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UNASSIGNED: Several studies have compared outcomes from lumbar epidural steroid injections (ESIs) based upon technique (transforaminal (TF) vs interlaminar (IL) vs caudal). However, little on this topic has been reported in the cervical spine, and results have been conflicting.
UNASSIGNED: To compare success rates of fluoroscopically-guided cervical TFESIs vs ILESIs.
UNASSIGNED: Retrospective, observational, in vivo study of consecutive patients at outpatient Physical Medicine & Rehabilitation clinics at a single academic spine center.
UNASSIGNED: Consecutive patients who received a cervical TF or IL ESI between January 2010 and October 2018.
UNASSIGNED: NRS pain scores within 60 days of the ESI.
UNASSIGNED: Current procedural terminology (CPT) codes were used to search all consecutive patients at a single outpatient academic spine center who received a cervical TF or IL ESI between January 2010 October 2018. All patients with pre and post injection NRS pain scores within 60 days of the injection were included in the analysis.
UNASSIGNED: A total of 178 ​TF and 185 ILESIs were analyzed. Success was defined as ≥ 50% improvement in NRS pain score. 52% [95% CI: 47 - 57%] of all patients receiving a cervical ESI achieved a successful outcome. There was a strong trend towards better results in the ILESI group with 59% [95% CI: 52 - 66%] of patients achieving at least 50% pain relief compared to 46% [95% CI: 39 - 53%] in the TF group. A higher proportion of patients in the IL group obtained at least 80% pain relief (37% [95% CI: 30 - 44%]) compared to those in the TF group (17% [95% CI: 11 - 23%]). Post-procedure median NRS pain scores, and improvement in median NRS pain scores were better in the ILESI group compared to the TFESI group (p<0.001).
UNASSIGNED: This retrospective study demonstrated better results in the cervical ILESI group compared to the cervical TFESI group.

UNASSIGNED: Describe a catastrophic complication of cervical epidural injection (CEI) in a patient with prior anterior cervical discectomy with fusion (ACDF).
UNASSIGNED: Interlaminar CEI at C7-T1 was performed under minimal sedation.
UNASSIGNED: Right hemiparesis, diffuse dysesthesia, and tactile allodynia were immediately described after the procedure. 24 hours after CEI, an MRI showed an increased T2 signal and decreased T1 signal in the spinal cord extending from C3-T3. Postsurgical ACDF changes, cervicovertebral ligament anomalies, repetitive microtrauma from serial CEI\'s, and epidural space compromise may have complicated the loss of resistance technique and increased the risk for dural puncture and intrinsic cord injury.
UNASSIGNED: Knowledge of cervical spinal anatomy, biomechanical implications of ACDF, ligamentous inflammation, pre-operative image review, and perioperative patient feedback are valuable insights that may mitigate the risk of severe adverse events.

UNASSIGNED: Cervical transforaminal epidural steroid injections (CTFESI) are commonly used in the treatment of upper extremity radicular pain. Recently, a modification of the conventional technique has been developed and validated which has a theoretical safety advantage of less risk of needle contact of the spinal nerve and vertebral artery. The new approach involves a needle trajectory under fluoroscopic guidance which is directly based upon the specific superior articular process angle measurement on MRI.
UNASSIGNED: The purpose of this study was to evaluate the discontinuation rate of the modified approach CTFESI procedure in a non-sedated patient population. The study was also undertaken to confirm the safety of the procedure in an office-based setting.
UNASSIGNED: A retrospective review was performed of the authors\' (DL, SH) practice to identify all CTFESI using the modified approach, performed between October 2018 through January 2021 through a query of the investigators\' (DL and SH) electronic medical record system. Any discontinued CTFESI procedure was identified. The reason for discontinuation was determined through medical record review. In addition, any significant neurologic or cardiovascular event occurring during or immediately following any completed or discontinued CTFESI was identified. Mild vasovagal reaction was not considered a significant complication.
UNASSIGNED: A total of 973 CTFESI procedures were performed using the modified approach during the study period. Twelve procedures, 1.2% (95% CI 0.7-2.1%) were discontinued. Nine were aborted due to vascular flow not resolved with needle repositioning. Only three, 0.3% (95% CI 0.1-0.9) were aborted due to patient intolerance. There were zero significant neurologic or cardiovascular complications.
UNASSIGNED: The performance of the modified approach CTFESI appears to be well tolerated with a very low rate, 0.3%, of discontinuation due to intolerance in non-sedated patients. The zero incidence of neurologic or cardiovascular complication contributes to the current literature on the safety of this procedure.

Numerous traditional practices are both beneficial and harmful. Traditional harmful practices, such as female genital mutilation and traditional cervical cauterization, are carried out for a number of reasons but can have negative health and social effects. In addition to deeply held beliefs, a lack of knowledge and awareness of the consequences of these practices contributes to the persistence of these issues. The objective of this study is to examine whether traditional cervical cauterizations were associated with preterm births in Somalia. This prospective cohort study was conducted at our hospital over a one-year period. Seven hundred and two patients were included in this study; these patients were divided into two groups, cauterized and non-cauterized groups, and the two groups were compared on pregnancy outcomes. We examined whether traditional cervical cauterizations were associated with adverse pregnancy outcomes, including preterm births. According to the findings of this study, traditional cervical cauterization was prevalent among patients visiting MSTREH (n = 328, 46.7%). Infections of the uterine cervix and infertility were the two main indications for cauterization, 44.8%, and 34.8%, respectively.Being older, uneducated, and poverty were significantly associated with traditional cauterization (P < 0.001). There was a significant correlation between prior traditional cervical cauterization and the risk of preterm births. Women with prior cauterization were two and half times more likely to deliver a preterm fetus (OR: 2.64, 95% CI 2.15-3.33) compared to non-cauterized mothers. Our findings show that women who have previously undergone traditional cervical cauterization have a significantly higher risk of preterm birth and negative pregnancy outcomes than non-cauterized women. Health professionals, particularly those who are close to the community, are crucial in developing and putting into practice plans to end harmful traditions in Somalia.

BACKGROUND: The effect of fat infiltration in the paraspinal muscles on cervical degenerative disease has been confirmed by multiple studies. However, little is known about fat infiltration in the paraspinal extensors in patients with acute cervical spinal cord injury (SCI). This study aimed to investigate the difference in paraspinal extensor fatty infiltration between patients with acute cervical SCI and healthy controls, and to further explore the protective role of the paravertebral extensor muscles in patients with cervical SCI.
METHODS: A total of 50 patients with acute cervical SCI admitted to the emergency department from January 2019 to November 2023 were retrospectively analyzed, including 26 males and 24 females, with an average age of 59.60 ± 10.81 years. A control group of 50 healthy middle-aged and elderly individuals was also included, comprising 28 males and 22 females, with an average age of 55.00 ± 8.21 years. Cervical spine magnetic resonance imaging (MRI) was used to measure the cross-sectional areas of the superficial and deep cervical extensor muscles, the corresponding vertebral body cross-sectional areas, and the fat area within the superficial and deep extensor muscle groups using Image J software. Differences between the two groups were compared, and the cervical SCI patients were further analyzed based on the severity of the spinal cord injury and gender differences.
RESULTS: The deep fatty infiltration ratio (DFIR) and superficial fatty infiltration ratio (SFIR) at C4-C7 in the cervical SCI group were significantly higher than those in the control group (P < 0.001). The cross-sectional area of the functional deep extensor area (FDEA) relative to the vertebral body area (VBA) and the cross-sectional area of the functional superficial extensor area (FSEA) relative to the VBA at the C5 and C6 levels in the cervical SCI group were significantly lower than those in the control group (P < 0.001, P < 0.001, P = 0.034, P = 0.004 respectively). Among the cervical SCI patients, the cross-sectional areas of the deep extensor area (DEA) and the superficial extensor area (SEA) in males were significantly higher than those in females (P < 0.001). At the C6 and C7 levels, the FDEA/VBA and FSEA/VBA ratios in the male group were higher than those in the female group (P = 0.009, P = 0.022, P = 0.019, P = 0.005, respectively).
CONCLUSIONS: Patients with acute cervical SCI exhibit significantly higher fatty infiltration and a greater degree of paravertebral extensor muscle degeneration compared to healthy controls. This finding underscores the importance of the paravertebral extensor muscles in the context of cervical SCI and may guide future therapeutic strategies.

UNASSIGNED: A 2-year-old spayed female domestic shorthair cat presented with tetraparesis after being involved in a road traffic accident. Survey spine radiographs revealed a C2-C3 cervical subluxation, which was confirmed by a CT scan. Surgical stabilisation was performed using screws and polymethyl methacrylate (PMMA) via a ventral approach. A postoperative CT scan demonstrated correct implant positioning and good reduction of the subluxation. After surgery, the cat rapidly recovered to a neurologically normal status.
UNASSIGNED: Trauma-induced cervical subluxation is an uncommon occurrence in cats but should be considered in the differential diagnosis. This report describes the surgical management of a C2-C3 cervical subluxation in a cat using screws and PMMA. This is the first case report of a surgically treated subaxial cervical subluxation in a cat.

Cervical cancer is a significant health concern for women worldwide, with human papillomavirus (HPV) being the primary cause. This study aimed to assess Saudi women\'s awareness and knowledge of HPV, determine their information sources, and evaluate their intention to receive the HPV vaccine. A questionnaire-based survey was conducted among 654 Saudi females aged 18 to 60 years from January to May 2023. The results revealed that 60.85% of the participants had heard about HPV, but only 8.25% had received the HPV vaccination. Despite the low vaccination rate, 71.11% of the respondents expressed willingness to receive the vaccine. Educational level was the significant predictor of the vaccine awareness and acceptance. The internet and social media were the most prevalent sources of information about HPV. The study highlights the need for additional education about HPV-related diseases and vaccination among Saudi women. Although there is a high level of HPV vaccine acceptance, the lack of knowledge suggests that targeted educational interventions are necessary to increase awareness and promote vaccination uptake. These findings can inform public health strategies to reduce the burden of cervical cancer in Saudi Arabia through improved HPV vaccination coverage and education.

BACKGROUND: Long lateral mass screw (LLMS) technique for posterior cervical fusion has been performed in our hospital since 2019. In this study, the LLMS insertion technique, deviation rate, and insertion torque have been described. Moreover, several major concerns associated with LLMS have been adequately addressed.
METHODS: This study included 58 patients (43 men and 15 women) who had undergone LLMS surgery at our hospital during the four-year period from December 2019 to December 2023, and were evaluated using postoperative CT. The evaluation parameters included the screw length at each vertebral segment, screw angle in the sagittal section, distance between the screw heads, and complications.
RESULTS: The median screw length at C3 was 23.0 mm (22.0-24.0 mm), the screw angle was 36.1° (31.6-41.8°), and the distance between screw heads was 13.8 mm (11.6-17.2 mm). The median screw length at C4 was 22.0 mm (21.0-24.0 mm), the screw angle was 36.2° (28.7-40.7°), and the distance between screw heads was 15.9 mm (13.0-19.0 mm). The median screw length at C5 was 21.0 mm (20.0-22.0 mm), the screw angle was 35.6° (28.0-39.7°), and the distance between screw heads was 17.6 mm (15.1-20.4 mm). The median screw length for C6 was 20.0 mm (19.0-22.0 mm), the screw angle was 29.2° (25.2-36.8°), and the distance between screw heads was 20.4 mm (16.1-24.4 mm).
CONCLUSIONS: The major limitations of the LLMS technique were inadequate screw angle, difficulty inserting long screws, inadequate decompression, and the inability to perform cervical laminoplasty. However, these limitations did not substantially affect the efficiency of LLMS. LLMS has fewer complications and can insert longer screws than LMS.

OBJECTIVE: To determine whether postoperative neck pain in the first 4 weeks following multi-level posterior cervical fusion (PCF) with orthosis is equivalent to multi-level PCF without orthosis.
METHODS: Patients were randomly assigned in a 1:1 ratio to postoperative orthosis (CO) for 6 weeks or no orthosis (NO). Randomization was stratified by indication (traumatic vs. degenerative), and preoperative opioid use. A model of longitudinal regression for repeated measures was used. The two-sided 95% confidence interval (CI) was used to test equivalence. If the CI lay between the pre-determined margin of equivalence (-2.0 to + 2.0 pain score) the two groups were considered equivalent. A multiple imputation procedure was used to replace missing data.
RESULTS: Thirty-one patients were enrolled in each group. At baseline, the CO group had more neck pain (5.3 vs. 3.2, p = 0.013). The Four week post-operative neck pain intensity score was 4.6 ± 0.3 for the CO group vs. 4.9 ± 0.3 for the NO group. The 95% confidence interval (-1.2 to 0.6) was within the pre-determined equivalence margin. Neck Disability Index, quality-of-life scores, and arm pain were similar. Eleven patients in the CO group and 12 patients in the NO group had an adverse event. The CO group had reduced range of motion at 6 weeks.
CONCLUSIONS: Pain scores over the first 4 weeks after surgery were equivalent for patients undergoing multi-level PCF treated with or without a cervical orthosis. Our findings do not support the routine use of a postoperative cervical orthosis for postoperative pain control. Clinical Trials Registration Number NCT04308122, April 22, 2020.