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Klein Heerenbrink S, Coenen P, Coppieters MW, van Dongen JM, Vleggeert-Lankamp CLA, Rooker S, Ter Meulen BC, Bosboom JLW, Bouma GJ, Lutke Schipholt IJ, Sleijser-Koehorst MLS, de Vries R, Ostelo RWJG, Scholten-Peeters GGM. (Cost-)effectiveness of personalised multimodal physiotherapy compared to surgery in patients with cervical radiculopathy: A systematic review. J Eval Clin Pract 2024; 30:1227-1238. [PMID: 38825757 DOI: 10.1111/jep.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/10/2024] [Accepted: 05/19/2024] [Indexed: 06/04/2024]
Abstract
RATIONALE Cervical radiculopathy is initially typically managed conservatively. Surgery is indicated when conservative management fails or with severe/progressive neurological signs. Personalised multimodal physiotherapy could be a promising conservative strategy. However, aggregated evidence on the (cost-)effectiveness of personalised multimodal physiotherapy compared to surgery with/without post-operative physiotherapy is lacking. AIM/OBJECTIVES To systematically summarise the literature on the (cost-)effectiveness of personalised multimodal physiotherapy compared to surgery with or without post-operative physiotherapy in patients with cervical radiculopathy. METHODS PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched from inception to 1st of March 2023. Primary outcomes were effectiveness regarding costs, arm pain intensity and disability. Neck pain intensity, perceived recovery, quality of life, neurological symptoms, range-of-motion, return-to-work, medication use, (re)surgeries and adverse events were considered secondary outcomes. Randomised clinical trials comparing personalised multimodal physiotherapy versus surgical approaches with/without post-operative physiotherapy were included. Two independent reviewers performed study selection, data-extraction, and risk of bias assessment using the Cochrane RoB 2 and Consolidated Health Economic Evaluation Reporting Standards statement. Certainty of the evidence was determined using Grading of Recommendations, Assessment, Development and Evaluations. RESULTS From 2109 records, eight papers from two original trials, with 117 participants in total were included. Low certainty evidence showed there were no significant differences on arm pain intensity and disability, except for the subscale 'heavy work' related disability (12 months) and disability at 5-8 years. Cost-effectiveness was not assessed. There was low certainty evidence that physiotherapy improved significantly less on neck pain intensity, sensory loss and perceived recovery compared to surgery with/without physiotherapy. Low certainty evidence showed there were no significant differences on numbness, range of motion, medication use, and quality of life. No adverse events were reported. CONCLUSION Considering the clinical importance of accurate management recommendations and the current low level of certainty, high-quality cost-effectiveness studies are needed.
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Affiliation(s)
- Sebastiaan Klein Heerenbrink
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physiotherapy, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carmen L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Servan Rooker
- Department of Neurosurgery, Kliniek ViaSana, Mill, The Netherlands
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Bastiaan C Ter Meulen
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, OLVG Teaching Hospital Amsterdam, Amsterdam, The Netherlands
| | - Johannes L W Bosboom
- Department of Neurology, OLVG Teaching Hospital Amsterdam, Amsterdam, The Netherlands
| | - Gerrit J Bouma
- Department of Neurosurgery, OLVG Teaching Hospital Amsterdam, Amsterdam, The Netherlands
| | - Ivo J Lutke Schipholt
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marije L S Sleijser-Koehorst
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Talbot R, Higham R, Croft J, Ainsworth G, Brown S, Kelly R, Stocken D, Thomson S, Rousseau N. Rapid qualitative analysis of recruitment obstacles in the FORVAD (Posterior Cervical Foraminotomy surgery versus Anterior Cervical Discectomy surgery in the treatment of cervical brachialgia) randomised, controlled trial. Trials 2024; 25:546. [PMID: 39152476 PMCID: PMC11330054 DOI: 10.1186/s13063-024-08391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND The number of surgical trials is increasing but such trials can be complex to deliver and pose specific challenges. A multi-centre, Phase III, RCT comparing Posterior Cervical Foraminotomy versus Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Brachialgia (FORVAD Trial) was unable to recruit to target. A rapid qualitative study was conducted during trial closedown to understand the experiences of healthcare professionals who participated in the FORVAD Trial, with the aim of informing future research in this area. METHODS Semi-structured interviews were conducted with 18 healthcare professionals who had participated in the FORVAD Trial. Interviews explored participants' experiences of the FORVAD trial. A rapid qualitative analysis was conducted, informed by Normalisation Process Theory. RESULTS Four main themes were generated in the data analysis: (1) individual vs. community equipoise; (2) trial set-up and delivery; (3) identifying and approaching patients; and (4) timing of randomisation. The objectives of the FORVAD trial made sense to participants and they supported the idea that there was clinical or collective equipoise regarding the two FORVAD interventions; however, many surgeons had treatment preferences and lacked individual equipoise. The site which had most recruitment success had adopted a more structured process for identification and recruitment of patients, whereas other sites that adopted more "ad hoc" screening strategies struggled to identify patients. Randomisation on the day of surgery caused both medico-legal and practical concerns at some sites. CONCLUSIONS Organisation and implementation of a surgical trial in neurosurgery is complex and presents many challenges. Sites often reported low recruitment and discussed the logistical issues of conducting a complex surgical RCT. Future trials in neurosurgery may need to offer more flexibility and time during set-up to maximise opportunities for larger recruitment numbers. Rapid qualitative analysis informed by Normalisation Process Theory was able to quickly identify key issues with trial implementation so rapid qualitative analysis may be a useful approach for teams conducting qualitative research in trials. TRIAL REGISTRATION ISRCTN, ISRCTN reference: 10,133,661. Registered 23rd November 2018.
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Affiliation(s)
- Rebecca Talbot
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ruchi Higham
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Gemma Ainsworth
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Rachel Kelly
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Deborah Stocken
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Simon Thomson
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nikki Rousseau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
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Sharmin F, Hossain KMA, Kabir F, Hossain MZ, Jahan S, Rahman E, Islam MA. Efficacy of neck muscle activation versus strengthening for adults with chronic cervical radiculopathy: a study protocol for a randomised clinical trial. BMJ Open Sport Exerc Med 2024; 10:e001819. [PMID: 38362563 PMCID: PMC10868178 DOI: 10.1136/bmjsem-2023-001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Chronic cervical radiculopathy is a common condition characterised by neck and arm pain, numbness and weakness. Both neck muscle activation and strengthening exercises are widely recognised treatments for cervical radiculopathy, but there is a research gap on the efficacy of neck muscle activation versus strengthening. This protocol will determine the efficacy of neck muscle activation alongside conventional care versus strengthening exercise and conventional care for cervical radiculopathy. Methods and analysis We planned a 5-week parallel, two-arm randomised clinical trial on 80 participants with chronic cervical radiculopathy (lasting over 3 months) between July and December 2023. Participants will be recruited from Dhaka's Agrani Specialised Physiotherapy Centre in Bangladesh and randomly assigned to two groups in a 1:1 ratio. Both groups will receive 14 sessions, each lasting 30-45 min. Post-treatment evaluations will be employed on Brief Pain Inventory (BPI), range of motion, craniovertebral angle (CVA), strength, endurance and Neck Disability Index (NDI) after 5 weeks and follow-up after 12 weeks of post-test analysis. Primary outcomes (strength, endurance and CVA) will be measured using a handheld dynamometer, digital inclinometer and goniometer. Secondary outcomes (pain, range of motion and disability) will be assessed through the BPI scale, digital inclinometer and NDI. Ethics and dissemination The Institute of Physiotherapy Rehabilitation and Research of Bangladesh Physiotherapy Association has approved the study. All participants will provide informed consent, and data will be anonymised and accessible only to authorised personnel. The study's findings will be disseminated in peer-reviewed journals and conferences. Clinical trial registry India CTRI/2023/09/057587 (13/09/2023).
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Affiliation(s)
- Farzana Sharmin
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh
| | - K M Amran Hossain
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Feroz Kabir
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Md. Zahid Hossain
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Sharmila Jahan
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Ehsanur Rahman
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Md. Aminul Islam
- Department of Petroleum and Mining Engineering, Jashore University of Science and Technology, Jashore, Bangladesh
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Plener J, da Silva-Oolup S, To D, Csiernik B, Hofkirchner C, Cox J, Chow N, Hogg-Johnson S, Ammendolia C. Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review. Spine (Phila Pa 1976) 2023; 48:E132-E157. [PMID: 36730764 DOI: 10.1097/brs.0000000000004537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/13/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The aim of this study was to evaluate the inclusion and exclusion criteria for participants in randomized control trials (RCTs) assessing conservative management for cervical radiculopathy (CR), to determine if any consensus exists within the literature. SUMMARY OF BACKGROUND DATA A 2012 systematic review identified a lack of uniformity for the eligibility criteria of participants in RCTs evaluating conservative interventions for CR. Since then, a large number of RCTs have been published, signaling the need for an updated evaluation of this topic. MATERIALS AND METHODS We electronically searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022, to identify RCTs assessing conservative management of CR. Information extracted was analyzed to determine the level of homogeneity and/or heterogeneity of the inclusion and exclusion criteria across studies. RESULTS Seventy-six RCTs met our inclusion criteria with 68 distinct trials identified. The inclusion of arm pain with or without another symptom ( i.e. numbness, paresthesia, or weakness) was required in 69.12% of trials, 50% of trials required participants to exhibit neck symptoms, and 73.53% of studies required some form of clinical examination findings, but inconsistencies existed for the number and type of tests used. Furthermore, 41.18% of trials included imaging, with 33.82% of trials requiring magnetic resonance imaging findings. The most common exclusion criteria included were the presence of red flags and cervical myelopathy in 66.18% and 58.82% of trials, respectively. CONCLUSIONS Overall, there is still a lack of uniformity for the inclusion/exclusion criteria of trials assessing the conservative management of CR, with some improvements noted compared with the 2012 review. Based on the current literature assessing the diagnostic utility of clinical symptoms and confirmatory tests, we proposed inclusion criteria for trials assessing conservative interventions. Future research should aim to develop standardized classification criteria to improve consistency among studies.
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Affiliation(s)
- Joshua Plener
- Division of Graduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sophia da Silva-Oolup
- Division of Graduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Daphne To
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Ben Csiernik
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | | | - Jocelyn Cox
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Ngai Chow
- Private Practice, Toronto, ON, Canada
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Disability and Rehabilitation Research, Oshawa, ON, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Carlo Ammendolia
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Guo L, Wang J, Zhao Z, Li J, Zhao H, Gao Y, Chen C. Microscopic Anterior Cervical Discectomy and Fusion Versus Posterior Percutaneous Endoscopic Cervical Keyhole Foraminotomy for Single-level Unilateral Cervical Radiculopathy: A Systematic Review and Meta-analysis. Clin Spine Surg 2023; 36:59-69. [PMID: 35344521 PMCID: PMC9949523 DOI: 10.1097/bsd.0000000000001327] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE The objective of this study was to compare the safety of microscopic anterior cervical discectomy and fusion (MI-ACDF) and posterior percutaneous endoscopic keyhole foraminotomy (PPEKF) in patients diagnosed with single-level unilateral cervical radiculopathy. SUMMARY OF BACKGROUND DATA After conservative treatment, the symptoms will be relieved in about 90% of cervical radiculopathy patients. For the other one tenth of patients, surgical treatment is needed. The overall complication rate of MI-ACDF and PPEKF ranges from 0% to 25%, and the reoperation rate ranges from 0% to 20%. MATERIALS AND METHODS Electronic retrieval of studies from PubMed, Embase, and Cochrane Library was performed to identify comparative or single-arm studies on MI-ACDF and PPEKF. A total of 24 studies were included in our meta-analysis by screening according to the inclusion and exclusion criteria. After data extraction and quality assessment of the included studies, a meta-analysis was performed by using the R software. The pooled incidences of efficient rate, total complication rate, and reoperation rate were calculated. RESULTS A total of 24 studies with 1345 patients (MI-ACDF: 644, PPEKF: 701) were identified. There was no significantly statistical difference in pooled patient effective rate (MI-ACDF: 94.3% vs. PPEKF: 93.3%, P =0.625), total complication rate (MI-ACDF: 7.1% vs. PPEKF: 4.7%, P =0.198), and reoperation rate (MI-ACDF: 1.8% vs. PPEKF: 1.1%, P =0.312). However, the common complications of the 2 procedures were different. The most common complications of MI-ACDF were dysphagia and vertebral body sinking, whereas the most common complication of PPEKF was nerve root palsy. CONCLUSIONS Both MI-ACDF and PPEKF can provide a relatively safe and reliable treatment for single-level unilateral cervical radiculopathy. The 2 techniques are not significantly different in terms of effective rate, total complication rate, and reoperation rate.
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Affiliation(s)
| | | | | | - Jing Li
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital
| | | | - Yong Gao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Chao Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Orthopaedics, Hefeng Central Hospital, Enshi, Hubei Province, China
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6
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Plener J, Csiernik B, To D, da Silva-Oolup S, Hofkirchner C, Cox J, Cancelliere C, Chow N, Hogg-Johnson S, Ammendolia C. Conservative Management of Cervical Radiculopathy: A Systematic Review. Clin J Pain 2023; 39:138-146. [PMID: 36599029 DOI: 10.1097/ajp.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to assess the effectiveness and safety of conservative interventions compared with other interventions, placebo/sham interventions, or no intervention on disability, pain, function, quality of life, and psychological impact in adults with cervical radiculopathy (CR). METHODS We searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022 to identify studies that were randomized controlled trials, had at least one conservative treatment arm, and diagnosed participants with CR through confirmatory clinical examination and/or diagnostic tests. Studies were appraised using the Cochrane Risk of Bias 2 tool and the quality of the evidence was rated using the Grades of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Of the 2561 records identified, 59 trials met our inclusion criteria (n = 4108 participants). Due to clinical and statistical heterogeneity, the findings were synthesized narratively. There is very-low certainty evidence supporting the use of acupuncture, prednisolone, cervical manipulation, and low-level laser therapy for pain and disability in the immediate to short-term, and thoracic manipulation and low-level laser therapy for improvements in cervical range of motion in the immediate term. There is low to very-low certainty evidence for multimodal interventions, providing inconclusive evidence for pain, disability, and range of motion. There is inconclusive evidence for pain reduction after conservative management compared with surgery, rated as very-low certainty. DISCUSSION There is a lack of high-quality evidence, limiting our ability to make any meaningful conclusions. As the number of people with CR is expected to increase, there is an urgent need for future research to help address these gaps.
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Affiliation(s)
- Joshua Plener
- Division of Graduate Education
- Institute of Health Policy, Management and Evaluation
| | | | | | | | | | | | - Carol Cancelliere
- Institute for Disability and Rehabilitation Research
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | | | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College
- Institute of Health Policy, Management and Evaluation
- Dalla Lana School of Public Health
- Institute for Disability and Rehabilitation Research
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation
- Department of Surgery, University of Toronto
- Department of Medicine, Mount Sinai Hospital, Toronto
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7
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Gebreyohanes A, Erotocritou M, Choi D. Appraising The Evidence for Conservative versus Surgical Management of Motor Deficits in Degenerative Cervical Radiculopathy. Global Spine J 2023; 13:547-562. [PMID: 35708971 PMCID: PMC9972261 DOI: 10.1177/21925682221109562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Understanding the prevalence and outcome of motor deficits in degenerative cervical radiculopathy is important to guide management. We compared motor radiculopathy outcomes after conservative and surgical management, a particular focus being painful vs painless radiculopathy. METHODS MEDLINE and EMBASE databases were searched. We stratified each study cohort into 1 of 6 groups, I-VI, based on whether radiculopathy was painful, painless or unspecified, and whether interventions were surgical or non-surgical. RESULTS Of 10 514 initial studies, 44 matched the selection criteria. Whilst 42 (95.5%) provided baseline motor radiculopathy data, only 22 (50.0%) provided follow-up motor outcomes. Mean baseline prevalence of motor deficits was 39.1% (9.2%-73.3%) in conservative cohorts and 60.5% (18.5%-94.1%) in surgical cohorts. Group VI, 'surgically-managed motor radiculopathy with unclear pain status' had the largest number of cohorts. Conversely, no cohorts were found in Group III, 'conservatively-managed painless motor radiculopathy'. Large disparities in data quality made direct comparison of conservative vs operative management difficult. CONCLUSIONS Overall pre-intervention prevalence of motor deficits in degenerative cervical radiculopathy is 56.4%. Many studies fail to report motor outcomes after intervention, meaning statistical evidence to guide optimal management of motor radiculopathy is currently lacking. Our study highlights the need for more evidence, preferably from a prospective long-term study, to allow direct comparisons of motor outcomes after conservative and surgical management.
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Affiliation(s)
- Axumawi Gebreyohanes
- Victor Horsley Department of
Neurosurgery, The National Hospital for Neurology
and Neurosurgery, UK,University College London (UCL)
Medical School, UK,Axumawi Mike Hailu Gebreyohanes, BSc,
Complex Spine Team, Victor Horsley Department of Neurosurgery, The National
Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United
Kingdom.
| | | | - David Choi
- Victor Horsley Department of
Neurosurgery, The National Hospital for Neurology
and Neurosurgery, UK
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Pinter ZW, Sebastian AS, Wagner SC, Morrissey PB, Kaye ID, Hilibrand AS, Vaccaro A, Kepler C. Indicators for Substantial Neurological Recovery Following Elective Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2022; 35:E698-E701. [PMID: 35552290 DOI: 10.1097/bsd.0000000000001340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/09/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purposes of this study were to determine the rate of improvement of significant preoperative weakness, identify risk factors for failure to improve, and characterize the motor recovery of individual motor groups. SUMMARY OF BACKGROUND DATA While neck and arm pain reliably improve following anterior cervical discectomy and fusion (ACDF), the frequency and magnitude of motor recovery following ACDF remain unclear. METHODS We performed a retrospective review of patients undergoing 1-4-level ACDF at a single institution between September 2015 and June 2016. Patients were subdivided into 2 groups based upon the presence or absence of significant preoperative weakness, which was defined as a motor grade <4 in any single upper extremity muscle group. Clinical notes were reviewed to determine affected muscle groups, rates of motor recovery, and risk factors for failure to improve. RESULTS We identified 618 patients for inclusion. Significant preoperative upper extremity weakness was present in 27 patients (4.4%). Postoperatively, 19 of the affected patients (70.3%) experienced complete strength recovery, and 5 patients (18.5%) experienced an improvement in muscle strength to a motor grade ≥4. The rate of motor recovery postoperatively was 85.7% in the triceps, 83.3% in the finger flexors, 83.3% in the hand intrinsics, 50.0% in the biceps, and 25.0% in the deltoids. Risk factors for failure to experience significant motor improvement were the presence of myelomalacia (odds ratio: 28.9, P <0.01) and the performance of >2 levels of ACDF (odds ratio: 10.1, P <0.01). CONCLUSIONS Patients with substantial preoperative upper extremity weakness can expect high rates of motor recovery following ACDF, though patients with deltoid weakness, myelomalacia, and >2 levels of ACDF are less likely to experience significant motor improvement.
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Affiliation(s)
| | | | - Scott C Wagner
- Walter Reed National Military Medical Center, Bethesda, MD
| | - Patrick B Morrissey
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Ian David Kaye
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Alexander Vaccaro
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Christopher Kepler
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
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9
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Schuermans VN, Smeets AY, Wijsen NP, Curfs I, Boselie TF, van Santbrink H. Clinical adjacent segment pathology after anterior cervical discectomy, with and without fusion, for cervical degenerative disc disease: A single center retrospective cohort study with long-term follow-up. BRAIN & SPINE 2022; 2:100869. [PMID: 36248168 PMCID: PMC9560678 DOI: 10.1016/j.bas.2022.100869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 12/25/2022]
Abstract
Introduction Clinical adjacent segment pathology (CASP) continues to be a cause of concern after anterior surgical treatment for single- or multilevel cervical degenerative disc disease (CDDD). The current literature reports inconsistent incidence rates and contended risk factors in the development of CASP. Research question The aim is to determine the incidence of additional CASP-related surgeries after anterior cervical discectomy with fusion (ACDF) or without fusion (ACD) for CDDD. Secondary outcomes include risk factors for the development of CASP and long-term clinical outcomes. Materials & methods This is a single-center, retrospective cohort study with a long-term follow up. Patients undergoing ACD(F) for CDDD between January 2012 and December 2019 were included. Results A total of 601 patients were included, with an average follow-up period of 5.0 years. Most patients underwent ACDF with stand-alone cages (87.7%). CASP developed in 58 (9.7%) patients, 41 (70.7%) of which required additional adjacent level surgery. ACD significantly accelerated the development of CASP. The C2-C7 Cobb angle appeared less lordotic upon early post-operative imaging in ACDF patients that later-on developed CASP. Baseline degeneration at the index level and adjacent levels was not significantly different between patients with and without CASP. Discussion & conclusion In this retrospective cohort, we observe a relatively low rate of additional surgery for CASP in ACDF with stand-alone cages. We suggest that surgical technique, fusion, segmental kyphosis and natural degeneration play a multifactorial role in the development of CASP. Complication rates were low and clinical outcomes were similar for all techniques used.
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Affiliation(s)
- Valérie N.E. Schuermans
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
| | - Anouk Y.J.M. Smeets
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
| | - Nienke P.M.H. Wijsen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands
| | - Inez Curfs
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
| | - Toon F.M. Boselie
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
| | - Henk van Santbrink
- Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands
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10
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Campbell WW, Landau M. Treatment and Management of Segmental Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Biomechanical effect of different plate-to-disc distance on surgical and adjacent segment in anterior cervical discectomy and fusion - a finite element analysis. BMC Musculoskelet Disord 2021; 22:340. [PMID: 33836709 PMCID: PMC8035773 DOI: 10.1186/s12891-021-04218-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/03/2021] [Indexed: 01/05/2023] Open
Abstract
Background The plate-to-disc distance (PDD) is an important factor affecting the degeneration of adjacent segments after anterior cervical discectomy and fusion (ACDF). However, the most suitable PDD is controversial. This study examined the adjacent intervertebral disc stress, bone graft stress, titanium plate stress and screw stress to evaluate the biomechanical effect of different PDD on surgical segment and adjacent segment following C5/C6 ACDF. Methods We constructed 10 preoperative finite element models of intact C4–C7 segments and validated them in the present study. We simulated ACDF surgery based on the 10 intact models in software. We designed three different distance of plate-to-disc titanium plates: long PDD (10 mm), medium PDD (5 mm) and short PDD (0 mm). The changes in C4/C5 and C6/C7 intervertebral disc stress, bone graft stress, titanium plate stress and screw stress were analyzed. Results The von Mises stress of C4/C5 and C6/C7 intervertebral discs had no significant differences (P > 0.05) in three different PDD groups. Titanium plate stress increased as the PDD decreased. The bone graft stress and screws stress decreased as the PDD decreased. The maximum stress of each part occurred was mostly in the conditions of rotation and lateral bending. Conclusions The PDD has no effect on adjacent intervertebral disc stress, but it is an important factor that affecting the bone graft stress, titanium plate stress and screws stress after ACDF. Shorter PDD plate can provide better stability to reduce stress on screws and bone graft, which may be helpful to prevent cage subsidence, pseudarthrosis and instrument failure. This can serve as a reference for clinical choice of plate.
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12
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Cui Y, Zhou Y, Liu J, Duan D, Gong L, Li W. ACDF plus Uncovertebrectomy versus ACDF alone for the Treatment of Cervical Spondylotic Radiculopathy: Minimum 5-Year Follow-Up. J Neurol Surg A Cent Eur Neurosurg 2021; 82:154-160. [PMID: 33386028 DOI: 10.1055/s-0040-1720992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The surgical approach for cervical spondylotic radiculopathy (CSR) is controversial. This study aims to investigate the effectiveness of the combined anterior cervical diskectomy and fusion (ACDF) and uncovertebrectomy for treatment of CSR. METHODS This is a retrospective case control study. One hundred and forty-six patients with CSR who underwent two different procedures (ACDF alone [group A]) and a combination of ACDF and uncovertebrectomy [group B]) from March 2008 to April 2013 were included. The operation time, blood loss, Visual Analog Scale scores of the neck (VAS-neck) and arm (VAS-arm), Neck Disability Index (NDI) score, 36-Item Short Form Health Survey (SF-36) score, fusion segment curvature, global cervical curvature, and the rate of surgical complication were evaluated. RESULTS There were no significant differences in the basic demographic and clinical characteristics between the two groups (p > 0.05). No significant differences were noticed in the fusion segment curvature and global cervical curvature between the two groups (p > 0.05). Whereas the operation time and blood loss in group B were greater than those in group A (p < 0.05), the VAS-neck, VAS-arm, NDI, and SF-36 scores were better in group B (p < 0.05). The surgical complication rate between the two groups was not significantly different (p > 0.05). CONCLUSIONS Clinical efficacy of ACDF plus uncovertebrectomy for the treatment of patients with CSR may be better than that of ACDF alone, but at the expense of more operation time and blood loss.
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Affiliation(s)
- Yaqing Cui
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Yongchun Zhou
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Jun Liu
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Dapeng Duan
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Liqun Gong
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Weiwei Li
- Department of Orthopaedic, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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13
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Impact of preoperative weakness and duration of symptoms on health-related quality-of-life outcomes following anterior cervical discectomy and fusion. Spine J 2020; 20:1744-1751. [PMID: 32603856 DOI: 10.1016/j.spinee.2020.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The majority of patients with preoperative upper extremity weakness show improvements in motor function after anterior cervical discectomy and fusion (ACDF). Although numerous studies have examined both the extent and time course to which motor function can be expected to improve, few have shown that these improvements in motor function translate to improved health related quality of life (HRQOL) outcomes. PURPOSE The purpose of this study was to examine the effect of preoperative weakness and duration of symptoms on HRQOL outcomes in patients who underwent ACDF. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Adult patients who underwent an ACDF procedure at an academic hospital from January 2015 to December 2016 by a fellowship-trained spine surgeon. OUTCOME MEASURES The primary outcomes of interest were HRQOL outcomes: Short Form-12 Physical/Mental Component Scores (SF-12 PCS/MCS), Neck Disability Index (NDI), and Visual Analog Scale Arm/Neck scores (VAS Arm/Neck). METHODS Patient demographics, surgical case characteristics, and motor strength exams were collected in patients who underwent ACDF over a 2-year period. Preoperative weakness was defined by a strength grade ≤3 (on a scale from 0 to 5) in at least one upper extremity muscle group. Multivariate linear regression analysis was performed to determine the effect of the preoperative weakness on HRQOL outcomes. RESULTS Of the 276 patients identified, 45 (16.3%) showed evidence of preoperative weakness, 44 (97.8%) of which showed subsequent postoperative motor improvements after ACDF. All patients reported significant improvements in all HRQOL outcome measures. Patients with preoperative weakness reported significantly worse preoperative VAS Arm (6.9 vs. 5.2; p=.01) and VAS Neck (6.1 vs. 4.8; p=.02) pain scores. Compared with patients without preoperative weakness, those with preoperative weakness reported significantly more improvement in NDI (β: -10.9; p=.001). Patients with symptoms greater than or equal to 12 months and preoperative weakness showed significantly less improvement in NDI (β: 14.8; p=.03). CONCLUSIONS Patients with preoperative weakness generally exhibited worse pain and HRQOL measures preoperatively, and showed greater potential for improvement after ACDF. Patients with a shorter duration of preoperative weakness had greater potential for improvement in HRQOL measures after ACDF compared with those with longer duration of symptoms. ACDF is an effective procedure to improve strength and HRQOL measures across all patient groups under appropriate indications.
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14
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Clinicians' User Experience of Telemedicine in Neurosurgery During COVID-19. World Neurosurg 2020; 146:e359-e367. [PMID: 33203534 DOI: 10.1016/j.wneu.2020.10.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Restricted access to hospitals due to the 2019 novel coronavirus disease (COVID-19) pandemic has significantly altered practice patterns for elective neurosurgical care. Particularly, telemedicine has become the primary modality of patient visits for nonemergent conditions. This study aimed to characterize user experiences of neurosurgeons and advanced practice providers focusing on perceived utility and barriers of telemedicine in management of elective neurosurgical patients during COVID-19. METHODS An online survey was sent to clinicians involved in neurosurgical care using telemedicine with questions focusing on frequency of utilization, duration of patient encounters, benefits of telemedicine, and barriers to current forms of remote patient visits. Survey responses were stratified by clinical position (neurosurgeon vs. advanced practice provider) and subspecialty focus (cranial vs. spinal neurosurgery). RESULTS The survey was completed by 14 of 17 eligible clinicians. Respondents included 10 neurosurgeons and 4 APPs with 57% specializing in cranial neurosurgery and 43% specializing in spinal neurosurgery. During the COVID-19 period, 78% of respondents used teleconference/video conference visits multiple times in a week, and 86% planned to continue using telemedicine after the pandemic. The most common barrier for telemedicine was the inability to perform a neurological examination, while the most common perceived benefit was increased convenience for patients. CONCLUSIONS During the COVID-19 period, telemedicine was heavily relied on to ensure the continuation of perioperative care for patients with elective neurosurgical pathologies. While clinicians identified numerous barriers for current telemedicine platforms, the use of telemedicine will likely continue, as it has provided unique benefits for patients, clinicians, and hospitals.
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15
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Hagan CR, Anderson AR. Cervical spine thrust and non-thrust mobilization for the management of recalcitrant C6 paresthesias associated with a cervical radiculopathy: a case report. Physiother Theory Pract 2020; 38:1311-1318. [PMID: 32896223 DOI: 10.1080/09593985.2020.1818340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The conservative management of cervical radiculopathy is supported by moderate evidence to include interventions such as manual therapy, traction, and therapeutic exercise. There is sparse evidence, however, to support specific manual therapy techniques, particularly thrust manipulation. CASE DESCRIPTION A 35-year-old male presented to physical therapy with a clinical diagnosis of cervical radiculopathy. He complained of neck and upper arm pain with 1st and 2nd digit paresthesias. He was initially managed with repeated movements that restored the cervical range of motion and centralized neck and upper arm pain. Non-thrust upslope joint mobilizations resulted in improved sensation detection in the hand, but the paresthesias did not completely resolve. Immediately following cervical spine upslope thrust manipulation, symptoms fully resolved. Outcomes: The patient fully returned to prior level of function. His DASH score reduced from 40/100 to 2/100, PSFS improved from 1.66/10 to 9.66/10, and he reported to be 'a great deal better' on the GROC. DISCUSSION This case demonstrates the safe and effective utilization of cervical spine thrust manipulation and non-thrust mobilization in the management of a patient with cervical radiculopathy with lingering paresthesias in the distal upper extremity.
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Affiliation(s)
- Christopher R Hagan
- OMPT Fellowship, University of Illinois at Chicago, Chicago, IL, USA.,Rush University Medical Center, Chicago, IL, USA
| | - Alexandra R Anderson
- OMPT Fellowship, University of Illinois at Chicago, Chicago, IL, USA.,UI Health, Chicago, IL, USA
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16
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Wagner A, Shiban Y, Zeller L, Aftahy K, Lange N, Motov S, Joerger AK, Meyer B, Shiban E. Psychological predictors of quality of life after anterior cervical discectomy and fusion for degenerative cervical spine disease. Sci Rep 2020; 10:13415. [PMID: 32770143 PMCID: PMC7414876 DOI: 10.1038/s41598-020-70437-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 07/29/2020] [Indexed: 11/22/2022] Open
Abstract
We aimed to identify independent psychological predictors of quality of life (QOL) and functional outcome after anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease. We prospectively included patients undergoing ACDF for degenerative cervical disc herniation and stenosis. Patients completed a structured psychological assessment including the Center for Epidemiological Studies Depression Scale (ADS-K), Post-Traumatic Stress Scale-10 (PTSS-10), State Trait Anxiety Inventory-State Anxiety and - Trait Anxiety (STAI-S and STAI-T) and Anxiety Sensitivity Index-3 (ASI-3) before surgery, after 3 and 12 months. Outcome measures included EuroQol-5D (EQ), Short Form-36 (SF-36) and Oswestry Disability Index (ODI) scores. Of 104 included patients who underwent ACDF between March 2013 and November 2017, 92 completed follow-up after 3 and 12 months. The mean Visual Analogue Scale (VAS) scores for neck pain (− 1.4; p < .001) and arm pain (− 1.8; p = .031) significantly decreased by 12 months. QOL scores significantly increased by 3 months (EQ: + 0.2; p < .001; SF-36 PCS: + 6.2; p < .001; SF-36 MCS: + 2.5; p = .044), a benefit which was retained at 12 months. Linear regression analyses identified statistically significant predictors in preoperative ASI-3, SF-36 MCS and STAI-S for postoperative QOL and ODI scores. There is a benefit for patients in terms of quality of life and function after undergoing surgery for degenerative cervical spine disease. With the ASI-3, SF-36 MCS and STAI-S there exist some predictors for postoperative QOL and ODI scores.
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Affiliation(s)
- Arthur Wagner
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Youssef Shiban
- Department of Clinical Psychology, Private University of Applied Sciences, Göttingen, Germany
| | - Leonie Zeller
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kaywan Aftahy
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nicole Lange
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stefan Motov
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ann-Kathrin Joerger
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ehab Shiban
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
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17
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Fang W, Huang L, Feng F, Yang B, He L, Du G, Xie P, Chen Z. Anterior cervical discectomy and fusion versus posterior cervical foraminotomy for the treatment of single-level unilateral cervical radiculopathy: a meta-analysis. J Orthop Surg Res 2020; 15:202. [PMID: 32487109 PMCID: PMC7268305 DOI: 10.1186/s13018-020-01723-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/20/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To compare the effectiveness and safety of anterior cervical discectomy and fusion (ACDF) with posterior cervical foraminotomy (PCF) for patients diagnosed with single-level unilateral cervical radiculopathy. METHODS Relevant studies comparing ACDF with PCF for cervical radiculopathy were searched in an electronic database. After data extraction and quality assessment of included studies, a meta-analysis was done by using the RevMan 5.3 software. The random effects model was used if there was heterogeneity between studies; otherwise, the fixed effects model was used. RESULTS A total of 3 randomized controlled trials (RCT) and 12 retrospective studies including 52705 patients were included in the meta-analysis. There were no significant differences in Neck Disability Index (NDI), Visual Analog Scale (VAS), and patients' satisfaction (P > 0.05) between treatment groups. The complication rate of the PCF group was equivalent compared with the ACDF group (P = 0.60), but the reoperation rate following PCF was on the higher side (P = 0.02). Data analysis also showed that the PCF group was associated with shorter operation time (P = 0.001) and shorter length of hospital stay (P = 0.002). CONCLUSIONS Among patients with single-level unilateral cervical radiculopathy, PCF has comparable effectiveness and complication rate compared with ACDF. It seems that PCF is a sufficient alternative procedure with shorter operation time, shorter length of hospital stay, and less total hospital cost for the treatment of cervical radiculopathy. However, the higher reoperation rate following PCF should be also taken into consideration.
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Affiliation(s)
- Wenguang Fang
- Orthopedic Center, The Sixth People's Hospital of Huizhou, No. 2 Aimindong Road, Huizhou, 516211, Guangdong, China
| | - Lijun Huang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Feng Feng
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Bu Yang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Lei He
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Guizhong Du
- Orthopedic Center, The Sixth People's Hospital of Huizhou, No. 2 Aimindong Road, Huizhou, 516211, Guangdong, China
| | - Peigen Xie
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China.
| | - Zihao Chen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China.
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18
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Wong CE, Hu HT, Hsieh MP, Huang KY. Optimization of Three-Level Cervical Hybrid Surgery to Prevent Adjacent Segment Disease: A Finite Element Study. Front Bioeng Biotechnol 2020; 8:154. [PMID: 32195235 PMCID: PMC7064443 DOI: 10.3389/fbioe.2020.00154] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/14/2020] [Indexed: 12/23/2022] Open
Abstract
Hybrid surgery (HS) allows surgeons to tailor fusion and arthroplasty in the treatment of multiple-level cervical disc degeneration. However, the decision making of selecting either ACDF or ADR for each level in three-level HS remains controversial and has not been fully investigated. This study was aimed to optimize three-level cervical hybrid constructs by systematically investigating their biomechanical properties and their effect on adjacent levels. A finite element model of cervical spine (C2–C7) was developed, and eight C3–C6 surgical models including six HS were constructed. The range of motion (ROM) in flexion, extension, lateral bending, and axial rotation under 2.0 Nm moments with 30 N follower load were simulated. The von Mises stress, strain energy at the adjacent intervertebral disc (IVD) and force at the adjacent facet were calculated. The ROM of the hybrid constructs and adjacent levels was close to that of the intact spine. HS with arthroplasty performed at C5-6 had better performance in terms of ROM reduction at the inferior adjacent level (C6-7). Moreover, C-D-D and 3ADR had best performance in reducing the von Mises stress and strain energy at C6-7. All HS reduced the facet burden at both C2-3 and C6-7 levels. However, the major drawback of HS revealed here is that the effect of C6-7 protection is at the cost of increased C2-3 IVD burden. In conclusion, we recommend C-D-D and 3ADR for patient with C3–C6 disc degeneration without predisposing C2-3 condition. C-C-D could be a good alternative with a lower medical cost. This analysis guides the decision making in three-level cervical HS before future cadaver studies or human clinical trials.
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Affiliation(s)
- Chia-En Wong
- Department of Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsuan-Teh Hu
- Department of Civil Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Pu Hsieh
- Department of Civil Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Yuan Huang
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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19
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Peolsson A, Löfgren H, Dedering Å, Öberg B, Zsigmond P, Hedevik H, Wibault J. Postoperative structured rehabilitation in patients undergoing surgery for cervical radiculopathy: a 2-year follow-up of a randomized controlled trial. J Neurosurg Spine 2019; 31:60-69. [PMID: 30901755 DOI: 10.3171/2018.12.spine181258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/18/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Information about postoperative rehabilitation for cervical radiculopathy (CR) is scarce. The aim of this study was to investigate the additional benefits of structured postoperative rehabilitation (SPT), which was performed in all patients, compared with a pragmatic standard postoperative approach (SA), in which rehabilitation was used as needed and patients sought physiotherapy on their own without a referral, in patients with MRI evidence of disc herniation and concomitant clinical signs who underwent surgery for CR. METHODS Patients (n = 202) were randomized to receive SPT or SA. Included key variables in the present study were primary and selected secondary outcomes of a prospective randomized controlled multicenter study. The main outcome was the Neck Disability Index (NDI) score. The NDI score, pain variables, self-efficacy, and health-related quality of life were investigated at baseline and 3, 6, 12, and 24 months postoperatively. RESULTS SPT provided no additional benefits over SA (p = 0.08 to p = 0.99) at the postoperative 2-year follow-up. Both groups improved over time (p < 0.0001), with no reported adverse effects. CONCLUSIONS One can conclude that SPT offered no additional benefits over SA; however, patients tolerated postoperative neck exercises without any negative side effects. These findings are important for the development of future active and neck-specific postoperative rehabilitation interventions for patients with CR.Clinical trial registration no.: NCT01547611 (clinicaltrials.gov).
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Affiliation(s)
- Anneli Peolsson
- 1Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping
| | - Håkan Löfgren
- 2Neuro-Orthopedic Center, Ryhov Hospital, Region Jönköping County, Jönköping
| | - Åsa Dedering
- 3Allied Health Professionals Function, Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm
- 4Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm
| | - Birgitta Öberg
- 1Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping
| | - Peter Zsigmond
- 5Department of Neurosurgery, Linköping University Hospital, Linköping; and
| | - Henrik Hedevik
- 1Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping
| | - Johanna Wibault
- 1Department of Medical and Health Sciences, Physiotherapy, Linköping University, Linköping
- 6Department of Activity and Health, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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20
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Kreitz TM, Hollern DA, Padegimas EM, Schroeder GD, Kepler CK, Vaccaro AR, Hilibrand AS. Clinical Outcomes After Four-Level Anterior Cervical Discectomy and Fusion. Global Spine J 2018; 8:776-783. [PMID: 30560028 PMCID: PMC6293423 DOI: 10.1177/2192568218770763] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Anterior cervical discectomy and fusion (ACDF) demonstrates reliable improvement in neurologic symptoms associated with anterior compression of the cervical spine. There is a paucity of data on outcomes following 4-level ACDFs. The purpose of this study was to evaluate clinical outcomes for patients undergoing 4-level ACDF. METHODS All 4-level ACDFs with at least 1-year clinical follow-up were identified. Clinical outcomes, including fusion rates, neurologic outcomes, and reoperation rates were determined. RESULTS Retrospective review of our institutional database revealed 25 patients who underwent 4-level ACDF with at least 1-year clinical follow-up. Average age was 57.5 years (range 38.2-75.0 years); 14 (56%) were male, and average body mass index was 30.2 kg/m2 (range 19.9-43.4 kg/m2). Two (8%) required secondary cervical surgery at an average of 94.5 days postoperatively while the remaining 23 did not with an average follow-up of 19 months. Of 23 patients not requiring revision surgery, 16 (69%) patients fused by definition of less than 1 mm of spinous process motion per fused level in flexion and extension. Fifteen (65%) had at least one muscle group with one grade of weakness preoperatively. Nineteen of these patients (83%) had improved to full strength while no patients lost muscle strength. CONCLUSIONS Review of our institution's experience demonstrated a low rate of revision cervical surgery for any reason of 8% at mean 19 months follow-up, and neurological examinations consistently improved, despite a high rate of radiographic nonunion (31%).
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Affiliation(s)
- Tyler M. Kreitz
- Thomas Jefferson University, Philadelphia, PA, USA,Tyler M. Kreitz, Department of Orthopaedic Surgery,
Thomas Jefferson University, 1025 Walnut Street, Room 516 College, Philadelphia, PA 19107,
USA.
| | | | | | | | | | | | - Alan S. Hilibrand
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA,
USA
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21
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Akkan H, Gelecek N. The effect of stabilization exercise training on pain and functional status in patients with cervical radiculopathy. J Back Musculoskelet Rehabil 2018; 31:247-252. [PMID: 28946516 DOI: 10.3233/bmr-169583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no consensus about treatment of neck patients who have radicular symptoms. OBJECTIVE The purpose of the study was to investigate the effect of stabilization exercise training on pain and functional status in patients with cervical radiculopathy. METHODS The patients (n= 32) with cervical radiculopathy were randomized to two groups as follows: Stabilization exercise group (Group 1; n= 18); Home-exercise group (Group 2; n= 16). The patients were evaluated with visual analog scale, Neck Disability Index, SF-36 (Short-Form), Corbin postural assessment scale and hand grip at baseline, after treatment at 4th week and 3rd month. RESULTS At baseline, there were no statistically differences between groups in terms of evaluated parameters (p> 0.05). After treatment and three months later, pain and Neck Disability Index decreased; Corbin postural scores, hand grip and SF-36 scores improved statistically in both groups (p< 0.05). Changes of the measurements in both groups were similar and there were no significant differences between group 1 and group 2 at 4th week and 3rd month (p> 0.05) except postural scores. CONCLUSIONS This study demonstrates that stabilization exercise training could be an effective intervention for decreasing pain and improving quality of life and posture in patients with cervical radiculopathy.
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Affiliation(s)
- Hakan Akkan
- Department of Physiotherapy and Rehabilitation, School of Health Sciences, Dumlupinar University, Kutahya, Turkey
| | - Nihal Gelecek
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Inciralti-Izmir, Turkey
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Prolonged Preoperative Weakness Affects Recovery of Motor Function After Anterior Cervical Diskectomy and Fusion. J Am Acad Orthop Surg 2018; 26:67-73. [PMID: 29239868 DOI: 10.5435/jaaos-d-16-00606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Some patients who undergo anterior cervical diskectomy and fusion for radiculopathy or myelopathy demonstrate preoperative weakness. The purpose of this study was to determine which factors predict motor recovery in patients undergoing anterior cervical diskectomy and fusion. METHODS A retrospective review of our institutional database identified patients undergoing anterior cervical diskectomy and fusion between 2010 and 2013 with 2 years of clinical follow-up. Patients with substantial weakness, defined as preoperative grade ≤3 (on a scale from 0 to 5) in one or more upper extremity muscle groups, were identified. Regression analysis was used to determine risk factors associated with persistent postoperative weakness. RESULTS Of the 1,001 patients who were included, 54 (5.4%) demonstrated substantial weakness. By 2 years postoperatively, 47 of 54 patients (87%) demonstrated motor recovery. The duration of preoperative weakness was an independent predictor of recovery (median, 4 months of preoperative weakness among patients with recovery versus 10 months in patients with persistent weakness; P = 0.012). DISCUSSION Duration of preoperative motor weakness is an independent predictor of motor recovery after anterior cervical diskectomy and fusion in patients with substantial motor weakness. CONCLUSION Patients being considered for anterior cervical diskectomy and fusion who have substantial preoperative motor deficits may benefit from earlier surgical intervention.
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Zhang X, Zhang Z, Wen J, Lu J, Sun Y, Sang D. The effectiveness of therapeutic strategies for patients with radiculopathy: A network meta-analysis. Mol Pain 2018; 14:1744806918768972. [PMID: 29651898 PMCID: PMC5900815 DOI: 10.1177/1744806918768972] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/16/2018] [Accepted: 02/07/2018] [Indexed: 12/16/2022] Open
Abstract
Objectives The aim of this network meta-analysis is to assess the effectiveness of therapeutic strategies for patients with radiculopathy, including physical, medical, surgical, and other therapies. Methods We electronically searched electronic databases including PubMed and Embase for randomized controlled trials. The response rate and visual analog scale of pain change were considered as primary outcomes. The outcomes were measured by odds ratio (OR) value and corresponding 95% credible intervals (CrIs) or standardized mean difference (MD) with 95% CrIs. Besides, surface under cumulative ranking curve (SUCRA) were performed to rank efficacy and safety of treatments on each end points. Results A total of 16 eligible studies with 1071 subjects were included in this analysis. Our results showed that corticosteroid was significantly more effective than control regarding the response rate (OR = 3.86, 95% CrI: 1.16, 12.55). Surgery had a better performance in pain change compared with control (MD = -1.92, 95% CrI: -3.58, -0.15). According to the SUCRA results, corticosteroid, collar, and physiotherapy ranked the highest concerning response rate (SUCRA = 0.656, 0.652, and 0.610, respectively). Surgery, traction, and corticosteroid were superior to others in pain change (SUCRA = 0.866, 0.748, and 0.589, respectively). Conclusion According to the network meta-analysis result, we recommended surgery as the optimal treatment for radiculopathy patients; traction and corticosteroids were also recommended for their beneficial interventions.
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Affiliation(s)
- Xiaoyu Zhang
- Department of General Rehabilitation, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Zhiqiang Zhang
- Community Chronic Disease Research Center, Institute of Chinese Basic Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianzhong Wen
- Department of Anesthesiology, Second Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Lu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yingchun Sun
- Chinese Medicine Treatment Center, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Dechun Sang
- Department of General Rehabilitation, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
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Fieseler G, Laudner KG, Irlenbusch L, Meyer H, Schulze S, Delank KS, Hermassi S, Bartels T, Schwesig R. Inter- and intrarater reliability of goniometry and hand held dynamometry for patients with subacromial impingement syndrome. J Exerc Rehabil 2017; 13:704-710. [PMID: 29326903 PMCID: PMC5747206 DOI: 10.12965/jer.1735110.555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/09/2017] [Indexed: 12/03/2022] Open
Abstract
The purpose of this study was to examine the intra- and interrater reliability of measuring shoulder range of motion (ROM) and strength among patients diagnosed with subacromial impingement syndrome (SAIS). Twenty-five patients (14 female patients; mean age, 60.4± 7.84 years) diagnosed with SAIS were assessed to determine the intrarater reliability for glenohumeral ROM. Twenty-five patients (16 female patients; mean age, 60.4± 7.80 years) and 76 asymptomatic volunteers (52 female volunteers; mean age, 29.4± 14.1 years) were assessed for interrater reliability. Dependent variables were active shoulder ROM and isometric strength. Intrarater reliability was fair-to-excellent for the SAIS patients (intraclass correlation coefficient [ICC], 0.52–0.97; standard error of measurement [SEM], 4.4°–9.9° N; coefficient of variation [CV], 7.1%–44.9%). Based on the ICC, 11 of 12 parameters (92%) displayed an excellent reliability (ICC> 0.75). The interrater reliability showed fair-to-excellent results (SAIS patients: ICC, 0.13–0.98; SEM, 2.3°–8.8°; CV, 3.6%–37.0%; controls: ICC, 0.11–0.96; SEM, 3.0°–35.4°; CV, 5.6%–26.4%). In accordance with the intrarater reliability, glenohumeral adduction ROM was the only parameter with an ICC below 0.75 for both samples. Painful shoulder ROM in the SAIS patients showed no influence on the quality of reliability for measurement. Therefore, these protocols should be considered reliable assessment techniques in the prevention, diagnosis, and treatment of painful shoulder conditions such as SAIS.
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Affiliation(s)
- Georg Fieseler
- Division for Shoulder Surgery and Sports Orthopedics, Helios Clinic, Warburg/Westfalen, Germany
| | - Kevin G Laudner
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
| | - Lars Irlenbusch
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Henrike Meyer
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephan Schulze
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Karl-Stefan Delank
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Souhail Hermassi
- Tunisian Researches Laboratory "Sport Performance Optimization", Tunis, Tunisia
| | - Thomas Bartels
- SportsClinic Halle, Center for Joint Surgery, Halle (Saale), Germany
| | - René Schwesig
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Yeh YC, Yang CC, Tai CL, Tsai TT, Lai PL, Fu TS, Niu CC, Chen LH, Chen WJ. Characterization of a novel caudal vertebral interbody fusion in a rat tail model: An implication for future material and mechanical testing. Biomed J 2017; 40:62-68. [PMID: 28411885 PMCID: PMC6138589 DOI: 10.1016/j.bj.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 07/12/2016] [Indexed: 11/30/2022] Open
Abstract
Background Of the proposed animal interbody fusion models, rat caudal discs have gained popularity in disc research due to their strong resemblance to human discs with respect to geometry, composition and mechanical properties. The purpose of this study is to demonstrate an efficient, repeatable and easily accessible animal model of interbody fusion for future research into mechanical testing and graft materials. Methods Twelve 12-week-old female Sprague–Dawley (SD) rats underwent caudal interbody fusion of the third and fourth coccygeal vertebrae of the tail. Serial radiological evaluation, and histological evaluation and manual palpation after sacrifice were performed to assess the fusion quality. Mechanical testing of functional units (FUs) of non-operated and operated segments was compared using a three-point bending test. Results At postoperative 12 weeks, callus formation was observed at the fusion sites in all rats, with the mean radiological evaluations of 2.75/3 according to the Bransford classification. Newly formed bone tissue was also observed in all rats with the mean histological score of 5.85/7, according to the Emery grading system. No palpable gaps and obvious change of bending stiffness was observed in the operated segments. The mean bending stiffness of the FUs was statistically higher than that of the control FUs (26.57 ± 6.71 N/mm vs. 12.45 ± 3.21 N/mm, p < 0.01). Conclusion The rat caudal disc interbody fusion model proved to be an efficient, repeatable and easily accessible model. Future research into adjuvant treatments like growth factor injection and alternative fusion materials under conditions of osteoporosis using this model would be worthwhile.
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Affiliation(s)
- Yu-Cheng Yeh
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Chun Yang
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Lung Tai
- Graduate Institute of Medical Mechatronics, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lih-Huei Chen
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Jer Chen
- Department of Orthopaedic Surgery, Spine Section, Musculoskeletal Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Evolution of Muscles Dysfunction From Myofascial Pain Syndrome Through Cervical Disc-Root Conflict to Degenerative Spine Disease. Spine (Phila Pa 1976) 2017; 42:151-159. [PMID: 27196021 DOI: 10.1097/brs.0000000000001691] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Comparative clinical and neurophysiological study in three groups of patients with general diagnosis of neck pain. OBJECTIVE To determine symptoms of muscles dysfunction in patients with myofascial pain syndrome, disc-root conflict, and degenerative changes at cervical spine. SUMMARY AND BACKGROUND DATA The explanation for cervical pain origin should be based on results from chosen clinical and neurophysiological studies in correlation with neuroimaging findings. METHODS Three subgroups of patients (N = 60 each) with certain symptoms were examined. Clinical evaluation included examination of pain intensity in VAS scale, muscle strength in Lovett scale, evaluation of reflexes, Spurling test, assessment of active trigger points (TRPs), and superficial sensory perception. Neurophysiological testing included surface electromyography at rest (rEMG) and during maximal contraction (mcEMG) as well as electroneurography (ENG). RESULTS The greatest pain intensity with its decentralization phenomenon occurred in patients with disc-root conflict. Significant decrease of muscle strength was detected in trapezius muscle in myofascial pain syndrome subgroup. Weakness of abductor pollicis brevis muscle in patients with disc-root conflict differed them from patients with myofascial pain syndrome (P = 0.05). Patients with disc-root conflict and degenerative spine disease showed differences (P = 0.03) in reflexes evoked from triceps brachii. Positive Spurling symptom was most common (56.7%) in disc-root conflict subgroup. TRPs in trapezius muscle were found in all patients with myofascial pain syndrome. Results of rEMG amplitude measurements differed patients at P = 0.05. Only mcEMG recording from abductor pollicis brevis muscle allows for their clear cut differentiation. ENG studies showed abnormalities in patients with disc-root conflict and degenerative spine disease (P from 0.05 to 0.02). Positive correlation of VAS, TRPs, and rEMG as well as Lovett scores, mcEMG, and ENG results was found. CONCLUSION Only applying several clinical and neurophysiological tests together makes it possible to differentiate patients with different etiological reasons of pain at cervical spine. LEVEL OF EVIDENCE 4.
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Whitfield P, Derriford Hospital, Plymouth, UK, Yuen J, South West Deanery, UK. https://www.acnr.co.uk/2017/09/anterior-cervical-discectomy-and-fusion-acdf-for-degenerative-cervical-diseases-six-decades-on/. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2017. [DOI: 10.47795/iwdk8512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Thoomes EJ. Effectiveness of manual therapy for cervical radiculopathy, a review. Chiropr Man Therap 2016; 24:45. [PMID: 27980724 PMCID: PMC5146882 DOI: 10.1186/s12998-016-0126-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/11/2016] [Indexed: 12/16/2022] Open
Abstract
Manual therapy is often used for patients with neck pain with or without radicular symptoms. There is sparse evidence on the effectiveness in cervical radiculopathy. The aim of this study was to assess current levels of evidence on the effectiveness of manual therapy interventions for patients with cervical radiculopathy. Electronic data bases were systematically searched for clinical guidelines, reviews and randomised clinical trials (RCTs) reporting on the effectiveness of manual therapy for patients with cervical radiculopathy. Eight relevant reviews, two guidelines and two recent RCTs, that had not yet been included in either, were retrieved. The overall quality of the evidence of included studies was evaluated using the GRADE method. Most interventions were only studied in one single RCT. There is low level evidence that cervical manipulation and mobilisation as unimodal interventions are effective on pain and range of motion at the immediate follow up, but no evidence on the effectiveness of thoracic manipulation or mobilisation as unimodal interventions. There is low level evidence that a combination of spinal mobilisation and motor control exercises is more effective on pain and activity limitations than separate interventions or a wait-and-see policy. There is low level evidence of the effectiveness of cervical mobilisation with a neurodynamical intent as unimodal intervention, on the effectiveness of a multimodal intervention with neurodynamic intent on pain activity limitations and global perceived effect compared to a wait-and-see policy. There is also low level evidence that a multimodal intervention consisting of spinal and neurodynamic mobilisations and specific exercises is effective on pain in patients with CR. There is low level evidence that traction is no more effective than placebo traction.
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Affiliation(s)
- E. J. Thoomes
- Fysio-Experts Physical Therapy Clinic, Hazerswoude, The Netherlands
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Cervical disc arthroplasty for symptomatic cervical disc disease: Traditional and Bayesian meta-analysis with trial sequential analysis. Int J Surg 2016; 35:111-119. [PMID: 27693477 DOI: 10.1016/j.ijsu.2016.09.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/22/2016] [Accepted: 09/25/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cervical disc arthroplasty (CDA) has been designed as a substitute for anterior cervical discectomy and fusion (ACDF) in the treatment of symptomatic cervical disc disease (CDD). Several researchers have compared CDA with ACDF for the treatment of symptomatic CDD; however, the findings of these studies are inconclusive. Using recently published evidence, this meta-analysis was conducted to further verify the benefits and harms of using CDA for treatment of symptomatic CDD. METHODS Relevant trials were identified by searching the PubMed, EMBASE, and Cochrane Library databases. Outcomes were reported as odds ratio or standardized mean difference. Both traditional frequentist and Bayesian approaches were used to synthesize evidence within random-effects models. Trial sequential analysis (TSA) was applied to test the robustness of our findings and obtain more conservative estimates. RESULTS Nineteen trials were included. The findings of this meta-analysis demonstrated better overall, neck disability index (NDI), and neurological success; lower NDI and neck and arm pain scores; higher 36-Item Short Form Health Survey (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores; more patient satisfaction; greater range of motion at the operative level; and fewer secondary surgical procedures (all P < 0.05) in the CDA group compared with the ACDF group. CDA was not significantly different from ACDF in the rate of adverse events (P > 0.05). TSA of overall success suggested that the cumulative z-curve crossed both the conventional boundary and the trial sequential monitoring boundary for benefit, indicating sufficient and conclusive evidence had been ascertained. CONCLUSIONS For treating symptomatic CDD, CDA was superior to ACDF in terms of overall, NDI, and neurological success; NDI and neck and arm pain scores; SF-36 PCS and MCS scores; patient satisfaction; ROM at the operative level; and secondary surgical procedures rate. Additionally, there was no significant difference between CDA and ACDF in the rate of adverse events. However, as the CDA procedure is a relatively newer operative technique, long-term results and evaluation are necessary before CDA is routinely used in clinical practice.
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Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2000-22. [PMID: 26984876 DOI: 10.1007/s00586-016-4467-7] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 02/15/2016] [Accepted: 02/15/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE To develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD). METHODS This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I-III NAD <6 months duration. RECOMMENDATION 1 Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III. RECOMMENDATION 2 Clinicians should assess prognostic factors for delayed recovery from NAD. RECOMMENDATION 3 Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I-III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care. RECOMMENDATION 4 For NAD grades I-II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat. RECOMMENDATION 5 For NAD grades I-II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections. RECOMMENDATION 6 For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction. RECOMMENDATION 7: For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management. RECOMMENDATION 8: Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.
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Latka D, Miekisiak G, Jarmuzek P, Lachowski M, Kaczmarczyk J. Treatment of degenerative cervical spondylosis with radiculopathy. Clinical practice guidelines endorsed by The Polish Society of Spinal Surgery. Neurol Neurochir Pol 2016; 50:109-13. [PMID: 26969567 DOI: 10.1016/j.pjnns.2015.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Degenerative cervical spondylosis (DCS) with radiculopathy is the most common indication for cervical spine surgery despite favorable natural history. Advances in spinal surgery in conjunction with difficulties in measuring the outcomes caused the paucity of uniform guidelines for the surgical management of DCS. AIMS The aim of this paper is to develop guidelines for surgical treatment of DCS. For this purpose the available up-to-date literature relevant on the topic was critically reviewed. METHODS AND RESULTS Six questions regarding most important clinical questions encountered in the daily practice were formulated. They were answered based upon the systematic literature review, thus creating a set of guidelines. The guidelines were categorized into four tiers based on the level of evidence (I-III and X). They were designed to assist in the selection of optimal and effective treatment leading to the most successful outcome. CONCLUSIONS The evidence based medicine (EBM) is increasingly popular among spinal surgeons. It allows making unbiased, optimal clinical decisions, eliminating the detrimental effect of numerous conflicts of interest. The key role of opinion leaders as well as professional societies is to provide guidelines for practice based on available clinical evidence. The present work contains a set of guidelines for surgical treatment of DCS officially endorsed by the Polish Spine Surgery Society.
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Affiliation(s)
- Dariusz Latka
- Department of Neurosurgery, Regional Medical Center, Opole, Poland.
| | - Grzegorz Miekisiak
- Department of Neurosurgery, Specialist Medical Center, Polanica-Zdrój, Poland
| | - Pawel Jarmuzek
- Department of Neurosurgery, Regional Neurosurgery and Neurotrauma Center, Zielona Góra, Poland
| | | | - Jacek Kaczmarczyk
- Department of Orthopedics and Traumatology, Poznan University of Medical Sciences, Poland
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Cheng CH, Tsai LC, Chung HC, Hsu WL, Wang SF, Wang JL, Lai DM, Chien A. Exercise training for non-operative and post-operative patient with cervical radiculopathy: a literature review. J Phys Ther Sci 2015; 27:3011-8. [PMID: 26504347 PMCID: PMC4616148 DOI: 10.1589/jpts.27.3011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Cervical radiculopathy is a clinical condition associated with pain, numbness
and/or muscle weaknesses of the upper extremities due to a compression or irritation of
the cervical nerve roots. It is usually managed conservatively but surgical intervention
is sometimes required for those who fail to respond adequately. This study performed a
literature review to determine the effects of exercise on non-operative and post-operative
cervical radiculopathy patients. [Methods] The PubMed, MEDLINE, CINAHL and Scopus
databases were searched to identify relevant articles published from January 1997 to May
2014, which explicitly stated that an exercise program was employed as an intervention for
cervical radiculopathy. The therapeutic effectiveness and outcomes were then classified
based on the International Classification of Functioning, Disability and Health (ICF)
model. [Results] Eleven studies were identified and included in the final analysis. In
these studies, the main forms of exercise training were specific strengthening and general
stretching exercises. Levels of evidence were graded as either I or II for all studies
according to the Oxford Centre for Evidence-based Medicine. The PEDro Scale score of these
studies ranged from 5 to 8. [Conclusion] A review of eleven high-level evidence and
high-quality studies revealed that, based on the ICF model, exercise training is
beneficial for improving the body function as well as activity participation of cervical
radiculopathy patients.
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Affiliation(s)
- Chih-Hsiu Cheng
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taiwan
| | | | - Hui-Chu Chung
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan
| | - Shwu-Fen Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan
| | - Jaw-Lin Wang
- Institute of Biomedical Engineering, National Taiwan University, Taiwan
| | - Dar-Ming Lai
- Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Andy Chien
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taiwan
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Gross A, Langevin P, Burnie SJ, Bédard-Brochu MS, Empey B, Dugas E, Faber-Dobrescu M, Andres C, Graham N, Goldsmith CH, Brønfort G, Hoving JL, LeBlanc F. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev 2015; 2015:CD004249. [PMID: 26397370 PMCID: PMC10883412 DOI: 10.1002/14651858.cd004249.pub4] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Manipulation and mobilisation are commonly used to treat neck pain. This is an update of a Cochrane review first published in 2003, and previously updated in 2010. OBJECTIVES To assess the effects of manipulation or mobilisation alone compared wiith those of an inactive control or another active treatment on pain, function, disability, patient satisfaction, quality of life and global perceived effect in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache (CGH) at immediate- to long-term follow-up. When appropriate, to assess the influence of treatment characteristics (i.e. technique, dosage), methodological quality, symptom duration and subtypes of neck disorder on treatment outcomes. SEARCH METHODS Review authors searched the following computerised databases to November 2014 to identify additional studies: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We also searched ClinicalTrials.gov, checked references, searched citations and contacted study authors to find relevant studies. We updated this search in June 2015, but these results have not yet been incorporated. SELECTION CRITERIA Randomised controlled trials (RCTs) undertaken to assess whether manipulation or mobilisation improves clinical outcomes for adults with acute/subacute/chronic neck pain. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, abstracted data, assessed risk of bias and applied Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods (very low, low, moderate, high quality). We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs). MAIN RESULTS We included 51 trials (2920 participants, 18 trials of manipulation/mobilisation versus control; 34 trials of manipulation/mobilisation versus another treatment, 1 trial had two comparisons). Cervical manipulation versus inactive control: For subacute and chronic neck pain, a single manipulation (three trials, no meta-analysis, 154 participants, ranged from very low to low quality) relieved pain at immediate- but not short-term follow-up. Cervical manipulation versus another active treatment: For acute and chronic neck pain, multiple sessions of cervical manipulation (two trials, 446 participants, ranged from moderate to high quality) produced similar changes in pain, function, quality of life (QoL), global perceived effect (GPE) and patient satisfaction when compared with multiple sessions of cervical mobilisation at immediate-, short- and intermediate-term follow-up. For acute and subacute neck pain, multiple sessions of cervical manipulation were more effective than certain medications in improving pain and function at immediate- (one trial, 182 participants, moderate quality) and long-term follow-up (one trial, 181 participants, moderate quality). These findings are consistent for function at intermediate-term follow-up (one trial, 182 participants, moderate quality). For chronic CGH, multiple sessions of cervical manipulation (two trials, 125 participants, low quality) may be more effective than massage in improving pain and function at short/intermediate-term follow-up. Multiple sessions of cervical manipulation (one trial, 65 participants, very low quality) may be favoured over transcutaneous electrical nerve stimulation (TENS) for pain reduction at short-term follow-up. For acute neck pain, multiple sessions of cervical manipulation (one trial, 20 participants, very low quality) may be more effective than thoracic manipulation in improving pain and function at short/intermediate-term follow-up. Thoracic manipulation versus inactive control: Three trials (150 participants) using a single session were assessed at immediate-, short- and intermediate-term follow-up. At short-term follow-up, manipulation improved pain in participants with acute and subacute neck pain (five trials, 346 participants, moderate quality, pooled SMD -1.26, 95% confidence interval (CI) -1.86 to -0.66) and improved function (four trials, 258 participants, moderate quality, pooled SMD -1.40, 95% CI -2.24 to -0.55) in participants with acute and chronic neck pain. A funnel plot of these data suggests publication bias. These findings were consistent at intermediate follow-up for pain/function/quality of life (one trial, 111 participants, low quality). Thoracic manipulation versus another active treatment: No studies provided sufficient data for statistical analyses. A single session of thoracic manipulation (one trial, 100 participants, moderate quality) was comparable with thoracic mobilisation for pain relief at immediate-term follow-up for chronic neck pain. Mobilisation versus inactive control: Mobilisation as a stand-alone intervention (two trials, 57 participants, ranged from very low to low quality) may not reduce pain more than an inactive control. Mobilisation versus another active treatment: For acute and subacute neck pain, anterior-posterior mobilisation (one trial, 95 participants, very low quality) may favour pain reduction over rotatory or transverse mobilisations at immediate-term follow-up. For chronic CGH with temporomandibular joint (TMJ) dysfunction, multiple sessions of TMJ manual therapy (one trial, 38 participants, very low quality) may be more effective than cervical mobilisation in improving pain/function at immediate- and intermediate-term follow-up. For subacute and chronic neck pain, cervical mobilisation alone (four trials, 165 participants, ranged from low to very low quality) may not be different from ultrasound, TENS, acupuncture and massage in improving pain, function, QoL and participant satisfaction at immediate- and intermediate-term follow-up. Additionally, combining laser with manipulation may be superior to using manipulation or laser alone (one trial, 56 participants, very low quality). AUTHORS' CONCLUSIONS Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.
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Affiliation(s)
- Anita Gross
- School of Rehabilitation Science & Department of Clinical Epidemiology and Biostatistics, McMaster University, 1400 Main Street West, Hamilton, ON, Canada, L8S 1C7
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Anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of brachialgia: the Leeds spinal unit experience (2008-2013). Acta Neurochir (Wien) 2015; 157:1595-600. [PMID: 26144567 DOI: 10.1007/s00701-015-2491-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The surgical management of cervical brachialgia utilising anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) is a controversial area in spinal surgery. Previous studies are limited by utilisation of non-validated outcome measures and, importantly, absence of pre-operative analysis to ensure both groups are matched. The authors aimed to compare the effectiveness of ACDF and PCF using validated outcome measures. To our knowledge, it is the first study in the literature to do this. METHODS The authors conducted a 5-year retrospective review (2008-2013) of outcomes following both the above procedures and also compared the effectiveness of both techniques. Patients with myelopathy and large central discs were excluded. The main outcome variables measured were the neck disability index (NDI) and visual analogue scores (VAS) for neck and arm pain pre-operatively and again at 2-year follow-up. The Wilcoxon signed-rank test and Student t-tests were used to test differences. RESULTS A total of 150 ACDFs and 51 PCFs were performed for brachialgia. There was no differences in the pre-operative NDI, VAS neck and arm scores between both groups (p > 0.05). As expected, both ACDF and PCF delivered statistically significant improvement in NDI, VAS-neck and VAS-arm scores. The degree of improvement of NDI, VAS-neck and VAS-arm were the same between both groups of patients (p > 0.05) with a trend favouring the PCF group. In the ACDF group, two (1.3 %) patients needed repeat ACDF due to adjacent segment disease. One patient (0.7 %) needed further decompression via a foraminotomy. In the PCF group one (2.0 %) patient needed ACDF due to persistent brachialgia. CONCLUSIONS We found both interventions delivered similar improvements in the VAS and NDI scores in patients. Both techniques may be appropriately utilised when treating a patient with cervical brachialgia.
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Rastegar S, Mahdavi SB, Mahmoudi F, Basiri K. Herpes zoster segmental paresis in an immunocompromised breast cancer woman. Adv Biomed Res 2015; 4:170. [PMID: 26436084 PMCID: PMC4581133 DOI: 10.4103/2277-9175.162547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/11/2015] [Indexed: 11/04/2022] Open
Abstract
Herpes zoster is an infectious disease with neurological complications caused by reactivation of varicella zoster virus in dorsal root ganglia of spinal cord which is also known as "Shingles." Suppression of immune system is the major predisposing factor for reactivation of latent virus. Disease is mainly characterized by rash, vesicles and pain along one or more dermatomes which are innervated from one or more spinal nerve roots. Complications may be present after a while despite of patient treatment. Motor involvement is included. Some previous studies showed segmental zoster paresis as a rare complication, a few weeks after first presentation, among immunocompetent individuals. We present post herpetic motor involvement of C5 and C6 in a 59-year-old woman who underwent chemotherapy and radiotherapy due to breast cancer, manifesting left upper limb weakness and paresis, 6 months after left partial mastectomy. Segmental paresis of zoster virus should be considered as a cause of motor impairment in an immunocompromised person suffering from shingles.
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Affiliation(s)
- Shirvan Rastegar
- Department of Orthopedics, Alzahra Hospital, Isfahan University of Medical sciences, Isfahan, Iran
| | - Sadegh Baradaran Mahdavi
- Medical Students' Research Center, Isfahan University of Medical sciences, Isfahan, Iran ; Neurosciences Research Center, Isfahan University of Medical sciences, Isfahan, Iran
| | - Farhad Mahmoudi
- Medical Students' Research Center, Isfahan University of Medical sciences, Isfahan, Iran
| | - Keivan Basiri
- Neurosciences Research Center, Isfahan University of Medical sciences, Isfahan, Iran
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Boselie TFM, Willems PC, van Mameren H, de Bie R, Benzel EC, van Santbrink H. WITHDRAWN: Arthroplasty versus fusion in single-level cervical degenerative disc disease. Cochrane Database Syst Rev 2015; 2015:CD009173. [PMID: 25994307 PMCID: PMC6457693 DOI: 10.1002/14651858.cd009173.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background There is ongoing debate about whether fusion or arthroplasty is superior in the treatment of single level cervical degenerative disc disease. Mainly because the intended advantage of arthroplasty over fusion, that is, the prevention of symptoms due to adjacent segment degeneration in the long term, is not confirmed yet. Until sufficient long‐term results become available, it is important to know whether results of one of the two treatments are superior to the other in the first one to two years. Objectives To assess the effects of arthroplasty versus fusion for radiculopathy or myelopathy, or both due to single level cervical degenerative disc disease. Search methods We searched the following databases for randomised controlled trials (RCTs): CENTRAL (The Cochrane Library 2011, Issue 2), MEDLINE, EMBASE, and EBMR. Additionally, we searched the System for Information on Grey Literature (SIGLE), subheading Biological and Medical Sciences, the US Food and Drug Administration (FDA) database on medical devices, and Clinicaltrials.gov to identify trials in progress. We also screened the reference list of all selected papers. Date of search: 25 May 2011. Selection criteria We included RCTs that directly compared any type of cervical fusion with any type of arthroplasty, with at least one year of follow‐up. Primary outcomes were arm pain, neck pain, neck‐related functional status, patient satisfaction, neurological outcome, and global health status. Secondary outcomes were the presence of (radiological) fusion, revision surgery at the treated level, secondary surgery on adjacent levels, segmental mobility of treated and adjacent levels, and work status. Data collection and analysis Study selection was performed independently by three review authors, and 'Risk of bias' assessment and data extraction were performed by two review authors. In case of missing data or insufficient information for a judgement about risk of bias, we tried to contact the study authors or the study sponsor. The data were entered into RevMan by one review author and subsequently checked by a second review author. We assessed the quality of evidence using GRADE. We analysed heterogeneity and performed sensitivity analyses for the pooled analyses. Main results We included nine studies (2400 participants), five of which had a low risk of bias. Eight of these studies were industry sponsored. The most important results showed low‐quality evidence for a small but significant difference in alleviation of arm pain at one to two years in favour of arthroplasty (mean difference (MD) ‐1.54; 95% confidence interval (CI) ‐2.86 to ‐0.22; 100‐point scale). A small study effect could not be ruled out for this outcome in the sensitivity analyses. This means that smaller studies (or small published subsets of larger studies) showed larger differences for this outcome, which may indicate publication bias. Also, moderate‐quality evidence showed a small difference in neck‐related functional status at one to two years in favour of arthroplasty (MD ‐2.79; 95% CI ‐4.73 to ‐0.85; 100‐point scale) and a small difference in neurological outcome in favour of arthroplasty (risk ratio (RR) 1.05; 95% CI 1.01 to 1.09). These two outcomes were robust to sensitivity analyses. For none of the primary outcomes, was a clinically relevant difference shown. Additionally, there was high‐quality evidence for a large, statistically significant difference in segmental mobility at one to two years (measured as degrees segmental range of motion) at the treated level (MD 6.90; 95% CI 5.45 to 8.35). There was low‐quality evidence that there was no statistically significant difference in secondary surgery at the adjacent levels at one to two years (RR 0.60; 95% CI 0.35 to 1.02). The latter was not robust to sensitivity analyses. Authors' conclusions There was a tendency for clinical results to be in favour of arthroplasty; often these were statistically significant. However, differences in effect size were invariably small and not clinically relevant for all primary outcomes. Significance was often gained or lost in the varying sensitivity analyses, probably owing to the relatively small number of studies, in combination with the small differences that were found. Given the fact that all of the included studies were not blinded, this could be due to patient or carer expectations. However, at this time both treatments can be seen as valid options with respect to results at a maximum of one to two years. Given the current absence of truly long‐term results, use of these mobile disc prostheses should still be limited to clinical trials. There was high‐quality evidence that the goal of preservation of segmental mobility in arthroplasty was met. A statistically significant effect on the incidence of secondary symptoms at adjacent levels, the primary goal of arthroplasty over fusion, was not found at one to two years. If there was a protective effect, this should become clearer over time. A future update, when studies with 'truly long‐term' results (five years or more) become available, should focus on this issue. A herniated disc in the neck often causes radiating pain, numbness, and weakness in muscles of the neck, shoulders, arms, and hands. It may also lead to symptoms in the trunk and legs. When there is no or insufficient relief of symptoms with non‐surgical treatment, surgery can be an option. Traditional 'fusion' surgery involves fusion of the two bones of the spine (the vertebrae) that form the disc space. Motion between these two vertebrae is then no longer possible. It has been suggested that this may cause the adjacent parts of the spine to become more mobile, as compensation. This in turn might accelerate normal wear and tear in these parts of the spine, which could lead to new symptoms. At present this is not confirmed. Mobile disc prostheses have been introduced in an effort to reduce the amount of new symptoms at the longer term after surgery by preserving motion between the vertebrae involved. Long‐term results are not available yet. However, it is important to know whether disc arthroplasty is at least as effective as fusion in relieving symptoms, the primary aim of surgery. In this review we have searched for all studies in which the patient receives one of these two possible treatments at random. We identified nine studies (2400 participants), and considered five of these to have high methodological quality. This review shows that patients who were treated with a mobile disc prosthesis had less pain radiating to the arm one to two years after surgery, and less disability owing to these complaints. However, the actual differences were very small, only between 1 and 5 points on a 100‐point scale. The overall quality of the evidence was low to moderate, which means that including new studies in future years could change these conclusions. The conclusion that mobility is in fact preserved after placement of a mobile disc prosthesis, compared to traditional 'fusion' surgery, is unlikely to change. Whether this preserved mobility will lead to fewer new symptoms in the future is uncertain based on results for the first one to two years after surgery. Therefore, a comparison of results in the long term (five years or more) will be made when more studies with long‐term results have become available.
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Affiliation(s)
- Toon FM Boselie
- Maastricht University Medical CentreDepartment of NeurosurgeryP. Debeyelaan 25MaastrichtNetherlands6229 HX
| | - Paul C Willems
- Maastricht University Medical CentreDepartment of OrthopaedicsPO Box 5800MaastrichtNetherlands6202 AZ
| | - Henk van Mameren
- Maastricht UniversityDepartment of EpidemiologyPO Box 616MaastrichtNetherlands200 MD
| | - Rob de Bie
- Maastricht UniversityDepartment of EpidemiologyPO Box 616MaastrichtNetherlands200 MD
| | - Edward C Benzel
- Cleveland Clinic FoundationDepartment of NeurosurgeryS‐80, 9500 Euclid AvenueClevelandUSA44195
| | - Henk van Santbrink
- Maastricht University Medical CentreDepartment of NeurosurgeryP. Debeyelaan 25MaastrichtNetherlands6229 HX
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Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc 2015; 90:284-99. [PMID: 25659245 DOI: 10.1016/j.mayocp.2014.09.008] [Citation(s) in RCA: 342] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/07/2014] [Accepted: 09/10/2014] [Indexed: 01/22/2023]
Abstract
Neck pain is the fourth leading cause of disability, with an annual prevalence rate exceeding 30%. Most episodes of acute neck pain will resolve with or without treatment, but nearly 50% of individuals will continue to experience some degree of pain or frequent occurrences. History and physical examination can provide important clues as to whether the pain is neuropathic or mechanical and can also be used to identify "red flags" that may signify serious pathology, such as myelopathy, atlantoaxial subluxation, and metastases. Magnetic resonance imaging is characterized by a high prevalence of abnormal findings in asymptomatic individuals but should be considered for cases involving focal neurologic symptoms, pain refractory to conventional treatment, and when referring a patient for interventional treatment. Few clinical trials have evaluated treatments for neck pain. Exercise treatment appears to be beneficial in patients with neck pain. There is some evidence to support muscle relaxants in acute neck pain associated with muscle spasm, conflicting evidence for epidural corticosteroid injections for radiculopathy, and weak positive evidence for cervical facet joint radiofrequency denervation. In patients with radiculopathy or myelopathy, surgery appears to be more effective than nonsurgical therapy in the short term but not in the long term for most people.
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD; Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD.
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Gross A, Kay TM, Paquin J, Blanchette S, Lalonde P, Christie T, Dupont G, Graham N, Burnie SJ, Gelley G, Goldsmith CH, Forget M, Hoving JL, Brønfort G, Santaguida PL, Cervical Overview Group, Cochrane Back and Neck Group. Exercises for mechanical neck disorders. Cochrane Database Syst Rev 2015; 1:CD004250. [PMID: 25629215 PMCID: PMC9508492 DOI: 10.1002/14651858.cd004250.pub5] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Neck pain is common, disabling and costly. Exercise is one treatment approach. OBJECTIVES To assess the effectiveness of exercises to improve pain, disability, function, patient satisfaction, quality of life and global perceived effect in adults with neck pain. SEARCH METHODS We searched MEDLINE, MANTIS, ClinicalTrials.gov and three other computerized databases up to between January and May 2014 plus additional sources (reference checking, citation searching, contact with authors). SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing single therapeutic exercise with a control for adults suffering from neck pain with or without cervicogenic headache or radiculopathy. DATA COLLECTION AND ANALYSIS Two review authors independently conducted trial selection, data extraction, 'Risk of bias' assessment and clinical relevance. The quality of the evidence was assessed using GRADE. Meta-analyses were performed for relative risk and standardized mean differences (SMD) with 95% confidence intervals (CIs) after judging clinical and statistical heterogeneity. MAIN RESULTS Twenty-seven trials (2485 analyzed /3005 randomized participants) met our inclusion criteria.For acute neck pain only, no evidence was found.For chronic neck pain, moderate quality evidence supports 1) cervico-scapulothoracic and upper extremity strength training to improve pain of a moderate to large amount immediately post treatment [pooled SMD (SMDp) -0.71 (95% CI: -1.33 to -0.10)] and at short-term follow-up; 2) scapulothoracic and upper extremity endurance training for slight beneficial effect on pain at immediate post treatment and short-term follow-up; 3) combined cervical, shoulder and scapulothoracic strengthening and stretching exercises varied from a small to large magnitude of beneficial effect on pain at immediate post treatment [SMDp -0.33 (95% CI: -0.55 to -0.10)] and up to long-term follow-up and a medium magnitude of effect improving function at both immediate post treatment and at short-term follow-up [SMDp -0.45 (95%CI: -0.72 to -0.18)]; 4) cervico-scapulothoracic strengthening/stabilization exercises to improve pain and function at intermediate term [SMDp -14.90 (95% CI:-22.40 to -7.39)]; 5) Mindfulness exercises (Qigong) minimally improved function but not global perceived effect at short term. Low evidence suggests 1) breathing exercises; 2) general fitness training; 3) stretching alone; and 4) feedback exercises combined with pattern synchronization may not change pain or function at immediate post treatment to short-term follow-up. Very low evidence suggests neuromuscular eye-neck co-ordination/proprioceptive exercises may improve pain and function at short-term follow-up.For chronic cervicogenic headache, moderate quality evidence supports static-dynamic cervico-scapulothoracic strengthening/endurance exercises including pressure biofeedback immediate post treatment and probably improves pain, function and global perceived effect at long-term follow-up. Low grade evidence supports sustained natural apophyseal glides (SNAG) exercises.For acute radiculopathy, low quality evidence suggests a small benefit for pain reduction at immediate post treatment with cervical stretch/strengthening/stabilization exercises. AUTHORS' CONCLUSIONS No high quality evidence was found, indicating that there is still uncertainty about the effectiveness of exercise for neck pain. Using specific strengthening exercises as a part of routine practice for chronic neck pain, cervicogenic headache and radiculopathy may be beneficial. Research showed the use of strengthening and endurance exercises for the cervico-scapulothoracic and shoulder may be beneficial in reducing pain and improving function. However, when only stretching exercises were used no beneficial effects may be expected. Future research should explore optimal dosage.
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Affiliation(s)
- Anita Gross
- McMaster UniversitySchool of Rehabilitation Science & Department of Clinical Epidemiology and Biostatistics1400 Main Street WestHamiltonONCanadaL8S 1C7
| | - Theresa M Kay
- Women's College HospitalTorontoONCanada
- University of TorontoDepartment of Physical TherapyTorontoCanada
| | | | | | | | | | | | - Nadine Graham
- McMaster UniversitySchool of Rehabilitation Science1200 Main Street WestHamiltonONCanada
| | - Stephen J Burnie
- Canadian Memorial Chiropractic CollegeDepartment of Clinical Education6100 Leslie StreetTorontoONCanadaM2H 3J1
| | - Geoff Gelley
- University of ManitobaApplied Health Sciences500 University CentreWinnipegMBCanadaR3T 2N2
| | - Charles H Goldsmith
- Simon Fraser UniversityFaculty of Health SciencesBlossom Hall, Room 95108888 University DriveBurnabyBCCanadaV5A 1S6
| | - Mario Forget
- National Defence | Défense Nationale, Government of Canada | Gouvernement du CanadaCanadian Forces Health Services Group | Groupe de services de santé des Forces Canadiennes33 Canadian Forces Health Services Centre | 33ième Centre de services de santé des Forces CanadiennesKingstonONCanadaK7K 7B4
| | - Jan L Hoving
- Academic Medical Center, University of AmsterdamCoronel Institute of Occupational Health and Research Center for Insurance MedicinePO Box 22700AmsterdamNetherlands1100 DE
| | - Gert Brønfort
- University of MinnesotaIntegrative Health & Wellbeing Research Program, Center for Spirituality & Healing420 Delaware Street SE, MMC505MinneapolisMNUSA55455
| | - Pasqualina L Santaguida
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1280 Main Street WestCourthouse T‐27 Building, Room 309HamiltonONCanadaL8S 4L8
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Li GL, Hu JZ, Lu HB, Qu J, Guo LY, Zai FL. Anterior cervical discectomy with arthroplasty versus anterior cervical discectomy and fusion for cervical spondylosis. J Clin Neurosci 2014; 22:460-7. [PMID: 25533051 DOI: 10.1016/j.jocn.2014.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 08/30/2014] [Accepted: 09/02/2014] [Indexed: 11/29/2022]
Abstract
This meta-analysis aims to estimate the benefits and drawbacks associated with anterior cervical discectomy with arthroplasty (ACDA) versus anterior cervical discectomy and fusion (ACDF) for cervical spondylosis. Of 3651 identified citations, 10 randomised controlled studies involving 2380 participants were included. Moderate quality evidence supports that patients in the ACDA group had: (1) a higher Neck Disability Index (NDI) success rate at 3 month (relative risk [RR]=0.85, 95% confidence interval [CI] 0.78 to 0.93, p=0.0002) and 2 year follow-up (RR=0.95, 95%CI 0.91 to 1.00, p=0.04); (2) greater neurological success at 2 year follow-up (RR=0.95, 95%CI 0.92 to 0.98); and (3) were more likely to be employed within 6 weeks after surgery (RR=0.80 95%CI 0.66 to 0.96). In summary, the current evidence indicates that ACDA is associated with a higher NDI success rate in the short and long-term as well as a higher neurological success rate. Patients who undergo ACDA may also have a greater likelihood of being employed in the short-term. However, all of the evidence reviewed is of moderate or low quality and the clinical significance often marginal or unclear. Additional data are needed to compare the benefits and limitations of ACDA and ACDF.
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Affiliation(s)
- Gao-Ling Li
- Department of Spinal Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jian-Zhong Hu
- Department of Spinal Surgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Hong-Bin Lu
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China.
| | - Jin Qu
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Li-Yun Guo
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Feng-Lei Zai
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
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Zarghooni K, Beyer F, Siewe J, Eysel P. The orthotic treatment of acute and chronic disease of the cervical and lumbar spine. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 110:737-42. [PMID: 24280429 DOI: 10.3238/arztebl.2013.0737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 08/12/2013] [Accepted: 08/12/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Orthoses are external aids that are often used to treat pain and diseases affecting the spine, such as lumbago, whiplash, and disc herniation. In this review, we assess the effectiveness and complications of orthotic treatment for typical spinal conditions and after spinal surgery. The orthotic treatment of fractures and postural abnormalities are beyond the scope of this article. METHOD This review is based on a selective search in the Medline database with consideration of controlled trials, systematic reviews, and the recommendations of the relevant medical societies. RESULTS Three relevant systematic reviews and four controlled trials were found. Very few controlled trials to date have studied the efficacy of orthotic treatment compared to other conservative treatments and surgery. No definitive evidence was found to support the use of orthoses after surgery, in lumbar radiculopathy, or after whiplash injuries of the cervical spine. In a single trial, short-term immobilization was an effective treatment of cervical radiculopathy. Orthoses are not recommended for nonspecific low back pain. The potential complications of cervical orthoses include pressure-related skin injuries and dysphagia. CONCLUSION No definitive evidence as yet supports the use of orthoses after spinal interventions or in painful conditions of the cervical or lumbar spine. They should, therefore, be used only after individual consideration of the indications in each case.
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Affiliation(s)
- Kourosh Zarghooni
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Centre for Clinical Trials, University of Cologne
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Iwata T, Mitoro M, Kuzumoto N. Feasibility of Early and Repeated Low-dose Interscalene Brachial Plexus Block for Residual Pain in Acute Cervical Radiculopathy Treated with NSAIDS. Korean J Pain 2014; 27:125-32. [PMID: 24748940 PMCID: PMC3990820 DOI: 10.3344/kjp.2014.27.2.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 03/03/2014] [Accepted: 03/06/2014] [Indexed: 11/16/2022] Open
Abstract
Background To improve residual pain management in acute cervical radiculopathy treated with NSAIDs, the feasibility of early and repeated low-dose interscalene brachial plexus block (IS-BPB) needs to be assessed. Methods This was a prospective study on patients receiving NSAIDs (loxoprofen) for cervical radiculopathy of ≤ 2-week onset. Pain was assessed using the visual analogue scale (VAS). A low-dose ultrasonography (USG)-guided IS-BPB (dexamethasone [1.65 mg; 0.5 ml] and mepivacaine [1%; 3.0 ml]) was performed at baseline and weekly thereafter for 4 weeks in an outpatient setting for the intervention group. All patients were evaluated using a visual satisfaction score (VSS) at week 4. Patients with baseline VAS scores < 70 (mild to moderate pain; MM group) and ≥ 70 (severe pain; SE group) were compared to the controls receiving NSAIDs. Results A total of 316 IS-BPBs were performed in the intervention group. There was a significant difference in the decline in the VAS from week 0 to week 3 in the MM and SE groups (P < 0.05); however, from week 3 to week 4, the therapeutic effect exhibited no significant difference. Thirteen patients at week 2 (15.5%; MM: 27.7%; SE: 0%), 43 at week 3 (51.2%; MM: 83.0%; SE: 10.8%), and 47 at week 4 (56.0%; MM: 85.1%; SE: 18.9%) achieved a VAS score of ≤ 20. Patient satisfaction was high, and the decrease in VAS scores in both groups was significant (P < 0.05) compared to the controls. Conclusions Weekly, low-dose, USG-guided IS-BPB can be implemented for early pain relief in acute cervical radiculopathy, with high patient satisfaction.
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Affiliation(s)
- Toshio Iwata
- Department of Anesthesiology, Nara Prefectural Mimuro Hospital, Nara, Japan
| | - Mari Mitoro
- Department of Anesthesiology, Nara Prefectural Mimuro Hospital, Nara, Japan. ; Department of Anesthesiology, Heisei Memorial Hospital, Nara, Japan
| | - Naoya Kuzumoto
- Department of Anesthesiology, Nara Prefectural Mimuro Hospital, Nara, Japan. ; Department of Anesthesiology, Nara Prefectural Nara Hospital, Nara, Japan
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Savva C, Giakas G, Efstathiou M, Karagiannis C. Test-retest reliability of handgrip strength measurement using a hydraulic hand dynamometer in patients with cervical radiculopathy. J Manipulative Physiol Ther 2014; 37:206-10. [PMID: 24630769 DOI: 10.1016/j.jmpt.2014.02.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/30/2013] [Accepted: 01/09/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the test-retest reliability of handgrip strength measurement using a hydraulic hand dynamometer in patients with cervical radiculopathy (CR). METHODS A convenience sample of 19 participants (14 men and 5 women; mean ± SD age, 50.5 ± 12 years) with CR was measured using a Jamar hydraulic hand dynamometer by the same rater on 2 different testing sessions with an interval of 7 days between sessions. Data collection procedures followed standardized grip strength testing guidelines established by the American Society of Hand Therapists. During the repeated measures, patients were advised to rest their upper limb in the standardized arm position and encouraged to exert 3 maximum gripping efforts. The mean value of the 3 efforts (measured in kilogram force [Kgf]) was used for data analysis. The intraclass correlation coefficient, SEM, and the Bland-Altman plot were used to estimate test-retest reliability and measurement precision. RESULTS Grip strength measurement in CR demonstrated an intraclass correlation coefficient of 0.976, suggesting excellent test-retest reliability. The small SEM in both testing sessions (SEM1, 2.41 Kgf; SEM2, 2.51 Kgf) as well as the narrow width of the 95% limits of agreements (95% limits of agreement, -4.9 to 4.4 Kgf) in the Bland-Altman plot reflected precise measurements of grip strength in both occasions. CONCLUSIONS Excellent test-retest reliability for grip strength measurement was measured in patients with CR, demonstrating that a hydraulic hand dynamometer could be used as an outcome measure for these patients.
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Affiliation(s)
- Christos Savva
- Clinical Trainer, Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus.
| | - Giannis Giakas
- Senior Lecturer in Biomechanics, Department of Physical Education and Sport Science, University of Thessaly, Volos, Greece
| | - Michalis Efstathiou
- Clinical Trainer, Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
| | - Christos Karagiannis
- Clinical Trainer, Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
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Abstract
Study Design Retrospective review. Objective The objective of this study is to describe the natural history of neurologic recovery after anterior cervical discectomy and fusion (ACDF). Methods Patients between 18 and 80 years of age, diagnosed with cervical radiculopathy, who underwent single-level ACDF and were followed for a minimum of 2 years were identified from a single-center database. Sensory and motor deficits were documented and graded based on physical examination findings at preoperative and postoperative visits, and used to calculate deficit rates. Results One hundred eighteen patients were included in the study. Mean age was 46 ± 9.2 years and mean follow-up time was 3.8 ± 2.1 years. At the time of surgery, 66% had a sensory deficit. Recovery of sensory function was seen in 85% of patients within 1 year. At final follow-up, new sensory deficits had developed in 30% of patients, 60% of whom had adjacent-level sensory deficits. Patients with preoperative sensory deficits tended to be more likely to develop a new deficit postoperatively (p = 0.05). At the time of surgery, 55% had a motor deficit. Recovery of motor function was seen in 95% of patients within 1 year, and 14% developed new postoperative motor deficits by final follow-up. Of those patients who developed a new motor deficit postoperatively, 76% did so at an adjacent level. Conclusions In our series, a high percentage of patients recovered neurologic function during the first year after ACDF. Adjacent-level and remote-level degeneration were large contributors to neurologic deficits that occurred in subsequent years.
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Warren D, Andres T, Hoelscher C, Ricart-Hoffiz P, Bendo J, Goldstein J. Cost-utility analysis modeling at 2-year follow-up for cervical disc arthroplasty versus anterior cervical discectomy and fusion: A single-center contribution to the randomized controlled trial. Int J Spine Surg 2013; 7:e58-66. [PMID: 25694905 PMCID: PMC4300975 DOI: 10.1016/j.ijsp.2013.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients with cervical disc herniations resulting in radiculopathy or myelopathy from single level disease have traditionally been treated with Anterior Cervical Discectomy and Fusion (ACDF), yet Cervical Disc Arthroplasty (CDA) is a new alternative. Expert suggestion of reduced adjacent segment degeneration is a promising future result of CDA. A cost-utility analysis of these procedures with long-term follow-up has not been previously reported. METHODS We reviewed single institution prospective data from a randomized trial comparing single-level ACDF and CDA in cervical disc disease. Both Medicare reimbursement schedules and actual hospital cost data for peri-operative care were separately reviewed and analyzed to estimate the cost of treatment of each patient. QALYs were calculated at 1 and 2 years based on NDI and SF-36 outcome scores, and incremental cost effectiveness ratio (ICER) analysis was performed to determine relative cost-effectiveness. RESULTS Patients of both groups showed improvement in NDI and SF-36 outcome scores. Medicare reimbursement rates to the hospital were $11,747 and $10,015 for ACDF and CDA, respectively; these figures rose to $16,162 and $13,171 when including physician and anesthesiologist reimbursement. The estimated actual cost to the hospital of ACDF averaged $16,108, while CDA averaged $16,004 (p = 0.97); when including estimated physicians fees, total hospital costs came to $19,811 and $18,440, respectively. The cost/QALY analyses therefore varied widely with these discrepancies in cost values. The ICERs of ACDF vs CDA with Medicare reimbursements were $18,593 (NDI) and $19,940 (SF-36), while ICERs based on actual total hospital cost were $13,710 (NDI) and $9,140 (SF-36). CONCLUSIONS We confirm the efficacy of ACDF and CDA in the treatment of cervical disc disease, as our results suggest similar clinical outcomes at one and two year follow-up. The ICER suggests that the non-significant added benefit via ACDF comes at a reasonable cost, whether we use actual hospital costs or Medicare reimbursement values, though the actual ICER values vary widely depending upon the CUA modality used. Long term follow-up may illustrate a different profile for CDA due to reduced cost and greater long-term utility scores. It is crucial to note that financial modeling plays an important role in how economic treatment dominance is portrayed.
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Affiliation(s)
| | - Tate Andres
- NYU Hospital for Joint Diseases, New York, NY
| | | | | | - John Bendo
- NYU Hospital for Joint Diseases, New York, NY
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Kroeling P, Gross A, Graham N, Burnie SJ, Szeto G, Goldsmith CH, Haines T, Forget M, Cochrane Back and Neck Group. Electrotherapy for neck pain. Cochrane Database Syst Rev 2013; 2013:CD004251. [PMID: 23979926 PMCID: PMC10696490 DOI: 10.1002/14651858.cd004251.pub5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neck pain is common, disabling and costly. The effectiveness of electrotherapy as a physiotherapeutic option remains unclear. This is an update of a Cochrane review first published in 2005 and previously updated in 2009. OBJECTIVES This systematic review assessed the short, intermediate and long-term effects of electrotherapy on pain, function, disability, patient satisfaction, global perceived effect, and quality of life in adults with neck pain with and without radiculopathy or cervicogenic headache. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL, without language restrictions, from their beginning to August 2012; handsearched relevant conference proceedings; and consulted content experts. SELECTION CRITERIA Randomized controlled trials (RCTs), in any language, investigating the effects of electrotherapy used primarily as unimodal treatment for neck pain. Quasi-RCTs and controlled clinical trials were excluded. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. We were unable to statistically pool any of the results, but we assessed the quality of the evidence using an adapted GRADE approach. MAIN RESULTS Twenty small trials (1239 people with neck pain) containing 38 comparisons were included. Analysis was limited by trials of varied quality, heterogeneous treatment subtypes and conflicting results. The main findings for reduction of neck pain by treatment with electrotherapeutic modalities were as follows.Very low quality evidence determined that pulsed electromagnetic field therapy (PEMF) and repetitive magnetic stimulation (rMS) were more effective than placebo, while transcutaneous electrical nerve stimulation (TENS) showed inconsistent results.Very low quality evidence determined that PEMF, rMS and TENS were more effective than placebo.Low quality evidence (1 trial, 52 participants) determined that permanent magnets (necklace) were no more effective than placebo (standardized mean difference (SMD) 0.27, 95% CI -0.27 to 0.82, random-effects model).Very low quality evidence showed that modulated galvanic current, iontophoresis and electric muscle stimulation (EMS) were not more effective than placebo.There were four trials that reported on other outcomes such as function and global perceived effects, but none of the effects were of clinical importance. When TENS, iontophoresis and PEMF were compared to another treatment, very low quality evidence prevented us from suggesting any recommendations. No adverse side effects were reported in any of the included studies. AUTHORS' CONCLUSIONS We cannot make any definite statements on the efficacy and clinical usefulness of electrotherapy modalities for neck pain. Since the evidence is of low or very low quality, we are uncertain about the estimate of the effect. Further research is very likely to change both the estimate of effect and our confidence in the results. Current evidence for PEMF, rMS, and TENS shows that these modalities might be more effective than placebo. When compared to other interventions the quality of evidence was very low thus preventing further recommendations.Funding bias should be considered, especially in PEMF studies. Galvanic current, iontophoresis, EMS, and a static magnetic field did not reduce pain or disability. Future trials on these interventions should have larger patient samples, include more precise standardization, and detail treatment characteristics.
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Affiliation(s)
- Peter Kroeling
- Ludwig‐Maximilians‐University of MunichDept. of Physical Medicine and RehabilitationMarchionini‐Str. 17D‐81377 MünchenGermanyD‐80801
| | - Anita Gross
- McMaster UniversitySchool of Rehabilitation Science & Department of Clinical Epidemiology and Biostatistics1400 Main Street WestHamiltonOntarioCanadaL8S 1C7
| | - Nadine Graham
- McMaster UniversitySchool of Rehabilitation Science1200 Main Street WestHamiltonOntarioCanada
| | - Stephen J Burnie
- Canadian Memorial Chiropractic CollegeDepartment of Clinical Education6100 Leslie StreetTorontoONCanadaM2H 3J1
| | - Grace Szeto
- The Hong Kong Polytechnic UniversityDepartment of Rehabilitation SciencesHung HomKowloonHong Kong
| | - Charles H Goldsmith
- Simon Fraser UniversityFaculty of Health SciencesBlossom Hall, Room 95108888 University DriveBurnabyBCCanadaV5A 1S6
| | - Ted Haines
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHSC 3H54HamiltonOntarioCanadaL8N 3Z5
| | - Mario Forget
- Department of National Defense (DND)Department of PhysiotherapyPO Box 17000, Stn. ForcesKingstonONCanadaK7K 7B4
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Arthroplasty versus fusion in single-level cervical degenerative disc disease: a Cochrane review. Spine (Phila Pa 1976) 2013; 38:E1096-107. [PMID: 23656959 DOI: 10.1097/brs.0b013e3182994a32] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review of randomized controlled trials (RCTs). OBJECTIVE To assess the effects of arthroplasty versus fusion in the treatment of radiculopathy or myelopathy, or both, due to single-level cervical degenerative disc disease. SUMMARY OF BACKGROUND DATA There is ongoing debate about whether fusion or arthroplasty is superior in the treatment of single-level cervical degenerative disc disease. Mainly because the intended advantage of arthroplasty compared with fusion, prevention of symptoms due to adjacent segment degeneration in the long term, is not confirmed yet. Until sufficient long-term results become available, it is important to know whether results of 1 of the 2 treatments are superior to the other in the first 1 to 2 years. METHODS We searched electronic databases for randomized controlled trials. We included randomized controlled trials that directly compared any type of cervical fusion with any type of cervical arthroplasty, with at least 1 year of follow-up. Study selection was performed independently by 3 review authors, and "risk of bias" assessment and data extraction were independently performed by 2 review authors. In case of missing data, we contacted the study authors or the study sponsor. We assessed the quality of evidence. RESULTS Nine studies (2400 participants) were included in this review; 5 of these studies had a low risk of bias. Results for the arthroplasty group were better than the fusion group for all primary comparisons, often statistically significant. For none of the primary outcomes was a clinically relevant difference in effect size shown. Quality of the evidence was low to moderate. CONCLUSION There is low to moderate quality evidence that results are consistently in favor of arthroplasty, often statistically significant. However, differences in effect size were invariably small and not clinically relevant for all primary outcomes. LEVEL OF EVIDENCE 1.
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Sato T, Masui K. Morphologic Differences in Intervertebral Foramina: A Radiographic Study of Cervical Spine Positions in Asymptomatic Men. J Manipulative Physiol Ther 2013; 36:327-32. [DOI: 10.1016/j.jmpt.2013.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 09/23/2012] [Accepted: 10/07/2012] [Indexed: 01/12/2023]
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Variation in the hypothenar muscles and its impact on ulnar tunnel syndrome. Surg Radiol Anat 2013; 35:893-9. [DOI: 10.1007/s00276-013-1113-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/21/2013] [Indexed: 10/27/2022]
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Cervical Foraminal Versus Interlaminar Epidurals: Risks, Benefits, and Alternatives. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0013-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Park EJ, Park SY, Lee SJ, Kim NS, Koh DY. Clinical outcomes of epidural neuroplasty for cervical disc herniation. J Korean Med Sci 2013; 28:461-5. [PMID: 23487574 PMCID: PMC3594612 DOI: 10.3346/jkms.2013.28.3.461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/11/2013] [Indexed: 11/20/2022] Open
Abstract
Cervical disc herniation is a common disorder characterized by neck pain radiating to the arm and fingers as determined by the affected dermatome. This condition has a favorable prognosis, but pain can have a serious detrimental impact on daily activities. Epidural neuroplasty has been applied as a treatment option for cervical disc herniation; however, no study has addressed the clinical outcomes. This retrospective study evaluated the clinical outcomes of epidural neuroplasty on 128 patients for the treatment of cervical disc herniation. To measure pain-related disabilities over time, the changes of pain scores in neck and arm were evaluated using a numerical rating scale (NRS) and the neck disability index (NDI). Compared with preprocedural values, the pain NRS of neck and arm demonstrated significant improvement at day 1, and 1, 3, 6, and 12 months after the procedure (P < 0.001). Likewise, the NDI was significantly reduced at 3, 6, and 12 months after the procedure (P < 0.001). There were no serious complications. Cervical epidural neuroplasty shows good clinical outcomes in the treatment of cervical disc herniation and can be considered a treatment modality for cervical disc herniation refractory to conservative treatment.
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Affiliation(s)
| | - Sun Young Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Se Jin Lee
- Department of Anesthesiology and Pain Medicine, Soonchunhyang Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Nan Seol Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Do Yle Koh
- Godoil Spine and Pain Hospital, Seoul, Korea
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