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Query: UMLS:C0007859 (neck pain)
 3,931 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Somatosensory evoked potentials (SEPs) following median, ulnar and tibial nerve stimulation were recorded from sites over the shoulders, neck and scalp in 34 patients with cervical spondylosis. Twenty control subjects were matched for sex and age. Detailed clinical and radiological data were assembled, with particular attention to the sensory modalities impaired and the locus and severity of cord compression. The patients were divided clinically into 4 groups: combined myelopathy and radiculopathy (6 cases), myelopathy alone (15), radiculopathy (6) and neck pain (7). Four cases are described in detail. SEP abnormalities were strongly correlated with clinical myelopathy, but not with radiculopathy. Median and ulnar nerve responses were less often affected than tibial, even with myelopathy above C6 level. Tibial nerve SEP abnormalities were strongly correlated with posterior column signs on the same side of the body, but not with anterolateral column sensory signs. In myelopathy cases, the SEP examination appeared to be more sensitive to sensory pathway involvement than clinical sensory testing. SEP abnormalities were infrequent in cases of radiculopathy and neck pain, bearing no relation to the clinical locus of root lesions. Abnormal SEPs consistent with subclinical posterior column involvement, however, were recorded in 1 patient with radiculopathy and 2 with neck pain. Follow-up recordings made postoperatively in 7 myelopathy cases reflected the clinical course (improvement, deterioration or no change) in 4, but failed to reflect improvement in 3. The correlation of SEP findings with radiological data was generally poor. SEP abnormalities were detected in 6 out of 8 patients with clinical myelopathy but no radiological evidence of posterior cord compression, suggesting that impairment of the blood supply may be an important factor contributing to cord damage. An application for SEPs in the clinical management of cervical spondylosis may lie in the detection of posterior column involvement and the differential diagnosis from disorders such as multiple sclerosis and amyotrophic lateral sclerosis.
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PMID:Somatosensory evoked potentials in cervical spondylosis. Correlation of median, ulnar and posterior tibial nerve responses with clinical and radiological findings. 400 25

Fractures of the articular processes occurred in 16 (20.8%) of 77 patients with cervical spine fractures as demonstrated by multidirectional tomography. Plain films demonstrated the fractures in only two patients. Acute cervical radiculopathy occurred in five of the patients with articular process fractures (superior process, two cases; inferior process, three cases). Persistent neck pain occurred in one other patient without radiculopathy. Three patients suffered spinal cord damage at the time of injury, which was not the result of the articular process fracture itself. In the other seven cases, no definite sequelae occurred. However, disruption of the facet joint may predispose to early degenerative joint disease and chronic pain; unilateral or bilateral facet dislocation was present in five patients. In patients with cervical trauma who develop cervical radiculopathy, tomography should be performed to evaluate the articular processes.
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PMID:Fractures of the articular processes of the cervical spine. 697 90

Between 1985 and 1990, 68 patients with cervical radiculopathy due to soft disc herniation were treated by anterior cervical discectomy without interbody fusion. Eleven patients were unavailable for follow-up examination. The mean follow-up was 23 months (range 12-54 months). Both clinical and radiographic follow-ups were done, and 92% of the patients was found to have excellent or good clinical results. Radiographic follow-up revealed that 34% had fused spontaneously and 66% developed fibrous healing of the disc space with an average range of mobility of 2.07 deg. All patients were shown to be stable on flexion-extension films. Complications included two transient CSF leaks. No neurologic deficits arose. One patient was reoperated and fused for intractable residual neck pain. We conclude that anterior cervical discectomy without interbody fusion is a simple, safe and effective procedure for patients with soft disc herniation.
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PMID:Anterior discectomy without interbody fusion for cervical disc herniation. 774 7

Neck pain may affect one third of the adult population from time to time and may persist for 6 months or longer in 10% to 15% of these patients. In addition, cervical spine disease or trauma may result in injury to the spinal cord or nerve roots, through a variety of mechanisms, leading to a group of syndromes that can be broadly classified as myelopathy or radiculopathy. This review addresses recent developments in the anatomy and physiology of the normal cervical spine, common ill-defined or miscellaneous neck pain problems, and cervical injuries, with emphasis on the flexion-extension injury called "whiplash." Other types of injuries, including fractures and fracture dislocations, also are discussed, as well as neurologic consequences of cervical disk and facet joint degenerative disease, with emphasis on cervical spondylitic myelopathy. The complications of inflammatory joint diseases such as ankylosing spondylitis and rheumatoid arthritis are not specifically addressed in this review.
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PMID:Cervical spine and radicular pain syndromes. 776 94

Anterior cervical discectomy and interbody grafting provide excellent results in treating cervical radiculopathy. This prospective study compares the results of the technique obtaining autogenous bone from the cervical vertebrae for grafting to the modified Smith-Robinson technique using autogenous iliac crest graft. Seven levels in six patients were fused using the vertebral body autograft technique and 43 levels in 40 patients using the standard technique. All patients had radiculopathy and neck pain. Statistically significant differences in fusion rate (4/7 vertebral body autograft; 40/43 modified Smith-Robinson) (p = 0.029), disc height maintenance (p = 0.001), and neck pain improvement (p = 0.05) occurred between the techniques. We do not recommend vertebral body autograft over the modified Smith-Robinson technique for anterior cervical fusion following discectomy.
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PMID:Comparison of anterior cervical fusions using autogenous bone graft obtained from the cervical vertebrae to the modified Smith-Robinson technique. 787 47

Deposition of calcium pyrophosphate dihydrate (CPPD) crystals in the yellow ligament occasionally leads to neurological deficits through compression of the spinal cord. Although it is widely accepted that CPPD crystal induces severe inflammation in arthropathy, little attention has been paid to the acute inflammation that may accompany the CPPD crystals in the ligamentum flavum. The present study reviews eight patients with radiculomyelopathy due to calcification of the cervical yellow ligament. Acute inflammation of the yellow ligament accompanying the crystalline deposits, both with and without attendant granulation tissue-proliferation, was evaluated as contributing to cervical radiculomyelopathy. Three cases with attendant granulation tissue suffered from recurrent attacks of neck pain and fever with coincidental radicular pain in the upper arm. The local inflammation of the ligamentum flavum might have participated in the exacerbation of the cervical radiculopathy.
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PMID:Cervical radiculomyelopathy due to deposition of calcium pyrophosphate dihydrate crystals in the ligamentum flavum: historical and histological evaluation of attendant inflammation. 787 50

Neck pain often occurs in the absence of neurologic findings, and the diagnostic dilemma of the clinician is to determine if there is a definable lesion. Radiographically, the cervical spine is commonly involved, especially in persons older than 50 years. Excluding soft-tissue inflammation and spasm, osteoarthritis is the most common rheumatic disease of the cervical spine. Radiculopathy and myelopathic involvement from disk, foraminal, or spinal canal impingement are all sequelae of this disease. Other diseases, such as DISH, rheumatoid arthritis, and ankylosing spondylitis, can affect the spine as well. Assessment of the integrity of the atlantoaxial joint is important in avoiding neurologic compromise.
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PMID:Arthritis of the cervical spine. 807

The purpose of this article is to analyze the role of cervical diskography as a diagnostic method via reproduced pain. A nonionic contrast medium (Iohexol) that does not harm normal tissue was used in this series to prevent false-positive provocative pain. One hundred forty-four patients (128 with cervical spondylotic myelopathy, eight with cervical spondylotic radiculopathy, and eight with cervical spondylotic amyotrophy) were studied. Among 72 patients in the symptomatic neck pain group who complained of neck pain before diskography, 65% showed reproduced pain. However, in the control group (neurologic symptoms only) 50% of the patients complained of provocative neck pain during dye injection. These results demonstrated that this provocation technique appeared unreliable for diagnosing symptomatic disk levels.
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PMID:Evaluation of cervical diskography in pain origin and provocation. 827 11

A retrospective analysis was done on 100 patients who had received cervical epidural steroid injections for neck pain and cervical radiculopathy to identify the predictors of outcome after such treatment. Potential predictors of outcome were assessed individually and then simultaneously with a multiple-regression model. Patients with radicular symptoms and signs had the best pain relief in contradistinction to those with axial (neck) pain. A clinical classification model predicting the outcome and an algorithm for the use of such injections in the treatment of cervical radiculopathy were developed.
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PMID:Clinical classification as a predictor of therapeutic outcome after cervical epidural steroid injection. 851 3

Eighty-eight consecutive patients underwent anterior cervical discectomy (ACD) with banked fibula fusion and internal fixation using the locking cervical plate. Pathology included cervical spondylotic radiculopathy in 48, cervical spondylotic radiculomyelopathy in 30, cervical facet dislocations with associated disc herniations in six, and autologous iliac crest graft collapse pseudoarthrosis with recurrent symptoms in four patients. Operations were single-level banked fibula fusion with plating in 37, multilevel banked fibula fusion with plating in 45, and combined single-level ACD banked fibula fusion with plating and posterior fusion in six patients. The only perioperative complication was transient hoarseness. There were no transfusions, infections, neurological injuries, or deaths. The mean time in the hospital for the nontraumatic cases was 1.8 days. The mean follow up was 22 months (range 12-30 months). There has been no motion at the fused level on flexion/extension films, no kyphosis, no screw plate backout, and no banked fibula has suffered graft collapse. Following a high-speed motor vehicle accident 6 months after a multilevel fusion, one alcoholic man suffered a fractured plate with transient worsening of neck pain, and the plate has remained in place for an additional 11 months of follow-up care. Compared to 100 consecutive autologous iliac crest fusions performed by the same surgeon, there were significantly fewer graft-related complications (p < 0.001). There was a significantly greater chance of autologous iliac crest collapsing with the passage of time as compared to banked fibula. Time until return to work was shorter by 5 weeks for the plate/banked fibula group (p < 0.05). When fusion is considered following ACD, the combination of banked fibula and locking cervical plates is significantly superior to autologous iliac crest grafts.
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PMID:Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy. 881 89


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