Neck Solutions

Association between cervical pillar hyperplasia and degenerative joint disease

Segment-specific association between cervical pillar hyperplasia and degenerative joint disease

From: Chiropractic & Osteopathy 2006, 14:21

Cervical pillar hyperplasia is a radiological finding which first made its appearance in the literature less than 30 years ago. Its etiology and clinical significance are presently unknown; nevertheless, studies have shown that cervical pillar hyperplasia is a frequently overlooked etiology for the loss of the cervical lordosis. While these findings were disputed by several authors, other consequences of cervical pillar hyperplasia are not known at the present time. It has been theorized that the architectural difference that the presence of hyperplasia introduces into the cervical pillar may cause segmental biomechanical changes and may lead to a higher prevalence of degenerative joint disease at the hyperplastic or adjacent cervical levels. The clinical significance of this phenomenon, if found to be related to degenerative joint disease, should prompt an astute clinician into evaluating the articular pillars on all cervical spine radiographs – particularly because there could be a chance that the patient may develop degeneration at the specific cervical levels and may experience associated neck pain. The architecture of the cervical pillars cannot be modified by conservative therapy; therefore, clinicians should be aware that some of the symptoms may be attributed to degeneration and may influence the expected prognosis of the management of neck pain in those particular patients.

Continue reading Association between cervical pillar hyperplasia and degenerative joint disease…

Magnetic Resonance Imaging for the assessment of degenerative disc disease of the lumbar spine

Advances in Magnetic Resonance Imaging for the assessment of degenerative disc disease of the lumbar spine

From: Semin Spine Surg. 2007 June; 19(2): 65–71

The intervertebral disc is characterized by a tension-resisting annulus fibrosus, and a compression-resisting nucleus pulposus composed largely of proteoglycan. Both the annulus and the nucleus function in concert to provide the disc with mechanical stability. Early disc degeneration begins in the nucleus with proteoglycan depletion. Quantitative MRI techniques have been developed to non-invasively quantify the earliest degenerative changes that occur within the disc. Our ability to identify and quantify these early biochemical changes will provide a better understanding of the pathophysiology of disc degeneration and facilitate the study of interventions that aim to halt or reverse the degenerative process.

Degenerative disc disease of the intervertebral disc is the most common cause of back-related disability among North American adults. This sometimes debilitating condition affects nearly 12 million people in the United States, and may generate direct and indirect costs exceeding 50 billion dollars annually in health-related expenditures. The radiographic evaluation of patients with degenerative disc disease often begins with plain film radiography and a standard T1- and T2-weighted MRI to assess for structural changes within the nucleus and annulus indicative of disc degeneration including a loss of T2-weighted MRI signal, loss of disc height, disc bulge or herniation, posterior element arthrosis, stenosis, and potential vertebral body compromise. While standard MRI is able to detect these later stage developments, it is not able to provide a quantitative measure of the early changes that characterize early degenerative disc disease. This limitation has led to the search for quantitative, non-invasive measures to evaluate the earliest changes involved in the initiation of the degenerative cascade. Such an imaging tool will be important for the evaluation of the patients with early degenerative disc disease, and also in the assessment of disc regenerative or restorative technologies that aim to halt or reverse the degenerative process.

Continue reading Magnetic Resonance Imaging for the assessment of degenerative disc disease of the lumbar spine…

Whiplash injuries can be visible by functional magnetic resonance imaging

Whiplash injuries can be visible by functional magnetic resonance imaging

From: Pain Res Manag. 2006 Autumn;11(3):197-9

Whiplash trauma can result in injuries that are difficult to diagnose. Diagnosis is particularly difficult in injuries to the upper segments of the cervical spine (craniocervical joint complex). Studies indicate that neck injuries in that region may be responsible for the cervicoencephalic syndrome, as evidenced by headache, balance problems, vertigo, dizziness, eye problems, tinnitus, poor concentration, sensitivity to light and pronounced fatigue. Consequently, diagnosis of lesions in the craniocervical joint region is important.

Functional magnetic resonance imaging is a radiological technique that can visualize injuries of the ligaments and the joint capsules, and accompanying pathological movement patterns. Three severely injured patients that had been extensively examined without any findings of structural lesions were diagnosed by functional magnetic resonance imaging to have injuries in the craniocervical joint region. These injuries were confirmed at surgery, and after surgical stabilization the medical condition was highly improved. It is important to draw attention to the urgent need to diagnose lesions and dysfunction in the craniocervical joint complex and also improve diagnostic methods in whiplash injuires.

Satisfaction with low back pain care

Satisfaction with low back pain care

From: Spine J. 2008 May-Jun;8(3):510-21. Epub 2007 May 25

By using a unique, prospective study of occupational back pain claims, they examined health care satisfaction by provider type and its effect on return to work. They estimated satisfaction differentials by provider type, decomposing overall satisfaction into two components: bedside manner and effectiveness of care. They also examined how health care satisfaction affects the duration of jobless claims. The Arizona State University Healthy Back Study is a prospective study of work related back pain; 1,831 workers completed a baseline interview, with follow-up interviews at 1 month, 6 months, and 1 year. The Arizona State University Healthy Back Study merged demographic and claim characteristics from the workers’ compensation claim files with self-reported severity measures, measures of satisfaction, and postonset employment from worker interviews.

Overall and detailed satisfaction with treatment and workers’ compensation claim duration. They performed a nonparametric descriptive analysis of satisfaction by provider type and used multivariate regressions to decompose overall satisfaction into component parts. The duration analysis links differentials in health care satisfaction to differences in claim durations. Workers treated by surgeons, chiropractors (DCs), or physical therapists are more satisfied with their health care than those treated by MDs. Workers are more concerned with the effectiveness of care than with the bedside manner of their provider. A one standard deviation improvement in satisfaction with the health care provider reduces claim duration by about 25%.

Subendplate microcirculation disturbance in intervertebral disc degeneration

Subendplate microcirculation disturbance directly contributes to intervertebral disc degeneration

From: Zhonghua Wai Ke Za Zhi. 2008 Feb 1;46(3):213-6 Article in Chinese

To build subendplate microcirculation disturbance animal model and to investigate the potential pathogenesis of intervertebral disc degeneration. Twenty four New Zealand white rabbits were divided into treatment group (Group A) and control group (Group B). In Group A, animals received endotoxin and corticosteroid application to build subendplate microcirculation disturbance animal model, validated by microthrombus staining. In Group B, animals were given no drug, but standard feeding. After 3 month, the extent of intervertebral disc degeneration was evaluated by the water content, biochemistry analysis, and morphology. Subendplate microthrombus staining confirmed the exist of microcirculation disturbance.

The water content and biochemistry components content of disc in Group A were lower than those of disc in Group B, and intervertebral disc degeneration was observed in morphology. Subendplate microcirculation disturbance can directly contribute to intervertebral disc degeneration, the nutrients diffusion barrier is the potential pathogenesis of intervertebral disc degeneration.

The role of the cervical spine and the craniomandibular system in tinnitus

The role of the cervical spine and the craniomandibular system in the pathogenesis of tinnitus. Somatosensory tinnitus

From: HNO. 2008 Jul;56(7):673-7 Article in German

The causes of tinnitus, vertigo, and hearing disturbances may be pathological processes in the cervical spine - neck and temporomaxillary joint. In these cases, tinnitus is called somatosensory tinnitus. For afferences of the cervical spine, projections of neuronal connections in the cochlear nucleus were found. A reflex-like impact of the cervical spine on the cochlear nucleus can be assumed. The tinnitus treatment concept of the Charité University Hospital in Berlin involves the cooperation of ENT specialists with many other disciplines in an outpatient clinic. A standardized examination protocol has been established, and physical therapy has been integrated into the interdisciplinary tinnitus treatment. For tinnitus modulating therapy of muscular trigger points, local anesthetics as well as self-massage or treatment by a physiotherapist or osteopath are useful.

Continue reading The role of the cervical spine and the craniomandibular system in tinnitus…

Reliability of muscle tests in postural neck pain

Reliability of isometric muscle endurance tests in subjects with postural neck pain

From: J Manipulative Physiol Ther. 2008 Jun;31(5):348-54

The purpose of this study was to determine the reliability of 3 isometric muscle endurance tests in subjects with postural neck pain. Twenty-one subjects with chronic postural neck pain performed 3 submaximal muscle tests twice on the first occasion and once at the second session 3 days later. The tests examined isometric neck flexion, neck extension, and scapular muscle endurance. Reliability was excellent for the neck flexor test, moderate for the scapular test, and good for the neck extensor test. The standard error of measure for the tests was 6.4, 10.9, and 25.9 seconds, respectively. The minimum change required to represent real change in muscle endurance was 17.8 seconds for the neck flexor test, 30.1 seconds for the scapular test, and 71.3 seconds for the neck extensor test. This study showed the reliability of 3 cervical spine and shoulder girdle submaximal muscle endurance tests in patients with postural neck pain.

Neck muscle isometric contractions in chronic tension type headache

Cervical muscle co-activation in isometric contractions is enhanced in chronic tension type headache patients

From: Cephalalgia. 2008 Jul;28(7):744-51. Epub 2008 May 5

The purpose of the study was to compare the co-activation of cervical agonist and antagonist muscles between people with chronic tension type headache and healthy controls during brief isometric neck flexion and extension contractions. Nine women with chronic tension type headache and 10 matched controls participated. Surface electromyographic (EMG) signals were detected from the sternocleidomastoid and splenius capitis muscles bilaterally during neck flexion and extension contractions of linearly increasing force from 0% to 60% of the maximum voluntary contraction in 3 s. Sternocleidomastoid and splenius capitis EMG average rectified values were estimated at 10% maximum voluntary contraction force increments. During cervical extension contraction, sternocleidomastoid (i.e. antagonist muscle) average rectified values was greater for patients than for controls in the force range 20-60% maximum voluntary contraction. During cervical flexion, the left splenius capitis (i.e. antagonist muscle) average rectified values was greater for chronic tension type headache patients regardless of the force level. Maximum neck flexion and extension force was lower for the chronic tension type headache patients compared with controls.

In conclusion, women with chronic tension type headache demonstrated greater co-activation of antagonist musculature during cervical extension and flexion contractions compared with healthy women. Increased co-activation of antagonist musculature may reflect reorganization of the motor control strategy in chronic tension type headache patients, potentially leading to muscle overload and increased nociception.

Caveolin-1 stress induced premature senescence in intervertebral disc degeneration

Caveolin-1 expression and stress induced premature senescence in human intervertebral disc degeneration

From: Arthritis Res Ther. 2008 Aug 5;10(4):R87 [Epub ahead of print]

Chronic and debilitating low back pain is a common condition and a huge economic burden. Many cases are attributed to age related degeneration of the intervertebral disc, however, age related degeneration appears to occur at an accelerated rate in some individuals. We have previously demonstrated biomarkers of cellular senescence within the human intervertebral disc and suggested a role for senescence in intervertebral disc degeneration. Senescence occurs with ageing, but can also occur prematurely in response to stress. We hypothesised that stress induced premature senescence occurs within the intervertebral disc and here we have investigated the expression and production of caveolin-1, a protein that has been shown previously to be upregulated in stress induced premature senescence.

Caveolin-1 gene expression in human nucleus pulposus cells was assessed by conventional and quantitative real-time PCR and caveolin-1 protein expression examined within human intervertebral discs using immunohistochemistry. Correlation between caveolin-1 and p16INK4a biomarker of cellular senescence gene expression was investigated using quantitative real-time PCR.

Caveolin-1 gene and protein expression were demonstrated within the human intervertebral disc for the first time. Nucleus pulposus cells from degenerate discs exhibited elevated levels of caveolin-1 that did not relate to increasing chronological age. A negative correlation was observed between gene expression for caveolin-1 and donor age and no correlation was found between caveolin-1 protein expression and age. A positive correlation was identified between gene expression of caveolin-1 and biomarker of cellular senescence.

Our findings are consistent with a role for caveolin-1 in degenerative rather than age induced changes in the nucleus pulposus. Its expression in intervertebral disc tissue and its association with the senescent phenotype suggests that caveolin-1 and stress induced premature senescence may play a prominent role in the pathogenesis of intervertebral disc degeneration.

Continue reading Caveolin-1 stress induced premature senescence in intervertebral disc degeneration…

Painful disc lesion in biplanar magnetic resonance imaging and discography

Painful Disc Lesion: Can Modern Biplanar Magnetic Resonance Imaging Replace Discography?

From: J Spinal Disord Tech 2008; 21:430–435

Internal disc disruption’’ is one of the prominent somatic sources of low back pain. MRI is the most common investigation performed to evaluate discogenic pain. Though MRI has advantages of being a sensitive investigation for identifying pathologic anatomy of disc degeneration, its value is limited by its inability to evaluate the physiologic status of the disc. Studies have questioned the specificity of MRI in diagnosing discogenic pain and have reported degenerative changes in 26% to 57% of asymptomatic volunteers. Discography is a useful tool to identify the painful disc responsible for patient’s symptoms. In evaluation of discogenic low back pain there has been a debate as to whether discography should replace MRI. Proponents of discography believe that it is an invaluable tool for identifying the pathologic disc producing pain. Critics believe that discography is an invasive investigation and has no place in modern practice.

Over the last decade there has been a vast improvement in the quality of MR images. Attempts have been made to identify features on MRI scans that would correlate with patient’s symptoms and would potentially eliminate the need for discography. Such features are the vertebral end plate changes described by Modic and the high intensity zone described by Aprill and Bogduk. The implications of these findings have been a subject of controversy.

This is a prospective study aimed at correlating the results of discography with new MRI classification in a consecutive series of patients with disabling low back pain considered for spinal surgery. In addition, we also aimed to compare vertebral end plate changes and high intensity zones seen on MRI with discography findings.

Continue reading Painful disc lesion in biplanar magnetic resonance imaging and discography…