Deep Learning-Based Cervical Spine Posterior Percutaneous Endoscopic Disc Nucleus Resection for the Treatment of Cervical Spondylotic Radiculopathy

In the past 10 years, the technology of percutaneous spine endoscopy has been continuously developed. The indications have expanded from simple lumbar disc herniation to various degenerative diseases of the cervical, thoracic, and lumbar spine. Traditional surgery for the treatment of cervical radiculopathy includes anterior cervical decompression surgery, anterior cervical decompression plus fusion surgery, and posterior limited fenestration surgery. This article mainly studies the treatment of cervical spondylosis caused by radiculopathy caused by the nucleus resection of the posterior cervical spine percutaneous spinal endoscopy based on deep learning. In the PPECD group, the height of the intervertebral cavity was measured before the operation and during the final follow-up, and the height change of the intervertebral cavity was evaluated. The relative angle and relative displacement of the sagittal plane of the operation segment in the PPECD group were measured, and the stability was evaluated. Using the cervical spine X-ray Kelvin degeneration evaluation criteria, before and during the final follow-up operation, the degeneration of the adjacent segments of the two groups was evaluated. A retrospective analysis of 26 cases of cervical radiculopathy that met the criteria for diagnosis, inclusion, and exclusion was reviewed. Among them, 11 cases were treated with PPECD surgery; 15 cases were treated with ACDF surgery. According to the evaluation method of Odom, the excellent rate and the good rate of the two groups were compared. According to the location of the lesion, the nerve detection or dull tip device is exposed under the armpit or shoulder of the nerve root, and the protruding nucleus pulposus tissue is explored and removed, and annulus fibrosus is performed as needed. After hemostasis was detected, the surgical instruments were removed and the surgical incision was completely sutured. Before the operation and 3 months after the operation, the final follow-up made no significant difference in the overall average height of the intervertebral cavity (F = 2.586, P > 0.05 ). The results show that posterior foramen expansion is an effective surgical method for the treatment of cervical spondylotic radiculopathy, but surgical adaptation requires strict management. In order to achieve satisfactory results, appropriate cases must be selected.

Comparative Analysis of the Biomechanical Characteristics After Different Minimally Invasive Surgeries for Cervical Spondylopathy: A Finite Element Analysis

Minimally invasive surgeries, including posterior endoscopic cervical foraminotomy (PECF), microsurgical anterior cervical foraminotomy (MACF), anterior transdiscal approach of endoscopic cervical discectomy (ATd-ECD), and anterior transcorporeal approach of endoscopic cervical discectomy (ATc-ECD), have obtained positive results for cervical spondylotic radiculopathy. Nonetheless, there is a lack of comparison among them regarding their biomechanical performance. The purpose of this study is to investigate the biomechanical changes of operated and adjacent segments after minimally invasive surgeries compared to a normal cervical spine. A three-dimensional model of normal cervical vertebrae C3–C7 was established using finite element analysis. Afterwards, four surgical models (PECF, MACF, ATd-ECD, and ATc-ECD) were constructed on the basis of the normal model. Identical load conditions were applied to simulate flexion, extension, lateral bending, and axial rotation of the cervical spine. We calculated the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus pressure (AFP), uncovertebral joints contact pressure (CPRESS), and facet joints CPRESS under different motions. For all circumstances, ATc-ECD was close to the normal cervical spine model, whereas ATd-ECD significantly increased ROM and joints CPRESS and decreased IDP in the operated segment. PECF increased more the operated segment ROM than did the MACF, but the MACF obtained maximum IDP and AFP. Except for ATc-ECD, the other models increased joints CPRESS of the operated segment. For adjacent segments, ROM, IDP, and joints CPRESS showed a downward trend in all models. All models showed good biomechanical stability. With their combination biomechanics, safety, and conditions of application, PECF and ATc-ECD could be appropriate choices for cervical spondylotic radiculopathy.

Comparison of Region-of-Interest Delineation Methods for Diffusion Tensor Imaging in Patients with Cervical Spondylotic Radiculopathy

Background Diffusion tensor imaging is a promising technique for determining the responsible lesion of cervical radiculopathy, but the selection and delineation of the region of interest (ROI) affects the results. To explore the impact of different ROI sketching methods on the repeatability and consistency of DTI measurement values in patients with cervical spondylotic radiculopathy (CSR). Methods This was a retrospective study that included CSR patients who underwent DTI imaging. The images were analyzed independently by two radiologists. Four delineation methods were used: free-hand method, maximum roundness, quadrilateral method, and multi-point averaging method. They re-examined the images 6 weeks later. To investigate the consistency between the two measurements and the reproducibility between two radiologists, the intra-class correlation coefficient (ICC) was used. Results A total of 42 CSR patients were enrolled in this study. The distribution of compressed nerve roots was five C4, eight C5, sixteen C6, eleven C7, and two C8. No difference was found among the four methods in fractional anisotropy (FA) or apparent diffusion coefficient (ADC), irrespective of radiologists. (all P>0.05). Similar results were observed between the first and second measurements (all P>0.05), but some significant differences were observed for radiologist 2 for the four-small rounds method (P=0.033). Between the two measurements and the two radiologists, the free-hand and single largest circle methods were the two methods with the highest ICC (all ICC >0.90). Conclusion For the delineation of DTI ROI in patients with CSR, the free-hand and single largest circle methods were the most consistent methods.

Traditional Chinese medicine therapies for cervical spondylotic radiculopathy: A protocol for Bayesian network meta-analysis

Review question / Objective: P: Patients diagnosed with cervical spondylotic radiculopathy (CSR). I: The treatmen group will be treated with traditional Chinese medicine therapies (with/without additional treatment) including acupuncture of several types (acupuncture, acupoint sticking, acupoint injection, electroacupuncture and so on), massage, cervical traction, fire needle, traditional Chinese medicine hot compress, or their combination. No restrictions are imposed on length of the treatment period, times of treatment, and frequency of treatment. C: The traditional Chinese medicine therapies (with/without additional treatment) including acupuncture of several types (acupuncture, acupoint sticking, acupoint injection, electroacupuncture and so on), massage, cervical traction, fire needle, traditional Chinese medicine hot compress, or their combination will be included in this review. S: Only randomized controlled trials (RCTs) will be included.

Are Facet Orientation and Tropism Risk Factors for Cervical Spondylotic Radiculopathy? A Retrospective Study in a Chinese Population

Background Facet parameters, such as facet orientation (FO) and tropism (FT) are thought to be predisposing factors for pathological changes in the lumbar spine. This study aimed to explore the association between facet parameters and cervical spondylotic radiculopathy (CSR) on 3-dimentional views. Methods A total of 226 patients with single-level CSR and 182 normal control participants were included. FO, FT and the incidence of FT (defined as FT ≥ 7) based on reconstructed CT images were measured. Univariate and multiple logistic regression analysis were used to investigate the association between facet joint parameters and the incidence of CSR. The Pearson Chi-square test was used to find out the relationship between the side of herniation and facet joint parameters in CSR patients. Results Axial FT of CSR group was significantly larger compared to control group at each spinal level, while sagittal except C5/6 and coronal FT shown not. The differences of incidence of axial FT at all levels between groups were statistically significant, as well as incidence of sagittal FT at C4/5 and C5/6. Incidence of axial FT with respect to all levels was significantly associated with CSR, and incidence of sagittal FT only at C4/5 and C5/6 was associated with CSR. The proportion between the left and right side of greater FO was significantly different on axial view. Conclusion Axial and sagittal FT but not FO were associated with CSR, and axial FT might exert more dominant function on the development of CSR. Moreover, CSR might be more vulnerable to more severe axial FT, which should be paid more attention. The side of herniation might prefer the side of greater axial FO.

The Role of Digital X-Ray in Curative Effect and Nursing Evaluation of Cervical Spondylotic Radiculopathy

The present study attempted to analyze the features of atlanto-occipital radiograph in patients with cervical spondylotic radiculopathy or vertebral artery type. In order to reduce the interference of human factors and the measurement error as much as possible, this experiment adopts the blind design and analyzes the digital format X-ray films by using the computer software ImageJ. Because the tangent line between the outer plates of the anterior and posterior margin of the foramen magnum was not accurately located on the X-ray film, the angle formed by the line between the saddle dorsal slope and the center point of the anterior and posterior nodule with a clear display was selected as the measurement method of the angle between the atlanto-occipital joints. The results showed that the lateral cervical curvature of the VCS group was 0.43 ± 0.51, and the lateral cervical curvature of the CSR group was 0.46 ± 0.49, both of which were significantly lower than the normal value (1.2 ± 0.5 cm). Patients in both groups had the characteristic of cervical curvature straightening. The changes of cervical curvature in overflexion and overextension positions can indirectly reflect the state of cervical motion. The anterior flexion neck curve of the VCS group was less than that of the CSR group ( P < 0.05 ). Compared with the CSR group, VCS showed limited cervical anterior flexion movement. In this study, X-ray films of both CSR and VCS showed occipitocervical flexion and extension disorders, cervical curvature straightening, and lower cervical instability. In VCS, occipitocervical flexion and extension disorders were mainly manifested in atlantoaxial flexion disorders, while in CSR, atlanto-occipitocervical flexion and extension disorders were mainly manifested in atlantoaxial flexion disorders.

Clinical Validity of the Smallest Oblique Sagittal Area of the Neural Foramen in Patients With Suspected Cervical Spondylotic Radiculopathy

Objective To evaluate the smallest oblique sagittal area of the neural foramen in detecting cervical spondylotic radiculopathy and to determine its potential significance for treatment decisions. Methods The subjects of the study were patients with cervical spondylotic radiculopathy who visited the spine surgery from 2016 to 2019. All patients were compared according to the minimum oblique sagittal area and the cut-off point value, and they were divided into positive and negative parameters. The changes in neck disability index (NDI), Japanese Orthopaedic Association score (JOA) and visual analog scale (VAS) during the two treatment groups from baseline to at least 24 months of follow-up were compared.Results In the surgery group, there was no significant difference in symptom improvement between patients with positive and negative parameters. In the non-surgical group, for patients with positive parameters, NDI decreased by 2.35, JOA increased by 0.88, and neck VAS score improved by 0.42. For patients with negative parameters, NDI decreased by 10.32, JOA increased by 2.86 on average, and neck VAS score improved by 2.46 points on average (both p＜0.01 on t test).Conclusions In patients undergoing surgery, the symptoms of the patients have been significantly improved after surgery, and the smallest oblique sagittal area of the neural foramen seems to be unable to predict the outcome of the surgery. However, in non-surgical patients, the improvement of symptoms in the stenosis group was more limited. This may imply that surgery may be effective for patients who had positive parameters.