scholarly journals Analysis of compliance and efficacy of integrated management of whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation

2020 ◽  
Author(s):  
Zhongyan Jiang ◽  
Ansu Wang ◽  
Chong Wang ◽  
Weijun Kong
Keyword(s):  
Neck Pain ◽  
Recurrence Rate ◽  
Disc Herniation ◽  
Integrated Management ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Control Group ◽  
Efficacy Rate ◽  
The Difference ◽  
Experimental Group

Abstract Background: Percutaneous spinal endoscopy is a new type of surgery for the treatment of cervical disc herniation. It can avoid the complications of the classic anterior cervical discectomy and fusion (ACDF) approach and the risk of adjacent spondylosis. How can we effectively improve patients' awareness of spinal endoscopy and their election of endoscopic techniques?Objective: To analyze the compliance and clinical effect of the integrated management of the whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation.Methods: Retrospective analysis of 72 patients with cervical disc herniation undergoing surgery in our hospital from August 2015–August 2017 was performed. The whole-process integrated management model was used for all the patients. The 36 patients in the experimental group were treated by percutaneous full-endoscopic cervical discectomy, and the 36 patients in the control group were treated by ACDF. The postoperative feeding time, time to get out of bed, length of hospital stay, compliance, clinical efficacy, and recurrence rate of neck pain were observed. Changes between the preoperative and postoperative pain visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed.Results: The postoperative feeding time in the experimental group was 8.319 ± 1.374 hours, the postoperative time to get out of bed was 16.64 ± 3.728 hours, and the hospitalization time was 6.403 ± 0.735 days. The excellent and good clinical efficacy rate was 91.67%, the compliance rate was 88.89%, and the neck pain recurrence rate was 5.56%. The postoperative feeding time in the control group was 26.56 ± 9.512 hours, the postoperative time to get out of bed was 45.06 ± 9.027 hours, and the length of hospital stay was 8.208 ± 0.865 days. The excellent and good clinical efficacy rate was 88.89%, the compliance rate was 69.4%, and the neck pain recurrence rate was 8.33%. There was no significant difference between the two groups in the excellent efficacy rate and the neck pain recurrence rate, p>0.05. The compliance rate in the experimental group was better than that in the control group, and the difference was statistically significant, p<0.05. The hospitalization time of the experimental group was significantly lower than that of the control group, and the difference was statistically significant, p<0.05. The postoperative VAS scores and JOA scores of the two groups were significantly better than the preoperative scores, and the difference was statistically significant, p<0.05; there was no significant difference between the two groups, p>0.05.Conclusion: The integrated management of the whole course can effectively improve the compliance of patients with cervical disc herniation receiving endoscopic treatment, yield the same treatment effect as the classic operation, shorten the hospitalization time, speed up the turnover of hospital beds, and improve satisfaction with medical quality and is worthy of clinical application.

scholarly journals Analysis of Compliance and Efficacy of Integrated Management of Whole Process in the Choice of Percutaneous Full-endoscopic Surgery for Patients With Cervical Disc Herniation

2020 ◽  
Author(s):  
Zhongyan Jiang ◽  
Ansu Wang ◽  
Chong Wang ◽  
Weijun Kong
Keyword(s):  
Neck Pain ◽  
Recurrence Rate ◽  
Disc Herniation ◽  
Integrated Management ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Control Group ◽  
Efficacy Rate ◽  
The Difference ◽  
Experimental Group

Abstract Background: Percutaneous spinal endoscopy is a new type of surgery for the treatment of cervical disc herniation. It can avoid the complications of the classic anterior cervical discectomy and fusion (ACDF) approach and the risk of adjacent spondylosis. How can we effectively improve patients' awareness of spinal endoscopy and their election of endoscopic techniques?Objective: To analyze the compliance and clinical effect of the integrated management of the whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation.Methods: Retrospective analysis of 72 patients with cervical disc herniation undergoing surgery in our hospital from August 2015–August 2017 was performed. The whole-process integrated management model was used for all the patients. The 36 patients in the experimental group were treated by percutaneous full-endoscopic cervical discectomy, and the 36 patients in the control group were treated by ACDF. The postoperative feeding time, time to get out of bed, length of hospital stay, compliance, clinical efficacy, and recurrence rate of neck pain were observed. Changes between the preoperative and postoperative pain visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed.Results: The postoperative feeding time in the experimental group was 8.319 ± 1.374 hours, the postoperative time to get out of bed was 16.64 ± 3.728 hours, and the hospitalization time was 6.403 ± 0.735 days. The excellent and good clinical efficacy rate was 91.67%, the compliance rate was 88.89%, and the neck pain recurrence rate was 5.56%. The postoperative feeding time in the control group was 26.56 ± 9.512 hours, the postoperative time to get out of bed was 45.06 ± 9.027 hours, and the length of hospital stay was 8.208 ± 0.865 days. The excellent and good clinical efficacy rate was 88.89%, the compliance rate was 69.4%, and the neck pain recurrence rate was 8.33%. There was no significant difference between the two groups in the excellent efficacy rate and the neck pain recurrence rate, p>0.05. The compliance rate in the experimental group was better than that in the control group, and the difference was statistically significant, p<0.05. The hospitalization time of the experimental group was significantly lower than that of the control group, and the difference was statistically significant, p<0.05. The postoperative VAS scores and JOA scores of the two groups were significantly better than the preoperative scores, and the difference was statistically significant, p<0.05; there was no significant difference between the two groups, p>0.05.Conclusion: The integrated management of the whole course can effectively improve the compliance of patients with cervical disc herniation receiving endoscopic treatment, yield the same treatment effect as the classic operation, shorten the hospitalization time, speed up the turnover of hospital beds, and improve satisfaction with medical quality and is worthy of clinical application.

scholarly journals Analysis of compliance and efficacy of integrated  management of whole process  in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation

2020 ◽  
Author(s):  
Weijun Kong ◽  
Zhongyan Jiang ◽  
Ansu Wang ◽  
Chong Wang
Keyword(s):  
Neck Pain ◽  
Recurrence Rate ◽  
Disc Herniation ◽  
Integrated Management ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Control Group ◽  
Feeding Time ◽  
The Difference ◽  
Experimental Group

Abstract Background : Percutaneous spinal endoscopy technique is a new type of surgery for the treatment of cervical disc herniation. It can avoid the complications of classic ACDF approach and the risk of adjacent spondylosis. How to effectively improve patients' awareness of spinal endoscopy and choose to receive endoscopic techniques? Objective: To analyze the compliance and clinical effect of the integrated management of whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation. Methods: Retrospective analysis of 72 patients with cervical disc herniation undergoing surgery in our hospital in August 2015~ August 2017, all of them carried out the whole process integrated management mode, 36 patients in the experimental group were treated by percutaneous full-endoscopic cervical discectomy, and 36 patients in the control group were treated by anterior cervical discectomy and fusion(ACDF). The postoperative feeding time, time to get out of bed, length of hospital stay, compliance, clinical efficacy, and recurrence rate of neck pain were observed. And changes in pain visual analogue score (VAS) and neurological function JOA score of preoperative and postoperative. Results: The postoperative feeding time in the experimental group was 8.319 ± 1.374 hours, the postoperative bedtime was 16.64 ± 3.728 hours, and the hospitalization time was 6.403 ± 0.735 days; The clinical excellent and good rate was 91.67%, the compliance rate was 88.89%, and the neck pain recurrence rate was 5.56%. The postoperative feeding time in the control group was 26.56 ± 9.512 hours, the postoperative bedtime was 45.06 ± 9.027 hours, and the length of hospital stay was 8.208 ± 0.865 days; The excellent and good rate was 88.89%, the compliance rate was 69.4%, and the neck pain recurrence rate was 8.33%. There was no significant difference between the two groups in the excellent treatment rate and the recurrence rate of neck pain, p> 0.05; The compliance rate of the experimental group was better than the control group, and the difference was statistically significant, p <0.05; the hospitalization time of the experimental group was significantly lower than that of the control group, the difference was statistically significant, p<0.05. The postoperative VAS scores and JOA scores of the two groups were significantly improved compared with preoperative, the difference was statistically significant, p<0.05; and there was no significant difference between the two groups, p> 0.05. Conclusion : The integrated management mode of the whole course can effectively improve the compliance of patients with cervical disc herniation receiving endoscopic treatment, obtain the same treatment effect as the classic operation, shorten the hospitalization time, speed up the turnover of hospital beds, improve the satisfaction of medical quality, and be worthy of clinical application.

Cervical Interlaminar Epidural Injections In The Treatment Of Cervical Disc Herniation, Post Surgery Syndrome, Or Discogenic Pain: Cost Utility Analysis From Randomized Trials

2019 ◽  
Vol 5 (22;5) ◽  
pp. 421-431
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Neck Pain ◽  
Disc Herniation ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Utility Analysis ◽  
Discogenic Pain ◽  
Epidural Injections ◽  
Post Surgery

Background: Neck pain is one of the major conditions attributing to overall disability in the United States. There have been multiple publications assessing clinical and cost effectiveness of multiple modalities of interventions in managing chronic neck pain. Even then, the literature has been considered sparse in relation to cervical interlaminar epidural injections in managing chronic neck pain. In contrast, cost utility studies of lumbar interlaminar injections, caudal epidural injections, cervical and lumbar facet joint nerve blocks, percutaneous adhesiolysis demonstrated costs of less than $3,500 for quality-adjusted life year (QALY). Objectives: To assess the cost utility of cervical interlaminar epidural injections in managing chronic neck and/or upper extremity pain secondary to cervical disc herniation, post-surgery syndrome in neck, and axial or discogenic neck pain. Study Design: Analysis based on 3 previously published randomized trials of the effectiveness of cervical interlaminar epidural injections assessing their role in disc herniation, cervical post-surgery syndrome, and axial or discogenic pain. Setting: A contemporary, private, specialty referral interventional pain management center in the United States. Methods: Cost utility of cervical interlaminar epidural injections with or without steroids in managing cervical disc herniation, cervical post-surgery syndrome, and cervical discogenic or axial neck back pain was conducted with data derived from 3 randomized controlled trials (RCTs) that included a 2-year follow-up, with inclusion of 356 patients. The primary outcome was significant improvement defined as at least 50% in pain reduction and disability status. Direct payment data from all carriers from 2018 was utilized for the assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.67 to accommodate for indirect payments respectively for disc herniation, discogenic pain, and cervical post-surgery syndrome. Results: The results of the 3 RCTs showed direct cost utility for one year of QALY of $2,412.31 for axial or discogenic pain without disc herniation, $2,081.07 for disc herniation, and $2,309.20 for post surgery syndrome, with an average cost per one year QALY of $2,267.57, with total estimated overall costs with addition of indirect costs of $3,475.38, $4,028.55, $3,856.36, and $3,785.89 respectively. Limitations: The limitation of this cost utility analysis includes that it is a single center evaluation. Indirect costs were extrapolated. Conclusion: This cost utility analysis of cervical interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, post surgery syndrome and axial or discogenic neck pain shows $2,267.57 for direct costs with a total cost of $3,785.89 per QALY. Key words: Cervical interlaminar epidural injections, chronic neck pain, cervical disc herniation, cervical discogenic pain, post surgery syndrome, cost utility analysis, cost effectiveness analysis, quality-adjusted life years

scholarly journals Self Manipulated Cervical Spine Leads to Posterior Disc Herniation and Spinal Stenosis

2019 ◽  
Vol 9 (6) ◽  
pp. 125 ◽  
Author(s):  
Wyatt McGilvery ◽  
Marc Eastin ◽  
Anish Sen ◽  
Maciej Witkos
Keyword(s):  
Emergency Department ◽  
Neck Pain ◽  
Spinal Stenosis ◽  
Disc Herniation ◽  
Spinal Manipulation ◽  
Cervical Spinal Cord ◽  
Cervical Vertebrae ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Manipulation Therapy

The authors report a case in which a 38-year-old male who presented himself to the emergency department with a chief complaint of cervical neck pain and paresthesia radiating from the right pectoral region down his distal right arm following self-manipulation of the patient’s own cervical vertebrae. Initial emergency department imaging via cervical x-ray and magnetic resonance imaging (MRI) without contrast revealed no cervical fractures; however, there was evidence of an acute cervical disc herniation (C3–C7) with severe herniation and spinal stenosis located at C5–C6. Immediate discectomy at C5–C6 and anterior arthrodesis was conducted in order to decompress the cervical spinal cord. Acute traumatic cervical disc herniation is rare in comparison to disc herniation due to the chronic degradation of the posterior annulus fibrosus and nucleus pulposus. Traumatic cervical hernias usually arise due to a very large external force causing hyperflexion or hyperextension of the cervical vertebrae. However, there have been reports of cervical injury arising from cervical spinal manipulation therapy (SMT) where a licensed professional applies a rotary force component. This can be concerning, considering that 12 million Americans receive SMT annually (Powell, F.C.; Hanigan, W.C.; Olivero, W.C. A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurgery 1993, 33, 73–79.). This case study involved an individual who was able to apply enough rotary force to his own cervical vertebrae, causing severe neurological damage requiring surgical intervention. Individuals with neck pain should be advised of the complications of SMT, and provided with alternative treatment methods, especially if one is willing to self manipulate.

scholarly journals Correlation between cervical lordosis and cervical disc herniation in young patients with neck pain

Medicine ◽  
2019 ◽  
Vol 98 (31) ◽  
pp. e16545 ◽  
Author(s):  
Kun Gao ◽  
Jiliang Zhang ◽  
Jinquan Lai ◽  
Weidong Liu ◽  
Hanqing Lyu ◽  
...  
Keyword(s):  
Neck Pain ◽  
Disc Herniation ◽  
Young Patients ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cervical Lordosis

scholarly journals Efficacy and Safety of Mecobalamin Combined with Prokinetic Agents in the Treatment of Diabetic Gastroparesis: A Meta-Analysis

2021 ◽  
Author(s):  
Jia Yao ◽  
Bo Peng ◽  
Xiayu Gong ◽  
Xiaoyan Shi ◽  
Simin Fan ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Adverse Reactions ◽  
Meta Analysis ◽  
Diabetic Gastroparesis ◽  
Control Group ◽  
Efficacy Rate ◽  
Efficacy And Safety ◽  
Prokinetic Drugs ◽  
Prokinetic Agents ◽  
Experimental Group

Background: The aim of the present study was to systematically review the efficacy and safety of mecobalamin combined with prokinetic agents in diabetic gastroparesis (DGP). Methods: A variety of databases were searched from inception to Nov 2, 2018. RCTs of mecobalamin combined with prokinetic agents group (experimental group) versus prokinetic agents only group (control group) in DGP were included. RevMan 5.3 and Stata 12.0 were used to perform the meta-analysis. Finally, 24 RCTs with 1,878 patients were included. Results: The total efficacy rate was significantly higher in the experimental group (mecobalamin combined with prokinetic drugs) compared with the control group (prokinetic drugs alone) (P<0.001), and the improvement was observed regardless of the administration route. Furthermore, the treatment group exhibited a significantly improved gastric emption rate (P<0.001), motilin (P<0.001) and recurrence rate (P<0.001), and there was no statistical difference in the incidence of adverse reactions between two groups (P=0.49). Conclusion: Mecobalamin combined with prokinetic agents can significantly improve total efficacy rate and gastric emptying rate, decrease serum motilin and the recurrence rate without increasing adverse reactions in DGP. Thus, mecobalamin may can be used as a new therapeutic option for DGP.

scholarly journals The Effectiveness of Fluoroscopic Cervical Interlaminar Epidural Injections in Managing Chronic Cervical Disc Herniation and Radiculitis: Preliminary Results of a Randomized, DoubleBlind, Controlled Trial

2010 ◽  
Vol 3;13 (3;5) ◽  
pp. 223-236
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Neck Pain ◽  
Upper Extremity ◽  
Disc Herniation ◽  
Local Anesthetic ◽  
Chronic Neck Pain ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Epidural Injections ◽  
Group I ◽  
Group Ii

Background: Chronic neck pain is a common problem in the adult population with a typical 12- month prevalence of 30% to 50%. Cervical disc herniation and radiculitis is one of the common conditions described responsible for chronic neck and upper extremity pain. Cervical epidural injections for managing chronic neck pain with disc herniation are one of the commonly performed non-surgical interventions in the United States. However, the literature supporting cervical interlaminar epidural steroids in managing chronic neck pain is scant. Study Design: A randomized, double-blind, controlled trial. Setting: A private interventional pain management practice and specialty referral center in the United States. Objectives: To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in providing effective and long-lasting relief in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis, and to evaluate the differences between local anesthetic with or without steroids. Methods: Patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received cervical interlaminar epidural injections with 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Outcomes Assessment: Multiple outcome measures were utilized. They included the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake. Assessments were done at baseline and 3, 6, and 12 months post-treatment. Significant pain relief was defined as 50% or more; significant improvement in disability score was defined as a reduction of 50% or more. Results: Significant pain relief (≥ 50%) was demonstrated in 77% of patients in both groups. Functional status improvement was demonstrated by a reduction (> 50%) in the NDI scores in 74% of Group I and 71% of Group II at 12 months. The overall average procedures per year were 3.7 ± 1.1 in Group I and 4.0 ± 0.91 in Group II; the average total relief per year was 39.45 ± 11.59 weeks in Group I and 41.06 ± 11.56 weeks in Group II over the 52 week study period in the patients defined as successful. The initial therapy was considered to be successful if a patient obtained consistent relief with 2 initial injections lasting at least 4 weeks. All others were considered failures. Limitations: The study results are limited by the lack of a placebo group and a preliminary report of 70 patients, 35 in each group. Conclusion: Cervical interlaminar epidural injections with local anesthetic with or without steroids might be effective in 77% of patients with chronic function-limiting neck pain and upper extremity pain secondary to cervical disc herniation and radiculitis. Key words: Chronic neck pain, cervical disc herniation, upper extremity pain, cervical epidural injections, epidural steroids, local anesthetics

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