BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognos...BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognoses.There are few accurate assessments of bone mineral density in AS patients.AIM To analyze Hounsfield units(HUs)for assessing bone mineral density in AS patients with cervical fracture-dislocation.METHODS The HUs from C2 to C7 of 51 patients obtained from computed tomography(CT)scans and three-dimensional reconstruction of the cervical spine were independently assessed by two trained spinal surgeons and statistically analyzed.Inter-reader reliability and agreement were assessed by interclass correlation coefficient.RESULTS The HUs decreased gradually from C2 to C7.The mean values of the left and right levels were significantly higher than those in the middle.Among the 51 patients,25 patients(49.02%)may be diagnosed with osteoporosis,and 16 patients(31.37%)may be diagnosed with osteopenia.CONCLUSION The HUs obtained by cervical spine CT are feasible for assessing bone mineral density with excellent agreement in AS patients with cervical fracture-dislocation.展开更多
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...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.展开更多
Non-carious cervical lesions (NCCLs) are defined as the loss of dental hard tissue at the cement-enamel junction. Erosion, abrasion, and attrition have been associated with this disorder. Objective: Recently, occlusal...Non-carious cervical lesions (NCCLs) are defined as the loss of dental hard tissue at the cement-enamel junction. Erosion, abrasion, and attrition have been associated with this disorder. Objective: Recently, occlusal stress causing of cervical enamel cracks (abfraction) has been considered as an additional etiology for NCCLs to facilitate the erosion and abrasion mechanisms in tooth wear. Study Design: The prevalence of NNCLs and wear facets in a population with permanent dentition in absence of any clear etiological factors related to erosion and abrasion causes is evaluated. A total 295 subjects are enrolled for this study and divided into four age groups (subjects aged 15 - 27 years, 28 - 42 years, 43 - 57 years and 58 - 75 years respectively). An overall of 6629 teeth are investigated to find NCCLs and wear facets. The occlusion is analyzed in each patient. Results: An overall of 801 teeth (12%) show NCCLs and 623 of them (78%) highlight also wear facets. The higher number of teeth with NCCLs and of these with simultaneous presence also of wear facets are found on teeth of patients of group-3 (11% of all teeth examined for group and 81% respectively) and to group-4 (24.4% of all teeth examined for group and 86.5% respectively) of remaining teeth without NCCLs (5828) only 138 (2.4%) shown wear facets. Conclusion: The results of this study held the occlusal forces as the main cause of NCCLs on teeth in presence of wear facets.展开更多
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 ...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.展开更多
Background: Cervical spine injuries are common as a result of a growing number of high energy accidents. The subaxial Injury Classification System and Severity Score (SLICS) suggest that a unilateral or bilateral face...Background: Cervical spine injuries are common as a result of a growing number of high energy accidents. The subaxial Injury Classification System and Severity Score (SLICS) suggest that a unilateral or bilateral facet dislocation must be managed surgically, even in the absence of SCI (Level of Evidence III). The surgical approaches could be anterior, posterior or combined anterior and posterior approaches. Methods: 20 patients, 12 males and 8 females, with age ranged from 20 to 45 years with lower cervical spine locked facet treated operatively by anterior or posterior spinal instrumentation after trial of closed reduction by skull traction. Results: In this series, satisfactory closed reduction was achieved in 15 patients with percentage 75% and fixed anteriorly, but 5 patients with percentage 25% needed posterior approach for reduction. Regarding ASIA score all of the patients improved at least one level after surgery except 2 cases with preoperative score A: they didn’t improve. Mean preoperative pain score VAS was 7.7 (range from 5 to 9) and postoperative mean of VAS was 0.75 with range from 0 to 3 until final follow up. Conclusion: Anterior approach with discectomy and fusion is necessary;however, if the closed reduction failed, posterior open reduction is indicated with lateral mass fixation, combined approaches can be indicated in specific cases such as increase of the kyphotic angle post anterior approach or when an osteotomy may be required to restore cervical alignment and neural decompression.展开更多
Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods...Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This展开更多
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(...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.展开更多
基金the Second Affiliated Hospital of Naval Medical University for assistance with planning statistical analyses.Gratitude is also extended to the patients who participated in our study,providing invaluable data.In addition,we appreciate the editorial team of this journal for their insightful review and guidance.
文摘BACKGROUND Cervical spine fracture-dislocations in patients with ankylosing spondylitis(AS)are mostly unstable and require surgery.However,osteoporosis,one of the comorbidities for AS,could lead to detrimental prognoses.There are few accurate assessments of bone mineral density in AS patients.AIM To analyze Hounsfield units(HUs)for assessing bone mineral density in AS patients with cervical fracture-dislocation.METHODS The HUs from C2 to C7 of 51 patients obtained from computed tomography(CT)scans and three-dimensional reconstruction of the cervical spine were independently assessed by two trained spinal surgeons and statistically analyzed.Inter-reader reliability and agreement were assessed by interclass correlation coefficient.RESULTS The HUs decreased gradually from C2 to C7.The mean values of the left and right levels were significantly higher than those in the middle.Among the 51 patients,25 patients(49.02%)may be diagnosed with osteoporosis,and 16 patients(31.37%)may be diagnosed with osteopenia.CONCLUSION The HUs obtained by cervical spine CT are feasible for assessing bone mineral density with excellent agreement in AS patients with cervical fracture-dislocation.
基金Grants from Centers for Disease Control to Cavanaugh JM,No.R49-CCR519751 and R49-CE000455
文摘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.
文摘Non-carious cervical lesions (NCCLs) are defined as the loss of dental hard tissue at the cement-enamel junction. Erosion, abrasion, and attrition have been associated with this disorder. Objective: Recently, occlusal stress causing of cervical enamel cracks (abfraction) has been considered as an additional etiology for NCCLs to facilitate the erosion and abrasion mechanisms in tooth wear. Study Design: The prevalence of NNCLs and wear facets in a population with permanent dentition in absence of any clear etiological factors related to erosion and abrasion causes is evaluated. A total 295 subjects are enrolled for this study and divided into four age groups (subjects aged 15 - 27 years, 28 - 42 years, 43 - 57 years and 58 - 75 years respectively). An overall of 6629 teeth are investigated to find NCCLs and wear facets. The occlusion is analyzed in each patient. Results: An overall of 801 teeth (12%) show NCCLs and 623 of them (78%) highlight also wear facets. The higher number of teeth with NCCLs and of these with simultaneous presence also of wear facets are found on teeth of patients of group-3 (11% of all teeth examined for group and 81% respectively) and to group-4 (24.4% of all teeth examined for group and 86.5% respectively) of remaining teeth without NCCLs (5828) only 138 (2.4%) shown wear facets. Conclusion: The results of this study held the occlusal forces as the main cause of NCCLs on teeth in presence of wear facets.
文摘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.
文摘Background: Cervical spine injuries are common as a result of a growing number of high energy accidents. The subaxial Injury Classification System and Severity Score (SLICS) suggest that a unilateral or bilateral facet dislocation must be managed surgically, even in the absence of SCI (Level of Evidence III). The surgical approaches could be anterior, posterior or combined anterior and posterior approaches. Methods: 20 patients, 12 males and 8 females, with age ranged from 20 to 45 years with lower cervical spine locked facet treated operatively by anterior or posterior spinal instrumentation after trial of closed reduction by skull traction. Results: In this series, satisfactory closed reduction was achieved in 15 patients with percentage 75% and fixed anteriorly, but 5 patients with percentage 25% needed posterior approach for reduction. Regarding ASIA score all of the patients improved at least one level after surgery except 2 cases with preoperative score A: they didn’t improve. Mean preoperative pain score VAS was 7.7 (range from 5 to 9) and postoperative mean of VAS was 0.75 with range from 0 to 3 until final follow up. Conclusion: Anterior approach with discectomy and fusion is necessary;however, if the closed reduction failed, posterior open reduction is indicated with lateral mass fixation, combined approaches can be indicated in specific cases such as increase of the kyphotic angle post anterior approach or when an osteotomy may be required to restore cervical alignment and neural decompression.
文摘Objective To evaluate surgical strategy of decompression via posterior-anterior approach and anterior fixation in treatment fracture-dislocation of lower cervical spine with bilateral facet joints dislocation. Methods This
文摘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.