The Prevalence and Clinical Importance of Pathological Findings in Cervical MRI among Patients Presenting with Neck Pain at Kumi Orthopaedic Center

Introduction: Neck pain is a major public health problem in the general population. It not only constitutes a major personal burden but also affects families and the health and economic structure of the countries. In Uganda, despite the impact of neck pain, its burden has not been comprehensively presented, in a way that can serve as the basis for different types of epidemiological studies and for evaluating the current abnormalities related to neck pain. We aimed to evaluate pathological findings commonly detected on Magnetic Resonance Imaging (MRI) scans of the spine, to find the frequency of these findings and to emphasize their clinical importance. Methods: This was a retrospective study involving all patients with neck pain (with or without radicular symptoms) seen at Kumi Orthopaedic Center between 2019 and 2023 who had an MRI of the cervical spine. These were identified in the patient register. MRI findings were extracted and quantified from the radiologist’s narrative report Results: MRI reports of 131 patients were included. The mean age was 50.5 years (SD 15.13: range 12 - 87) and 55.7% were men. The most prevalent MRI findings were Disc bulges (54.2%), foraminal compromise (42.7%), and nerve root compression (36.6%). The least prevalent finding was fracture (2.3%). The number of abnormalities significantly increased with an increase in age. However, there was no significant difference in findings between males and females across all age groups. The most involved vertebrae were C5/C6 (67.2%), C4/C5 (60.3%) and C6/C7 (56.8%). The least involved vertebra was C1/C2 (13.8%). Conclusion: The findings of this study provide a comprehensive and informative overview useful in informing the clinicians in diagnosis and decision making thus improving patient management.

Vaginal endoscopy combined with gonadotropin-releasing hormone agonist successfully treated a patient with cervical endometriosis:a case report

A 36-year-old unmarried woman with no sexual history presented with 12 days of uncontrollable yellowish vaginal discharge,bloating,lower back pain,frequent urination,and urgency.Her menstrual cycles were regular with moderate flow and worsening dysmenorrhea.Ultrasound and magnetic resonance imaging identified uterine and cervical masses.Laparoscopic surgery and postoperative gonadotropin-releasing hormone agonist injections led to significant lesion reduction.The patient is currently on oral dienogest acetate with ongoing follow-up.

Neck neuromuscular treatment for depressive disorders with cervical muscular tension or chronic neck pain—A pilot study

BACKGROUND: An intimate relationship between depressive disorders and chronic pain is well known but often neglected. We studied patients with depressive disorders accompanying cervical muscular tension or neck pain. They also complaints of various physical, psychosomatic, and psychiatric signs such as anxiety and non-specific complaints related to autonomic imbalance. These complaints or symptoms are commonly resistant to pharmacological treatment, and thus we tried to treat these conditions by reducing their cervical muscular tension or pain. METHODS: We evaluated 30 complaints of 138 patients suffering from depressive disorders with cervical muscular abnormality (52 men and 86 women). The presence of the 30 complaints was evaluated as ‘positive’ or ‘negative’ before and during treatment. The necks of all patients were treated using low-frequency stimulation, micro-wave therapies, electric needle application, and acupuncture. RESULTS: Reducing cervical muscular tension remitted or cured the 30 complaints including depressive mood. The reduction of cervical muscle pain or tension initially ameliorated the depressive symptoms and anxiety, and subsequently improved their autonomic imbalances. Discriminant analysis of the first and second examinations correctly classified 95.3% of original grouped cases. CONCLUSION: Reducing cervical muscular tension is an effective treatment for patients suffering from depressive disorders with cervical neuromuscular pain or rigidity.

The Experience of Pain and Anxiety in Cervical Cancer Patients Undergoing Multiple Fraction High-Dose Rate Brachytherapy: A Prospective Observational Study

Purpose: To evaluate the anxiety and pain levels of cervical cancer patients undergoing intracavitary multifraction high-dose rate (HDR) brachytherapy, as part of a process to develop guidelines for quality patient-centered care. Methods: Cervical cancer patients (n = 31) undergoingmultiple fraction HDR brachytherapy treatment at the National Institute of Oncology in Rabat (Morocco) completed ratings of pain and anxiety intensity using 11-point verbal analog scales, at 6 key time points over 2 brachytherapy insertion procedures and 4 brachytherapy fractions. Women were evaluated for psychological status at baseline before starting the brachytherapy process using the Hospital Anxiety and Depression Scale (HADS). Scores were grouped as follows: 0 - 7 = normal, 8 - 10 = borderline, 11 - 21 = abnormal. Factors that could affect anxiety levels such as education level, relationship status, number of pregnancies and prior surgical history were documented. Results: Between July and August 2020, 31 women with a median age of 49.6 years were evaluated (range: 27 - 70). The HADS score identified depression in 5 patients (16.1%) and anxiety in 12 patients (38.7%). Throughout both treatment procedures, anticipatory anxiety was reported, with a maximum intensity in the operating room during spinal anesthesia (3.23 ± 1.7) and during applicator insertion (2.97 ± 2.4). Moderate-to-severe anxiety scores were reported in 25.8% and 22.6% of patients respectively. Level of education showed a significant correlation with anxiety scores (p = 0.027). Pain increased significantly during the procedure (p ± 1.4) and applicator removal (4.74 ± 1.5) turned out to be the most painful parts of the procedure. No correlation was found between pain and anxiety levels. Conclusion: Intracavitary multifraction high-dose rate brachytherapy is associated with mild to moderate levels of pain and anxiety, although a subset of patients reported more severe symptoms and may require additional medical and psychological support, with particular emphasis on bed-rest duration and applicator removal. The development of effective interventions (both pharmacological and non-pharmacological) is needed to improve women’s experiences of brachytherapy for locally advanced cervical cancer.

Interventional pain therapy in cervical post-surgery syndrome

Fifteen percent to forty percent of patients present with persistent disabling neck pain or radicular pain after cervical spine surgery. Persistent pain after cervical surgery is called cervical post-surgery syndrome(CPSS). This review investigates the literature about interventional pain therapy for these patients. Because different interventions with different anatomical targets exist, it is important to find the possible pain source. There has to be a distinction between radicular symptoms(radicular pain or radiculopathy) or axial pain(neck pain) and between persistent pain and a new onset of pain after surgery. In the case of radicular symptoms, inadequate decompression or nerve root adherence because of perineural scarring are possible pain causes. Multiple structures in the cervical spine are able to cause neck pain. Hereby, the type of surgery and also the number of segments treated is relevant. After fusion surgery, the so-called adjacent level syndrome is a possible pain source. After arthroplasty, the load of the facet joints in the index segment increases and can cause pain. Further, degenerative alterations progress. In general, two fundamentally different therapeutic approaches for interventional pain therapy for the cervical spine exist: Treatment of facet joint pain with radiofrequency denervation or facet nerve blocks, and epidural injections either via a transforaminal or via an interlaminar approach. The literature about interventions in CPSS is limited to single studies with a small number of patients. However, some evidence exists for these procedures. Interventional pain therapies are eligible as a target-specific therapy option. However, the risk of theses procedures(especially transforaminal epidural injections) must be weighed against the benefit.

Neck pain and absence of cranial nerve symptom are clues of cervical myelopathy mimicking stroke:Two case reports

BACKGROUND Cervical myelopathy is a potential stroke imitator,for which intravenous thrombolysis would be catastrophic.CASE SUMMARY We herein present two cases of cervical myelopathy.The first patient presented with acute onset of right hemiparesis and urinary incontinence,and the second patient presented with sudden-onset right leg monoplegia.The initial diagnoses for both of them were ischemic stroke.However,both of them lacked cranial nerve symptom and suffered neck pain at the beginning of onset.Their cervical spinal cord lesions were finally confirmed by cervical computed tomography.A literature review showed that neck pain and absence of cranial nerve symptom are clues of cervical myelopathy.CONCLUSION The current report and the review remind us to pay more attention to these two clues in suspected stroke patients,especially those within the thrombolytic time window.

Improvement of Somatic Cervical Pain and Disability after the Application of a Portable TENS Device

Background: Cervical facet joints and neck muscles are common nociceptive pain generator, with neck and shoulder muscles pain, and limited retroflexion. Objective: To test the hypothesis that the portable TENS device would relieve cervical somatic pain. Methods: Forty-four patients with chronic cervical pain patients with somatic pain, but without radicular symptoms were evaluated in a double-blind, prospective, randomized fashion, divided into sham and active groups. The active TENS (TANYXò) or sham device was placed over C7-T1 spinous process, perpendicular to the spine, for 20 min at 12-hour interval during 3 days. The two groups were: placebo group (PG), with a sham device and the active TENS group (TG), which produced a mixed (85 Hz) frequency of stimulation, conventional, and burst. Diclofenac up to three times daily was available. Efficacy measures were pain relief, rescue analgesics and neck disability. Results: The active TENS device induced pain relief after its first application, which persisted during the 3-day treatment. By the end of the TENS application, the capability of rotation, lateral extension and retroflexion was improved (p < 0.05). The pain score and rescue analgesics consumption reduced in the TG (p < 0.01, p < 0.05, respectively), and the mean pain score dropped from 8 to 3 points (p < 0.01). There were no adverse events. Conclusions: Somatic cervical pain and disability improved after active TENS application during the three consecutive days, which persisted upon the 1-month reevaluation.

Effects of ketamine combined with lidocaine for preemptive analgesia on postoperative pain, inflammatory response and stress response in patients with cervical cancer

Objective:To investigate the effects of ketamine combined with lidocaine for preemptive analgesia on postoperative pain, inflammatory response and stress response in patients with cervical cancer.Methods: A total of 68 patients with cervical cancer who received radical operation in the hospital between July 2016 and May 2017 were divided into routine analgesia group (n=37) and ketamine group (n=31) according to the postoperative analgesic solution. Routine analgesia group received lidocaine for preemptive analgesia and ketamine group received ketamine combined with lidocaine for preemptive analgesia. The differences in serum levels of pain mediators, inflammatory factors and stress hormones were compared between the two groups before surgery (T0), immediately after postoperative recovery (T1) and 24h after surgery (T2).Results: At T0, there was no statistically significant difference in serum levels of pain mediators, inflammatory factors and stress hormones between the two groups. At T1 and T2, serum pain mediators SP and NPY levels of ketamine group were lower than those of routine analgesia group;inflammatory factors IL-1β, IL-6 and IL-8 levels were lower than those of routine analgesia group;stress hormones AngⅠ, AngⅡ and NE levels were lower than those of routine analgesia group.Conclusion: Ketamine combined with lidocaine for preemptive analgesia can effectively suppress the early postoperative pain mediator secretion and relieve the systemic inflammatory response and stress response in patients with cervical cancer.

Effect of small-dose ketamine combined with dexmedetomidine on emergence stress response as well as postoperative pain and Th cell deviation in patients with cervical cancer surgery under general anesthesian

Objective:To study the effect of small-dose ketamine combined with dexmedetomidine on emergence stress response as well as postoperative pain and Th cell deviation in patients with cervical cancer surgery under general anesthesia.Methods: A total of 136 patients who received radical operation for cervical cancer in our hospital between May 2013 and May 2016 were selected and randomly divided into control group, dexmedetomidine group (Dex), ketamine group (Ket group) and combined group, and serum was collected to determine the levels of stress hormones, pain mediators and Th cytokines.Results: During anesthesia recovery, serum NE, E, Cor, Ins and C-P levels of combined group, Dex group and Ket group were significantly lower than those of control group, and serum NE, E, Cor, Ins and C-P levels of combined group were significantly lower than those of Dex group and Ket group;after surgery, serum SP, PGE2,β-EP, NO, IL-4, IL-5 and IL-10 levels of combined group, Dex group and Ket group were significantly lower than those of control group while IL-2, TNF-α and IFN-γ levels were significantly higher than those of control group, and serum SP, PGE2,β-EP, NO, IL-4, IL-5 and IL-10 levels of combined group were significantly lower than those of Dex group and Ket group while IL-2, TNF-α and IFN-γ levels were significantly higher than those of Dex group and Ket group.Conclusion:Small-dose ketamine combined with dexmedetomidine can more effectively reduce emergence stress response and postoperative pain, and improve Th cell deviation than single drug intervention.

Mechanical and cellular processes driving cervical myelopathy

Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment. Despite advances in surgical technology and treatment innovations, there are limited neuro-protective treatments for cervical myelopathy, which reflects an incomplete understanding of the pathophysiological processes involved in this disease. The aim of this review is to provide a comprehensive overview of the key pathophysiological processes at play in the development of cervical myelopathy.

Analgesic effects of balanced acupuncture versus body acupuncture in low-back and leg pain patients with lumbar disc herniation, as assessed by resting-state functional magnetic resonance imaging

Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain patients with lumbar disc herniation were treated with balanced acupuncture or body acupuncture. Central mechanisms of vaded acupunctures were compared using resting-state functional MRI. Patients from both groups received functional MRI before and after acupuncture. Functional connectivity in brain regions that were strongly associated with the bilatera amygdala was analyzed utilizing AFNI software. Visual analogue scale scores were greater in the balanced acupuncture group compared with the body acupuncture group. Function of the endogenous pain regulation network was enhanced in patients in the balanced acupuncture group, but was not changed in the body acupuncture group. This result indicates that the analgesic effects of body acupuncture do not work through the central nervous system. These data suggest that balanced acupuncture exerts analgesic effects on low-back and leg pain patients with lumbar disc herniation by regulating the function of the endogenous pain regulation network.

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.

Innervation of cervical ventral facet joint capsule: Histological evidence

AIM: To assess the presence of nerves in ventral facet joint capsules as facet capsules are generally implicated in neck pain.METHODS: Twenty-four ventral cervical facet joint capsules were harvested from 3 unembalmed cadavers. Paraffin sections from these capsules were processed to identify neurofilament and substance P immunoreactive fibers. Nerve fiber presence was also verified by a silver impregnation method.RESULTS: Neurofilament reactive fibers were observed in sections from 9 capsules. They were observed in areas with collagen fibers and areas with irregular connective tissue. Substance P reactive nerve fibers were found in sections from 7 capsules in similar areas. Silver impregnation also revealed the presence of nerve fibers. The nerve fibers were also found as bundles in the lateral margins of the capsule. A Pacinian corpuscle-like ending was also observed in onespecimen.CONCLUSION: Nerve fibers revealed by neurofilament immunoreactivity and silver staining support innervation of the ventral aspect of the facet joint capsule. The presence of substance P reactive fibers supports the potential role of these elements in mediating pain. The presence of a Pacinian-like ending implicates a potential role in joint movement.

Establishment of an animal model of extra-vertebral foramen cervical nerve entrapment by local electrical stimulation and selection of suitable stimulation parameters

A rat model of extra-vertebral foramen cervical nerve entrapment was established according to the following parameters： stimulation intensity 20 V; frequency 50 Hz; pulse width 200 μs; duration 333 ms/s for a total of 8 hours. After the electrical stimulation, rats exhibited mild muscle fiber atrophy, mild inflammatory exudates, connective tissue local fibrosis and chondrocyte metaplasia. Mean muscle fiber cross-sectional area was reduced. The nerve myelin sheath continuity was partially demyelinated. The microstructure of nerve cells was disrupted and these symptoms worsened with prolongation of the stimulation. The shoulder, neck and upper extremity muscles on the tested side demonstrated positive sharp waves and fibrillations. The severity increased with continuation of the stimulation. High amplitude and polyphasic motor unit potentials gradually appeared. Similar findings were seen in the contralateral side, but at a less severe level.

A Case of Posttraumatic Cervical Dystonia Treated with OnabotulinumtoxinA

Cervical dystonia (CD) is a condition that typically presents with cervical muscle spasm, producing head tilt and cervical rotation. CD is most often idiopathic, however, in a small number of patients, CD occurs within one day to one year after mild to severe trauma. This type of CD is further classified as posttraumatic CD. OnabotulinumtoxinA (Botox) injections are considered to be a controversial treatment for posttraumatic CD and have produced variable result. This report describes the case of a 32-year-old female presenting with a two year history of posttraumatic CD and associated head, neck, and shoulder pain after obtaining a severe head injury during a motorcycle accident. OnabotulinumtoxinA was used to successfully treat her posttraumatic CD muscle spasms and associated chronic pain. Three months after her first and second ONA treatments, the patient reported at least 50% improvement in her overall pain symptoms and a noticeable reduction in cervical paraspinal muscle spasms.

Management of symptomatic cervical facet cyst with cervical interlaminar epidural block: A case report

BACKGROUND Symptomatic cervical facet cysts are relatively rare compared to those in the lumbar region.These cysts are usually located in the 7th cervical and 1st thoracic vertebral(C7/T1)area,and surgical excision is performed in most cases.However,facet cysts are associated with degenerative conditions,and elderly patients are often ineligible for surgical procedures.Cervical interlaminar epidural block has been used in patients with cervical radiating symptoms and achieved good results.Therefore,cervical interlaminar epidural block may be the first-choice treatment for symptomatic cervical facet cysts.CASE SUMMARY A 70-year-old man complained of a tingling sensation in the left hand,focused on the 4th and 5th fingers,for 1 year,and posterior neck pain for over 5 mo.The patient’s numeric rating scale(NRS)score was 5/10.The patient was diagnosed with symptomatic cervical facet cyst at the left C7/T1 facet joint.Fluoroscopyguided cervical interlaminar epidural block at the C7/T1 level with 20 mg triamcinolone and 5 mL of 0.5%lidocaine was administered.The patient's symptoms improved immediately after the block,with an NRS score of 3 points.After 3 mo,his left posterior neck pain and tingling along the left 8th cervical dermatome were relieved,with an NRS score of 2.CONCLUSION A cervical interlaminar epidural block is a good alternative for managing symptomatic cervical facet cysts.

Treatment for Depression with Chronic Neck Pain Completely Cured in 94.2% of Patients Following Neck Muscle Treatment

We report three patients with cervical neuromuscular syndrome (CNMS) who followed similar courses. Autonomic imbalance may occur following neck muscle pain, and a wide variety of somatic symptoms including headache and vertigo appear and a generalized poor condition may continue for long periods. If many such somatic symptoms persist for months to years, symptoms of depression are exacerbated. The patients end up in psychiatric clinics, where they are diagnosed with depression, but they do not respond to antidepressants. Thus, they continue to suffer for many years. These patients eventually were completely cured with the resolution of neck pain by neck muscle treatment, using two types of special low-frequency therapy equipment, far-infrared radiation and acupuncture. When treatment for the neck muscles is initiated, symptoms of depression are quickly relieved, and diverse somatic symptoms disappear one after another as neck muscle tension is gradually alleviated (the number of abnormal neck muscle checkpoints decreases). Such a course suggests that neck muscle tension and chronic pain are closely related to depression. Neck muscle-related depression due to CNMS clearly differs from psychiatric conditions such as major and bipolar depression. In patients with neck muscle-related depression, symptoms of depression are not accompanied by ungrounded anxiety, a sense of emptiness, apathy, or self-rejection. Neck muscle abnormalities leading to CNMS are caused by head injury, whiplash injury, and a prolonged forward-bent-posture due to using a personal computer, playing computer games, texting, and engaging in machine-paced work such as assembly-line operation.

基于筋骨理论对青少年颈痛的临床新思考

青少年颈痛症状类似于成人颈椎病,但其病理改变并不完全符合颈椎椎间盘退变。因此,应积极探索更符合其临床特点的病因学和病理学理论,实现临床对青少年颈痛的有效诊断与治疗。在石氏伤科百年治伤临床经验和最新科学研究认识的基础上,探讨青少年颈痛的诊断名称和基于“筋骨合和”理论的病因病机,并针对颈部“筋出槽、骨错缝”核心病机建立“四以相和”的诊治策略。

归芪活血胶囊对神经根型颈椎病大鼠炎性损伤和微循环血流的影响

目的:探究归芪活血胶囊(GQ)对神经根型颈椎病(CSR)大鼠的治疗效应及机制。方法:观察CSR大鼠自发痛、热痛阈、步态评分、前肢和颈部体表微循环状态、脊髓病理结构及超微结构变化、脊髓p38磷酸化情况以及血清白细胞介素-1β(IL-1β)、IL-6以及肿瘤坏死因子-α(TNF-α)。结果:GQ高、中剂量在干预第14天时可显著升高CSR模型大鼠的热痛阈(P<0.05),降低其步态评分和自发痛评分(P<0.05,P<0.01);GQ各剂量均可改善CSR大鼠脊髓炎症水肿变化,显著增加尼氏(Nissl)染色阳性细胞数目(P<0.05),恢复髓鞘和线粒体正常形态,且GQ中剂量效果较明显;GQ高、中剂量可显著升高CSR大鼠颈部和前肢皮肤血流灌注量(P<0.05),对前肢远端血流灌注量的改善程度优于芬必得组(P<0.01);与模型组比较,GQ中剂量可降低CSR大鼠脊髓p38磷酸化比率。结论:GQ可以缓解CSR大鼠热痛觉过敏和步态不稳的程度,改善脊髓炎症病理变化,恢复前肢和颈部体表血流灌注量,且GQ中剂量在改善CSR大鼠炎症损伤方面更有优势。

颈项功治疗颈型颈椎病60例的疗效观察

目的:通过对颈型颈椎病患者进行锻炼干预,比较颈项功和常规米字操治疗颈型颈椎病的临床疗效及对颈痛、压痛阈(Pressure Pain Threshold,PPT)的影响。方法:选择2020年11―12月浙江中医药大学纳入的60例颈型颈椎病患者,应用随机数字表法将60例颈型颈椎病患者分为功法组和常规米字操组,每组各30例。功法组患者采用功法“仙鹤点水”锻炼,常规米字操组患者采用常规米字操锻炼,两组患者每天早晚各锻炼1次,以锻炼4周为一个疗程。锻炼前对两组患者进行压痛点筛查,结果得到两组患者压痛点多在肩井穴和C3夹脊穴,并以此作为PPT值的采集点。观察各组患者在锻炼前后的视觉模拟评分法(Visual Analogue Scale,VAS)评分、Northwick Park颈痛量表(Northwick Park Neck-pain Questionnaire,NPQ)评分及肩井穴和C3夹脊穴的PPT值,并综合评定各组的临床疗效。结果:锻炼4周后两组患者的VAS评分和NPQ评分均较锻炼前降低(P<0.05),两组患者肩井穴的PPT值均较锻炼前升高(P <0.05),功法组C3夹脊穴的PPT值较锻炼前升高(P <0.05),常规米字操组C3夹脊穴的PPT值与锻炼前差异无统计学意义(P> 0.05)。功法组的总有效率为86.67%(26/30),优于常规米字操组的63.33%(19/30)(P <0.05)。结论:功法和常规米字操均能改善颈型颈椎病患者的颈部疼痛和压痛,但功法的疗效更加显著。