompressed in the patients with cervical radiculopathy at multiple levels. Cervicogenic headaches of suboccipital headaches, retro-orbital pain, retro-auricular pain, or temporal pain may be associated with C2, C3, and C4 radiculopathies. The pain around scapula may be associated with C5, C6, C7, and C8 radiculopathies. However, there is insufficient evidence to make recommendations for the use in clinical practice because they did not evaluate sensitivity and specificity.

Radiographic Changes in the Cervical Spine Following Anterior Arthrodesis: A Long-Term Analysis of 166 Patients.

Adjacent segment degeneration frequently develops following anterior cervical discectomy and fusion. The objectives of the present study were to characterize the long-term evolution of degenerative radiographic changes at segments adjacent to anterior cervical fusion and to identify factors associated with the development of these changes, including the preoperative condition of the cervical spine and parameters related to arthrodeses. One hundred and sixty-six patients who underwent anterior cervical discectomy and fusion for symptomatic cervical spondylosis or disc herniation were followed radiographically for a mean time of 12.7 years (range, 5 to 30 years). Radiographic changes representing degeneration at adjacent levels, including disc height loss, osteophyte formation, end-plate sclerosis, and facet arthrosis, along with changes in sagittal alignment of the fusion segment and cervical spine, were recorded preoperatively and at the time of the latest follow-up. Regression models were used to identify the parameters that affect these degenerative changes. More than 90% of patients had worsened anterior and posterior osteophytes at segments immediately adjacent to the fusion. Degenerative changes were significantly affected by the proximity of the level to the fusion and were inversely affected by the preoperative degenerative changes present at the segment (p < 0.0001). The time elapsed since the surgical procedure was a significant predictor of degenerative changes (p < 0.0001). However, the patient age, the number of levels fused, and the sagittal alignment of the fusion segment had no influence on the degenerative changes at adjacent segments. Multiple factors likely contribute to adjacent segment degeneration following cervical arthrodesis. Although mechanical parameters associated with arthrodesis, such as length and alignment of the fusion, did not appear to play a role, the preoperative degenerative condition of the spine and inclusion of C5-C6 in the arthrodesis influenced the incidence of adjacent segment degeneration. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Relationship of Modic Changes, Disk Herniation Morphology, and Axial Location to Outcomes in Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation: A Prospective Study

ObjectiveThe purpose of this study was to evaluate whether cervical disk herniation (CDH) location, morphology, or Modic changes (MCs) are related to treatment outcomes. MethodsMagnetic resonance imaging (MRI) and outcome data from 44 patients with CDH treated with spinal manipulative therapy were evaluated. MRI scans were assessed for CDH axial location, morphology, and MCs. Pain (0-10 for neck and arm) and Neck Disability Index (NDI) data were collected at baseline; 2 weeks; 1, 3, and 6 months; and 1 year. The Patient’s Global Impression of Change data were collected at all time points and dichotomized into “improved,” yes or no. Fischer’s exact test compared the proportion improved with MRI abnormalities. Numerical rating scale and NDI scores were compared with MRI abnormalities at baseline and change scores at all time points using the t test or Mann-Whitney U test. ResultsPatients who were Modic positive had higher baseline NDI scores (P = .02); 77.8% of patients who were Modic positive and 53.3% of patients who were Modic negative reported improvement at 2 weeks (P = .21). Fifty percent of Modic I and 83.3% of Modic II patients were improved at 2 weeks (P = .07). At 3 months and 1 year, all patients with MCs were improved. Patients who were Modic positive had higher NRS and NDI change scores. Patients with central herniations were more likely to improve only at the 2-week time point (P = .022). ConclusionsAlthough patients who were Modic positive had higher baseline NDI scores, the proportion of these patients improved was higher for all time points up to 6 months. Patients with Modic I changes did worse than patients with Modic II changes at only 2 weeks.

Symptomatic, Magnetic Resonance Imaging–Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy

ObjectiveThe purpose of this study was to compare the outcomes of overall improvement, pain reduction, and treatment costs in matched patients with symptomatic, magnetic resonance imaging–confirmed cervical disk herniations treated with either spinal manipulative therapy (SMT) or imaging-guided cervical nerve root injection blocks (CNRI). MethodsThis prospective cohort comparative-effectiveness study included 104 patients with magnetic resonance imaging–confirmed symptomatic cervical disk herniation. Fifty-two patients treated with CNRI were age and sex matched with 52 patients treated with SMT. Baseline numerical rating scale (NRS) pain data were collected. Three months after treatment, NRS pain levels were recorded and overall “improvement” was assessed using the Patient Global Impression of Change scale. Only responses “much better” or “better” were considered “improved.” The proportion of patients “improved” was calculated for each treatment method and compared using the χ2 test. The NRS and NRS change scores for the 2 groups were compared at baseline and 3 months using the unpaired t test. Acute and subacute/chronic patients in the 2 groups were compared for “improvement” using the χ2 test. Results“Improvement” was reported in 86.5% of SMT patients and 49.0% of CNRI patients (P = .0001). Significantly more CNRI patients were in the subacute/chronic category (77%) compared with SMT patients (46%). A significant difference between the proportion of subacute/chronic CNRI patients (37.5%) and SMT patients (78.3%) reporting “improvement” was noted (P = .002). ConclusionSubacute/chronic patients treated with SMT were significantly more likely to report relevant “improvement” compared with CNRI patients. There was no difference in outcomes when comparing acute patients only.

Cost-effectiveness of treatments for cervical disc herniation

In this current area of value-based health care, it is important to consider both the effectiveness and the cost of an intervention. Anterior cervical discectomy and fusion (ACDF) has long been considered as an effective treatment option for patients with symptomatic cervical spondylosis and/or disc herniation that is refractory to conservative treatment. Other treatment options, such as posterior decompression and cervical disc replacement (CDR), are also effective for certain types of pathology. More recent studies have looked at the cost-effectiveness of these interventions.

Seminars in cervical disc herniation: Posterior cervical foraminotomy—Indications, technical nuances, and a review of outcomes

Posterior cervical foraminotomy for the treatment of symptomatic cervical disc herniation is a well-established and effective procedure providing long-lasting relief of radicular pain. Many patients will have partial to complete resolution of radicular symptoms without any surgical treatment, (Carette and Fehlings, 20051) and it is therefore reasonable to provide a trial of nonsurgical management in the absence of weakness, or pain causing significant disability. Attention to technique and anatomy is essential in limiting morbidity, which can include focal motor neuropathy and pain. Guidance for treatment of cervical radiculopathy with a posterolateral soft disc compression corresponding to the symptomatic level is through class III studies.

Epidemiology and pathophysiology of cervical disc herniation

The objective of this article is to review the epidemiology and pathophysiology of cervical disc herniation (CDH). A literature search was performed using PubMed as well as other online data sources (e.g., Science Direct). Reviews, case reports, and both prospective and retrospective studies were searched and have been referenced. The data regarding epidemiology of CDH is not as extensive as that of lumbar disc herniation, however, CDH tends to be the most common among those with degenerative disc disease more than 40 years of age. Presenting symptoms include radiculopathy associated most commonly with the cervical (C) 6–7 level. The pathophysiology of symptomatic CDH may be understood by appreciating both the mechanical and chemical changes that occur within the intervertebral disc as one ages. Finally, more studies should be conducted to better understand the outcome and prognosis of this diverse patient population.