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PubMed2005

[Observation on therapeutic effect of acupuncture at lateral cervical Jiaji points on cervical spondylosis of vertebroarterial type].

OBJECTIVE: To compare therapeutic effects of acupuncture at lateral cervical Jiaji and at traditional Jiaji points on cervical spondylosis of vertebroarterial type. METHODS: Seventy-two cases of vertebroarterial type cervical spondylosis were randomly divided into a needling lateral cervical Jiaji group (n=40) and a traditional Jiaji group (n=32). After 2 courses, therapeutic effects were evaluated and ultrasound Doppler's detection of skull was conducted. RESULTS: The therapeutic effect in the lateral cervical Jiaji group was better than that in the traditional Jiaji group (P < 0.05); And there was a significant or very significant difference between the two groups in the velocity of blood flow and the index of vascular pulsation (P < 0.05 or P < 0.01). CONCLUSION: The results of acupuncture at lateral cervical Jiaji points is better than that of acupuncture at traditional Jiaji points for treatment of cervical spondylosis of vertebroarterial type.

Acupuncture Points↗

PubMed1985

The correlation of myelographic root sleeve deformity, uncovertebral spondylosis and radiculopathy.

Myelographic root sleeve deformities, uncovertebral spondylosis and myelopathy were correlated in 56 patients. Good correlation between root sleeve deformities and uncovertebral spondylosis was found. However, in some cases with spinal canal stenosis root sleeve deformities were found without corresponding bone changes. The correlation of radiculopathy to root sleeve deformity and uncovertebral spondylosis was 61 and 67%, respectively. Radiologic changes at an adjacent root level were often seen in patients without clinically correlated radiculopathy. The myelographic changes were verified at operation in all the 46 patients operated upon.

Adult↗

PubMed1990

Identifiable causes for poor outcome in surgery for cervical spondylosis. Post-operative computed myelography and MR imaging.

Outcome from surgery for cervical spondylosis is often disappointing. To identify possible causes of poor outcome 56 such patients referred for post-operative computed myelography or MRI were evaluated, 22 of which eventually had further surgery. Alternative diagnoses to cervical spondylosis were eventually established in 14.3%; 26.8% had spinal cord atrophy 15.6% of which also had myelomalacia; 28.6% had diffuse spinal canal stenosis; and in 57.1% surgery had failed to decompress the spinal canal. These findings can be partly explained by patient selection criteria; nevertheless they do serve to emphasises the point often ignored in discussions of the efficacy of surgery in cervical spondylosis, that operations significantly often fail to achieve adequate decompression. Furthermore there was no evidence in this material that osteophytes regress after spinal fusion.

Adult↗

PubMed2006

On the coincidence of cervical spondylosis and multiple sclerosis.

Multiple sclerosis (MS) and cervical spondylosis are relatively common diseases. It is therefore inevitable that the MS clinician will be confronted with patients with myelopathy in whom the two conditions coexist. When faced with an MS patient who has cord compression secondary to cervical spondylosis as well as cord demyelination, the issue of surgical decompression of the cord arises. Whether the trauma of cord compression aggravates the MS lesions is still a matter of debate and should not influence treatment decisions. There is little prospective evidence-based support for the notion of surgical cord decompression in cervical spondylosis without MS, and none at all for surgery in MS, with only small published retrospective series available. The clinician must therefore make a judgment-based treatment decision. Guidelines for the management of patients with coincidental cervical cord compression and MS are suggested.

Cervical Vertebrae↗

PubMed2006

The association between positional vertebral and basilar artery flow lesion and prevalence of vertigo in patients with cervical spondylosis.

OBJECTIVE: The aim of our investigations was to characterize the relationship between basilar artery (BA) flow velocity in patients with cervical spondylosis and age, grade of radiological changes, prevalence of vertigo, and decreased blood flow velocity through vertebral arteries (VA) after head rotation. STUDY DESIGN AND SETTING: A prospective, controlled study in academic neurotology was conducted. We examined 80 patients with radiological evidence of cervical spondylosis. Forty patients complained of positional vertigo lasting more than 6 months. Patients were examined by transcranial Doppler ultrasound with head rotations. RESULTS: We showed significant association between velocity flow in basilar artery after neck rotation and age, prevalence of vertigo, grade of radiological changes, and positional vertebral artery flow lesion. CONCLUSION: Spondylotic-induced VA compression may be the reason for decreased blood flow velocity in the basilar artery during head rotation, which may be of particular importance for older patients, especially complaining of vertigo. SIGNIFICANCE: Every patient with high-grade cervical spondylosis, especially complaining of vertigo, should be examined by using TCD (transcranial Doppler) with head rotations. In case of positional blood flow reduction during head rotation, further angiographic examination should be undertaken so as to plan suitable treatment. EBM RATING: C-4.

Age Factors↗

PubMed1991

Experimental cervical spondylosis in the mouse.

A reproducible experimental model of cervical spondylosis in mice was established by means of detachment of the posterior paravertebral muscles from the vertebrae and resection of the spinous processes along with the supraspinous and interspinous ligaments. Mechanical instability in the cervical spine elicited by this surgical intervention accelerated the process of intervertebral disc degeneration, and when extended over a 6-12-month period, induced cervical spondylosis in the mice. The pathologic findings in the cervical intervertebral discs of this experimental model varied: proliferation of cartilaginous tissue and fissures in the anulus fibrosus, shrinkage of the nucleus pulposus, herniation of disc material, and osteophyte formation. The availability of this experimental model should be valuable for biochemical and biomechanical understanding of the pathogenesis of cervical spondylosis.

Animals↗

PubMed1999

The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis.

STUDY DESIGN: A Cochrane review of randomized controlled trials. OBJECTIVES: To collate the scientific evidence on surgical management for lumbar-disc prolapse and degenerative lumbar spondylosis. SUMMARY OF BACKGROUND DATA: Surgical investigations and interventions account for as much as one third of the health care costs for spinal disorders, but the scientific evidence for most procedures still is unclear. METHODS: A highly sensitive search strategy identified all published randomized controlled trials. Cochrane methodology was used for meta-analysis of the results. RESULTS: Twenty-six randomized controlled trials of surgery for lumbar disc prolapse and 14 trials of surgery for degenerative lumbar spondylosis were identified. Methodologic weaknesses were found in many of the trials. Only one trial directly compared discectomy and conservative management. Meta-analyses showed that surgical discectomy produces better clinical outcomes than chemonucleolysis, which is better than placebo. Three trials showed no difference in clinical outcomes between microdiscectomy and standard discectomy, but in three other studies, both produced better results than percutaneous discectomy. Three trials showed that inserting an interposition membrane after discectomy does not significantly reduce scar formation or alter clinical outcomes. Five heterogeneous trials on spinal stenosis and degenerative spondylolisthesis permit very limited conclusions. There were nine trials of instrumented versus noninstrumented fusion: Meta-analysis showed that instrumentation may facilitate fusion but does not improve clinical outcomes. CONCLUSIONS: There is now strong evidence on the relative effectiveness of surgical discectomy versus chemonucleolysis versus placebo. There is considerable evidence on the clinical effectiveness of discectomy for carefully selected patients with sciatica caused by lumbar disc prolapse that fails to resolve with conservative management. There is no scientific evidence on the effectiveness of any form of surgical decompression or fusion for degenerative lumbar spondylosis compared with natural history, placebo, or conservative management. The Cochrane reviews will be updated continuously as other trials become available.

Databases, Factual↗

PubMed2003

Partial corpectomy for cervical spondylosis.

STUDY DESIGN: A retrospective review was performed of a single surgeon's experience with partial corpectomy over a 9-year period. The measures evaluated included fusion rate, complications, and neurologic symptoms. OBJECTIVE: To demonstrate the safety and efficacy of partial corpectomy for multilevel cervical spondylosis. SUMMARY OF BACKGROUND DATA: Strategies for the surgical management of cervical spondylosis have included laminectomy, multilevel corpectomy, and multilevel discectomy. All have significant disadvantages, including high nonunion rates and late deformity. A procedure incorporating multilevel discectomy, partial corpectomy, strut graft, and plating is described. By removal of the anterior two thirds of the intervening vertebral body, visualization of the interface between the dura and the disc or PLL is enhanced, and osteophytes can be easily removed. Fusion rates are improved. METHODS: All partial corpectomy cases with a 2-year follow-up evaluation managed by the senior author for multilevel cervical spondylosis from 1991 to June 1999 were reviewed for the number of levels decompressed, graft source, use of plating, fusion success, and neurologic status. RESULTS: Most of the patients (n = 97) were managed with two-level discectomies, with 42 requiring treatment of three levels and 5 requiring treatment of four or more levels. Allograft was used in 60%. The remainder received iliac crest bone graft. The majority (81%) were plated. Of the cases with 2-year follow-up evaluation, the fusion rate was 95.8%, independent of the number of levels fused. Among the 11% who had continued problems, most had improved. Nonunions were higher in smokers. CONCLUSIONS: Partial corpectomy is an effective strategy for treating multilevel cervical disc disease. It is associated with a high fusion rate. In addition, partial corpectomy facilitates a complete decompression by providing excellent visualization of the dural interface.

Adult↗

PubMed2007

Cervical spondylosis anatomy: pathophysiology and biomechanics.

Cervical spondylosis is the most common progressive disorder in the aging cervical spine. It results from the process of degeneration of the intervertebral discs and facet joints of the cervical spine. Biomechanically, the disc and the facets are the connecting structures between the vertebrae for the transmission of external forces. They also facilitate cervical spine mobility. Symptoms related to myelopathy and radiculopathy are caused by the formation of osteophytes, which compromise the diameter of the spinal canal. This compromise may also be partially developmental. The developmental process, together with the degenerative process, may cause mechanical pressure on the spinal cord at one or multiple levels. This pressure may produce direct neurological damage or ischemic changes and, thus, lead to spinal cord disturbances. A thorough understanding of the biomechanics, the pathology, the clinical presentation, the radiological evaluation, as well as the surgical indications of cervical spondylosis, is essential for the management of patients with cervical spondylosis.

Biomechanical Phenomena↗

PubMed2004

Prevalence of spondylosis deformans and estimates of genetic parameters for the degree of osteophytes development in Italian Boxer dogs.

The aim of this study was to assess the prevalence of spondylosis deformans and to investigate genetic aspects of the degree of osteophytes development (DOD) in the Italian Boxer dog population. A total of 849 Boxer dogs was radiographed on the thoracic, lumbar, and sacral regions of the spine and scored for DOD. Grading of DOD was performed for all 20 intervertebral sites comprised within the first thoracic site (site T1-T2) and the site between the seventh lumbar and the first sacral vertebra (site L7-S1). Scores for DOD ranged from 0 (no osteophytes development) to 3 (presence of a bony spur formed by osteophytes on adjoining vertebrae). The first five thoracic sites exhibited no variation for DOD and were not considered in the analysis. The prevalence of spondylosis deformans was 84%, and frequency of dogs showing at least one intervertebral site that scored 3 for DOD was 50%. Scores for DOD at different sites were analyzed as different traits. Nongenetic effects influencing DOD scores were sex, age at screening, and the kennel. Posterior densities of heritability (h2) were estimated using a univariate Bayesian analysis. Eight sites exhibited a posterior probability greater than 0.8 for h2 > 10% and were considered in a multivariate restricted maximum likelihood analysis. Estimated h2 from multivariate analysis ranged from 25 to 48% (SE from 5 to 7%). Three sites exhibited h2 estimates greater than 40%. Genetic correlations for DOD scored at different sites ranged from 0.07 to 0.96. All thoracic sites had estimated correlations larger than 0.85 with other thoracic sites. Genetic correlation between the first and the second lumbar site was 0.91. Correlations between thoracic sites and the first two lumbar sites ranged from 0.5 to 0.9. Sites L6-L7 and L7-S1 also exhibited weak relationships with all remaining sites. Breeding values of dogs for DOD at the eight sites were predicted using estimated covariance matrices. A selection index for DOD was computed from predicted breeding values and a set of relative weighting factors produced by a panel of veterinarians. The index was the most important effect influencing phenotypic differences between dogs for average DOD score, number of affected sites, and number of sites with a DOD score > 1 (P < 0.001). The degree of osteophytes development is a trait showing exploitable additive genetic variance, and breeding programs for decreasing prevalence and severity of spondylosis deformans might focus on this trait.

Age Factors↗

PubMed1999

Laminectomy with posterior wiring and fusion for cervical ossification of the posterior longitudinal ligament, spondylosis, ossification of the yellow ligament, stenosis, and instability: a study of 5 patients.

Cervical laminectomy with posterior wiring and fusion is valuable for the management of cervical ossification of the posterior longitudinal ligament (OPLL), spondylosis, ossification of the yellow ligament (OYL), stenosis, and instability. Within 1.5 years, five patients averaging 73 years of age developed severe myelopathy. Dynamic radiographs confirmed an intact cervical lordosis with active subluxation and instability at one or two levels, whereas magnetic resonance and computed tomography scans showed OPLL, spondylosis, OYL, and stenosis. After multilevel laminectomy with posterior wiring and fusion and immobilization in cervicothoracic orthoses, patients fused in an average of 3.6 months. All patients improved, showing mild to moderate residual postoperative myelopathy an average of 13 months later (range, 6-19 months). With an intact cervical lordosis, laminectomy with posterior wiring and fusion was used successfully to manage five patients with OPLL, spondylosis, OYL, stenosis, and instability.

Aged↗

PubMed1999

Syndrome of cervical spondylosis in Blantyre, Malawi.

OBJECTIVE: To define the spectrum of clinical and radiological presentations of cervical spondylosis in Malawians. DESIGN: A prospective study. SETTING: The Queen Elizabeth Central Hospital, Blantyre which is the main referral hospital in Malawi and the teaching hospital of Malawi College of Medicine. SUBJECTS: Thirty seven patients (nineteen females and eighteen males) who presented with cervical spondylosis between February 1997 and September 1998. INTERVENTIONS: Treatment was conservative except one patient with cervical myelopathy who had laminectomy. RESULTS: Four of the patients were aged below 40 years; six were in the seventh decade, 13 in the fifth and fourteen in the sixth decades of life. All the 37 patients had discogenic disorder which manifested as brachial neuropathy. In addition, five (13.5%) had cervical myelopathy and two (5.4%) each had vertebro-basilar artery insufficiency, pseudoangina and dysphagia. Anterior osteophytes were three times as common as posterior osteophytes. CONCLUSION: In view of the various manifestations of cervical spondylosis the term cervical syndrome can be aptly applied to this disease.

Adult↗

PubMed2002

[Allograft fibula in treatment of cervical spondylosis].

OBJECTIVE: To evaluate the efficacy of allograft fibula in anterior cervical fusion for cervical spondylosis patients treated by Smith-Robinson operation supplemented with anterior instrumentation. METHODS: The clinical outcome of 38 patients with cervical spondylosis treated by Smith-Robinson operation using allograft fibula supplemented with anterior titanium plate were retrospectively studied. The patients were followed up on average was (9.5 +/- 3.4) months. The average preoperative and postoperative JOA scores were assessed and myelopathy severity was graded using the Nurick myelopathy grading system. Lateral views in neutral position, in flexion, and in extension of preoperative cervical roentgenograms were analyzed in comparison with last follow-up films to identify the changes in the height of intervertebral space and the quality of fusion. RESULTS: Statistical analysis of all patients revealed mean JOA scores of 12.54 +/- 1.62 and 16.07 +/- 1.13 before surgery and at final examination (P < 0.05), respectively. And the mean Nurick grades were 2.46 +/- 0.43 and 0.72 +/- 0.37 before and after surgery (P < 0.05), respectively. Radiographic follow-up revealed that the height intervertebral space and the lordosis of the cervical spine had been restored and no allograft was found displaced or collapsed and also revealed that all grafts obtained union by 5 months after surgery. CONCLUSIONS: Fibular allograft can replace autologous iliac crest graft in the treatment of cervical spondylosis patients. This method is safe and efficacious and can avoid bone graft-site morbidity.

Adult↗

PubMed2002

[The effect of cervical spine instability on sympathetic cervical spondylosis].

OBJECTIVE: To investigate the effect of cervical spine instability on sympathetic cervical spondylosis. METHODS: Twelve patients with cervical spondylosis showing sympathetic symptoms from 1992 to 2 000 were evaluated for cervical spine instability, immobilization of collar brace, MRI and surgical results. RESULTS: Radiologic evaluation cervical instability was observed radiologically in 7 of the 12 cases. Collar brace was obviously effective in 5 of the 12 cases and slightly effective in 7 cases. MRI showed abnormal signal for instability of the cervical spine in 7 cases. Surgery was markedly effective in 7 cases and moderately effective in 4 cases. CONCLUSION: Cervical spine instability was an important factor for sympathetic cervical spondylosis, which can be improved effectively by surgery.

Adult↗

PubMed1992

Role of vitamin A and E in spondylosis.

A biomedical study was undertaken at the Institute of Nutrition and Food Science, University of Dhaka to observe the effect of the antioxidative roles of vitamins A and E on the degenerative process occurring in spondylosis in human. A single and a double blind study were done. Thirty two patients suffering from spondylosis were selected for the study on the basis of certain criteria. The serum vitamin E level in most of the patients were lower (5.8 +/- 2.7 umol/L) than normal (11-41 umol/L). Vitamin E administration at a dose of 100 mg daily for three weeks resulted in a significant increase in serum vitamin E level accompanied by complete relief of pain. The serum vitamin A level of the patients were already within the normal (0.53-2 umol/L) range and vitamin A administration was not effective in relieving the pain. The results therefore strongly indicate that vitamin E is effective in curing spondylosis and most probably due to its antioxidant activity.

Adult↗

PubMed2003

[Peri-operative treatment with botulinum A toxin prior to posterior cervical decompression in a case with cervical spondylosis caused by spasmodic torticollis secondary to cerebral palsy].

Patients with spasmodic torticollis secondary to athetoid cerebral palsy may develop symptomatic degenerative cervical disc disease or spondylosis. In these cases, peri-operative stabilization of the cervical spine is considered to be difficult and recurrence occurs frequently. We reported a case with cervical spondylosis induced by athetoid cerebral palsy. A 44-year-old female with athetoid cerebral palsy had suffered from secondary spasmodic torticollis. 7 years previously, she had been admitted to our hospital for the first time with complaints of gait disturbance, dysesthesia and hypesthesia in all extremities. CT-myelography and MRI showed disc degeneration and spondylosis at the level of C4/5 and C5/6, compressing the spinal cord. She underwent C5 vertebrectomy and C4-6 anterior fusion. However, due to cervical dystonia, it was difficult for her to wear a Philadelphia collar, so she had to under go complete bed rest for postoperative neck stabilization. Her symptoms improved after the operation. 5 years after the first operation, she complained of gait disturbance and sensory disturbance, again. MRI showed compression of the spinal cord at C2-C4, rostral to the level of the previous surgical area. So we planned the second operation. Prior to the operation, we used botulinum A toxin to reduce the athetoid movement of the neck. And we performed C3-6 expansive laminoplasty and partial laminectomy of C2 and C7 laminae. After the second operation, she was able to wear the Philadelphia collar without trouble and her neurological condition improved again. Botulinum A toxin was very effective to control the spasmodic torticollis peri-operatively in this case with cervical dystonia.

Adult↗

PubMedDate not supplied

Cervical vertigo and cervical spondylosis--a need for adequate evaluation.

BACKGROUND: Cervical spine spondylotic changes are known to cause vertigo. The mechanism by which cervical vertigo is induced is very debatable. This study was to highlight the prevalence of vertigo and other vestibulocochlear organ affectation in patients with cervical spondylosis and to serve as a template for further research in this area. METHODOLOGY: A six-year retrospective review of vertiginous patients with radiological evidence of cervical spondylosis seen at the Otorhinolaryngology Clinic of University College Hospital (UCH), Ibadan. RESULTS: Forty-three patients, 23 males (53.5%) and 20 females (46.5%) had vertigo as a symptom and radiological evaluation for cervical spondylosis. The radiological findings were normal in 11 patients (26%) and abnormal in 32 patients (74%). Of the twenty-five patients who had pure tone audiometry, 40% were normal and 60% abnormal. Out of 20 affected ears, seven patients (47%) had right, 3 patients (20%) left and 5 patients (33%) both ear involved respectively. High frequency range was affected in 8 (40%), low in 2 (10%) and all in 10 (50%) ears respectively. Decibel hearing level (dBHL) loss ranged from 30-90 dBHL with a mean binaural of 43 (+/- 8.5) dBHL. CONCLUSION: We advocate early multidisciplinary approach in the management of all established cases of cervical vertigo.

Adult↗

PubMed2006

[Chief physician Lian Yu-lin's experience on treatment of cervical spondylosis by classification].

In clinical teaching practice of over 30 years, professor LIAN Yu-lin combines physiological, pathological and anatomic knowledge with TCM treatment based on syndrome differentiation, forming own unique theoretical system. This paper introduces LIAN's experience on treatment of cervical spondylosis in detail, and location of cervical vertebra three lines and determination of needling depth and reinforcing-reducing manipulation based on clinical manifestations of various types of cervical spondylosis, and combination of long needle with short needle, deep needling with superficially needling, stressing the main point and having a definite object. This is an effective pathway for treatment of cervical spondylosis.

Acupuncture Therapy↗