Pregnancy Outcomes Following Transvaginal Cerclage for Cervical Insufficiency：Results From a Single-center Retrospective Study

To study maternal and perinatal outcomes after cervical cerclage in both singleton and twin pregnancies,we retrospectively reviewed women undergoing cervical cerclage for cervical insufficiency at Tongji Hospital,Wuhan,China from January 1,2010 to July 31,2015 to evaluate primary and secondary outcomes for subgroups with cervical length（CL） ≤15,〉15 to 〈25,and ≥25 mm.Of 166 patients who underwent cervical cerclage,after exclusion of patients with missed abortion and continuing pregnancy,141 patients（121 singleton and 20 twin pregnancies） were included in the analysis.Mean gestational age at birth was 34.22 and 28.27 weeks for singleton and twin pregnancies,respectively.There were 17（14.05%） and 13（33.33%） neonatal deaths in singleton and twin pregnancies,respectively.Mean age（31.60±4.62 vs.31.22±4.63 years,P=0.39） and gestational weeks at cerclage（18.50±4.62 vs.19.31±4.99,P=0.47） were similar for both groups.Mean gestational weeks at delivery（34.22±5.77 vs.28.27±6.17,P〈0.001） and the suture to delivery interval（15.72±7.15 vs.8.96±6.70,P〈0.001） were significantly longer in the singleton group.These variables indicate a linear negative correlation with the degree of CL shortening,with better outcomes in patients with CL ≥25 mm who underwent cerclage,both in singleton and twin pregnancies.No difference in mode of delivery existed between the singleton group and twin group.Our results indicate a high risk of preterm delivery in both groups,especially in the twin group.Patients with a history of preterm labor and CL 〉25 mm in the current pregnancy,possibly in a twin pregnancy,could benefit from elective cervical cerclage;however,cervical cerclage was inadvisable for twin pregnancies with a CL 〉15 and 〈25 mm.Our data emphasize the importance of re-evaluating the efficacy of cervical cerclage for twin pregnancies in well-designed clinical trials.

CERVICAL PLEXUS PUNCTURING PLUS MOXIBUSTION FOR TREATMENT OF 78 CASES OF CERVICAL VERTIGO

Objective: To observe the effect of puncturing cervical plexus plus moxibustion in treatment of cervical vertigo. Methods: 78 inpatients were randomly divided into acupuncture + moxibustion (acumoxi) group (n = 40) and Western medicine (control) group (n =38). Acupuncture needles were inserted separately into the points about 0. 5 cun beside the spinous processes of the cervical vertebral1-7. Results: The cure rates and total effective rates of acumoxi group and control group were 70.00%, 95.00%, 31 . 58% and 92% respectively, with the cure rate of the acumoxi group being significantly higher than that of control group (P<0.05). After treatment, the mean velocity of blood flow of the vertebral artery and basal artery decreased significantly (P <0.05, 0.01) . Conclusion: Acupuncture of cervical plexus plus moxibustion is effective definitely in treatment of cervical vertigo and superior to that of control group.

Spontaneous Cervical Epidural Hematomas in Mild Cervical Spondylotic Myelopathy Patients：An Analysis of 8 Cases

Spontaneous cervical epidural hematoms（SCEH） complicated with mild cervical spondylotic myelopathy（CSM） is a rare but emerging condition.Early diagnosis and treatment are important for good outcomes.This study aimed to investigate the clinical characteristics of this condition and to discuss the optimal treatment.The clinical data from 8 patients with SCEH plus CSM who were divided into two groups by treatment methods were retrospectively analyzed.The neurological function of the patients was assessed by Japanese Orthopedic Association（JOA） score before and after the surgical operations.Other factors were reviewed with medical records.Among them,4 out of the 8 patients underwent emergency surgery,and the rest 3 patients experienced an initial conservative treatment and ultimately received a laminectomy.We found that the Frankel Scale scores in most of the surgical patients were increased after surgery（6/7,85.7%）.However,the JOA scores at the 6th month after onset were even lower than those before onset in 3 of the operative cases,and those in the patients who were given conservative treatment showed no significant change.It was concluded that some patients with SCEH and CSM treated with a timely operation may obtain relief from their previous CSM symptoms.However,the final neurological deficits of these patients were closely related to the progressive interval which refers to the hours between the initial onset and the occurrence of new neurological deficits or mild CSM deterioration,no matter whether they accept the operation.We found the crucial progressive interval may be in 9 h.Early MRI and prompt neurosurgical intervention are also important to improve the neurological deficits.

A CLINICAL OBSERVATION ON THE THERAPEUTIC EFFECT OF CERVICAL SPONDYLOPATHY OF NERVE ROOT TYPE TREATED BY COMBINED CERVICAL TRACTION AND ELECTROACUPUNCTURE

Objective: To observe the therapeutic effect of combined cervical traction and electroacupuncture (EA) on Cervical Spondylopathy of Nerve Root Type (CSNRT). Methods: 145 patients diagnosed as CSNRT were randomized into 3 groups: combined treatment group, EA group, and cervical traction (CT) group. The combined group was treated with traction followed by EA of Dazhui (大椎 GV 14), Fengchi (风池 GB 20), cervical Jiaji (夹脊 EX-B 2), etc.. Patients of two control groups were only treated by either CT or EA. Results: The markedly-effective rate and total effective rate were 76.0% and 94.0% respectively in the combined treatment group, 62.5% and 81.25% respectively in CT group, and 63.82% and 82.97% respectively in EA group. The therapeutic effect of the combined treatment group was significantly superior to that of two control groups (P<0.05). At 6-month follow-up, the above two markedly-effective and total effective rates in the combined treatment group remained 74.0% and 92.0%, still significantly higher than that in two control groups. Conclusion: Combining cervicle traction with EA treatment can effectively eliminate or relieve the symptoms and signs in patients with nerve root type cervical spondylopathy.

Mid-term outcomes of Bryan cervical disc arthroplasty versus anterior cervical discectomy and fusion for cervical spondylopathy

Objective To compare the clinical outcomes of Bryan disc replacement with anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylopathy. Methods Sixteen patients underwent Bryan cervicaldisc replacement (A group) ,and

Free-hand cervical pedicle screw fixation for upper cervical fracture and instability

Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability. Methods A retrospective review was performed on 15 patients

Acupuncture at the superficial fascia for 48 cases of cervical type of cervical spondylosis

Objective To observe the clinical efficacy of acupuncture at the superficial fascia for cervical type of cervical spondylosis. Methods Acupuncture at the superficial fascia was carried out for 48 patients with cervical type of cervical spondylosis by selecting the tender points on both sides of the cervical vertebral body and on the neck and shoulders. The treatment was conducted for once a day and treatment for 5 times was considered as 1 course of treatment. Two days were free from treatment between courses, and 3 courses were needed in total. The scores of McGill pain questionnaire [MPQ, including three indexes： Pain rating index （PRI）, Visual analogue scale （VAS） and Present pain intensity （PPI） ] of patients before and after treatment were compared, therapeutic effct of cervical type of cervical spondylosis was evaluated. Results According to the comparison before and after treatment, the scores of PRI （29.44±9.26 vs13.15±7.04）, VAS （5.63±2.73 vs 1.23±1.15）, and PPI （3.00±1.24 vs 0.38±0.49） of patients with cervical type of cervical spondylosis reduced significantly （all P〈0.05）, indicating that the differences were statistically significant. Among 48 cases, cured 40 cases （83.33%）, markedly effective 4 cases （8.34%）, effective 3 cases （6.25%）, ineffective i case （2.08%）. The total effective rate was 97.92% （47/48）. Conclusion The curative effect of acupuncture at the superficial fascia for cervical type of cervical spondylosis was satisfactory.