|
1
|
Cui HC, Chang ZQ, Zhao SK. Atypical cervical spondylotic radiculopathy resulting in a hypertensive emergency during cervical extension: A case report and review of literature. World J Orthop 2024; 15:981-990. [DOI: 10.5312/wjo.v15.i10.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 09/06/2024] [Accepted: 09/14/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Extensive research revealed the absence of reports documenting hypertensive emergencies precipitated by changes in the cervical spine posture.
CASE SUMMARY We here present a 57-year-old woman diagnosed as having cervical spondylotic radiculopathy (CSR) who was scheduled for anterior cervical decompression and fusion. During post-anesthetic positioning, a sudden hypertensive surge was observed when the patient was in a supine position with the neck being slightly extended. This surge was promptly reversed through cervical flexion and head elevation. This event however required an alternate surgical approach for recovery—posterior laminoplasty and endoscopy-assisted nucleus pulposus removal. Following the 6-month outpatient follow-up period, cervical flexion and extension activities substantially improved in the patient without any episodes of increase in acute blood pressure.
CONCLUSION Maintaining a safe hypotensive posture and performing rapid, thorough decompression surgery may serve as effective interventions for patients presenting symptoms similar to those of CSR accompanied by hypertensive emergencies (HE). This would mitigate the underlying causes of these HEs.
Collapse
Affiliation(s)
- Hao-Cheng Cui
- Department of Orthopedic Surgery, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Zheng-Qi Chang
- Department of Orthopedic Surgery, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Shao-Ke Zhao
- Department of Orthopedic Surgery, 960th Hospital of PLA, Jinan 250031, Shandong Province, China
| |
Collapse
|
|
2
|
Shishonin AY, Bekkushe I, Vetcher AA, Pavlov VI. [Spinal manipulation techniques in the treatment of arterial hypertension. (A literature review)]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2024; 102:52-59. [PMID: 39248587 DOI: 10.17116/kurort202410104152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
There is a long-observed relationship between the pathology of the spine and arterial hypertension. There are a number of explanations for this, including one based on reflex effects and obstruction of blood flow to the cerebral vasodilatory centre localized in the rhomboid fossa projection. Obstruction can be absolute and relative, preventing the increase of blood flow during stress, when the brain turns on additional energy demand (phenomenon of «selfish brain»). In conditions of insufficient blood supply anaerobic metabolism is included, requiring in the future, the addition of anaerobic glycolysis products. This leads to the persistence of an elevated level of AD and is part of the theory of centralized compensation of aerobic-anaerobic balance (theoretical aerobic-anaerobic energy concept, TAAEBC). The existing methods of manual manipulation and physical action on the spine, mainly the atlantoacral section of the cervical spine, have, according to existing publications, varying degrees of effectiveness. The modern approach to treatment of arterial hypertension and correction of metabolic disorders by A. Shishonin is promising. It is based on the TAAEBC concept and assumes a system approach and long-term effect through a consistent three-step manual and physical interventions aimed at restoring, retaining and long-term support of the vertebral blood flow.
Collapse
Affiliation(s)
- A Yu Shishonin
- Complementary and Integrative Health Clinic of Dr. Shishonin, Moscow, Russia
| | - I Bekkushe
- Peoples' Friendship University of Russia, Moscow, Russia
| | - A A Vetcher
- Complementary and Integrative Health Clinic of Dr. Shishonin, Moscow, Russia
- Peoples' Friendship University of Russia, Moscow, Russia
| | - V I Pavlov
- S.I. Spasokukotsky Moscow Scientific and Practical Center for Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
| |
Collapse
|
|
3
|
Chu ECP, Ng L. Dystonic Tremor as an Atypical Presentation of Cervical Radiculopathy. Cureus 2024; 16:e51441. [PMID: 38298318 PMCID: PMC10829058 DOI: 10.7759/cureus.51441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 02/02/2024] Open
Abstract
Cervical radiculopathy often presents with neck pain, sensory disturbances, or motor weakness. This case report describes an atypical presentation of cervical radiculopathy manifesting as dystonic tremor and brachialgia, which has been documented only once previously. A 46-year-old, right-handed, male delivery worker presented with severe neck pain that gradually evolved into a dystonic tremor and sharp aching pain across his right shoulder. Despite medical intervention, his symptoms persisted, leading him to seek chiropractic care. Physical examination and diagnostic tests revealed degenerative osteophytes, causing bilateral foraminal impingement and narrowing. As orthopedic interventions only provide temporary relief, the patient opted for conservative chiropractic management, which led to a remarkable reduction in pain and complete resolution of the dystonic tremor and brachialgia. This case demonstrates that cervical disc prolapse may manifest with dystonic tremor due to excruciating radiculopathy. Additionally, it emphasizes the potential benefits of chiropractic care in managing such atypical presentations and underscores the need for further research on the mechanisms and management of such cases.
Collapse
Affiliation(s)
- Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Lucina Ng
- Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| |
Collapse
|
|
4
|
Guadarrama-Ortiz P, Ruíz-Rivero CO, Capi-Casillas D, Román-Villagómez A, Prieto-Rivera ÁD, Choreño-Parra JA. Demographic and Clinical Characteristics of Patients With Cervical Spine Degeneration Reveal Frequent Cervicolumbar Tandem Spinal Stenosis in Mexico. Int J Spine Surg 2023; 17:670-677. [PMID: 37460237 PMCID: PMC10623664 DOI: 10.14444/8520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Limited literature exists regarding the differences in demographics, causes, comorbidities, presentation, and structural changes associated with cervical spine degeneration in patients from distinct geographic regions. The authors aimed to evaluate the demographic and clinical characteristics of patients with cervical spine degeneration admitted to a single center in Mexico. METHODS This study enrolled patients with degenerative disease of the cervical spine. Clinical data were retrieved from medical records and retrospectively characterized. RESULTS A total of 50 patients with cervical spine degeneration were included in the analysis. Of these, 26% were men with a median age of 54 years. Hypertension, depression, anxiety, obesity, and alcohol consumption were presented in about a quarter of the participants. In addition, we observed hypertriglyceridemia and hypercholesterolemia in 72% and 46% of participants, respectively. The median duration of symptoms was 11 months, including radicular arm/neck pain (80%), tingling (80%), reduced muscle strength (48%), and gait disturbances (48%). Forty percent of patients had 2 cervical segments radiologically involved, mainly at C5-C6, with changes such as disc herniation (88%), foraminal stenosis with nerve root compression (67%), reduced spinal canal-to-vertebral body ratio (38%), and ligamentum flavum hypertrophy (24%). Also, 22% of patients showed degenerative cervical myelopathy. Strikingly, 48% of enrolled individuals showed cervicolumbar tandem spinal stenosis, mainly in L4-L5 and L5-S1, who were generally older, had a longer duration of symptoms, and had a higher comorbidity burden, including hyperglycemia, hypertension, and depression. CONCLUSIONS The demographic and clinical characteristics of degenerative cervical spine disease in Mexico differ with respect to other geographical regions by a younger age of diagnosis, a high frequency of cardiovascular, metabolic, and mental health comorbidities, and an increased prevalence of concomitant lumbar spinal stenosis. CLINICAL RELEVANCE Our findings reveal a considerably high burden of cervicolumbar tandem spinal stenosis as a distinctive feature of Mexican patients with cervical spine degeneration. LEVEL OF EVIDENCE: 1
Collapse
Affiliation(s)
- Parménides Guadarrama-Ortiz
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| | - César Osvaldo Ruíz-Rivero
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| | - Deyanira Capi-Casillas
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| | - Alondra Román-Villagómez
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| | - Ángel Daniel Prieto-Rivera
- Department of Neurosurgery, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| | - José Alberto Choreño-Parra
- Department of Clinical Research, Centro Especializado en Neurocirugía y Neurociencias México, Mexico City, Mexico
| |
Collapse
|
|
5
|
Kulkarni AG, Gunjotikar S, Yeshwanth T, Pathan S, Goparaju P, Waghmare N, Bhansali G. Baroreflex Failure After Anterior Cervical Discectomy and Fusion: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00083. [PMID: 34936581 DOI: 10.2106/jbjs.cc.21.00510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 58-year-old man underwent anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylotic myelopathy. Immediately after surgery, the patient experienced elevated blood pressure with a fall in oxygen saturation which prevented extubation. He required admission to the critical care unit and was diagnosed with baroreflex failure syndrome (BFS). He was managed with a 4-drug medical regimen and stabilized by the second postoperative day. CONCLUSION BFS should be considered in the setting of sudden sharp elevation in blood pressure after ACDF. Early diagnosis and initiation of appropriate pharmacotherapy may reduce patient morbidity and mortality.
Collapse
Affiliation(s)
- Arvind Gopalrao Kulkarni
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Sharvari Gunjotikar
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Thonangi Yeshwanth
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Shahrukh Pathan
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Praveen Goparaju
- Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital & Medical Research Centre, Mumbai, India
| | | | | |
Collapse
|
|
6
|
Korolishin VA, Stepanov IA, Beloborodov VA, Brinyuk ES, Konovalov NA. [Effect of renin-angiotensin-aldosterone system inhibitors on functional activity of the spinal cord and nerve roots in patients with degenerative lumbar spine diseases]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:41-45. [PMID: 34714002 DOI: 10.17116/neiro20218505141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High neuroprotective activity of renin-angiotensin-aldosterone system (RAAS) inhibitors in patients with vascular diseases of the brain and spinal cord has been confirmed. OBJECTIVE To evaluate the effect of renin-angiotensin-aldosterone system inhibitors on functional activity of the spinal cord and nerve roots in patients with degenerative lumbar spine diseases. MATERIAL AND METHODS A retrospective observational cohort study was performed. We evaluated clinical and radiological parameters (gender, age of patients, type of antihypertensive drug, concomitant diseases, ODI (6) and SF-36 (7) scores of patient quality of life), functional recovery, increase of signal intensity and its area in T2WIs, localization and maximum spinal canal stenosis, as well as maximum spinal cord and nerve root compression. RESULTS The study included 117 medical records of respondents (88 men and 29 women aged 56.9±13.2 years) who underwent lumbar spine surgery for degenerative diseases. Arterial hypertension was verified in 68 (58.1%) patients, diabetes mellitus in 22 (18.8%) respondents. Age (p=0.002), diabetes mellitus (p=0.007), arterial hypertension (p=0.015) and antihypertensive therapy (p=0.023) were significantly associated with worse clinical and neurological status of patients. Binary logistic regression model demonstrated that only arterial hypertension was significantly associated with low preoperative quality of life (p=0.002). CONCLUSION Intake of AT II-1 receptor blockers and angiotensin converting enzyme inhibitors for arterial hypertension is a significant predictor of decrease in signal intensity of the spinal cord and its roots according to T2WIs.
Collapse
Affiliation(s)
| | - I A Stepanov
- Irkutsk State Medical University, Irkutsk, Russia.,Kharlampiev Hospital, Irkutsk, Russia
| | | | - E S Brinyuk
- Burdenko Neurosurgical Center, Moscow, Russia
| | | |
Collapse
|
|
7
|
Perdomo-Pantoja A, Chara A, Liu A, Jin Y, Taylor M, El Demerdash N, Ahmed AK, Pennington Z, Cottrill E, Westbroek EM, Bydon A, Theodore N, Witham TF. Surgical Decompression for Cervical Spondylotic Myelopathy in Patients with Associated Hypertension: A Single-Center Retrospective Cohort and Systematic Review of the Literature. World Neurosurg 2021; 155:e119-e130. [PMID: 34400323 DOI: 10.1016/j.wneu.2021.08.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To explore the relationship between spinal cord compression and hypertension through analysis of blood pressure (BP) variations in a cervical spondylotic myelopathy (CSM) cohort after surgical decompression, along with a review of the literature. METHODS A single-institution retrospective review of patients with CSM who underwent cervical decompression between 2016 and 2017 was conducted. Baseline clinical and imaging characteristics, preoperative and postoperative BP readings, heart rate, functional status, and pain scores were collected. In addition, a PRISMA guidelines-based systematic review was performed. RESULTS We identified 264 patients with CSM treated surgically; 149 (56.4%) of these had hypertension. The degree of spinal canal compromise and spinal cord compression, preoperative neurologic examination, and the presence of T2-signal hyperintensity on magnetic resonance imaging were associated with hypertension. Overall mean arterial pressure (MAP) decreased significantly at 1 and 12 months after surgery. Patients without T2-signal hyperintensity on imaging showed a MAP reduction at 12 months postoperatively, whereas those with T2-signal hyperintensity showed a transient MAP reduction at 1 month postoperatively before returning to preoperative values. At 12 months after surgery, 24 of 97 patients (24.7%) with initially uncontrolled hypertension had controlled BP values with significant reduction of MAP, systolic BP, and diastolic BP. Including the present study, 5 articles were eligible for systematic review, with all reporting a BP decrease in patients with CSM after decompression. CONCLUSIONS Analysis of our retrospective cohort and a systematic review suggest that cervical surgical decompression reduces BP in some patients with CSM. However, this improvement is less apparent in patients with preoperative spinal cord T2-signal hyperintensity.
Collapse
Affiliation(s)
| | - Alejandro Chara
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yike Jin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maritza Taylor
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Nagat El Demerdash
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erick M Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
|
8
|
Liu H, Wang HB, Yue L, Ma WG, Ploumis A, Gao LL, Wu YF. Effects of Decompressive Cervical Surgery on Blood Pressure in Cervical Spondylosis Patients With Hypertension: A Time Series Cohort Study. Int J Spine Surg 2021; 15:683-691. [PMID: 34266926 DOI: 10.14444/8090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The blood pressure of cervical spondylosis (CS) patients with hypertension often returns to normal after decompressive cervical surgery (DCS). However, the effect of DCS on the blood pressure of patients with CS has not been rigorously studied. METHODS We recruited 50 consecutive CS patients with hypertension from 2014-2017 and investigated the changes in blood pressure after DCS using a time series design. Ambulatory blood pressure monitoring (ABPM) was performed at 3 and 0 days before DCS and at 30 and 90 days after DCS. The primary outcome was mean 24-hour systolic blood pressure (SBP). Secondary outcomes included mean 24-hour diastolic blood pressure (DBP), office blood pressure, and the percentage of patients on antihypertensive medication. Paired t test was used for assessing the changes in blood pressure over time and a McNemar test was used for comparison among different medication groups. RESULTS The mean 24-hour SBP did not vary significantly among 4 time points (134.5 ± 14.7, 132.8 ± 14.7, 131.5 ± 13.3, and 133.2 ± 14.6, respectively; P = .42). The mean 24-hour DBP showed a similar trend. However, mean office SBP/DBP decreased significantly from 142.5/82.0 mm Hg before surgery to 127.3/76.6 mm Hg after surgery (both P < .01). The corresponding percentage of patients on antihypertensive medication decreased significantly, from 84% to 54% (P < .01). CONCLUSIONS This study confirmed previous findings of reduction in office blood pressure associated with DCS among CS patients with hypertension. However, this was not confirmed by multiple-time series of 24-hour ABPM. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Hong Liu
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China
| | - Hai-Bo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Lei Yue
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Beijing, China.,Aortic Institute at Yale-New Haven, Yale School of Medicine, New Haven, CT
| | - Avraam Ploumis
- Division of Orthopedics and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Ling-Ling Gao
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Yang-Feng Wu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| |
Collapse
|
|
9
|
Sharma R, Garg K, Agrawal S, Mishra S, Gurjar HK, Tandon V, Agrawal D, Singh M, Chandra SP, Kale SS. Atypical Symptoms of Cervical Spondylosis: Is Anterior Cervical Discectomy and Fusion Useful? - An Institutional Experience. Neurol India 2021; 69:595-601. [PMID: 34169849 DOI: 10.4103/0028-3886.317235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background A significant proportion of patients with cervical spondylosis can present with atypical symptoms like vertigo, tinnitus, nausea, vomiting, headache, blurred vison, palpitations and gastrointestinal (GI) discomfort. The role of ACDF in alleviating these atypical symptoms remains unexplored. Objective The current study attempts to investigate the role of anterior cervical discectomy and fusion (ACDF) in alleviating atypical symptoms associated with cervical spondylosis. Materials and Methods The patients with cervical spondylosis who underwent ACDF between January 2011 and December 2015 were contacted by phone. Data regarding the severity and frequency of atypical symptoms was collected by a structured questionnaire. Wilcoxon signed rank test was used to compare the severity and frequency of these symptoms before the surgery and at last follow up. Results A total of 467 patients underwent ACDF for cervical spondylosis between January 2011 and December 2015, of which 358 patients were interviewed telephonically. 99 of 358 (27.65%) patients who met the eligibility criteria were included in the final analysis. The severity and frequency of vertigo, headache, nausea, vomiting and GI discomfort significantly improved at last follow-up (P < 0.001) compared to pre-operative period. Significant improvement in hypertension was also seen (P = 0.001). Improvements in severity and frequency of tinnitus (P = 0.083), palpitation (P = 0.317) and blurring of vision (P = 1.00) were not significant. Conclusions ACDF might improve the atypical symptoms like vertigo, headache, nausea, vomiting and GI discomfort in patients with cervical spondylosis. Some patients also show improvement in hypertension following surgery.
Collapse
Affiliation(s)
- Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Agrawal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh K Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
|
10
|
Gera C, Malik M, kaur J, Saini M. A systematic review and meta-analysis on effect of spinal mobilization and manipulation on cardiovascular responses. Hong Kong Physiother J 2020; 40:75-87. [PMID: 33005072 PMCID: PMC7526060 DOI: 10.1142/s1013702520500122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/26/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Spinal pain or misalignment is a very common disorder affecting a significant number of populations resulting in substantial disability and economic burden. Various manual therapeutic techniques such as spinal manipulations and mobilizations can be used to treat and manage pain and movement dysfunctions such as spinal mal-alignments and associated complications. These manual therapeutic techniques can affect the cardiovascular parameters.Objective: The objective of this systematic review and meta-analysis is to assess the effect of spinal manipulation and mobilization on cardiovascular parameters.Methods: We conducted a systematic review and meta-analysis to assess the effects of spinal mobilization and manipulation on cardiovascular responses. Mean changes in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR) were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Quality of the included studies was assessed by PEDro Rating scale. Risk of bias was assessed by Cochrane collaboration tool of risk of bias.Results: Results of meta-analysis showed that there was statistically significant decrease in SBP ([Formula: see text], 95% [Formula: see text], 0.08; [Formula: see text]) with moderate heterogeneity ([Formula: see text], [Formula: see text]) in experimental group as compared to control group. There was statistically non-significant decrease in DBP ([Formula: see text], 95% [Formula: see text], 0.69; [Formula: see text]) with high heterogeneity ([Formula: see text], [Formula: see text]), Change HR was statistically non-significant ([Formula: see text], 95% [Formula: see text], 3.11; [Formula: see text]) with moderate heterogeneity ([Formula: see text], [Formula: see text]). Exclusion of short duration studies in sensitivity analysis revealed a statistically significant change in DBP ([Formula: see text], 95% [Formula: see text], [Formula: see text]; [Formula: see text]). However, the result was statistically non-significant for HR after sensitivity analysis.Conclusion: Spinal manipulations and mobilizations may result in significant decrease of systolic as well as diastolic Blood Pressure.
Collapse
Affiliation(s)
- Charu Gera
- Department of Physiotherapy, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - Manoj Malik
- Department of Physiotherapy, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - Jaspreet kaur
- Department of Physiotherapy, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - Minaxi Saini
- Mother Teresa Saket College of Physiotherapy, Saket, Panchkula, Haryana, India
| |
Collapse
|
|
11
|
Perdomo-Pantoja A, Chara A, Kalb S, Casaos J, Ahmed AK, Pennington Z, Cottrill E, Shah S, Jiang B, Manbachi A, Zygourakis C, Witham TF, Theodore N. The effect of renin-angiotensin system blockers on spinal cord dysfunction and imaging features of spinal cord compression in patients with symptomatic cervical spondylosis. Spine J 2020; 20:519-529. [PMID: 31821888 DOI: 10.1016/j.spinee.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical spondylosis may lead to spinal cord compression, poor vascular perfusion, and ultimately, cervical myelopathy. Studies suggest a neuroprotective effect of renin-angiotensin system (RAS) inhibitors in the brain, but limited data exist regarding their impact on the spinal cord. PURPOSE To investigate whether RAS blockers and other antihypertensive drugs are correlated with preoperative functional status and imaging markers of cord compression in patients with symptomatic cervical spondylosis. STUDY DESIGN Retrospective observational study. PATIENT SAMPLE Individuals with symptomatic degenerative cervical stenosis who underwent surgery. OUTCOME MEASURES Imaging features of spinal cord compression and functional status (modified Japanese Orthopedic Association [mJOA] and Nurick grading scales). METHODS Two hundred sixty-six operative patients with symptomatic degenerative cervical stenosis were included. Demographic data, comorbidities, antihypertensive medications, and functional status (including mJOA and Nurick grading scales) were collected. We evaluated canal compromise, cord compromise, surface area of T2 signal cord change, and pixel intensity of signal cord change compared with normal cord on T2-weighted magnetic resonance imaging sequences. RESULTS Of 266 patients, 41.7% were women, 58.3% were men; median age was 57.2 years; 20.6% smoked tobacco; 24.7% had diabetes mellitus. One hundred forty-nine patients (55.8%) had hypertension, 142 (95.3%) of these were taking antihypertensive medications (37 angiotensin-II receptor blockers [ARBs], 44 angiotensin-converting enzyme inhibitors, and 61 other medications). Patients treated with ARBs displayed a higher signal intensity ratio (ie, less signal intensity change in the compressed cord area) compared with untreated patients without hypertension (p=.004). Patients with hypertension had worse preoperative mJOA and Nurick scores than those without (p<.001). In the multivariate analysis, ARBs remained an independent beneficial factor for lower signal intensity change (p=.04), whereas hypertension remained a risk factor for worse preoperative neurological status (p<.01). CONCLUSIONS In our study, patients with hypertension who were treated with RAS inhibitors had decreased T2-weighted signal intensity change than untreated patients without hypertension. Patients with hypertension also had worse preoperative functional status. Prospective case-control studies may deepen understanding of RAS modulators in the imaging and functional status of chronic spinal cord compression.
Collapse
Affiliation(s)
| | - Alejandro Chara
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Samuel Kalb
- Division of Neurological Surgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Joshua Casaos
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Zachary Pennington
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Sohan Shah
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Bowen Jiang
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Amir Manbachi
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University School Of Medicine, Stanford, CA, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA.
| |
Collapse
|
|
12
|
Yi YY, Xu HW, Zhang SB, Hu T, Wang SJ, Wu DS. Does the C3/4 disc play a role in cervical spondylosis with dizziness? A retrospective study. INTERNATIONAL ORTHOPAEDICS 2020; 44:1159-1168. [PMID: 32193610 DOI: 10.1007/s00264-020-04531-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the effect of C3/4 disc degeneration on cervical spondylosis with dizziness (CSD) and to assess the curative effect of anterior cervical decompression and fusion (ACDF) in patients with CSD. METHOD Four hundred nineteen patients who underwent ACDF for treatment of myelopathy or radiculopathy were divided into dizziness and non-dizziness group. The visual analog scale (VAS) score and Japanese Orthopaedic Association (JOA) score were used to determine the intensity of dizziness and neurological symptoms, respectively. Cervical disc degeneration was evaluated using Miyazaki's classification system. Some parameters were measured using cervical radiographs. The surgical effects on CSD were compared between surgery with and without C3/4 level. Multivariate logistic regression analysis was used to determine the risk factors for CSD. RESULTS The pre-operative incidence of CSD was 33.9%. Women were more likely to develop dizziness than men (p < 0.05), CSD was significantly associated with C3/4 disc degeneration (69.7%, p < 0.001), and smokers were more subject to dizziness (p < 0.05). Regression analysis showed that female (OR = 1.611, p = 0.031), smoking (OR = 1.719, p = 0.032), Miyazaki grade of C3/4 ≥ IV (OR = 2.648, p < 0.001), and instability on C3/4 (OR = 1.672, p = 0.024) were risk factors for CSD. Treatment of CSD by ACDF involving C3/4 was more effective than not involving C3/4 (efficacy rate, 73.2% vs 51.7%, p < 0.05). CONCLUSION The CSD is a common clinical manifestation in elderly patients, especially patients with cervical spondylosis at the C3/4 level. Female, smoking, instability on C3/4, and C3/4 Miyazaki grade ≥ IV could be considered significant risk factors for CSD. CSD is more likely to be alleviated by ACDF involving C3/4.
Collapse
Affiliation(s)
- Yu-Yang Yi
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao-Wei Xu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shu-Bao Zhang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tao Hu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shan-Jin Wang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - De-Sheng Wu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
|
13
|
Meng X, Cheng W, Zhong S, Zhang P, Qin L, Wang X. Anti-inflammatory effects of Jingshu Keli capsule and its components on human synoviocyte MH7A cells. ARTHROPLASTY 2020; 2:7. [PMID: 35236422 PMCID: PMC8796523 DOI: 10.1186/s42836-020-00026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Jingshu Keli (JSKL), a traditional Chinese medicine (TCM) formula consisting of multiple active compounds, has been officially approved by National Medical Products Administration (NMPA) for treatment of cervical radiculopathy. It relieves pain, according to TCM theory, by activating blood circulation to dissipate blood stasis. The pain mainly stems from neurogenic inflammation caused by mechanical compression of the cervical nerve root. In addition, inflammation mediators also cause the development of other joint diseases, such as osteoarthritis (OA). The purpose of this paper was to evaluate the anti-inflammatory effects of JSKL and identify the biologically active herbs and compounds in vitro. METHODS Enzyme-linked immunosorbent assay (Elisa) was used to determine the expression of pro-inflammatory cytokines, tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6) and interleukin 8 (IL-8), in the culture medium of human MH7A cells stimulated by lipopolysaccharides (LPS). RESULTS JSKL and three single-herb capsules, Cinnamomum cassia Presl (C.C.), Angelica Sinensis (Oliv.) Diels (A.S.) and Carthamus tinctorius L. (C.T.), significantly inhibited the secretion of TNF-α. If one of these three herbal components was removed, suppressing effect of the single-herb-deleted JSKL on TNF-α was abolished. Cinnamaldehyde (CIN) from C.C. was the most potent ingredient that inhibited the expression of IL-6 and IL-8 in the culture medium of both LPS-stimulated MH7A cells and primary synovial cells. CONCLUSIONS JSKL was found to possess anti-inflammatory effect in vitro; C.C., A.S. and C.T. were the principal and essential herbal components responsible for such activity; CIN from C.C. is one the most potent single compound among indicator components of JSKL recorded in 2015 Chinese pharmacopoeia. This study provided scientific evidence for the clinical application of JSKL as an agent for targeted treatment of cervical radiculopathy. Furthermore, CIN has potential to be used for the treatment of some inflammation-related orthopedic diseases, such as rheumatic arthritis and osteoarthritis.
Collapse
Affiliation(s)
- Xiangbo Meng
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Wenxiang Cheng
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Shan Zhong
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Peng Zhang
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Ling Qin
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.,Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Xinluan Wang
- Translational Medicine R&D Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China. .,Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| |
Collapse
|
|
14
|
Wang X, Ju J, Xu H. Nondrug therapies for hypertensive patients complicated with cervical spondylosis: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19006. [PMID: 32000442 PMCID: PMC7004688 DOI: 10.1097/md.0000000000019006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to systematically evaluate the efficacy and safety of nondrug therapies for hypertensive patients complicated with cervical spondylosis. METHODS Randomized controlled trials (RCTs) concerned with nondrug therapies for hypertensive patients complicated with cervical spondylosis were identified by searching 5 English and Chinese databases. Study selection, data extraction, and risk of bias assessment were conducted independently by 2 authors. RevMan 5.3 software was used for meta-analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI). RESULTS A total of 13 studies involving 929 patients were included. The majority of the included trials were assessed to be of high clinical heterogeneity and high risk of bias. The results of meta-analysis showed that there was a significant improvement in the effectiveness rate of cervical vertebra symptoms (RR = 1.67, 95% CI [1.33, 2.10], P < .0001), effectiveness rate of blood pressure lowering (RR = 1.35, 95% CI [1.06, 1.71], P = .02), systolic blood pressure reduction (MD = -11.05, 95% CI [-14.12, -7.98] mmHg, P < .0001), and diastolic blood pressure reduction (MD = -6.96, 95% CI [-8.89, -5.04] mmHg, P < .00001). Nondrug therapies had no significant difference compared with drugs in the effectiveness rate of overall improvement (RR = 1.3, 95% CI [0.93, 1.82], P = .12). There were no serious adverse effects related to nondrug therapies in the included trials. CONCLUSION The results show sound advantages of nondrug therapies over conventional medicine or sham procedure in efficacy. However, the evidence remains weak because of the high clinical heterogeneity and high risk of the included trials. Therefore, further thorough investigation, large-scale, proper-designed, randomized trials of nondrug therapies for hypertension complicated with cervical spondylosis are warranted. PROSPERO REGISTRATION NUMBER CRD2019123175.
Collapse
Affiliation(s)
- Xinyi Wang
- Graduate School, Beijing University of Chinese Medicine
| | - Jianqing Ju
- Xiyuan Hospital, China Academy of Chinese Medical Sciences
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Hao Xu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| |
Collapse
|
|
15
|
Lin SY, Hsu WH, Lin CC, Lin CL, Tsai CH, Lin CH, Chen DC, Lin TC, Hsu CY, Kao CH. Association of Arrhythmia in Patients with Cervical Spondylosis: A Nationwide Population-Based Cohort Study. J Clin Med 2018; 7:jcm7090236. [PMID: 30142924 PMCID: PMC6162845 DOI: 10.3390/jcm7090236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sympathetic activity, including cervical ganglia, is involved in the development of cardiac arrhythmias. OBJECTIVE The present study investigated the association between cervical spondylosis and arrhythmia, which has never been reported before. METHODS Patients newly diagnosed with cervical spondylosis (CS) with an index date between 2000 and 2011 were identified from the National Health Insurance Research Database. We performed a 1:1 case-control matched analysis. Cases were matched to controls according to their estimated propensity scores, based on demographics and existing risk factors. Cox proportional hazard models were applied to assess the association between CS and arrhythmia. RESULTS The CS cohort comprised 22,236 patients (males, 42.6%; mean age, 54.4 years) and non-CS cohort comprised 22,236 matched controls. There were 1441 events of arrhythmia in CS cohort and 537 events of arrhythmia in non-CS cohort, which 252 and 127 events of atrial fibrillation in CS and non-CS cohort, 33 and 12 events of ventricular tachycardia in CS cohort and non-CS cohort, 78 and 35 events of supraventricular tachycardia in CS cohort and non-CS cohort. The CS cohort had an arrhythmia incidence of 11.1 per 1000 person-years and a higher risk [adjusted hazard ratio (aHR) = 3.10, 95% confidence interval (CI) = 2.80⁻3.42] of arrhythmia, 2.54-fold aHR of ventricular tachycardia (95% CI = 1.70⁻3.79), and 2.22-fold aHR of atrial fibrillation (95% CI = 1.79⁻2.76) compared with non-CS cohort. CONCLUSIONS Cervical spondylosis is associated with a higher risk of arrhythmia.
Collapse
Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung 404, Taiwan.
| | - Wu-Huei Hsu
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital and China Medical University, Taichung 404, Taiwan.
| | - Cheng-Chieh Lin
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
- Department of Family Medicine, China Medical University Hospital, Taichung 404, Taiwan.
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan.
- College of Medicine, China Medical University, Taichung 404, Taiwan.
| | - Chun-Hao Tsai
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
- Department of Orthopedics, China Medical University Hospital, Taichung 404, Taiwan.
| | - Chih-Hsueh Lin
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
- Department of Family Medicine, China Medical University Hospital, Taichung 404, Taiwan.
| | - Der-Cherng Chen
- Department of Orthopedics, China Medical University Hospital, Taichung 404, Taiwan.
| | - Tsung-Chih Lin
- Department of Orthopedics, St. Martin De Porres Hospital, Chiayi 600, Taiwan.
| | - Chung-Y Hsu
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
- Department of Nuclear Medicine, China Medical University Hospital, Taichung 404, Taiwan.
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 413, Taiwan.
| |
Collapse
|
|
16
|
Peng B. Cervical Vertigo: Historical Reviews and Advances. World Neurosurg 2018; 109:347-350. [PMID: 29061460 DOI: 10.1016/j.wneu.2017.10.063] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 01/23/2023]
Abstract
Vertigo is one of the most common presentations in adult patients. Among the various causes of vertigo, so-called cervical vertigo is still a controversial entity. Cervical vertigo was first thought to be due to abnormal input from cervical sympathetic nerves based on the work of Barré and Liéou in 1928. Later studies found that cerebral blood flow is not influenced by sympathetic stimulation. Ryan and Cope in 1955 proposed that abnormal sensory information from the damaged joint receptors of upper cervical regions may be related to pathologies of vertigo of cervical origin. Further studies found that cervical vertigo seems to originate from diseased cervical intervertebral discs. Recent research found that the ingrowth of a large number of Ruffini corpuscles into diseased cervical discs may be related to vertigo of cervical origin. Abnormal neck proprioceptive input integrated from the signals of Ruffini corpuscles in diseased cervical discs and muscle spindles in tense neck muscles secondary to neck pain is transmitted to the central nervous system and leads to a sensory mismatch with vestibular and other sensory information, resulting in a subjective feeling of vertigo and unsteadiness. Further studies are needed to illustrate the complex pathophysiologic mechanisms of cervical vertigo and to better understand and manage this perplexing entity.
Collapse
Affiliation(s)
- Baogan Peng
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China.
| |
Collapse
|
|
17
|
Triantafyllidi H, Arvaniti C, Schoinas A, Benas D, Vlachos S, Palaiodimos L, Pavlidis G, Ikonomidis I, Batistaki C, Voumvourakis C, Lekakis J. Bilateral sphenopalatine ganglion block reduces blood pressure in never treated patients with essential hypertension. A randomized controlled single-blinded study. Int J Cardiol 2018; 250:233-239. [DOI: 10.1016/j.ijcard.2017.10.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/04/2017] [Accepted: 10/11/2017] [Indexed: 01/21/2023]
|
|
18
|
Peng B, Yang L, Yang C, Pang X, Chen X, Wu Y. The effectiveness of anterior cervical decompression and fusion for the relief of dizziness in patients with cervical spondylosis: a multicentre prospective cohort study. Bone Joint J 2018; 100-B:81-87. [PMID: 29305455 DOI: 10.1302/0301-620x.100b1.bjj-2017-0650.r2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Cervical spondylosis is often accompanied by dizziness. It has recently been shown that the ingrowth of Ruffini corpuscles into diseased cervical discs may be related to cervicogenic dizziness. In order to evaluate whether cervicogenic dizziness stems from the diseased cervical disc, we performed a prospective cohort study to assess the effectiveness of anterior cervical discectomy and fusion on the relief of dizziness. PATIENTS AND METHODS Of 145 patients with cervical spondylosis and dizziness, 116 underwent anterior cervical decompression and fusion and 29 underwent conservative treatment. All were followed up for one year. The primary outcomes were measures of the intensity and frequency of dizziness. Secondary outcomes were changes in the modified Japanese Orthopaedic Association (mJOA) score and a visual analogue scale score for neck pain. RESULTS There were significantly lower scores for the intensity and frequency of dizziness in the surgical group compared with the conservative group at different time points during the one-year follow-up period (p = 0.001). There was a significant improvement in mJOA scores in the surgical group. CONCLUSION This study indicates that anterior cervical surgery can relieve dizziness in patients with cervical spondylosis and that dizziness is an accompanying manifestation of cervical spondylosis. Cite this article: Bone Joint J 2018;100-B:81-7.
Collapse
Affiliation(s)
- B Peng
- General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, China
| | - L Yang
- General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, China
| | - C Yang
- Changzheng Hospital, 415 Fengyang Rd, Huangpu Qu, Shanghai 200000, China
| | - X Pang
- General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, China
| | - X Chen
- Changzheng Hospital, 415 Fengyang Rd, Huangpu Qu, Shanghai 200000, China
| | - Y Wu
- 304th Hospital, 28 Fuxing Rd, Haidian Qu, Beijing 100853, China
| |
Collapse
|
|
19
|
Atlantoaxial Misalignment Causes High Blood Pressure in Rats: A Novel Hypertension Model. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5986957. [PMID: 28791307 PMCID: PMC5534292 DOI: 10.1155/2017/5986957] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 02/08/2023]
Abstract
Atlantoaxial disorders are often correlated with hypertension in practice. In order to study the relationship between atlantoaxial disorder and hypertension, we attempted to construct an animal model. In this work, we presented an animal model where their atlantoaxial joints were misaligned. We investigated the changes of blood pressure before and after treatments of the modeled rats. We had the following results. (1) SBP and DBP of each surgery group were significantly higher than those of control and sham groups. (2) After the second operation (the fixture was removed), SBP and DBP of both surgery groups decreased and got closer to the control and sham groups after 7 days. (3) Heart rates got significantly higher in both surgery groups, compared to control and sham groups. (4) The blood Ach levels of the surgery groups were significantly lower than those of control and sham groups. With these results, we concluded that we successfully constructed cervical atlantoaxial disorder models in rats that showed hypertension symptom. However, the underlying mechanism connecting atlantoaxial disorder and hypertension still requires further study.
Collapse
|
|
20
|
Yang L, Yang C, Pang X, Li D, Chen X, Shi J, Zhou X, Wu Y, Lu X, Yang H, Jia L, Peng B. Cervical Decompression Surgery for Cervical Spondylotic Myelopathy and Concomitant Hypertension: A Multicenter Prospective Cohort Study. Spine (Phila Pa 1976) 2017; 42:903-908. [PMID: 27792119 DOI: 10.1097/brs.0000000000001941] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We performed decompression surgery or conservative treatments on 135 cervical spondylotic myelopathy (CSM) patients with concomitant hypertension and did follow-up assessments up to 1 year to examine the change of blood pressure, spinal cord function, and cervical pain. OBJECTIVE The aim of this study was to determine whether concomitant hypertension is relieved after decompression surgery, and whether it is related to the improvement of spinal cord function or cervical pain. SUMMARY OF BACKGROUND DATA In clinical practice, we often found that some patients with CSM have concomitant hypertension. Interestingly, after CSM was treated successfully by decompression surgery, some patients' high blood pressure returned to normal range even without oral medications. METHODS We enrolled 135 CSM patients with hypertension, 103 of whom received decompression surgery, and remaining 32 patients accepted conservative treatments. We did follow-up assessments at 3, 6, and 12 months. The primary endpoints were changes of blood pressure, and secondary endpoints were changes of modified Japanese Orthopedic Association (mJOA) score and cervical pain visual analogue scale (VAS). Spearman correlation coefficients were calculated between changes in systolic blood pressure (SBP) and mJOA scores, VAS scores. RESULTS In patients with decompression surgery, the significant decrease in both SBP and diastolic blood pressure (DBP) that was seen 3 months and sustained through subsequent visit at 12 months. Paired-samples t test showed that both SBP and DBP were significantly lower than baseline blood pressure at all time points after procedure (P < 0.001). Significant correlation was found between the improvement rates of mJOA score and changes in SBP (r = -0.579, P < 0.001). But the correlation between changes in VAS score and changes in SBP was not significant (r = 0.58, P = 0.571). CONCLUSION Cervical decompression surgery could reduce concomitant high blood pressure in CSM patients, indicating a significant association between the decrease in blood pressure and the improvement of spinal cord function. LEVEL OF EVIDENCE 2.
Collapse
Affiliation(s)
- Liang Yang
- Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- Department of Orthopeadics, Pingjin Hospital, Logistics College of Armed Police Forces, Tianjin, China
| | - Cheng Yang
- Department of Orthopeadics, Changzheng Hospital, Shanghai, China
| | - Xiaodong Pang
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Duanming Li
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Xiongsheng Chen
- Department of Orthopeadics, Changzheng Hospital, Shanghai, China
| | - Jiangang Shi
- Department of Orthopeadics, Changzheng Hospital, Shanghai, China
| | - Xuhui Zhou
- Department of Orthopeadics, Changzheng Hospital, Shanghai, China
| | - Ye Wu
- Department of Orthopeadics, 304th Hospital, Beijing, China
| | - Xiang Lu
- Department of Orthopeadics, 304th Hospital, Beijing, China
| | - Hong Yang
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Lianshun Jia
- Department of Orthopeadics, Changzheng Hospital, Shanghai, China
| | - Baogan Peng
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| |
Collapse
|
|
21
|
Yang L, Yang C, Pang X, Li D, Yang H, Zhang X, Yang Y, Peng B. Mechanoreceptors in Diseased Cervical Intervertebral Disc and Vertigo. Spine (Phila Pa 1976) 2017; 42:540-546. [PMID: 27438387 DOI: 10.1097/brs.0000000000001801] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We collected the samples of cervical intervertebral discs from patients with vertigo to examine the distribution and types of mechanoreceptors in diseased cervical disc. OBJECTIVE The aim of this study was to determine whether mechanoreceptors are distributed more abundantly in cervical discs from patients with cervical spondylosis, and whether they are related to vertigo. SUMMARY OF BACKGROUND DATA Previous limited studies have found that normal cervical intervertebral discs are supplied with mechanoreceptors that have been considered responsible for proprioceptive functions. Several clinical studies have indicated that the patients with cervical spondylosis manifested significantly impaired postural control and subjective balance disturbance. METHODS We collected 77 samples of cervical discs from 62 cervical spondylosis patients without vertigo, 61 samples from 54 patients with vertigo, and 40 control samples from 8 cadaveric donors to investigate distribution of mechanoreceptors containing neurofilament (NF200) and S-100 protein immunoreactive nerve endings. RESULTS The immunohistochemical investigation revealed that the most frequently encountered mechanoreceptors were the Ruffini corpuscles in all groups of cervical disc samples. They were obviously increased in the number and deeply ingrown into inner annulus fibrosus and even into nucleus pulposus in the diseased cervical discs from patients with vertigo in comparison with the discs from patients without vertigo and control discs. Only three Golgi endings were seen in the three samples from patients with vertigo. No Pacinian corpuscles were found in any samples of cervical discs. CONCLUSION The diseased cervical discs from patients with vertigo had more abundant distribution of Ruffini corpuscles than other discs. A positive association between the increased number and ingrowth of Ruffini corpuscles in the diseased cervical disc and the incidence of vertigo in the patients with cervical spondylosis was found, which may indicate a key role of Ruffini corpuscles in the pathogenesis of vertigo of cervical origin. LEVEL OF EVIDENCE 1.
Collapse
Affiliation(s)
- Liang Yang
- Department of Orthopeadics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
- Department of Orthopedics, Pingjin Hospital, Logistics College of Armed Police Forces, Tianjin, China
| | - Cheng Yang
- Department of Orthopeadics, Changzheng Hospital, Shanghai, China
| | - Xiaodong Pang
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Duanming Li
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Hong Yang
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| | - Xinwu Zhang
- Department of Pathology, General Hospital of Armed Police Force, Beijing, China
| | - Yi Yang
- Department of Pathology, 304th Hospital, Beijing, China
| | - Baogan Peng
- Department of Spinal Surgery, General Hospital of Armed Police Force, Beijing, China
| |
Collapse
|
|
22
|
Liu H, Wang HB, Wu L, Wang SJ, Yang ZC, Ma RY, Reilly KH, Yan XY, Ji P, Wu YF. Effects of decompressive cervical surgery on blood pressure in cervical spondylosis patients with hypertension: a time series cohort study. BMC Surg 2016; 16:2. [PMID: 26738624 PMCID: PMC4704254 DOI: 10.1186/s12893-015-0117-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/21/2015] [Indexed: 12/28/2022] Open
Abstract
Background Patients with cervical spondylosis myelopathy (CSM) and complicated with hypertension are often experiencing a blood pressure decrease after taking cervical decompressive surgery in clinical observations, but how this blood pressure reduction is associated with the surgery, which cut cervical sympathetic nervous, has never been rigorously assessed. Thus, the purpose of this study is to investigate the effect of cervical decompressive surgery on blood pressure among CSM patients with hypertension. Methods/Design The study will be a time series cohort study. Fifty eligible patients will be selected consecutively from the Peking University First Hospital. Two 24-h ambulatory blood pressure measurement (ABPM) will be taken before the surgery, apart by at least 3 days. The patients will be followed up for another two ABPMs at 1 and 3 months after the surgery. We will recruit subjects with cervical spondylosis myelopathy meeting operation indications and scheduled for receiving cervical decompressive surgery, aged 18–84 years, have a history of hypertension or office systolic blood pressure ≥140 mmHg on initial screening, and willing to participate in the study and provide informed consent. Exclusion criteria includes a history of known secondary hypertension, visual analogue scale (VAS) score ≥4, and unable to comply with study due to severe psychosis. The change in systolic ABPs over the four times will be analyzed to observe the overall pattern of the blood pressure change in relation to the surgery, but the primary analysis will be the comparison of systolic ABP between the 2nd and 3rd , 4th measurements (before and after the surgery). We will also calculate the regression-to-the-mean adjusted changes in systolic ABP as sensitivity analysis. Secondary endpoints are the changes in 24 h ABPM diastolic blood pressure, blood pressure control status, the use and dose adjustment of antihypertensive medication, and the incidence of operative complications. Primary outcome analyses will be carried out using analysis of covariance, as well as the first secondary endpoint. Discussion This study will inform us the important knowledge about cervical sympathetic nervous system (SNS) and blood pressure. Once confirmed, it may help to produce new method for control of hypertension, which is the leading cause of death in the world. Trial registration The study is registered to Clinical Trials.gov (NCT02016768).
Collapse
Affiliation(s)
- Hong Liu
- Department of Orthopaedic Surgery, Peking University First Hospital, Xishikuda Street 8#, Xicheng Dist, Beijing, 100034, P.R. China.
| | - Hai-Bo Wang
- Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, P.R. China
| | - Lin Wu
- Department of Cardiology, Peking University First Hospital, Xishenkuda Street 8#, Xicheng Dist, Beijing, 100034, P.R. China
| | - Shi-Jun Wang
- Department of Orthopaedic Surgery, Peking University First Hospital, Xishikuda Street 8#, Xicheng Dist, Beijing, 100034, P.R. China
| | - Ze-Chuan Yang
- Department of Orthopaedic Surgery, Peking University First Hospital, Xishikuda Street 8#, Xicheng Dist, Beijing, 100034, P.R. China
| | - Run-Yi Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, P.R. China
| | | | - Xiao-Yan Yan
- Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, P.R. China
| | - Ping Ji
- Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, P.R. China
| | - Yang-feng Wu
- Peking University Clinical Research Institute, Xueyuan Rd 38#, Haidian Dist, Beijing, 100191, P.R. China. .,The George Institute for Global Health at Peking University Health Science Center, No. 6 Zhichun Road, Beijing, 100083, P.R. China.
| |
Collapse
|