Advances in Cervical Artificial Disc Replacement for Cervical Spondylosis

Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusion segment-associated postoperative complications emerged gradually.Reserved cervical stability and activity,the concept of non-fusion was born.As a non-fusion technique,cervical artificial disc replacement(CADR)developed rapidly.With the continuous development of artificial prosthesis materials and design concepts,and specification and proficiency of surgical procedures,CADR has achieved better short and mid-term clinical efficacy than ACDF.Compared with ACDF,the main advantages of CADR are that the postoperative recovery is quick,the activity and stability of cervical vertebra are maintained,the height of cervical intervertebral space is restored,and the stress of adjacent segments and the rate of surgical renovation are reduced.In clinical work,as an emerging technology,CADR requires spine surgeons to control the surgical indications,contraindications,and patients'conditions strictly.This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.

Research Updates of Traditional Rehabilitation Therapy in Treating Cervical Spondylosis

Cervical spondylosis has many obvious symptoms.Through literature reviews and hospital visits and collecting information under the guidance of our instructors,three methods of traditional rehabilitation therapy are reviewed in this study:massage,cupping,and Gua Sha.Information regarding cervical spondylosis was sorted out,from the causes of the disease and treatment methods to precautionary measures,which are discussed in this paper.

Acupuncture-based treatments on cervical spondylosis of vertebral artery type

Cervical spondylosis of vertebral artery type is one of the chief patterns of cervical spondylosis.It is often described as neck pain accompanied with radiating pain and neurologic symptoms,such as sudden dizziness,blurred vision,tinnitus,nausea,vomiting,memory loss,and sudden fainting.The incidence of cervical spondylosis increases and patients with cervical spondylosis become progressively younger.Acupuncture in the cervical spondylosis of vertebral artery type treatment has a local positive reaction“Liuhe point”,in order to dredge the local Qi and blood.More and more evidences into the effectiveness and safety of cervical spine acupuncture for cervical spondylosis,specific neck pain,cervical radiculopathy,etc.This article summarizes the recent literature on acupuncture and acupuncture combined with other therapies for cervical spondylosis of vertebral artery type treatment and provides a comprehensive review from the perspectives of acupuncture therapy,warm needle moxibustion therapy,electroacupuncture,and acupuncture combined with other therapies,in order to provide reference and reference for clinical treatment.

Acupuncture of different stimulation for the treatment of neck type cervical spondylosis:a randomised controlled trial

Objective:To observe the difference in clinical efficacy of acupuncture with strong and weak stimulation in treating neck type cervical spondylosis.Methods:64 patients with neck type cervical spondylosis were randomly divided into strong stimulation group and weak stimulation group,with 32 cases in each group.The acupoints selected are Jingjiaji 5-7(cervical acupoints EX-B2 C5-C7),Tianzhu(BL10)on both sides,Houxi(SI3)on both sides,Hegu(LI4)on both sides,Geshu(BL17)on both sides,and Ashi.In the strong stimulation group,deep needling with 0.25 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method.The twisting angle was 90°-180°,the frequency was 60-90 times/min,and the needles were applied for 1 min at each point.Keep the needle for 30 minutes,twisting was performed every 10 min during the retention period.Change hands once.In the weak stimulation group,shallow acupuncture with a 0.18 mm×40 mm milli-needle was performed,with a mild reinforcing-reducing method,with a twisting angle of 60°-90°,a frequency of 30-60 times/min,and acupuncture for 10 seconds at each acupoint.Keep the needle for 30 minutes,and no needle during the retention period.Patients in both groups were treated once every 1 to 2 days,3 times a week for 2 weeks,and followed up for 1 month after all treatments.The two groups of patients were compared before and after treatment and during follow-up.The McGill pain questionnaire score and the cervical spine dysfunction index score were compared to determine the clinical efficacy.Statistical analysis was performed using SPSS 22.0 statistical software.Results:1 case drop-out in the strong stimulation group and 1 case in the weak stimulation group.The total effective rate of the strong stimulation group was 90.32%,the total effective rate of the weak stimulation group was 83.87%,and the total effective rate of the strong stimulation group was higher than that of the weak stimulation group(P<0.05).The total scores of the short-form McGill pain questionnaire,the VAS score,and the cervical spine dysfunction index scores of the two groups of patients were significantly lower than those of this group before treatment,and the difference was statistically significant(P<0.05).The total scores of the short-form McGill pain questionnaire,visual analogue scale score,and cervical spine dysfunction index scores of the strong stimulation group after treatment and follow-up were significantly lower than those of the weak stimulation group(P<0.05).Conclusion:Acupuncture with strong and weak stimulation can effectively treat patients with cervical spondylosis,and deep acupuncture with filiform needles and strong stimulation have better effect.

Clinical observation on the treatment of sympathetic cervical spondylosis with meridian acupoint massage combined with curvature traction

Objective:To evaluate the clinical effect of meridian acupoint massage combined with curvature traction on sympathetic cervical spondylosis its influence on heart rate variability and norepinephrine concentration.Methods:80 patients with sympathetic cervical spondylosis were divided into the treatment group and control group randomly,with 40 patients in each group.Patients in the two groups were treated with massage on the basis of curvature traction.Among them,the treatment group was treated with meridian acupoint massage,while the control group was treated with routine massage.Each subject was treated once a day for 2 weeks.Before and after treatment,VAS,NRS,"20 score method",NDI,JOA,and Borden's method were used to evaluate the pain,sympathetic symptoms and cervical function of the two groups.At the same time,the changes of RR interval standard deviation and urine noradrenaline concentration were also observed.Finally the clinical efficacy of the two groups were evaluated.Results:The cure rate of the treatment group was 62.50%,while it was 40.00%in the control group,and the effective rate of the treatment group was 95.00%,the total effective rate of the control group was 80.00%,the treatment group was superior to the control group in both cure rate and total effective rate(P<0.05).During post-therapy,VAS score,NRS score,sympathetic symptom score,cervical physiological curvature,NDI score,and noradrenaline concentration in urine in both groups were lower than those of pre-treatment(P<0.01),JOA score and heart rate variability SDNN value were significantly higher(P<0.01),and the treatment group was superior to the control group(P<0.01).Conclusion:Meridian acupoint massage combined with curvature traction has a significant clinical effect on sympathetic cervical spondylosis,which is worth further promotion and application.

Research Progress of Traditional Chinese Medicine Constitution Theory in Patients with Cervical Spondylosis

This paper expounds the theory of traditional Chinese medicine(TCM)constitution applied to patients with cervical spondylosis,in order to clarify the distribution characteristics of TCM constitution of patients with cervical spondylosis.And to analyze the correlation between TCM constitution theory and cervical spondylosis is helpful to provide ideas for integrated nursing care of TCM and western medicine in patients with cervical spondylosis,and provide the basis for the construction of health management program and the evaluation of health promotion effect.

Massage Treatment for Spinal cord of Cervical Spondylosis

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Potential Mechanism of Huangqi Guizhi Wuwu Decoction for Cervical Spondylosis treatment based on Network Pharmacology

Objective:To study the potential mechanism of Huangqi Guizhi Wuwu Decoction in the treatment of cervical spondylosis based on the network pharmacological method,and to provide a basis for clinical application and pharmacological research.Methods:TCMSP search was used to screen the main active compounds and related action targets of Huangqi Guizhi Wuwu Decoction,the standard names of action targets were obtained through the Uniprot database,and the"drug-target"interaction network was constructed by using Cytoscape3.6.1 software.The related targets of cervical spondylosis were obtained by searching GeneCards,OMIM,DisGeNET,and CTD databases,and the disease targets and drug targets were mapped by the Venny platform,and the intersection genes of them were the potential targets for drug treatment of this disease.Then,the intersection genes were input into the STRING database and Cytoscape 3.6.1 software,and the protein-protein interactions(PPI)network of"drug-disease intersection targets"was constructed,and we screened the core targets.Finally,GO biological function analysis and KEGG signaling pathway analysis of core targets were carried out through the DAVID database.Results:According to the screening conditions,74 effective compounds and 138 drug action targets of Huangqi Guizhi Wuwu Decoction were obtained,12179 genes related to cervical spondylosis were obtained,and the Venny platform analysis obtained 105 intersecting targets.With visual network processing by Cytoscape software,33 core targets were obtained by analyzing and calculating the core target degree values,which were JUN,PTGS2,NR3C1,TNF,IL6,TP53,EGFR,VEGFA,NOS3,IL1B,and so on.GO analysis showed that there were 133 items(P<0.05),involving adrenergic receptor activation,neurotransmitter receptor activation,nuclear receptor activation,catecholamine binding,etc.KEGG analysis obtained a total of 139 pathways(P<0.05),involving IL-17 signaling pathway,and tumor necrosis factor signaling pathway,relaxin signaling pathway,AGE-RAGE signaling pathway of diabetic complications,fluid shear stress,and atherosclerosis.Conclusion:the active components in Huangqi Guizhi Wuwu decoction may act on the core targets such as JUN,PTGS2,NR3C1,TNF,IL6,TP53,VEGFA through IL-17 signal pathway,tumor necrosis factor signal pathway,and AGE-RAGE signal pathway of diabetic complications,and exert their therapeutic effects.The research results can provide a basis for future basic and clinical research.

Clinical Application Value and Satisfaction Analysis of Physical Therapy in rehabilitation treatment of cervical spondylosis

Objective:To analyze the clinical value and nursing satisfaction of physical therapy in the rehabilitation of patients with cervical spondylosis.Methods:From November 2019 to November 2020,84 patients with cervical spondylosis were randomly divided into two groups.Group A was given physical therapy,while group B was not given physical therapy.The differences of curative effect,cervical function,quality of life score and nursing satisfaction between the two groups were analyzed.Results:The curative effect of group A was 97.62%higher than that of group B 83.33%,P<0.05;The score of cervical function in group A(8.09±1.75)was higher than that in group B(8.09±1.75),P<0.05;The scores of quality of life in group A were better than those in group B(P<0.05);The nursing satisfaction of group A was 95.24%,which was better than that of group B 78.57%,P<0.05.Conclusions:Physical therapy intervention for patients with cervical spondylosis can improve nursing satisfaction and cervical function,which can be widely used.

Wet Cupping Therapy Improves Local Blood Perfusion and Analgesic Effects in Patients with Nerve-Root Type Cervical Spondylosis

Objective： To observe wet cupping therapy（WCT） on local blood perfusion and analgesic effects in patients with nerve-root type cervical spondylosis（NT-CS）. Methods： Fifty-seven NT-CS patients were randomly divided into WCT group and Jiaji acupoint-acupuncture（JA） group according a random number table. WCT group（30 cases） was treated with WCT for 10 min, and JA group（27 cases） was treated with acupuncture for 10 min. The treatment efficacies were evaluated with a Visual Analogue Scale（VAS）. Blood perfusion at Dazhui（GV 14） and Jianjing（GB 21） acupoints（affected side） was observed with a laser speckle flowmetry, and its variations before and after treatment in both groups were compared as well. Results： In both groups, the VAS scores significantly decreased after the intervention（P〈0.01）, while the blood perfusion at the two acupoints significantly increased after intervention（P〈0.05）; however, the increasement magnitude caused by WCT was obvious compared with JA（P〈0.05）. Conclusion： WCT could improve analgesic effects in patients with NT-CS, which might be related to increasing local blood perfusion of acupunct points.

Analysis on the Effect of Acupuncture in Treating Cervical Spondylosis with Different Syndrome Types

Objective:To observe the clinical effect of acupuncture in treating cervical spondylosis with different syndrome types.Methods:One hundred and seventeen patients were randomized into the treated group (59 cases),treated with normal acupuncture,and the control group(58 cases),treated with sham acupuncture, operated once every other day,9 times in total(in 18 days) as one therapeutic course,and a succeeding 3-month follow-up study was carried out after terminating the therapy.The efficacy of treatment was eva...

Application of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis

Background Airway management is crucial in clinical anesthesia.Many complications associated with airway management result from unexpected difficult airway,but predicting a difficult airway is a major challenge.We investigated the efficacy of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis,a population with a high incidence of difficult airway.Methods We randomly enrolled 303 patients scheduled for elective surgery for cervical spondylosis at Peking University Third Hospital between August 2012 and March 2013.Preoperatively,patients were evaluated for difficult airway according to a clinical index and parameters on lateral cervical radiographs and magnetic resonance images.Difficult airway was defined as Cormack-Lehane grades Ⅲ-Ⅳ.Logistic regression was used to identify a combined （clinical and radiological） model for difficult airway.A receiver operating characteristic （ROC） curve was used to describe the effectiveness of prediction.Results We identified three clinical predictive factors using the ROC curve：mouth opening,stemomental distance,and neck mobility.We created a clinical model using three factors：gender,age,and mouth opening,with odds ratios （OR） of 0.370,1.034,and 0.358,respectively.Using the clinical and radiological parameters,we formulated a combined model with five risk factors：gender,mouth opening,atlanto-occipital gap,the angle from the second to sixth cervical vertebraes in the neutral position,and the angle difference of δ （the angle between the laryngeal axis and the epiglottic axis） from the neutral position to extension （OR：0.107,0.355,0.846,1.057,and 0.952,respectively）.The sensitivity and specificity of the combined model were 80.0％ and 65.7％,respectively,and the ROC curve confirmed that the combined model was better than any single clinical predictor and the clinical model.Conclusion The efficacy of the combined model including both clinical and radiological indicators was better than any single clinical predictor or the clinical model in patients undergoing elective surgery for cervical spondylosis.

Neuromyelitis Optica Spectrum Disorder Associated with Cervical Spondylosis

Neuromyelitis optica spectrum disease （NMOSD） refers to a group of related disease, in which potential pathogenesis is similar to neuromyelitis optica （NMO）, but clinical involvement does not exactly correspond to the diagnosis of NMO. Owing to varied clinical manifestations, it is apt to be misdiagnosed. We report a case of NMOSD with cervical spondylosis and discuss the experience of diagnosis.

Application of a modified surgical position in anterior approach for total cervical artificial disc replacement

BACKGROUND Total cervical artificial disc replacement(TDR)has been considered a safe and effective alternative surgical treatment for cervical spondylosis and degenerative disc disease that have failed to improve with conservative methods.Positioning the surgical patient is a critical part of the procedure.Appropriate patient positioning is crucial not only for the safety of the patient but also for optimizing surgical exposure,ensuring adequate and safe anesthesia,and allowing the surgeon to operate comfortably during lengthy procedures.The surgical posture is the traditional position used in anterior cervical approach;in general,patients are in a supine position with a pad under their shoulders and a ring-shaped pillow under their head.AIM To investigate the clinical outcomes of the use of a modified surgical position versus the traditional surgical position in anterior approach for TDR.METHODS In the modified position group,the patients had a soft pillow under their neck,and their jaw and both shoulders were fixed with wide tape.The analyzed data included intraoperative blood loss,position setting time,total operation time,and perioperative blood pressure and heart rate.RESULTS Blood pressure and heart rate were not significantly different before and after body positioning in both groups(P>0.05).Compared with the traditional position group,the modified position group showed a statistically significantly longer position setting time(P<0.05).However,the total operation time and intraoperative blood loss were significantly reduced in the modified position group compared with the traditional position group(P<0.05).CONCLUSION The clinical outcomes indicated that total operation time and intraoperative blood loss were relatively lower in the modified position group than in the traditional position group,thus reducing the risks of surgery while increasing the position setting time.The modified surgical position is a safe and effective method to be used in anterior approach for TDR surgery.

Cervical intervertebral disc degeneration and dizziness

Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness.Anterior cervical surgery can eliminate not only chronic neck pain,cervical radiculopathy or myelopathy,but also dizziness.Immunohistochemical studies show that a large number of mechanoreceptors,especially Ruffini corpuscles,are present in degenerated cervical discs.The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease(i.e.cervical discogenic dizziness).Disc degeneration is characterized by an elevation of inflammatory cytokines,which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization.Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system,resulting in sensory mismatches with vestibular and visual information and leads to dizziness.In addition,neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles.Like cervical discogenic pain,the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out.Conservative treatment is effective for the majority of patients.Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.

THE CHANGE AND SIGNIFICANCE OF ENDOTHELIN IN SERUM OF VERTEBRAL ARTERIAL INSUFFICIENCY TYPE ERVICAL SPONDYLOSIS

we studied 30 vertebral arterial insufficiency type cervical spondylosis patients and 30sex and age matched healthy controls by detecting their serum endothelin (ET) levels with radioimmuuoassay (RIA).At the same time, we selected 20 severe patients for operation therapy,and compared their serum ET levels before and after operation.The results showed that 30 patients had higher ET levels [(119. 46±58.65)ng/L] than those of the controls [(38. 43±14.33)ng/L], and the 20 patients had higher ET levels before operation [(139. 34±52. 56)ng/L] than after operation [(50.84±21. 67)ng/L)].Both have statistical significance (P<0.001 ).Therefore, we think that serum ET is one or important humoral factors contributing to vertebral arterial insufficiency type cervical spondylosis.It may be useful in treating verteibral arterial insufficiency type cervical spondylosis with effective ET-antibody, inhibitor or ET converting enzyme and special ET receptor blocker.

The effect of Shufengzhitong decoction combined with four cervical needles on cervical spondylotic radiculopathy and leukotriene and inflammatory factors

Objective:To investigate the effect of shufengzhitong decoction combined with four cervical needles on cervical spondylotic radiculopathy(CSR)and leukotriene and inflammatory factors.Methods:110 patients with CSR were randomly divided into two groups,with 55 in each group.There was no significant difference in baseline data between the two groups(P>0.05).The control group were treated with Shufeng Zhitong decoction orally,and the treatment group were treated with four neck acupuncture on the basis of the control group.Neck pain scale score(NPQ),Cervical spondylosis clinical evaluation scale score(CASCS)Cervical range of motion score(CROM),Emg surface signal and serum Levels of leukotriene B4(LTB4),leukotrieneC4(LTC4),leukotrieneD4(LTD4),interleukin(IL)-1β,tumor necrosis factor-alpha(TNF-α),IL-6,IL-8 and IL-18 were compared before and after treatment.The clinical effect of the two groups was compared.Results:NPQ of the treatment group was lower than that of the control groupafter treatment(P<0.01),the scores of CASCS and CROM were higher than those of the control group(P<0.01),the median frequency of surface EMG signal of biceps brachii and superior trapezius muscle were higher than those of the control group(P<0.01),the levels of serum LTB4,LTC4,LTD4,IL-1β,TNF-α,IL-6,IL-8 and IL-18 were lower than those of the control group(P<0.01),the clinical effect was better than that of the control group(P<0.05),and the differences were statistically significant.Conclusion:Shufengzhitong decoction combined with cervical four acupuncture can effectively alleviate the symptoms of cervical spondylosis,regulate the myoelectric signal of muscle surface,reduce the content of leukotriene in serum,reduce the expression of inflammatory factors,and it has a significant effect on the treatment of CSR.

Development of a Rehabilitation Instrument of Neurological Training for Cervical Spine

Objective: To develop a kind self active resistance movement training equipment for cervical spine, so as to restore the dynamic balance of the front and back muscle strength of the cervical spine in order to correct the abnormal physiological radian of the cervical spine, thereby relieving the clinical symptoms. Methods: The air spring with adjustable strength was used to provide the power of resistance active movement, and the neurological training cervical audio-visual synthesis training software was used to automatically guide patients to perform resistance active movement training of the cervical spine. Thirty two patients with cervical spondylosis were enrolled for treatment, and SPSS26 was used to statistically analyze the VAS, Lovett muscle strength, head and neck range of motion and C2-3 vertebral body curvature before and after the treatment. Result: There were significant differences in posterior cervical muscle strength (Lovett), dizziness, shoulder and neck pain (VAS) and C2-3 vertebral curvature before and after training in 32 patients (p˂0.001). Conclusion: The application of neurological training cervical vertebra self rehabilitation training instrument can effectively relieve clinical symptoms, restore head and neck range of motion, improve nape muscle strength, restore the dynamic balance of front and rear cervical muscle strength, and also can correct the abnormal physiological radian of the cervical vertebra.

Shikani Optical Stylet versus Macintosh Laryngoscope for Intubation in Patients Undergoing Surgery for Cervical Spondylosis： A Randomized Controlled Trial

Background： Airway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Styler （SOS） has become increasingly popular in difficult airway. We compared the effects ofintubation with SOS versus Macintosh laryngoscope （MLS） in patients undergoing surgery for cervical spondylosis. Methods： A total of 270 patients scheduled for elective surgery for cervical spondylosis of spinal cord and nerve root type from August 2012 to January 2016 were enrolled and randomly allocated to the MLS or SOS group by random numbers. Patients were evaluated for difficult airway preoperatively, and Cormack-Lehane laryngoscopy classification was determined during anesthesia induction. Difficult airway was defined as Cormack-Lehane Grades IlI IV. Patients were intubated with the randomly assigned intubation device. The success rate, intubation time, required assistance, immediate complications, and postoperative complaints were recorded. Categorical variables were analyzed by Chi-square test, and continuous variables were analyzed by independent samples t-test or rank sum test. Results： The success rate of intubation among normal airways was 100% in both groups. In patients with difficult airway, the success rates in the MLS and SOS groups were 84.2% and 94.1%, respectively （P = 0.605）. lntubation with SOS took longer compared with MLS （normal airway： 25.1 ± 5.8 s vs. 24.5 ± 5.7 s, P = 0.426; difficult airway： 38.5± 8.5 s vs. 36.1 ±8,2 s, P = 0.389）. Intubation with SOS required less assistance in patients with difficult airway （5.9% vs. 100%, P 〈 0.001 ）. The frequency of postoperative sore throat was lower in SOS group versus MLS group in patients with normal airway （22.0% vs. 34.5%, P =0.034）. Conclusions： SOS is a sale and effective airway management device in patients undergoing surgery for cervical spondylosis. Compared with MLS, SOS appears clinically beneficial for intubation, especially in patients with difficult airway. Trial Registration： Chinese Clinical Trial Registry, ChiCTR-IOR- 16007821 ; http：//www.chictr.org.cn/showproj.aspx？proj-13203.

Operation rules of scraping technique

Traditional Chinese medicine scraping is a kind of natural therapy with a long history of simple and safe operation.It is easy to learn and tools are readily available,so that it has a very wide range of practical value.This paper introduces the definition and indications,function and standardization process of scraping technology,the technical operation specifications and matters needing attentions,as well as the application method of scraping technology,with a view to providing reference for clinical use of scraping technology in the treatment of cervical spondylosis,periarthritis of shoulder,lumbar muscle strain,hypertension,chloasma,and other diseases.