Symptoms Of Cervical Radiculopathy Research Articles

Ayurvedic management in case of Vishwachi (Cervical Radiculopathy): A Case Report

Cervical problems are very similar to Vata Vyadhi disorders. Thus, in the current investigation, in Vata Dosha Janya Vyadhi management by Brimhana Chikitsa is very effective. A disease known as Vishwachi has been described in Ayurvedic Samhitas as one of these illnesses. The symptoms of Cervical Radiculopathy, such as pain in neck region which is radiating to the upper limbs and sometimes restricted neck movements, have been explained in Internal Medicine books (Davidsons, Harrison). Vishwachi is a Vataja Nanatmaja Vyadhi. According to several Acharyas Ruja, Stambhata, Todan, Karmakshaya, and Chestapaharana of Bahus are symptoms that affects the cervical region and upper extremities. According to Acharya Dalhana, the treatment of Vishwachi is similar to Gridhrasi, a disorder that affects the unilateral or bilateral lower extremities and divided into two types: Vataja and Vatakaphaja. Vishwachi has symptoms which are comparable to Cervical Radiculopathy, a degenerative disorder of the cervical spinal part. Nasya Karma has been described as the treatment of Shirogata Vyadhis. Dhatukshaya is a main contributor of disease to the development of Vishwachi. Present study is an effort made to better understanding of disease and its management.

Improvement and Complications after Two-Level ACDF Surgery at a Tertiary Care Facility: A Retrospective Study

Objective: To assess immediate and long-term outcomes and complications of two-level ACDF in patients with degenerative cervical disc disease. Materials & Methods: A retrospective study was carried out in the Department of Neurosurgery at Prime teaching hospital, Peshawar. Patients with symptoms of cervical radiculopathy and radiculomyelopathy with two-level cervical disc disease were included. Patients with trauma, single-level disease, and those who had cervical corpectomy were excluded. Age, gender, Nurick Grading, level of involvement, and post-op outcomes were recorded. Results: 27 cases among which 18 were males and 9 females were studied. 21 patients had radiculopathy while 6 had radiculomyelopathy. The mean age was 46 years. Nurick grade was from 2 to 6. ACDF was chosen as the procedure of choice. Follow-up involved the immediate post-op period for dysphagia, hoarseness of voice, and any neurological deficit, at 6 months and one year for outcomes of pain relief, improvement in paresthesia, and spasticity. Conclusion: ACDF is a safe and recommended procedure for 2-level cervical disc disease in terms of pain relief, paresthesia, and spasticity with acceptable complications.

Clinical Correlation of Change in Sagittal Parameters after Anterior Cervical Microdiscectomy

Objective: Cervical radiculopathy is the syndrome of pain and / or sensorimotor deficit caused by compression of the cervical nerve root. Symptoms of cervical radiculopathy in the upper limb are described as pain, numbness, or weakness. Conservative treatment is recommended initially for degenerative cervical radiculopathy. Surgical treatment is recommended in cases where progressive loss of muscle strength does not respond to conservative therapy. Many radiographic parameters are used to define the sagittal alignment of the cervical spine. This variation contrasts with the assessment of caudal spine segments where there are more established guides for measuring deformity angles. The aim of this study is to evaluate the effect of anterior cervical discectomy and fusion, which are widely used in spinal surgery practice, on cervical sagittal alignment.Methods: We retrospectively evaluated 33 patients who were operated with anterior cervical discectomy and fusion technique with the diagnosis of single level degenerative cervical disc hernia after an average of 3 months of follow-up period. For radiological evaluation, we analyzed the C2-C7 lordosis angles, the anterior and posterior disc heights at the operating level on lateral scoliosis radiographs, preoperatively and at 3rd month postoperatively. Japanese Orthopedic Association scores and visual analog scale scores were examined to evaluate clinical results.Results: A statistically significant difference was found between the preoperative radiological sagittal parameters and the postoperative 3rd month (p = 0.001). When the clinical correlation of the findings was examined, a statistically significant difference was found in the Japanese Orthopedic Association scores and visual analog scale scores of the patients measured preoperatively versus 3 months postoperatively (p < 0.001).Conclusion: Radiological and clinical parameters improve significantly in patients after single level anterior cervical discectomy surgery.

Surgical Interventions for Cervical Radiculopathy without Myelopathy: A Systematic Review and Meta-Analysis.

The effectiveness of surgical interventions for cervical degenerative disorders has been investigated in multiple systematic reviews. Differences in study population (e.g., patients with myelopathy and/or radiculopathy) were often neglected. Therefore, the objective of this study was to investigate the effectiveness of surgical interventions for patients with symptoms of cervical radiculopathy without myelopathy by conducting a systematic review and meta-analysis based on randomized controlled trials (RCTs). A comprehensive systematic search was conducted in MEDLINE, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) to identify RCTs that investigated the effectiveness of surgical interventions using an anterior or posterior approach compared with other interventions for patients with pure cervical radiculopathy. Outcomes were success rates (Odom criteria, similar rating scales, or percentage of patients who improved), complication and reoperation rates, work status, disability (Neck Disability Index), and pain (arm and neck). The Cochrane risk-of-bias tool was used to assess the likelihood of the risk of bias. A random-effects model was used. Heterogeneity among study results (I2 ≥ 50% or p < 0.05) was explored by conducting subgroup analyses. Funnel plots were used to assess the likelihood of publication bias. A total of 21 RCTs were included, comprising 1,567 patients. For all outcomes, among all surgical techniques, only 1 pooled estimate showed a significant effect on success rate, which was in favor of anterior cervical discectomy with fusion compared with anterior cervical discectomy without an intervertebral spacer (p = 0.02; risk ratio [RR] = 0.87; 95% confidence interval [CI] = 0.77 to 0.98). Complication rates were higher when autologous bone graft from the iliac crest was used as an intervertebral spacer (p < 0.01; RR = 3.40; 95% CI = 1.56 to 7.43), related to donor-site morbidity. This meta-analysis demonstrated consistent results regarding clinical outcome for pure cervical radiculopathy among all studied interventions. Complication and reoperation rates were also similar, with the exception of higher complication rates in patients in whom autologous bone grafts were used. On the basis of clinical outcome and safety, there is no superior surgical intervention for pure cervical radiculopathy. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Mimickers of Cervical Radiculopathy.

Degenerative changes of the cervical spine are the primary cause of nerve root compression leading to symptomatic radiculopathy. Genetic and age-related changes, including loss of intervertebral disc height, as well as facet and uncovertebral joint hypertrophy, produce narrowing of the neural foramen. A herniated nucleus pulposus may cause acute foraminal stenosis. Symptomatic nerve root compression may ensue, leading to pain radiating from the neck into the shoulder, arm, forearm, and/or hand, with or without accompanying numbness and paresthesias. Several musculoskeletal and nonmusculoskeletal entities have a presentation similar to that of cervical radiculopathy and can be easily overlooked if the diagnosis of radiculopathy is assumed (Table I). Therefore, the clinician should be familiar with the classic signs and symptoms of cervical radiculopathy as well as a spectrum of differential diagnoses that may mimic it. View this table: TABLE I Mimickers of Cervical Radiculopathy by Nerve Root Patients with cervical radiculopathy may report antecedent trauma, but the typical onset is more insidious. Acute, severe pain in a dermatomal distribution typically results from cervical disc herniation, whereas subacute, chronic, or intermittent radicular pain tends to be secondary to a chronically herniated disc or degenerative foraminal stenosis. Henderson et al.1, in a report on >700 patients who had been diagnosed with cervical radiculopathy, noted upper extremity pain in 99.4% of the patients, sensory changes to pinprick in 85.2%, neck pain in 79.7%, diminished reflexes in 71.2%, and diminished strength in 68%. Nearly 54% of the patients experienced pain or paresthesias in a dermatomal pattern, …

Effects of Qishe Pill, a compound traditional Chinese herbal medicine, on cervical radiculopathy: study protocol for a randomized controlled trial

BackgroundNeck pain is a common symptom in most patients suffering from cervical radiculopathy. However, some conservative treatments are limited by their modest effectiveness. On the other hand, surgical intervention for cervical disc disorders is indicated when symptoms are refractory to conservative treatments and neurological symptoms are progressive. Many patients use complementary and alternative medicine, including traditional Chinese medicine, to address their symptoms. The purpose of the present study is to examine the efficacy and safety of Qishe Pill, a compound traditional Chinese herbal medicine, for neck pain in patients with cervical radiculopathy.Methods/designA multicenter, double-blind, randomized, placebo-controlled trial to evaluate the efficacy and safety of the Qishe Pill is proposed. The study will include 240 patients from five sites across China and diagnosed with cervical radiculopathy, according to the following inclusion criteria: age 18 to 65 with pain or stiffness in the neck for at least 2 weeks (neck disability index score 25 or more) and accompanying arm pain that radiates distally from the elbow. Qualified participants will be randomly allocated into two groups: Qishe Pill group and placebo group. The prescription of the trial medications (Qishe Pill/placebo) are 3.75 g each twice a day for 28 consecutive days. The primary outcome is pain severity. Secondary outcomes are functional status, patient satisfaction, and adverse events as reported in the trial.DiscussionQishe Pill is composed of processed Radix Astragali, Muscone, Szechuan Lovage Rhizome, Radix Stephaniae Tetrandrae, Ovientvine, and Calculus Bovis Artifactus. According to modern research and preparation standards, Qishe Pill is developed to improve on the various symptoms of cervical radiculopathy, especially for neck pain. As it has a potential benefit in treating patients with neck pain, we designed a double-blind, prospective, randomized-controlled trial and would like to publish the results and conclusions later. If Qishe Pill can alleviate neck pain without adverse effects, it may be a unique strategy for the treatment of cervical radiculopathy.Trial registrationThis study is registered at ClinicalTrials.gov, NCT01274936

Poster 64: Correlation of Clinical Findings, Electrodiagnosis, and Magnetic Resonance Imaging Study in Cervical Roots Lesion

Objective: To determine the correlation between clinical findings and magnetic resonance imaging (MRI) and electrodiagnostic studies in the diagnosis, determination of severity, and differential diagnosis of cervical radiculopathy. Design: Cross-sectional analysis. Setting: Electrodiagnosis clinic of a medical center. Participants: 40 persons with clinical signs and symptoms of cervical radiculopathy. Interventions: Not applicable. Main Outcome Measures: All subjects had cervical MRI as diagnosed by 1 radiologist. The electrodiagnostic clinic history and physical examination were done by an attending physiatrist and recorded in a special chart; then electrodiagnostic study, including nerve conduction and electromyography, was done by another physiatrist who was blinded to MRI and clinical examination. Collected data were analyzed. Results: All cases had at least 1 positive clinical finding, however, MRI was positive in 36 cases and electrodiagnosis was positive in 33 cases. The overall correlation of MRI and electrodiagnosis was 87.5%, but for each specific nerve root the correlation was only 45%. Electrodiagnostic and clinical examination had a 75% correlation. This correlation was only 52% for MRI and clinical examination. Electrodiagnostic findings were more prominent in cases with clinical findings of numbness, decreased or absent deep tendon reflex or weakness, and positive Spurling test. The most involved root was C6. The most involved muscles with prominent findings in each root were the deltoid (C5), pronator teres (C6), triceps brachii (C7), and abductor pollicis brevis (APB) (C8) muscles. The most prominent active denervation potentials were found in the pronator teres. Conclusions: Although MRI is an excellent imaging tool with which to study cervical radiculopathy, application of electrodiagnosis and its correlation with MRI and clinical examination is very helpful for a more precise determination of the involved root. We recommend the deltoid, pronator teres, triceps brachii, and APB as the muscles of choice in electrodiagnostic study of cervical roots lesion.

Endoscopic Microsurgical Treatment In Cervical Spinal Stenosis

Introduction: Cervical myelopathy and cervical radiculopathy caused by degenerative disease has been surgically treated either by a posterior approach or by an anterior approach with or without interbody fusion. The posterior approach, that is to say the laminectomy, was first described in 1950 by Spurling and Scoville to treat primarily laterally displaced disc herniation. It has been used less frequently since the development of the anterior approach to the cervical spine. Positioning the patient in the prone position, the complications associated with posterior approach include nerve root injury, particularly when more than one root is exposed; spinal cord injury secondary to cord retraction, particularly during transdural approach to the herniated disc; spinal instability, particularly when the facet joint is removed; posterior muscle trauma and injury. For the past 40 years, the anterior approach has become very popular. Three common techniques of fusion are described by Cloward, Bailey and Badgley, and Smith and Robinson. In Cloward's 1958 publication, he described his operative technique. With minimally invasive spinal surgery the trauma for the patient in the surgical area is minimised, and consequently iatrogenic effects may be avoided. Materials And Methods: This study was carried out from January 1991 to October 2006. Three hundred and eleven patients with symptoms of cervical radiculopathy and/or myelopathy should have undergone to traditional surgery. They were, instead, treated by using the endoscopic microsurgical techniques. In 287 cases the surgical procedure was performed by an anterior approach, while in 24 cases by a posterior approach . In the first time we used endoscopic microsurgery with posterior approach for the far lateral osteophyte in the stenosis of the foramen. The operative techniques must be followed carefully, in general anaesthesia, step by step, and the operating surgeon must be properly trained in these endoscopic techniques. Results: In our study there were neither incidents during surgery, nor major complications following these operations. We had in few cases transient hoarseness and dysphagia; in three cases transitory Horner's syndrome, in some cases temporary paresthesias or hyperesthesias in a specifc dermatome of the upper extremity, in very few cases fleeting neck pain, occipital pain or shoulder pain. During this study period six patients experienced relapse; three of these were operated again by the same technique and three in other hospitals. After surgery the success rate, according to Odom criteria, was 93.0% (289 patients). Conclusion: This study suggests that for cervical spinal stenosis, the endoscopic microsurgical technique is an extremely advantageous and safe method. The goal of this surgical technique was to achieve direct and effective anatomical decompression of the spinal cord and nerve roots, without post-operative immobilisation by the maintenance of the integral spinal stability. By using this endoscopic technique it is possible to maintain a normal mobility of the intervertebral space, avoiding the inevitable stresses applied to adjacent interspaces following fusion and the consequent secondary morbidity. We think that a continuous development and improvement of instruments, a longer follow-up periods and a greater number of patient treated, will further confirm this endoscopic microsurgical technique.

Cervical Radiculopathy or Parsonage-Turner Syndrome: Differential Diagnosis of a Patient With Neck and Upper Extremity Symptoms

Resident's case problem. The signs and symptoms of cervical radiculopathy (CR) warrant the consideration of several other conditions in CR's differential diagnosis. One condition that may mimic CR, which is not well known amongst physical therapists, is Parsonage-Turner syndrome (PTS). PTS is characterized by an onset of intense pain that typically subsides within days to weeks. However, as pain subsides, weakness and/or paralysis may develop in upper extremity muscles. The purpose of this resident's case problem is to describe a patient who presented to our clinic with a diagnosis of CR, but had findings consistent with PTS. The patient was a 43-year-old male referred to physical therapy with a diagnosis of CR. He had a previous episode of CR 1 year ago that was treated successfully. He had positive magnetic resonance imaging findings of structural abnormalities suggestive of causative factors for CR. The patient was treated for CR with thoracic and cervical spine manipulations and intermittent cervical traction. The initial acute severe pain subsided, but weakness in the upper extremity worsened. Diagnosis of PTS was made upon exclusion of other potential confounding diagnoses and the findings of fibrillation potentials and positive waves in electrodiagnostic studies. CR and PTS are characterized by pain in the cervical spine, shoulder, and upper extremity. CR generally has an insidious onset, while PTS has a rapid onset of intense pain. Symptoms of CR are exacerbated with neck movements, while symptoms related to PTS should not be exacerbated with neck movements. In patients that do not respond to conventional therapy and have a progression of upper extremity muscle weakness, regardless of decreased pain, the diagnosis of PTS should be considered.

Results of halter cervical traction for the treatment of cervical radiculopathy: retrospective review of 81 patients

The percentage of patients responding to conservative treatment for cervical radiculopathy secondary to nerve root compression is not well quantified. To clarify this question, the authors retrospectively reviewed the records obtained over a 4-year period in patients with cervical radiculopathy to determine their response to conservative measures (cervical collar therapy and halter cervical traction). Cervical radiculopathy was diagnosed in patients if they suffered from radiating arm pain made worse by neck movement and at least one of the following: reflex loss, dermatomal numbness, and/or myotomal weakness. Patients with neck pain alone or arm pain without neurological deficit were excluded from analysis. Those patients without excruciating pain, severe weakness, or evidence of myelopathy were offered a course of halter traction before surgery was to be considered. Ninety-six patients met the inclusion criteria; there were 61 males and 35 females, and the mean age was 47 years. Fifty-five patients presented with C-7, 37 with C-6, two with C-5, and two with C-8 radiculopathy. Eighty-one patients underwent a trial of traction that consisted of wearing a cervical collar and home-based halter cervical traction: 8 to 12 pounds, applied for 15 minutes, three times a day for 3 to 6 weeks The mean duration of symptoms prior to neurosurgical evaluation was 43 days +/- 8.3 days (standard deviation). Sixty-three (78%) of 81 patients responded to therapeutic traction, experiencing significant or total pain relief, three could not tolerate the traction, and traction failed in 15 patients. Of the 81 patients in whom traction was undertaken, 78 underwent magnetic resonance imaging prior to being seen, which revealed herniated discs at the corresponding levels in 71 and foraminal stenosis in seven. Three of the 63 patients in whom an initial response to traction was noted suffered recurrence of symptoms and required surgery. It would appear that in patients in whom symptoms of cervical radiculopathy were present for approximately 6 weeks that 75% will respond to further conservative treatment (halter traction and cervical collar) over the next 6 weeks.

Early results using the Atlantis anterior cervical plate system

The authors present a retrospective review of 77 patients in whom they performed anterior cervical discectomy and fusion (ACDF) in the treatment of radiculopathy and/or myelopathy. In all cases anterior interbody fusion was performed using the Atlantis locking plate system to treat the degenerative disease. There were 41 men and 36 women (mean age 53.8 years), and 24 active cigarette smokers (31%) in the group. All patients presented with signs and symptoms of cervical radiculopathy and/or myelopathy, and magnetic resonance imaging or computerized tomography myelography demonstrated evidence of radicular and/or spinal cord compression at one or more cervical levels. Thirty-one patients underwent single-level ACDF, 20 patients underwent multilevel ACDF without posterior instrumentation, in eight patients one- to four-level corpectomies were supplemented with posterior fixation, 12 patients underwent single-level corpectomy, and six patients underwent multilevel corpectomy with no posterior instrumentation. The mean follow-up period was 15.33 months; overall good-to-excellent outcome was seen in 75% of patients; osseous fusion was demonstrated in 93.5%. In all patients except three, fibular allograft was used as graft material. The degree of overall cervical lordosis was measured at the last follow up and was compared with normal values obtained in age-matched individuals. In addition, the degree of cervical lordosis at fusion levels was compared with overall cervical lordosis. In patients in all five of the aforementioned categories significantly less lordosis was demonstrated than in age-matched controls. In patients who underwent single-level ACDF, single-level corpectomy, and multilevel ACDF significantly less lordosis was observed at the fusion segment than that in the overall cervical spine. Complications included one episode of chronic anterior wound drainage treated with intravenous antibiotic medication and one postoperative posterior wound infection, which required reoperation and intravenous antibiotic medication. Two cases (2.6%) of anterior screw backout and/or breakage were identified. One patient died of unrelated causes within 3 months of operation. These initial results indicate that use of the Atlantis plate system for anterior cervical arthrodesis produces fusion rates and clinical outcomes that are comparable with those obtained using other locking plating systems. It has the unique advantage, however, of providing the surgeon with the choice of fixed, variable, or hybrid screw constructs as a way of tailoring screw angles to individual anatomical/biomechanical needs.

Combined use of spin-echo and gradient-echo MR-imaging in cervical disk disease

In a prospective study we compared the diagnostic value of combined gradient-echo (GE) and spin-echo (SE) MR imaging with cervical myelography in 30 patients with clinical signs and symptoms of cervical radiculopathy and/or myelopathy due to disk disease. Only patients who subsequently underwent surgery (anterior interbody approach) were included. By means of MRI the clinically relevant segment was identified in all cases, by means of myelography in all but two patients. Using both spin-echo (SE) and gradient-echo (GE) techniques it was possible to differentiate between bone tissue and disk material by MR in all but one. It is concluded that MRI-especially gradient-echo imaging is a viable alternative to cervical myelography and can be considered as an initial diagnostic procedure for suspected cervical disk disease.

Spinal epidural hematoma with delayed appearance of neurological symptoms

Two weeks after trauma a young man developed signs and symptoms of cervical radiculopathy and myelopathy. Myelography revealed an extradural mass in the spinal canal at the cervicothoracic junction. At operation an epidural hematoma was found, the pathological features of which suggested that it had been present since the injury. This case is exceptional in that spinal epidural hematomas are nearly always associated with rapidly progressing neurological syndromes.