OBJECTIVE: To explore clinical features, treatment methods and clinical effects of cervical spondylosis with proximal muscular atrophy. METHODS: Eleven patients with proximal-type cervical spondylotic amyotrophy were retrospectively studied from September 2016 to November 2020, including 7 males and 4 females, aged 38 to 68 years old. Clinical symptoms, MRI and neuroelectrophysiological manifestations were analyzed, and patients were treated with conservative treatment or anterior cervical decompression fusion surgery, respectively. The efficacy was evaluated by manual muscle test (MMT) before and after treatment, and patients' satisfaction was followed up at the same time. RESULTS: All patients were followed up for 6 to 19 months. All 11 patients were unilateral, mainly manifested by atrophy of deltoid muscle, supraspinatus muscle and infraspinatus muscle, and may be accompanied by ipsilateral neck and shoulder pain at early stage. MRI showed lesions at C_4,5, C_5,6 segments were more common. Electrophysiological examination showed the affected muscle was denervated, and amplitude of compound muscle action potential (CMAP) of innervated nerve on the affected side was lower than that on the healthy side. All patients were obtained bone fusion. One patient who were underwent anterior cervical corpectomy and fusion (ACCF) occurred developed contralateral C5 nerve root paralysis after operation, which recovered completely after 10 weeks of symptomatic treatment. At 12 months after operation, the efficacy was evaluated according to MMT, 3 patients were treated conservatively, 2 patients excellent and 1 good;in 8 patients treated by operation, 3 patients were excellent, 4 good, and 1 moderate. CONCLUSION The incidence of cervical spondylosis with proximal muscular atrophy is low, which is manifested as unilateral proximal muscle atrophy and may be accompanied by ipsilateral neck and shoulder pain in the early stage. Combined with MRI and neuroelectrophysiological examination, misdiagnosis could be reduced. In the early stage of disease, especially in the case of nucleus pulposus protrusion leading to nerve compression, conservative treatment could be taken. When the conservative treatment is ineffective or the pain cannot be tolerated, anterior decompression surgery is recommended, and the overall effect is satisfactory.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Retrospective Studies ; Shoulder Pain ; Cervical Vertebrae/pathology* ; Muscular Atrophy/surgery* ; Decompression, Surgical/methods* ; Spondylosis/surgery* ; Treatment Outcome ; Spinal Fusion/adverse effects*

OBJECTIVE: The purpose of the study is to investigate the relationship between dental calcification stages (DCS) and cervical vertebral maturation stages (CVMS) in patients with unilateral complete cleft lips and palates (UCLP) and to provide a theoretical basis for the treatment time selection of cleft lip and palate (CLP) patients. METHODS: A total of 123 UCLP patients and 215 non-CLP subjects were selected. The DCS of the left mandibular canine, premolar, and second molar in non-CLP subjects and on both cleft sides of UCLP patients were assessed utilizing the Demirjian method. CVMS was observed utilizing the Baccetti method. The results were analyzed by Spearman rank correlation, and the correlation coefficients were compared. RESULTS: There was a correlation between the CVMS and the DCS of the left mandibular canine, the first premolar, the second premolar, and the second molar in the non-CLP subjects and on both cleft sides of the UCLP patients (r=0.762-0.864, P<0.05; r=0.809-0.914, P<0.05, respectively). The correlation between the CVMS and the DCS of the mandibular first premolar was highest among the UCLP patients. Except for the first and the second premolars of UCLP females, the correlation between the DCS and the CVMS of the other teeth did not differ among the non-CLP subjects (P>0.05). CONCLUSIONS DCS can be utilized as a biological index to determine the growth development statuses. The correlation between the CVMS and the DCS of the mandibular first premolar was the highest.
Bicuspid ; Calcinosis ; Cervical Vertebrae ; pathology ; Cleft Lip ; physiopathology ; Cleft Palate ; physiopathology ; Cuspid ; Female ; Humans

OBJECTIVETo explore the early clinical effect and safety of percutaneous transforaminal endoscopic technology for cervical spondylotic radiculopathy.

METHODSFrom August 2016 to September 2017, 14 patients with cervical spondylotic radiculopathy who responded poorly to non-surgical treatment for at least 6 weeks underwent percutaneous transforaminal endoscopic discectomy via posterior approach. There were 6 males and 8 females, aging from 32 to 68 years old with an average of (40.5±7.6) years. The course of disease ranged from 0.5 to 13.0 months with an average of (6.0±1.33) months. The lesions involved C₄,₅ in 2 cases, C₅,₆ in 8 cases, C₆,₇ in 4 cases. Visual analogue scale (VAS), Japanese Orthopedic Association (JOA), Short Form 36 health survey questionnaire(SF-36) were recorded preoperatively and during the latest follow-up to evaluate the clinical outcome. Horizontal displacement and angular displacement of vertebral body were measured by cervical dynamic X-rays.

RESULTSAll operations were successful. No spinal cord injury, nerve root or vascular injuries were found. Operation time was from 60 to 100 min with a median of 75 min;intraoperative bleeding was from 30 to 80 ml with a median of 40 ml. All patients were followed up for 2 to 13 months with a median of 9 months. During the follow-up period, the patients with neck and shoulder pain were significantly relieved without recurrence. No nucleus pulposus protrusion was found in the primary surgical segment, and there was no obvious sign of degeneration in the adjacent vertebral body. At the latest follow-up, VAS, JOA and SF-36 scores were obviously improved(<0.05). There was no significant difference in horizontal displacement and angular displacement of vertebral body before and after the operation (>0.05). The cervical curvature at the latest follow-up was higher than preoperative findings (<0.05). And there was no significant difference in intervertebral disc height preoperatively and postoperatively(>0.05).

CONCLUSIONSPercutaneous transforaminal endoscopic discectomy in treating cervical spondylotic radiculopathy can effectively and safely relieve neck and shoulder pain, improving nerve function, enhance life quality, maintaining cervical stability. It is worthwhile to generalize and apply in clinical settings.

Adult ; Aged ; Cervical Vertebrae ; pathology ; Diskectomy, Percutaneous ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Radiculopathy ; surgery ; Spondylosis ; surgery ; Treatment Outcome

OBJECTIVE: Cervical ossification of the posterior longitudinal ligament (OPLL) can be treated via anterior or posterior approach, or both. The optimal approach depends on the characteristics of OPLL and cervical curvature. Although most patients can be successfully treated by a single surgery with the proper approach, renewed or newly developed neurological deterioration often requires repeat surgery.METHODS: Twenty-seven patients with renewed or newly developed neurological deterioration requiring salvage surgery for multi-segment cervical OPLL were enrolled. Ten patients (group AP) underwent anterior approach, and 17 patients (group PA) underwent posterior approach at the initial surgery. Clinical and radiological data from initial and repeat surgeries were obtained and analyzed retrospectively.RESULTS: The intervals between the initial and repeat surgeries were 102.80±60.08 months (group AP) and 61.00±8.16 months (group PA) (p < 0.05). In group AP, the main OPLL lesions were removed during the initial surgery. There was a tendency that the site of main OPLL lesions causing renewed or newly developed neurological deterioration were different from that of the initial surgery (8/10, p < 0.05). Repeat surgery was performed for progressed OPLL lesions at another segment as the main pathology. In group PA, the main OPLL lesions at the initial surgery continued as the main pathology for repeat surgery. Progression of kyphosis in the cervical curvature (Cobb’s angle on C2–7 and segmental angle on the main OPLL lesion) was noted between the initial and repeat surgeries. Group PA showed more kyphotic cervical curvature compared to group AP at the time of repeat surgery (p < 0.05).CONCLUSION: The reasons for repeat surgery depend on the type of initial surgery. The main factors leading to repeat surgery are progression of remnant OPLL at a different segment in group AP and kyphotic change of the cervical curvature in group PA.
Cervical Vertebrae ; Female ; Humans ; Kyphosis ; Longitudinal Ligaments ; Ossification of Posterior Longitudinal Ligament ; Pathology ; Reoperation ; Retrospective Studies

STUDY DESIGN: Retrospective study. PURPOSE: The purpose of this study was to investigate the influence of sagittal alignment of the strut graft on graft subsidence and clinical outcomes after anterior cervical corpectomy and fusion (ACCF). OVERVIEW OF LITERATURE: ACCF is a common technique for the treatment of various cervical pathologies. Although graft subsidence sometimes occurs after ACCF, it is one cause for poor clinical results. Malalignment of the strut graft is probably one of the factors associated with graft subsidence. However, to the best of our knowledge, no prior reports have demonstrated correlations between the alignment of the strut graft and clinical outcomes. METHODS: We evaluated 56 patients (33 men and 23 women; mean age, 59 years; range, 33–84 years; 45 with cervical spondylotic myelopathy and 11 with ossification of the posterior longitudinal ligament) who underwent one- or two-level ACCF with an autogenous fibular strut graft and anterior plating. The Japanese Orthopaedic Association (JOA) score recovery ratio for cervical spondylotic myelopathy was used to evaluate clinical outcomes. The JOA score and lateral radiograms were evaluated 1 week and 1 year postoperatively. Patients were divided into two groups (a straight group [group I] and an oblique group [group Z]) based on radiographic assessment of the sagittal alignment of the strut graft. RESULTS: Group I showed a significantly greater JOA score recovery ratio (p<0.05) and a significantly lower graft subsidence than group Z (p<0.01). CONCLUSIONS: Our findings suggest that a straight alignment of the strut graft provides better clinical outcomes and lower incidence of graft subsidence after ACCF. In contrast, an oblique strut graft can lead to significantly increased strut graft subsidence and poor clinical results.
Asian Continental Ancestry Group ; Bone Transplantation ; Cervical Vertebrae ; Clinical Study ; Female ; Humans ; Incidence ; Male ; Pathology ; Retrospective Studies ; Spinal Cord Compression ; Spinal Cord Diseases ; Spinal Fusion ; Transplants*

The neck has intricately connected neural structures, including cervical and brachial plexi, the sympathetic system, lower cranial nerves, and their branches. Except for brachial plexus, there has been little research regarding the normal imaging appearance or corresponding pathologies of neural structures in the neck. The development in imaging techniques with better spatial resolution and signal-to-noise ratio has made it possible to see many tiny nerves to predict complications related to image-guided procedures and to better assess treatment response, especially in the management of oncology patients. The purposes of this review is to present imaging-based anatomy of major nerves in the neck and explain their relevant clinical significance according to representative pathologies of regarded nerves in the neck.
Accessory Nerve ; Brachial Plexus ; Cervical Plexus ; Cervical Vertebrae ; Cranial Nerves ; Female ; Ganglia, Sympathetic ; Humans ; Magnetic Resonance Imaging ; Neck* ; Pathology* ; Signal-To-Noise Ratio ; Vagus Nerve

Cervical Vertebrae ; pathology ; surgery ; Humans ; Laminoplasty ; methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Diseases ; pathology ; surgery

OBJECTIVES: To study the characteristics of the relationship between injury and disease in forensic identification cases of cervical trauma with cervical vertebra degeneration, and to explore the problems about how to identify the participation rates of injury and disease using the clinical information, forensic examination and imaging examination. METHODS: Seventeen forensic identification cases of cervical trauma with cervical vertebra degeneration were collected. The age distributions, injury formations, injury severities and imaging findings of these cases were analyzed and the relationship between injury and disease was evaluated comprehensively. RESULTS: Middle-aged and elderly were common in 17 cases and every case was involved with intervertebral disc herniation. The main reasons of injuries were hyperextension. The degree of injury severity and vertebra degeneration were graded according to the imaging findings. The participation rates of injury and disease were also calculated comprehensively. CONCLUSIONS The forensic identification cases of cervical trauma with cervical vertebra degeneration should be evaluated with clinical information, forensic examination and imaging finding.
Adult ; Age Distribution ; Aged ; Cervical Vertebrae/pathology* ; Humans ; Intervertebral Disc Degeneration/pathology* ; Intervertebral Disc Displacement/pathology* ; Middle Aged

OBJECTIVETo explore the pathomorphological change of the atlanto-occipital segment of vertebral artery (V3 part) related with cervical vertigo.

METHODSFrom June 1999 to November 2011, the pathomorphological change of the atlanto-occipital segment of vertebral artery were observed in 1680 patients with cervical vertigo using 3D-CTA technology. The clinical data of these patients were analyzed. There were 783 males and 897 females, aged from 22 to 70 years old with an average of 52.8 years old. Doppler examination showed vertebral basilar artery flow velocity to speed up or slow down.

RESULTSThe blood vessel of 3360 branches were detected in 1680 patients and 2778 branches were detected out vascular anomaly. And 829 branches were in V1 segment, 421 were in V2, 328 were in V3, 1190 were in V4. The pathomorphological changes in the atlanto-occipital segment (V3) of vertebral artery included angiospasm, congenital absence, abnormal exit, localized stenosis.

CONCLUSIONThere are 4 kinds of pathomorphological changes in the atlanto-occipital segment of vertebral artery related with cervical vertigo. The 3D-CTA result can be used to judge prognosis and adopt reasonable treatment for the patients.

Adult ; Aged ; Atlanto-Occipital Joint ; Cervical Vertebrae ; Female ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Vertebral Artery ; diagnostic imaging ; pathology ; Vertigo ; pathology

BACKGROUNDPosterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM). Each posterior technique has its own advantages and disadvantages. In the present study, we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.

METHODSForty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery, Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study. Patients were divided into two groups by surgical procedure: Laminoplasty (Group L) and hemilaminectomy (Group H). Perioperative parameters including age, sex, duration of symptoms, operative duration, and intraoperative blood loss were recorded and compared. Spinal canal area, calculated using AutoCAD ® software(Autodesk Inc., San Rafael, CA, USA), and neurological improvement, evaluated with Japanese Orthopedic Association score, were also compared.

RESULTSNeurological improvement did not differ significantly between groups. Group H had a significantly shorter operative duration and significantly less blood loss. Mean expansion ratio was significantly greater in Group L (77.83 ± 6.41%) than in Group H (62.72 ± 3.86%) (P < 0.01).

CONCLUSIONSBoth surgical approaches are safe and effective in treating multilevel CSM. Laminoplasty provides a greater degree of enlargement of the spinal canal, whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.

Aged ; Aged, 80 and over ; Cervical Vertebrae ; pathology ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Diseases ; pathology ; surgery