Atypical cervical spondylotic radiculopathy resulting in a hypertensive emergency during cervical extension: A case report and review of literature

BACKGROUND Extensive research revealed the absence of reports documenting hypertensive emergencies precipitated by changes in the cervical spine posture.CASE SUMMARY We here present a 57-year-old woman diagnosed as having cervical spondylotic radiculopathy(CSR)who was scheduled for anterior cervical decompression and fusion.During post-anesthetic positioning,a sudden hypertensive surge was observed when the patient was in a supine position with the neck being slightly extended.This surge was promptly reversed through cervical flexion and head elevation.This event however required an alternate surgical approach for recovery—posterior laminoplasty and endoscopy-assisted nucleus pulposus removal.Following the 6-month outpatient follow-up period,cervical flexion and extension activities substantially improved in the patient without any episodes of increase in acute blood pressure.CONCLUSION Maintaining a safe hypotensive posture and performing rapid,thorough deco-mpression surgery may serve as effective interventions for patients presenting symptoms similar to those of CSR accompanied by hypertensive emergencies(HE).This would mitigate the underlying causes of these HEs.

Keyhole Foraminotomy via a Percutaneous Posterior Full-endoscopic Approach for Cervical Radiculopathy:An Advanced Procedure and Clinical Study

Endoscopic cervical foraminotomy is increasingly used for cervical spondylotic radiculopathy(CSR),but there is great concern about radiation exposure because of the heavy dependence of this surgical method on fluoroscopy.The objective of this study was to introduce in detail an advanced surgical technique of keyhole foraminotomy via a percutaneous posterior full-endoscopic approach as a treatment for CSR and investigate its clinical outcomes.We retrospectively reviewed 33 consecutive patients with CSR who underwent keyhole foraminotomy via a percutaneous posterior full-endoscopic approach from October 2015 to April 2017.The patients’general characteristics,including operative time,blood loss,hospital stay,complications,and recurrence,were obtained.Clinical outcomes were evaluated using the visual analogue scale(VAS)for radicular pain,the neck disability index(NDI)for functional assessment,and the modified MacNab criteria for patient satisfaction.All operations were successfully performed(mean operation time,62 min),with no measurable blood loss or severe related complications.The mean follow-up was 25 months.The VAS and NDI scores were significantly improved as compared with those in the preoperative period(preoperative vs.final follow-up:7.6±1.6 vs.3.83±7.34 for VAS,P<0.01;69.5%±10.5%vs.17.54%±13.40%for NDI,P<0.01).Of the 33 patients,32(97.0%)had good-to-excellent global outcomes and all patients obtained symptomatic improvement.In conclusion,keyhole foraminotomy via a percutaneous posterior full-endoscopic approach is an efficient,safe,and feasible procedure for the treatment of CSR.Its simplified single-step blunt incision for localization appears to decrease radiation exposure risks.

Incremental value of magnetic resonance neurography of Lumbosacral plexus over non-contributory lumbar spine magnetic resonance imaging in radiculopathy: A prospective study

AIM: To test the incremental value of 3T magnetic resonance neurography(MRN) in a series of unilateral radiculopathy patients with non-contributory magnetic resonance imaging(MRI).METHODS: Ten subjects(3 men,7 women; mean age54 year and range 22-74 year) with unilateral lumbar radiculopathy and with previous non-contributory lumbar spine MRI underwent lumbosacral(LS) plexus MRN over a period of one year. Lumbar spine MRI performed as part of the MRN LS protocol as well as bilateral L4-S1 nerves,sciatic,femoral and lateral femoral cutaneous nerves were evaluated in each subject for neuropathy findings on both anatomic(nerve signal,course and caliber alterations) and diffusion tensor imaging(DTI)tensor maps(nerve signal and caliber alterations).Minimum fractional anisotropy(FA) and mean apparent diffusion coeffcient(ADC) of L4-S2 nerve roots,sciatic and femoral nerves were recorded.RESULTS: All anatomic studies and 80% of DTI imaging received a good-excellent imaging quality grading. In a blinded evaluation,all 10 examinations demonstrated neural and/or neuromuscular abnormality corresponding to the site of radiculopathy. A number of contributory neuropathy findings including double crush syndrome were observed. On DTI tensor maps,nerve signal and caliber alterations were more conspicuous. Although individual differences were observed among neuropathic appearing nerve(lower FA and increased ADC) as compared to its contralateral counterpart,there were no significant mean differences on statistical comparison of LS plexus nerves,femoral and sciatic nerves(P > 0.05).CONCLUSION: MRN of LS plexus is useful modality for the evaluation of patients with non-contributory MRI of lumbar spine as it can incrementally delineate the etiology and provide direct objective and non-invasive evidence of neuromuscular pathology.

Complete recovery of herpes zoster radiculopathy based on electrodiagnostic study:A case report

BACKGROUND Herpes zoster is a painful infectious disease caused by the varicella zoster virus.Herpes zoster radiculopathy,which is a type of segmental zoster paresis,can complicate the disease and cause motor weakness.This complication should be considered when a patient with a rash complains of acute-onset motor weakness,and the diagnosis can be verified via electrodiagnostic study.CASE SUMMARY A 64-year-old female with a history of asthma presented to the emergency department with stabbing pain,an itching sensation,and a rash on the right anterior shoulder that had begun 5 d prior.Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions.Because herpes zoster was suspected,the patient immediately received intravenous acyclovir.On the third hospital day,she complained of motor weakness in the right upper extremity.Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression.On the 12th hospital day,electrodiagnostic study revealed right cervical radiculopathy,mainly in the C5/6 roots.Six months later,monoparesis resolved,and follow-up electrodiagnostic study was normal.CONCLUSION This case emphasizes that clinicians should consider the possibility of postherpetic paresis,such as herpes zoster radiculopathy,and that electrodiagnostic study is useful for diagnosis and follow-up.

Epidural gas-containing pseudocyst leading to lumbar radiculopathy:A case report

BACKGROUND Lumbar radiculopathy is a common symptom in the clinic and is often caused by lumbar disc herniation or osteophytes compressing the nerve root;however,it is rare for nerve roots to be compressed by epidural gas.Few symptomatic epidural gas-containing pseudocyst cases have been reported.Furthermore,the reported cases were due to a mix of gas and obvious osteophytes;therefore,it was hard to rigorously conclude that gas was the factor responsible for radiculopathy.We provide evidence that because no epidural gas accumulated before radiculopathy occurred and the symptoms were relieved after removal of the gas,the epidural gas-containing pseudocyst was the root cause of radiculopathy in this case.CASE SUMMARY An 87-year-old man with a 3-wk history of right radiating pain was admitted to our hospital.Computed tomography(CT)and magnetic resonance imaging(MRI)examinations showed a vacuum phenomenon and huge lesions with low signal intensity located in the same area where the pain occurred.After carefully checking the images acquired in the last 3 mo,we found an abdominal CT examination performed 40 d prior because of abdominal pain.The CT images showed no gas-containing pseudocyst in the epidural space and notably,he had no leg pain at the time.To ensure a low-intensity intervention and complete decompression of the nerve,percutaneous endoscopic lumbar nerve decompression surgery was advised.A gas-containing pseudocyst was identified under endoscopy.The symptoms were relieved after surgery,and the postoperative images showed total disappearance of the vacuum phenomenon and lesions with low signal intensity on CT and MRI.Histological examination showed that the sampled gas-containing pseudocyst tissue was fibrous connective tissue.CONCLUSION This case thoroughly illustrates that an epidural gas-containing pseudocyst can result in radiculopathic pain through a comprehensive evidence chain.Percutaneous endoscopic decompression is a minimally invasive and effective treatment method.

Anterior Discectomy and Fusion versus Posterior Foraminotomy in Treatment of Cervical Radiculopathy: A Comparative Prospective Study

Introduction: Cervical radiculopathy is caused by either cervical disc herniation or bone spurs due to cervical spine degeneration. It is common in middle aged and elderly patients. Those patients who are refractory to conservative treatment are candidates for surgical management. The surgical approaches for cervical radiculopathy are either anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). In spite of many reports on ACDF and PCF, only a few studies directly compare the outcomes of both techniques. Purpose: To compare anterior cervical discectomy and fusion (ACDF) with posterior cervical foraminotomy (PCF) for the treatment of cervical radiculopathy, regarding the surgical, clinical and radiological outcomes. Patient and methods: This is a prospective randomized controlled clinical study carried on 44 patients with unilateral cervical radiculopathy. They are divided into 2 groups;group (A) included 23 patients who underwent ACDF and group (B) included 21 patients who underwent PCF, with 1 year follow up. The patient age, sex, clinical manifestations, surgical outcomes as number of cervical level, operative time, blood loss, complications and length of hospital stay were recorded. Visual analogus scale (VAS) and neck disability index (NDI) were used for evaluation of clinical outcomes. Postoperative imaging was done after 1 year to detect instability or adjacent level degeneration. Chi-square and unpaired T-test were used to compare the mean values of both groups. Results: The mean age was nearly 45 years for both groups. C5-6 ACDF was the most common level in group (A), while C6-7 PCF was the most frequent operated level in group (B). PCF group had less operative time, blood loss and length of hospital stay than ACDF group. Clinical improvement of the mean values of VAS and NDI were more pronounced in PCF group as compared to ACDF group with statistically significant difference. No cases of cervical instability were recorded during the period of follow up. Conclusion: Posterior cervical foraminotomy is a safe and effective technique for the treatment of cervical radiculopathy as compared to anterior cervical discectomy and fusion. PCF has a shorter operative time, less hospital stay and better clinical outcome.

Analysis of Pain Scores and Rehabilitation of Patients with Cervical Spondylotic Radiculopathy Receiving Massage Combined with Traction and Ultrashort Wave

OBJECTIVE: To evaluate the pain scores and rehabilitation of patientis with cervical spondylotic radiculopathy receiving massage therapy combined with traction and ultrashort wave therapy. METHODS: A total of 84 patients with cervical spondylotic radiculopathy treated in 105 Hospital of People's Liberation Army from June 2014 to June 2017 were included and divided into study group and control group according to different treatment regimens. A total of 42 patients in the study group was treated with cervical traction, ultrashort wave and massage therapy at the same time, whereas the other 42 patients in the control group were only treated with cervical traction and ultrashort wave. Comparison of the clinical efficacy and adverse reactions of the 2 groups was made and the Visual Analogue Scale (VAS) scores before and after treatment were observed to assess the patient's pain. Comparison of rehabilitation in the 2 groups was made by applying the Clinical Assessment Scale for Cervical Spondylosis (CASCS). RESULTS: After comparing the therapeutic effect between the study group and the control group, it showed that the total effective rate (90.48%) in the study group was significantly higher than that in the control group (73.81%), the difference was statistically significant (P < 0.05). By comparing the incidence of adverse reactions in the study group and the control group, results showed that the incidence of adverse reactions such as nausea, palpitations, vomiting, sweating, dizziness and colorless complexion in the study group (9.52%) was significantly lower than that in the control group (21.43%), the difference was statistically significant (P < 0.05). After the treatment, the VAS pain scores of the study group and the control group were both significantly improved (P < 0.05), but the improvement of the patients in the study group was more significantly (P < 0.05), and the difference was statistically significant. After treatment, the CASCS scores of the patients in the study group and the control group were significantly improved (P < 0.05), but the improvement of the study group was more (P < 0.05), and there was statistically significant difference. CONCLUSION: The combination of massage, traction and ultrashort wave therapy can significantly reduce the pain and reduce the incidence of adverse reactions in patients with cervical spondylotic radiculopathy, which is of great clinical significance to the rehabilitation of patients.

Exploration on Clinical Effect of Traditional Chinese Medicine Rehabilitation to Treat Cervicalspondylotic Radiculopathy

The purpose of this paper is to study the clinical effect of using traditional Chinese medicine rehabilitation model to treat patientswith cervicalspondylotic radiculopathy.Choosing 84 patients with cervicalspondylotic radiculopathy, who used to be treated in our hospital,anddividing them into control group and treatment group by the way of random grouping,each group has 42 patients.The control group was treatedwith conventional therapy, and the treatment group was treated with rehabilitation therapy of traditional Chinese medicine.The time of symptomdisappearance of cervical spondylopathy of patients and total time of the implementation of treatment plan of the treatment group are shorterthan that of the control group,the difference between groups is remarkable（P〈0.05）;Only 2 adverse reactions occurred during the treatmentperiod,and only 4 patients relapsed within 3 months after treatment,this is significantly less than the 9 patients and 15 patients of the controlgroup,the difference is remarkable（P〈0.05）;The improvement range of clinical symptom score before and after treatment is greater than thatof the control group,difference between groups is remarkable（P〈0.05）;Total effective rate of treatment of cervicalspondylotic radiculopathyreaches 90.5%,which is higher than that of the control group（69.0%）,the difference is remarkable（P〈0.05）.Adopting traditional Chinese medicinerehabilitation model to treat patients with cervicalspondylotic radiculopathy can improve symptoms in a short period of time,reduce adversereactions,reduce the possibility of recurrence after treatment.

Intraneural ganglion cyst of the lumbosacral plexus mimicking L5 radiculopathy:A case report

BACKGROUND Intraneural ganglion cysts are benign gelatinous masses that form within the epineurium of a peripheral nerve.Only few cases of intraneural ganglion cyst arising from the hip joint have been reported.CASE SUMMARY A previously healthy 65-year-old woman who had been experiencing left buttock pain radiating to the dorsum of the foot for 2 years visited our clinic.Prior to visiting the clinic,she underwent lumbar spine magnetic resonance imaging and received physiotherapy,pain killers,and epidural injections based on a presumptive diagnosis of spinal stenosis for 2 years in other hospitals.Repeat magnetic resonance imaging revealed joint connection of the articular branch of the hip joint and rostral extension of the cyst along the L5 spinal nerve near the L5-S1 neural foramen.The patient was diagnosed with intraneural ganglion cyst arising from the articular branch of the hip joint based on high-resolution magnetic resonance neurography.Using the arthroscopic approach,a cystic opening within the intra-articular space was detected,and cyst decompression was then performed.The pain in the left leg was significantly relieved during the 6-mo follow-up.CONCLUSION Although intraneural ganglion cysts arising from the hip joint are rare,they can cause typical radicular pain and mimic common L5 radiculopathy.Typical cyst ascent phenomenon starting from the termination of the articular branch on magnetic resonance imaging is a crucial finding indicative of intraneural ganglion cysts arising from the hip joint.

MOTOR EVOKED POTENTIAL OF MAGNETIC STIMULATION IN THE DETERMINATION OF S_1 RADICULOPATHY

Motor evoked potentlal (MEP) elicited by magnetic stimulation was utilised to diagnose S1 radiculopathy non-invasively. Magnetic stimulation estimated motor nerve conduction time (MNCT), which was used in combination with F response recorded from soleus, allowed calculation of motor root conduction time (MRCT). 50 healthy controls and 30 patients with S1 radiculopathy were studied- The results showed that no difference was seen in MNCT in all patients, but MRCT were markedly prolonged in 87% of the patients, which was higher than the prolongation of F wave latency in 71% or the patients. it is concluded that MEP of magnetic stimulation is a useful technique for non-invasive diagnosis of S, radiculopathy.

ELECTRODIAGNOSIS OF LUMBOSACRAL RADICULOPATHY

For diagnosiug lumbosacral radicuiopathy precisely, electromyogram(EMG),nerve conduction velocity(NCV),conventional H reflex and H reflex by nerve root stimulation were done in 79 patients with clinical symptoms and signs of lumbosacral radiculopathy.The rate or appearance fibrillation voltage and/or positive sharp wave in the paraspinal muscles was the highest among them.In the comparison of the affected and the healthy sides in patients with S1 radlculopathy,and of affected side and control group,H-M wave interval of H reflex by nerve root stimulation were significantly prolonged(P<0.01,P<0.05);compared with control group,the dirference or H-M wave interval between the two sides was also significantly prolonged (P<0. 05).But the differences were not so significant in patients with L5 radlculopathy.The results suggest that the abnormal changes or EMG or the paraspinal muscles and H reflex by nerve root stimulation are reliable methods of diagnosing lumbosacral radiculopathy, H reflex by nerve root stimulation can be used to differentiate L5 and S1 nerve root lesions,and measure motor conduction velocity(MCV)and sensory conduction velocity(SCV) or the proximal sciatic nerve.

VALUE OF MOTOR EVOKED POTENTIALS BY MAGNETIC STIMULATION IN DIAGNOSIS OF LUMBOSACRAL RADICULOPATHY

Motor root conduction time(MRCT) was calculated by combining the magnetic stimulatiou eliciting motor evoked poentials (MEP)in lumbosacral region with F wave in popliteal rossa.Motor nerve conduction time(MNCT)and MRCT were calculated reliably from the tibialis and the soleal MEPS in 40 patients suffering from L5 or S1 radlculopathies owing to disc protrusion,and in 50 healthy controls.Meanwhile,corticals somatosensory evoked potentials(SEP)were recorded by segmental cutaneous nerve stimulation for comparison.The results showed that no differences were seen in MNCT in all patients,but MRCT was markedly prolonged in 85%or the patients,which was higher than the prolongation of SEP in 45% or the patients.It is concluded that magnetic stimulation of MEP is a useful technique ror non-invasive diagnosis of lumbosacral radlculopathies.

Detecting the nerve function of fibril in patients with cervicalspondylotic radiculopathy using quantitative sensory testing

BACKGROUND: Pain and sensory disability are greatly affected by subjective factors, there are no quantitative indexes to evaluate cervical spondylotic radiculopathy(CSR). The judgment on clinical body examination and chief complaint always causes nonobjective results with great individual differences. Quantitative sensory testing (QST) can be used to judge the nerve function of fibril. The application of QST for the quantitative evaluation of peripheral nervous system disease needs to be further studied. OBJECTIVE: The cold-thermal sensation and pain of patients with CSR are quantitatively analyzed by using QST technology in order to evaluate the nerve function of fibril in patients with CSR. DESIGN: Case-control observation. SETTING: Pain Center of Beijing Hospital of Ministry of Health. PARTICIPANTS: Twenty patients with CSR, including 8 males and 12 females, aged from 33 to 70 years, who received treatment between January and April 2005 in Pain Center of Beijing Hospital of Ministry of Health were involved in CSR group. All the involved patients presented symptoms in unilateral upper extremity (left side 10 patients, right side 10 patients). They did not undergo physical therapy or nerve block therapy in 1 week before examination. Eight non-CSR patients who received treatment in Pain Center concurrently were involved in the control group (2 patients with trigeminal neuralgia, 4 with osteoarthrosis of knee joint and 2 with lumbar intervertebral disc protrusion), and another 12 healthy volunteers were involved. Four non-CSR patients and 12 healthy volunteers, 8 male and 12 female, were aged from 23 to 75 years. The informed consents were obtained from all the involved subjects. METHODS: The volar thresholds of cold sensation, thermal sensation, cryalgesia of thenar eminence of both upper extremities of all the subjects were examined separately by limit method with type TSA-Ⅱ temperature sensation analysator made by Medco Company (Israel). The subjects were pre-examined to be familiar with the method for sensory discrimination and affirmation. Thenar eminence vola of bilateral upper extremities were detected. The infrared detector of a semiconductor was contacted with skin. The infrared detector could be used to heat and cool skin. A group of cold-heat water circulation device was given electric current to produce temperature gradient, which was higher or lower than skin temperature. The initial temperature of infrared detector was 32 ℃, stimulation temperature was increased or decreased progressively at 1 ℃/s, and temperature change range was 0 to 50 ℃. In the first step, subjects pressed down the button to stop the stimulation when the temperature of infrared detector was decreased progressively until the subjects felt, and the threshold of cold sensation was obtained; In the second step, the threshold of thermal sensation was obtained when the temperature of infrared detector was increased progressively until the subjects felt; In the third step, the threshold of cryalgesia was obtained when the temperature of infrared detector was decreased progressively until subjects felt; and in the fourth step, the threshold of thermalgesia was obtained when the temperature of infrared detector was increased progressively until subjects felt. Each step was conducted 4 times and the mean threshold was obtained. Before each measurement, the temperature was made to rebound to the initial temperature and kept for 10 s. MAIN OUTCOME MEASURES: The thresholds of cold sensation, thermal sensation and cryalgesia, thermalgesia of thenar eminence vola of bilateral upper extremities of all the subjects. RESULTS: Twenty patients with CSR and 20 healthy subjects participated in the final results. ① In the CSR group, the threshold of cold sensation of affected side was lower than that of intact side [(29.00±1.26) ℃ vs.(30.00±1.06) ℃, P < 0.05], and the threshold of thermal sensation of affected side was higher than that of intact side [(35.04±0.87) ℃ vs. (34.14±0.99) ℃, P < 0.05]. There were no significant differences in the thresholds of cold and thermal sensation between affected side and intact side (P > 0.05). ②In the CSR group, the difference of threshold of cold sensation, thermal sensation, cryalgesia and thermalgesia between affected side and intact side was (-1.01±0.57), (0.89±0.39), (2.49±1.10) and (-1.62±0.86) ℃, respectively , the absolute value of which was higher than that of control group, respectively [(0.04±0.28),(0.05±0.26),(0.28±1.79),(0.17±1.10) ℃,P < 0.01]. In the CSR group, the threshold of cold sensation and thermalgesia of affected side was lower than that of intact side, respectively; and the threshold of thermal sensation and cryalgesia of affected side was higher than that of intact side, respectively. CONCLUSION: The superficial sensation of affected extremity of patients with CSR is lessened as compared with that of intact extremity. There are dysfunctions of small myelinated fiber (Aδ fiber) and demyelinated fiber (C fiber) in the affected-side extremity. QST, as a mean for quantitatively evaluating the function of Aδ fiber and C fiber, plays an objective evaluative role in the diagnosis and therapeutic effect observation of CSR.

Assessment of Glycosaminoglycan Content of Lumbar Intervertebral Discs in Patients with Radiculopathy

Objective: To assess glycosaminoglycan (GAG) content of lumbar intervertebral discs (IVDs) in patients with radiculopathy compared with healthy volunteers with glycosaminoglycan chemical exchange saturation transfer (gagCEST). Methods: The lumbar spines of 15 patients with radiculopathy (9 women, 6 men;mean age 45 years;range: 19 - 80 years) and 13 healthy controls (10 women, 3 men;mean age 29 years;range: 19 - 38 years) without lumbar back pain or previous spine surgery were examined at a 3 Tesla (T) magnetic resonance imaging (MRI) scanner in this prospective study. The MRI protocol included standard morphological, sagittal, and transverse T2-weighted (T2w) images of the five lumbar IVDs (L1-S1) to assess Pfirrmann score and to detect disc disorders according to the Combined Task Force classification. To analyze biochemically the lumbar IVDs, a gagCEST sequence was applied to measure the GAG content of the nucleus pulposus (NP) and annulus fibrosus (AF). Results: Patients with radiculopathy indicated significantly lower gagCEST values in NP than healthy volunteers (2.82% &plusmn;3.12% vs. 4.09% &plusmn;2.25%, P = 0.017). The GAG content of AF showed no significant difference between volunteers and patients (2.66% &plusmn;2.01% vs. 1.92% &plusmn;2.56%;P = 0.175). Conclusions. Patients with radiculopathy presented with lower GAG values than healthy volunteers in NP, indicating an association between pain and IVD degeneration. gagCEST of lumbar IVDs is a powerful, non-invasive tool to investigate early disc degeneration, which we could demonstrate in the NP in our study collective.

Lumbar Facet Cyst Causing S1 Radiculopathy with Concomittent Acute on Chronic Cervical Prolapse Intervertebral Disc, a Rare Case Report

Tandem spinal stenosis is described as concurrent symptomatic cervical and lumbar spinal stenosis. The clinical presentation includes neurogenic claudication, gait disturbance, myelopathy and polyradicuopathy in both upper and lower limbs. A 43-year-old female presented with predominant low back pain with right S1 radiculopathy leading to diagnosis of synovial facet cyst of lumbar spine. She was managed surgically after medical treatment failed. After 1 week post operatively, she presented with severe neck pain with left radiculopathy. MRI revealed acute on chronic cervical prolapsed intervertebral disc, cervical decompression surgery proceeded. Post operative improvement was noted on follow up. We report a case of tandem spinal stenosis, which both of the pathologies were managed with endoscopic approach.

Current challenges in diagnosis of lumbar radiculopathy

Lumbar radiculopathy(LR) is a term used to describe a pain syndrome caused by compression or irritation of nerve roots in the lower back. The surgery cost for LR increased by 23% annually during 1992-2003 in the developed country. Although it is one of most common complaints in clinical practice, the diagnosis for LR is still very challenging. Here we discuss the current tools of LR diagnosis and highlight the needs to develop new diagnosis tools for LR.

Advances in modern Chinese medicine treatment of cervical spondylotic radiculopathy

Objective: On the basis of a brief description of the current research status of modern Chinese medicine on the name, etiology, pathogenesis and classification of cervical spondylotic radiculopathy, this paper summarizes the research progress of modern Chinese medicine treatment of cervical spondylotic radiculopathy from the perspective of modern Chinese medicine treatment. This article mainly summarizes the following aspects: modern Chinese medicine for internal and external use;Chinese medicine acupuncture with filiform needle, electro-acupuncture and warm moxibustion;Chinese medicine massage and acupoint therapy;moxibustion, cupping, scraping and other comprehensive treatment;and Chinese medicine comprehensive therapy. The purpose of this article is to provide references for modern Chinese medicine treatment of cervical spondylotic radiculopathy.

Evaluation of the quality of randomized controlled trials on exercise for cervical radiculopathy

Objective:To review and evaluate the quality of the randomized controlled trials of exercise for the treatment of cervical radiculopathy with the present internationally recognized CONSORT statement, which provides reference and basis for the improvement of clinical research on exercise for intervening cervical radiculopathy in the future.Methods: A computer-based search of large domestic databases, including CNKI, Wanfang database and VIP database screened out literature that meet the requirements and used CONSORT statement for quality assessment.Results: According to the prescribed inclusion and exclusion criteria, 30 articles were retrieved in accordance with the standard. No literature was referred to the randomized controlled trial, 2 documents clearly defined the type of test design, 1 documents carried out the calculation of sample size, 13 documents clearly randomly assigned, 1 literature implemented the blind method, in the 7 literature, baseline information was shown in tabular form, and no reference was made to trial registration, trial protocol and funding.Conclusion:There are some aspects of randomized controlled trials on exercise for the treatment of cervical radiculopathy. However, there are some aspects that need to be improved. In the future randomized controlled trial report, the CONSORT statement should be highly valued and carefully considered to improve the accuracy and credibility of the research.

Persistent Post-Operative Low Back Pain, True Radiculopathy and Pseudoradiculopathy: Retrospective Observational Study and Point of View of a Practicing Clinician

Purpose: Persistent Postoperative Low Back Pain (PLBP) is inordinately common, and has been attributed to various pre-operative and post-operative anatomical and mechanical factors in the spine. It may or may not be associated with sensory symptoms in the lower extremities—frequently termed “radiculopathy”—with or without Electromyographic (EMG) or imaging abnormalities. The present study aimed to look at these various symptoms in the lower extremities from a different angle and perspective and to clarify the distinction between true radiculopathy and pseudoradiculopathy;and determine their possible relationship with the outcome of surgery. Methods: Medical records of twenty-four patients with PLBP who were referred to the author for clinical and electrodiagnostic examinations several months after surgery were reviewed. Clinical symptomatology, with special reference to the presence or absence of sensory and motor deficits together with EMG findings, were reviewed and categorized into 4 groups: non radicular, true radiculopathy, pseudoradiculopathy, and peripheral neuropathy. Results: Lower Back Pain (LBP) in all patients persisted following successful and uncomplicated surgery. LBP in patients with true radiculopathy persisted but was less disabling when the neurologic deficits resolved partially or significantly. As expected, the neurologic deficits related to peripheral neuropathy, together with LBP, remained persistent. Conclusion: LBP and various sensory and motor symptoms in the lower extremities are 2 distinct entities, both clinically and pathophysiologically. These sensory and motor symptoms, together with the heightened activity of various pro-inflammatory cytokines and neurotrophins—setting aside the various anatomical and mechanical factors in the spine—can influence the outcome of surgery, favorably or unfavorably.

Minimally Invasive Widening of the Facet Joints in Cervical Radiculopathy by Modified Needles： Technical Report

Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects, we devised a new minimally invasive treatment method that widens the facet joints to decompress nerve roots and release the muscle spasm in cervical radiculopathy with acupuncture needles with blunt tip and mini-scalpel, and named it modified acupuncture procedure. MAP （Modified acupuncture procedure） was administered for 37 patients （mean age = 53.1 years, follow-up = 14.2 months） with cervical radiculopathy who did not recover from 4 weeks of nonsurgical treatment. We analyzed clinical outcomes of patients before and after the procedure through VAS （Visual Analogue Scale） and NDI （Neck Disability Index）. On average, patients received 1.4 MAP （modified acupuncture procedures）. The VAS score difference on the day after procedure and at 1 year follow-up was 36.8 ± 26.5 （from 60.1 ± 25.3 at the baseline to 25.3 ± 17.8 at the reading） （P 〈 0.01） and 31.0 ± 30.4 （29.0 ± 21.8 at the reading） respectively. The NDI value dropped by 19.9 ± 18.3 （from 37.2 ± 19.7 at the baseline to 17.2 ± 15.0 at the reading） （P〈 0.01） on 1 year follow up. MAP was found to have clinical efficacy for cervical radiculopathy.