OBJECTIVE: Cervical spondylosis may lead to changes in the sagittal parameters of the neck and trigger compensatory alterations in systemic sagittal parameters. However, there is currently a dearth of comparative research on the changes and compensatory alterations to sagittal parameters resulting from different types of cervical spondylosis. This study compared the preoperative sagittal alignment sequences among patients with cervical spondylotic radiculopathy (CSR), ossification of the posterior longitudinal ligament (OPLL), and cervical spondylotic myelopathy (CSM) caused by factors resulting from non-OPLL factors.
METHODS: Full length lateral X-ray of the spine and cervical computed tomography (CT) of 256 patients (134 men, 122 women; mean age, 56.9 ± 9.5 years) were analyzed retrospectively. A total of 4096 radiomics features were measured through the lateral X-ray by two spinal surgeons with extensive experience. The clinical symptoms measures were the Japanese Orthopaedic Association (JOA) score, number of hand actions in 10 s, hand-grip strength, visual analog scale (VAS) score. Normally distributed data was compared using one-way analysis of variance (ANOVA) for parametric variables and χ2 test were used to analyze the categorical data.
RESULTS: In the OPLL group, the C2-C7 Cobb angle was greater than in the CSR and CSM groups (19.8 ± 10.4°, 13.3 ± 10.3°, and 13.9 ± 9.9°, respectively, p < 0.001). Additionally, the C7-S1 SVA measure was found to be situated in the anterior portion with regards to the CSM and CSR groups (19.7 ± 58.4°, -6.3 ± 34.3° and -26.3 ± 32.9°, p < 0.001). Moreover, the number of individuals with C7-S1 SVA >50 mm was significantly larger than the CSM group (26/69, 11/83, p < 0.001). In the CSR group, the TPA demonstrated smaller values compared to the OPLL group (8.8 ± 8.5°, 12.7 ± 10.2°, p < 0.001). Furthermore, the SSA was comparatively smaller as opposed to both the OPLL and CSM groups (49.6 ± 11.2°, 54.2 ± 10.8° and 54.3 ± 9.3°, p < 0.05).
CONCLUSIONS: Patients with OPLL exhibit greater cervical lordosis than those with CSR and CSM. However, OPLL is more likely to result in spinal imbalance when compared to the CSM group. Furthermore, OPLL and CSM patients exhibit anterior trunk inclination and worse global spine sagittal parameters in comparison to CSR patients.

OBJECTIVE: To observe the clinical efficacy of modified cervical Jiaji acupuncture in the treatment of mixed cervical spondylosis (MCS).
METHODS: In this retrospective study, 120 patients with MCS who were treated in Yongchuan Hospital, Affiliated with Chongqing Medical University, from May 2020 to May 2023, were selected as the study subjects. According to the treatment methods, 52 patients who were treated with ordinary seat traction, tendon manipulation and ironing from January 2020 to December 2021 were grouped as the traditional treatment group. From January 2022 to December 2023, 68 patients who were treated with acupuncture at cervical Jiaji points formed the acupuncture group. Cervical Jiaji points (EX-B2) are located on both sides of the spinous process from the first to the seventh cervical vertebra, 0.5 inch lateral to the posterior median line, with 7 points on one side, and a total of 14 points. The patients were in a prone position and the points were treated using direct needling with filiform needle and reinforcing-reducing manipulation. Both groups were treated for 2 weeks. The pain, pain intensity, pain improvement quality, blood flow improvement, cervical spine mobility, cervical spine function and clinical efficacy of the two groups before and after treatment were compared.
RESULTS: After treatment, the pain rating index (PRI) score, present pain intensity (PPI) score and visual analogue scale (VAS) score of the two groups all decreased, with those in the acupuncture group decreasing more substantially than that in the traditional treatment group (all P < 0.05). The mean blood flow velocity (Vm) in the right vertebral artery, left vertebral artery and basilar artery in the acupuncture group were significantly higher than in the traditional treatment group (all P < 0.05). The right-handed, left-handed, posterior, anteflexion, left-flexion and right-flexion activities of the acupuncture group were better than in the traditional treatment group (all P < 0.05), and the neck disability index (NDI) score and clinical assessment scale for cervical spondylosis (CASCS) scores of in the acupuncture group were better than the traditional treatment group (all P < 0.05). After therapy, the total effective rate of the acupuncture group was 86.67%, which was significantly higher than 71.67% in the traditional treatment group (P < 0.05).
CONCLUSIONS: Modified cervical Jiaji acupuncture is effective in treating MCS. It can improve the clinical symptoms, cervical spine function and cervical spine mobility, and reduce the intensity of pain.

BACKGROUND: Currently, there is a lack of large-scale prospective cohort data to explore the response of neck pain to anterior cervical decompression and fusion (ACDF). The aim of this study was to investigate whether patients with neck pain can achieve consistent neck pain relief following ACDF regardless of preoperative neurological symptoms and number of surgical segments.
METHODS: The study was a pooled analysis of three multicenter prospective cohort studies. Patients with cervical radiculopathy and/or myelopathy with significant neck pain (visual analogue scale [VAS] ≥ 4) underwent ACDF were included. Neck pain VAS scores (VAS-neck) were collected at preoperative and postoperative follow-up time points (3 months, 6 months, and 1 year). Subgroup analyses were conducted for patients with radiculopathy, myelopathy, or myeloradiculopathy, as well as for single- versus multi-segment ACDF.
RESULTS: A total of 237 patients were confirmed. Patients showed significant improvement in VAS-neck at all follow-up time points compared with baseline (P < 0.001 for each). In the first year after surgery, VAS-neck were reduced by 3.3 points (57.0%) on average, and the rates of achieving minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) were 72.2% and 73.8%, respectively. Meanwhile, one year after surgery, there was no significant difference in ΔVAS-neck, recovery rate, MCID and PASS attainment rate between the radiculopathy, myelopathy and myeloradiculopathy groups, and the same trend was observed between the single-segment and multi-segment groups.
CONCLUSIONS: This study found that ACDF significantly improved neck pain in the patients with cervical spondylosis, regardless of preoperative neurological symptoms and number of surgical segments.

This study reports two cases of rare symptomatic subsidence of titanium cages after anterior cervical discectomy and fusion (ACDF). First, an 82-year-old man underwent ACDF at C5/6 and C6/7 using two 6 mm height box-type titanium cages. On the 34th postoperative day, motor weakness occurred in the right upper limb, and CT showed that the cage at C5/6 had subsided 6 mm into the C6 vertebral body. On postoperative day 55, both cages were removed, and C6 corpectomy was performed. The C5-7 space was refixed with a mesh cage and plate. He was discharged home from the rehabilitation hospital three months later. Second, a 41-year-old man underwent ACDF at C5/6 and C6/7 using two 5 mm height box-type titanium cages. He fell violently on the 33rd postoperative day, causing pain from the neck to the left hand, weakness, and skillful movement disorder in the left hand, and CT showed that the cages at C5/6 and C6/7 had subsided by 7 mm and 6 mm, respectively. On the 65th postoperative day, both cages were removed by reoperation, and C6 and 7 corpectomy was performed. The space between C5 and T1 was refixed with a mesh cage and plate. He was discharged home two months later. Possible causes of titanium cage subsidence include osteoporosis, trauma, vertebral cortex damage by an operative procedure, and cage height of 6 mm or more. While ACDF is safe and effective for cervical spondylosis, special caution is needed in older osteoporotic patients.

The study of TCM manipulation\'s mechanism is the key scientific issue in the current manipulation research. It is the key and difficult point on the road of modernization and internationalization of Chinese orthopedics and traumatology. Meanwhile, it is also an important way to clarify systematically the scientific connotation of TCM manipulation. At present, our country is in an important period when multi-disciplinary intersection lead knowledge production, scientific innovation, and discipline development. The trend of cross-innovation between Chinese orthopedics and traumatology and other disciplines provides the carrier and method for the study of TCM manipulation\'s mechanism. Cervical spondylosis is the traditional dominant disease of Chinese orthopedics and traumatology. In recent years, many scholars have applied multi-disciplinary techniques and theories to explore the mechanism of TCM manipulation by focusing on the four dimensions of muscle, bone, blood vessel and nerve. The article takes the treatment of cervical spondylosis by TCM manipulation as the research entry point, and integrates the application status and implementation strategies of various techniques and theories under the background of multi-disciplinary intersection, which is conducive to the better combination, innovation and transformation of Chinese orthopedics and traumatology with other disciplines, and provides ideas and references for systematically clarifying the scientific connotation of TCM manipulation.

Cervical spondylosis is the most common degenerative spinal disorder in modern societies. Patients require a great deal of medical knowledge, and large language models (LLMs) offer patients a novel and convenient tool for accessing medical advice. In this study, we collected the most frequently asked questions by patients with cervical spondylosis in clinical work and internet consultations. The accuracy of the answers provided by LLMs was evaluated and graded by 3 experienced spinal surgeons. Comparative analysis of responses showed that all LLMs could provide satisfactory results, and that among them, GPT-4 had the highest accuracy rate. Variation across each section in all LLMs revealed their ability boundaries and the development direction of artificial intelligence.

BACKGROUND: Endoscopic posterior approach can effectively decompress cervical root and cord secondary to posterior compression. This publications is aimed to present our experience in 229 patients using tubular retractor and the relevant literature is reviewed.
METHODS: Retrospective analysis of multilevel myelopathy and or radiculopathy was performed. Indications for posterior approach was primary posterior compressions at cord and or root. Combined compression from posterior side and mild to moderate anterior pressure with acceptable lordosis were also decompressed. Bilateral cord decompression and foraminotomy for radiculopathy was performed using tubular retractor.
RESULTS: There were myelopathy and radiculopathy in 220 and 9 patients respectively. A total of 53 foraminotomy procedures were performed in 36 patients. All patients showed improvement, with the mean preoperative Nurick grade decreasing from 2.72 ± 0.799 to 0.78 ± 0.911 after surgery. There was significant improvement in postoperative Nurick grades compared to preoperative grades (Z-value =13.306, P less than 0.0001). Operative results were better in patients with good preoperative Nurick grades (grades 1 and 2) compared to those with poorer grades (grades 3 and 4). Minor bleeding, small dural tear, and root injury was observed in 42, 4 and 8 patients respectively.
CONCLUSIONS: Endoscopic approach was effective and safe for root and cord decompression. This study was limited by its single-center, retrospective design, exclusion of some eligible patients, a short postoperative Nurick grade assessment period of six months, and absence of a comprehensive long-term postoperative biomechanical assessment. To validate these results, a prospective multicenter study addressing these limitations is needed.

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Rheumatoid arthritis (RA) is a disease characterized by symmetrical erosive polyarthritis that results in progressive disability. In patients with RA, the clinical course can be intermittent or progressive, depending on the severity of the symptoms. As complications of RA may develop within months of presentation, it is recommended that patients seek treatment with disease-modifying antirheumatic drugs as soon as possible. Wrists, proximal interphalangeal joints, metacarpophalangeal joints, and metatarsophalangeal joints are the most commonly involved joints, with the spinal joints and distal interphalangeal joints usually spared. The term cervical spondylosis refers to the general wear and tear of the cervical spine (neck) caused by aging, which can result in neck pain, neck stiffness, etc. Cervical degenerative spondylosis is caused by arthritic changes to the osseocartilaginous components of the cervical spine. This may result in compression of spinal nerve roots or the spinal cord, leading to pain in the neck, radiculopathy, or myelopathy. The present case report is of a 57-year-old female having pain in her neck and lower back for 20 years. She also complained of pain in the bilateral wrist joint, proximal interphalangeal joints, distal interphalangeal joints, metacarpophalangeal joints, and metatarsophalangeal joints. The pain was insidious in onset and gradually progressive. The pain has progressed to such an extent that it was hindering her day-to-day activities. The pain progressed on movement and was relieved with rest and medications. The pain was not associated with tingling or numbness. Physical therapy aims to strengthen weak structures, lessen pain, increase joint range of motion, improve movement patterns, increase cardiovascular endurance, and enhance the patient\'s quality of life.

UNASSIGNED: Cervical foraminal stenosis on MRI may be assessed using the Kim, modified Kim or Siller methods. This study aimed to investigate which morphological features of cervical foraminal stenosis in patients with cervical radiculopathy correlated best with pre-operative and post-operative surgical outcome following Anterior Cervical Discectomy (ACD) or a Posterior Cervical Foraminotomy (PCF).
UNASSIGNED: Pre-operative MRIs of adults with cervical radiculopathy were assessed by six raters. The following measurements were made; uncompressed nerve root diameter, maximal compressed nerve root diameter, anterior & posterior compression, length of the neuroforaminal canal where the diameter was less than the uncompressed nerve root diameter and the distance of maximum compression from the apex of the ligamentum flavum. The Kim, modified Kim and Siller grades were calculated. Neck Disability Index (NDI) was measured pre-operatively and six weeks post-operatively. The radiological measurements and grades were compared to the pre-operative and change in NDI.
UNASSIGNED: Mean NDI was higher in female (58.2) than male patients (45.6) p = 0.05. No other baseline, operative or radiological factors where significantly associated with the pre-operative NDI. The mean [±SD] post-operative NDI was 14.3 [±22.5]. This represents a change of 37.8 (p < 0.001). The pre-operative NDI correlated strongly with the post-operative NDI but no other patient, operation or radiological factors correlated significantly. Neither pre-operative NDI or change in NDI was statistically different in those treated with ACD and those treated with PCF.
UNASSIGNED: There was no association between pre-operative NDI and any of the radiological measurements or radiological grades. Furthermore, whilst surgery significantly improved NDI, for those patients with anterior compression, there was no difference in outcome between those treated with an ACD and those treated with a PCF. Current axial MRIs do not adequately assess the cervical nerve root foramina or predict surgical approach, 3D isotropic acquisition and DTI should be explored.