Cervical Disorder

Abstract: Degenerative cervical spine disorders will affect up to two-thirds of the population in their lifetime. While often benign and episodic in nature, cervical disorders may become debilitating resulting in severe pain and possibly neurologic sequelae. Non-operative treatment continues to play an important role in treating these patients, with medications, therapy and interventional pain injections playing increasing roles in treatment. Surgical treatment including anterior and posterior decompression and fusion have been effective treatments of many cervical disorders, but may lead to significant problems including adjacent level disease. Laminotomy/foraminotomy and total disc arthroplasty may avoid some of these problems while providing similar clinical results. Ongoing clinical trials and studies are helping to define the role of these new technologies in treatment of patients with degenerative cervical disorders, although their greater benefit has yet to be proven.

Abstract: Antibody activity to herpesvirus hominis type 2 (HVH-2) in 151 women cured of cervical carcinoma (60 in situ, 91 invasive) and in 106 controls differed significantly, especially between the in situ (73%) and control (17%) groups. Sera of 57 patients with cervical atypia showed an increased antibody activity to HVH-2 (58%), compared with that of the 57 matched controls (23%). Antibodies to cytomegalovirus (CMV) were detected more frequently in sera of women with atypia (61%) than in sera of women with cervical disorders other than atypia (42%) or in sera of healthy controls (33%). HVH antigens were present in cervical cells from patients with atypia and from matched controls. Not only exfoliated (imprints) but also cultured and cocultured cervical cells contained HVH antigens; there was no correlation between antigen positivity and antibody activity to HVH-2. Our data further supported the association between HVH-2 and cervical anaplasia and indicated that CMV may also be implicated in its etiology.

Abstract: This is a correlation analysis between severity of the ossification of the nuchal ligament (ONL) and clinical cervical disorders including neck dysfunction, cervical malalignment, and morphologic changes of the cervical neural foramen (CNF). The clinical effects of ONL on active range of motion (AROM) of neck, cervical radiculopathy, abnormal cervical curvature, and the degree of CNF stenosis in patients with painful neck stiffness are investigated. Studies have investigated the predisposing factors to cervical dysfunction and degenerative disorders; however, few studies have examined the influence of the ONL on neck function and cervical spine. A total of 31 participants with painful neck stiffness were recruited. They accepted measurement of cervical AROM and serial cervical radiographs at anterior-posterior view, lateral view, and bilateral oblique views. Parameters of radiographs measurement included cervical lordotic curve, and cross-sectional areas (CSA) of the ONL and CNF (C2-C3, C4-C5, C5-C6, and C6-C7 levels). The ratio of CSA of the lower CNF (C4-C5, C5-C6, C6-C7) to CSA of the upper CNF (C2-C3) was used as a CNF stenosis ratio. The correlations of ONL size, neck symptoms, cervical AROM, lordotic curve, and CNF stenosis ratio were analyzed. More than half of all patients were positive in cervical root signs and prone to have larger ONL. Neck AROM of all participants was significantly below normal average in all directions, and a moderate negative association was found between the ONL CSA and AROM in flexion-extension. Most patients had moderate loss of cervical lordotic curve despite there being no significant correlation between ONL CSA and cervical curvature. Moreover, CNF stenosis ratio significantly negatively correlated with ONL CSA. Patients with larger ONL had more severe cervical radiculopathy, more stiffness in flexion-extension direction, more complex degenerative change of spine, and worse CNF stenosis.

Abstract: DNA filter in situ hybridisation (FISH) was used to determine the presence of human papillomavirus (HPV) genotypes 6/11, 16/18, and 31/33 in cell scrapes of the cervix and vulva of 128 women who had precancerous lesions and/or HPV infection of the cervix diagnosed by cytology, colposcopy, and histology. HPV-DNA was found in 87 (68%) vulval and 95 (74%) cervical cell scrapes, and in both the vulval and cervical scrapes of 73 (57%) women, but not in either the vulva or the cervix of 19 women (15%). Of the HPV-DNA-positive smears, the prevalence of the HPV types was 61% HPV 16/18, 14% HPV 6/11, 3% HPV 31/33, and 22% HPV 6/11 and 16/18. By contrast, HPV-DNA was not detected in the cervical smears of a control group of 35 women who were assessed to be free of cervical abnormalities by colposcopy and cytology. The epithelial response of the vulva and the cervix to application of 5% acetic acid was assessed by colposcopy and the results correlated with the presence of HPV genotypes. A possible or definite disorder of the cervix and vulva was detected by colposcopy in 95 (74%) and 96 (75%) of the 128 cases, respectively. The colposcopic assessment of the vulva was inconclusive in ten cases (8%), and only eight women (6%) were found to be free of both a vulval and cervical disorder. This study shows subclinical papillomavirus infections of the vulva frequently coexist with HPV infections and precancerous lesions of the cervix. Careful colposcopic examination and greater attention to HPV infections of the vulva may improve the treatment and management of precancerous lesions and HPV infections of the cervix, and help to reduce their recurrence. Should new methods of treatment of HPV disorders be developed, vulval infections will need to be treated coincidentally with those of the cervix.