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Frontiers in Pain Research (Lausanne,... 2024
PubMed: 38596258
DOI: 10.3389/fpain.2024.1400548 -
Clinical Spine Surgery Nov 2023Narrative review. (Review)
Review
STUDY DESIGN
Narrative review.
OBJECTIVE
To review indications and strategies for revision of cervical disc arthroplasty (CDA).
SUMMARY OF BACKGROUND DATA
No data were generated as part of this review.
METHODS
A narrative review of the literature was performed.
RESULTS
No results were generated as part of this review.
CONCLUSIONS
CDA is a proven, motion-sparing surgical option for the treatment of myelopathy or radiculopathy secondary to cervical degenerative disc disease. As is the case with any operation, a small percentage of CDA will require revision, which can be a technically demanding endeavor. Here we review available revision strategies and associated indications, a thorough understanding of which will aid the surgeon in finely tailoring their approach to varying presentations.
Topics: Humans; Treatment Outcome; Intervertebral Disc Degeneration; Neck; Intervertebral Disc; Cervical Vertebrae; Arthroplasty; Spinal Fusion
PubMed: 37752631
DOI: 10.1097/BSD.0000000000001542 -
World Neurosurgery Dec 2023Herniated thoracic disk has an incidence of 1/1 million. Treatment options for a calcified herniated disk include conservative management or diskectomy with or without...
Herniated thoracic disk has an incidence of 1/1 million. Treatment options for a calcified herniated disk include conservative management or diskectomy with or without fusion. We describe a patient who presented a year ago with a 5-month history of back pain, thoracic radiculopathy, and normal physical examination. Imaging revealed a giant calcified herniated thoracic disk at T10-T11. She underwent epidural steroid injections and chiropractic manipulation. Imaging obtained at 1-year follow-up showed near-complete resorption of the calcified thoracic disk.
Topics: Female; Humans; Intervertebral Disc Displacement; Back Pain; Diskectomy; Radiculopathy; Thoracic Vertebrae
PubMed: 37778626
DOI: 10.1016/j.wneu.2023.09.102 -
FP Essentials Dec 2023The incidence of neck pain in US primary care settings ranges from 10% to 21% per year. A key component in evaluation of patients with neck pain is identification of red...
The incidence of neck pain in US primary care settings ranges from 10% to 21% per year. A key component in evaluation of patients with neck pain is identification of red flag signs or symptoms that indicate the need for urgent evaluation for possible serious conditions. These include fever, unexplained weight loss, trauma, vision changes, new or severe headache, and altered mental status, among others. Patients with acute onset or worsening chronic neck pain without trauma or red flag signs or symptoms should be assessed initially with x-ray. Magnetic resonance imaging study is recommended for patients with progressive neurologic symptoms, neurologic compromise, suspected infection, or other red flag signs or symptoms. Common conditions and injuries associated with neck pain in the primary care setting include cervical strains and sprains, cervical spondylosis, cervical discogenic pain, cervical radiculopathy and myelopathy, whiplash, cervical fracture, and postural pain. Most patients with neck pain without red flag signs or symptoms recover with conservative management, however, there is little evidence to support these treatments. Pharmacotherapy includes nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants. Small benefits have been shown for combination exercise programs, mind-body programs, and acupuncture. Referral for surgical management is indicated for patients with progressive neurologic deficits.
Topics: Humans; Neck Pain; Sprains and Strains; Acetaminophen; Acupuncture Therapy; Exercise
PubMed: 38109046
DOI: No ID Found -
Life (Basel, Switzerland) Nov 2023Lumbar radiculopathy causes lower back and lower extremity pain that may be managed with neural mobilization (NM) techniques. This meta-analysis aims to evaluate the... (Review)
Review
Lumbar radiculopathy causes lower back and lower extremity pain that may be managed with neural mobilization (NM) techniques. This meta-analysis aims to evaluate the effectiveness of NM in alleviating pain and reducing disability in patients with lumbar radiculopathy. We hypothesized that NM would reduce pain and improve disability in the lumbar radiculopathy population, leveraging the statistical power of multiple studies. Electronic databases from their inception up to October 2023 were searched for randomized controlled trials (RCTs) that explored the impact of NM on lumbar radiculopathy. Our primary outcome measure was the alteration in pain intensity, while the secondary one was the improvement of disability, standardized using Hedges' . To combine the data, we employed a random-effects model. A total of 20 RCTs comprising 877 participants were included. NM yielded a significant reduction in pain intensity (Hedges' = -1.097, 95% CI = -1.482 to -0.712, < 0.001, I2 = 85.338%). Subgroup analyses indicated that NM effectively reduced pain, whether employed alone or in conjunction with other treatments. Furthermore, NM significantly alleviated disability, with a notable effect size (Hedges' = -0.964, 95% CI = -1.475 to -0.453, < 0.001, I2 = 88.550%), particularly in chronic cases. The findings provide valuable insights for clinicians seeking evidence-based interventions for this patient population. This study has limitations, including heterogeneity, potential publication bias, varied causal factors in lumbar radiculopathy, overall study quality, and the inability to explore the impact of neural pathology on NM treatment effectiveness, suggesting opportunities for future research improvements.
PubMed: 38137856
DOI: 10.3390/life13122255 -
Advanced Biomedical Research 2023A case with an inflamed or damaged nerve root in the cervical spine is defined as cervical radiculopathy.The purpose of the current study is to recognize the most... (Review)
Review
A case with an inflamed or damaged nerve root in the cervical spine is defined as cervical radiculopathy.The purpose of the current study is to recognize the most effective surgical procedures in cervical radiculopathy subjects. All related studies were taken using PubMed searching international databases, Scopus, ISI Web of Science (WoS), and Science direct with no limit of until November 20, 2021. Finally, based on the inclusion and exclusion criteria, after reviewing all randomized controlled trial studies which had the related data the researchers were looking for, they conducted meta-analysis with the seven remaining studies including eight different treatments. Heterogeneity was evaluated by Cochran's Q and Higgins I using R software for the network. In the results presented in this study, the neck disability index (NDI) changes as a result of taking cervical anterior discectomy without (ACD) and with fusion (ACDF) and ACD arthroplasty were -0.003, -1.659, and -1.656, respectively. According to the final diagram of the network, 11 comparisons were made in pairs. When each treatment group is compared with ACDF, it is shown that there was a significant mean effect among the patients who receive Mobi-C, Kineflx|C, and ADR, with mean differences of - 8.60 [CI 95% (- 12.75, - 4.45)], - 1.10 [CI 95% (- 5.22, 3.02)], and - 1.00 [CI 95% (- 7.18, 5.18)], respectively. The most effective surgical treatments for cervical radiculopathy were Mobi-c, Kineflx|C, and artificial disc replacement compared to ACDF treatment, respectively.
PubMed: 37694261
DOI: 10.4103/abr.abr_251_22 -
Handbook of Clinical Neurology 2024The sciatic nerve is the body's largest peripheral nerve. Along with their two terminal divisions (tibial and fibular), their anatomic location makes them particularly...
The sciatic nerve is the body's largest peripheral nerve. Along with their two terminal divisions (tibial and fibular), their anatomic location makes them particularly vulnerable to trauma and iatrogenic injuries. A thorough understanding of the functional anatomy is required to adequately localize lesions in this lengthy neural pathway. Proximal disorders of the nerve can be challenging to precisely localize among a range of possibilities including lumbosacral pathology, radiculopathy, or piriformis syndrome. A correct diagnosis is based upon a thorough history and physical examination, which will then appropriately direct adjunctive investigations such as imaging and electrodiagnostic testing. Disorders of the sciatic nerve and its terminal branches are disabling for patients, and expert assessment by rehabilitation professionals is important in limiting their impact. Applying techniques established in the upper extremity, surgical reconstruction of lower extremity nerve dysfunction is rapidly improving and evolving. These new techniques, such as nerve transfers, require electrodiagnostic assessment of both the injured nerve(s) as well as healthy, potential donor nerves as part of a complete neurophysiological examination.
Topics: Humans; Electrodiagnosis; Sciatic Neuropathy; Tibial Neuropathy
PubMed: 38697738
DOI: 10.1016/B978-0-323-90108-6.00003-X -
Journal of Neurology, Neurosurgery, and... Aug 2023The myotome of a muscle is the basis for diagnosing spinal and peripheral nerve disorders. Despite its critical importance in clinical neurology, myotome charts... (Review)
Review
The myotome of a muscle is the basis for diagnosing spinal and peripheral nerve disorders. Despite its critical importance in clinical neurology, myotome charts presented in many textbooks, surprisingly, show non-negligible discordances with each other. Many authors do not even clearly state the bases of their charts. Studies that have presented with raw data regarding myotome identification are rather rare. A classic study in the 19th century that pursued the nerve course in cadavers still has a substantial influence on existing charts, despite its definite limitations. Other scarce studies in humans include identification by root stimulation during surgery, clinical observations in root avulsion or spinal cord injury and clinical and electromyographical investigations in patients with single radiculopathies or certain plexopathies. A few recent studies have proposed new theories regarding the myotomes of some muscles. T1 innervation of the median intrinsic hand muscles is a typical example. We have added a number of new findings, such as T1 innervation of the forearm flexor muscles innervated by the median nerve except the pronator teres and flexor carpi radialis, C5 innervation of the brachioradialis, and two C6 indicator muscles, pronator teres and extensor carpi radialis brevis. Increased accuracy of the myotome charts will improve the localisation in neurology.
Topics: Humans; Muscle, Skeletal; Median Nerve; Forearm; Electromyography; Hand
PubMed: 36653172
DOI: 10.1136/jnnp-2022-329696 -
World Neurosurgery Oct 2023There are no systematic evidence-based medical data on the complications of endoscopic cervical spinal surgery. This narrative analysis compiled data from various... (Review)
Review
BACKGROUND
There are no systematic evidence-based medical data on the complications of endoscopic cervical spinal surgery. This narrative analysis compiled data from various studies that examined endoscopic complications, such as cervical disc herniation and foraminal stenosis. This study aimed to investigate the efficacy and safety of endoscopic surgery in cervical radiculopathy.
METHODS
We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and keywords were set as "endoscopic cervical spinal surgery", "endoscopic cervical discectomy", "endoscopic cervical foraminotomy", and "percutaneous endoscopic cervical discectomy". We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic cervical surgery was divided into three categories: full endoscopic anterior, endoscopic posterior, and unilateral biportal approaches. We excluded duplicate publications, studies without full text, studies without complications or incomplete information, and studies that did not provide the necessary data for extraction, animal experiments, or reviews.
RESULTS
Difficulties in swallowing, hematoma, and hoarseness are common complications associated with the anterior cervical approach. In contrast, complications of the posterior approach include nerve root injury, hematoma, and dysesthesia. However, endoscopic cervical spinal surgery, including the full endoscopic anterior, posterior, and unilateral biportal approaches, is a safe and effective treatment for cervical radiculopathy.
CONCLUSIONS
Complications of full endoscopic cervical spinal surgery differ significantly depending on the anterior and posterior approaches. In the anterior approach, swallowing difficulty, recurrent disc, hematoma, and dysphonia are the common complications. In contrast, transient dysesthesia, dural tears, upper limb motor deficits, and persistent arm pain are commonly reported with the posterior approach.
Topics: Humans; Radiculopathy; Paresthesia; Cervical Vertebrae; Endoscopy; Intervertebral Disc Displacement; Diskectomy; Hematoma; Treatment Outcome; Retrospective Studies
PubMed: 37479028
DOI: 10.1016/j.wneu.2023.07.058