Traditional Chinese Medicine believes that "Gu Cuo Feng and Jin Chu Cao "is the key pathogenesis for spinal degenerative disease, such as cervical spondylosis, but there is also lots of controversy for the concept of "Go Cuo Feng and Jin Chu Cao". The paper emphasizes the concept of "Cu Cuo Feng and Jin Chu Cao" from structural abnormality and dysfunction, and build the clinical standard of cervical "Gu Cuo Feng and Jin Chu Cao" from clinical symptoms, conventional physical signs of cervical spondylosis, special physical signs (mainly by palpation) and imaging measurement (special measuring method).
Cervical Vertebrae ; diagnostic imaging ; Diagnostic Imaging ; Humans ; Radiography ; Spondylosis ; diagnosis ; diagnostic imaging

Cervical Vertebrae/diagnostic imaging* ; Humans ; Range of Motion, Articular ; Spondylosis/diagnostic imaging* ; Treatment Outcome

OBJECTIVE: To observe the changes of functional connectivity of brain pain-emotion regulation region in patients with cervical spondylosis of cervical type by functional magnetic resonance imaging (fMRI). METHODS: Thirty-two subjects were selected. Of them, 16 patients with cervical spondylosis of cervical type were divided into an observation group and 16 healthy subjects into a control group. The patients in the observation group were treated with acupuncture at Tianzhu (BL 10), Jingbailao (EX-HN 15), Jianzhongshu (SI 15) and RESULTS: In the observation group, the VAS score was (1.94±1.12) after the treatment, which was lower than (5.62±1.20) before treatment ( CONCLUSION Pain involves the formation and expression of "pain-emotion-cognition". Acupuncture can systematically regulate the brain functional connections between cognitive regions such as dorsal prefrontal lobe and anterior cingulate gyrus and emotional regions such as insula and VTA in patients with cervical spondylosis of cervical type, suggesting that acupuncture has a multi-dimensional and comprehensive regulation effect on pain.
Acupuncture Therapy ; Brain/diagnostic imaging* ; Emotions ; Humans ; Magnetic Resonance Imaging ; Pain ; Spondylosis/therapy*

OBJECTIVETo improve the X-ray diagnosis of cervical spondylosis of vertebral artery type (VCS).

METHODSA blinded design research. The X-ray signs both 60 patients with VCS and 60 patients with cervical spondylotic radiculopathy were collected from January 2011 to November 2012. There were 36 males and 84 females, aged from 25 to 65 years old with an average of (48.4 ± 12.3) years old. Cervical curvature, atlanto-occipital joint angle, atlanto-axial joint angle, C2/C3 joint angle and lower cervical instability condition and segmental distribution were measured and recorded by X-rays. These data were analyzed and compared between the two groups after unblended. Combined with clinical manifestations,the X-ray imaging features of VCS were further analyzed.

RESULTSThere was significant difference in cervical curvature between two groups in anteflexion X-ray films (P < 0.05). There was significant difference in extension degree of atlanto-occipital joint angle between two groups (P < 0.01). There was significant difference in atlanto-axial joint angle between two groups in lateral X-ray films (P< 0.05). There was significant.difference in anteflexion degree of atlanto-axial joint angle between two groups (P < 0.05). There was no significant difference in C2/C3 joint angle between two groups. There was no significant difference in the lower cervical instability condition and segmental distribution between two groups. In VCS group, the mild and moderate dizziness was main symptom, flexion and extension activities of neck was most common cause in the dizziness; and always accompanied with headache; tenderness mostly concentrated in the upper cervical area.

CONCLUSIONBoth X-ray signs and clinical manifestations can prompt the abnormalities of the upper cervical structure or function in patients with VCS. Anteflexion activities of neck observed by functional position of X-ray films should be emphasized in diagnosis of VCS.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Radiculopathy ; diagnostic imaging ; Radiography ; Spondylosis ; diagnostic imaging ; Vertebral Artery ; X-Rays

BACKGROUNDAirway management is crucial in clinical anesthesia. Many complications associated with airway management result from unexpected difficult airway, but predicting a difficult airway is a major challenge. We investigated the efficacy of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis, a population with a high incidence of difficult airway.

METHODSWe randomly enrolled 303 patients scheduled for elective surgery for cervical spondylosis at Peking University Third Hospital between August 2012 and March 2013. Preoperatively, patients were evaluated for difficult airway according to a clinical index and parameters on lateral cervical radiographs and magnetic resonance images. Difficult airway was defined as Cormack-Lehane grades III-IV. Logistic regression was used to identify a combined (clinical and radiological) model for difficult airway. A receiver operating characteristic (ROC) curve was used to describe the effectiveness of prediction.

RESULTSWe identified three clinical predictive factors using the ROC curve: mouth opening, sternomental distance, and neck mobility. We created a clinical model using three factors: gender, age, and mouth opening, with odds ratios (OR) of 0.370, 1.034, and 0.358, respectively. Using the clinical and radiological parameters, we formulated a combined model with five risk factors: gender, mouth opening, atlanto-occipital gap, the angle from the second to sixth cervical vertebraes in the neutral position, and the angle difference of d (the angle between the laryngeal axis and the epiglottic axis) from the neutral position to extension (OR: 0.107, 0.355, 0.846, 1.057, and 0.952, respectively). The sensitivity and specificity of the combined model were 80.0% and 65.7%, respectively, and the ROC curve confirmed that the combined model was better than any single clinical predictor and the clinical model.

CONCLUSIONThe efficacy of the combined model including both clinical and radiological indicators was better than any single clinical predictor or the clinical model in patients undergoing elective surgery for cervical spondylosis.

Adult ; Cervical Vertebrae ; diagnostic imaging ; surgery ; Female ; Humans ; Male ; Middle Aged ; Models, Statistical ; Radiography ; Risk Factors ; Spondylosis ; diagnostic imaging ; surgery

OBJECTIVETo observe the impacts on pain matrix (PM) brain area in the patients of cervical spondylosis of neck type treated with acupuncture at single point and the multiple points.

METHODSForty-nine patients of cervical spondylosis of neck type were randomized into a single-point group (25 cases) and a multiple-point group (24 cases), and treated with acupuncture at Bailao (EX-HN 15) singly or Bailao (EX-HN 15) and Hegu (LI 4) in combination correspondingly. At the same time, 19 healthy people were selected as a control group. The resting state functional magnetic resonance imaging (fMRI) was conducted in each group before and after treatment. The changes in the regional homogeneity (ReHo) of brain area PM were analyzed in terms of the different therapeutic programs. The relevant analysis was on the scores of the Northwick Park neck pain questionnaire (NPQ) and short form 36 questionnaire (SF-36) for life quality.

RESULTSCompared with the control group, ReHo value was increased in supplementary motor area (SMA) of PM in the patients, of cervical spondylosis of neck type. In the single-point group, after treatment, ReHo value was reduced in the bilateral medial superior frontal gyri of patients. In the multiple-point group, ReHo values were reduced in the left medial superior frontal gyrus and right SMA in PM area after treatment. In the single-point group, ReHo value in each brain area of PM was not significantly correlated with NPQ and SF-36 scores. In the multiple-point group, the changes of ReHo value in superior frontal gyrus were positively correlated with those of NPQ scores.

CONCLUSIONConsidering the clinical efficacy of acupunctrue for cervical spondylosis of neck type, the overall result in the multiple-point group is better than that in the single-point group. It is deduced that the advantages of the therapeutic program in the multiple-point group is relevant with the cooperative integration of the stimulation at multiple points in cerebral analgesic center.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Brain ; diagnostic imaging ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Neck Pain ; diagnostic imaging ; therapy ; Radiography ; Spondylosis ; diagnostic imaging ; therapy ; Treatment Outcome ; Young Adult

OBJECTIVETo assess the influence of different hinge positions on clinical results of expansive open-door laminoplasty (EOLP) for cervical spondylotic myelopathy (CSM).

METHODSA total of 102 CSM patients who underwent EOLP from February 2006 to February 2007 were enrolled in this randomized controlled trial. Using a random digits table, 57 patients with the hinge located at the inner margin of the lateral mass were classified as wide-open group, while 45 patients with the hinge positioned at the lamina margin served as narrow-open group. All patients were observed over 24 months, and the clinical and radiological results were analyzed statistically.

RESULTSThere were no significant differences in operation duration, intraoperative bleeding volume, Japanese Orthopaedic Association (JOA) scores, cervical curvature index, range of motion and neural function recovery rate. The neural functions were satisfactorily improved after surgery in both groups, while the severity of axial symptoms was significantly lower in the narrow-open group than in the wide-open group (P equal to 0.003). The incidence of C(5) palsy in the wide-open group was higher than that in the narrow-open group (5.3% vs 0), even though the difference did not reach statistical significance (one tailed Fisher's exact test, P equal to 0.17).

CONCLUSIONSProper inward shift of the hinge can ensure effectiveness of surgical decompression, avoid an excessive backward shift of the spinal cord, decrease the incidence of C(5) palsy and alleviate the severity of axial symptoms.

Aged ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Spondylosis ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo investigate the correlation between subaxial cervical spine instability and cervical spondylotic sympathetic symptoms as well as the difference of cervical spondylotic subaxial instability between male and female patients.

METHODSWe analyzed retrospectively 318 surgical cases of cervical spondylosis treated at Department of Orthopedic Surgery of Peking Union Medical College Hospital between July 2003 and December 2007. All cases were divided into group A without sympathetic symptoms (n=284) and group B with sympathetic symptoms (n=34). Angular and horizontal translation values between two adjacent vertebral bodies from C2 to C7 were measured separately on hyperflexion and hyperextension lateral cervical spine radiographs. Fisher's exact test was used to evaluate the correlation between subaxial cervical instability and sympathetic symptoms. Intragroup correlation between patient gender and subaxial cervical instability was also evaluated.

RESULTSSubaxial instability incidences in groups A and B were 21.8% (62/284) and 55.9% (19/34), respectively. Statistical analysis indicated a definite correlation between subaxial cervical instability and sympathetic symptoms (P=0.000). Among patients without sympathetic symptoms, subaxial instability incidences were 21.4% (37/173) in males and 22.5% (25/111) in females, respectively (P=0.883). While among patients with sympathetic symptoms, subaxial instability incidences were 27.3% (3/11) in males and 69.6% (16/23) in females, respectively, indicating significant difference (P=0.030). Subaxial instability was most commonly seen at C4-C5 intervertebral space in sympathetic cervical spondylosis patients.

CONCLUSIONSHigh correlation exists between subaxial cervical spine instability and cervical spondylotic sympathetic symptoms, especially in female patients. Hyperextension and hyperflexion radiographs of cervical spine are important to assess sympathetic cervical spondylotic subaxial instability.

Cervical Vertebrae ; diagnostic imaging ; pathology ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Sex Characteristics ; Spine ; diagnostic imaging ; pathology ; Spondylosis ; diagnostic imaging ; pathology

OBJECTIVE: To explore clinical symptoms and X-ray imaging features of cervical instability in young adult represented by postgraduates with a master's degree in medicine. METHODS: Totally 91 postgraduates with a master's degree in medicine were investigated from September to December 2021, including 45 males and 46 females;aged from 22 to 30 years old with an average of (25.30±2.18) years old. The cervical spondylosis-related discomfort symptoms of the subjects were collected and examined by the examiner for neck and shoulder tenderness point examination and cervical vertebra positive and lateral and functional X-ray radiography. According to the results of X-ray examination, the subjects were divided into stable cervical group and unstable cervical group. RESULTS: Among 91 subjects, there were 50 patients with cervical instability, accounting for 54.90% of total number of subjects. The cervical curvature was abnormal in 78 patients, accounting for 85.70% of total number of subjects. Among 50 patients with cervical instability, 50 patients were diagnosed as cervical instability on the basis of angular displaxement(AD)≥ 11 °, including 13 cases of C_3,4 instability, 30 cases of C_4,5 instability and 7 cases of C_5,6 instability;and 5 cases were diagnosed as cervical instability based on horizontal displacement(HD)≥ 3.5 mm, including 1 case of C_3,4 instability and 4 cases of C_4,5 instability. Compared with stable cervical group, the number of discomfort symptoms of neck pain, headache and shoulder pain in instability group was significantly higher than that of in stable cervical group(P<0.05);and the number of tenderness in spinous process space of C_4,5 and C_5,6, 2 cm adjacent to the spinous process of C₂-C₅ and the superior angle of the scapula (the stop point of levator scapulae) in the instability group was significantly higher than that in the stable cervical group (P<0.05);and the cervical curvature in the instability group was significantly lower than that in stable cervical group(P<0.05). CONCLUSION The incidence of cervical instability in young adult represented by postgraduates with a master's degree in medicine is high, they are mainly diagnosed as cervical instability on the basis of vertebral angular displacement ≥ 11°, and the instability segments are concentrated on C_3,4, C_4,5 and C_5,6 segments, the occurrence of cervical instability is often accompanied by abnormalities of cervical curvature. Most of clinical manifestations are head, neck and shoulder pain, especially neck pain in unstable segment.
Male ; Female ; Humans ; Young Adult ; Adult ; Neck Pain/etiology* ; Shoulder Pain ; Spinal Diseases ; Radiography ; Spondylosis/diagnostic imaging* ; Joint Instability/diagnostic imaging* ; Cervical Vertebrae/diagnostic imaging*

OBJECTIVETo study the mechanisms of tuina manipulation for treating the dislocation of bone in cervical spondylosis (CS) patients by observing the effects of tuina manipulation on the three-dimensional (3D) angles.

METHODSFrom August to December 2009 20 CS patients were assigned to Group 1 (10 cases, treated with relaxing manipulation) and Group 2 (10 cases, treated with relaxing manipulation and joint regulation). Besides, 10 healthy subjects were recruited as the normal group (treated with relaxing manipulation). Before and after manipulation intervention, all of them were scanned from the base of the skull to the first thoracic vertebra using Philips 64 spiral CT under equal conditions, thus obtaining the volume data. The 0.625 mm thickness was reconstructed using ITK reconstruction software provided by the digital medical laboratory, Software College of Shanghai Jiaotong University. The reconstruction of each cervical skeleton was finished referring to CT data. Changes of the 3D angles were compared among the three groups.

RESULTSThe regulation of the 3D C2 vertebra: Results of Group 2 were significantly larger than those of the normal group at X-, Y-, and Z-axis (P < 0.05). Results of Group 2 were significantly larger than those of Group 1 at X- and Z-axis (P < 0.05). But results of Group 1 were significantly larger than those of the normal group at Z-axis (P < 0.05). The regulation of the 3D C3 vertebra: Results of Group 2 were significantly larger than those of the normal group at X- and Y-axis (P < 0.05). Results of Group 2 were significantly larger than those of Group 1 at X-axis (P < 0.05). But results of Group 1 were significantly larger than those of the normal group at X-axis (P < 0.05). The regulation of the 3D C4 vertebra: Results of Group 2 were significantly larger than those of the normal group at X- and Y-axis (P < 0.05). Results of Group 2 were significantly larger than those of Group 1 at X- and Z-axis (P < 0.05). There were no significant difference among the three groups in the 3D spaces of C1, C5, C6, and C7. The larger 3D space was shown in Group 2 than in Group 1 and the normal group.

CONCLUSIONSThe relaxing manipulation combined with joint regulation significantly improved the 3D angles of C2, C3, and C4 in CS patients. The mechanism of tuina manipulation for treating the dislocation of bone in CS patients might lie in adjusting the 3D space of the cervical spine, and improving its functions.

Aged ; Cervical Vertebrae ; diagnostic imaging ; Female ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Manipulation, Spinal ; Spondylosis ; diagnostic imaging ; therapy ; Tomography, X-Ray Computed ; methods