Association between excessive smartphone use and cervical disc degeneration in young patients suffering from chronic neck pain

Correlation analysis between neck muscles and lifestyle habits in patients with cervical instability

BACKGROUND

The neck muscles play a crucial role in maintaining cervical spine stability. A thorough understanding of the changes in neck muscles during cervical instability (CI), along with an analysis of their correlation with lifestyle habits, can provide valuable data for the prevention and treatment of CI.

METHODS

A total of 98 patients with CI and 88 healthy subjects were included in the study. Their cervical MRI images and lifestyle habits information were collected. The relative cross-sectional area (RCSA) and fat signal fraction (FSF) of the neck muscles were obtained from the MRI images. Correlation analysis was conducted between the muscle parameters, CI, and lifestyle habits information.

RESULTS

CI subjects spent more time working (P =.026) and using computers daily than the healthy subjects (P =.023). The cervical curvature of the CI subjects was significantly smaller compared to healthy subjects (P =.004). CI subjects had significantly smaller RCSA (P =.003) and greater FSF (P =.011) in the deep muscles at the back of the neck compared to healthy subjects. FSF in the deep muscles at the back of the neck (OR = 2.343, 95%CI = 1.261-4.352) and cervical curvature (OR = 0.904, 95%CI = 0.848-0.965) were risk factors for CI. Keeping head down time per day (r = - 0.286) and using the computer time per day (r = - 0.230) were negatively correlated with the RCSA in the deep muscles at the back of the neck.

CONCLUSIONS

Changes in the deep muscles at the back of the neck are key factors in the development of CI. Prolonged maintenance of a single downward head posture is closely related to changes in the deep muscles at the back of the neck.

TRIAL REGISTRATION

The study protocol is registered with Chinese Clinical Trial Registry (registration number: ChiCTR2100053525, registration date: November 24, 2021).

Daily physical activity, coffee and energy drink consumption, and sleep patterns among Chinese elite professional esports athletes: a case study of Zhejiang Regans Gaming

Purpose

Esports is increasingly recognized as both a legitimate sport and profession. However, evidence on the health behaviors of esports athletes remains limited. Due to the nature of their activity, these athletes face occupational health risks associated with prolonged sedentary behavior, sleep deprivation, and excessive energy drink consumption. This study aimed to document the health behaviors of professional esports athletes.

Methods

This case study sampled athletes from Zhejiang Regans Gaming, who are full-time professionals competing at the elite level. Data were collected over three training days, with moderate-to-vigorous physical activity and sleep patterns monitored using the Apple Watch Series 9.

Results

Athletes trained for an average of 13 h daily in a seated position, engaging in only 35.6 ± 0.9 min of moderate-to-vigorous physical activity. The extended training hours led to delayed sleep schedules, with a typical bedtime of 3:05 a.m. Sleep quality was poor, with athletes averaging 45.2 ± 13.0 min awake in bed, 392.8 ± 13.9 min of total sleep, and a sleep efficiency of 89.7 ± 3.0%. Likely due to sleep deprivation, athletes consumed an average of 2 cups of coffee and 2.5 ± 0.4 bottles of energy drinks daily.

Conclusion

This study offers firsthand evidence of the concerning health behaviors among Chinese elite professional esports athletes. Physical activity levels and sleep quality are notably poor, while energy drink consumption is prevalent. Team managers should monitor sleep quality and energy drink consumption, while governing bodies must recognize the long-term risks of excessive sedentary behavior in esports.

Comparison of Cervical Spine Kinematics and Clinical Neck Symptoms Between Mobile Device and Desktop Computer Use

The widespread use of mobile devices and desktop computers has been associated with mechanical neck symptoms, yet few studies have compared cervical kinematics and clinical symptoms between them. In this study, 15 participants (27.7 ± 4.4 years, 12 male) performed four randomly ordered 20 min tasks: two mobile (smartphone and tablet) and two desktop computer (keyboard and mouse) tasks. Kinematic variables, including neck flexion, lateral bending, axial rotation, anterior translation, and total distance moved, were measured using an optical motion capture system, while clinical symptoms, including discomfort, pain, tension, and fatigue, were assessed using a visual analog scale. Paired t-tests and linear mixed models were used for analysis. Results showed that mobile device users exhibited greater neck flexion (38.9° [32.1-45.6°] vs. -0.2° [-4.3-3.9°], p < 0.001) and anterior translation (21.0 cm [12.0-30.1] vs. 1.6 cm [-4.4-7.7], p < 0.001) compared to desktop users. All clinical symptoms were significantly higher during mobile device use (p < 0.05), with neck flexion and anterior translation strongly correlating with symptom severity. In conclusion, mobile device use leads to more severe neck symptoms compared to desktop computer use, which is associated with increased flexion and forward head posture. To reduce neck symptoms, avoiding sustained flexion and forward head positions during mobile device use is recommended.

Unveiling the grip of mobile phone addiction: an in-depth review

Mobile Phone Addiction represents an emergent addictive disorder that gravely jeopardizes the physical and mental health of adolescents worldwide, necessitating exhaustive research. Current reviews of MPA are in dire need of updates and enhancements. Therefore, this review aggregates the extant research spanning the past two decades on the prevalence, pathogenesis, comorbidities, assessment, and treatment of MPA, aiming to furnish a reference for future investigations into this condition.

Evaluation of Subjective Visual Vertical and Cervical Neuromotor Control in Young Nomophobians: A Cross Sectional Study

Misperceptions of subjective visual vertical are associated with poor balance, increasing the risk of falls and accidents. The aim of the present study was to evaluate the effect of nomophobia on verticality perception using subjective visual vertical (S.V.V.) test and cervical neuromotor control of the deep neck flexors (DNF) in adults aged 18-29 years old. This cross-sectional study employed convenience sampling and was conducted at a tertiary health institute over an eight-month period.After obtaining the written informed consent, 102 participants were asked to fill the Nomophobia Questionnaire (NMP-Q) and based on the responses participants were stratified into mild (n1 = 34), moderate(n2 = 34), and severe(n3 = 34) nomophobian group. Each nomophobian group underwent testing for verticality perception by using the SVV test and cervical neuromotor control. 102 healthy age and gender matched controls were recruited and underwent testing for verticality perception by using the SVV test and cervical neuromotor control. The mean age of the study participants was 22 ± 3.15 years with 35(33.98%) males and 67(65.04%) females. There was a statistically significant difference between the median scores across the three nomophobian groups with S.V.V. (p = 0.005), activation score (p = 0.012), and endurance score (p = 0.000) of the deep neck flexors in the severe nomophobia group. This study demonstrated that SVV and cervical neuromotor control was predominantly affected in the severe nomophobian group.

Zero-profile implant system versus novel plate systems after ACDF for comparison of sagittal balance parameters and clinical efficacy analysis

BACKGROUND

The zero-profile implant system (Zero-P) and conventional plates have been widely used in anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis. The purpose of this study was to compare the effects of the application of Zero-P and new conventional plates (ZEVO, Skyline) in ACDF on the sagittal imaging parameters of cervical spondylosis patients and to analyze their clinical efficacy.

METHODS

We conducted a retrospective study on 119 cervical spondylosis patients from January 2018 to December 2021, comparing outcomes between those receiving the Zero-P device (n = 63) and those receiving a novel conventional plate (n = 56, including 46 ZEVO and 10 Skyline plates) through ACDF. Cervical sagittal alignment was assessed pre- and postoperatively via lateral radiographs. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were recorded at baseline, after surgery, and at the 2-year follow-up to evaluate patient recovery and intervention success.

RESULTS

There were significant differences in the postoperative C0-C2 Cobb angle and postoperative sagittal segmental angle (SSA) between patients in the novel conventional plate group and those in the Zero-P group (P < 0.05). Postoperatively, there were significant changes in the C2‒C7 Cobb angle, C0‒C2 Cobb angle, SSA, and average surgical disc height (ASDH) compared to the preoperative values in both patient groups (P < 0.05). Dysphagia in the immediate postoperative period was lower in the Zero-P group than in the new conventional plate group (0% in the Zero-P group, 7.14% in the novel conventional plate group, P = 0.046), and the symptoms disappeared within 2 years in both groups. There was no statistically significant difference between the two groups in terms of complications of adjacent spondylolisthesis (ASD) at 2 years postoperatively (3.17% in the Zero-P group, 8.93% in the novel conventional plate group; P = 0.252). According to the subgroup analysis, there were significant differences in the postoperative C2‒C7 Cobb angle, C0‒C2 Cobb angle, T1 slope, and ASDH between the ZEVO group and the Skyline group (P < 0.05). Compared with the preoperative scores, the JOA, NDI, and VAS scores of all groups significantly improved at the 2-year follow-up (P < 0.01). According to the subgroup analysis, the immediate postoperative NDI and VAS scores of the ZEVO group were significantly better than those of the Skyline group (P < 0.05).

CONCLUSION

In ACDF, both novel conventional plates and Zero-P can improve sagittal parameters and related scale scores. Compared to the Zero-P plate, the novel conventional plate has a greater advantage in correcting the curvature of the surgical segment, but the Zero-P plate is less likely to produce postoperative dysphagia.

Validation of the Chinese version of the Smartphone Distraction Scale

The Smartphone Distraction Scale (SDS) is a novel assessment scale for smartphone distraction; it comprises 16 items that cover attention impulsiveness, online vigilance, multitasking, and emotion regulation. This study aimed to investigate the validity and reliability of the SDS in college students in China. After translating and culturally adapting the original version of the SDS into Chinese, the scale was tested on a sample of 1302 college students.The validity and reliability were assessed utilizing SPSS 25.0, AMOS 25.0 and Mplus 8.3. Parallel analysis, Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed for the validity analysis. Criterion-related validity for the SDS was tested by correlation analysis with the mobile phone addiction scale (MPAI). The reliability analysis was tested by Cronbach's alpha coefficients and intraclass correlation coefficients (ICC). EFA and parallel analysis revealed a three-factor structure. The EFA identified factor loadings on three factors (14 items), explaining a total variance of 60.73 %. The CFA model fit was good (χ2/df = 4.644, RMSEA = 0.047, GFI = 0.930, CFI = 0.955, SRMR = 0.047), and the multigroup confirmatory factor analysis indicated measurement invariance for gender. Both convergent and discriminant validity were established. The criterion-related validity was established based on a significant correlation (r = 0.758) with the MPAI. The Cronbach's alpha coefficient was 0.916, and the split-half reliability was 0.769, demonstrating a satisfactory internal consistency. The score of ICC was 0.907, demonstrating the stability of the SDS. Based on these data, the Chinese version of the SDS demonstrated satisfactory validity and reliability in a sample of college students.

Tracked and self-reported nighttime smartphone use, general health, and healthcare utilization: results from the SmartSleep Study

STUDY OBJECTIVES

Nighttime smartphone use is an increasing public health concern. We investigated whether nighttime smartphone use is associated with general health and primary healthcare utilization.

METHODS

Four thousand five hundred and twenty individuals (age 35.6 ± 9.7 years, 35% male) provided self-reported information on smartphone use frequency, symptoms of depression, and general health (one-item perceived health and cross-symptom composite score). A subset of the study sample (n = 3221) tracked their nighttime smartphone use. Primary healthcare utilization, i.e. the number of weeks in which at least one service from the patient's general practitioner (GP) was billed in 2020, was extracted from Danish population registries. Statistical analysis comprised logistic and multiple linear regression, controlling for sociodemographics.

RESULTS

Three hundred and nineteen individuals (7%) reported using their smartphone almost every night or more. More frequent self-reported nighttime smartphone use was associated with poor general health across all measures. Using the smartphone almost every night or more was associated with 2.8 [95% CI: 1.9, 4.1] fold higher odds of reporting poor health and with an average of 1.4 [95% CI: 0.7, 2.1] additional GP utilizations per year compared to no use. Associations were also found for the cross-symptom composite score across all symptoms. Further adjustment for symptoms of depression attenuated some associations. Smartphone use towards the end of the sleep period (sleep-offset use) was associated with poorer self-reported general health, but not with healthcare utilization.

CONCLUSIONS

Nighttime smartphone use frequency is associated with poor general health and healthcare utilization. Further studies should investigate the underlying causal structure and nighttime smartphone use as a transdiagnostic intervention target.

Clinical Manifestations' Spectrum of Smartphone Addiction: Moving from an Addiction toward a Clinical Syndrome

Background

Smartphone addiction is an emerging type of addiction in the digital era, characterized by smartphone dependence that negatively affects human health with a wide range of psychological and physical manifestations.

Objective

This study aimed to evaluate the detailed clinical manifestations of smartphone addiction as a delineated clinical syndrome.

Methods

A cross-sectional study design was employed to assess smartphone addiction prevalence and its health impacts among Syrian undergraduates using the Smartphone Addiction Scale-Short Version (SAS-SV 2013), the Kessler psychological distress scale (K-6), and a comprehensive assessment of the clinical manifestations frequently linked to smartphone addiction in the literature. Different statistical modeling techniques were applied; a P value of < .05 was considered statistically significant.

Results

Of 1532 invited undergraduates, 1401 (91.45%) completed the assessment adequately. Most participants were females (59.7%) and below 23 years of age (73.2%). The prevalence of smartphone addiction was 67.80%; statistically significant smartphone addiction associations were revealed with psychological distress (P < .0001) with odds ratios of 3.308. Most screened physical manifestations also showed a significant association with smartphone addiction.

Conclusion

A high prevalence of smartphone addiction was observed with a broad spectrum of associated mental and physical manifestations. As smart device addiction becomes a global health concern, combining the clinical findings reported in the related literature into one clinical identity is necessary to develop a holistic management approach for the delineated clinical syndrome.

Automated, IMU-based spine angle estimation and IMU location identification for telerehabilitation

BACKGROUND

Telerehabilitation is a promising avenue for improving patient outcomes and expanding accessibility. However, there is currently no spine-related assessment for telerehabilitation that covers multiple exercises.

METHODS

We propose a wearable system with two inertial measurement units (IMUs) to identify IMU locations and estimate spine angles for ten commonly prescribed spinal degeneration rehabilitation exercises (supine chin tuck head lift rotation, dead bug unilateral isometric hold, pilates saw, catcow full spine, wall angel, quadruped neck flexion/extension, adductor open book, side plank hip dip, bird dog hip spinal flexion, and windmill single leg). Twelve healthy subjects performed these spine-related exercises, and wearable IMU data were collected for spine angle estimation and IMU location identification.

RESULTS

Results demonstrated average mean absolute spinal angle estimation errors of 2.59∘ and average classification accuracy of 92.97%. The proposed system effectively identified IMU locations and assessed spine-related rehabilitation exercises while demonstrating robustness to individual differences and exercise variations.

CONCLUSION

This inexpensive, convenient, and user-friendly approach to spine degeneration rehabilitation could potentially be implemented at home or provide remote assessment, offering a promising avenue to enhance patient outcomes and improve accessibility for spine-related rehabilitation.

TRIAL REGISTRATION

No. E2021013P in Shanghai Jiao Tong University.

A tree-based corpus annotated with Cyber-Syndrome, symptoms, and acupoints

Prolonged and over-excessive interaction with cyberspace poses a threat to people's health and leads to the occurrence of Cyber-Syndrome, which covers not only physiological but also psychological disorders. This paper aims to create a tree-shaped gold-standard corpus that annotates the Cyber-Syndrome, clinical manifestations, and acupoints that can alleviate their symptoms or signs, designating this corpus as CS-A. In the CS-A corpus, this paper defines six entities and relations subject to annotation. There are 448 texts to annotate in total manually. After three rounds of updating the annotation guidelines, the inter-annotator agreement (IAA) improved significantly, resulting in a higher IAA score of 86.05%. The purpose of constructing CS-A corpus is to increase the popularity of Cyber-Syndrome and draw attention to its subtle impact on people's health. Meanwhile, annotated corpus promotes the development of natural language processing technology. Some model experiments can be implemented based on this corpus, such as optimizing and improving models for discontinuous entity recognition, nested entity recognition, etc. The CS-A corpus has been uploaded to figshare.

The efficacy of virtual reality technology for the postoperative rehabilitation of patients with cervical spondylotic myelopathy (CSM): a study protocol for a randomized controlled trial

BACKGROUND

Patients with cervical spondylosis myelopathy (CSM) may experience severe neurological dysfunction due to untimely spinal cord compression after surgery. These disorders may lead to sensory and motion disorders, causing considerable psychological distress. Recent studies found that virtual reality (VR) technology can be an effective tool for treating spinal cord injuries. Owing to this discovery, we developed an exploratory research project to investigate the impact of this intervention on the postoperative recovery of patients with CSM.

METHODS

The purpose of this randomized controlled trial was to evaluate the efficacy of combining VR technology with conventional rehabilitation strategies for the postoperative rehabilitation of patients with CSM. A total of 78 patients will be recruited and randomized to either the conventional rehabilitation group or the group subjected to VR technology combined with conventional rehabilitation strategies. The Japanese Orthopaedic Association (JOA) scale will be the main tool used, and secondary outcomes will be measured via the visual analogue scale (VAS), neck disability index (NDI), and functional MRI (fMRI). The data analysis will identify differences between the intervention and control groups as well as any relationship between the intragroup changes in the functional area of the brain and the subjective scale scores after the intervention.

DISCUSSION

The aim of this trial is to investigate the effect of VR training on the postoperative rehabilitation of patients with CSM after 12 intervention treatments. Positive and negative outcomes will help us better understand the effectiveness of the intervention and its neural impact. If effective, this study could provide new options for the postoperative rehabilitation of patients with CSM.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2300071544). Registered 17 May 2023, https://www.chictr.org.cn/ .

A skin-integrated device for neck posture monitoring and correction

Cervical spondylosis is a common disease that is often caused by long-term abnormal cervical curvature due to activities such as reading books and using computers or smartphones. This paper explores building an untethered and skin-integrated device in an e-skin form factor to monitor and haptically correct neck posture. The proposed design features a multilayered structure that integrates all flexible electronic circuits and components into a compact skin space while being untethered and skin conformal. An accelerometer in the e-skin attaches to the neck for posture sensing, while four vibration actuators closely touch the neck skin to provide localized vibrotactile stimuli that encode four-direction correction cues of neck flexion ± α and lateral bending ± β . To ensure the reliability of posture sensing and vibrotactile rendering during neck movement, it is necessary to prevent the e-skin device from shifting position. Thus, a hollow structure-based method is implemented for stably attaching the e-skin to the neck skin. Experiments validated the e-skin device's sensing precision, skin-conformal compliance, stickiness, stability and effectiveness during the motion of neck postures, including its discrimination of localized four-direction vibrotactile cues. A user study verified the device's performance for sensing and correcting different abnormal neck postures during activities such as using smartphones, reading books, and processing computer files. The proposed e-skin device may create opportunities for more convenient cervical spondylosis prevention and rehabilitation.

Neck and Upper Extremity Musculoskeletal Symptoms Secondary to Maladaptive Postures Caused by Cell Phones and Backpacks in School-Aged Children and Adolescents

Technology is an essential part of our lives. Nowadays, it is almost impossible to leave the house without a cell phone. Despite the wide range of benefits of cell phones and handheld electronic devices, this evolution of technology has not come without a price. The pandemic of cell phone use among children and young adolescents has led to the emergence of a set of musculoskeletal (MSK) symptoms that have not been seen before in this age group. These symptoms can range from neck and shoulder discomfort to pain, peripheral neurological symptoms of the upper extremity, and long-term complications such as disk prolapse and degenerative disk disease of the cervical spine. This clinical presentation is known as “text neck syndrome.” In addition to MSK symptoms, text neck syndrome could also include eye and ear symptoms, psychological problems, peripheral neurological symptoms, and poor academic performance. Multiple mechanisms have been discussed by which cell phone use causes MSK symptoms. Maladaptive postures, a decrease in physical activity leading to obesity, and the direct effect of electromagnetic radiation are some of the mechanisms by which long-term use of cell phones leads to the clinical presentation of text neck syndrome and its long-term consequences. The purpose of this article is to review the literature, discuss the epidemiology of cell phone use and MSK symptoms associated with its use in children and adolescents, describe its clinical presentation, explain the pathophysiology behind it, and provide preventative guidelines that can be used by this age group to allow for the continued use of these electronics without harmful effects on their posture and long-term health.

Kinematic Analysis of the Forward Head Posture Associated with Smartphone Use

Background: Frequent use of mobile devices has a known association with musculoskeletal neck pain. This study sought out to localize the region with greatest flexion in the cervical spine and explored the role of symmetry in maintaining the pose during texting. Methods: Three inertial measuring units (IMUs) superficially attached along the cervical spine divided the cervical spine into two measurable segments. Twenty-five subjects participated in the study and performed three tasks when using smartphones: sitting, standing, and walking. Data from each IMU were used to calculate the flexion of cervical divided into two segments: craniocervical junction (C0–C1) and subaxial (C1–C7). Results: The greatest flexion by far occurred at C0–C1. While sitting, standing, and walking, the mean flexion angles were 33.33 ± 13.56°, 27.50 ± 14.05°, and 32.03 ± 10.03° for the C0–C1 joint and −3.30 ± 10.10°, 2.50 ± 9.99°, and −1.05 ± 11.88° for the C2–C7 segment, respectively. There is a noticeable pattern of yaw movement of the head, with a slow rotation toward symmetry and a fast corrective movement toward the smartphone held in one hand. Conclusions: This study identified the region of greatest contribution toward forward flexion along the cervical parameters during various tasks involving smartphone use. With each task, the greatest contributor to head flexion was the C0–C1 joint. There is involuntary rotation of the cervical spine toward symmetry when texting.

Texting on a Smartphone While Walking Affects Gait Parameters

Cell phone use while walking is an ever-increasing traffic hazard, and leads to an augmented risk of accidents. There is a rising number of injuries to pedestrians using a cell phone. Texting on a cell phone while walking is an emerging problem among people of different ages. The aim of this experiment was to investigate whether using a cell phone while walking affects walking velocity, as well as cadence, stride width, and length in young people. Forty-two subjects (20 males, 22 females; mean age: 20.74 ± 1.34 years; mean height: 173.21 ± 8.07 cm; mean weight: 69.05 ± 14.07 kg) participated in the study. The subjects were asked to walk on an FDM-1.5 dynamometer platform four times at a constant comfortable velocity and a fast velocity of their choice. They were asked to continuously type one sentence on a cell phone while walking at the same velocity. The results showed that texting while walking led to a significant reduction in velocity compared to walking without the phone. Width, cadence, and length of right and left single steps were statistically significantly influenced by this task. In conclusion, such changes in gait parameters may result in an increased risk of pedestrian crossing accidents and tripping while walking. Phone use is an activity that should be avoided while walking.

A Bibliometric Analysis of the Top 100 Cited Articles in Anterior Cervical Discectomy and Fusion

Study design

A bibliometric analysis.

Objective

To identify and analyze the top 100 cited articles in anterior cervical discectomy and fusion.

Summary of Background Data

Anterior cervical discectomy and fusion (ACDF) is one of the most routine surgical procedures in spine surgery. Many surgeons and academics have researched ACDF thoroughly and published numerous articles. However, there is no relevant bibliometric analysis. Therefore, our study aims to identify and analyze the top 100 cited articles in ACDF to identify the research trends.

Methods

We searched the Web of Science (WOS) Core Collection database with restrictions and identified the top 100 cited publications in ACDF for analysis.

Results

The citation counts of the top 100 cited publications ranged from 37 to 361 (mean 67.42). All studies were published between 2008 and 2019, with 2013 and 2015 the most prolific years. The journals Spine and Journal of Neurosurgery-Spine provided the majority of the articles. Overall, the 100 articles came from 12 countries, with the United States being the top producer, followed by China and South Korea. The most frequent keywords were "spine", "anterior cervical discectomy and fusion", "interbody fusion", 'arthrodesis', "follow-up", "decompression", and "ACDF".

Conclusion

ACDF has been regarded as a classical gold standard in anterior cervical surgery, and the emergence of new surgical procedures has not affected its status. Cervical disc arthroplasty still needs further research and development. As the first bibliometric analysis of ACDF, this bibliometric study is meant to provide guidance for clinicians and scholars to research the development trend of this field.

Association between Sagittal Cervical Spinal Alignment and Degenerative Cervical Spondylosis: A Retrospective Study Using a New Scoring System

(1) Background: Prolonged neck flexion is thought to cause harmful loading on the cervical spine. Along with the degenerative process, cervical alignment tends to change toward lordotic curvature. The association between cervical alignment and cervical spondylosis remains unclear. (2) Methods: Three raters retrospectively assessed cervical radiographies of outpatients at a tertiary center in 2019 using degenerative cervical spondylosis score (DCS score; a newly developed scoring system), C2-7 absolute rotational angle (ARA), and C2-7 sagittal vertical axis (SVA). (3) Results: A total of 561 patients were included in the analysis. Multiple regression analysis with adjustments for age and sex revealed that C2-7 ARA, rather than SVA, was a significant parameter for degenerative spondylosis. The interaction between age and C2-7 ARA was significant, indicating that the increase in DCS score with increasing age was more pronounced in patients with kyphotic cervical alignment. The direct effect of age on DCS score was 0.349 (95% CI 0.319 to 0.380, p < 0.001) and the proportion of the mediation effect of C2-7 ARA was −0.125 (p < 0.001). (4) Conclusions: C2-7 ARA was significantly associated with DCS after adjustment for both age and sex. Subjects with more kyphotic cervical alignment showed a greater correlation between increased DCS score and older age.

Identification of compositional and structural changes in the nucleus pulposus of patients with cervical disc herniation by Raman spectroscopy

PURPOSE

Cervical disc herniation (CDH) is one of the most common spinal diseases in modern society; intervertebral disc degeneration (IVDD) has long been considered as its primary cause. However, the mechanism of intervertebral disc degeneration is still unclear. The aim of the study is to examine the components and structures of proteoglycan and collagen in cervical disc herniated nucleus pulposus (NP) using a validated and convenient Raman spectra technique and histological methods to further elucidate the mechanism of IVDD at the microscopic level.

METHODS

Our study used a burgeoning technique of Raman spectroscopy combined with in vitro intervertebral disc NP to characterize the above mentioned research purposes. Firstly, we collected cervical disc NP samples and imaging data by certain inclusion and exclusion criteria. Then, we graded the NP of the responsible segment according to the patient's preoperative cervical magnetic resonance imaging (MRI) T2-weighted images by Pfirrmann grading criteria while measuring the T2 signal intensity value of NP. In addition, the structure of the NP samples was evaluated by histological staining (H&E staining and Safranin-O staining). Finally, the samples were scanned and analyzed by Raman spectroscopy.

RESULTS

A total of 28 NP tissues from 26 patients (two of these patients were cases that involved two segments) with CDH were included in this study. According to the Raman spectroscopy scan, the relative content of proteoglycans which is characterized by the ratio of the two peaks (I _1,064/ I _1,004) in the NP showed a significantly negative correlation with Pfirrmann grade (P < 0.001), while the collagen content and the NP intensity value showed a positive correlation (P < 0.001). For the microstructural characterization of collagen, we found that it may have an essential role in the degenerative process of the intervertebral disc. Moreover, histological staining (H&E staining and Safranin-O staining) showed the general structure of the NP and the distribution of macromolecules.

CONCLUSION

The present study demonstrated the possibility of characterizing the macromolecular substances inside the cervical disc NP tissue by Raman spectroscopy. It also confirmed that macromolecular substances such as proteoglycans and collagen have some degree of alteration in content and structure during degeneration, which has a further positive significance for the elucidation of CDH's mechanism.

Bibliometric and visualized analysis of the top 100 most-cited articles on anterior cervical surgery

Anterior cervical surgery (ACS) owes its development to various pioneering individuals whose revolutionary works form key advances and guide current medical decisions. This bibliometric study aimed to identify, analyse and visualize the main features of the most-cited papers in ACS.

The citation count for the top 100 most-cited articles ranged from 148 to 1,197, and citations per year ranged from 3.1 to 89.8. The articles were published from 1958 to 2016, with the 2000s being the most active decade. There was an inverse correlation between the average citations per year since publication and article age.

The oldest as well as most-cited two articles were both published in 1958 by Smith and Robinson, and Cloward, respectively. In their studies, the authors individually described the technique of anterior cervical discectomy with fusion (ACDF).

The most popular keywords were: ‘fusion’ (22), ‘spine’ (20), ‘cervical spine’ (16), ‘complications’ (15), ‘arthrodesis’ (13), ‘interbody fusion’ (13), ‘bone morphogenetic protein’ (13), and ‘radiculopathy’ (12).

ACDF was the most frequent surgical procedure (80%), while cervical disc arthroplasty is of gradual greater impact.

The surgical techniques of ACDF have remained unaltered for over 60 years. More attempts are needed to promote its development.

Cite this article: EFORT Open Rev 2021;6:1203-1213. DOI: 10.1302/2058-5241.6.210074

Smartphone Addiction and Associated Health Outcomes in Adult Populations: A Systematic Review

BACKGROUND

Smartphones play a critical role in increasing human-machine interactions, with many advantages. However, the growing popularity of smartphone use has led to smartphone overuse and addiction. This review aims to systematically investigate the impact of smartphone addiction on health outcomes.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to carry out the systematic review. Five electronic databases including Medline, Web of Science, PsycINFO, PubMed, and Scopus were searched to identify eligible studies. Eligible studies were screened against predetermined inclusion criteria and data were extracted according to the review questions. This review is registered in PROSPERO (CRD42020181404). The quality of the articles was assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

A total of 27 of 2550 articles met the inclusion criteria. All of the studies were cross-sectional and focused on physical, mental, and neurological health outcomes. The majority of the studies focused on mental health outcomes and consistent associations were observed between smartphone addiction and several mental health outcomes. Anxiety and depression were commonly found to mediate mental health problems. A wide range of physical health sequelae was also associated with smartphone addiction. Furthermore, there was an association between smartphone addiction and neurological disorders.

CONCLUSIONS

Our findings suggest that there are consistent associations between smartphone addiction and physical and mental health, especially mental health. Social awareness campaigns about smartphone addiction and its impact on physical and mental health are needed. Further studies, especially randomized controlled trials, are warranted to validate the impacts of smartphone addiction.

Disruption of human brain connectivity networks in patients with cervical spondylotic myelopathy

Background

Brain functional plasticity and reorganization in patients with cervical spondylotic myelopathy (CSM) is increasingly being explored and validated. However, specific topological alterations in functional networks and their role in CSM brain functional reorganization remain unclear. This study investigates the topological architecture of intrinsic brain functional networks in CSM patients using graph theory.

Methods

Functional MRI was conducted on 67 CSM patients and 60 healthy controls (HCs). The topological organization of the whole-brain functional network was then calculated using theoretical graph analysis. The difference in categorical variables between groups was compared using a chi-squared test, while that between continuous variables was evaluated using a two-sample t-test. Nonparametric permutation tests were used to compare network measures between the two groups.

Results

Small-world architecture in functional brain networks were identified in both CSM patients and HCs. Compared with HCs, CSM patients showed a decreased area under the curve (AUC) of the characteristic path length (FDR q=0.040), clustering coefficient (FDR q=0.037), and normalized characteristic path length (FDR q=0.038) of the network. In contrast, there was an increased AUC of normalized clustering coefficient (FDR q=0.014), small-worldness (FDR q=0.009), and global network efficiency (FDR q=0.027) of the network. In local brain regions, nodal topological properties revealed group differences which were predominantly in the default-mode network (DMN), left postcentral gyrus, bilateral putamen, lingual gyrus, and posterior cingulate gyrus.

Conclusions

This study reported altered functional topological organization in CSM patients. Decreased nodal centralities in the visual cortex and sensory-motor regions may indicate sensory-motor dysfunction and blurred vision. Furthermore, increased nodal centralities in the cerebellum may be compensatory for sensory-motor dysfunction in CSM, while the increased DMN may indicate increased psychological processing in CSM patients.

Excessive Smartphone Use Is Associated With Health Problems in Adolescents and Young Adults

Background and Aims: This present paper will review the existing evidence on the effects of excessive smartphone use on physical and mental health. Results: Comorbidity with depression, anxiety, OCD, ADHD and alcohol use disorder. Excessive smartphone use is associated with difficulties in cognitive-emotion regulation, impulsivity, impaired cognitive function, addiction to social networking, shyness and low self-esteem. Medical problems include sleep problems, reduced physical fitness, unhealthy eating habits, pain and migraines, reduced cognitive control and changes in the brain's gray matter volume. In Conclusion: Excessive smartphone use is associated with psychiatric, cognitive, emotional, medical and brain changes that should be considered by health and education professionals.

Prevalence of Internet-based addictive behaviors during COVID-19 pandemic: a systematic review

With the outbreak of the COVID-19 worldwide pandemic, many countries have imposed lockdowns which have caused an increase in Internet use. As large-scale disasters may have an impact on addictions, a review on Internet-based addictive behaviors seems necessary. The goals of this review are to find whether Internet-based addictive behaviors have increased during the pandemic and to define the main reasons for this increase. The systematic search was conducted in Google Scholar, Science Direct, PsycINFO, and PubMed in October of 2020, to determine the current evidence and observations concerning the Internet-based addictive behaviors amid COVID-19. Studies were included if they considered the Internet-based addictive behaviors during the current pandemic. We used all the names of the coronavirus 2 (SARS-CoV2 previously 2019 nCoV), the name of the coronavirus disease 2019 (COVID-19), and common Internet-based addictive behaviors, namely Internet addiction, online gaming disorder, online gambling disorder, pornography use, and smartphone use disorder. The study design is PEOs, finding if individuals' exposure to the COVID-19 pandemic has caused an increase in Internet-based addictive behaviors. The quality of the studies was assessed independently by two authors using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The articles found in this review proved an increase in Internet-based addictive behaviors during the COVID-19 pandemic mostly due to financial hardships, isolation, problematic substance use, and mental health issues such as depression, anxiety, and stress. Effective interventions should be scaled up to prevent and reduce online addictive behaviors, as well as accessible guidelines, particularly for adolescents.