颈部疼痛程度与颈椎曲度相关性的临床观察

目的:探讨颈部疼痛程度与颈椎曲度的相关性。方法:2009年6月～2011年4月在我院颈椎专家门诊就诊的颈部疼痛患者121例,男性56例,女性65例,年龄17～79岁,平均51.2±17.7岁。对所有患者的颈痛程度进行数字分级法(numeric rating scales,NRS)评分,根据中立位颈椎X线侧位片的颈椎曲度(颈椎角)分为4组,即前凸组、曲度变直组、反屈组和S型组,比较各组之间颈痛程度,并对颈痛程度与颈椎曲度进行相关性分析。结果:121患者中颈椎前凸37例,曲度变直26例,反屈31例,S型27例,其NRS评分分别为4.81±1.90分,5.63±3.64分,5.15±2.47分,6.81±4.65分,颈椎曲度变直组和曲度S型组患者的颈痛程度NRS评分与颈椎前凸组相比差异有显著性(P<0.05),其余各组间两两比较差异无显著性(P>0.05)。患者颈痛程度与颈椎角成弱负相关(r=-0.218,P=0.039)。结论:颈部疼痛程度与颈椎曲度有关,颈痛程度与颈椎角成弱负相关,在治疗颈椎疾患时应注意对颈椎曲度的矫正。     

Relationship between Northwick Park neck pain questionnaire and cervical spine MR imaging findings

The study was aimed at determining the association between the self-report of pain and disability by means of Northwick neck pain questionnaire (NPQ) and cervical spine MR imaging findings. A random sample of 251 patients, 132 men and 119 women aged 43±13 years, submitted with neck pain were investigated. Patients with previous discitis, surgery, neoplasm or hospitalized for cervical spine trauma were excluded. All patients completed the NPQ and were studied with sagittal gradient-echo T1 and turbo spin-echo T2, axial gradient-echo T2* and heavily T2 weighted MR myelographic weighted images. MR images of the two most affected disc levels were read, offering an MR imaging score from 0 to 30. There was no statistically significant correlation between NPQ and MR imaging scores. From the NPQ items, only difficulty in sleeping and numbness were related to the MR imaging score. Disc extrusion was the only MR finding almost significantly associated with NPQ (P=0.054). Neck injury did not increase NPQ scores. In patients with neck pain, NPQ scores do not correlate with MR imaging findings. NPQ and cervical spine MR imaging show different facets of the multidimensional complex of neck pain.     

Smoking and degenerative changes of the cervical spine: a roentgenographic study.

BACKGROUND CONTEXT: Cigarette smoking has been implicated in low back pain and intervertebral disc degeneration; however, there is no conclusive evidence that cigarette smoking is an important contributing factor to intervertebral disc degeneration. PURPOSE: The objective of this study is to determine whether heavy cigarette smoking is a contributing factor to the development and severity of degenerative disc disease of the cervical spine. STUDY DESIGN: This is a comparative roentgenographic study of degenerative changes of the cervical spine in age- and sex-matched smokers and nonsmokers. PATIENT SAMPLE: Two hundred asymptomatic subjects, 100 women and 100 men, were equally divided into 50 nonsmokers and 50 heavy smokers. OUTCOME MEASURES: A numerical grading system previously developed was used to grade the presence and severity of degenerative changes at each cervical level, and cervical lordosis was measured. This was performed on a lateral cervical spine roentgenogram. METHODS: A single lateral roentgenogram of the cervical spine was taken in each individual, and in the smokers a short questionnaire was administered to determine the amount and duration of smoking. The roentgenograms were read by the three authors. Average values of all three observers were used for statistical analysis. RESULTS: There were no statistically significant differences between smokers and nonsmokers. CONCLUSIONS: Based on the evidence of the plain roentgenograms used in this study, we found no evidence to suggest that cigarette smoking is a causative factor in asymptomatic people in the development of degenerative disc disease in the cervical spine. Whether cigarette smoking has a significant effect in people with neck symptoms cannot be determined by this study.     

The association between cervical spine curvature and neck pain

Degenerative changes of the cervical spine are commonly accompanied by a reduction or loss of the segmental or global lordosis, and are often considered to be a cause of neck pain. Nonetheless, such changes may also remain clinically silent. The aim of this study was to examine the correlation between the presence of neck pain and alterations of the normal cervical lordosis in people aged over 45 years. One hundred and seven volunteers, who were otherwise undergoing treatment for lower extremity problems in our hospital, took part. Sagittal radiographs of the cervical spine were taken and a questionnaire was completed, enquiring about neck pain and disability in the last 12 months. Based on the latter, subjects were divided into a group with neck pain (N = 54) and a group without neck pain (N = 53). The global curvature of the cervical spine (C2–C7) and each segmental angle were measured from the radiographs, using the posterior tangent method, and examined in relation to neck complaints. No significant difference between the two groups could be found in relation to the global curvature, the segmental angles, or the incidence of straight-spine or kyphotic deformity (P > 0.05). Twenty-three per cent of the people with neck pain and 17% of those without neck pain showed a segmental kyphosis deformity of more than 4° in at least one segment—most frequently at C4/5, closely followed by C5/6 and C3/4. The average segmental angle at the kyphotic level was 6.5° in the pain group and 6.3° in the group without pain, with a range of 5–10° in each group. In the group with neck pain, there was no association between any of the clinical characteristics (duration, frequency, intensity of pain; radiating pain; sensory/motor disturbances; disability; healthcare utilisation) and either global cervical curvature or segmental angles. The presence of such structural abnormalities in the patient with neck pain must be considered coincidental, i.e. not necessarily indicative of the cause of pain. This should be given due consideration in the differential diagnosis of patients with neck pain.     

Association between Modic changes,disc degeneration,and neck pain in the cervical spine: a systematic review of literature

BACKGROUNDThe contribution of Modic changes (MCs) in relation to spinal pain and degenerative changes has been evaluated frequently. However, most studies focus on lumbar spine. The association between MCs, neck pain, and cervical disc degeneration is not clear.PURPOSEThe objective of this study was to review current literature on the association between MCs, cervical disc degeneration, and neck pain.STUDY DESIGNA systematic reviewMETHODSA literature search was performed in PubMed, Embase, and Web of Science using a sensitive search string combination. Studies were selected by predefined selection criteria and risk of bias was assessed using a validated Cochrane Checklist adjusted for this purpose.RESULTSFourteen articles that associated MCs with neck pain and/or cervical disc degeneration were included in the present study. Ten articles showed low risk of bias and four showed intermediate risk of bias. The prevalence of MCs in cervical spine varied from 5% to 40% and type II was predominant. Patients with MCs were reported to experience more neck pain and disability. Cervical disc degeneration was detected more frequently in patients with MCs.CONCLUSIONSModic changes were found to be associated with neck pain and with disc degeneration. Therefore, the large variation in prevalence that is reported is highly dependent on the nature of the studied population.     

Shoulder harness traction for roentgenographic assessment of the cervical spine

We evaluated the clinical usefulness of a new shoulder traction device to facilitate a rapid complete cervical spine examination in an uncooperative patient population with multiple trauma. Forty-eight patients were randomly designated to receive the shoulder traction device or the standard technique (manual traction on the patient's upper extremities). Patient groups were equivalent in mean coma scale scores, trauma scores, age, and incidence of cervical fracture. Male-female ratios differed between groups, yet were biased against the harness technique. Fewer roentgenograms (lateral view) were required to visualize adequately all cervical vertebrae when the harness device was utilized (mean roentgenograms per patient, 1.2 vs 2.6; P less than .01). Shoulder harness traction during roentgenographic evaluation of the cervical spine may be a useful method to promote visibility of the lower cervical vertebrae.     

Association between insurance status and patient safety in the lumbar spine fusion population

Background Context

Lumbar fusion is a common and costly procedure in the United States. Reimbursement for surgical procedures is increasingly tied to care quality and patient safety as part of value-based reimbursement programs. The incidence of adverse quality events among lumbar fusion patients is unknown using the definition of care quality (patient safety indicators [PSI]) used by the Centers for Medicare and Medicaid Services (CMS). The association between insurance status and the incidence of PSI is similarly unknown in lumbar fusion patients.

Roentgenographic findings of the cervical spine in asymptomatic people

The purpose of this study was to determine the incidence and severity of degenerative changes seen on lateral roentgenograms in 200 asymptomatic men and women in five age groups with an age range of 20-65 years and to determine the normal values of cervical lordosis and spinal canal sagittal diameters and their relationship to degenerative changes. It was found that by age 60-65, 95% of the men and 70% of the women had at least one degenerative change on their roentgenograms. A small sagittal diameter correlated with the presence of degenerative changes at the same disc level, and the strongest correlation was with the size of the posterior osteophytes at C5-6 (r = 0.52). Cervical lordosis measurements did not relate to degenerative changes except for subjects over age 50 with moderate or severe intervertebral narrowing. It is important to realize that although roentgenographic abnormalities represent structural changes in the spine, they do not necessarily cause symptoms.     

Association between prehypertension and chronic kidney disease in the Japanese general population

The increased prevalence of chronic kidney disease (CKD) is a consequence of the accumulation of risk factors, one of which is hypertension. Here we assessed the prevalence of CKD according to blood pressure among 232,025 patients in a Japanese nationwide database with a focus on the prevalence and risk factors of CKD in prehypertension. Patients were stratified by blood pressure and included 75,474 with optimal blood pressure (less than 120/80 mm Hg); 59,194 with prehypertension and a normal blood pressure (120-129/80-84 mm Hg) or 46,547 patients with high-normal blood pressure (130-139/85-89 mm Hg); and 50,810 with hypertension (over 140/90 mm Hg without anti-hypertensive drugs). CKD was defined as an estimated glomerular filtration rate of stage 3 or lower or having proteinuria greater than 1+ by a dipstick method. The prevalence of CKD among patients with optimal blood pressure, prehypertension having normal or high-normal blood pressure, and hypertension was 13.9, 15.6, 18.1, and 20.7% in men, and 10.9, 11.6, 12.9, and 15.0% in women, with a significant difference between genders at each strata of blood pressure. In men, but not in women, whose blood pressure was high-normal, the CKD risk was significantly greater (odds ratio 1.11) than those with optimal blood pressure. Obesity (body mass index over 25) was significantly associated with an increased risk of CKD in both men and women (odds ratio 1.43 and 1.26, respectively), and there was an additive effect of obesity and pre-hypertension on CKD risk in men compared with men with optimal blood pressure. Thus, the prevalence of CKD increased with the severity of blood pressure. Prehypertension with high-normal blood pressure, particularly in conjunction with obesity, was found to be an independent risk factor of CKD in men.     

Association between radiological findings and symptoms at the patellofemoral joint in advanced knee osteoarthritis

We investigated the association between the radiological findings and the symptoms arising from the patellofemoral joint in advanced osteoarthritis (OA) of the knee. Four radiological features, joint space narrowing, osteophyte formation, translation of the patella and focal attrition were assessed in 151 consecutive osteoarthritic knees in 107 patients undergoing total knee replacement. The symptoms which were assessed included anterior knee pain which was scored, the ability to rise from a chair and climb stairs, and quadriceps weakness. Among the radiological features, only patellar translation and obliteration of the joint space had a statistically significant association with anterior knee pain (odds ratio (OR) 4.85; 95% confidence interval (CI) 1.83 to 12.88 and OR 11.23; 95% CI 2.44 to 51.62) respectively. Patellar translation had a statistically significant association with difficulty in rising from a chair (OR 9.06; 95% CI 1.75 to 45.11). Other radiological features, including osteophytes, joint space narrowing, and focal attrition had no significant association. Our study indicates that the radiological findings of patellar translation and significant loss of cartilage are predictive of patellofemoral symptoms and functional limitation in advanced OA of the knee.     

Scintigraphic findings in acute whiplash injury of the cervical spine

A prospective scintigraphic and radiographic study was carried out in 35 patients with a whiplash injury of the cervical spine. The scintigraphic findings were within normal limits in 31 of the patients, while four had either a focal or multifocal increase in activity. Plain radiography revealed skeletal changes secondary to spondylosis in three patients and a localized bony spur with avulsion of a barely visible fragment in one. Our investigation shows that skeletal lesions after whiplash injury, although very few, are shown by plain skeletal radiography. Scintigraphy is not indicated for screening purposes.     

Primary osteosarcoma of the cervical spine causing neurological symptoms

A case of primary osteosarcoma of the C-6 vertebra in a 39-year-old woman is described. The tumor presented with signs and symptoms of radicular involvement, which were successfully treated surgically. Osteosarcomas of the vertebral column are uncommon, and their localization in the cervical region is definitely rare. The literature on the subject is briefly reviewed.     

Relationship between magnetic resonance imaging findings and spinal cord injury in extension injury of the cervical spine

Objective

The purpose of this study was to determine the relationship between magnetic resonance imaging (MRI) findings and neurologic symptoms in cervical spine extension injury and to analyze the MRI parameters associated with neurologic outcome.

Materials and methods

This study included 102 patients with cervical spine extension injury, whose medical records and MRI scans at the time of injury were available. Quantitative MRI parameters such as maximum spinal canal compression (MSCC), maximum cord compromise (MCC), and lesion length showing intramedullary signal changes were measured. Furthermore, intramedullary hemorrhage, spinal cord edema, and soft tissue damage were evaluated. Fisher’s exact test was used for a cross-analysis between the MRI findings and the three American Spinal Injury Association category groups depending on the severity level of neurologic injury: complete (category A), incomplete (categories B–D), and normal (category E).

Results

MSCC accounted for 23.05, 19.5, and 9.94 % for the complete, incomplete, and normal AIS categories, respectively, without showing statistically significant differences (P = 0.085). MCC was noted in 22.05, 15.32, and 9.2 %, respectively, with the complete-injury group (AIS category A) showing significantly higher. In particular, cases of complete injury had >15 % compression, accounting for 87.5 % (P < 0.001). The mean intramedullary lesion length was significantly higher in complete-injury patients than in incomplete-injury patients (24.22 vs. 8.24 mm). Intramedullary hemorrhage and spinal cord edema were significantly more frequently observed in complete-injury cases (P < 0.001). The incidence of complete injury was proportional to the severity of soft tissue damage.

Conclusion

MCC, intramedullary lesion length, intramedullary hemorrhage, and spinal cord edema were MRI parameters associated with poor neurologic outcomes in patients with cervical spine extension injury.

     

Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up.

STUDY DESIGN: The lateral roentgenographic findings in 159 initially asymptomatic persons were reviewed at a 10-year interval. A questionnaire was used at the time of the last roentgenogram to determine the incidence of pain. OBJECTIVES: To identify the number of persons who experienced pain during that 10-year period, describe the roentgenographic changes, and determine the association between the development of symptoms and roentgenographic findings. SUMMARY OF BACKGROUND DATA: It is well established that degenerative changes of the cervical spine increase with age and may occur in asymptomatic persons. However, it is unknown whether pain is more likely to develop in persons with degenerative changes than in those with normal roentgenograms. METHODS: Lateral cervical roentgenograms were obtained in 200 asymptomatic persons, 100 women and 100 men, to obtain normal values of cervical lordosis and degenerative changes in persons aged 20-65 years. Ten years later, 159 participants had repeat roentgenograms and were administered a questionnaire regarding the presence or absence of pain. RESULTS: There was an increase in the number of subluxations and an increase in degenerative changes. Pain developed in 15% of participants in the 10-year interval. The presence of degenerative changes at C6-C7 on the initial roentgenogram was a statistically significant predictor of pain. CONCLUSION: With age, there is an increase in the number of subluxations and the incidence and severity of degenerative changes. Pain is more likely to develop in persons with degenerative changes at C6-C7.     

Association between MRI findings and clinical outcomes in a period of 5 years after lumbar spine microdiscectomy

European Journal of Orthopaedic Surgery & Traumatology - To evaluate the associations between magnetic resonance imaging (MRI) findings and pain, disability and quality of life before surgery...