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Javanshir K, Ghafouri-Rouzbehani P, Zohrehvand A, Naeimi A, Fernández-de-las-Peñas C, Nikbakht HA, Mousavi-Khatir SR, Valera-Calero JA. Cervical Multifidus and Longus Colli Ultrasound Differences among Patients with Cervical Disc Bulging, Protrusion and Extrusion and Asymptomatic Controls: A Cross-Sectional Study. J Clin Med 2024; 13:624. [PMID: 38276132 PMCID: PMC10816935 DOI: 10.3390/jcm13020624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to analyze the differences in morphological and histological features of the cervical multifidus (CM) and longus colli (LC) muscles among patients with cervical disc bulging, protrusion, or extrusion. Fifteen patients with cervical disc bulging (20% male, mean age: 48.5, standard deviation (SD) 7.5 years), fifteen with cervical disc protrusion (6% male, mean age: 43, SD 7.8 years), and fifteen with cervical disc extrusion (40% male, mean age: 44, SD 8 years) diagnosed via clinical and imaging findings participated in this study. Additionally, fifteen asymptomatic controls (40% male, mean age: 40.4, SD 9.7 years) were also included. The following ultrasound measurements, cross-sectional area (CSA), anterior-posterior distance (APD), lateral dimension (LD), and mean echo-intensity (EI) of the CM and LC at C5-C6 level were examined by an assessor blinded to the subject's condition. The results revealed no group ×side significant differences among the groups (p > 0. 00625). However, group effects were found for APD and MEI of the CM (p = 0.006 and p < 0.001, respectively) and CSA, APD and MEI of the LC (all, p < 0.001). The LD of the LC muscle and the APD and LD of the CM were negatively associated with related disability (p < 0.01; p < 0.05 and p < 0.01, respectively), and pain intensity was negatively associated with LC APD and LD (both p < 0.05). These results suggest that US can be used to detect bilateral morphological changes in deep cervical flexors and extensors to discriminate patients with cervical disc alterations.
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Affiliation(s)
- Khodabakhsh Javanshir
- Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Science, Babol 47176-47745, Iran; (K.J.); (P.G.-R.); (S.R.M.-K.)
| | - Payam Ghafouri-Rouzbehani
- Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Science, Babol 47176-47745, Iran; (K.J.); (P.G.-R.); (S.R.M.-K.)
| | - Amirhossein Zohrehvand
- Department of Neurosurgery, School of Medicine, Babol University of Medical Sciences, Babol 47176-47745, Iran;
| | - Arvin Naeimi
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht 41446-66949, Iran;
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Madrid, Spain;
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol 47176-47745, Iran;
| | - Seyedeh Roghayeh Mousavi-Khatir
- Department of Physical Therapy, School of Rehabilitation, Babol University of Medical Science, Babol 47176-47745, Iran; (K.J.); (P.G.-R.); (S.R.M.-K.)
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Jin L, Sun K, Liu G, Yuan W, Chen H, Tian Y. Comparison of clinical outcomes between sequestered cervical disk herniation and non-sequestered cervical disk herniation after anterior cervical decompression and fusion: a cohort study. J Orthop Surg Res 2024; 19:37. [PMID: 38183107 PMCID: PMC10771008 DOI: 10.1186/s13018-023-04515-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND The advantages of anterior cervical decompression and fusion (ACDF) were well published, while research on postoperative results in different subtypes of cervical disk herniation (CDH) still remains blank. This study aimed to explore the surgical outcome between sequestration and other types in CDH. METHODS This retrospective cohort study enrolled 108 patients treated with ACDF in our hospital. The participants were divided into two groups according to the existence of a sequestered disk. The Visual analog scale score, the Japanese Orthopedics Association (JOA) score and the Neck disability index score were used to evaluate postoperative outcome. RESULTS Significant improvements were observed in both groups at every viewpoint (P < 0.001). The mean JOA was 15.04 ± 1.26 in the sequestered disk group and 14.45 ± 1.43 in the non-sequestered disk group two months after the operation (P = 0.026 < 0.05). The improvement in JOA at two months after ACDF showed a significant difference: 46.58% ± 39.17% in the sequestered disk group and 33.39% ± 28.82% in the non-sequestered disk group (P = 0.047 < 0.05). Thirty-two patients in the sequestered disk group (64%) and 19 patients in the non-sequestered disk group (32.76%) presented with high signal intensity of the spinal cord on preoperative cervical T2-weighted MRI (P < 0.001). CONCLUSIONS Patients with sequestered cervical disks seemed to have a higher degree of symptom improvement two months after ACDF. CDH with a sequestered disk appears to be more likely to cause high signal intensity changes in the compressed cervical spine on T2-weighted MRI. We prefer early positive surgery in patients with sequestered cervical disks from the clinical point of view.
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Affiliation(s)
- Lanbo Jin
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, 415 Feng Yang Road, Huangpu District, Shanghai, 200003, China
| | - Ke Sun
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, 415 Feng Yang Road, Huangpu District, Shanghai, 200003, China
| | - Gang Liu
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, 415 Feng Yang Road, Huangpu District, Shanghai, 200003, China
| | - Wen Yuan
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, 415 Feng Yang Road, Huangpu District, Shanghai, 200003, China
| | - Huajiang Chen
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, 415 Feng Yang Road, Huangpu District, Shanghai, 200003, China
| | - Ye Tian
- Department of Orthopedics, Spine Center, Changzheng Hospital, Naval Medical University, 415 Feng Yang Road, Huangpu District, Shanghai, 200003, China.
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An Z, Fan G, Su W, Chen C, Lai T, Dong L. Evaluation of the efficacy and safety of day surgery for cervical disc herniation treated with low temperature plasma radiofrequency ablation. INTERNATIONAL ORTHOPAEDICS 2024; 48:211-219. [PMID: 37668729 DOI: 10.1007/s00264-023-05955-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate and compare the clinical efficacy of patients with cervical disc herniation (CDH) treated by low-temperature plasma radiofrequency ablation (LTP-RFA) as day surgery with traditional inpatients. METHODS According to the selection criteria, single-segment mild to moderate CDH patients who received LTP-RFA from January 2020 to December 2021 were divided into day surgery procedure (DSP) group and a traditional inpatient procedure (TIP) group. The visual analogue score (VAS) and modified Japanese Orthopedic Association score (mJOA) of neurological function of patients in the two groups were recorded at the time of preoperative, and one day, three months, six months after surgery and the last follow-up respectively. The gender, age, responsible segment, surgical complications, hospitalization time, hospitalization expenses, and patient satisfaction were recorded and analyzed for both groups. The modified Macnab standard was used to evaluate the postoperative efficacy at one month and six months after operation. RESULTS A total of 127 patients (75 in DSP;52 in TIP) with complete data were enrolled and completed six month follow-up. There were no statistically significant pre-treatment VAS scores and mJOA scores in the two groups (P>0.05). The postoperative VAS and mJOA scores in both groups were improved after surgery (P<0.05). However, there was no significant difference in VAS scores and mJOA scores between the two groups in the same postoperative period (all P > 0.05). The efficacy of MacNab was similar one month and six months after operation (P > 0.05). The hospitalization time and hospitalization cost were significantly lower in DSP group (all P<0.05). As the treatment effects were comparable, patients in both groups were similarly satisfied at discharge. CONCLUSION LTP-RFA is an effective method for the treatment of mild to moderate CDH. We suggest that the application of LTP-RFA in DSP for mild to moderate CDH is worthy of wide application.
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Affiliation(s)
- Zhongcheng An
- Department of Orthopedics and Traumatology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Guangya Fan
- Department of Orthopedics and Traumatology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Wenshuo Su
- Department of Orthopedics and Traumatology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Chen Chen
- Department of Orthopedics and Traumatology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Tingyuan Lai
- Department of Orthopedics and Traumatology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Liqiang Dong
- Department of Orthopedics and Traumatology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China.
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Gao Q, Yang H, Masood U, Zhou C, Cen Y, Song Y. Lumbar Disc Herniation with Contralateral Symptoms: A Case-Series of 11 Patients and Literature Review. Orthop Surg 2023; 15:2839-2847. [PMID: 37749774 PMCID: PMC10622262 DOI: 10.1111/os.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Lumbar disc herniation (LDH) is a common pathology that typically causes unilateral radiculopathy on the same side as herniation, while patients may occasionally present with contralateral symptoms. Owing to the rare incidence of LDH with contralateral symptoms, the pathological mechanism remains unclear and the optimal surgical strategy is a subject of debate. This study aimed to provide new insights into the pathological mechanism of contralateral symptoms and assess the efficacy of ipsilateral hemilaminectomy and discectomy surgery in this population. METHODS This study was a retrospective, single-center, clinical case series, including 11 LDH cases with exclusive contralateral symptoms. We searched for LDH cases that were presented at our institution between January 2011 and December 2020. Adult LDH Patients with contralateral radicular pains were included, while those with ipsilateral radiculopathy, lumbar stenosis, foraminal stenosis on the symptomatic side, multilevel disc herniations, scoliosis, and lumbar operation history were excluded. Visual Analog Scale (VAS), clinical features, radiographic images, and other data were collected from the study cohort of 11 cases for further analysis. We also reviewed LDH cases in English literature from 1978 to 2023 to analyze their clinical characteristics and treatment. RESULTS The incidence rate of LDH with contralateral symptoms in single-level LDH cases was 0.32%. The average age of our 11 cases was 49.3 years old, and five of them were female (45.5%). All individuals had single-level lateral LDH, with six cases (54.5%) located at L4-5 and five cases (45.5%) located at L5-S1. Upon admission, patients presented with lower back pain (seven cases, 63.6%), radicular pain (seven cases, 63.6%), hypoesthesia (seven cases, 63.6%), and muscle weakness (one case, 9.1%) on the contralateral side alone. Each case experienced ipsilateral hemilaminectomy and discectomy, and no lateral recess stenosis, hypertrophy of facets or ligaments, and sequestrated discs were found during surgery. All of them have good pain relief with two cases reporting no pain and nine cases reporting only mild pain at the last follow-up. CONCLUSIONS Based on the surgical findings of our 11 LDH cases with contralateral symptoms, we hypothesized that the contralateral symptoms might be produced when the nerve root on the contralateral symptomatic side was tightly pulled by the herniated disc via the dural mater. Ipsilateral hemilaminectomy and discectomy surgery effectively and efficiently relieve the symptoms without postoperative complications for these patients.
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Affiliation(s)
- Qingyang Gao
- Department of Plastic and Burn Surgery, West China HospitalSichuan UniversityChengduChina
| | - Huiliang Yang
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Umar Masood
- Jacobs School of Medicine and Biomedical SciencesUniversity at Buffalo, The State University of New YorkBuffaloNew YorkUSA
| | - Chunguang Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Ying Cen
- Department of Plastic and Burn Surgery, West China HospitalSichuan UniversityChengduChina
| | - Yueming Song
- Department of Orthopedics, Orthopedic Research Institute, West China HospitalSichuan UniversityChengduChina
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Zhang GZ, Li L, Luo ZB, Zhang CY, Wang YG, Kang XW. Identification and experimental validation of key extracellular proteins as potential targets in intervertebral disc degeneration. Bone Joint Res 2023; 12:522-535. [PMID: 37661086 PMCID: PMC10475329 DOI: 10.1302/2046-3758.129.bjr-2022-0369.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Aims This study aimed, through bioinformatics analysis and in vitro experiment validation, to identify the key extracellular proteins of intervertebral disc degeneration (IDD). Methods The gene expression profile of GSE23130 was downloaded from the Gene Expression Omnibus (GEO) database. Extracellular protein-differentially expressed genes (EP-DEGs) were screened by protein annotation databases, and we used Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) to analyze the functions and pathways of EP-DEGs. STRING and Cytoscape were used to construct protein-protein interaction (PPI) networks and identify hub EP-DEGs. NetworkAnalyst was used to analyze transcription factors (TFs) and microRNAs (miRNAs) that regulate hub EP-DEGs. A search of the Drug Signatures Database (DSigDB) for hub EP-DEGs revealed multiple drug molecules and drug-target interactions. Results A total of 56 EP-DEGs were identified in the differential expression analysis. EP-DEGs were enriched in the extracellular structure organization, ageing, collagen-activated signalling pathway, PI3K-Akt signalling pathway, and AGE-RAGE signalling pathway. PPI network analysis showed that the top ten hub EP-DEGs are closely related to IDD. Correlation analysis also demonstrated a significant correlation between the ten hub EP-DEGs (p<0.05), which were selected to construct TF-gene interaction and TF-miRNA coregulatory networks. In addition, ten candidate drugs were screened for the treatment of IDD. Conclusion The findings clarify the roles of extracellular proteins in IDD and highlight their potential as promising novel therapeutic targets.
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Affiliation(s)
- Guang-Zhi Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, China
- The International Cooperation Base of Gansu Province for The Pain Research in Spinal Disorders, Lanzhou, China
| | - Lei Li
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, China
- The International Cooperation Base of Gansu Province for The Pain Research in Spinal Disorders, Lanzhou, China
| | - Zhang-Bin Luo
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, China
- The International Cooperation Base of Gansu Province for The Pain Research in Spinal Disorders, Lanzhou, China
| | - Cang-Yu Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, China
- The International Cooperation Base of Gansu Province for The Pain Research in Spinal Disorders, Lanzhou, China
| | - Yong-Gang Wang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, China
- The International Cooperation Base of Gansu Province for The Pain Research in Spinal Disorders, Lanzhou, China
| | - Xue-Wen Kang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, China
- The International Cooperation Base of Gansu Province for The Pain Research in Spinal Disorders, Lanzhou, China
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