Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0007859 (neck pain)
 3,931 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neck pain is a common complaint that typically represents a spectrum of disorders affecting the cervical spine. The clinical history and examination of patients with neck pain dictate the proper timing and selection of diagnostic studies such as plain radiography, MRI, and myelography with CT. Most neck pain is self-limiting and will resolve with appropriate conservative care. Nonsurgical treatment is the most appropriate first step in almost all cases of cervical radiculopathy. In contrast, the conservative care of cervical spondylotic myelopathy with measures such as physical therapy, spinal manipulation, medications, collars, and traction is limited.
 ...
PMID:Evaluation of neck pain, radiculopathy, and myelopathy: imaging, conservative treatment, and surgical indications. 1269 Aug 75

This study evaluated the efficacy and safety of titanium cage implants in cervical reconstruction to treat cervical spondylosis. Surgical data covered a 4-year period from January 1999 to December 2002 and included 34 consecutive patients, 20 men and 14 women, with ages ranging from 27 to 84 years (mean, 57 years). Patients underwent anterior cervical microdiscectomy followed by interbody fusion with a titanium cage implant (rather than an autogenous iliac crest bone graft) at a single level ranging from C3 to C7. Twenty-one patients had a herniated intervertebral disc, nine had degenerative disc disease, and four had previous failed autograft fusion surgery that required revision. At clinical presentation, 26 patients had neck pain, 23 had radiculopathy, and nine had myelopathy. Diagnostic imaging studies included spinal dynamic roentgenography, computerized tomography, and magnetic resonance imaging. Lesions were located at C3-4 in seven cases, C4-5 in 14 cases, C5-6 in nine cases, and C6-7 in four cases. The follow-up period ranged from 7 to 48 months (mean, 26 months). Results revealed that the procedure was technically feasible. There were no intra- or postoperative complications. The most commonly used cage was 9 mm high. Imaging studies showed no cage instability, migration, or pseudarthrosis. Although mild subsidence (< 5 mm) was observed in three cases, these patients preserved adequate postoperative cervical lordosis and the subsidence did not preclude a good clinical result. The advantages of this procedure over a similar operation using traditional tricorticate bone graft are: no graft morbidity; shorter operation time (mean time saved, 35 minutes); reduced blood loss (average blood loss, 75 mL); and early postoperative ambulation (mean, 4.7 hospital days). Nearly all patients rapidly lost their neck pain (92%, 24/26) and radicular symptoms (87%, 20/23) after surgery. The recovery rate from myelopathy was 44% (4/9). Progressive bony shield formation over the anterior/posterior cortex (sentinel sign) indicated fusion in five cases.
 ...
PMID:Preliminary experience with anterior interbody titanium cage fusion for treatment of cervical disc disease. 1282 77

Anterior cervical decompression and fusion with anterior plating of the cervical spine is a well-accepted treatment for cervical radiculopathy. Recently, to minimise the extent of surgery, anterior interbody fusion with cages has become more common. While there are numerous reports on the primary stabilising effects of the different cervical cages, little is known about the subsidence behaviour of such cages in vivo. We retrospectively reviewed eight patients with cervical radiculopathy operated upon with anterior discectomy and fusion with a stand-alone titanium cervical cage. During surgery, only the cartilage portion of the end plate was removed and the cages were filled with autologous cancellous bone graft from the iliac crest. To assess possible subsidence or migration, three different radiographic measurements in the sagittal plane were taken for each case, postoperatively and at the latest follow-up. Subsidence was defined as any change in at least one of our parameters of at least 3 mm. Follow-up time was 12-18 months (average 15 months). Five of the nine fused levels had radiological signs of cage subsidence. No posterior or anterior migration was observed. However, subsidence did not correlate with clinical symptoms in four of the five patients. The remaining patient with signs of subsidence, whose neck pain and neurologic symptoms had regressed in the early postoperative course, suffered recurrence of radiculopathy 6 months after the surgery. Her symptoms were explained by the subsidence of the cage and the subsequent foraminal stenosis observed on the magnetic resonance imaging (MRI) scan. At 15 months' follow-up, her cage was broken. Our preliminary results, so far limited in number, represent a serious warning to the proponents of stand-alone cervical cages
 ...
PMID:Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. 1511 77

Although soft tissue calcifications are well known to occur as a late manifestation in scleroderma, symptomatic paraspinal calcinosis is very rare. Clinically, patients present with focal neck pain, weakness or radiculopathy, and decreased range of motion of the neck. We describe the imaging features of a rare case of cervical paraspinal calcinosis in a 74-year-old woman with long-standing scleroderma. Standard radiography is usually sufficient to confirm the diagnosis, but CT-scan allows a more precise location of the calcifications around the facet joints, sometimes with associated erosions. The advantage of MRI is to evaluate the possible intraspinal extension of the calcifications in case of focal neurological symptomatology.
 ...
PMID:Paraspinal cervical calcifications associated with scleroderma. 1283 21

Most patients with axial neck pain and cervical radiculopathy can be managed conservatively. Surgical intervention for radiculopathy is considered only when conservative management has failed unless the neurologic deficits are very significant. In cases of myelopathy, surgery may be considered earlier, but if the myelopathy is mild, conservative treatment and close observation are still appropriate. For patients with axial neck pain, surgery is generally not considered except for rare cases caused by single- or two-level degenerative disk disease with severe and unrelenting pain. There are many surgical options for the patients with the degenerative cervical spine, but the indications are different. Surgical intervention involves a complete understanding of the disease process both from physical examination and from radiographic studies. If surgery is undertaken without appropriate clinical correlation, poor results often occur. Although the operative planning is the responsibility of the surgeon. the referring physician should also have some awareness of the basic principles behind the different surgeries.
 ...
PMID:Operative treatment of the patient with neck pain. 1294 48

Treatment for chronic atlanto-axial instability remains problematic despite recent innovations in new surgical techniques and instrumentation. Our team reviewed a series of 23 cases of patients with chronic atlanto-axial instability who underwent posterior transarticular screw fixation operations between May 1998 and September 2002. Etiologies of these patients included failed prior surgery, rheumatoid arthritis, congenital anomalies and old odontoid fractures. The clinical presentations were nuchal pain and cervical myelopathy or radiculopathy, with sensory and/or motor deficits that persisted for more than 3 months. We routinely used external reduction to realign the C1-C2 axis prior to operating, and operated on patients using halo-vest fixation. After surgery, the halo-vest was replaced by a collar. In the post-operative follow-up, 22 of the 23 patients (96%) were found to have achieved solid, bony or fibrous union of the C1-C2 axis. Eleven of the 14 (79%) patients with pre-operative neck pain experienced immediate relief or significant improvement. Thirteen of the 20 patients (65%) with myelo-radiculopathy demonstrated improvement of previous motor deficits. Major morbidity included a vertebral artery (VA) injury and a malpositioned screw. No cases of mortality or neurological complications occurred in this series. Posterior transarticular C1-C2 screw fixation results in a high fusion rate without the additional need for rigid external immobilization. It allows good neurological recovery in cases of chronic atlanto-axial instability. Judicious pre-surgical planning and meticulous operative technique may avoid neurological complications and vertebral artery injury.
 ...
PMID:Posterior transarticular screw fixation for chronic atlanto-axial instability. 1508 Sep 49

Synovial cysts of the cervical spine occur infrequently in the spinal canal and are most often associated with degenerative facet joints. Despite the prevalence of degenerative spinal disease, symptomatic synovial cysts are extremely uncommon. We report a rare case that showed an exacerbation of a cervical radiculopathy due to an acute expansion of the synovial cyst. Magnetic resonance (MR) images originally revealed a small cystic extradural lesion when the patient presented with neck pain and slightly numbness in the right hand. The patient's complaints subsequently subsided after administration of pain killers. However, 2 weeks after this, the patient experienced a spontaneous, sudden, severe radiating pain into the right arm without any accompanying cervical injury. MR images showed that the cyst had become markedly increased in size in the intervening 4 weeks and compressed the spinal cord laterally. Because the arm pain was so severe and neurologic examinations revealed the paralysis of the C8 nerve root, the synovial cyst was excised surgically and a good clinical outcome achieved. Thus, even if symptoms are mild and the size of the synovial cyst is small, acute expansion of the cyst might be rarely observed and careful management, including surgical consideration, is needed.
 ...
PMID:An expanding cervical synovial cyst causing acute cervical radiculopathy. 1528 Jul 65

Neck pain is almost universal and is a common patient complaint. Although the differential diagnosis is extensive, most symptoms are from biomechanical sources, such as axial neck pain, whiplash-associated disorder (WAD), and radiculopathy. Most symptoms abate quickly with little intervention. There is relatively little high-quality treatment evidence available, and no consensus on management of axial neck pain or radiculopathy. A number of general pain management guidelines are applicable to neck pain, and specific guidelines are available on the management of WAD. The goal of diagnosis is to identify the anatomic pain generator(s). Patient history and examination are important in distinguishing potential causes and identifying red flags. Diagnostic imaging should be ordered only when necessary because of the high incidence of asymptomatic radiographic abnormalities. First-line drug treatments include acetaminophen, cyclo-oxygenase 2-specific inhibitors, or nonsteroidal anti-inflammatory drugs. Short-term use of muscle relaxants may be considered. Opioids should be used if other treatments are ineffective and continued if improved function outweighs impairment. Adjuvant antidepressants and anticonvulsants should be considered in chronic or neuropathic pain and coincident depression. Epidural steroids should be considered only in radiculopathy. Physical modalities supported by evidence should be used. If symptoms have not resolved in 4 to 6 weeks, re-evaluation and additional workup should be considered.
 ...
PMID:Evaluation and treatment of posterior neck pain in family practice. 1557 26

This case report describes a 38-year-old-man who initially underwent a C5-C6 anterior cervical decompression and interbody fusion and plating for a right C6 radiculopathy. Within a few months of his surgery, he developed bilateral C7 radiculopathies, with imaging confirming adjacent segment foraminal stenosis. Repeat imaging suggested some subsidence of the original interbody graft but no overt pseudoarthrosis, and flexion/extension films showed no evidence of movement at the fused level. Six months after the original surgery, he underwent re-exploration. Decompression and arthroplasty were effected at the C6-C7 level. The old fusion was removed at the C5-C6 level and remobilized, and an arthroplasty was performed. At discharge, the patient's neck pain and hand symptoms had improved, and he had motion demonstrable on radiologic imaging at C5-C6. This is the first reported case of reversal of a cervical fusion with re-establishment of motion and represents an alternate acceptable management of pseudoarthrosis or recent spinal fusion.
 ...
PMID:Reversal of anterior cervical fusion with a cervical arthroplasty prosthesis. 1569 98

The authors describe the case of a 55-year-old woman who presented with a left C-6 radiculopathy and neck pain and in whom there was evidence of disc/osteophyte compression of the left C-6 nerve root. The patient underwent a C5-6 anterior cervical decompression and placement of a Bryan disc prosthesis. More than 7000 cervical discs have been inserted worldwide. Postoperatively, dynamic imaging demonstrated loss of motion at the instrumented level. The patient suffered persistent neck and arm pain that was slow to resolve. Seventeen months after the initial surgery osseous fusion was observed across the interspace and posterior surface of the prosthesis. This is the first documented case of fusion occurring at the level at which cervical arthroplasty had been performed. The precise reason for this phenomenon is unclear, but potential contributing factors include patient-related issues, poor motion due to neck pain, or possibly implant-related issues. To date, this is an exceedingly rare complication and warrants careful and prolonged follow up of all arthroplasty-treated cases.
 ...
PMID:Cervical arthroplasty complicated by delayed spontaneous fusion. Case report. 1579 66


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>