The common form of diabetic neuropathy is symmetrical peripheral polyneuropathy, which involves the distal part of the lower extremities whereas diabetic amyotrophy is seen in the proximal part of the lower extremities. Although other regions may also be affected, the presence of upper extremity involvement has rarely been emphasized. Diabetic radiculopathy may involve the cervical region before, after, or concurrently with lumbosacral radiculopathy. We report 2 rare cases of diabetic radiculopathy which involves the cervical region without involving the lumbosacral region. To our knowledge, these are the first reported cases of diabetic radiculopathy involving the cervical region only. In our cases, severe adhesive capsulitis in a shoulder was noticed together with cervical radiculopathy. Both diabetic radiculopathy and adhesive capsulitis have a poorly understood pathogenesis and their combined presence is presumed to be rare. Clinical features and management of cervical radiculopathy with adhesive shoulder capsulitis in 2 diabetic patients is described.
Bursitis/*complications ; Diabetes Mellitus, Type II/*complications ; Female ; Human ; Male ; Middle Aged ; Radiculopathy/*etiology ; *Shoulder Joint

The common form of diabetic neuropathy is symmetrical peripheral polyneuropathy, which involves the distal part of the lower extremities whereas diabetic amyotrophy is seen in the proximal part of the lower extremities. Although other regions may also be affected, the presence of upper extremity involvement has rarely been emphasized. Diabetic radiculopathy may involve the cervical region before, after, or concurrently with lumbosacral radiculopathy. We report 2 rare cases of diabetic radiculopathy which involves the cervical region without involving the lumbosacral region. To our knowledge, these are the first reported cases of diabetic radiculopathy involving the cervical region only. In our cases, severe adhesive capsulitis in a shoulder was noticed together with cervical radiculopathy. Both diabetic radiculopathy and adhesive capsulitis have a poorly understood pathogenesis and their combined presence is presumed to be rare. Clinical features and management of cervical radiculopathy with adhesive shoulder capsulitis in 2 diabetic patients is described.
Bursitis/*complications ; Diabetes Mellitus, Type II/*complications ; Female ; Human ; Male ; Middle Aged ; Radiculopathy/*etiology ; *Shoulder Joint

Acupuncture Points ; Acupuncture Therapy ; Adult ; Female ; Humans ; Male ; Middle Aged ; Radiculopathy ; etiology ; physiopathology ; therapy ; Spondylosis ; complications ; Upper Extremity ; physiopathology

OBJECTIVETo investigate the clinical effectiveness of cervical arthroplasty with Mobi-C prosthesis for treatment of cervical spondylotic radiculopathy.

METHODSFrom March 2008 to November 2009, a group of 67 patients with cervical spondylotic radiculopathy were analyzed retrospectively. The short form-36 physical component summary (SF-36) and visual analogue scale (VAS) score were used to compare clinical outcome pre- and postoperatively. The follow-up was performed at 3 d, 3 months, 6 months and 1 year postoperatively. Static and dynamic radiography were taken to evaluate height of disc space, range of motion (ROM) and heterotopic ossification (HO) of index levels.

RESULTSFifty-one cases were followed up, 16 cases were lost. Average follow-up was for 19.7 months (13 - 31 months). All of patients had improvement for clinical symptoms. There was a significant difference on SF-36 between pre- and postoperatively. The significant difference was found in VAS score in which neck pain was decreased from preoperative 4.6 ± 0.4 to postoperative 2.0 ± 0.5 (P < 0.05), arm pain was decreased from preoperative 6.5 ± 0.4 to postoperative 1.3 ± 0.4 (P < 0.05). There was a significant difference in height of disc space which was increased from preoperative (6.5 ± 1.1) mm to (7.7 ± 0.9) mm (P < 0.05). ROM was increased from preoperative 7.2° ± 3.1° to latest follow-up 8.1° ± 3.2°, however, no significant difference was found concerning ROM pre- and postoperatively (P > 0.05). No other complications were met during follow-up period other than the 17 cases of heterotopic ossification in ClassI, the 7 cases in Class II in 1 year postoperatively, but no any correlation were found between the radiographic finding in HO and clinical symptoms.

CONCLUSIONSCervical arthroplasty with Mobi-C could improve neurofunctional symptoms, maintain ROM of index level and height of disc space. For accurate patient selection, long term follow-up is still needed in prospective randomized study.

Adult ; Arthroplasty, Replacement ; methods ; Cervical Vertebrae ; Female ; Humans ; Joint Prosthesis ; Male ; Middle Aged ; Radiculopathy ; complications ; surgery ; Retrospective Studies ; Spondylosis ; etiology ; surgery ; Treatment Outcome

OBJECTIVETo analyze the clinical and radiologic outcomes of bilateral uncovertebral joints resection and decompression in treating cervical spondylotic radiculopathy through anterior approach.

METHODSFrom January 2007 to December 2009, the clinical data of 56 patients with cervical spondylotic radiculopathy undergoing sugical treatment were retrospectively analyzed. There were 33 males and 23 females with an average age of (58.83 +/- 8.01) years (ranged 41 to 72). The course was from 5 to 48 months with an average of (14.09 +/- 8.54) months. All patients underwent bilateral uncovertebral joints resection, vertebral canal decompression and fusion through anterior approach. Perioperative, radiologic,nerve functional parameters were analyzed before and after operation. Perioperative parameters included hospital stay days and blood loss volume and operative time; radiologic parameters included vertebral height and lordosis angle and fusion rate; and according to JOA score to evaluate the nerve function.

RESULTSAll patients were followed up from 12 to 30 months with an average of 18.2 months. Hospital stay days, blood loss volume and operative time were (4.42 +/- 0.25) d, (195.51 +/- 23.67) ml and (145.52 +/- 28.29) min, respectively. Preoperative vertebral height was (5.19 +/- 0.03) cm, and postoperative 1 year arrived to (5.37 +/- 0.29) cm, there was no significant difference between preoperative and postoperative (P > 0.05). Lordosis angle increased from preoperative (1.53 +/- 0.03) degrees to (7.78 +/- 0.66) degrees at the 1 year after operation (P<0.01). Fusion rate was 96.5% at the 1 year after operation. JOA score increased from preoperative 8.69 +/- 2.13 to 15.58 +/- 2.45 at the 1 year after operation (P < 0.001). According to standard of JOA scoring, 20 cases were excellent, 28 good, 7 fair and 1 poor.

CONCLUSIONUncovertebral joints resection and decompression through anterior cervical approach in treating cervical spondylotic radiculopathy is safe and reliable, which can get satisfactory clinical outcomes. This surgical procedure is suitabl oe for the patients of cervical spondylosis, especially combined canal stenosis and osteophytosis of the uncovertebral joint.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Radiculopathy ; etiology ; surgery ; Spinal Fusion ; methods ; Spondylosis ; surgery

OBJECTIVETo determine the effects of the autologous nucleus pulposus on the pain-related behaviors of hind paws in rats.

METHODSThe nucleus pulposus harvested from autologous coccygeal vertebra was applied beside the unilateral L4 and L5 nerve roots without compression. The mechanical withdrawal threshold of both paws were measured in different times after surgery. And hematoxylin and eosin (HE) staining was applied to observe the changes of nucleus pulposus and nerve roots.

RESULTSMechanical sensitivity of the operated side in paws obviously increased after application of autologous nucleus pulposus beside the lumbar nerve roots without compression. And HE staining showed obviously inflammatory changes in the nucleus pulposus and vacuolation in the nerve roots.

CONCLUSIONSInflammation resulted from nucleus pulposus may contribute to the development of mechanical hyperalgesia. The results suggest that in addition to mechanical compression, inflammation may be an important factor in the pathogenesis of sciatica.

Animals ; Disease Models, Animal ; Hyperalgesia ; etiology ; pathology ; physiopathology ; Intervertebral Disc Displacement ; complications ; pathology ; physiopathology ; Male ; Radiculopathy ; complications ; pathology ; physiopathology ; Rats ; Rats, Sprague-Dawley

The excitability of nociceptive neurons increases in the intact dorsal root ganglion (DRG) after a chronic compression, but the underlying mechanisms are still unclear. The aim of this study was to investigate the ionic mechanisms underlying the hyperexcitability of nociceptive neurons in the compressed ganglion. Chronic compression of DRG (CCD) was produced in adult rats by inserting two rods through the intervertebral foramina to compress the L4 DRG and the ipsilateral L5 DRG. After 5-7 d, DRG somata were dissociated and placed in culture for 12-18 h. In sharp electrode recording model, the lower current threshold and the depolarized membrane potential in the acutely dissociated CCD neurons were detected, indicating that hyperexcitability is intrinsic to the soma. Since voltage-gated K(+) (Kv) channels in the primary sensory neurons are important for the regulation of excitability, we hypothesized that CCD would alter K(+) current properties in the primary sensory neurons. We examined the effects of 4-aminopyridine (4-AP), a specific antagonist of A-type potassium channel, on the excitability of the control DRG neurons. With 4-AP in the external solution, the control DRG neurons depolarized (with discharges in some cells) and their current threshold decreased as the CCD neurons demonstrated, indicating the involvement of decreased A-type potassium current in the hyperexcitability of the injured neurons. Furthermore, the alteration of A-type potassium current in nociceptive neurons in the compressed ganglion was investigated with the whole-cell patch-clamp recording model. CCD significantly decreased A-type potassium current density in nociceptive DRG neurons. These data suggest that a reduction in A-type potassium current contributes, at least in part, to the increase in neuron excitability that may lead to the development of pain and hyperalgesia associated with CCD.
Animals ; Female ; Ganglia, Spinal ; physiopathology ; Hyperalgesia ; etiology ; physiopathology ; Neurons, Afferent ; physiology ; Nociceptors ; physiology ; Pain ; physiopathology ; Potassium Channels ; physiology ; Radiculopathy ; physiopathology ; Rats ; Rats, Sprague-Dawley

BACKGROUND: The purpose of this study was to evaluate the clinical feasibility of an electric nerve stimulator in a lumbar transforaminal epidural block. METHODS: Using an electric nerve stimulator, transforaminal epidural blocks were performed in 105 segments of 49 patients who presented with lower back pain with radiating pain to lower extremities. The contrast medium was injected to delineate the nerve root after positioning an insulated needle at the intervertebral foramen under fluoroscopic guidance. Then, the nerve root was electrically stimulated with the insulated needle to confirm whether or not the same radiating pain was evoked. RESULTS: Of the 105 foraminal segments, the same radiating pain was evoked at 0.5 mAh in 47 segments (44.8%), at 1.0 mAh in 22 (21.0%), at 1.5 mAh in 3 (2.9%), at 2.0 mAh in 15 (14.3%), at 2.5 mAh in 4 (3.8%), and at 3.0 mAh in 5 (4.8%). No response was observed in 9 segments (8.6%). The fluoroscopy revealed successful positioning of the needle in the patients with an evoked radiating pain over 2.0 mAh. The visual analogue scale (VAS) obtained for pain improved from a mean of 7.5 to 2.7 after the block (p = 0.001). In the 9 cases without response to electrical stimulation, the patients showed an improvement on VAS from 7.8 to 3.4 (p = 0.008) also. CONCLUSIONS: A nerve stimulator can help to predict the accuracy of needle positioning as a supplemental aid for a successful lumbar transforaminal epidural block. It is sufficient to initiate a proper stimulation amplitude of the nerve at 2 mAh.
Adult ; Aged ; Aged, 80 and over ; Analgesia, Epidural ; *Electric Stimulation Therapy ; Feasibility Studies ; Female ; Humans ; Low Back Pain/etiology/*therapy ; *Lumbar Vertebrae ; Male ; Middle Aged ; *Nerve Block ; Radiculopathy/etiology/therapy ; Spinal Diseases/*complications

Adult ; Aged ; Cervical Vertebrae ; pathology ; physiopathology ; surgery ; Female ; Fracture Fixation, Internal ; adverse effects ; Humans ; Intervertebral Disc Displacement ; pathology ; Male ; Middle Aged ; Radiculopathy ; Spinal Cord Diseases ; etiology ; Spinal Cord Injuries ; pathology ; Spinal Diseases ; pathology ; Spinal Osteophytosis ; etiology ; Transplants ; adverse effects

OBJECTIVETo explore the clinical features, treatment and prognosis of the C5 palsy after surgery of cervical spondylosis.

METHODSTwo hundred and twenty-three cases treated from March 1994 to October 2003 were retrospectively reviewed.

RESULTSSeven of the 223 cases developed the complication of C5 palsy, manifesting the paresis of the deltoid muscle as well as the sensory deficits and (or) intractable pain in shoulder. The incidence was 3.1%. In this study, 2 cases occurred in the anterior subcorpectomy, 5 cases developed in the laminoplasty with 1 case on the opened side, 3 cases on the hinged side and 1 case on both sides. All the 7 cases with the C5 palsy recovered within 2 weeks to 6 months.

CONCLUSIONThe C5 palsy can develop either anterior decompression or posterior open-door laminoplasty of cervical spondylosis. Generally speaking, patients with postoperative C5 palsy can be cured by conservative measures. And prognosis is good.

Adult ; Aged ; Bone Transplantation ; adverse effects ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; adverse effects ; Female ; Humans ; Laminectomy ; adverse effects ; Male ; Middle Aged ; Postoperative Complications ; diagnosis ; etiology ; prevention & control ; Radiculopathy ; diagnosis ; etiology ; prevention & control ; Retrospective Studies ; Spinal Nerve Roots ; Spinal Osteophytosis ; surgery