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.

Syringomyelia associated with cervical spondylosis: A rare condition

Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division and treated by our institute. It is the case of a 66-yearold woman. At our observation she was affected by moderate-severe spastic tetraparesis. T2-weighted magnetic resonance imaging(MRI) showed an hyperintense signal within spinal cord from C3 to T1 with a more sharply defined process in the inferior cervical spinal cord. At the same level bulging discs, facets and ligamenta flava hypertrophy determined a compression towards subarachnoid space and spinal cord. Spinal cord compression was more evident in hyperextension rather than flexion. A 4-level laminectomy and subsequent posterior stabilization with intra-articular screws was executed. At 3-mo follow up there was a regression of tetraparesis but motor deficits of the lower limbs residuated. At the same follow up postoperative MRI was executed. It suggested enlargement of the syrinx. Perhaps hyperintensity within spinal cord appeared "bounded" from C3 to C7 with clearer margins. At the level of surgical decompression, subarachnoid space and spinal cord enlargement were also evident. A review of the literature was executed using Pub Med database. The objective of the research was to find an etiopathological theory able to relate syringomyelia with cervical spondylosis. Only 6 articles have been found. At the origin of syringomyelia the mechanisms of compression and instability are proposed. Perhaps other studies assert the importance of subarachnoid space regard cerebrospinal fluid(CSF) dynamic. We postulate that cervical spine instability may be the cause of multiple microtrauma towards spinal cord and consequently may damage spinal cord parenchyma generating myelomalacia and consequently syrinx. Otherwise the hemorrhage within spinal cord central canal can cause an obstruction of CSF outflow, finally generating the syrinx. On the other hand in cervical spondylosis the stenotic elements can affect subarachnoid space. These elements rubbing towards spinal cord during movements of the neck can generate arachnoiditis, subarachnoid hemorrhages and arachnoid adhesions. Analyzing the literature these "complications" of cervical spondylosis are described at the origin of syringomyelia. So surgical decompression, enlarging medullary canal prevents rubbings and contacts between the bone-ligament structures of the spine towards spinal cord and subarachnoid space therefore syringomyelia. Perhaps stabilization is also necessary to prevent instability of the cervical spine at the base of central cord syndrome or syringomyelia. Finally although patients affected by central cord syndrome are usually managed conservatively we advocate, also for them, surgical treatment in cases affected by advanced state of the symptoms and MRI.

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 CERVICAL SPONDYLOSIS, SCAPULOHUMERAL PERIARTHRITIS AND LUMBAR MUSCLE STRAIN BY A MODEL FZ-1 SIMULATED TUINA (MASSAGE) APPARATUS

We have treated 30 cases of cervical spondylosis, 30 cases of scapulohumeral periarthritis and 30 cases of lumbar muscle strain with a Model FZ - 1 Simulated Massage Apparatus, and gained satisfactory therapeutic effect for all cases treated. Moreover, this apparatus is applied conveniently,and has no adverse reaction.

CLINICAL OBSERVATION ON TREATMENT OF 68 CASES OF CERVICAL SPONDYLOSIS WITH ACUPUNCTURE SUPPLEMENTED BY TRACTION OF NECK

The 68 patients of cervlcal spondylosis were treated with acupuneture at Fengchi（GB 20）,Fengfu（GV 16）and Ashi point supplemented by traction of neck,once a day or every 2days,10 times of treatment for one course.After atreatment of 2 courses,31 cases（45.5％）werecured;13 cases（19.1％）markedly improved;18 cases （26.4％）improved and 6 cases（8.8％）notimproved.The total effective rate was 91.1％.In this article the classification,etiology and principlesof treatment of this dseases were discussed。

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.

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.

On the prevention and treatment of cervical spondylosis^1

Cervical spondylosis is a kind of frequently occurring and refractory disease with high recurrence rate and tends to be younger. It has become a multiple refractory disease at home and abroad, and its mechanism research and clinical diagnosis and treatment are still controversial. This article will discuss the etiology, pathogenesis, mechanism and treatment of cervical spondylosis from ancient Chinese medicine and modern western medicine, and focus on the research progress of modern prevention and treatment of cervical spondylosis, in order to provide reference for modern clinical treatment of cervical spondylosis.

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.

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.

Evaluation of a granulated formula for the nerve root type and vertebral artery type of cervical spondylosis：a multicenter,single-blind,randomized,controlled,phase Ⅲ clinical trial

OBJECTIVE:To evaluate the effectiveness and safety of cervical spondylosis formula granules in reducing the symptoms of patients with the nerve root type and the vertebral artery type of cervical spondylosis.METHODS:This was a multicenter, single-blind,randomized, controlled trial.From April 2002 to November 2003, 499 patients were randomly assigned to either the treatment or the control group.The treatment group was orally administered granules prepared with a formula for cervical spondylosis, while the control group was given Jingfukang granules.The treatment course was 1 month for both groups.RESULTS:In patients with the nerve root type of cervical spondylosis, the total effect rate in the treatment group(87.21%) was significantly higher than that in the control group(80.70%, P < 0.01).After the treatment period in both groups, the treatment group had a significantly greater rate of resolution of pain, numbness of the upper limbs, muscle strength of the upper limbs, and fatigue than the control group(all P < 0.05).In patients with the vertebral artery type of cervical spondylosis, the total effect rate in the treatment group(82.07%) was similar to that in the control group(71.21%, P >0.05).After the treatment period in both groups,the treatment group had a significantly greater rate of resolution of weakness of the waist and knees than the control group(P < 0.05).CONCLUSION:The cervical spondylosis formula granules significantly improve numbness, muscle strength, and fatigue, and reduce pain in patients with the nerve root type of cervical spondylosis,and improve the weakness of the waist and knees in patients with the vertebral artery type of cervical spondylosis.

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.

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...

Effect of Chinese Herbal Fumigation Combined with Tuina on Vertigo and Concentrations of Endothelin and Calcitonin Gene-related Peptide in Patients with Vertebral Artery Cervical Spondylosis

Objective: To observe the effect of Chinese herbal fumigation combined with three-step tuina manipulation on concentration of endothelin(ET) and calcitonin gene-related peptide(CGRP) and vertigo in patients with vertebral artery cervical spondylosis(VACS). Methods: A total of 120 eligible cases were randomly allocated into an observation group and a control group, 60 in each group. Cases in the observation group were treated with Chinese herbal fumigation combined with three-step tuina manipulation, whereas cases in the control group were treated with oral Flunarizine Hydrochloride Capsules. Results: After treatment, vertigo in both groups was alleviated; there were intra-group significant differences in ET decrease and CGRP increase(P<0.01, P<0.05); and there were also inter-group significant differences(both P<0.05). Conclusion: Chinese herbal fumigation combined with three-step tuina manipulation can regulate the levels of ET and CGRP and improve vertigo in patients with VACS. Its therapeutic efficacy is superior to oral Flunarizine Hydrochloride Capsules.