scholarly journals Six-Month Results of Cervical Intradiscal Oxygen-Ozone Mixture Therapy on Patients with Neck Pain: Preliminary Findings

2018 ◽  
Vol 1 (21;1) ◽  
pp. E499-E456 ◽  
Author(s):  
Serbülent Gökhan Beyaz
Keyword(s):  
Neck Pain ◽  
Disc Herniation ◽  
Chronic Neck Pain ◽  
Percutaneous Treatment ◽  
Cervical Disc Herniation ◽  
Pain Clinic ◽  
Cervical Disc ◽  
Preoperative Pain ◽  
Cross Sectional ◽  
Mixture Treatment

Background: Numerous techniques have been developed for the treatment of disc herniation. Oxygen-ozone (O2 -O3 ) mixture therapy is a minimally invasive percutaneous treatment for disc herniation. Objective: The aim of the study is to investigate the 6-month efficacy and safety of O2 -O3 mixture therapy in patients with cervical disc herniation (CDH) and chronic neck pain. Study Design: This is a cross-sectional, single-center study. Setting: The study was conducted from January 2012 to May 2016 on patients visiting Sakarya University Training and Research Hospital’s pain clinic. Methods: Each patient was evaluated before the procedure (baseline) and at 2 weeks (W2), 6 weeks (W6), and 6 months (M6) after the procedure using the visual analog scale (VAS) and the Oswestry Disability Index scores. Results: A total of 44 patients with CDH underwent the same treatment with an O2 -O3 mixture. Significant pain relief was observed compared with preoperative pain at W2, W6, and M6 according to patient self-evaluation (P = 0.01). The mean VAS score was 7.89 ± 1.13 before the procedure, 4.22 ± 1.62 at W2, 3.03 ± 1.66 at W6, and 2.27 ± 1.25 at the end of M6. No significant complications or side effects were reported during or after the procedure. Limitations: Our study was conducted retrospectively, which resulted in problems obtaining follow-up data. In addition, this study was performed in a small patient group. Conclusion: Based on our results, intradiscal injection of an O2 -O3 mixture treatment showed a beneficial long-term effect. Key words: Cervical disc herniation, chemonucleolysis, injection, intradiscal, oxygen-ozone mixture, percutaneous treatment

scholarly journals Long-term Clinical Effects of DiscoGel for Cervical Disc Herniation

2018 ◽  
Vol 1 (21;1) ◽  
pp. E71-E78
Author(s):  
Serbülent Gökhan Beyaz
Keyword(s):  
Neuropathic Pain ◽  
Chronic Neck Pain ◽  
Pain Clinic ◽  
Cervical Disc ◽  
Clinical Effects ◽  
Preoperative Pain ◽  
Cross Sectional ◽  
Oswestry Disability Index Score

Background: Radiopaque gelified ethanol (RGE; DiscoGel®, Gelscom SAS, France) is used as a chemonucleolysis substance in treating intradiscal herniation, showing good results without complications. It has also been used in cervical disc herniations (CDHs), demonstrating the potential efficacy of this substance. Objective: The aim of the study is to investigate the long-term effectiveness and safety of DiscoGel® in patients with CDH and chronic neck pain. Study Design: This is a cross-sectional, single-center study. Setting: The study was conducted from November 2013 to May 2016 on patients visiting Sakarya University Training and Research Hospital’s pain clinic . Methods: Each patient was evaluated before the procedure (baseline) and at 1, 3, 6, and 12 months after the procedure, using the visual analog scale (VAS) score for pain, the Oswestry Disability Index score to measure degree of disability, and estimate quality of life for those with pain; this coincides with scores on the Neuropathic Pain Questionnaire (DN4) for differential diagnoses. Results: Thirty-three patients with CDH underwent the same treatment with DiscoGel® between November 2013 and May 2016. Significant pain relief was noted, as opposed to preoperative pain, at 1, 3, 6, and 12 months after the procedure according to each patient’s self-evaluation (P = 0.01). Differences in VAS, ODI, and DN4 scores between 1, 3, 6, and 12 months with the same variables were not statistically significant. There were no complications with the procedure. Limitations: Our study was conducted retrospectively, which led to problems with long-term follow-up data. In addition, this study was performed with a small group of patients. Conclusions: RGE is a potential alternative to surgery for patients with pain at the cervical level. However, we concluded that more studies with longer follow-up intervals with RGE will be necessary for assessment of the technique’s efficiency. Key words: Cervical pain, herniation, neuropathic pain, injection, DiscoGel®, chemonucleolysis

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

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 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 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 Evaluation of Concordance between Degenerative Changes on Neck X-Ray and Symptomatic Cervical Disc Herniation

2020 ◽  
Vol 8 (2) ◽  
pp. 22
Author(s):  
Amir Abbas Ghasemi ◽  
Saber Ramezanpour
Keyword(s):  
Cervical Spine ◽  
Disc Herniation ◽  
Demographic Data ◽  
Degenerative Changes ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cross Sectional ◽  
Radiographic Findings ◽  
X Ray ◽  
Level Group

Objectives: Radiographic assessment of cervical spine can help find the etiology of neck symptoms, however association between these findings is debatable. The aim of this study was to investigate the association between degenerative changes of the cervical spine and symptomatic cervical disc herniation. Patients and Methods: This cross-sectional retrospective study included 160 patients who underwent anterior cervical discectomy and fusion between February 2012 and June 2017 for cervical disc herniation. Demographic data, patients’ symptoms and radiographic findings and indices were evaluated. The Chi-Square (X2) and one-way ANOVA were used to compare the observed data. Results: A total of 160 patients were studied. Among them, 83 (52%) were male and 77(48%) were female. The patients were classified into four groups on the basis of imaging findings: 89(55.6%) with degenerative changes and symptomatic disc herniation at the same level (group 1), 40(25%) with degenerative changes at a level adjacent to symptomatic level (group 2), 23(14.3%) with symptomatic herniation both at the degenerated level and at level immediately adjacent to it (group 3), and 8(5%) symptomatic herniation and degenerative changes at non-adjacent levels (group 4). There were no significant differences among the four groups from the viewpoint of gender, age, symptoms, smoking and sedentary life style. The study also showed no significant differences between groups with respect to Ishihara index, disc height and posterior osteophyte length. Conclusion: Degenerative changes visible on neck X-ray can be useful clues to the symptomatic disc herniation, but disc herniation may also develop at adjacent and non-adjacent levels.

Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single-level disc herniation: a prospective comparative study

2006 ◽  
Vol 4 (4) ◽  
pp. 292-299 ◽  
Author(s):  
Frédéric Schils ◽  
Benedict Rilliet ◽  
Michael Payer
Keyword(s):  
Carbon Fiber ◽  
Neck Pain ◽  
Disc Herniation ◽  
Iliac Crest ◽  
Radicular Pain ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cervical Discectomy ◽  
Single Level ◽  
Autograft Group

Object The authors conducted a study to evaluate and compare prospectively the implantation of either an empty carbon fiber composite frame cage (CFCFC) or an iliac crest autograft after anterior cervical discectomy (ACD) for cervical disc herniation with monoradiculopathy. Methods Thirty-six consecutive patients with one-level radiculopathy due to single-level cervical disc herniation were treated by ACD, and implantation of either an empty CFCFC (24 patients) or an iliac crest autograft (12 patients). Radiological and clinical assessments were performed preoperatively, immediately postoperatively; and at 3, 6, and 12 months postoperatively. Fusion, at the 12-month follow-up examination was demonstrated in 96% of the patients in the cage group and in 100% of those in the autograft group. The mean anterior intervertebral body height was 3.7 mm preoperatively and 3.9 mm at 12 months in the CFCFC, and 4.1 and 3.8 mm, respectively, in the autograft group. In cage-treated patients, neck pain, as measured using the visual analog scale (VAS) (Score 0 = minimum; 10 = maximum) decreased from 6.4 preoperatively to 2.0 at 12 months, and radicular pain, decreased from 8.4 preoperatively to 1.5 at 12 months. In the autograft group, neck pain changed from a mean preoperative VAS score of 7.2 to 2.5 at 12 months, and radicular pain decreased from a preoperative mean of 7.8 to 1.4 at 12 months. Analysis of the 12-Item Short Form Health Survey domains and the Oswestry Disability Index scores indicated a significant improvement in both the Physical and Mental Component Summary domains in both groups. Conclusions Implantation of an empty CFCFC or a tricortical iliac crest autograft after ACD are safe and reliable options for the treatment of cervical disc herniation causing one-sided radiculopathy. Both procedures produced equally satisfying clinical and radiological results, leading to a high fusion rate and maintaining intervertebral height. Implantation of an empty CFCFC has the advantages of avoiding any donor site morbidity and requiring a significantly shorter operative time.

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