The Relationship Between Generalized Joint Hypermobility and Cervical Disc Degeneration, Neck Pain: A Multidisciplinary Clinical Study

Objective: Generalized joint hypermobility (GJH) is a condition of the connective tissue, which has movement ability beyond the normal limit of synovial joints. Its effects on disc degeneration and neck pain are not fully known. The aim of the present study was to determine the relationship between GJH and cervical disc degeneration that is detected in magnetic resonance imaging (MRI) and also neck pain. Methods: Cases aged between 20 and 50 years who were admitted to outpatient clinics with neck and arm pain were included in the study. Their cervical MRIs were evaluated. Beighton score was used to evaluate these cases for GJH, and they were also evaluated prospectively using the Visual Analog Scale (VAS) for pain and Neck Disability Index (NDI) for disability. Results: Of the 75 cases, 59 (78.7%) were female, 16 (21.3%) were male, and GJH was found in 15 (20%). There was no statistically significant difference in the values of Miyazaki grade parameters in all cervical disc levels and VAS and NDI values between the patients with and without GJH (p>0.05). Conclusion: This result suggests that GJH may not be a single risk factor for cervical disc degeneration, and VAS and NDI values increase in patients aged between 20 and 50 years.

Generalize Eklem Hipermobilitesi ile Servikal Disk Dejenerasyonu ve Boyun Ağrısı İlişkisi: Bir Multidisipliner Klinik Çalışma

Amaç: Generalize eklem hipermobilitesi (GEH) sinovial eklemlerin normal sınırın ötesinde hareket yeteneğinin olduğu bir durum olup disk dejenerasyonu üzerine etkileri bilinmemektedir. Çalışmamızın amacı GEH ile manyetik rezonans görüntülemede (MRG) saptanılan servikal disk dejenerasyonu ve boyun ağrısı arasındaki ilişkiyi ortaya çıkarmaktır. Gereç ve Yöntem: Beyin cerrahisi ve fizik tedavi ve rehabilitasyon polikliniklerine boyun ve/veya kol ağrısı yakınması ile baş vuran 20–50 yaş arasındaki olgular çalışmaya alındı. Kriterlere uyan olguların servikal MRG’leri değerlendirildi. Bu olguları GEH yönünden değerlendirmede Beighton skoru kullanıldı. Olgular ayrıca Vizüel Analog Skala (VAS) kullanılarak ağrı, Boyun Dizabilite İndeksi (BDİ) kullanılarak dizabilite yönünden ileriye dönük olarak değerlendirildiler. Bulgular: Çalışma kriterlerine uyan 75 olgunun 59’u kadın (%78.7), 16’sı erkek (%21.3), yaş ortalamaları 37.61±7.89 yıl idi. Olguların 15’inde GEH saptandı (%20), 60’ında GEH’ye rastlanılmadı (%80). GEH görülenlerle görülmeyenler arasında servikal disk düzeylerinde Miyazaki grade parametreleri açısından istatistiksel olarak anlamlı bir farklılık bulunmadı (p>0.05). Aynı şekilde gruplar arasında VAS ve BDİ değerleri açısından da istatistiksel olarak anlamlı bir farklılık yoktu (p>0.05). Sonuç: Bu sonuç 20–50 yaş aralığındaki olgularda, normal şartlar altında, GEH’nin servikal disk dejenerasyonu ile VAS ve BDİ artışında tek başına bir risk faktörü olmayabileceğini düşündürmüştür.

Kaynakça

1. Baeza-Velasco C, Gély-Nargeot MC, Pailhez G, Vilarrasa AB. Joint hypermobility and sport: a review of advantages and disadvantages. Curr Sports Med Rep 2013;12:291–5.

2. Simmonds JV, Keer RJ. Hypermobility and the hypermobility syndrome. Man Ther 2007;12:298–309.

3. Suri P, Dharamsi AS, Gaviola G, Isaac Z. Are facet joint bone marrow lesions and other facet joint features associated with low back pain? A pilot study. PM R 2013;5:194–200.

4. Adib N, Davies K, Grahame R, Woo P, Murray KJ. Joint hypermobility syndrome in childhood. A not so benign multisystem disorder? Rheumatology (Oxford) 2005;44:744–50.

5. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis 1973;32:413–8.

6. Ross J, Grahame R. Joint hypermobility syndrome. BMJ 2011;342:c7167.

7. Remvig L, Jensen DV, Ward RC. Are diagnostic criteria for general joint hypermobility and benign joint hypermobility syndrome based on reproducible and valid tests? A review of the literature. J Rheumatol 2007;34:798–803.

8. Simpson MR. Benign joint hypermobility syndrome: evaluation, diagnosis, and management. J Am Osteopath Assoc 2006;106:531–6.

9. Murray KJ. Hypermobility disorders in children and adolescents. Best Pract Res Clin Rheumatol 2006;20:329–51.

10. Côté P, Cassidy JD, Carroll LJ, Kristman V. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain 2004;112:267–73.

11. Hogg-Johnson S, van der Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J, et al. The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000- 2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008;33:S39–51.

12. Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthop J 2014;8:326–45.

13. Cheung KM, Karppinen J, Chan D, Ho DW, Song YQ, Sham P, et al. Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine (Phila Pa 1976) 2009;34:934–40.

14. Miyazaki M, Hong SW, Yoon SH, Morishita Y, Wang JC. Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. J Spinal Disord Tech 2008;21:288– 92.

15. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), ShortForm McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011;63 Suppl 11:S240–52.

16. Huskisson EC. Measurement of pain. Lancet 1974;2:1127–31.

17. Kesiktas N, Ozcan E, Vernon H. Clinimetric properties of the Turkish translation of a modified neck disability index. BMC Musculoskelet Disord 2012;13:25.

18. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991;14:409–15.

19. Lee SM, Oh SC, Yeom JS, Shin JH, Park SG, Shin DS, et al. The impact of generalized joint laxity (GJL) on the posterior neck pain, cervical disc herniation, and cervical disc degeneration in the cervical spine. Spine J 2016;16:1453–8.

20. Castori M, Hakim A. Contemporary approach to joint hypermobility and related disorders. Curr Opin Pediatr 2017;29:640–9.

21. Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990;72:1178–84.

22. Kanayama M, Togawa D, Takahashi C, Terai T, Hashimoto T. Crosssectional magnetic resonance imaging study of lumbar disc degeneration in 200 healthy individuals. J Neurosurg Spine 2009;11:501–7.

23. Matsumoto M, Fujimura Y, Suzuki N, Nishi Y, Nakamura M, Yabe Y, et al. MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br 1998;80:19–24.

24. Risbud MV, Shapiro IM. Role of cytokines in intervertebral disc degeneration: pain and disc content. Nat Rev Rheumatol 2014;10:44– 56.

25. Ikeda H, Hanakita J, Takahashi T, Kuraishi K, Watanabe M. Nontraumatic cervical disc herniation in a 21-year-old patient with no other underlying disease. Neurol Med Chir (Tokyo) 2012;52:652–6.

26. O’Laoire SA, Thomas DG. Spinal cord compression due to prolapse of cervical intervertebral disc (herniation of nucleus pulposus). Treatment in 26 cases by discectomy without interbody bone graft. J Neurosurg 1983;59:847–53.

27. Adams MA, Freeman BJ, Morrison HP, Nelson IW, Dolan P. Mechanical initiation of intervertebral disc degeneration. Spine (Phila Pa 1976) 2000;25:1625–36.

28. Kim HJ, Yeom JS, Lee DB, Kang KT, Chang BS, Lee CK. Association of benign joint hypermobility with spinal segmental motion and its clinical implication in active young males. Spine 2013;38:E1013–9.

29. Pacey V, Nicholson LL, Adams RD, Munn J, Munns CF. Generalized joint hypermobility and risk of lower limb joint injury during sport: a systematic review with meta-analysis. Am J Sports Med 2010;38:1487–97.

30. Cakir B, Carazzo C, Schmidt R, Mattes T, Reichel H, Käfer W. Adjacent segment mobility after rigid and semirigid instrumentation of the lumbar spine. Spine (Phila Pa 1976) 2009;34:1287–91.

31. Lee SM, Lee GW. The impact of generalized joint laxity on the clinical and radiological outcomes of single-level posterior lumbar interbody fusion. Spine J 2015;15:809–16.

32. Goffin J, Geusens E, Vantomme N, Quintens E, Waerzeggers Y, Depreitere B, et al. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech 2004;17:79–85.

33. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999;81:519–28.

34. Phillips FM, Geisler FH, Gilder KM, Reah C, Howell KM, McAfee PC. Long-term Outcomes of the US FDA IDE Prospective, Randomized ControlledClinical Trial Comparing PCM Cervical Disc Arthroplasty With AnteriorCervical Discectomy and Fusion. Spine (Phila Pa 1976) 2015;40:674–83.

35. Wu JC, Liu L, Wen-Cheng H, Chen YC, Ko CC, Wu CL, et al. The incidence of adjacent segment disease requiring surgery after anterior cervical diskectomy and fusion: estimation using an 11-year comprehensive nationwide database in Taiwan. Neurosurgery 2012;70:594– 601.

36. Hu Y, Lv G, Ren S, Johansen D. Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials. PLoS One 2016;11:e0149312.

37. Shriver MF, Lubelski D, Sharma AM, Steinmetz MP, Benzel EC, Mroz TE. Adjacent segment degeneration and disease following cervical arthroplasty: a systematic review and meta-analysis. Spine J 2016;16:168–81.

38. Yao Q, Liang F, Xia Y, Jia C. A meta-analysis comparing total disc arthroplasty with anterior cervical discectomy and fusion for the treatment of cervical degenerative diseases. Arch Orthop Trauma Surg 2016;136:297–304.

39. Zhu Y, Tian Z, Zhu B, Zhang W, Li Y, Zhu Q. Bryan Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion for Treatment of Cervical Disc Diseases: A Meta-analysis of Prospective, Randomized Controlled Trials. Spine (Phila Pa 1976) 2016;41:E733–41.

40. Modic MT, Masaryk TJ, Ross JS, Carter JR. Imaging of degenerative disk disease. Radiology 1988;168:177–86.

41. Sambrook PN, MacGregor AJ, Spector TD. Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum 1999;42:366–72.

42. Kraus VB, Li YJ, Martin ER, Jordan JM, Renner JB, Doherty M, et al. Articular hypermobility is a protective factor for hand osteoarthritis. Arthritis Rheum 2004;50:2178–83.

Kaynak Göster

Southern Clinics of Istanbul Eurasia
  • ISSN: 2587-0998
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2017

1.1b380

Sayıdaki Diğer Makaleler

An Extraordinary Cause in the Etiology of Recurrent Massive Hemoptysis: Hughes–Stovin Syndrome

Onur DERDİYOK, Hakan YILMAZ, Serdar EVMAN, Volkan BAYSUNGUR

The Relationship Between Generalized Joint Hypermobility and Cervical Disc Degeneration, Neck Pain: A Multidisciplinary Clinical Study

Neşe KESER, Esin Derin ÇİÇEK, Arzu ATICI, Pınar AKPINAR, Özge Gülsüm İLLEEZ, Ahmet Eren SEÇEN

Fetal Neuroblastoma: Prenatal Ultrasonography and Magnetic Resonance Imaging Findings

Serdar ASLAN, Mesut ÖZTÜRK, Meltem Ceyhan BİLGİCİ, Dilek SAĞLAM, Handan ÇELİK, Ayhan DAĞDEMİR

Relationship Between Pulmonary Thromboembolism, its Mortality and Seasonal, Meteorological Factors

Seda Beyhan SAĞMEN, Sevda CÖMERT, Nesrin KIRAL, Gamze Çelik TÜRNÜKLÜ, Coşkun DOĞAN, Elif TORUN PARMAKSIZ, Ali FİDAN

The Relationship Between Restless Legs Syndrome and Anxiety, Depression, and Quality of Life

Şenay AYDIN, Cengiz ÖZDEMİR

Is Lymphopenia Detected in Sarcoidosis Associated with the Disease Activity?

Coşkun DOĞAN, Sevda ŞENER CÖMERT, Benan ÇAĞLAYAN, Elif TORUN PARMAKSIZ, Nesrin KIRAL, Recep DEMİRHAN, Ali FİDAN, Seda Beyhan SAĞMEN

The Role of Alpha Atrial Natriuretic Hormone in Pneumonectomy: An Experimental Study

Murat AKKUŞ, Yener YÖRÜK

Cord Blood Vitamin D Level in Neonates of Preeclamptic Mothers

Didem ARMAN, Seçil ERÇİN, Sevilay TOPÇUOĞLU, Ayşem KAYA, Fahri OVALI, Güner KARATEKİN

Evaluation of the Quality of Life in Patients with Pleurodesis

Hasan ERSÖZ, Hatice DAYILAR CANDAN

Use of Intermittent Bolus Erector Spinae Plane (ESP) Block for Analgesia in Open Cholecystectomy: A Case Report

Peter MERJAVY