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.

Clinical and radiological outcomes of dynamic cervical implant arthroplasty:A 5-year follow-up

BACKGROUND Dynamic cervical implant(DCI)stabilization has been reported to have satisfactory clinical and radiological results with short-and mid-term follow-up in the treatment of cervical degenerative disc disease.However,few reports about the clinical and radiological outcome with more than 5-year follow-up exist.AIM To investigate the long-term clinical and radiological results of DCI arthroplasty.METHODS A total of 40 patients who received DCI arthroplasty were consecutively reviewed from May 2010 to August 2015.Visual analogue scale(VAS),neck disability index(NDI)score,Japanese Orthopaedic Association(JOA)score,and SF-36 items were used to assess neural function rehabilitation.Static and dynamic radiographs and 3-dimentional computed tomography were used to evaluate the radiological outcomes.RESULTS The scores of neck/arm VAS,NDI,JOA,and 8-dimensions of SF-36 were significantly improved at the 1-mo follow-up(P<0.05)and maintained until the last follow-up(P<0.05).The range of motion(ROM)of C2-C7,functional spinal unit(FSU),upper/lower adjacent level,C2-C7 lateral bending,and FSU lateral bending decreased at the 1-mo follow-up(P<0.05),whereas they increased to the preoperative level at the later follow-up intervals(P>0.05),except the ROM of FSU lateral bending(P<0.05).The C2-C7 alignment and FSU angle kept more lordotic at the last follow-up(P<0.05).The intervertebral height increased significantly at the 1-mo follow-up(P<0.05)and decreased at later follow-ups(P>0.05).At the last follow-up,12(26.1%)segments developed heterotopic ossification.CONCLUSION DCI arthroplasty is a safe and effective non-fusion technique to treat cervical degenerative disc disease in long-term follow-up.

Application of cervical arthroplasty with Bryan cervical disc： long-term X-ray and magnetic resonance imaging follow-up results

Background Cervical disc arthroplasty is a new technique for treating degenerative cervical disease. Its goal is to avoid the degeneration of adjacent levels by preserving motion at the treated level. The aims of this study were to evaluate the radiologic outcomes of Bryan cervical disc replacement and the degenerative status of adjacent segments.Methods Twenty-two patients at a single center underwent discectomy and implantation of Bryan cervical disc. The mean follow-up period was 60 months （57-69 months）. Twenty patients underwent single-level arthroplasty and two underwent arthroplasty at two levels. The levels of surgery included C3/4 （3 levels）, C4/5 （2 levels）, C5/6 （18 levels） and C6/7 （1 level）. Radiographic evaluation included dynamic X-ray examination and magnetic resonance imaging （MRI） at baseline and at final follow-up.Results On X-ray examination, the range of motion （ROM） at the operated level was 7.2° （2.5°-13.0°） at baseline and 7.8° （1.0°-15.0°） at final follow-up （P 〉0.05）. Heterotopic ossification around the prosthesis was observed in eight levels,and two levels showed loss of motion （ROM 〈2°）. MRI showed worsening by a grade at the upper level in 2/22 patients,and worsening by a grade at the lower level in 3/22, according to Miyazaki＇s classification. No further impingement of the ligamentum flavum into the spinal canal was observed at adjacent levels, though the disc bulge was slightly increased at both the adjacent upper and lower levels at final follow-up.Conclusions Arthroplasty using Bryan cervical disc prosthesis resulted in favorable radiologic outcomes in this study.Disc degeneration at adjacent levels may be postponed by this technique.