scholarly journals Features of conducting medial branches radiofrequency neurotomy in the cervical spine

2018 ◽  
Vol 24 (2) ◽  
pp. 37-43
Author(s):  
V.G. Sichinava
Keyword(s):  
Cervical Spine ◽  
Pain Intensity ◽  
Functional State ◽  
Neck Disability Index ◽  
Chronic Neck Pain ◽  
Spinal Nerve ◽  
Medial Branch ◽  
Preoperative Pain ◽  
Factors Affecting ◽  
Radiofrequency Neurotomy

Objective — optimize the technique of radiofrequency destruction of the medial branch of the spinal nerve and evaluate its effectiveness in the treatment of reflex pain syndromes of the cervical spine. Materials and methods. In 30 patients with chronic pain in the neck and upper extremities who were treated in the department of neurosurgery N 2 of the Kyiv City Clinical Emergency Hospital from 2014 to 2017, the effectiveness of the radiofrequency neurotomy of the medial branch of the spinal cord back root and the clinical significance of diagnostic blockades. There were 14 men (46.7 %), women — 16 (53.3 %). The age of the patients is from 38 to 75 years (the average age is 53.7 years). Neurotomy was performed in patients with chronic neck pain with irradiation in the upper limbs, in which diagnostic blockades were effective. The study did not include patients with myelopathy and radiculopathy. Preoperative pain intensity ranges from 5 to 9 points (on average, 7.50 ± 0.86 points) on a visual analog scale (VAS). The duration of pain before surgery ranged from 6 months to 20 years (an average is 3.5 years). In 21 patients, the pain was one-sided (9 in the right, 12 in the left), and the others with a bilateral one. All patients underwent clinical and neurological examination, roentgenography of the cervical spine and magnetic resonance imaging. The efficacy of the therapy was assessed with the help of the VAS, the functional state using the NDI (Neck Disability Index) questionnaire. Results. The pain intensity was assessed after 1, 3, 6 and 12 months. The pain intensity according to the VAS decreased from (7.50 ± 0.86) point before the operation to (2.07 ± 0.74) points after 12 months. A significant statistically significant (p < 0.05) improvement in the functional state compared with the baseline was noted in the postoperative period. Preoperative functional status was assessed on average (27.80 ± 1.19) points on the NDI scale. A week after the neurotomy, there was a statistically significant decrease in the total score on the NDI scale to an average of 12.90 ± 0.69, after 12 months to 13.10 ± 1.01. Conclusions. Factors affecting the effectiveness of radiofrequency destruction include the proper selection of patients, the accuracy of diagnostic tests and the technically correct installation of the electrode. Knowledge of the anatomical features of the medial branch of the spinal nerve, the X-ray anatomy, the characteristics and size of the damage during radiofrequency destruction ensure the effectiveness of neurotomy.

Examination of Regional Interdependence Theory in Chronic Neck Pain: Interpretations from Correlation of Strength Measures in Cervical and Pain-Free Regions

Pain Medicine ◽  
2019 ◽  
Author(s):  
Leila Ghamkhar ◽  
Amir Massoud Arab ◽  
Mohammad Reza Nourbakhsh ◽  
Amir Hossein Kahlaee ◽  
Reyhaneh Zolfaghari
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Neck Disability Index ◽  
Chronic Neck Pain ◽  
Pain Intensity Score ◽  
Painful Condition ◽  
Asymptomatic Volunteers ◽  
Interdependence Theory ◽  
Regional Interdependence ◽  
Pain Patients

Abstract Objective Impairments present in chronic pain conditions have been reported not to be limited to the painful region. Pain-free regions have also been proposed to be adversely affected as a cause or consequence of the painful condition. The aim of this study was to investigate the association between muscle strength in painful and pain-free regions and chronic neck pain. Design A cross-sectional study. Setting Rehabilitation hospital laboratory. Subjects One hundred twenty-two patients with chronic neck pain (87 female) and 98 asymptomatic volunteers (52 female) were included in the study. Methods Maximal isometric strength measures of the neck, scapulothoracic, shoulder, trunk, and hip muscles were assessed using a hand-held dynamometer in all participants. Pain intensity and pain-related disability were also assessed in patients through visual analog scale and Neck Disability Index scores, respectively. Results Principal component analysis revealed one component for each of the studied regions. Multivariate analysis of variance found neck (d = 0.46), scapulothoracic (d = 0.46), shoulder (d = 0.60), trunk flexor (d = 0.38), extensor (d = 0.36), and hip (d = 0.51) strength components to be lower in the neck pain patients compared with asymptomatic participants (P < 0.01). Logistic and linear regression analyses found the shoulder strength component both to be a significant predictor for neck pain occurrence (β = 0.53, P < 0.01) and to have a considerable effect on pain intensity score (β=–0.20, P = 0.02), respectively. Conclusions The results found that some pain-free regions in addition to the cervical spine to exhibit lower levels of muscular strength in neck pain patients. These findings support the regional interdependence theory, which proposes that impairments are not limited to the painful area and are possibly mediated by central mechanisms.

scholarly journals CORRELATION BETWEEN CERVICAL MORPHOLOGY, PAIN, FUNCTIONALITY, AND ROM IN INDIVIDUALS WITH CERVICALGIA

2019 ◽  
Vol 18 (2) ◽  
pp. 101-105
Author(s):  
Mateus Alves Aimi ◽  
Eduardo Gonçalves Raupp ◽  
Emanuelle Francine Detogni Schmit ◽  
Adriane Vieira ◽  
Cláudia Tarragô Candotti
Keyword(s):  
Cervical Spine ◽  
Pain Intensity ◽  
Range Of Motion ◽  
Functional Disability ◽  
Sagittal Plane ◽  
Neck Disability Index ◽  
X Rays ◽  
Level Of Evidence ◽  
Spine Curvature ◽  
The Right

ABSTRACT Objective: To verify if there is a correlation between the morphology of the cervical spine curvature, pain intensity, functional disability, and range of motion in individuals with cervicalgia. Methods: Thirty-nine individuals were evaluated using x-rays in the right sagittal plane (Cobb C1-C7 two-line method), visual analogue scale, Neck Disability Index questionnaire, and fleximeter. Descriptive statistical analysis (percentage, mean and standard deviation) and inferential (independent t-test and Pearson product-moment correlation coefficient, α=0.05) were performed. Results: There were significant correlations, ranging from moderate to high, between functional capacity and pain intensity (r=0.637, p<0.001), and total range of motion (r=-0.568, p<0.001), and extension (r=-0.610, p<0.001), and between pain intensity and range of motion (r=-0.422, p=0.007). Regarding the morphology of the cervical spine curvature, none of the variables showed a significant correlation. Conclusions: Cervical morphology, more specifically related to the curvature in the sagittal plane, does not seem to interfere alone with pain, functionality, and range of motion. In contrast, it is possible to affirm that higher levels of pain generate a smaller range of cervical movement, especially of extension, which, in turn, results in greater functional losses in individuals with neck pain. Level of Evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

Influence of the cervical spine manipulation in the neck disability index in patients with chronic neck pain: A preliminary study.

2015 ◽  
Vol 13 ◽  
pp. 283
Author(s):  
Iã Ferreira Miranda ◽  
Daniel Facchini ◽  
Eliane Fátima Manfio
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Sham Group ◽  
Neck Disability Index ◽  
Chronic Neck Pain ◽  
Post Treatment ◽  
Group Method ◽  
Cervical Spine Manipulation ◽  
Pre Treatment ◽  
Neck Disability

Background: Neck pain is one of the major problems managed by chiropractors, therefore its common the use of spinal manipulation to manage this problem.   Objective: To evaluate the influence of Cervical Spine Manipulation (CSM) in the Neck Disability Index (NDI) of patients with chronic neck pain compared to a manipulative sham group. Method: 15 patients with chronic neck pain, were randomly assigned into one of two groups. Experimental Group (EG), with 8 patients, mean age of 30.6(13.7) years and Sham Group (SG), with 7 patients, mean age of 38.9(17.0) years. All the patients signed a Voluntary Informed Consent Document, approved by the university’s research ethics committee (n°555.015). The NDI was used to evaluate the outcome. The EG intervention was the CSM, performed 4 times, along a mean of 39.2 days. The SG was subjected to a similar cervical manipulative sensory experience, also performed 4 times, along a mean of 30.6 days. Paired and unpaired Student’s t-test was used to assess intra and inter group differences, respectively. Results: Statistically significant differences (p=0.000) were found for NDI between the pre and post-treatment evaluations of both the EG (26.3(5.0) % pre; 10.9(7.1) % post) and the SG (30.1(3.7) % pre; 18.4(5.3) % post). There were no significant differences for NDI in the pre-treatment between groups (p=0.122), however statistically significant differences were found in the post-treatment between the EG and the SG (p=0.039). Conclusion: The result shows that after the treatment period both groups showed improvement for NDI, however the CSM in the EG resulted in an improved outcome in the treatment of patients with chronic neck pain.

Cervical Facet Nerve Block: Ultrasound

2016 ◽  
Author(s):  
Andreas Siegenthaler
Keyword(s):  
Facet Joint ◽  
Chronic Neck Pain ◽  
Medial Branch ◽  
Lumbar Region ◽  
Nerve Blocks ◽  
Radiofrequency Neurotomy ◽  
Fluoroscopic Control ◽  
Actual Target ◽  
Cervical Facet ◽  
Better Than

The cervical facet joints are well-documented sources of chronic neck pain and headache. Ultrasound may offer the advantage of visualizing the actual target nerves, which is not possible with fluoroscopy. The relevant structures are located much more superficially than in the lumbar spine, hence visibility of the potential targets with ultrasound is expected to be better than in the lumbar region. Besides the ability to perform diagnostic nerve blocks, ultrasound imaging is expected to increase precision of radiofrequency neurotomy due to the ability to localize the exact course of a facet joint supplying nerve. For practitioners with only little experience in cervical sonoanatomy, we recommend performing ultrasound-guided cervical medial branch blocks with parallel fluoroscopic control first till one gains more experience. Correct level determination with ultrasound as described may be difficult for beginners, and the parallel use of fluoroscopy will help developing a “feel” for the procedure.

Sensitization in office workers with chronic neck pain in different pain conditions and intensities

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alexandre Nunes ◽  
Kristian Petersen ◽  
Margarida Espanha ◽  
Lars Arendt-Nielsen
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Neck Disability Index ◽  
Chronic Neck Pain ◽  
Office Workers ◽  
Moderate Pain ◽  
Pain Group ◽  
Trapezius Myalgia ◽  
Pain Pathways ◽  
Neck Disability

Abstract Objectives Office workers with chronic neck pain demonstrates signs of widespread hyperalgesia, less efficient descending pain modulation, which could indicate sensitization of central pain pathways. No studies have assessed a wide variety of office workers with different chronic neck pain disorders and assessed the impact of pain intensity on assessments of central pain pathways. This study aimed to assessed pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM) and to associate these with pain intensity and disability in subgroups of office workers. Methods One hundred-and-seventy-one office workers were distributed into groups of asymptomatic and chronic neck pain subjects. Chronic neck pain was categorized as chronic trapezius myalgia and chronic non-specific neck pain and as ‘mild-pain’ (Visual Analog Scale [VAS]≤3) and ‘moderate-pain’ (VAS>3) groups. PPTs, TSP, CPM, and Copenhagen Psychosocial Questionnaire II were assessed in all subjects. Neck Disability Index and Pain Catastrophizing Scale were assessed in all the symptomatic office workers. Results PPTs were lower in moderate pain (n=49) and chronic trapezius myalgia (n=56) compared with asymptomatic subjects (n=62, p<0.05). TSP was facilitated in moderate pain group compared with mild pain (n=60, p<0.0001) group and asymptomatic subjects (p<0.0001). No differences were found in CPM comparing the different groups (p<0.05). Multiple regression analysis identified Neck Disability Index and TSP as independent factors for prediction of pain intensity in chronic trapezius myalgia (R2=0.319) and chronic non-specific neck pain (R2=0.208). Somatic stress, stress and sleep as independent factors in chronic non-specific neck pain (R2=0.525), and stress in moderate pain group (R2=0.494) for the prediction of disability. Conclusions Office workers with chronic trapezius myalgia and moderate pain intensity showed significant signs of widespread pressure hyperalgesia. Moreover, the moderate pain group demonstrated facilitated TSP indicating sensitization of central pain pathways. Neck Disability Index and TSP were independent predictors for pain intensity in pain groups. Sleep and stress were independent predictors for disability.

scholarly journals Multidimensional features of pain in patients with chronic neck pain

2017 ◽  
Vol 30 (3) ◽  
pp. 569-577 ◽  
Author(s):  
Fabianna Resende de Jesus-Moraleida ◽  
Leani Souza Máximo Pereira ◽  
Cristiane de Melo Vasconcelos ◽  
Paulo Henrique Ferreira
Keyword(s):  
Neck Pain ◽  
Pain Intensity ◽  
Neck Disability Index ◽  
Positive Association ◽  
Chronic Neck Pain ◽  
Mcgill Pain Questionnaire ◽  
Brazilian Version ◽  
Present Pain Intensity ◽  
Mild Disability ◽  
Neck Disability

Abstract Introduction: Chronic neck pain is associated with significant health costs and loss of productivity at work. Objective: to assess pain and disability in individuals with chronic neck pain. Methods: 31 volunteers with chronic neck pain, mean age 29, 65 years, were assessed using the McGill Pain Questionnaire in Brazilian version (Br-MPQ) and Neck Disability Index (NDI). The Br-MPQ analysis was performed based on the numerical values associated with the words selected to describe the experience of pain (Pain Rating Index - PRI), and present pain intensity (PPI). NDI was used to evaluate the influence of neck pain in performance of everyday tasks. Finally, we investigated the association between PPI and NDI. Results: PRI revealed that the most significant dimension was the sensory pain (70%), and the number of chosen words was 10 (2,62) out of 20 words. Mean PPI value was 1,23 (0,76) in five points; 40% of participants described pain intensity as moderate. NDI score was 9,77 (3,34), indicating mild disability. There was a positive association between disability and pain intensity (r = 0,36; p =0,046). Pain intensity and duration of pain were not associated. Conclusions: Findings of this study identified important information related to neck pain experienced by patients when suffering from chronic neck pain, moreover, the association between disability and pain intensity reinforces the importance of complementary investigation of these aspects to optimize function in them.

scholarly journals Comparative Outcomes of a 2-Year Follow-Up of Cervical Medial Branch Blocks in Management of Chronic Neck Pain: A Randomized, Double-Blind Controlled Trial

2010 ◽  
Vol 5;13 (5;9) ◽  
pp. 437-450 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Relief ◽  
Neck Pain ◽  
Local Anesthetic ◽  
Facet Joint ◽  
Neck Disability Index ◽  
Chronic Neck Pain ◽  
Medial Branch ◽  
Group I ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background: Cervical therapeutic intraarticular facet joint injections, therapeutic medial branch blocks, and radiofrequency neurotomy have been applied in managing chronic neck pain of cervical facet joint origin. However, the effectiveness of these modalities continues to be debated. The purpose of this study was to determine the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids. Study Design: A randomized, double-blind, controlled trial. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objective: To evaluate the clinical outcomes of therapeutic cervical medial branch blocks with local anesthetic with or without steroids in managing chronic neck pain of facet joint origin. Methods: A total of 120 patients meeting inclusion criteria were included. All of the patients met the diagnostic criteria of cervical facet joint pain by means of comparative, controlled diagnostic blocks, with at least 80% relief. Group I consisted of cervical medial branch blocks with bupivacaine only and Group II consisted of cervical medial branch blocks with bupivacaine and steroid. Therapeutic cervical medial branch blocks with local anesthetic with or without steroids were administered. Main outcome measures included numeric pain scores, Neck Disability Index (NDI), opioid intake, and work status evaluated at baseline, 6, 12, 18, and 24 months. The one-year results of outcomes were published in 2008. This manuscript describes the 2-year results. Significant improvement was defined as at least 50% improvement in pain relief and/or functional status improvement. Outcomes Assessment: Patient outcomes were measured at baseline, 3, 6, 12, 18, and 24 months post-treatment with the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake. Decrease of ≥ 50% of NRS scores and Oswestry scores were considered significant. Results: Eighty-five percent of patients in Group I and 93% of patients in Group II showed significant pain relief (≥ 50%) at 2 years. The average number of treatments for 2 years was 5.7. The duration of average pain relief with each procedure was 17-19 weeks on average in both groups. Significant improvement of pain and function was demonstrated for 83 to 89 weeks over a period of 2 years. Limitations: The study limitations include the lack of a placebo group. Conclusions: In this study, therapeutic cervical medial branch blocks instituted after the diagnosis, with controlled comparative local anesthetic blocks with 80% concordant pain relief, repeated approximately 6 times over a period of 2 years, provided significant improvement over a period of 2 years. Key words: Chronic neck pain, cervical facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, comparative controlled local anesthetic blocks, therapeutic cervical facet joint nerve blocks

scholarly journals Incidence of Cervicogenic Headache Following Lower Cervical Radiofrequency Neurotomy

2019 ◽  
Vol 2 (22.2) ◽  
pp. E127-E132
Author(s):  
Sanjeev Kumar
Keyword(s):  
Cervical Spine ◽  
Pain Management ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Chronic Neck Pain ◽  
Cervicogenic Headache ◽  
Pain Clinic ◽  
True Incidence ◽  
Radiofrequency Neurotomy ◽  
New Onset

Background: The facet joints contribute to chronic cervical spine pain in an estimated 55% of chronic neck pain cases and can be treated with percutaneous radiofrequency neurotomy (PRN). Damage to surrounding structures during treatment or successful treatment of the primary pain source leading to unmasking could lead to new onset of pain, including cervicogenic headache (CGH). In this study, we aimed to define the incidence of headache in patients who have been previously treated with PRN for lower cervical facet pain. Setting: All patients treated at a single academic institution’s pain management clinic from 2014 to 2016 with cervical PRN were reviewed. Methods: All patients treated at a single institution’s pain management clinic from 2014 to 2016 were reviewed. Those treated with lower cervical PRN were identified, and incidence of CGH was described as a percentage of the study population. Patient age and pain scores between those with and without headaches following treatment were compared by unpaired T-tests. Gender, presence of comorbid disease and levels involved, quality of pain, exacerbating and alleviating factors, location of referred pain, and previous treatments between those with and without headaches following treatment were compared using chi-square tests. Results: Among the 88 patients in the study group, 12 were found to have only moderate relief of their pretreatment pain as well as a new onset headache meeting the diagnostic criteria for cervicogenic headache. Compared to those without a headache after treatment, those diagnosed with cervicogenic headache were more likely to be female (P = 0.041), report a higher maximum pain level on presentation (P = 0.015), have a diagnosis of diabetes prior to presentation (P = 0.011), and have had the procedure performed at levels which included C3 (P = 0.013) (Table 1). Limitations: The limitations of this study include its single-center design, as this cohort may not be truly representative of the population of patients receiving cervical PRN as a whole, and as a result, these results may not be generalizable. Due to the small size of the cohort, more subtle differences in presenting signs and symptoms between those with and without headaches may not be detectable. Finally, as previously mentioned, the lack of data on some of the patients who presented with headache may have led to underdiagnosis of the true incidence of cervicogenic headache. Future work should look to re-examine the incidence of CGH in a larger cohort to validate the findings here and further define risk factors for post-procedural CGH. Conclusions: This retrospective review of all patients seen over 2 years in an academic pain clinic found a 13.6% incidence of cervicogenic headache following cervical radiofrequency neurotomy at levels C3-C7. This supports the possibility of the unmasking phenomenon following the procedure, though contributing mechanisms underlying this phenomenon may be multifactorial and require further study. IRB: This study was approved by the institution’s Institutional Review Board (IRB2010601795). Key words: Cervical spine, facetogenic pain, percutaneous radiofrequency neurotomy, cervicogenic headache, chronic pain, zygapophysial joints, innervation convergence, retrospective chart review

THE NATIONAL SECURITY SYSTEM

2018 ◽  
Vol 28 (6) ◽  
pp. 1849-1854
Author(s):  
Marin Petkov
Keyword(s):  
National Security ◽  
Functional State ◽  
Rapid Development ◽  
Science And Technology ◽  
Security System ◽  
Scientific Article ◽  
Moral Code ◽  
Internal Factors ◽  
Factors Affecting

The rapid development of science and technology has led to the emergence of a crisis in society. Science "pushes" religion, but does not offer a new moral code in its place. The definitions of "security" are almost as many and as controversial as postmodernism. For the purposes of this study, however, it will be sufficient to define security as "the functional state of a system that provides for the neutralization and counteraction of external and internal factors affecting or potentially damaging the system." This scientific article presents a study, which seeks to answer the question why the paradigm "security" is so important in the postmodern society, what are the roots of its influence and meaning, and to seek conclusions and guidelines for its increase.

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