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Upper thoracic-spine disc degeneration in patients with cervical pain
Estanislao Arana; Luis Martí-Bonmatí; Enrique Mollá; Salvador Costa
Objective To study the relationship of upper thoracic spine degenerative disc contour changes on MR imaging in patients with neck pain. The relation between upper thoracic and cervical spine degenerative disc disease is not well established. Design and patients One hundred and fifty-six patients referred with cervical pain were studied. There were 73 women and 77 men with a mean
... scan – cervical spine; Computed tomography scan – cervical spine; CT scan - cervical spine; Neck CT scan ... table that slides into the center of the CT scanner. Once you are inside the scanner, the ...
The initial effects of a cervical spine manipulative physiotherapy treatment on the pain and dysfunction of lateral epicondylalgia
Bill Vicenzino; David Collins; Anthony Wright
Manipulative therapy is frequently used in the management of musculoskeletal pain. A frequently reported clinical feature of this treatment is the immediacy with which it appears to initiate improvement in pain and function. A randomised, double blind, placebo controlled, repeated measures design was employed to study the initial effects of a cervical spine treatment technique in a group of 15
Fractures of the cervical spine
Marcon, Raphael Martus; Cristante, Alexandre Fogaça; Teixeira, William Jacobsen; Narasaki, Douglas Kenji; Oliveira, Reginaldo Perilo; de Barros Filho, Tarcísio Eloy Pessoa
OBJECTIVES: The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative. PMID:24270959
Pediatric cervical spine instability
El Hage, Samer; Rachkidi, Rami; Kharrat, Khalil; Dagher, Fernand; Kreichati, Gabi
Cervical spine instability in children is rare but not exceptional and may be due to many factors. Although it mostly occurs at the upper cervical spine, all vertebrae from the occiput to T1 may be involved. It may be acute or chronic, occurring secondary to trauma or due to congenital anomaly, skeletal or metabolic dystrophy or rheumatoid arthritis. It can be isolated or associated with other musculoskeletal or visceral anomalies. A thorough knowledge of embryology, anatomy, physiology and physiopathology of the cervical spine in children is essential to avoid pitfalls, recognize normal variants and identify children at risk of developing cervical spine instability and undertake the appropriate treatment. PMID:19308585
Extension and flexion in the upper cervical spine in neck pain patients.
Ernst, Markus J; Crawford, Rebecca J; Schelldorfer, Sarah; Rausch-Osthoff, Anne-Kathrin; Barbero, Marco; Kool, Jan; Bauer, Christoph M
Neck pain is a common problem in the general population with high risk of ongoing complaints or relapses. Range of motion (ROM) assessment is scientifically established in the clinical process of diagnosis, prognosis and outcome evaluation in neck pain. Anatomically, the cervical spine (CS) has been considered in two regions, the upper and lower CS. Disorders like cervicogenic headache have been clinically associated with dysfunctions of the upper CS (UCS), yet ROM tests and measurements are typically conducted on the whole CS. A cross-sectional study assessing 19 subjects with non-specific neck pain was undertaken to examine UCS extension-flexion ROM in relation to self-reported disability and pain (via the Neck Disability Index (NDI)). Two measurement devices (goniometer and electromagnetic tracking) were employed and compared. Correlations between ROM and the NDI were stronger for the UCS compared to the CS, with the strongest correlation between UCS flexion and the NDI-headache (r = -0.62). Correlations between UCS and CS ROM were fair to moderate, with the strongest correlation between UCS flexion and CS extension ROM (r = -0.49). UCS flexion restriction is related to headache frequency and intensity. Consistency and agreement between both measurement systems and for all tests was high. The results demonstrate that separate UCS ROM assessments for extension and flexion are useful in patients with neck pain. PMID:25578386
Selective posterior decompression of the cervical spine.
Kim, Kyongsong; Isu, Toyohiko; Sugawara, Atsushi; Matsumoto, Ryoji; Isobe, Masanori; Morimoto, Daijiro; Mishina, Masahiro; Kobayashi, Shiro; Yoshida, Daizo; Teramoto, Akira
Posterior decompression of the cervical spine is an accepted treatment for patients with cervical canal disease, but some patients experience postoperative axial pain and C5 or C6 palsy that affect their quality of life. Here we describe selective posterior decompression using a spinous process-splitting approach to prevent these complications performed in 17 patients with myelopathy treated at median 2.4 levels by selective posterior decompression via the transspinous approach. Clinical symptoms, axial pain, and C5 or C6 palsy were compared before and after treatment. The range of motion of the cervical spine and shift of the cervical cord were studied at the C5 level. All patients experienced symptom improvement and none suffered deterioration or required reoperation. The Japanese Orthopaedic Association score improved from 10.9 to 14.4 points and none of the patients reported C5 or C6 palsy or axial pain at the last follow-up visit. There was no statistically significant change in pre- and postoperative cervical alignment and range of motion. The posterior shift of the spinal cord at the C5 level was 1.7 mm. None of our 17 patients experienced significant postoperative axial pain after selective posterior decompression via the transspinous approach. Minimal spinal cord shift at the C5 level may have contributed to the reduced incidence of postoperative C5 or C6 palsy in our series. Selective posterior decompression is less invasive and effective in some patients with cervical canal disease. PMID:21358151
Bransford, Richard J; Alton, Timothy B; Patel, Amit R; Bellabarba, Carlo
Injuries to the upper cervical spine are potentially lethal; thus, full characterization of the injuries requires an accurate history and physical examination, and management requires an in-depth understanding of the radiographic projection of the craniocervical complex. Occipital condyle fractures may represent major ligament avulsions and may be highly unstable, requiring surgery. Craniocervical dissociation results from disruption of the primary osseoligamentous stabilizers between the occiput and C2. Dynamic fluoroscopy can differentiate the subtypes of craniocervical dissociation and help guide treatment. Management of atlas fractures is dictated by transverse alar ligament integrity. Atlantoaxial dislocations are rotated, translated, or distracted and are treated with a rigid cervical orthosis or fusion. Treatment of odontoid fractures is controversial and dictated by fracture characteristics, patient comorbidities, and radiographic findings. Hangman's fractures of the axis are rarely treated surgically, but atypical patterns and displaced fractures may cause neurologic injury and should be reduced and fused. Management of injuries to the craniocervical junction remains challenging, but good outcomes can be achieved with a comprehensive plan that consists of accurate and timely diagnosis and stabilization of the craniocervical junction. PMID:25344597
The loss of cervical lordosis in radiographs of patients presenting with neck pain is sometimes ascribed to muscle spasm. We performed a cross-sectional study of the prevalence of 'straight' cervical spines in three populations: 83 patients presenting to an accident department with acute neck pain, 83 referred to a radiology department with chronic neck problems, and 80 radiographs from a
Cervical spine injury in maxillofacial trauma
Z. Lalani; K. M. Bonanthaya
Objective—To find out the incidence of associated facial injuries and injuries to the cervical spine. Design—Retrospective study. Setting—Teaching hospital, India. Subjects-536 patients treated for maxillofacial injuries between January 1992 and November 1993. Interventions—Review of hospital case notes and radiographs. Main outcome measures—Coexisting facial and cervical spine injuries, morbidity and mortality. Results—16 patients (3%) had sustained both facial and cervical spine
Evaluation of pediatric cervical spine injuries
Chris Baker; Howard Kadish; Jeff E Schunk
To compare historical features, clinical examination findings, and radiographic results among pediatric patients with cervical spine injury (CSI), a retrospective review of patients who were diagnosed with CSI was undertaken. Two main groups were identified: radiographically evident cervical spine injury (RESCI), and spinal cord injury without radiographic abnormality (SCIWORA). Demographic, historical, clinical, and radiographic information was obtained from patients' charts
Congenital Disorders of the Cervical Spine
Robert N. Hensinger
\\u000a Radiological interpretation of the infant's spine may be difficult and a clear understanding of its appearance at different\\u000a ages is essential if deformity and malalignment are to be recognized. Normal development of the cervical spine is discussed\\u000a in the section on cervical trauma.
Cervical Spine MRI in Abused Infants.
ERIC Educational Resources Information Center
Feldman, Kenneth W.; And Others
This study attempted to use cervical spine magnetic resonance imaging (MRI) to detect cord injury in 12 dead children with head injury from child abuse. Eighty percent of children autopsied had small cervical spine hemorrhages; MRI did not identify them and did not identify cord injury in any child studied, indicating that MRI scans are probably…
Cervical spine injuries from motor vehicle accidents
N. Yoganandan; D. J. Maiman; F. A. Pintar
The objective of the study was to delineate the critical regions of the human cervical spine and determine the mechanisms of injury in motor vehicle accidents (MVA). The clinical data were gathered from patient records. Results indicated that while neck injuries in MVA are complex and can occur at any level of the cervical spine, the craniocervical junction (among fatalities)
A possible cervical cause of low back pain: pelvic distortion
Brett M. Carr; Ronald J. Tyszkowski
Objective: to discuss the diagnosis and treatment of pelvic distortion related to cervical spine dysfunction in a patient with low back pain, as well as presenting a theoretical etiology.Clinical features: pelvic distortion is a disorder in which the ilia become counter-rotated on the sacrum. Our clinical experience suggests that it can arise from dysfunction in the cervical spine. It can
Multiple noncontiguous fractures of the cervical spine.
Shear, P; Hugenholtz, H; Richard, M T; Russell, N A; Peterson, E W; Benoit, B G; da Silva, V F
Multiple noncontiguous fracture-subluxations of the cervical spine are fractures and subluxations separated by at least one normal intervening cervical vertebra. A review of all 66 consecutive cervical spine fractures treated by the Division of Neurosurgery at the University of Ottawa during 26 consecutive months revealed six such cases (9%). These injuries are more common than previously recognized. Special consideration is required in their treatment because of the presence of a mobile intermediate segment in some of these patients. PMID:3367408
Pharyngoesophageal perforation 3 years after anterior cervical spine surgery: a rare case report and literature review.
Yin, Dan-Hui; Yang, Xin-Ming; Huang, Qi; Yang, Mi; Tang, Qin-Lai; Wang, Shu-Hui; Wang, Shuang; Liu, Jia-Jia; Yang, Tao; Li, Shi-Sheng
Pharyngoesophageal perforation after anterior cervical spine surgery is rare and the delayed cases were more rarely reported but potentially life-threatening. We report a case of pharyngoesophageal perforation 3 years after anterior cervical spine surgery. The patient presented with dysphagia, fever, left cervical mass and developing dyspnea 3 years after cervical spine surgery for trauma. After careful examinations, he underwent an emergency tracheostomy, neck exploration, hardware removal, abscess drainage and infected tissue debridement. 14 days after surgery, CT of the neck with oral contrast demonstrated no contrast extravasation from the esophagus. Upon review of literature, only 14 cases of pharyngoesophageal perforation more than 1 year after anterior cervical spine surgery were found. We discussed possible etiology, diagnosis and management and concluded that in cases of dysphagia, dyspnea, cervical pain, swelling and edema of the cervical area even long time after anterior cervical spine surgery, potential pharyngoesophageal damage should be considered. PMID:25559465
Vertebral artery injuries in cervical spine surgery
Schroeder, Gregory D.; Hsu, Wellington K.
Background: Vertebral artery injuries during cervical spine surgery are rare, but potentially fatal. When performing cervical spine surgery, it is imperative that the surgeon has a systematic approach for avoiding, and if necessary, dealing with a vertebral artery injury. Methods: This is a review paper. Results: Upper posterior cervical spine surgeries put the vertebral artery at the highest risk, as opposed to anterior subaxial cervical spine procedures, which put the artery at the least risk. A thorough understanding of the complex anatomy of the vertebral artery is mandatory prior to performing cervical spine surgery, and since the vertebral artery can have a variable course, especially in the upper cervical spine, the surgeon must minimize the possibility of an arterial injury by preoperatively assessing the artery with a computed tomography (CT) scan or magnetic resonance imaging (MRI). Intraoperatively, the surgeon must be aware of when the vertebral artery is most at risk, and take precautions to avoid an injury. In the event of an arterial injury, the surgeon must have a plan of action to (1) Achieve control of the hemorrhage. (2) Prevent acute central nervous system ischemia. (3) Prevent postoperative complications such as embolism and pseudoaneurysm Conclusion: Prior to performing cervical spine surgery, one must understand the four A's of vertebral artery injuries: Anatomy, Assessment, Avoidance, and Action. PMID:24340233
Trampoline Injuries of the Cervical Spine
Peter G. Brown; Mark Lee
Trampolines were responsible for over 6,500 pediatric cervical spine injuries in 1998. This represents a five-fold increase in just 10 years. While most have been minor, paraplegia, quadriplegia and death are all reported. We present 2 cases of trampoline-related cervical spine injury and review the relevant literature. Additionally, we examine the efforts made to reduce the incidence of trampoline injuries,
Pediatric cervical spine injuries: a comprehensive review
Martin Mortazavi; Pankaj A. Gore; Steve Chang; R. Shane Tubbs; Nicholas Theodore
Introduction Cervical spine injuries can be life-altering issues in the pediatric population. The aim of the present paper was to review\\u000a this literature.\\u000a \\u000a \\u000a \\u000a \\u000a Conclusions A comprehensive knowledge of the special anatomy and biomechanics of the spine of children is essential in diagnosis and treating\\u000a issues related to spine injuries.
Anatomical and functional perspectives of the cervical spine: Part I: the "normal" cervical spine †
McGregor, Marion; Mior, Silvano
This is the first of a three part series describing the clinical issues surrounding the radiographic assessment of the cervical spine. Defined in this literature review is the working definition of cervical stability. Described are the "normal" anatomical relationships between the cervical vertebrae for both the adult and the child, as portrayed by lateral radiographs. Also presented is a review of available documentation regarding the normal segmental function of the vertebrae in the upper and in the lower cervical spine. The next two parts in this series will deal with the definitions and radiographic evaluation of cervical hypermobility and instability respectively.
Anesthetic Implications of Chronic Disease of the Cervical Spine
nderstanding the anatomy of the cervical spine and its anatomical relationships to the airway has daily importance to the anesthesiologist. Particularly important considerations include the con- tribution of chronic abnormalities of the cervical spine to the \\
Preoperative Embolization of Cervical Spine Tumors
Vetter, Sylvia C.; Strecker, Ernst-Peter [Department of Radiology and Nuclear Medicine, Diakonissenkrankenhaus, Diakonissenstrasse 28, D-76199 Karlsruhe (Germany); Ackermann, Ludwig W.; Harms, Juergen [Department of Orthopedic Surgery, Klinikum Karlsbad-Langensteinbach Guttmannstrasse 1, D-76307 Karlsbad (Germany)
Purpose: To assess the technical success rate, complications, and effect on intraoperative blood loss of preoperative transarterial embolization of cervical spine tumors. Methods: A retrospective analysis was performed on 38 patients with tumors of the cervical spine; 69 vertebrae were affected. Polyvinyl alcohol particles, coils, gelfoam particles, either alone or in combination, were used for preoperative tumor embolization. After embolization a total of 57 corporectomies with titanium basket implantation were performed. Results: In 36 of 38 patients, complete (n= 27) or partial (n= 9) embolization was achieved. In 23 patients one vertebral artery was completely occluded by coil placement, and in one patient the ipsilateral internal and external carotid arteries were occluded in addition. No neurological complications could be directly related to the embolization, but two postoperative brain stem infarctions occurred. The mean intraoperative blood loss was 2.4 L. Conclusion: Transarterial embolization of cervical spine tumors is a safe and effective procedure to facilitate extensive surgery.
Analysis of the cervical spine alignment following laminoplasty and laminectomy
Shunji Matsunaga; Takashi Sakou; Kenji Nakanisi
Very little detailed biomechanical examination of the alignment of the cervical spine following laminoplasty has been reported. We performed a comparative study regarding the buckling-type alignment that follows laminoplasty and laminectomy to know the mechanical changes in the alignment of the cervical spine. Lateral images of plain roentgenograms of the cervical spine were put into a computer and examined using
Anterior plating of unstable cervical spine fractures
D C Mann; B W Braner; J S Keene; A B Levin; David Mann
Medical records and radiographs of 16 patients who had anterior decompression, bone grafting, and plating of grade III and IV (Allen 1982) unstable cervical spine injuries were reviewed. Surgery was performed within 15 days of injury, reductions were achieved and maintained at follow-up, and fusion occurred in all cases. Neurologic function stabilised or improved in all cases. However, 3 patients
Cervical spine response in frontal crash
Matthew B. Panzer; Jason B. Fice; Duane S. Cronin
Predicting neck response and injury resulting from motor vehicle accidents is essential to improving occupant protection. A detailed human cervical spine finite element model has been developed, with material properties and geometry determined a priori of any validation, for the evaluation of global kinematics and tissue-level response. Model validation was based on flexion\\/extension response at the segment level, tension response
Dendritic spine dysgenesis in neuropathic pain.
Tan, Andrew M; Waxman, Stephen G
Neuropathic pain is a significant unmet medical need in patients with variety of injury or disease insults to the nervous system. Neuropathic pain often presents as a painful sensation described as electrical, burning, or tingling. Currently available treatments have limited effectiveness and narrow therapeutic windows for safety. More powerful analgesics, e.g., opioids, carry a high risk for chemical dependence. Thus, a major challenge for pain research is the elucidation of the mechanisms that underlie neuropathic pain and developing targeted strategies to alleviate pathological pain. The mechanistic link between dendritic spine structure and circuit function could explain why neuropathic pain is difficult to treat, since nociceptive processing pathways are adversely "hard-wired" through the reorganization of dendritic spines. Several studies in animal models of neuropathic pain have begun to reveal the functional contribution of dendritic spine dysgenesis in neuropathic pain. Previous reports have demonstrated three primary changes in dendritic spine structure on nociceptive dorsal horn neurons following injury or disease, which accompany chronic intractable pain: (I) increased density of dendritic spines, particularly mature mushroom-spine spines, (II) redistribution of spines toward dendritic branch locations close to the cell body, and (III) enlargement of the spine head diameter, which generally presents as a mushroom-shaped spine. Given the important functional implications of spine distribution, density, and shape for synaptic and neuronal function, the study of dendritic spine abnormality may provide a new perspective for investigating pain, and the identification of specific molecular players that regulate spine morphology may guide the development of more effective and long-lasting therapies. PMID:25445354
78 FR 36306 - Proposed Information Collection (Neck (Cervical Spine) Conditions Disability Benefits...
Federal Register 2010, 2011, 2012, 2013, 2014
...Information Collection (Neck (Cervical Spine) Conditions Disability Benefits Questionnaire...a claimant's diagnosis of a cervical spine condition. DATES: Written comments and...Control No. 2900--NEW (Neck (Cervical Spine) Conditions Disability Benefits...
Minimally Invasive Surgery for Osteoid Osteoma of the Cervical Spine Using Microendoscopic Discectomy System
Yabuki, Shoji; Kikuchi, Shin-Ichi; Konno, Shin-Ichi
We report herein the case of an 18-year-old man who underwent endoscopic resection for an osteoid osteoma in the seventh cervical facet joint. The patient had experienced right neck pain for approximately one year, but no neurological abnormalities were noted. Cervical magnetic resonance imaging suggested an osteoid osteoma in the superior articular process of the seventh cervical vertebra. The tumor was resected microendoscopically. Operative time was 1 hour 29 minutes, and blood loss was 5 mL. During the two years since surgery, the patient has remained pain free with no cervical spine instability. We thus propose microendoscopic surgery for osteoid osteoma developing in a posterior element of the cervical spine is a potentially effective operative procedure. PMID:23741555
Biomechanics of the cervical spine Part 2. Cervical spine soft tissue responses and biomechanical modeling
Narayan Yoganandan; Srirangam Kumaresan; Frank A Pintar
Objective. The responses and contributions of the soft tissue structures of the human neck are described with a focus on mathematical modeling. Spinal ligaments, intervertebral discs, zygapophysial joints, and uncovertebral joints of the cervical spine are included. Finite element modeling approaches have been emphasized. Representative data relevant to the development and execution of the model are discussed. A brief description
Cervical Spine Surgery: An Historical Perspective
Vincenzo Denaro; Alberto Di Martino
Background Continued innovation in surgery requires a knowledge and understanding of historical advances with a recognition of successes\\u000a and failures.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes To identify these successes and failures, we selectively reviewed historical literature on cervical spine surgery with respect\\u000a to the development of (1) surgical approaches, (2) management of degenerative disc disease, and (3) methods to treat segmental\\u000a instability.\\u000a \\u000a \\u000a \\u000a \\u000a Methods We performed a nonsystematic
Cervical Spine Involvement: A Rare Manifestation of Reiter's Syndrome
Rastegar, Khodakaram; Ghalaenovi, Hossein; Babashahi, Ali; Shayanfar, Nasrin; Jafari, Mohammad; Jalalian, Mehrdad; Fattahi, Arash
Spine involvement is less common in Reiter's syndrome than in other seronegative spondyloarthropathies. Also, cervical spine involvement rarely occurs in Reiter's syndrome and other spondyloarthropathies. This paper reports a rare case of Reiter's syndrome in which there was cervical spine involvement that presented clinically as an atlanto-axial rotatory subluxation. Reiter's Syndrome (RS) is one of the most common types of seronegative spondyloarthropathies (SSAs) that presents clinically with a triad of symptoms, i.e., conjunctivitis, urethritis, and arthritis. This case highlighted the importance of radiographs of the lateral cervical spine and dynamic cervical imaging for all patients who have Reiter's syndrome with cervical spine symptoms to ensure that this dangerous abnormality is not overlooked. PMID:25360183
From less to maximally invasiveness in cervical spine surgery
Visocchi, M.; Conforti, G.; Roselli, R.; La Rocca, G.; Spallone, A.
Introduction Multilevel cervical myelopathy without surgical treatment is generally poor in the neurological deficit without surgical decompression. The two main surgical strategies used for the treatment of multilevel cervical myelopathy are anterior decompression via anterior corpectomy or posterior decompression via laminctomy/laminoplasty. Presentation of case We present the case of a 62 year-old lady, harboring rheumatoid artritis (RA) with gait disturbances, pain, and weakness in both arms. A C5 and C6 somatectomy, C4–C7 discectomy and, instrumentation and fusion with telescopic distractor "piston like", anterior plate and expandable screws were performed. Two days later the patient complained dysfagia, and a cervical X-ray showed hardware dislocation. So a C4 somatectomy, telescopic extension of the construct up to C3 with expandible screws was performed. After one week the patient complained again soft dysfagia. New cervical X-ray showed the pull out of the cranial screws (C3). So the third surgery "one stage combined" an anterior decompression with fusion along with posterior instrumentation, and fusion was performed. Discussion There is a considerable controversy over which surgical approach will receive the best clinical outcome for the minimum cost in the compressive cervical myelopathy. However, the most important factors in patient selection for a particular procedure are the clinical symptoms and the radiographic alignment of the spine. the goals of surgery for cervical multilevel stenosis include the restoration of height, alignment, and stability. Conclusion We stress the importance of a careful patients selection, and invocated still the importance for 360° cervical fixation. PMID:25734320
Flexion-extension cervical spine radiography in pediatric blunt trauma
William A. Woods; William J. Brady; Gary Pollock; Narendra Kini; Jeffrey S. Young
Ligamentous cervical injury may not be apparent when viewed with static cervical spine radiography (CSR). Dynamic (flexion-extension)\\u000a views of the cervical spine may aid in the identification of such injury. A retrospective descriptive study was carried out\\u000a between July 1, 1990, and June 30, 1994, in an academic emergency department averaging 60,000 patient visits (of which 20%\\u000a are pediatric) per
Micromechanics of Minor Cervical Spine Injuries
NASA Astrophysics Data System (ADS)
Niederer, Peter F.; Schmitt, Kai-Uwe; Muser, Markus H.; Walz, Felix H.
Minor soft tissue injuries of the cervical spine are of increasing significance in public health. They may in particular be associated with long-term impairment. Such injuries are observed primarily in rear-end automobile collisions at low impact speeds and are attributed to a "whiplash"-type event. The question with respect to injury mechanisms of the cervical spine in cases of impacts of a low severity have raised controversial views in the past. Among proposed injury mechanisms, interactions between fluid and solid structures have been postulated: Viscous shear stresses or pressure gradients which arise in the deforming anatomical structures may have an adverse influence, e. g., on cellular membranes. In this communication, mathematical modeling approaches are presented which allow for a quantification of fluid/solid interactions under typical loading conditions of interest here. It is found, that the shear stresses caused by fluids and acting on accelerated surfaces of fluid-filled bodies depend largely on the size of the fluid space under consideration. Accelerations exhibit a stronger influence than their duration. It cannot be excluded that critical levels are reached even in a low speed impact scenario.
Return to play after cervical spine injury in sports.
Cantu, Robert C; Li, Yan Michael; Abdulhamid, Mohamed; Chin, Lawrence S
Spinal cord injuries (SCIs) resulting from sports now represent 8.9% of the total causes of SCI. Regardless of cause, there are bound to be return-to-play decisions to be made for athletes. Since catastrophic cervical spine injuries are among the most devastating injuries in all of sports, returning from a cervical spine injury is one of the most difficult decisions in sports medicine. Axial loading is the primary mechanism for catastrophic cervical spine injuries. Axial loading occurs as a result of intentional or unintentional head-down contact and spearing. Most would agree that the athlete returning to a contact or collision sport after a cervical spine injury must be asymptomatic, have full strength, and have full active range of motion; however, each situation is unique. The following review discusses the pathophysiology of these conditions and suggests guidelines for return to contact sports after traumatic cervical SCI. PMID:23314078
Bevilaqua-Grossi, Débora; Chaves, Thaís Cristina; de Oliveira, Anamaria Siriani
Aim: The purpose of this study was to assess in a sample of female community cases the relationship between the increase of percentage of cervical signs and symptoms and the severity of temporomandibular disorders (TMD) and vice-versa. Material and Methods: One hundred women (aged 18-26 years) clinically diagnosed with TMD signs and symptoms and cervical spine disorders were randomly selected from a sample of college students. Results: 43% of the volunteers demonstrated the same severity for TMD and cervical spine disorders (CSD). The increase in TMD signs and symptoms was accompanied by increase in CSD severity, except for pain during palpation of posterior temporal muscle, more frequently observed in the severe CSD group. However, increase in pain during cervical extension, sounds during cervical lateral flexion, and tenderness to palpation of upper fibers of trapezius and suboccipital muscles were observed in association with the progression of TMD severity. Conclusion: The increase in cervical symptomatology seems to accompany TMD severity; nonetheless, the inverse was not verified. Such results suggest that cervical spine signs and symptoms could be better recognized as perpetuating rather than predisposing factors for TMD. PMID:19089141
Tumoral calcinosis involving the cervical spine
Sasaki, Osamu; Nakamura, Kimihiko; Nashimoto, Takeo; Shibuya, Hiroyuki
Background: Tumoral calcinosis (TC) is a disease of unknown etiology characterized by the presence of calcified masses in the juxta-articular regions of the extremities. Involvement of the cervical spine is very rare. In this report, the characteristics of TC of the cervical spine, including the clinical presentation, radiographic features, and surgical management are discussed. Case Description: A 90-year-old healthy female suffering from numbness of the upper extremities for 3 months presented with a 2-week history of progressive weakness of the lower extremities. A neurological examination revealed mild weakness and sensory impairment of the bilateral upper and lower extremities. Computed tomography (CT) scans demonstrated amorphous calcified masses posterior to the spinous process that extended into the interlaminar spaces of C3/4 and C4/5. The masses involved the posterior elements of C3-C4. Interestingly, CT scans performed 4 years earlier showed subtle calcification of a yellow ligament at C3/4 and C4/5. However, neither calcified masses nor bone erosion were observed. On magnetic resonance (MR) imaging, the mass showed hypointensity on T1- and T2-weighted images. The lesion was compressing the spinal cord and was resected surgically. The pathological findings were consistent with those of TC. The natural history of TC is not understood. However, this case suggests that calcified masses may progress within several years and that the bone around the mass may be involved. Postoperatively, residual masses may disappear spontaneously, while new bone is formed in the erosive lamina and facet. Conclusion: The treatment of choice for TC, if the lesion causes progressive symptoms, is surgical resection.
Gout Initially Mimicking Rheumatoid Arthritis and Later Cervical Spine Involvement
Nunes, Eduardo Araújo Santana; Rosseti, Adroaldo Guimarăes; Ribeiro, Daniel Sá; Santiago, Mittermayer
Gout is clinically characterized by episodes of monoarthritis, but if not treated properly, it can lead to a chronic polyarthritis, which may eventually mimic rheumatoid arthritis (RA). We present the case of a 59-year-old man, with a history of symmetrical polyarthritis of the large and small joints with later development of subcutaneous nodules, which was initially misdiagnosed as RA, being treated with prednisone and methotrexate for a long period of time. He complained of occipital pain and paresthesia in his left upper limb, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of an expansive formation in the cervical spine with compression of the medulla. He was admitted for spinal decompressive surgery and the biopsy specimen demonstrated a gouty tophus. Chronic gout can mimic RA and rarely involves the axial skeleton, and thus its correct diagnosis and the implementation of adequate therapy can halt the development of such damaging complications. PMID:25574418
A delayed diagnosis of bilateral facet dislocation of the cervical spine: a case report
O'Shaughnessy, Julie; Grenier, Julie-Marthe; Stern, Paula J.
Objective: To review the case of a patient suffering from bilateral facet dislocation of the cervical spine. Clinical features: A 53-year-old male was involved in a car accident and was transported to the hospital. Cervical radiographs were taken at the emergency department and interpreted as normal. Four days later, he consulted a chiropractor where radiographs of the cervical spine were repeated. The examination revealed bilateral cervical facet joint dislocation at C5–C6 as well as a fracture involving the spinous process and laminae of C6. Intervention and outcome: The patient was referred to the hospital and underwent surgery. Conclusion: Patients involved in motor vehicle accidents often consult chiropractors for neck pain treatment. A high index of suspicion due to significant history and physical examination findings should guide the clinician in determining the need for reviewing the initial radiographs (if taken and available) or request repeat studies, regardless of the initial imaging status. PMID:24587496
Prevalence of cervical spine injuries in patients with facial trauma
Wolfgang Hackl; Karin Hausberger; Romed Sailer; Hanno Ulmer; Robert Gassner
Objective: Injuries to the spine may accompany facial trauma. By using a large computerized database the goal of this case control study was to assess the association between facial and cervical spine injuries among patients sustaining facial trauma. Study Design: During a period of 4 years (1995 to 1998) 3083 patients, 10 years or older, with facial injuries were admitted
Addressing the myths of cervical spine injury management
Michael E Ivy; Stephen M Cohn
Every year in the United States about 5,000 people sustain a cervical spinal cord injury. Vastly greater numbers present to hospitals after motor vehicle crashes and falls with potential cervical spine injuries (CSI) for evaluation. This group of patients requires very careful management while undergoing evaluation for potential CSI to minimize the potential for spinal cord injury. It is, therefore,
Cervical uncinate process: an anatomic study for anterior decompression of the cervical spine
J. Lu; N. A. Ebraheim; H. Yang; M. Skie; R. A. Yeasting
Morphometric evaluation of 54 dry cervical spines from C3 to C7 (a total of 270 cervical vertebrae) was performed to determine the bony boundaries of the uncinate process for resection of the uncinate process for access to posterolateral osteophytes or herniated disks at the time of anterior cervical diskectomy. The uncinate processes were significantly higher (p < 0.01) at the
Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study
Background To describe MRI and clinical findings in patients with juvenile idiopathic arthritis with cervical spine involvement at onset and follow-up under therapy. Methods 13 patients with signs of cervical spine involvement in juvenile idiopathic arthritis with a median disease duration of 1.7 years were included in the study. Clinical records and MR images were retrospectively analyzed according to symptoms and findings concerning the cervical spine. Results At the onset of cervical spine involvement all patients showed limited range of motion, whereas only 5 of them complained of pain. In MR images joint hyperintensity, contrast enhancement, malalignment, ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction were found at 28, 32, 15, 2, 2 and 3 sites in 12 (93%), 13 (100%), 8 (62%), 2 (15%), 2 and 3 (20%) patients respectively. 3 of the 5 patients with pain (60%) showed ankylosis, erosions or narrowing of the spinal canal at cranio-cervical junction on MRI. At follow-up - after a median disease duration of cervical spine arthritis of 2.1 years and a variable duration of treatment with methotrexate (all patients) and biological agents (12 patients) - joint hyperintensity, enhancement and malalignment decreased to 15, 19 and 6 sites in 10 (77%), 11 (85%) and 3 (20%) patients respectively whereas ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction increased to 7, 6 and 4 sites in 3 (20%), 4 (31%) and 4 patients respectively. Pain was no longer reported, but 9 of 13 (69%) patients still had a limited range of motion with 6 of them (46%) showing skeletal changes on MRI. Conclusions This first MRI based follow-up study shows that cervical spine arthritis can follow a severe disease course in juvenile arthritis. While malalignments and inflammation sites decreased osseous changes with erosions, ankylosis, and narrowing of the spinal canal increased under treatment despite only minor subjective complaints. Therefore close MRI monitoring of these patients appears to be reasonable. PMID:24593886
Anterolisthesis and retrolisthesis of the cervical spine in cervical spondylotic myelopathy in the elderly
Motohiro Kawasaki; Toshikazu Tani; Takahiro Ushida; Kenji Ishida
Background Degenerative spondylolisthesis of the cervical spine has received insufficient attention in contrast to that of the lumbar\\u000a spine. The authors analyzed the functional significance of anterior and posterior degenerative spondylolisthesis (anterolisthesis\\u000a and retrolisthesis) of the cervical spine to elucidate its role in the development of cervical spondylotic myelopathy (CSM)\\u000a in the elderly.\\u000a \\u000a \\u000a \\u000a Methods A total of 79 patients aged 65 or
Assessment of spine pain presence in children and young persons studying in ballet schools
Wójcik, Ma?gorzata; Siatkowski, Idzi
[Purpose] Spine disorders affect various sections of the spine and have a variety of causes. Most pain occurs in the lumbo-sacral and cervical regions. Dance is associated with exercise. High levels of physical activity predispose to back pain occurrence. [Subjects and Methods] The subjects were 237 ballet learners; 80 children (primary school level), mean age 11.24±0.77, mean of years of training ballet 2.14±0.74; 93 students (junior high school level), mean age 14.01±0.84, mean of years of learning ballet 4.64±1.24; 64 students (high school) mean age 17.01±0.77, mean of years of learning ballet 7.47±1.54. Numeric rating scale was used to determine spine pain. [Results] Feelings of pain were analyzed on the basis of "now" and "before" between levels education by using point statistics and statistical tests to compare groups. "Now" exhibited weaker back pain feelings than "before" at all the education levels. There were statistically significant differences in pain feeling for "before" (at any time of learning) and "now" (the day of survey). [Conclusion] All patients reported pain "before" and "now" in cervical, thoracic and lumbar spine. At all levels of education there were statistically significant differences in feelings of pain between "before" and "now". PMID:25995566
Cervical spine injury in dismounted improvised explosive device trauma
Taddeo, Joseph; Devine, Maj Melissa; McAlister, LCol Vivian C.
Background The injury pattern from improvised explosive device (IED) trauma is different if the target is in a vehicle (mounted) or on foot (dismounted). Combat and civilian first response protocols require the placement of a cervical collar on all victims of a blast injury. Methods We searched the Joint Theatre Trauma Registry (JTTR) and the Role 3 Hospital, Kandahar Airfield (KAF) database from Mar. 1, 2008, to May 31, 2011. We collected data on cervical fracture; head injury; traumatic amputation; initial blood pressure, pulse, injury severity score (ISS), Glasgow Coma Scale (GCS) score and base excess; and patient demographic information. Results The concordance rate between JTTR and KAF databases was 98%. Of the 15 693 admissions in JTTR, 326 patients with dismounted IED injuries were located. The rate of cervical collar prehospital placement was 7.6%. Cervical fractures were found in 19 (5.8%) dismounted IED victims, but only 4 (1.2%) were considered radiographically unstable. None of these 19 patients had prehospital placement of a collar. Patients with cervical spine fractures were more severely injured than those without (ISS 18.2 v. 13.4; GCS 10.1 v. 12.5). Patients with head injuries had significantly higher risk of cervical spine injury than those with no head injury recorded (13.6% v. 3.9%). No differences in frequency of cervical spine injury were found between patients who had associated traumatic amputations and those who did not (5.4% v. 6.0%). Conclusion Dismounted IED is a mechanism of injury associated with a low risk for cervical spine trauma. A selective protocol for cervical collar placement on victims of dismounted IED blasts is possible and may be more amenable to combat situations. PMID:26100769
Study on Cervical Spine Stresses Based on Three-Dimensional Finite Element Method
Zhang Lian-jie; Meng Qing-jun
To establish three dimensional finite element model of the whole cervical spine and investigate biomechanical characteristic of the human cervical spine for application of clinical diagnosis and therapy. Method: A healthy adult female was subjected, three dimensional finite element model of the whole cervical spine was established using the method of 3D interpolation with CT. Result: The model included seven
Radiographic Clearance of Blunt Cervical Spine Injury: Plain Radiograph or Computed Tomography Scan?
Margaret M. Griffen; Eric R. Frykberg; Andrew J. Kerwin; Miren A. Schinco; Joseph J. Tepas; Kathleen Rowe; Jennifer Abboud
Background: The purpose of this study was to evaluate the roles of cervical spine radiographs (CSR) and computed tomography of the cervical spine (CTC) in the exclusion of cervical spine injury for adult blunt trauma patients. Methods: At the authors' institution, all adult blunt trauma patients with phys- ical findings of posterior midline neck ten- derness, altered mental status, or
[Initial clinical experiences with the cervical spine titanium locking plate].
Arnold, W
The titanium CS (cervical spine) locking plate is a system that takes account not only of biochemical aspects, in the choice of material, but also new biomechanical aspects. With the help of a new hollow screwing system, such stability is achieved that in many cases there is no need for a second, dorsal, operation. Ten patients, most of whom had unstable fractures, have so far been treated. No complications attributable to this implantation system were observed. A further step in the attainment of security and stability by operative treatment of cervical spine disorders has been achieved with this system. PMID:2281326
Lateral Mass Fixation in the Subaxial Cervical Spine.
Kurd, Mark F; Millhouse, Paul W; Schroeder, Gregory D; Kepler, Christopher K; Vaccaro, Alexander R
The use of lateral mass screws and rods in the subaxial spine has become the standard method of fixation for posterior cervical spine fusions. Multiple techniques have been described for the placement of lateral mass screws, including the Magerl, the Anderson, and the An techniques. While these techniques are all slightly different, the overall goal is to obtain solid bony fixation while avoiding the neurovascular structures. The use of lateral mass screws has been shown to be a safe and effective technique for achieving a posterior cervical fusion. PMID:26049972
Cervical spine surgery in the ancient and medieval worlds.
Goodrich, James Tait
The early historical literature on cervical spine surgery lacks printed material for review, and we can rely only on pathological material from the prehistoric period that has survived as a result of anthropological investigations. After the introduction of Egyptian and early Hellenic medicine, some written material became available. This paper reviews these materials, from both books and manuscripts, in an effort to understand the development of cervical spine surgery from the perspectives of the personalities involved and the early surgical practices used. The review thus considers the following five eras of medicine: 1) prehistoric; 2) Egyptian and Babylonian; 3) Greek and early Byzantine; 4) Middle Eastern; and 5) medieval. PMID:17961063
A Validated Classification for External Immobilization of the Cervical Spine
Holla, Micha; Huisman, Joske M. R.; Hosman, Allard J. F.
Study Design?Interobserver and intraobserver reliability study. Objective?The aim of this study is to validate a new classification system of external cervical spine immobilization devices by measuring the interobserver and intraobserver agreement. Methods?A classification system, with five main categories, based on the anatomical regions on which the device supports, was created. A total of 28 independent observers classified 50 photographs of different devices, designed to immobilize the cervical spine according to the new proposed classification system. At least 2 weeks later, the same devices were classified again in a new random order. Before and after the classification, all the participants answered questions about the usefulness of the proposed classification. Results?The mean interobserver and intraobserver agreement Fleiss' kappa was 0.88 and 0.91, respectively. Both are, according to the interpretation described by Landis and Koch, "almost perfect." A majority of the participators answered that they needed a classification (89%) and considered the classification to be clear (96%). All the participants considered the classification to be useful in clinical practice. Conclusion?This study showed that the new classification of external cervical spine immobilizers, based on anatomical support areas, has an excellent interobserver and intraobserver agreement. Furthermore, the study participants considered the proposed classification to be clear and useful in clinical practice. As the majority of patients with cervical spine injuries are treated with external immobilization devices, this new classification system can improve the closed treatment of cervical spine injuries in daily clinical practice. Furthermore, it makes reproducible comparisons between groups possible, which are essential for further evolution of evidence-based spine care. PMID:24436704
Cervical uncinate process: an anatomic study for anterior decompression of the cervical spine
J. Lu; N. A. Ebraheim; H. Yang; M. Skie; R. A. Yeasting
Summary Morphometric evaluation of 54 dry cervical spines from C3 to C7 (a total of 270 cervical vertebrae) was performed to determine the bony boundaries of the uncinate process for resection of the uncinate process for access to posterolateral osteophytes or herniated disks at the time of anterior cervical diskectomy. The uncinate processes were significantly higher (p<0.01) at the C4
Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries
Hong, Rick; Meenan, Molly; Prince, Erin; Murphy, Ronald; Tambussi, Caitlin; Rohrbach, Rick; Baumann, Brigitte M
Introduction We wanted to compare 3 existing emergency medical services (EMS) immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based); the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria); and the Hankins' criteria (immobilization for patients <12 or >65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness).To determine the proportion of patients who would require cervical immobilization per protocol and the number of missed cervical spine injuries, had each protocol been followed with 100% compliance. Methods This was a cross-sectional study of patients ?18 years transported by EMS post-traumatic mechanism to an inner city emergency department. Demographic and clinical/historical data obtained by physicians were recorded prior to radiologic imaging. Medical record review ascertained cervical spine injuries. Both physicians and EMS were blinded to the objective of the study. Results Of 498 participants, 58% were male and mean age was 48 years. The following participants would have required cervical spine immobilization based on the respective protocol: PHTLS, 95.4% (95% CI: 93.1–96.9%); Domeier, 68.7% (95% CI: 64.5–72.6%); Hankins, 81.5% (95% CI: 77.9–84.7%). There were 18 cervical spine injuries: 12 vertebral fractures, 2 subluxations/dislocations and 4 spinal cord injuries. Compliance with each of the 3 protocols would have led to appropriate cervical spine immobilization of all injured patients. In practice, 2 injuries were missed when the PHTLS criteria were mis-applied. Conclusion Although physician-determined presence of cervical spine immobilization criteria cannot be generalized to the findings obtained by EMS personnel, our findings suggest that the mechanism-based PHTLS criteria may result in unnecessary cervical spine immobilization without apparent benefit to injured patients. PHTLS criteria may also be more difficult to implement due to the subjective interpretation of the severity of the mechanism, leading to non-compliance and missed injury. PMID:25035754
Magnetic Resonance Imaging of the Cervical, Thoracic, and Lumbar Spine in Children: Spinal Incidental Findings in Pediatric Patients
Ramadorai, Uma E.; Hire, Justin M.; DeVine, John G.
Study Design?Retrospective case series. Objective?To determine the rate of spinal incidental findings on magnetic resonance imaging (MRI) of the cervical, thoracic, and lumbar spine in the pediatric population. Methods?We reviewed MRI imaging of the neuraxial spine in patients less than 18 years of age and documented abnormal spinal findings. We then reviewed the charts of these patients to determine the reason for ordering the study. Those who presented with pain were considered symptomatic. Those who had no presenting complaint were considered asymptomatic. The data were analyzed to break down the rate of spinal incidental findings in the cervical, thoracic, and lumbar spine, respectively. Results?Thirty-one of the 99 MRIs had positive findings, with the most common being disk protrusion (51.6%). Spinal incidental findings were most common in the lumbar spine (9.4%) versus the cervical spine (8%) or thoracic spine (4.7%). In this group, Schmorl nodes and disk protrusion were the two most common findings (37.5% each). Other spinal incidental findings included a vertebral hemangioma and a Tarlov cyst. In the thoracic spine, the only spinal incidental finding was a central disk protrusion without spinal cord or nerve root compression. Conclusion?MRI is a useful modality in the pediatric patient with scoliosis or complaints of pain, but the provider should remain cognizant of the potential for spinal incidental findings. PMID:25396102
Magnetic resonance imaging of the cervical, thoracic, and lumbar spine in children: spinal incidental findings in pediatric patients.
Ramadorai, Uma E; Hire, Justin M; DeVine, John G
Study Design?Retrospective case series. Objective?To determine the rate of spinal incidental findings on magnetic resonance imaging (MRI) of the cervical, thoracic, and lumbar spine in the pediatric population. Methods?We reviewed MRI imaging of the neuraxial spine in patients less than 18 years of age and documented abnormal spinal findings. We then reviewed the charts of these patients to determine the reason for ordering the study. Those who presented with pain were considered symptomatic. Those who had no presenting complaint were considered asymptomatic. The data were analyzed to break down the rate of spinal incidental findings in the cervical, thoracic, and lumbar spine, respectively. Results?Thirty-one of the 99 MRIs had positive findings, with the most common being disk protrusion (51.6%). Spinal incidental findings were most common in the lumbar spine (9.4%) versus the cervical spine (8%) or thoracic spine (4.7%). In this group, Schmorl nodes and disk protrusion were the two most common findings (37.5% each). Other spinal incidental findings included a vertebral hemangioma and a Tarlov cyst. In the thoracic spine, the only spinal incidental finding was a central disk protrusion without spinal cord or nerve root compression. Conclusion?MRI is a useful modality in the pediatric patient with scoliosis or complaints of pain, but the provider should remain cognizant of the potential for spinal incidental findings. PMID:25396102
Missed upper cervical spine fracture: clinical and radiological considerations
Hadida, Camille; Lemire, Joe J
Objective: This report presents a case of missed upper cervical spine fracture following a motor vehicle accident and illustrates various clinical and radiographic considerations necessary in the evaluation of post traumatic cervical spine injuries. Specific clinical signs and symptoms, as well as radiographic clues should prompt the astute clinician to suspect a fracture even when plain film radiographs have been reported as normal. Clinical features: A 44-year-old male was referred for an orthopaedic consultation for assessment of headaches following a high speed head-on motor vehicle accident eleven weeks prior to his presentation. Cervical spine radiographs taken at an emergency ward the day of the collision were reported as essentially normal. Subsequent radiographs taken eleven weeks later revealed a fracture through the body of axis with anterior displacement of atlas. A review of the initial radiographs clearly demonstrated signs suggesting an upper cervical fracture. Intervention and outcome: Initially the patient was prescribed a soft collar which he wore daily until an orthopaedic consultation eleven weeks later. Fifteen weeks following trauma, the patient was considered for surgical intervention, due to persistent headaches associated with the development of neurological signs suggestive of early onset of cervical myelopathy. Conclusion: Cervical spine fractures can have disastrous consequences if not detected early. A thorough clinical and radiological evaluation is essential in any patient presenting with a history of neck or head trauma. Repeated plain film radiographs are imperative in the event of inadequate visualization of the cervical vertebrae. When in doubt, further imaging studies such as computed tomography or magnetic resonance imaging are required to rule out a fracture. ImagesFigure 1AFigure 1BFigure 2Figure 3
Successful treatment of severe sympathetically maintained pain following anterior spine surgery.
Woo, Jae Hee; Park, Hahck Soo
Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion block with a significant relief of his pain. The second patient complained of a cold sensation and severe unexpected pain in the lower extremity of the contralateral side after anterior lumbar interbody fusion and was treated with lumbar sympathetic block. We aimed to describe sympathetically maintained pain as one of the important causes of early postoperative pain and the treatment option chosen for these cases in detail. PMID:25289130
Successful Treatment of Severe Sympathetically Maintained Pain Following Anterior Spine Surgery
Woo, Jae Hee
Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion block with a significant relief of his pain. The second patient complained of a cold sensation and severe unexpected pain in the lower extremity of the contralateral side after anterior lumbar interbody fusion and was treated with lumbar sympathetic block. We aimed to describe sympathetically maintained pain as one of the important causes of early postoperative pain and the treatment option chosen for these cases in detail. PMID:25289130
Closed cervical spine trauma associated with bilateral vertebral artery injuries
P. Kloen; J. D. Patterson; B. I. Wintman; R. M. Ozuna; G. W. Brick
Bilateral vertebral artery injuries in closed cervical spine injuries are uncommon, but early recognition and treatment are important to prevent neurological deterioration. A case of bilateral vertebral injuries in a 35-year-old motor vehicle accident victim is presented, and the current literature is reviewed.
Chondrosarcoma of the cervical spine: A case report
O. Dejean; Ph. Hardy; M. Stromboni; A. Lortat-Jacob; J. Benoit
Summary Among spinal bone tumors, chondrosarcoma occupies the third rank after myeloma and chordoma. Its location in the cervical spine is exceptional. The authors report a case of this lesion involving C7. This new case illustrates well the therapeutic and diagnostic difficulties of this tumor site at the cervico-thoracic level. The radiologic and histologic aspects do not differ from these
Some borderlands of the cervical spine. Pt. 2
Kattan, K.R.; Pais, M.J.
The complexity of the structure of the cervical spine as well superimposition by the parts of adjacent vertebrae, as well as other structures may cause some abnormalities to be overlooked. Among those abnormalities are, the short sagittal diameter, neoplasm in the cancellous part of the vertebral bodies, spurs in the apophyseal joints, trauma, infection and others.
Collegiate Football Players Display More Active Cervical Spine Mobility Than High School Football Players
Johnson, Darren
Objectives: To compare the active cervical spine range of motion and resting cervical spine alignment (sagittal plane) of collegiate and high school football players using the Cervical Range of Motion (CROM) Measurement System and to identify normative values for these populations. Design and Setting: A 2 × 7 factorial design for main effects was used to evaluate the influence of level of play (college, high school) on the cervical spine range of motion of football players. Data were collected during preparticipation physical examinations. Subjects: A convenience sample of 189 unimpaired collegiate (n = 70, age = 19.5 ± 1.5 years) and high school (n = 119, age = 15.7 ± 1.4 years) football players participated. Measurements: Subjects were measured for active cervical spine range of motion using the CROM system and the manufacturer's recommended measurement techniques. Results: Collegiate football players had increased active cervical spine range of motion for flexion, extension, left cervical rotation, and left lateral flexion (overall mean increase = 4.3 ± 2°) compared with high school players. Collegiate players also assumed a more flexed resting sagittal-plane cervical spine posture (P = .001). Conclusions: Collegiate players generally displayed greater active cervical spine range of motion than high school players. The increased resting sagittal-plane cervical spine flexion alignment we report among the collegiate players suggests a change in the natural cervical spine lordosis, possibly due to a neutral-zone shift associated with combined increases in lower cervical spine flexion and upper cervical spine extension as an adaptation to football training or playing. Further study using radiographic or magnetic resonance imaging techniques is warranted. The CROM system is a useful tool for identifying aggregate hypomobile or hypermobile active cervical spine mobility among football players that might otherwise remain unrecognized during standard preparticipation physical examinations. In combination with manual segmental assessments of passive accessory intervertebral movements, CROM enables early identification of players with impaired or excessive cervical spine mobility, thus facilitating proactive injury-prevention intervention. PMID:15173865
Visuo-proprioceptive interactions in degenerative cervical spine diseases requiring surgery.
Freppel, S; Bisdorff, A; Colnat-Coulbois, S; Ceyte, H; Cian, C; Gauchard, G; Auque, J; Perrin, P
Cervical proprioception plays a key role in postural control, but its specific contribution is controversial. Postural impairment was shown in whiplash injuries without demonstrating the sole involvement of the cervical spine. The consequences of degenerative cervical spine diseases are underreported in posture-related scientific literature in spite of their high prevalence. No report has focused on the two different mechanisms underlying cervicobrachial pain: herniated discs and spondylosis. This study aimed to evaluate postural control of two groups of patients with degenerative cervical spine diseases with or without optokinetic stimulation before and after surgical treatment. Seventeen patients with radiculopathy were recruited and divided into two groups according to the spondylotic or discal origin of the nerve compression. All patients and a control population of 31 healthy individuals underwent a static posturographic test with 12 recordings; the first four recordings with the head in 0° position: eyes closed, eyes open without optokinetic stimulation, with clockwise and counter clockwise optokinetic stimulations. These four sensorial situations were repeated with the head rotated 30° to the left and to the right. Patients repeated these 12 recordings 6weeks postoperatively. None of the patients reported vertigo or balance disorders before or after surgery. Prior to surgery, in the eyes closed condition, the herniated disc group was more stable than the spondylosis group. After surgery, the contribution of visual input to postural control in a dynamic visual environment was reduced in both cervical spine diseases whereas in a stable visual environment visual contribution was reduced only in the spondylosis group. The relative importance of visual and proprioceptive inputs to postural control varies according to the type of pathology and surgery tends to reduce visual contribution mostly in the spondylosis group. PMID:24120556
Neck Pain (Cervical Strain) COMMON CAUSES
Virginia Tech
, such a sport injury or motor vehicle accident. More common and less dramatic causes include reaching or pulling trauma to head occurred or headache is severe. This side effect will resolve in time. Most injuriesNeck Pain (Cervical Strain) COMMON CAUSES: Neck pain may be triggered by a specific event
Cervical spine locking plate: in vitro biomechanical testing.
Smith, S A; Lindsey, R W; Doherty, B J; Alexander, J W; Dickson, J H
The AO cervical spine locking plate (CSLP) for anterior subaxial fixation was recently received increasing clinical acclaim, yet to date the in vitro mechanical properties of this implant have not been reported. To determine the in vitro biomechanical properties of this device, five fresh human cadaver cervical spines were subjected to nondestructive testing in flexion and torsion in three stages: stage 1: intact spine; stage 2: destabilized spine; stage 3: destabilized spine with CSLP. Stage 3 specimens were also subjected to large angular displacement testing to assess the integrity of the fixation. In flexion, mean spinous process displacement was 1.21 mm for stage 1, 3.19 mm for stage 2, and 1.37 mm, for stage 3. Mean torsional stiffness was 2.86 Nm/degree in stage 1, 1.82Nm/degree in stage 2, and 2.20Nm/degree in stage 3. Large angular displacement testing in stage 3 resulted in screw loosening from the bone in two specimens; no screw plate loosening occurred. In our severely destabilized in vitro model, the CSLP restored flexion stability but not rotational stability. This suggests that supplemented bracing or fixation may be required to restore torsional stability. PMID:20054921
Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis
Christoph-E Heyde; Johannes K Fakler; Erik Hasenboehler; Philip F Stahel; Thilo John; Yohan Robinson; Sven K Tschoeke; Ralph Kayser
Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific
... or hand. It can detect fractures in the cervical vertebrae or dislocation of the joints between the vertebrae. It's commonly done after someone has been in an automobile or other accident and has had an injury to the head, neck, or back, especially if ...
Osteoid osteoma of the cervical spine: surgical treatment or percutaneous radiofrequency coagulation?
Albisinni, U.; Alfonso, C.; Zappoli, F. A.
Osteoid osteoma (OO) of the cervical spine is frequently located close to the vertebral artery, spinal cord, or nerve roots and complete surgical excision is sometimes difficult by a limited approach and more extended surgery can require spinal fusion. Percutaneous radiofrequency coagulation (PRC) has demonstrated efficacy in the treatment of OO of the pelvis and limbs however, its role in the cervical spine is still nuclear. The Authors present a series of nine cases of OO of the cervical spine, six treated with surgical excision and three with PRC. No neurological or vascular complications occurred in both series. One case of the surgical series had only partial relief of persistent pain for 1 year due to incomplete excision, but is doing well 4 years after surgery. All the other surgical cases had complete relief of symptoms immediately after surgery and are symptom-free 3–10 years later. Two cases of PRC had complete relief of symptoms 24–48 h after surgery and are symptom-free 2 and 3 years later. One case of recurrent OO after surgery and treated with PRC with a reduced dose improved only, and still requires anti-inflammatory drugs 2 years after the procedure. Our still limited experience suggests that PRC can be safely performed in local anaesthesia with the patient awake, enabling to check for signs and symptoms of possible neurological injury. PRC can substitute extensive posterior approaches and reconstructions for OO of the posterior arch and joint pillar. PMID:17874147
Virchow's Triad and spinal manipulative therapy of the cervical spine
Symons, Bruce P; Westaway, Michael
The objective of this review paper is to borrow Virchow's Triad as a conceptual framework to examine the state of the art in research on thrombosis, specifically in the vertebrobasilar system as a consequence of high velocity, low amplitude spinal manipulation of the cervical spine. A revised Virchow's Triad is presented which emphasizes the interactions between various risk factors, as a tool for clinicians and researchers to use in their analyses of vertebrobasilar stroke. Endothelial injury, abnormal blood flow and hypercoagulability are discussed.
Tension-band laminoplasty of the cervical spine
N. Tsuzuki; R. Abe; K. Saiki; T. Iizuka
Summary. A new laminoplasty of the cervical spine has been developed using preserved ligaments as a tension-band. The laminae were\\u000a enlarged in an open-door fashion and spacers inserted to maintain the spinolaminoligamentous complex intact. The stretched\\u000a ligaments exerted a tension-band effect on the spacers and stabilised them so that neck movements could be started as soon\\u000a as bleeding stopped. The
Pediatric cervical spine trauma imaging: a practical approach
Alexia M. Egloff; Nadja Kadom; Gilbert Vezina; Dorothy Bulas
Cervical spine trauma in children is rare and the diagnosis can be challenging due to anatomical and biomechanical differences\\u000a as compared to adults. A variety of algorithms have been used in adults to accurately diagnose injuries, but have not been\\u000a fully studied in pediatric patients. In this article we review suggested imaging protocols and the general characteristics,\\u000a types of injuries,
Mortality in Elderly Patients After Cervical Spine Fractures
Harris, Mitchel B.; Reichmann, William M.; Bono, Christopher M.; Bouchard, Kim; Corbett, Kelly L.; Warholic, Natalie; Simon, Josef B.; Schoenfeld, Andrew J.; Maciolek, Lawrence; Corsello, Paul; Losina, Elena; Katz, Jeffrey N.
Background: Despite an increased risk of cervical spine fractures in older patients, little is known about the mortality associated with these fractures and there is no consensus on the optimal treatment. The purposes of this study were to determine the three-month and one-year mortality associated with cervical spine fractures in patients sixty-five years of age or older and to evaluate potential factors that may influence mortality. Methods: We performed a retrospective review of all cervical spine fractures in patients sixty-five years of age or older from 1991 to 2006 at two institutions. Information regarding age, sex, race, treatment type, neurological involvement, injury mechanism, comorbidity, and mortality were collected. Overall risk of mortality and mortality stratified by the above factors were calculated at three months and one year. Cox proportional-hazard regression was performed to identify independent correlates of mortality. Results: Six hundred and forty patients were included in our analysis. The mean age was eighty years (range, sixty-five to 101 years). Two hundred and ninety-four patients (46%) were male, and 116 (18%) were nonwhite. The risk of mortality was 19% at three months and 28% at one year. The effect of treatment on mortality varied with age at three months (p for interaction = 0.03) but not at one year (p for interaction = 0.08), with operative treatment being associated with less mortality for those between the ages of sixty-five and seventy-four years. A higher Charlson comorbidity score, male sex, and neurological involvement were all associated with increased risk of mortality. Conclusions: Operative treatment of cervical spine fractures is associated with a lower mortality rate at three months but not at one year postoperatively for patients between sixty-five and seventy-four years old at the time of fracture. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence. PMID:20194314
Subaxial Cervical Spine Trauma: Evaluation and Surgical Decision-Making
Joaquim, Andrei F.; Patel, Alpesh A.
Study Design?Literature review. Objective?To discuss the evaluation and management of subaxial cervical spine trauma (C3–7). Methods?A literature review of the main imaging modalities, classification systems, and nonsurgical and surgical treatment performed. Results?Computed tomography and reconstructions allow for accurate radiologic identification of subaxial cervical spine trauma in most cases. Magnetic resonance imaging can be utilized to evaluate the stabilizing discoligamentous complex, the nerves, and the spinal cord. The Subaxial Injury Classification (SLIC) is a new system that aids in injury classification and helps guide the decision-making process of conservative versus surgical treatment. Though promising, the SLIC system requires further validation. When the decision for surgical treatment is made, early decompression (less than 24 hours) has been associated with better neurologic recovery. Surgical treatment should be individualized based on the injury characteristics and surgeon's preferences. Conclusions?The current state of subaxial cervical spine trauma is one of great progress. However, many questions remain unanswered. We need to continue to account for the individual patient, surgeon, and hospital circumstances that effect decision making and care. PMID:24494184
Cervical spine trauma in the injured child: A tragic injury with potential for salvageable functional outcome
David A. Partrick; Denis D. Bensard; Ernest E. Moore; Casey M. Calkins; Frederick M. Karrer
Background\\/Purpose: Cervical spine injuries are uncommon in children, and, therefore, presumptive immobilization and diagnosis remain controversial. The purpose of this study was to review the author's experience with cervical spine injuries in children to determine the incidence, injury mechanism, pattern of injury, and subsequent functional outcome. Methods: Fifty-two children over a 6-year period (1994 to 1999) with a cervical spine
[Cervical myelopathy after low grade distortion of the cervical spine. Possible association with pre-existing spondylosis of the cervical spine].
Aurich, M; Hofmann, G O; Gras, F M
A patient with spondylosis deformans of the cervical spine with no neurological deficits developed rapidly progressive tetraparesis 1 day after a whiplash injury due to a car accident (rear end collision), although initially there were no clinical symptoms. Surgical decompression and spondylodesis led to relief of the neurological deficits. This case demonstrates that even a low grade whiplash injury (grade 1) can cause severe neurological symptoms later and that a degenerative disease of the spine is a predisposing factor. PMID:25336350
Acute hemorrhage within intradural extramedullary schwannoma in cervical spine presenting with quadriparesis
Sahoo, Ranjan Kumar; Das, Pulin Bihari; Sarangi, Gouri Sankar; Mohanty, Sureswar
Schwannoma with acute hemorrhage is rarely seen. A 44-years-old male patient presented with complaint of neck pain and acute onset of quadriparesis. Magnetic resonance imaging (MRI) of his cervical spine revealed evidence of an intradural extramedullary tumor with intratumoral acute hemorrhage. He was operated in emergency and the mass was found to be schwannoma with acute hemorrhage. Post operatively the patient improved significantly. Though schwannomas show microscopic intratumoral hemorrhage and necrosis at times, schwannoma with acute hemorrhage resulting acute onset of neurological deficit is very uncommon. PMID:25972715
Lateral mass fixation in subaxial cervical spine: anatomic review.
Mohamed, Elrahmany; Ihab, Zidan; Moaz, Anwar; Ayman, Nabawi; Haitham, Abo-Elw
Introduction?The cervical spine is a highly mobile segment of the spinal column, liable to a variety of diseases and susceptible to trauma. It is a complex region where many vital structures lie in close proximity. Lateral mass screw fixation has become the method of choice in stabilizing subaxial cervical spine among other posterior cervical fixation techniques whenever the posterior elements are absent or compromised. Objective?This study examined cervical specimens of cadavers and cervical computed tomography (CT) scans to minimize as much as possible complications of cervical lateral mass screw placement such as vertebral artery or nerve root injuries, facet joint violations, or inadequate placement. Methods?Forty normal cervical CT scans, obtained from the emergency unit as part of the trauma workup, were included in this study plus 10 cervical cadaveric specimens obtained from the Alexandria Neuro-anatomy laboratory. There were three fixed parameters for screw insertion in this study. First, the point of screw insertion was the midpoint of the lateral mass; it was the crossing point between the sagittal and axial planes of the posterior cortex of the lateral mass. Second, the direction of the screw in the craniocaudal plane was 30 degrees cranially to avoid facet joint penetration. Third, the exit point of the screw was located on the ventral cortex of the lateral mass just lateral to the root of the transverse process in the midaxial cut of each lateral mass, to make a sound bicortical fixation without injuring the vertebral artery or the nerve root. The selected screw trajectory in this study was the line drawn between the inlet and exit points. The depth and width of the lateral mass of the cervical vertebrae from C3 to C7 were measured as well as the angle of screw trajectory from the sagittal plane. All these measures were applied on the cadaveric specimens to make sure that no injury to the vertebral artery, nerve root, or facet joint occurred. Results?As regards the collected measurements of the lateral mass of all subaxial cervical vertebrae, the study revealed that the average depth of the lateral mass was 12.83?±?1.28 mm. The average width of the lateral mass was 11.92?±?0.96 mm. The average divergent angle of bicortical screw insertion without injury to the vertebral artery or the nerve root was 19.51?±?1.83 degrees. As regard the cadaveric specimens, based on all the collected measurements taken from the CT scans, there was no reported injury to the vertebral arteries or nerve roots or penetration to the facet joints. Conclusion?Lateral mass fixation can be applied easily and safely for all levels of subaxial cervical spine from C3 to C6 with the following parameters: (1) the point of entry is the midpoint of the lateral mass; (2) the screw trajectory is directed 30 degrees cranially and 20 degrees laterally; (3) the screw length is 13 to 15 mm. PMID:24353945
Return-to-play decisions after cervical spine injuries.
Ellis, Jessica L; Gottlieb, Jamie E
This article summarizes the current evidence and expert opinion on making return-to-play decisions after cervical spine injuries. Injuries discussed include fractures, central cord neuropraxia, stringers, disc herniations, strains, sprains, and instability. Each of these injuries may be complicated by coexistence of other conditions making return-to-play decisions more complicated. The congenital, developmental, and disease processes discussed include spear tackler's spine, congenital and developmental stenosis, Klippel-Feil syndrome, odontoid abnormalities, rheumatoid arthritis, spina bifida, and Arnold-Chiari malformations. Postsurgical considerations are also discussed. This review represents an abundant amount of expert opinion that was overwhelmingly based on case series, case reports, and biomechanical studies to support the return-to-play guidelines. PMID:17212914
[Anesthesia for surgery of degenerative and abnormal cervical spine].
Béal, J L; Lopin, M C; Binnert, M
A feature common to all congenital or inflammatory abnormalities of the cervical spine is an actual or potential reduction in the lumen of the spinal canal. The spinal cord and nerve roots are at risk. During intubation, and positioning the patient on the table, all untoward movements of the cervical spine may lead to spinal cord compression. Abnormalities of the cervical spine carry the risk of a difficult intubation. If there is much debate as to what constitutes optimum management of the airway, there is no evidence that any one method is the best. Recognizing the possible instability and intubating with care, are probably much more important in preserving neurological function than any particular mode of intubation. During maintenance of anaesthesia, the main goal is to preserve adequate spinal cord perfusion in order to prevent further damage. Spinal cord blood flow seems to be regulated by the same factors as cerebral blood flow. Hypercapnia increases cord blood flow while hypocapnia decreases it. Therefore, normocapnia or mild hypocapnia is recommended. Induced hypotension is frequently used to decrease blood loss. However, in patients with a marginally perfused spinal cord, the reduction in blood flow may cause ischaemia of the spinal cord and may therefore be relatively contraindicated. In addition to standard intraoperative monitoring, spinal cord monitoring is almost mandatory. Monitoring somatosensory evoked potentials is used routinely. However, the major limitation is that this technique only monitors dorsal column function; theoretically, motor paralysis can occur despite a lack of change in recorded signals. Neurogenic motor evoked potentials may now be used to monitor anterior spinal cord integrity.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8273927
Investigation of motorcyclist safety systems contributions to prevent cervical spine injuries using HUMOS model
J. Sun; A. Rojas; R. Kraenzler; P. J. Arnoux
To prevent motorcyclists' cervical spine injuries, many passive safety devices, commonly named neck braces, are available. This work aimed to promote a methodology to investigate how injury mechanisms or injury severity involved with cervical spine safety devices could be modified or avoided. Multidirectional head impact conditions were simulated on the head–neck–thorax isolated segment by testing three different neck brace technologies
Cervical spine in patients with diastrophic dysplasia - radiographic findings in 122 patients
Ville M. Remes; Eino J. Marttinen; Mikko S. Poussa; Ilkka J. Helenius; Jari I. Peltonen
Background. In previous studies, typical radiological findings in the cervical spine of patients with diastrophic dysplasia (DD) have been kyphosis, displacement of the vertebrae, spina bifida occulta (SBO), anterior hypoplasia of vertebrae C3-5, and hyperplasia and dysmorphism of the odontoid process. Objectives. To make a radiological analysis of the cervical spine in patients with DD. Materials and methods. The study
Soft tissue injury protocol (STIP) using motion MRI for cervical spine trauma assessment
Vincenzo Giuliano; Concetta Giuliano; Fabio Pinto; Mariano Scaglione
The purpose of this study was to establish a noninvasive scoring method, using motion MRI, to determine the degree of clinical impairment in traumatized cervical spines. This method is called the soft tissue injury protocol (STIP) scoring method. The cervical spines of 100 adult accident victims were evaluated prospectively using motion MRI at 12 weeks following hyperflexion\\/hyperextension injury from rear,
Solitary fibrous tumor in the cervical spine with destructive vertebral involvement: a case report and review of the literature
Koji Hashimoto; Kei Miyamoto; Hideo Hosoe; Gou Kawai; Kenta Kikuike; Kuniyasu Shimokawa; Naoki Suzuki; Masayuki Matsuo; Hirotaka Kodama; Katsuji Shimizu
Introduction Recently, solitary fibrous tumors occurring in spine-related lesions have been reported. However, the destruction of vertebral\\u000a bodies by this type of tumor has not been reported.\\u000a \\u000a \\u000a \\u000a Materials and methods A 71-year-old female presented with pain from a mass on the right side of her neck. Plain radiographs of the cervical spine\\u000a showed collapse of the C5 vertebral body and dislocation of
Clinical evaluation and airway management for adults with cervical spine instability.
Martini, Ross P; Larson, Dawn M
Airway management of patients with cervical spine instability may be difficult as a result of immobilization, and may be associated with secondary neurologic injury related to cervical spine motion. Spinal cord instability is most common in patients with trauma, but there are additional congenital and acquired conditions that predispose to subacute cervical spine instability. Patients with suspected instability should receive immobilization during airway management with manual in-line stabilization. The best strategy for airway management is one that applies the technique with the highest likelihood of success on the first attempt and the lowest biomechanical influence on a potentially unstable spine. PMID:25999005
Sensorimotor function of the cervical spine in healthy volunteers
Artz, Neil J.; Adams, Michael A.; Dolan, Patricia
Background Sensorimotor mechanisms are important for controlling head motion. However, relatively little is known about sensorimotor function in the cervical spine. This study investigated how age, gender and variations in the test conditions affect measures of position sense, movement sense and reflex activation in cervical muscles. Methods Forty healthy volunteers (19M/21F, aged 19–59 years) participated. Position sense was assessed by determining repositioning errors in upright and flexed neck postures during tests performed in 25%, 50% and 75% cervical flexion. Movement sense was assessed by detecting thresholds to passive flexion and extension at velocities between 1 and 25°s? 1. Reflexes were assessed by determining the latency and amplitude of reflex activation in trapezius and sternocleidomastoid muscles. Reliability was evaluated from intraclass correlation coefficients. Findings Mean repositioning errors ranged from 1.5° to 2.6°, were greater in flexed than upright postures (P = 0.006) and in people aged over 25 years (P = 0.05). Time to detect head motion decreased with increasing velocity (P < 0.001) and was lower during flexion than extension movements (P = 0.002). Reflexes demonstrated shorter latency (P < 0.001) and greater amplitude (P = 0.009) in trapezius compared to sternocleidomastoid, and became slower and weaker with age. None of the measures were influenced by gender. Reliability was good for movement sense measures, but was influenced by the test conditions when assessing position sense. Interpretation Increased repositioning errors and slower reflexes in older subjects suggest that sensorimotor function in the cervical spine becomes impaired with age. In position sense tests, reliability was influenced by the test conditions with mid-range flexion movements, performed in standing, providing the most reliable measurements. PMID:25686675
Bone morphogenetic protein in complex cervical spine surgery: A safe biologic adjunct?
Lebl, Darren R
The advent of recombinant DNA technology has substantially increased the intra-operative utilization of biologic augmentation in spine surgery over the past several years after the Food and Drug Administration approval of the bone morphogenetic protein (BMP) class of molecules for indications in the lumbar spine. Much less is known about the potential benefits and risks of the "off-label" use of BMP in the cervical spine. The history and relevant literature pertaining to the use of the "off-label" implantation of the BMP class of molecules in the anterior or posterior cervical spine are reviewed and discussed. Early prospective studies of BMP-2 implantation in anterior cervical spine constructs showed encouraging results. Later retrospective studies reported potentially "life threatening complications" resulting in a 2007 public health advisory by the FDA. Limited data regarding BMP-7 in anterior cervical surgery was available with one group reporting a 2.4% early (< 30 d) complication rate (brachialgia and dysphagia). BMP use in the decompressed posterior cervical spine may result in neurologic or wound compromise according to several retrospective reports, however, controlled use has been reported to increase fusion rates in select complex and pediatric patients. There were no cases of de novo neoplasia related to BMP implantation in the cervical spine. BMP-2 use in anterior cervical spine surgery has been associated with a high early complication rate. Definitive recommendations for BMP-7 use in anterior cervical spine surgery cannot be made with current clinical data. According to limited reports, select complex patients who are considered "high risk" for pseudoarthrosis undergoing posterior cervical or occipitocervical arthrodesis or children with congenital or traumatic conditions may be candidates for "off-label" use of BMP in the context of appropriate informed decision making. At the present time, there are no high-level clinical studies on the outcomes and complication rates of BMP implantation in the cervical spine. PMID:23610751
Cervical spine mobility analysis on radiographs: a fully automatic approach.
Lecron, Fabian; Benjelloun, Mohammed; Mahmoudi, Saďd
Conventional X-ray radiography remains nowadays the most common method to analyze spinal mobility in two dimensions. Therefore, the objective of this paper is to develop a framework dedicated to the fully automatic cervical spine mobility analysis on X-ray images. To this aim, we propose an approach based on three main steps: fully automatic vertebra detection, vertebra segmentation and angular measurement. The accuracy of the method was assessed for a total of 245 vertebrć. For the vertebra detection, we proposed an adapted version of two descriptors, namely Scale-invariant Feature Transform (SIFT) and Speeded-up Robust Features (SURF), coupled with a multi-class Support Vector Machine (SVM) classifier. Vertebrć are successfully detected in 89.8% of cases and it is demonstrated that SURF slightly outperforms SIFT. The Active Shape Model approach was considered as a segmentation procedure. We observed that a statistical shape model specific to the vertebral level improves the results. Angular errors of cervical spine mobility are presented. We showed that these errors remain within the inter-operator variability of the reference method. PMID:22981777
Cervical Spine Rotation and Range of Motion: Pilot Measurements During Driving
Jarrod A. J. Shugg; Christopher D. Jackson; James P. Dickey
Objective: Previous studies have evaluated the cervical range of axial rotation during simulated driving conditions. The goals of this pilot study were to describe cervical spine rotation during in-car driving and determine the percentage of time outside neutral neck rotation and peak cervical axial rotation angles that the subjects adopted during various driving conditions.Methods: Subjects drove around a specified route
Congenital Stenosis of the Cervical Spine: Diagnosis and Management
Countee, Roger W.; Vijayanathan, Thurairasah
An analysis of 11 cases of congenital stenosis of the cervical spine seen over the past three years is reported. The authors' experiences at an urban community hospital, as well as a large Veterans Administration Hospital, lead them to conclude that this disorder is a neurologically significant anomaly which is probably more common than published reports would imply. It can be clinically and radiographically distinguished from "pure" cervical spondylosis, to which it is related, and its treatment should be appropriately modified. It appears to have a predilection for young adult black males, and cervical myelopathy is the predominant clinical feature. Varying degrees of trauma, a disease endemic to the inner city, plays a major role in precipitating the neurological catastrophes associated with this potentially correctable disorder. Proper management of this entity demands a heightened awareness of its existence as well as a high standard of neurological and roentgenographic diagnosis, and operative performance. A flexible operative strategy which takes into account the specific biomechanical factors involved in this disorder as well as the patient's individual physiological and social status is imperative. Surgery offers a good opportunity for improving neurological function. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9 PMID:439156
Emergency department intubation of trauma patients with undiagnosed cervical spine injury
Patterson, H
Objectives: Some trauma patients have an undiagnosed cervical spine injury but require immediate airway control. This paper reports an emergency department's (ED) experience with these patients. In particular, is there a worse neurological outcome? Methods: A retrospective study over 6.5 years, based on prospectively collected data from the Royal Perth Hospital trauma registry. Patients with a cervical spine injury were identified and clinical data were abstracted. The primary outcome measure was evidence of exacerbation of cervical spine injury as a result of intubation by ED medical staff. Results: 308 patients (1.9%) of the 15 747 trauma patients were intubated by ED medical staff. Thirty seven (12%) were subsequently verified to have a cervical spine injury, of which 36 were managed with orotracheal intubation. Twenty five (69%) survived to have a meaningful post-intubation neurological examination. Fourteen (56%) of these 25 patients had an unstable cervical spine injury. Ninety per cent of all ED intubations were by ED medical staff. No worsening of neurological outcomes occurred. Conclusions: Every ninth trauma patient that this ED intubates has a cervical spine injury. Intubation by ED medical staff did not worsen neurological outcome. In the controlled setting of an ED staffed by senior practitioners, patients with undiagnosed cervical spine injury can be safely intubated. PMID:15107367
National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine–Injured Athlete
Swartz, Erik E; Boden, Barry P; Courson, Ronald W; Decoster, Laura C; Horodyski, MaryBeth; Norkus, Susan A; Rehberg, Robb S; Waninger, Kevin N
Objective: To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete. Background: The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment. Recommendations: Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department. PMID:19478836
Deceleration during 'real life' motor vehicle collisions – a sensitive predictor for the risk of sustaining a cervical spine injury?
Elbel, Martin; Kramer, Michael; Huber-Lang, Markus; Hartwig, Erich; Dehner, Christoph
Background The predictive value of trauma impact for the severity of whiplash injuries has mainly been investigated in sled- and crash-test studies. However, very little data exist for real-life accidents. Therefore, the predictive value of the trauma impact as assessed by the change in velocity of the car due to the collision (?V) for the resulting cervical spine injuries were investigated in 57 cases after real-life car accidents. Methods ?V was determined for every car and clinical findings related to the cervical spine were assessed and classified according to the Quebec Task Force (QTF). Results In our study, 32 (56%) subjects did not complain about symptoms and were therefore classified as QTF grade 0; 25 (44%) patients complained of neck pain: 8 (14%) were classified as QTF grade I, 6 (10%) as QTF grade II, and 11 (19%) as QTF grade IV. Only a slight correlation (r = 0.55) was found between the reported pain and ?V. No relevant correlation was found between ?V and the neck disability index (r = 0.46) and between ?V and the QTF grade (r = 0.45) for any of the collision types. There was no ?V threshold associated with acceptable sensitivity and specificity for the prognosis of a cervical spine injury. Conclusion The results of this study indicate that ?V is not a conclusive predictor for cervical spine injury in real-life motor vehicle accidents. This is of importance for surgeons involved in medicolegal expertise jobs as well as patients who suffer from whiplash-associated disorders (WADs) after motor vehicle accidents. Trial registration The study complied with applicable German law and with the principles of the Helsinki Declaration and was approved by the institutional ethics commission. PMID:19267940
Effects of Lateral Mass Screw Rod Fixation to the Stability of Cervical Spine after Laminectomy
NASA Astrophysics Data System (ADS)
Rosli, Ruwaida; Kashani, Jamal; Kadir, Mohammed Rafiq Abdul
There are many cases of injury in the cervical spine due to degenerative disorder, trauma or instability. This condition may produce pressure on the spinal cord or on the nerve coming from the spine. The aim of this study was, to analyze the stabilization of the cervical spine after undergoing laminectomy via computational simulation. For that purpose, a three-dimensional finite element (FE) model for the multilevel cervical spine segment (C1-C7) was developed using computed tomography (CT) data. There are various decompression techniques that can be applied to overcome the injury. Usually, decompression procedures will create an unstable spine. Therefore, in these situations, the spine is often surgically restabilized by using fusion and instrumentation. In this study, a lateral mass screw-rod fixation was created to stabilize the cervical spine after laminectomy. Material properties of the titanium alloy were assigned on the implants. The requirements moments and boundary conditions were applied on simulated implanted bone. Result showed that the bone without implant has a higher flexion and extension angle in comparison to the bone with implant under applied 1Nm moment. The bone without implant has maximum stress distribution at the vertebrae and ligaments. However, the bone with implant has maximum stress distribution at the screws and rods. Overall, the lateral mass screw-rod fixation provides stability to the cervical spine after undergoing laminectomy.
Three Dimensional Movements Of The Upper Cervical Spine
NASA Astrophysics Data System (ADS)
Panjabi, Manohar M.; Dvorak, Jiri; Duranceau, Joanne; Yamamoto, Isao
Ten fresh cadaveric whole cervical spine specimens (occiput to C7) were studied using well established techniques to document the movements in flexion, extension, left and right lateral bending and left and right axial rotation. Pure moments of maximum 1.5 newton meters were applied incrementally and three dimensional movements of the bones were recorded using stereophotogrammetry. Each moment was applied individually and in a three load/unload cycles. The motion measurements were made on the third load cycle. Parameters of neutral zone, elastic zone and range of motion were computed. Neutral zones for flexion/extension, right/left lateral bending and right/left axial rotation were respectively: 1.1, 1.5 and 1.6 (occiput-C1); and 3.2, 1.2 and 29.6 degrees (C1-C2). Ranges of motion for flexion, extension, lateral bending (one side) and axial rotation (one side) were respectively: 3.5, 21.0, 5.5 and 7.2 degrees (occiput-Cl joint) and 11.5, 10.9, 6.7 and 38.9 degrees (CI-CZ joint). The highest intervertebral motion in the spine was the axial rotation at the Cl-C2 joint, neutral zone constituting 75% of this motion.
Injury Mechanisms in the Pediatric Cervical Spine During Out-of-Position Airbag Deployments
Nightingale, Roger W.; Winkelstein, Beth A.; Van Ee, Chris A.; Myers, Barry S.
The pediatric cervical spine differs considerably from the adult in both its geometry and its constitutive properties. Therefore, it is susceptible to a different set of injuries, some of which are particularly severe. Recent data from the NHTSA on cervical spine injuries in low speed out-of-position airbag deployments shows that the spectrum of injuries in children is different from that of the adult. Almost all of the children (98%) sustained head or cervical spine injuries, as compared to only 38% of the adults. In addition, the injuries in children were not gender dependent, while injuries in adults occurred in females 72% of the time. The specific loads which result in these injuries are still unclear; however, examination of the biomechanical data for the adult may yield some insights. This examination also points to the need for additional biomechanical testing in order to define tolerances for pediatric cervical spine injury.
Occipital condyle to cervical spine fixation in the pediatric population.
Kosnik-Infinger, Libby; Glazier, Steven S; Frankel, Bruce M
Fixation at the craniovertebral junction (CVJ) is necessary in a variety of pediatric clinical scenarios. Traditionally an occipital bone to cervical fusion is preformed, which requires a large amount of hardware to be placed on the occiput of a child. If a patient has previously undergone a posterior fossa decompression or requires a decompression at the time of the fusion procedure, it can be difficult to anchor a plate to the occipital bone. The authors propose a technique that can be used when faced with this difficult challenge by using the occipital condyle as a point of fixation for the construct. Adult cadaveric and a limited number of case studies have been published using occipital condyle (C-0) fixation. This work was adapted for the pediatric population. Between 2009 and 2012, 4 children underwent occipital condyle to axial or subaxial spine fixation. One patient had previously undergone posterior fossa surgery for tumor resection, and 1 required decompression at the time of operation. Two patients underwent preoperative deformity reduction using traction. One child had a Chiari malformation Type I. Each procedure was performed using polyaxial screw-rod constructs with intraoperative neuronavigation supplemented by a custom navigational drill guide. Smooth-shanked 3.5-mm polyaxial screws, ranging in length from 26 to 32 mm, were placed into the occipital condyles. All patients successfully underwent occipital condyle to cervical spine fixation. In 3 patients the construct extended from C-0 to C-2, and in 1 from C-0 to T-2. Patients with preoperative halo stabilization were placed in a cervical collar postoperatively. There were no new postoperative neurological deficits or vascular injuries. Each patient underwent postoperative CT, demonstrating excellent screw placement and evidence of solid fusion. Occipital condyle fixation is an effective option in pediatric patients requiring occipitocervical fusion for treatment of deformity and/or instability at the CVJ. The use of intraoperative neuronavigation allows for safe placement of screws into C-0, especially when faced with a challenging patient in whom fixation to the occipital bone is not possible or is less than ideal. PMID:24206344
Cervical spine injury in children: a case report and literature review
Nebhani, Tahir; Bakkali, Hicham; Belyamani, Lahcen
Traumatic injuries of the cervical spine are less common in children than in adults. But may be associated with significant disability and mortality. Pediatric victims of blunt trauma have mechanisms of injury, developmental and anatomic characteristics different than the adults. The purpose of this observation is to highlight the differences between the adult and pediatric cervical spine. We report below the case of spinal cord cut occurs to a very young girl after a motor vehicle accident.
Prospective study of the radiological changes in hands, feet, and cervical spine in adult rheumatoid disease
J Winfield; A Young; P Williams; M Corbett
Annual radiographs of hands, feet, and cervical spine were taken in 100 patients with rheumatoid arthritis from the first year of disease for a mean follow-up period of 9.5 years. Seventy-six patients developed peripheral erosive disease and 54 developed rheumatoid changes of the cervical spine, of whom 34 (63%) had subluxations. The severity of rheumatoid neck damage correlated strongly with
Load-displacement properties of the normal and injured lower cervical spine in vitro
Marcus Richter; Hans-Joachim Wilke; Patrick Kluger; Lutz Claes; Wolfhart Puhl
The objective of this study was to determine which discoligamentous structures of the lower cervical spine provide significant\\u000a stability with regard to different loading conditions. Accordingly, the load-displacement properties of the normal and injured\\u000a lower cervical spine were tested in vitro. Four artificially created stages of increasing discoligamentous instability of\\u000a the segment C5\\/6 were compared to the normal C5\\/6 segment.
Intervertebral Neck Injury Criterion for Prediction of Multiplanar Cervical Spine Injury Due to Side Impacts
Manohar M. Panjabi; Paul C. Ivancic; Yasuhiro Tominaga; Jaw-Lin Wang
Objective. Intervertebral Neck Injury Criterion (IV-NIC) is based on the hypothesis that dynamic three-dimensional intervertebral motion beyond physiological limits may cause multiplanar injury of cervical spine soft tissues. Goals of this study, using a biofidelic whole human cervical spine model with muscle force replication and surrogate head in simulated side impacts, were to correlate IV-NIC with multiplanar injury and determine
When to suspect head injury or cervical spine injury in maxillofacial trauma?
Rahman, Sajjad A.; Chandrasala, Soumithran
Background: The global status report of the World Health Organization (WHO) on road safety suggested that India is leading in road traffic accidents in the world. According to the report on road accidents in India in 2010 by the Transport Research Wing, Ministry of Road Transport and Highways, New Delhi, Kerala ranked third in accidents per lakh population and second in persons injured per lakh population. As the face, brain, and cervical spine are in close proximity with one another, associated injuries can be suspected. The aim of this study was to determine the relationship between the severity of head, cervical spine, and facial injury and incidence of facial injury in patients with head and/or cervical spine injury. Materials and Methods: A prospective cohort study was conducted over a period of one year. The study population included all patients having computed tomography (CT)-demonstrable head injury, radiographic evidence of cervical spine injury, and associated head or cervical spine injury with facial injury. Data were analyzed using the chi-square test using statistical package SPSS. A P value less than 0.05 was considered statistically significant. Results: Of 124 patients, 59 (47.6%) had facial injuries. As severity of head injury increased, the number of facial injuries decreased. Statistically, no significant association between facial and head injury was seen. A statistically significant association between dentoalveolar involvement and cervical spine injury was seen (P < 0.001). The proportion of injuries in patients with cervical spine injuries alone was significantly lower in the frontal (P = 0.001) and orbital (P = 0.004) regions and higher in the mandibular region (P = 0.010). Conclusion: Midface injuries were more commonly associated with head injuries. Decreased facial involvement leads to increased severity of head injury. Simple injuries of the cervical spine were more commonly associated with facial injuries. PMID:25097643
Brown Tumor of the Cervical Spines: A Case Report with Literature Review
Halawani, Mohammed Mohamoud; Attia, Walid Ismail; Almusrea, Khaled Naser
To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion. PMID:25705344
Brown tumor of the cervical spines: a case report with literature review.
Alfawareh, Mohammad Dursi; Halawani, Mohammed Mohamoud; Attia, Walid Ismail; Almusrea, Khaled Naser
To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion. PMID:25705344
Respiratory dysfunction in patients with chronic neck pain - influence of thoracic spine and chest mobility.
Wirth, B; Amstalden, M; Perk, M; Boutellier, U; Humphreys, B K
Patients with chronic neck pain exhibit various musculoskeletal deficits and respiratory dysfunction. As there is a link between thoracic and cervical spine motion, the aim of this study was to investigate the relationship between thoracic spine and chest mobility with respiratory function and neck disability. Nineteen patients with chronic neck pain (7 male, 46.6 ± 10.5 years) and 19 healthy subjects (7 male, 46.5 ± 9.9 years) participated. Spirometry was conducted to determine maximal voluntary ventilation (MVV), maximal inspiratory (Pimax) and maximal expiratory pressure (Pemax). Thoracic spine mobility was measured using the Spinal Mouse(®). Chest expansion was assessed by subtracting chest circumference during maximal inspiration and expiration. Neck function was investigated by examining range of motion, forward head posture, neck flexor muscle synergy endurance and self-assessment (Neck disability index (NDI)). Correlation analyses and multiple linear regression analyses were conducted using MVV, Pimax and Pemax as independent variables. Thoracic spine mobility during flexion and chest expansion correlated significantly to MVV (r = 0.45 and 0.42), all neck motions (r between 0.39 and 0.59) and neck muscle endurance (rS = 0.36). Pemax and Pimax were related to NDI (r = -0.58 and -0.46). In the regression models, chest expansion was the only significant predictor for MVV, and Pemax was determined by neck muscle endurance. These results suggest that chronic neck pain patients should improve the endurance of the neck flexor muscles and thoracic spine and chest mobility. Additionally, these patients might benefit from respiratory muscle endurance training, possibly by increasing chest mobility and Pemax. PMID:24835338
Dynamic Mechanical Properties of Intact Human Cervical Spine Ligaments
Ivancic, Paul C.; Coe, Marcus P.; Ndu, Anthony B.; Tominaga, Yasuhiro; Carlson, Erik J.; Rubin, Wolfgang; (FH), Dipl-Ing; Panjabi, Manohar M.
BACKGROUND CONTEXT Most previous studies have investigated ligaments mechanical properties at slow elongation rates of less than 25 mm/s. PURPOSE To determine the tensile mechanical properties, at a fast elongation rate, of intact human cervical anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. STUDY DESIGN/SETTING In vitro biomechanical study. METHODS A total of 97 intact bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines (average age: 80.6 years, range, 71 to 92 years) and were elongated to complete rupture at an average (SD) peak rate of 723 (106) mm/s using a custom-built apparatus. Non-linear force vs. elongation curves were plotted and peak force, peak elongation, peak energy, and stiffness were statistically compared (P<0.05) among ligament. A mathematical model was developed to determine the quasi-static physiological ligament elongation. RESULTS Highest average peak force, up to 244.4 and 220.0 N in the ligamentum flavum and capsular ligament, respectively, were significantly greater than in the anterior longitudinal ligament and middle-third disc. Highest peak elongation reached 5.9 mm in the intraspinous and supraspinous ligaments, significantly greater than in the middle-third disc. Highest peak energy of 0.57 J was attained in the capsular ligament, significantly greater than in the anterior longitudinal ligament and middle-third disc. Average stiffness was generally greatest in the ligamentum flavum and least in the intraspinous and supraspinous ligaments. For all ligaments, peak elongation was greater than average physiological elongation computed using the mathematical model. CONCLUSIONS Comparison of the present results with previously reported data indicated that high speed elongation may cause cervical ligaments to fail at a higher peak force and smaller peak elongation and may be stiffer and absorb less energy, as compared to a slow elongation rate. These comparisons may be useful to clinicians for diagnosing cervical ligament injuries based upon the specific trauma. PMID:17998125
Pain Sensitivity Subgroups in Individuals With Spine Pain: Potential Relevance to Short-Term Clinical Outcome
Bialosky, Joel E.; Robinson, Michael E.
Background Cluster analysis can be used to identify individuals similar in profile based on response to multiple pain sensitivity measures. There are limited investigations into how empirically derived pain sensitivity subgroups influence clinical outcomes for individuals with spine pain. Objective The purposes of this study were: (1) to investigate empirically derived subgroups based on pressure and thermal pain sensitivity in individuals with spine pain and (2) to examine subgroup influence on 2-week clinical pain intensity and disability outcomes. Design A secondary analysis of data from 2 randomized trials was conducted. Methods Baseline and 2-week outcome data from 157 participants with low back pain (n=110) and neck pain (n=47) were examined. Participants completed demographic, psychological, and clinical information and were assessed using pain sensitivity protocols, including pressure (suprathreshold pressure pain) and thermal pain sensitivity (thermal heat threshold and tolerance, suprathreshold heat pain, temporal summation). A hierarchical agglomerative cluster analysis was used to create subgroups based on pain sensitivity responses. Differences in data for baseline variables, clinical pain intensity, and disability were examined. Results Three pain sensitivity cluster groups were derived: low pain sensitivity, high thermal static sensitivity, and high pressure and thermal dynamic sensitivity. There were differences in the proportion of individuals meeting a 30% change in pain intensity, where fewer individuals within the high pressure and thermal dynamic sensitivity group (adjusted odds ratio=0.3; 95% confidence interval=0.1, 0.8) achieved successful outcomes. Limitations Only 2-week outcomes are reported. Conclusions Distinct pain sensitivity cluster groups for individuals with spine pain were identified, with the high pressure and thermal dynamic sensitivity group showing worse clinical outcome for pain intensity. Future studies should aim to confirm these findings. PMID:24764070
Gadolinium Use in Spine Pain Management Procedures for Patients with Contrast Allergies: Results in 527 Procedures
Safriel, Yair [Yale University School of Medicine, Neuroradiology Section, Department of Radiology (United States)], E-mail: firstname.lastname@example.com; Ang, Roberto [Center for Diagnostic Imaging (United States); Ali, Muhammed [Kaiser Permanente Woodland Hills Medical Center (United States)
Introduction. To review the safety and efficacy of gadolinium in spine pain management procedures in patients at high risk for a contrast reaction and who are not suitable candidates for the use of standard non-ionic contrast. Methods. We reviewed records over a 61-month period of all image-guided spinal pain management procedures where patients had allergies making them unsuitable candidates for standard non-ionic contrast and where gadolinium was used to confirm needle tip placement prior to injection of medication. Results. Three hundred and four outpatients underwent 527 procedures. A spinal needle was used in all but 41 procedures. Gadolinium was visualized using portable C-arm fluoroscopy in vivo allowing for confirmation of needle tip location. The gadolinium dose ranged from 0.2 to 10 ml per level. The highest dose received by one patient was 15.83 ml intradiscally during a three-level discogram. Three hundred and one patients were discharged without complication or known delayed complications. One patient had documented intrathecal injection but without sequelae and 2 patients who underwent cervical procedures experienced seizures requiring admission to the intensive care unit. Both the latter patients were discharged without any further complications. Conclusion. Based on our experience we recommend using gadolinium judiciously for needle tip confirmation. We feel more confident using gadolinium in the lumbar spine and in cervical nerve blocks. Gadolinium should probably not be used as an injectate volume expander. The indications for gadolinium use in cervical needle-guided spine procedures are less clear and use of a blunt-tipped needle should be considered.
[Anterior cervical fusion on the lower cervical spine: own clinical experience].
Pazdernyik, Szilárd; Sándor, László; Elek, Péter; Barzó, Pál
Both acute and chronic instability of the cervical spine can be succesfully treated by anterior crevical fusion. The main goal is to create a spondylodesis through which the instable motion segments are fixed in the position defined by the surgeon. The spondylodesis is realised by the bone healing of the intervertebral space. The consolidation itself is facilitated by the operative stabilisation of the segments involved, and also by the implantation/transplantation of the osteoproductive/osteoinductive materials. The sooner consolidation is achieved, the more likely it is to be able to avoid the material dependent complications and/or that of dislocation. So as to support this theory a retrospective clinical/radiological study was performed. During this the length and the safety of the consolidation was measured by applying various anterior cervical plating systems. A total of 485 patients having cervical injuries or degenerative disc disease were treated by anterior cervical plating. For bone transplantation partly pure autolog spongious partly autolog cortico-spongious morsalised bone chips, furthermore autolog tricortical bone block were applied. A standard protocoll was used for data collection, evaluation and also follow-up. The patients treated with plate systems were divided into 3 groups: Group 1: Non-locked H-plate system with autogeneous cancellous bone (155 trauma patients, for a total of 210 cervical motion segments, 1.35 segments/patients). Group 2: Non-locked H-plate system with tricortical autograft (167 patients, for a total of 290 cervical motion segments, 1.73 segments/patients). Group 3: Locked cervical plate system with tricortical autograft (73 patients, for a total of 110 cervical motion segments, 1.5 segments/patients). Patients treated with standalone cage belong to group 4. These cages were filled with autogenous cortico-spongiosus bone chips (90 patients, for a total of 90 cervical motion segments, 1.0 segments/patients). Evaluations included postoperative clinical, X-ray and CT examination, and follow-ups at 6, 16, 52, and 104 weeks. We established three grades, and classified the degree of bony fusion between the graft and vertebra: not-yet-fused, fused or non-union. When evaluating the results the following statements/observations were made: a) There is a fast and safe consolidation in the case of those patients that underwent dinamic disc osteosynthesis (p = 0.00001). b) Whereas performing fixation with non-locked or locked screw plate systems and strutgrafted with tricortical autograft created prolonged healing requiring months and developed non-unions more often (non-locked screw-plate system versus locked screw-plate system) (p > 0.05). c) Using locked screw-plate fixation systems non-union rate in our study was 21%, suggesting that this form of fixation has only a limited use. d) In our study complete consolidation without pseudoarthrosis was achieved by using standalone cages filled with autolog cortico-spongiosus bone chips, but bony healing was delayed due to cage coating and the substitution of pure autogenous spongiosa for cortico-spongiosus bone chips. It is recommended to treat acute/chronic instability of the cervical spine both by using non-fixed plate system with autolog cancellosus bone and by standalone cage filled with cortico-spongiosus bone chips as well. It is worth keeping in mind that by applying this lattest an extra surgery to harvest the graft will be avoided. PMID:20420121
Palliative Occipito-Cervical Stabilization in Patients with Malignant Tumors of the Occipito-Cervical Junction and the Upper Cervical Spine
M. Zimmermann; R. Wolff; A. Raabe; D. Stolke; V. Seifert
Summary.\\u000a Summary. \\u000a ?\\u000a \\u000a \\u000a \\u000a \\u000a Background: Occipital-cervical stability may be impaired in patients with primary malignant or metastatic tumors of the cranio-cervical\\u000a junction and the upper cervical spine. The purpose of this study was to evaluate occipital-cervical fixation with prebended\\u000a titanium-loops and sublaminar wiring in order to achieve a rigid and safe stabilisation of the occipito-cervical region in\\u000a this group of patients.
Oropharyngeal Dysphagia after Anterior Cervical Spine Surgery: A Review
Anderson, Karen K.; Arnold, Paul M.
Study Design?Review. Objective?Postoperative oropharyngeal dysphagia is one of the most common complications following anterior cervical spine surgery (ACSS). We review and summarize recent literature in order to provide a general overview of clinical signs and symptoms, assessment, incidence and natural history, pathophysiology, risk factors, treatment, prevention, and topics for future research. Methods?A search of English literature regarding dysphagia following anterior cervical spine surgery was conducted using PubMed and Google Scholar. The search was focused on articles published since the last review on this topic was published in 2005. Results?Patients who develop dysphagia after ACSS show significant alterations in swallowing biomechanics. Patient history, physical examination, X-ray, direct or indirect laryngoscopy, and videoradiographic swallow evaluation are considered the primary modalities for evaluating oropharyngeal dysphagia. There is no universally accepted objective instrument for assessing dysphagia after ACSS, but the most widely used instrument is the Bazaz Dysphagia Score. Because dysphagia is a subjective sensation, patient-reported instruments appear to be more clinically relevant and more effective in identifying dysfunction. The causes of oropharyngeal dysphagia after ACSS are multifactorial, involving neuronal, muscular, and mucosal structures. The condition is usually transient, most often beginning in the immediate postoperative period but sometimes beginning more than 1 month after surgery. The incidence of dysphagia within one week after ACSS varies from 1 to 79% in the literature. This wide variance can be attributed to variations in surgical techniques, extent of surgery, and size of the implant used, as well as variations in definitions and measurements of dysphagia, time intervals of postoperative evaluations, and relatively small sample sizes used in published studies. The factors most commonly associated with an increased risk of oropharyngeal dysphagia after ACSS are: more levels operated, female gender, increased operative time, and older age (usually >60 years). Dysphagic patients can learn compensatory strategies for the safe and effective passage of bolus material. Certain intraoperative and postoperative techniques may decrease the incidence and/or severity of oropharyngeal dysphagia after ACSS. Conclusions?Large, prospective, randomized studies are required to confirm the incidence, prevalence, etiology, mechanisms, long-term natural history, and risk factors for the development of dysphagia after ACSS, as well as to identify prevention measures. Also needed is a universal outcome measurement that is specific, reliable and valid, would include global, functional, psychosocial, and physical domains, and would facilitate comparisons among studies. Results of these studies can lead to improvements in surgical techniques and/or perioperative management, and may reduce the incidence of dysphagia after ACSS. PMID:24436882
Variation in emergency department use of cervical spine radiography for alert, stable trauma patients
Stiell, I G; Wells, G A; Vandemheen, K; Laupacis, A; Brison, R; Eisenhauer, M A; Greenberg, G H; MacPhail, I; McKnight, R D; Reardon, M; Verbeek, R; Worthington, J; Lesiuk, H
OBJECTIVE: To, assess the emergency department use of cervical spine radiography for alert, stable adult trauma patients in terms of utilization, yield for injury and variation in practices among hospitals and physicians. DESIGN: Retrospective survey of health records. SETTING: Emergency departments of 6 teaching and 2 community hospitals in Ontario and British Columbia. PATIENTS: Consecutive alert, stable adult trauma patients seen with potential cervical spine injury between July 1, 1994, and June 30, 1995. MAIN OUTCOME MEASURES: Total number of eligible patients, referral for cervical spine radiography (overall, by hospital and by physician), presence of cervical spine injury, patient characteristics and hospitals associated with use of radiography. RESULTS: Of 6855 eligible patients, cervical spine radiography was ordered for 3979 (58.0%). Only 60 (0.9%) patients were found to have an acute cervical spine injury (fracture, dislocation or ligamentous instability); 98.5% of the radiographic films were negative for any significant abnormality. The demographic and clinical characteristics of the patients were similar across the 8 hospitals, and no cervical spine injuries were missed. Significant variation was found among the 8 hospitals in the rate of ordering radiography (p < 0.0001), from a low of 37.0% to a high of 72.5%. After possible differences in case severity and patient characteristics at each hospital were controlled for, logistic regression analysis revealed that 6 of the hospitals were significantly associated with the use of radiography. At 7 hospitals, there was significant variation in the rate of ordering radiography among the attending emergency physicians (p < 0.05), from a low of 15.6% to a high of 91.5%. CONCLUSIONS: Despite considerable variation among institutions and individual physicians in the ordering of cervical spine radiography for alert, stable trauma patients with similar characteristics, no cervical spine injuries were missed. The number of radiographic films showing signs of abnormality was extremely low at all hospitals. The findings suggest that cervical spine radiography could be used more efficiently, possibly with the help of a clinical decision rule. PMID:9176419
Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis
Heyde, Christoph-E; Fakler, Johannes K; Hasenboehler, Erik; Stahel, Philip F; John, Thilo; Robinson, Yohan; Tschoeke, Sven K; Kayser, Ralph
Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries. PMID:18538019
Blunt craniocervical artery injury in cervical spine lesions: the value of CT angiography
Steffen Kristian Fleck; Soenke Langner; Joerg Baldauf; Michael Kirsch; Christian Rosenstengel; Henry W. Schroeder
Objective The awareness of traumatic craniocervical artery injuries has increased over the last years, and the detection rate varies\\u000a in published trauma series. These injuries are often associated with cervical spinal and cranial trauma. The purpose of this\\u000a prospective study was to determine the frequency and injury characteristics of blunt traumatic cervical artery injuries in\\u000a patients suffering from cervical spine injuries
Low-back pain, sciatica, cervical and lumbar spondylosis
Nicholas WM Thomas
Spondylosis is the progressive, age-related degenerative changes of the spine. The mid-cervical and lower-lumbar regions are particularly affected because of the distribution of mechanical stresses due to spinal motion and loading of the spinal segments when in the erect posture. These changes are usually asymptomatic apart from increasing stiffness and reduced mobility of the spine. When symptomatic, clinical features include
Acute motor-sensory axonal neuropathy after cervical spine surgery.
Miscusi, Massimo; Currŕ, Antonio; Della Rocca, Carlo; Missori, Paolo; Petrozza, Vincenzo
The authors report the case of a 55-year-old man who presented with acute motor-sensory axonal neuropathy (AMSAN), a variant of Guillain-Barré syndrome with a poor prognosis, immediately after surgery for resection of a cervical chondroma. A misdiagnosis of spinal cord shock due to an acute surgical or vascular postoperative complication was initially made in this patient. Nevertheless, there was continuous transient improvement that was followed by progressive worsening, and further investigation was necessary. The diagnosis of AMSAN, associated with acute colitis caused by Helicobacter pylori, was made based on neurophysiological examinations and colonoscopy. Interestingly, the patient also developed nephrotic syndrome, which was thought to be a further complication of the autoimmune reaction. Delayed administration of immunoglobulins (400 mg/kg/day), mesalazine (800 mg 3×/day), and meropenem (3 g/day) was used to treat the Helicobacter infection and the autoimmune reaction, leading to restoration of renal function and slight neurological improvement. The patient's general condition and neurological status improved slightly, but he remained seriously disabled (Frankel Grade C). This case demonstrates that a new onset of neurological symptoms in the early postoperative period after spine surgery could be related to causes other than iatrogenic myelopathy, and that an early diagnosis can reduce neurological sequelae, leading to a better outcome. PMID:22559275
Theoretical increase of thyroid cancer induction from cervical spine multidetector computed tomography in pediatric trauma patients
Muchow, Ryan D.; Egan, Kelly R.; Peppler, Walter W.; Anderson, Paul A.
BACKGROUND The trend of increasing cervical spine multidirectional computed tomography (MDCT) imaging of pediatric trauma patients is characteristic of the overall dramatic increase in computed tomography utilization in the United States. The purpose of this study is to compare the amount of radiation a pediatric trauma patient absorbs to the thyroid from plain radiographs and MDCT of the cervical spine and to express risk by calculation of theoretical thyroid cancer induction. METHODS A retrospective evaluation of pediatric trauma patients admitted from October 1, 2004, to October 31, 2009, was performed at an academic, Level I trauma center. Inclusion criteria were Level I/II trauma patients, cervical spine imaging performed at our institution, and age <18 years. Absorbed thyroid radiation was calculated for patients receiving plain radiographs or MDCT. Thyroid cancer risk was calculated using the 2006 Biological Effects on Ionizing Radiation VII report. RESULTS Six hundred seventeen patients met inclusion criteria: 224 received cervical spine radiographs and 393 received cervical spine MDCT. The mean thyroid radiation absorbed from radiographs was 0.90 mGy for males and 0.96 mGy for females compared with 63.6 mGy (males) and 64.2 mGy (females) receiving MDCT (p < 0.001). The median excess relative risk of thyroid cancer induction from one cervical spine MDCT in males was 13.0% and females was 25.0%, compared with 0.24% (males) and 0.51% (females) for radiographs (p < 0.001). CONCLUSIONS The significant difference in radiation that MDCT delivers to the pediatric trauma patient when compared with plain radiographs should temper routine use of computed tomography in pediatric cervical spine clearance algorithms. PMID:22327982
[Tracheal intubation in patients with cervical spine injuries using a fiber optic laryngoscope].
Langeron, O; Riou, B; Lambert, Y; Viars, P
Eleven patients, with a cervical spine injury and scheduled for elective cervical spine fusion at least 48 h after their initial trauma, were intubated using a new fiberoptic laryngoscope (Bullard). This technique uses either a semi-rigid guide independent of the laryngoscope blade, or a rigid one attached to the blade. The cervical spine was immobilized with either a collar or a halo. General anaesthesia was carried out with thiopentone, fentanyl and vecuronium bromide. Orotracheal intubation was successful at the first attempts in 10 out of the 11 patients. No mobilization of the cervical spine occurred. In the first six patients, the semi-rigid guide was used, and the rigid one in the remaining five. The anaesthetist who carried out the intubations was always the same. Using the rigid guide was easier than the semi-rigid one. This is confirmed by the time required, 44 +/- 22 sec for the rigid guide, and 97 +/- 92 sec for the semi-rigid one. In the patient in whom this technique failed at the first attempt, endotracheal intubation was carried out by the nasal route and controlled by the fiberoptic laryngoscope. This technique enables a rapid and easy orotracheal intubation in trauma patients with an immobilized cervical spine, but careful training is necessary. PMID:1503320
Anterior Cervical Discectomy and Fusion Alters Whole-Spine Sagittal Alignment
Kim, Jang Hoon; Yi, Seong; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun
Purpose Anterior cervical discectomy and fusion (ACDF) has become a common spine procedure, however, there have been no previous studies on whole spine alignment changes after cervical fusion. Our purpose in this study was to determine whole spine sagittal alignment and pelvic alignment changes after ACDF. Materials and Methods Forty-eight patients who had undergone ACDF from January 2011 to December 2012 were enrolled in this study. Cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis (SVA), and pelvic parameters were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores and Neck Disability Index (NDI) values. Results Forty-eight patients were grouped according to operative method (cage only, cage & plate), operative level (upper level: C3/4 & C4/5; lower level: C5/6 & C6/7), and cervical lordosis (high lordosis, low lordosis). All patients experienced significant improvements in VAS scores and NDI values after surgery. Among the radiologic parameters, pelvic tilt increased and sacral slope decreased at 12 months postoperatively. Only the high cervical lordosis group showed significantly-decreased cervical lordosis and a shortened SVA postoperatively. Correlation tests revealed that cervical lordosis was significantly correlated with SVA and that SVA was significantly correlated with pelvic tilt and sacral slope. Conclusion ACDF affects whole spine sagittal alignment, especially in patients with high cervical lordosis. In these patients, alteration of cervical lordosis to a normal angle shortened the SVA and resulted in reciprocal changes in pelvic tilt and sacral slope. PMID:26069131
Radiation therapy for chordomas of the base of skull and cervical spine: Patterns of failure and outcome after relapse
Marcio A. Fagundes; Eugen B. Hug; Norbert J. Liebsch; William Daly; Jimmy Efird; John E. Munzenrider
Purpose: To determine the patterns of failure and outcome following relapse of chordomas of the base of skull and cervical spine.Methods and Materials: Between November 1975 and October 1993, 204 patients were treated for chordoma of the base of skull or cervical spine, of which 63 have developed relapse. These 63 patients constitute the main focus of this study. Forty-five
Development and validation of a 10-year-old child ligamentous cervical spine finite element model.
Dong, Liqiang; Li, Guangyao; Mao, Haojie; Marek, Stanley; Yang, King H
Although a number of finite element (FE) adult cervical spine models have been developed to understand the injury mechanisms of the neck in automotive related crash scenarios, there have been fewer efforts to develop a child neck model. In this study, a 10-year-old ligamentous cervical spine FE model was developed for application in the improvement of pediatric safety related to motor vehicle crashes. The model geometry was obtained from medical scans and meshed using a multi-block approach. Appropriate properties based on review of literature in conjunction with scaling were assigned to different parts of the model. Child tensile force-deformation data in three segments, Occipital-C2 (C0-C2), C4-C5 and C6-C7, were used to validate the cervical spine model and predict failure forces and displacements. Design of computer experiments was performed to determine failure properties for intervertebral discs and ligaments needed to set up the FE model. The model-predicted ultimate displacements and forces were within the experimental range. The cervical spine FE model was validated in flexion and extension against the child experimental data in three segments, C0-C2, C4-C5 and C6-C7. Other model predictions were found to be consistent with the experimental responses scaled from adult data. The whole cervical spine model was also validated in tension, flexion and extension against the child experimental data. This study provided methods for developing a child ligamentous cervical spine FE model and to predict soft tissue failures in tension. PMID:23817769
Primary headaches and painful spontaneous cervical artery dissection
Cynthia R. Campos; Marcelo Calderaro; Milberto Scaff; Adriana B. Conforto
The relation between primary headaches (PH) and pain related to spontaneous cervical artery dissection (SCAD) is still unclear,\\u000a as well as the progress of PH after dissection. To investigate this relation, the characteristics of pain related to SCAD\\u000a and changes in PH patterns after SCAD, we evaluated 54 consecutive patients. Thirty-five (65%) had previous PH. Painful SCAD\\u000a occurred in 39
Surgical treatment of low back pain in spine instability.
Bradford, D S
Spinal instability is a loosely used term resulting from a variety of traumatic, developmental, neoplastic, hereditary, and degenerative insults to the axial skeleton. As defined by White and Panjabi, lumbar instability would imply the loss of the spine's ability, under physiological loads, to maintain its patterns of displacement so as to avoid neurologic deficits, incapacitating deformity, and intractable pain. Although from a strict engineering standpoint, the concept of load and deformation is valid, it is not at all known what type of movement or what magnitude of movement is responsible for low back pain. In light of these considerations, the author would define instability as either acute or chronic. Acute mechanical instability would result from those conditions such as fracture, tumor infiltration, infection, postlaminectomy, and certain congenital defects where a small change in loading or deformation could lead to permanent vertebral displacement with fixed deformity and/or neurologic damage. Chronic instability would result from those low back disorders that lead to progressive deformity over a period of years, often producing back pain from degenerative osteoarthritis, and central as well as foraminal stenosis. These disorders would include lumbar scoliosis, kyphosis, and spondylolisthesis, either isthmic or degenerative type. In those situations associated with more chronic instability, the relationship of low back pain is not always discernable even with provocative discography or magnetic resonance imaging. The surgical treatment of low back pain associated with these spinal instabilities depends on the etiology of the conditions defined. Acute traumatic injuries are best managed by posterior segmental instrumentation. At the level of the upper lumbar spine, a combined approach may be desirable to support anterior column deficiency.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8076479
CT evaluation of the low severity cervical spine trauma: When is the scout view enough?
Nicholas Theocharopoulos; Georgios Chatzakis; Apostolos Karantanas; Konstantinos Chlapoutakis; John Damilakis
The aim of the current study was to compare the diagnostic information obtained from a helical CT examination in low severity cervical spine trauma with that from a lateral CT scout view. We included alert and clinically stable patients, who had suffered acute blunt trauma of low or moderate severity. Their scout images were interpreted independently by two radiologists and
Assessment of published reliability studies for cervical spine range-of-motion measurement tools
Kelvin Jordan
Objective: To assess the reliability of tools to measure cervical spine range of motion in clinical settings and discuss the necessary components for reliability studies.Data Sources: Database searches included Bandolier, Bath Information and Data Services including Index of Scientific and Technical Proceedings, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, English National Health Care Database, MEDLINE, Occupational
Placement of baclofen pumps through the foramen magnum and upper cervical spine
Kristine Dziurzynski; Deborah Mcleish; Michael Ward; Bermans J. Iskandar
Introduction The baclofen pump has been utilized in children with refractory spasticity. However, in children with prior lumbar fusion, the implantation of such a device is difficult and fraught with complications. As an alternative to placing the pump catheter through the lumbar spine, we report our experience with placement of the catheter in the spinal canal via a cervical approach through
Finite element modeling of the cervical spine: role of intervertebral disc under axial and eccentric loads
Srirangam Kumaresan; Narayan Yoganandan; Frank A Pintar; Dennis J Maiman
An anatomically accurate, three-dimensional, nonlinear finite element model of the human cervical spine was developed using computed tomography images and cryomicrotome sections. The detailed model included the cortical bone, cancellous core, endplate, lamina, pedicle, transverse processes and spinous processes of the vertebrae; the annulus fibrosus and nucleus pulposus of the intervertebral discs; the uncovertebral joints; the articular cartilage, the synovial
Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation
Srirangam Kumaresan; Narayan Yoganandan; Frank A. Pintar; Dennis J. Maiman; Vijay K. Goel
Cervical spine disorders such as spondylotic radiculopathy and myelopathy are often related to osteophyte formation. Bone remodeling experimental–analytical studies have correlated biomechanical responses such as stress and strain energy density to the formation of bony outgrowth. Using these responses of the spinal components, the present study was conducted to investigate the basis for the occurrence of disc-related pathological conditions. An
Flexion and extension structural properties and strengths for male cervical spine segments
Roger W. Nightingale; V. Carol Chancey; Danielle Ottaviano; Jason F. Luck; Laura Tran; Michael Prange; Barry S. Myers
New vehicle safety standards are designed to limit the amount of neck tension and extension seen by out-of-position motor vehicle occupants during airbag deployments. The criteria used to assess airbag injury risk are currently based on volunteer data and animal studies due to a lack of bending tolerance data for the adult cervical spine. This study provides quantitative data on
Cervical spine injuries sustained by motorcyclists in road crashes in Malaysia
S. S. Ooi; S. V. Wong; R S Radin Umar; A. A. Azhar; M M H Megat Ahmad
This study looks at cervical spine injuries sustained by motorcyclists in motorcycle road crashes. The motorcyclist is relatively more exposed to road hazards compared to the protected car passenger. They are therefore more prone to injury than those traveling in any other form of transportation. The motorcycle is relatively less stable and accords little protection to passengers in road crashes
Plate fixation adds stability to two-level anterior fusion in the cervical spine: a randomized study using radiostereometry.
Zoëga, B; Kärrholm, J; Lind, B
This study evaluated whether addition of a cervical spine locking plate (CSLP) in two-level disc fusions improved the postoperative stability and reduced the time to healing. Radiostereometric analysis was used to obtain precise recordings of the three-dimensional motion between the fused vertebrae. Eighteen consecutive patients were operated on with excision of two adjacent cervical discs and anterior horseshoe grafting with autologous bone (Smith Robinson technique). Nine patients were randomized to stabilization with autologous bone grafting and CSLP plate fixation and nine patients to grafting without fixation. Clinical symptoms in terms of pain in the neck and the arm were analysed preoperatively and after 1 year using a visual analogue scale (VAS). The patients operated without a plate displayed increased rotations around the transverse axis, corresponding to the development of a kyphosis [mean value no plate/plate 14.4 degrees/0.8 degrees (repeated measure ANOVA: P < 0.01)]. The mean compression was 3.2 mm larger in patients operated without a plate (repeated measure ANOVA: P < 0.01). Patients operated without a plate had more arm pain at the 1-year follow up (P < 0.05, Mann-Whitney U test). The VAS score for neck pain did not differ significantly between the two groups. Plate fixation could not be demonstrated to increase the healing rate, promote more rapid fusion or influence the frequency of graft complications. PMID:9765038
Dear Colleague, Spine related disorders, including disc disease, stenosis, neck and back pain, constitute the
Brownstone, Rob
Dear Colleague, Spine related disorders, including disc disease, stenosis, neck and back pain of spine referrals, so as to more quickly see your patients for whom surgery may be necessary or beneficial will be working to streamline the referral process and deal efficiently with the backlog of spine referrals
Is radiography justified for the evaluation of patients presenting with cervical spine trauma?
Theocharopoulos, Nicholas; Chatzakis, Georgios; Damilakis, John [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, 71003 Crete (Greece) and Department of Natural Sciences, Technological Education Institute of Crete, P.O. Box 140, Iraklion 71004 Crete (Greece); Department of Radiology, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, 71003 Crete (Greece); Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, 71003 Crete (Greece)
Conventional radiography has been for decades the standard method of evaluation for cervical spine trauma patients. However, currently available helical multidetector CT scanners allow multiplanar reconstruction of images, leading to increased diagnostic accuracy. The purpose of this study was to determine the relative benefit/risk ratio between cervical spine CT and cervical spine radiography and between cervical spine CT and cervical spine radiography, followed by CT as an adjunct for positive findings. A decision analysis model for the determination of the optimum imaging technique was developed. The sensitivity and specificity of CT and radiography were obtained by dedicated meta-analysis. Lifetime attributable risk of mortal cancer from CT and radiography was calculated using updated organ-specific risk coefficients and organ-absorbed doses. Patient organ doses from radiography were calculated using Monte Carlo techniques, simulated exposures performed on an anthropomorphic phantom, and thermoluminescence dosimetry. A prospective patient study was performed regarding helical CT scans of the cervical spine. Patient doses were calculated based on the dose-length-product values and Monte Carlo-based CT dosimetry software program. Three groups of patient risk for cervical spine fracture were incorporated in the decision model on the basis of hypothetical trauma mechanism and clinical findings. Radiation effects were assessed separately for males and females for four age groups (20, 40, 60, and 80 yr old). Effective dose from radiography amounts to 0.050 mSv and from a typical CT scan to 3.8 mSv. The use of CT in a hypothetical cohort of 10{sup 6} patients prevents approximately 130 incidents of paralysis in the low risk group (a priori fracture probability of 0.5%), 500 in the moderate risk group (a priori fracture probability of 2%), and 5100 in the high risk group (a priori fracture probability of 20%). The expense of this CT-based prevention is 15-32 additional radiogenic lethal cancer incidents. According to the decision model calculations, the use of CT is more favorable over the use of radiography alone or radiography with CT by a factor of 13, for low risk 20 yr old patients, to a factor of 23, for high risk patients younger than 80 yr old. The radiography/CT imaging strategy slightly outperforms plain radiography for high and moderate risk patients. Regardless of the patient age, sex, and fracture risk, the higher diagnostic accuracy obtained by the CT examination counterbalances the increase in dose compared to plain radiography or radiography followed by CT only for positive radiographs and renders CT utilization justified and the radiographic screening redundant.
Intra-operative computer navigation guided cervical pedicle screw insertion in thirty-three complex cervical spine deformities
Rajasekaran, S.; Kanna, P. Rishi Mugesh; Shetty, T. Ajoy Prasad
Background: Cervical pedicle screw fixation is challenging due to the small osseous morphometrics and the close proximity of neurovascular elements. Computer navigation has been reported to improve the accuracy of pedicle screw placement. There are very few studies assessing its efficacy in the presence of deformity. Also cervical pedicle screw insertion in children has not been described before. We evaluated the safety and accuracy of Iso-C 3D-navigated pedicle screws in the deformed cervical spine. Materials and Methods: Thirty-three patients including 15 children formed the study group. One hundred and forty-five cervical pedicle screws were inserted using Iso-C 3D-based computer navigation in patients undergoing cervical spine stabilization for craniovertebral junction anomalies, cervico-thoracic deformities and cervical instabilities due to trauma, post-surgery and degenerative disorders. The accuracy and containment of screw placement was assessed from postoperative computerized tomography scans. Results: One hundred and thirty (89.7%) screws were well contained inside the pedicles. Nine (6.1%) Type A and six (4.2%) Type B pedicle breaches were observed. In 136 levels, the screws were inserted in the classical description of pedicle screw application and in nine deformed vertebra, the screws were inserted in a non-classical fashion, taking purchase of the best bone stock. None of them had a critical breach. No patient had any neurovascular complications. Conclusion: Iso-C navigation improves the safety and accuracy of pedicle screw insertion and is not only successful in achieving secure pedicle fixation but also in identifying the best available bone stock for three-column bone fixation in altered anatomy. The advantages conferred by cervical pedicle screws can be extended to the pediatric population also. PMID:20890413
Single stage transforaminal retrojugular tumor resection: The spinal keyhole for dumbbell tumors in the cervical spine
Bobinski, Lukas; Henchoz, Yves; Sandu, Kishore; Duff, John Michael
Background: Dumbbell tumors are defined as having an intradural and extradural component with an intermediate component within an expanded neural foramen. Complete resection of these lesions in the subaxial cervical spine is a challenge, and it has been achieved through a combined posterior/anterior or anterolateral approach. This study describes a single stage transforaminal retrojugular (TFR) approach for dumbbell tumors resection in the cervical spine. Methods: This is a retrospective review of a series of 17 patients treated for cervical benign tumors, 4 of which were "true" cervical dumbbell tumors operated by a simplified retrojugular approach. The TFR approach allows a single stage gross total resection of both the extraspinal and intraspinal/intradural components of the tumor, taking advantage of the expanded neural foramen. All patients were followed clinically and radiologically with magnetic resonance imaging (MRI). Results: Gross total resection was confirmed in all four patients by postoperative MRI. Minimal to no bone resection was performed. No fusion procedure was performed and no delayed instability was seen. At follow up, one patient had a persistent mild hand weakness and Horners syndrome following resection of a hemangioblastoma of the C8 nerve root. The other three patients were neurologically normal. Conclusions: The TFR approach appears to be a feasible surgical option for single stage resection in selective cases of dumbbell tumors of the cervical spine. PMID:25883845
Fatal Isolated Cervical Spine Injury in a Patient with Ankylosing Spondylitis: A Case Report
Gelalis, Ioannis D.; Lykissas, Marios G.; Dimou, Apostolos A.; Giannoulis, Dionysios K.; Beris, Alexandros E.
Study Design?Case report. Objective?The purpose of the present case report was to present a patient with a history of ankylosing spondylitis who sustained a dislocation of C6 on C7 and died soon after his presentation in the emergency room (ER). Methods?An 88-year-old man was brought to the ER due to a neck injury secondary to a fall. Imaging of the cervical spine revealed anterior dislocation of C6 on C7 and the characteristic "bamboo" spine of ankylosing spondylitis. Results?The patient died within 30 minutes due to respiratory insufficiency. Conclusion?Isolated cervical spine injuries in patients with ankylosing spondylitis can be fatal. A high degree of clinical suspicion, thorough imaging with computed tomography, and meticulous handling are required in this patient population.
Detecting Facet Joint and Lateral Mass Injuries of the Subaxial Cervical Spine in Major Trauma Patients
Cheung, Ian; Dalzell, Kristian; Deverall, Hamish; Freeman, Brian J.C.; Morris, Stephen A.C.; Sandler, Simon J.I.; Williams, Richard; Yau, Y.H.; Goss, Ben
Study Design Radiologic imaging measurement study. Purpose To assess the accuracy of detecting lateral mass and facet joint injuries of the subaxial cervical spine on plain radiographs using computed tomography (CT) scan images as a reference standard; and the integrity of morphological landmarks of the lateral mass and facet joints of the subaxial cervical spine. Overview of Literature Injuries of lateral mass and facet joints potentially lead to an unstable subaxial cervical spine and concomitant neurological sequelae. However, no study has evaluated the accuracy of detecting specific facet joint injuries. Methods Eight spinal surgeons scored four sets of the same, randomly re-ordered, 30 cases with and without facet joint injuries of the subaxial cervical spine. Two surveys included conventional plain radiographs series (test) and another two surveys included CT scan images (reference). Facet joint injury characteristics were assessed for accuracy and reliability. Raw agreement, Fleiss kappa, Cohen's kappa and intraclass correlation coefficient statistics were used for reliability analysis. Majority rules were used for accuracy analysis. Results Of the 21 facet joint injuries discerned on CT scan images, 10 were detected in both plain radiograph surveys (sensitivity, 0.48; 95% confidence interval [CI], 0.26-0.70). There were no false positive facet joint injuries in either of the first two X-ray surveys (specificity, 1.0; 95% CI, 0.63-1.0). Five of the 11 cases with missed injuries had an injury below the lowest visible articulating level on radiographs. CT scan images resulted in superior inter- and intra-rater agreement values for assessing morphologic injury characteristics of facet joint injuries. Conclusions Plain radiographs are not accurate, nor reliable for the assessment of facet joint injuries of the subaxial cervical spine. CT scans offer reliable diagnostic information required for the detection and treatment planning of facet joint injuries.
Helmet use and cervical spine injury: a review of motorcycle, moped, and bicycle accidents at a level 1 trauma center.
Hooten, Kristopher G; Murad, Gregory J A
Helmet use in two-wheeled vehicle accidents is widely reported to decrease the rates of death and traumatic brain injury. Previous reports suggest that there exists a trade off with helmet use consisting of an increased risk of cervical spine injuries. Recently, a review of a national trauma database demonstrated the opposite, with reduction in cervical spinal cord injuries in motorcycle crashes (MCC). In 2000, the State of Florida repealed its mandatory helmet law to make helmet use optional for individuals older than 21 with $10,000 of health insurance coverage. To better ascertain the risks of cervical spine injury with non-helmet use in all two-wheeled vehicles, we analyzed the University of Florida level one trauma center experience. We reviewed the Traumatic injury database over a five-year period (January 1, 2005, to July 1, 2010) for all patients involved in two-wheeled vehicle accidents. Patients were stratified according to vehicle type (motorcycle, scooter, and bicycle), helmet use, and the presence or absence of a cervical spine injury. Outcomes were compared for injury severity, cervical spine injury, cervical spinal cord injury, and presence of cervical spine injuries requiring surgery. Population means were compared using paired t-test. A total of 1331 patients were identified: 995 involved in motorcycle accidents, 87 involved in low-powered scooter accidents, and 249 involved in bicycle accidents. Helmet use was variable between each group. One hundred thirty-five total cervical spine injuries were identified. No evidence was found to suggest an increased risk of cervical spine injury or increased severity of cervical spine injury with helmet use. This fact, in combination with our previous findings, suggest that the law's age and insurance exemption should be revoked and a universal helmet law be reinstated in the state of Florida. PMID:24661125
Calcification of the Alar Ligament Mimics Fracture of the Craniovertebral Junction (CVJ): An Incidental Finding from Computerised Tomography of the Cervical Spine Following Trauma.
Che Mohamed, Siti Kamariah; Abd Aziz, Azian
When performing a radiological assessment for a trauma case with associated head injury, a fragment of dense tissue detected near the craniovertebral junction would rapidly be assessed as a fractured bone fragment. However, if further imaging and evaluation of the cervical spine with computerised tomography (CT) did not demonstrate an obvious fracture, then the possibility of ligament calcification would be considered. We present a case involving a previously healthy 44-yearold man who was admitted following a severe head injury from a road traffic accident. CT scans of the head showed multiple intracranial haemorrhages, while scans of the cervical spine revealed a small, well-defined, ovoid calcification in the right alar ligament. This was initially thought to be a fracture fragment. Although such calcification is uncommon, accident and emergency physicians and radiologists may find this useful as a differential diagnosis in patients presenting with neck pain or traumatic head injury. PMID:22135515
Postural sway increase in low back pain subjects is not related to reduced spine range of motion
A Hamaoui; M. C Do; S Bouisset
This study questioned whether postural sway increase in low back pain subjects was related to impaired spine mobility, and especially to a decrease in the range of motion, which was assumed to represent structural spine stiffness. Ten low back pain subjects and ten healthy control subjects performed spine flexion-extension and spine side bending tests, and standing posturographic examination in different
Smith, Danny; Hoogenboom, Barb
Since the inception of the term Sports Medicine Athletic Trainers, Sports Physical Therapists, Paramedics, and Emergency Room Physicians have faced a number of challenges when it comes to providing care to an equipment laden athlete suspected of having a cervical spine or serious head injury. The same equipment that is designed to protect the player may significantly impede the medical team when it comes to diagnosing and treating cervical spine and head injuries. Incorrectly removing the helmet and shoulder pads from a football player with a cervical spine injury, may lead to unwanted motion of the cervical spine during removal. It is the purpose of this article to review the current concepts relating to equipment removal and to introduce a novel system for quick and easy removal of football shoulder pads called the Riddell™RipKord system. PMID:21712941
A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT.
James, Iyore Ao; Moukalled, Ahmad; Yu, Elizabeth; Tulman, David B; Bergese, Sergio D; Jones, Christian D; Stawicki, Stanislaw Pa; Evans, David C
Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT), magnetic resonance imaging of the cervical spine (CS-MRI) is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT) scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI) website (www.ncbi.nlm.nih.gov) for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%). The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%). Eleven patients (0.7%) had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary. PMID:25400384
Intradural tumor and concomitant disc herniation of cervical spine
Bapat, Mihir R; Rathi, Prasanna; Pawar, Uday; Chaudhary, Kshitij
We report a rare patient of a simultaneous extradural and intradural compression of the cervical spinal cord due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. The intradural lesion was missed resulting in recurrence of myelopathy after a surprisingly complete functional recovery following anterior cervical discectomy. Retrospectively, it was noted that the initial cord swelling noticed was tumor being masked by the compression produced by the herniated disc. A contrast magnetic resonance imaging scan is important in differentiating intradural tumors of the spinal cord. A high index of suspicion is often successful in unmasking both the pathologies. PMID:21221228
Intradural tumor and concomitant disc herniation of cervical spine.
Bapat, Mihir R; Rathi, Prasanna; Pawar, Uday; Chaudhary, Kshitij
We report a rare patient of a simultaneous extradural and intradural compression of the cervical spinal cord due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. The intradural lesion was missed resulting in recurrence of myelopathy after a surprisingly complete functional recovery following anterior cervical discectomy. Retrospectively, it was noted that the initial cord swelling noticed was tumor being masked by the compression produced by the herniated disc. A contrast magnetic resonance imaging scan is important in differentiating intradural tumors of the spinal cord. A high index of suspicion is often successful in unmasking both the pathologies. PMID:21221228
Early MRI findings in stab wound of the cervical spine: two case reports.
Alkan, A; Baysal, T; Saras, K; Sigirci, A; Kutlu, R
MR imaging was found to be the most sensitive modality for the detection of spinal cord abnormalities in the acutely injured spine. Although it is reported that traumatic pneumomyelogram indicates a base-of-skull or middle cranial fossa fracture and is almost certainly associated with intracranial subarachnoid air, early MR imaging may demonstrate subarachnoid air in penetrating trauma of the spinal cord without head injury. We report two cervical-spine stab-wound cases, one of which had subarachnoid air on early MR findings. PMID:11942503
Evaluation of the role of ligaments, facets and disc nucleus in lower cervical spine under compression and sagittal moments using finite element method
E. C Teo; H. W Ng
Cervical spinal instability due to ligamentous injury, degenerated disc and facetectomy is a subject of great controversy. There is no analytical investigation reported on the biomechanical response of cervical spine in these respects. Parametric study on the roles of ligaments, facets, and disc nucleus of human lower cervical spine (C4–C6) was conducted for the very first time using noninvasive finite
Fiberoptic intubation in 327 neurosurgical patients with lesions of the cervical spine.
Fuchs, G; Schwarz, G; Baumgartner, A; Kaltenböck, F; Voit-Augustin, H; Planinz, W
In patients with lesions of the cervical spine, direct laryngoscopy for endotracheal intubation entails the risk of injuring the spinal cord. In an attempt to avoid this complication, the authors used flexible fiberoptic nasal intubation in a series of 327 patients with cervical lesions undergoing elective neurosurgical procedures. The nasal route was preferred for laryngeal intubation because it is easier than the oral route and a restraining collar or halo device does not impair the intubating maneuver. Bronchoscopic intubation was possible in all patients. In 12 patients (3.6%), anatomic abnormalities prevented transnasal insertion of the endotracheal tube, and transoral fiberoptic intubation was necessary. Endotracheal intubation was graded as slightly difficult in 85 patients (26%). The minimal peripheral oxygen saturation during intubation exceeded 90% in 289 patients (88%). In the other 38 patients, the mean O2 saturation was 84.2+/-4.3% (range, 72-89%). Intubation was well tolerated by all patients and none had recall of the procedure. Cervical stabilizers did not have to be removed for intubation in any patient. None of the patients had postoperative neurologic deficits attributable to the intubation procedure. The authors consider fiberoptic transnasal intubation to be a useful alternative to direct laryngoscopic tracheal intubation in patients undergoing elective surgical procedures on the cervical spine to avoid potential injury to the cervical spinal cord. PMID:9890380
Effect of age on cervical spine injuries in children after motor vehicle collisions: effectiveness of restraint devices
Brian S Zuckerbraun; Katie Morrison; Barbara Gaines; Henri R Ford; David J Hackam
PurposeDespite the devastating consequences of cervical spine (C-spine) injury in children after motor vehicle collisions (MVC), the factors leading to the injury and the appropriateness of protective restraints remain undefined. The authors hypothesized that age-related anatomic factors contribute to inadequate restraints and therefore increase injury severity after MVC.
Oesophageal perforation caused by screw displacement 16 months following anterior cervical spine fixation.
Leaver, Nicholas; Colby, Alexandra; Appleton, Nathan; Vimalachandran, Dale
Anterior cervical spine plating is a standard procedure for fixing unstable vertebral fractures. Following surgery, oesophageal perforation has an incidence of 0.25% and this is usually hours following surgery, due to over prominent screws or friction between the oesophagus and the plate. Instrumentation failure of these plates months or years following surgery is very rare but potentially life-threatening. We report a case of microcytic anaemia which was investigated by oesophagogastroduodenoscopy, and subsequently found that a screw from the anterior plate had lifted off and perforated the oesophagus. This is very rare, but emphasises an important lesson. Anyone presenting with gastrointestinal bleeding or infectious signs, with a history of cervical spine plating should be investigated immediately for instrumentation failure as it brings a high mortality. PMID:25796082
Pain Relief in Cervical Dystonia with Botulinum Toxin Treatment
Camargo, Carlos Henrique Ferreira; Cattai, Lígia; Teive, Hélio Afonso Ghizoni
Dystonia is a neurological disorder characterized by intermittent or sustained muscle contractions that cause abnormal, usually repetitive, movements and postures. Dystonic movements can be tremulous and twisting and often follow a pattern. They are frequently associated with overflow muscle activation and may be triggered or worsened by voluntary action. Most voluntary muscles can be affected and, in the case of the neck muscles, the condition is referred to as cervical dystonia (CD), the most common form of dystonia. The high incidence of pain distinguishes CD from other focal dystonias and contributes significantly to patient disability and low quality of life. Different degrees of pain in the cervical region are reported by more than 60% of patients, and pain intensity is directly related to disease severity. Botulinum toxin (BoNT) is currently considered the treatment of choice for CD and can lead to an improvement in pain and dystonic symptoms in up to 90% of patients. The results for BoNT/A and BoNT/B are similar. The complex relationship between pain and dystonia has resulted in a large number of studies and more comprehensive assessments of dystonic patients. When planning the application of BoNT, pain should be a key factor in the choice of muscles and doses. In conclusion, BoNT is highly effective in controlling pain, and its analgesic effect is sustained for a long time in most CD patients. PMID:26110508
Kinematic analysis of the lower cervical spine in the protracted and retracted neck flexion positions
Park, So Hyun
[Purpose] The aim of this study was to analyze lower cervical spine kinematics in protracted and retracted neck flexion positions in healthy people. [Subjects and Methods] The craniovertebral angle (CVA) and intervertebral body angles of the lower cervical spine of 10 healthy individuals were analyzed using fluoroscopy in a neutral sitting with the head in the neutral (N), protracted (Pro), and retracted (Ret) positions and with the neck in full flexion with the head in the neutral (N-fx), protracted (Pro-fx), and retracted (Ret-fx) positions. [Results] There were significant differences in the CVA and intervertebral body angle at the C3–4 level, and the Ret position showed the highest values followed by the N and Pro positions. Regarding the intervertebral body angle at the C4–5 level, the Pro position showed a higher value than the N and Ret positions. At the C6–7 level, the Pro position showed the lowest value compared with the N and Ret positions. In the CVA, the Ret-fx position showed a higher value than the N-fx and Ret-fx positions. [Conclusion] The results suggest that in the neutral sitting position, protraction is an ineffective posture due to overstress of the C6–7 segment, which is placed in a hyperflexed position at this level. Instead, retraction is the recommend posture for the patient with C6–7 degeneration, which makes for a more flexed position in the upper cervical spine and a less flexed position in the lower cervical spine. PMID:25642057
Bartonella henselae osteoarthritis of the upper cervical spine in a 14-year-old boy.
Mirouse, G; Journe, A; Casabianca, L; Moreau, P E; Pannier, S; Glorion, C
We report a case of Bartonella henselae, an agent of cat scratch disease, C1-C2 osteoarthritis with osteolysis of the lateral mass of C2 in a 14-year-old boy. Oral antibiotics did not successfully treat the infection and surgery was necessary to treat the septic arthritis. The case opens discussion about bacterial osteoarthritis of the cervical spine and bone involvement in disseminated bartonellosis. PMID:25881557
Therapeutic effects of functional orthodontic appliances on cervical spine posture: a retrospective cephalometric study
Introduction Interactions between the cervical spine and the stomatognathic system have been discussed in literature. The present study was conducted to investigate whether, and to what extent, orthodontically induced mandibular advancement produces changes in cervical spine posture. Furthermore, possible appliance-specific effects should be distinguished. Material and methods The cephalograms of 64 patients with skeletal class II were analysed before and after mandibular advancement. Linear and angular cephalometric parameters were identified to define the position of the atlanto-occipital and atlantoaxial joints. The total example was divided into two subgroups (comprising 32 individuals each) according to the employed appliance: activator versus bite-jump appliance (BJA). Student's t-test and analysis of covariance were used for statistical analysis. Results Overall, a significant straightening of the cervical spine was observed during the treatment. This conclusion is based on changes of Chamberlain (p?=?0.0055), CVT (p?=?0.0003), OPT (p?0.0001), Redlund-Johnell/Petersson (p?0.0001), McGregor-mC2 (p?=?0.0333) and AT-FH (p?=?0.0445). Improvements in occipitoatlantal dislocation were also observed in the total sample. Appliance-specific changes were found in the activator subgroup for a number of linear parameters (Chamberlain, McGregor, CVT, OPT, Redlund-Johnell/Petersson). In contrast, only two linear parameters (OPT and Powers ratio) revealed statistically significant changes in the BJA subgroup. Conclusions During skeletal class II treatment the position of upper cervical spine changes. In the activator subgroup the observed effects were more pronounced than those in the BJA subgroup. Further studies including a control group comprised with non-treated class II patients are needed to assess whether these effects may be caused directly by the appliances irrespective of growth. PMID:24661951
The incidence and prognostic significance of radiological abnormalities in soft tissue injuries to the cervical spine
K. A. Miles; C. Maimaris; D. Finlay; M. R. Barnes
The radiographs and initial clinical findings of 73 patients who had sustained trauma to the cervical spine without bony injury in vehicle collisions were reviewed. The patients were also re-examined clinically two years after the injury. Forty eight (65.8%) had abnormal radiographs at presentation — prevertebral soft tissue swelling in 15 (20.6%), degenerative changes in 15 (20.6%), and an angular
Aminophylline for the treatment of symptomatic bradycardia and asystole secondary to cervical spine injury
Kyle A. Weant; Michaux Kilpatrick; Sivakumar Jaikumar
Introduction Bradycardia is a common complication of cervical spine damage in the weeks following injury, occurring in up to 100% of patients\\u000a in some studies. Cardiac arrest and asystole have been reported in as many as 15% of these patients and cardiac events are\\u000a the main cause of death within the first year. We describe the case of a 25-year-old African-American
A Technique for Dynamic Tensile Testing of Human Cervical Spine Ligaments
V. P. W. Shim; J. F. Liu; V. S. Lee
An experimental study is undertaken to examine the dynamic stress–strain characteristics of ligaments from the human cervical\\u000a spine (neck). Tests were conducted using a tensile split Hopkinson bar device and the engineering strain rates imposed were\\u000a of the order of 102?103\\/s. As ligaments are extremely soft and pliable, specialized test protocols applicable to Hopkinson bar testing were developed\\u000a to facilitate
Role of posterior elements in the disc bulging of a degenerated cervical spine
Solitro, Giovanni F.; Siemionow, Kris; Drucker, David; Upadhyay, Ashish; Patel, Priyesh
Background Many studies have been developed to characterize the mechanical behavior of the intervertebral disc specifically for the lumbar spine and there have been limited studies done on the cervical spine with the goal to evaluate the strength of the cervical spine under compression without any information on the bulging of the intervertebral discs. The goal of the current study is to examine the deformation response of the cervical intervertebral disc classified with grade III or greater degeneration and analyze the relationship between axial deformation and anterior and posterior bulge under compression up to 550 N. Methods Each specimen was compressed for 3 cycles to a maximum load of 550N in steps of 50 N. The bulge was measured using Linear Variable Differential Transformers (LVDTs on an intact spinal segment, spinal segment with post laminectomy, and spinal segment post facetectomy. Results The anterior budge for an intact spinal segment shows a change of slope at loads of 262N±66N. For a physiological load of 250N the vertical displacement or spine segment height was reduced by 10.1% for an intact segment and 8.78% for the laminectomy and facetectomy configurations with F = 0.159 (Fcrit = 3.89) with no statistical difference observed. For the post laminectomy there was a decrease of 35% in anterior bulge compared to the intact specimen. Conclusions Our results show that for grade III disc degeneration the cervical segments bulging for both the laminectomy and facetectomy procedures are not significantly different. In post laminectomy the average anterior and posterior bulges are similar to the average anterior and posterior bulge post facetectomy. PMID:26056628
A three-dimensional finite element model of the cervical spine: an investigation of whiplash injury
Jian-Guo Zhang; Fang Wang; Rui Zhou; Qiang Xue
Very few finite element models of the cervical spine have been developed to investigate internal stress on the soft tissues\\u000a under whiplash loading situation. In the present work, an approach was used to generate a finite element model of the head\\u000a (C0), the vertebrae (C1–T1) and their soft tissues. The global acceleration and displacement, the neck injury criterion (NIC),\\u000a segmental
A cervical spine model to predict injury scenarios and clinical instability
Abraham Tchako; Ali Sadegh
A complete and detailed three-dimensional finite element model of the human cervical spine (C1–C7), including soft and hard tissues, was created using a digitized geometric measurement tool. The model was validated against existing experimental studies in flexion, extension, lateral bending, and axial rotation. The aims of this study were to use the model to simulate the mechanisms of injury scenarios,
Random Positional Variation Among the Skull, Mandible, and Cervical Spine With Treatment Progression During Head-and-Neck Radiotherapy
Ahn, Peter H. [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (United States)], E-mail: firstname.lastname@example.com; Ahn, Andrew I. [Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (United States); Lee, C. Joe; Shen Jin; Miller, Ekeni; Lukaj, Alex; Milan, Elissa; Yaparpalvi, Ravindra; Kalnicki, Shalom; Garg, Madhur K. [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (United States)
Purpose: With 54{sup o} of freedom from the skull to mandible to C7, ensuring adequate immobilization for head-and-neck radiotherapy (RT) is complex. We quantify variations in skull, mandible, and cervical spine movement between RT sessions. Methods and Materials: Twenty-three sequential head-and-neck RT patients underwent serial computed tomography. Patients underwent planned rescanning at 11, 22, and 33 fractions for a total of 93 scans. Coordinates of multiple bony elements of the skull, mandible, and cervical spine were used to calculate rotational and translational changes of bony anatomy compared with the original planning scan. Results: Mean translational and rotational variations on rescanning were negligible, but showed a wide range. Changes in scoliosis and lordosis of the cervical spine between fractions showed similar variability. There was no correlation between positional variation and fraction number and no strong correlation with weight loss or skin separation. Semi-independent rotational and translation movement of the skull in relation to the lower cervical spine was shown. Positioning variability measured by means of vector displacement was largest in the mandible and lower cervical spine. Conclusions: Although only small overall variations in position between head-and-neck RT sessions exist on average, there is significant random variation in patient positioning of the skull, mandible, and cervical spine elements. Such variation is accentuated in the mandible and lower cervical spine. These random semirigid variations in positioning of the skull and spine point to a need for improved immobilization and/or confirmation of patient positioning in RT of the head and neck.
High rotation rate behavior of cervical spine segments in flexion and extension.
Barker, Jeffrey B; Cronin, Duane S; Chandrashekar, Naveen
Numerical finite element (FE) models of the neck have been developed to simulate occupant response and predict injury during motor vehicle collisions. However, there is a paucity of data on the response of young cervical spine segments under dynamic loading in flexion and extension, which is essential for the development or validation of tissue-level FE models. This limitation was identified during the development and validation of the FE model used in this study. The purpose of this study was to measure the high rotation rate loading response of human cervical spine segments in flexion and extension, and to investigate a new tissue-level FE model of the cervical spine with the experimental data to address a limitation in available data. Four test samples at each segment level from C2-C3 to C7-T1 were dissected from eight donors and were tested to 10 deg of rotation at 1 and 500 deg/s in flexion and extension using a custom built test apparatus. There was strong evidence (p < 0.05) of increased stiffness at the higher rotation rate above 4 deg of rotation in flexion and at 8 deg and 10 deg of rotation in extension. Cross-correlation software, Cora, was used to evaluate the fit between the experimental data and model predictions. The average rating was 0.771, which is considered to demonstrate a good correlation to the experimental data. PMID:25070575
Minimally invasive spine surgery in chronic low back pain patients.
Spoor, A B; Öner, F C
Low back pain (LBP) is a common disorder with a lifetime prevalence of 85%. The pathophysiology of LBP can be various depending on the underlying problem. Only in about 10% of the patients specific underlying disease processes can be identified. Patients with scoliosis, spondylolisthesis, herniated discs, adjacent disc disease, disc degeneration, failed back surgery syndrome or pseudoartrosis all have symptoms of LBP in different ways. Chronic low back pain patients are advised to stay active, however, there is no strong evidence that exercise therapy is significantly different than other nonsurgical therapies. Not every patient with symptoms of LBP is an appropriate candidate for surgery. Even with thorough systematic reviews, no proof can be found for the benefit of surgery in patients with low back pain, without serious neurologic deficit. And subjects like psychologic and socio-demographic factors also seem to be influencing a patients perception of back pain, expectations of treatment, and outcomes of treatment. Open lumbar fusion procedures are typically lengthy procedures and require a long exposure, which may result in ischemic necrosis of the paraspinal musculature, atrophy, and prolonged back pain. Minimally invasive spine surgery needed to take care of a decrease in muscle injuries due to retraction and avoidance of disruption of the osseotendineous complex of the paraspinal muscles, especially the multifidus attachment to the spinous process and superior articular process. Therefore, effort has been made to develop percutaneous fusion, as well as fixation methods, which avoid the negative effects of open surgery. Several minimally invasive fusion strategies have been described, like anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) and two lateral approaches (XLIF and DLIF), all with pro's and con's compared to open surgery and each other. The effect of MIS of all type is that patients have less blood loss, faster postoperative ambulation, lower use of opioids, and shorter in hospital stay, which is nearly always significantly better than an open procedure. And most of the studies show a significant improvement of VAS leg-and back pain, Oswestry Disability Index and a high fusion rate, but most of the times not significantly different than the open counterpart. When it comes to cost-effectiveness there is a trend in favor of MIS, but to when we want to differentiate MIS from open surgery, comorbidities and complications significantly affect general and disease-specific outcome measures. In our opinion, the actual better outcome of minimal invasive surgery comes down to obtain a good cost-effectiveness study, provided that minimally invasive surgery has an equal or better clinical and radiologic outcome, given that socio-economic, demographic and psychological influencers are equal for both types of surgery. There are no studies done on the subject MIS and low back pain solely. Deriving answers from the difference in VAS back pain in MIS studies reveal a 100% improvement of back pain after surgery. But that does not imply that this procedure, which is still in its childhood, will be the solution to all low back pain patients. PMID:23877267
Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related?
Goode, Adam P.; Carey, Timothy S.; Jordan, Joanne M.
Lumbar spine osteoarthritis (OA) is very common, with estimates of prevalence ranging from 40–85 %. The process of degeneration of the spine has commonly been classified as OA (disc space narrowing together with vertebral osteophyte formation); however, anatomically, the facet joint is the only synovial joint in the spine that has a similar pathological degenerative process to appendicular joints. Low back pain (LBP) is also a common condition, with nearly 80 % of Americans experiencing at least one episode of LBP in their lifetime. The complex relationship between spine radiographs and LBP has many clinical and research challenges. Specific conservative treatments for spine degeneration have not been established; there has, however, been recent interest in use of exercise therapy, because of some moderate benefits in treating chronic LBP. An understanding of the relationship between spine degeneration and LBP may be improved with further population-based research in the areas of genetics, biomarkers, and pain pathways. PMID:23307577
Airway management in cervical spine ankylosing spondylitis: Between a rock and a hard place.
Eipe, Naveen; Fossey, Susan; Kingwell, Stephen P
We report the perioperative course of a patient with long standing ankylosing spondylitis with severe dysphagia due to large anterior cervical syndesmophytes at the level of the epiglottis. He was scheduled to undergo anterior cervical decompression and the surgical approach possibly precluded an elective pre-operative tracheostomy. We performed a modified awake fibreoptic nasal intubation through a split nasopharyngeal airway while adequate oxygenation was ensured through a modified nasal trumpet inserted in the other nares. We discuss the role of nasal intubations and the use of both the modified nasopharyngeal airways we used to facilitate tracheal intubation. This modified nasal fibreoptic intubation technique could find the application in other patients with cervical spine abnormalities and in other anticipated difficult airways. PMID:24403620
Cervical radiculopathy: Pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar A prospective, controlled study
L. C. G. Persson; U. Moritz; L. Brandt; C.-A. Carlsson
This prospective, randomised study compares the efficacy of surgery, physiotherapy and cervical collar with respect to pain, motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment, with or without an additional bulging disk, as verified by MRI or CT-myelography. Pain intensity was registered on a
Pain Flare Is a Common Adverse Event in Steroid-Naďve Patients After Spine Stereotactic Body Radiation Therapy: A Prospective Clinical Trial
Chiang, Andrew [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada) [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada); Zeng, Liang; Zhang, Liying; Lochray, Fiona; Korol, Renee; Loblaw, Andrew; Chow, Edward [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada)] [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Sahgal, Arjun, E-mail: email@example.com [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada) [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada)
Purpose: To determine the incidence of pain flare after spine stereotactic body radiation therapy (SBRT) in steroid-naďve patients and identify predictive factors. Methods and Materials: Forty-one patients were treated with spine SBRT between February 2010 and April 2012. All patients had their pain assessed at baseline, during, and for 10 days after SBRT using the Brief Pain Inventory. All pain medications were recorded daily and narcotics converted to an oral morphine equivalent dose. Pain flare was defined as a 2-point increase in worst pain score as compared with baseline with no decrease in analgesic intake, a 25% increase in analgesic intake as compared with baseline with no decrease in worst pain score, or if corticosteroids were initiated at any point during or after SBRT because of pain. Results: The median age and Karnofsky performance status were 57.5 years (range, 27-80 years) and 80 (range, 50-100), respectively. Eighteen patients were treated with 20-24 Gy in a single fraction, whereas 23 patients were treated with 24-35 Gy in 2-5 fractions. Pain flare was observed in 68.3% of patients (28 of 41), most commonly on day 1 after SBRT (29%, 8 of 28). Multivariate analysis identified a higher Karnofsky performance status (P=.02) and cervical (P=.049) or lumbar (P=.02) locations as significant predictors of pain flare. In those rescued with dexamethasone, a significant decrease in pain scores over time was subsequently observed (P<.0001). Conclusions: Pain flare is a common adverse event after spine SBRT and occurs most commonly the day after treatment completion. Patients should be appropriately consented for this adverse event.
Ninety-day readmissions after degenerative cervical spine surgery: A single-center administrative database study
Akamnonu, Chibuikem; Goldstein, Jeffrey A.; Errico, Thomas J.; Bendo, John A.
Background Unplanned hospital readmissions result in significant clinical and financial burdens to patients and the healthcare system. Readmission rates and causes have been investigated using large administrative databases which have certain limitations in data reporting and coding. The objective of this study was to provide a description of 90 day post-discharge readmissions following surgery for common degenerative cervical spine pathologies at a large-volume tertiary hospital. The study also compared the readmission rates of patients who underwent anterior- and posterior-approach procedures. Methods The administrative records from a single-center, high-volume tertiary institution were queried using ICD-9 codes for common cervical pathology over a three year period to determine the rate and causes of readmissions within the 90 days following the index surgery. Results A total of 768 patients underwent degenerative cervical spine surgery during the three year study period. Within 90 days of discharge, 24 (3.13%) patients were readmitted; 16 (2.06%) readmissions were planned for lumbar surgery; 8 (1.04%) readmissions were unplanned. 640 patients underwent procedures involving an anterior approach and 128 patients underwent procedures involving a posterior approach. There were 14 (2.17%) planned readmissions in the anterior group and 2 (1.5%) in the posterior group. The unplanned readmission rate was 0.63% (4 patients) and 3.13% (4 patients) in the anterior and posterior groups, respectively. (p=0.0343). Conclusion The 90 day post-discharge unplanned readmission rate that followed elective degenerative cervical spine surgery was 1.04%. The unplanned readmission rate associated with posterior-approach procedures (3.13%) was significantly higher than that of anterior-approach procedures (0.63%). Level of evidence: IV
Giant Ventral Midline Schwannoma of Cervical Spine : Agonies and Nuances
Chagla, Aadil; Goel, Atul
Pure ventral midline giant schwannoma is an extremely rare entity. Spinal intradural extramedullary schwannomas commonly occur posterolateral or anterolateral to the spinal cord. A case of a pure midline ventrally situated giant pan cervical extramedullary schwannoma in an 18-year-old male patient with compressive myelopathy and sphincter involvement is presented. Spinal MR imaging showed a midline ventrally situated extramedullary tumor with severe spinal cord compression extending from clivus to C7 vertebra. It was resected through a posterolateral approach. Histology was consistent with a schwannoma. Post operative MR imaging showed no evidence of the tumor. The radiological features, pathogenesis and surgical strategies in management of these difficult tumors are discussed and the relevant literature is briefly reviewed. PMID:20617092
C5 Nerve root palsies following cervical spine surgery: A review
Epstein, Nancy E.; Hollingsworth, Renee
Background: Cervical C5 nerve root palsies may occur in between 0% and 30% of routine anterior or posterior cervical spine operations. They are largely attributed to traction injuries/increased cord migration following anterior/posterior decompressions. Of interest, almost all studies cite spontaneous resolution of these deficits without surgery with 3–24 postoperative months. Methods: Different studies cite various frequencies for C5 root palsies following anterior or posterior cervical spine surgery. In their combined anterior/posterior series involving C4-C5 level decompressions, Libelski et al. cited up to a 12% incidence of C5 palsies. In Gu et al. series, C5 root palsies occurred in 3.1% of double-door laminoplasty, 4.5% of open-door laminoplasty, and 11.3% of laminectomy. Miller et al. observed an intermediate 6.9% frequency of C5 palsies followed by posterior cervical decompressions and fusions (PCDF). Results: Gu et al. also identified multiple risk factors for developing C5 palsies following posterior surgery; male gender, ossification of the posterior longitudinal ligament (OPLL), narrower foramina, laminectomy, and marked dorsal spinal cord drift. Miller et al. also identified an average $1918 increased cost for physical/occupational therapy for patients with C5 palsies. Conclusions: The incidence of C5 root deficits for anterior/posterior cervical surgery at C4-C5 was 12% in one series, and ranged up to 11.3% for laminectomies, while others cited 0–30%. Although identification of preoperative risk factors for C5 root deficits may help educate patients regarding these risks, there is no clear method for their avoidance at this time. PMID:26005577
Biomechanical evaluation of Caspar and Cervical Spine Locking Plate systems in a cadaveric model.
Clausen, J D; Ryken, T C; Traynelis, V C; Sawin, P D; Dexter, F; Goel, V K
There exist two markedly different instrumentation systems for the anterior cervical spine: the Cervical Spine Locking Plate (CSLP) system, which uses unicortical screws with a locking hub mechanism for attachment, and the Caspar Trapezial Plate System, which is secured with unlocked bicortical screws. The biomechanical stability of these two systems was evaluated in a cadaveric model of complete C5-6 instability. The immediate stability was determined in six loading modalities: flexion, extension, right and left lateral bending, and right and left axial rotation. Biomechanical stability was reassessed following fatigue with 5000 cycles of flexion-extension, and finally, the spines were loaded in flexion until the instrumentation failed. The Caspar system stabilized significantly in flexion before (p < 0.05) but not after fatigue, and it stabilized significantly in extension before (p < 0.01) and after fatigue (p < 0.01). The CSLP system stabilized significantly in flexion before (p < 0.01) but not after fatigue, and it did not stabilize in extension before or after fatigue. The moment needed to produce failure in flexion did not differ substantially between the two plating systems. The discrepancy in the biomechanical stability of these two systems may be due to differences in bone screw fixation. PMID:8847569
Segmentation and feature extraction of cervical spine x-ray images
NASA Astrophysics Data System (ADS)
Long, L. Rodney; Thoma, George R.
As part of an R&D project in mixed text/image database design, the National Library of Medicine has archived a collection of 17,000 digitized x-ray images of the cervical and lumbar spine which were collected as part of the second National Health and Nutrition Examination Survey (NHANES II). To make this image data available and usable to a wide audience, we are investigating techniques for indexing the image content by automated or semi-automated means. Indexing of the images by features of interest to researchers in spine disease and structure requires effective segmentation of the vertebral anatomy. This paper describes work in progress toward this segmentation of the cervical spine images into anatomical components of interest, including anatomical landmarks for vertebral location, and segmentation and identification of individual vertebrae. Our work includes developing a reliable method for automatically fixing an anatomy-based coordinate system in the images, and work to adaptively threshold the images, using methods previously applied by researchers in cardioangiography. We describe the motivation for our work and present our current results in both areas.
Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation
Background Cervical pedicle screw (CPS) insertion is a technically demanding procedure. The quantitative understanding of cervical pedicle morphology, especially the narrowest part of cervical pedicle or isthmus, would minimize the risk of catastrophic damage to surrounding neurovascular structures and improve surgical outcome. The aim of this study was to investigate morphology and quantify cortical thickness of the cervical isthmus by using Multi-detector Computerized Tomography (MD-CT) scan. Methods The cervical CT scans were performed in 74 patients (37 males and 37 females) with 1-mm slice thickness and then retro-reconstructed into sagittal and coronal planes to measure various cervical parameters as follows: outer pedicle width (OPW), inner pedicle width (IPW), outer pedicle height (OPH), inner pedicle height (IPH), pedicle cortical thickness, pedicle sagittal angle (PSA), and pedicle transverse angle (PTA). Results Total numbers of 740 pedicles were measured in this present study. The mean OPW and IPW significantly increased from C3 to C7 while the mean OPH and IPH of those showed non-significant difference between any measured levels. The medial-lateral cortical thickness was significantly smaller than the superior-inferior one. PTA in the upper cervical spine was significantly wider than the lower ones. The PSA changed from upward inclination at upper cervical spine to the downward inclination at lower cervical spine. Conclusions This study has demonstrated that cervical vertebra has relatively small and narrow inner pedicle canal with thick outer pedicle cortex and also shows a variable in pedicle width and inconsistent transverse angle. To enhance the safety of CPS insertion, the entry point and trajectories should be determined individually by using preoperative MD-CT scan and the inner pedicle width should be a key parameter to determine the screw dimensions. PMID:24725394
Hyperextension cervical spine injuries and traumatic central cord syndrome.
Aarabi, Bizhan; Koltz, Michael; Ibrahimi, David
Traumatic central cord syndrome (TCCS), regardless of its biomechanics, is the most frequently encountered incomplete spinal cord injury. Patients with TCCS present with disproportionate weakness of the upper extremities, and variable sensory loss and bladder dysfunction. Fractures and/or subluxations, forced hyperextension, and herniated nucleus pulposus are the main pathogenetic mechanisms of TCCS. Nearly 50% of patients with TCCS suffer from congenital or degenerative spinal stenosis and sustained their injuries during hyperextension as originally described by Schneider in 1954. Immunohistochemical and imaging studies indicate mild to moderate insult to axons and their ensheathing myelin in the lateral funiculi culminating in cytoskeletal injury and impaired conduction. More than one-half of these patients enjoy spontaneous recovery of motor weakness; however, as time goes on, lack of manual dexterity, neuropathic pain, spasticity, bladder dysfunction, and imbalance of gait render their activities of daily living nearly impossible. Based on the current level of evidence, there is no clear indication of the timing of decompression for relief of sustained spinal cord compression in hyperextension injuries. Future research, taking advantage of validated digital imaging data such as maximum canal compromise, maximum spinal cord compression, and lesion length on the CT and MR images, as well as more sensitive measures of bladder and hand function, spasticity, and neuropathic pain may help tailor surgery for a specific group of these patients. PMID:18980483
Coexistence of neurofibroma and meningioma at exactly the same level of the cervical spine.
Chen, Kai-Yuan; Wu, Jau-Ching; Lin, Shih-Cheih; Huang, Wen-Cheng; Cheng, Henrich
We report a case of the coexistence of different spinal tumors at the same level of the cervical spine, without neurofibromatosis (NF), which was successfully treated with surgery. A 72-year-old female presented with right upper-limb clumsiness and weakness. Magnetic resonance imaging revealed an intradural, extramedullary tumor mass at the right C3-4 level with extradural extension into the intervertebral foramen. The extradural tumor was removed, and the pathology showed neurofibroma. After incision of the dura, the intradural tumor was removed, and was identified as meningioma in the pathological report. The patient did not meet the criteria of NF. Coexistence of neurofibroma and meningioma at exactly the same level of the spine without NF is extremely rare. Exploration of the intradural space may be necessary after resection of an extradural tumor if the surgical finding does not correlate well with the preoperative images. PMID:25128077
Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases
Sadrizadeh, Ali; Soltani, Ehsan; Abili, Mehdi; Dehghanian, Paria
Introduction: Although perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated. Case Report: Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem Conclusion: In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested. PMID:25938087
Osteoporosis in acute fractures of the cervical spine: the role of opportunistic CT screening.
Emohare, Osa; Dittmer, Alison; Morgan, Robert A; Switzer, Julie A; Polly, David W
OBJECT Recently published data make it possible to generate estimates of bone mineral density (BMD) by using CT attenuation; this innovation can save time and reduce costs. Although advanced age is associated with reduced BMD, especially in patients with a fracture of C-2, relatively few patients ever undergo formal dual x-ray absorptiometry studies. To the authors' knowledge, this is the first study to assess the utility of this technique in elucidating BMD in patients with an acute fracture of the cervical spine. METHODS Patients who presented to a Level I trauma center with an acute fracture of the cervical spine and underwent abdominal (or L-1) CT scanning either at admission or in the 6 months before or after the injury were evaluated. Using a picture-archiving and communication system, the authors generated regions of interest of similar size in the body of L-1 (excluding the cortex) and computed mean values for CT attenuation. The values derived were compared with threshold values, which differentiate between osteoporotic and nonosteoporotic states; age-stratified groups were also compared. RESULTS Of the 91 patients whose data were reviewed, 51 were < 65 years old (mean 43.2 years) and 40 were ? 65 years old (mean 80.9 years). The overall mean CT attenuation values (in Hounsfield units [HU]), stratified according to age, were 193.85 HU for the younger cohort and 117.39 HU for the older cohort; the result of a comparison between these two values was significant (p < 0.001). CONCLUSIONS Using opportunistic CT scanning, this study demonstrates the relative frequency of osteoporosis in acute fractures of the cervical spine. It also objectively correlates overall BMD with the known higher frequency of C-2 fractures in older patients. This technique harnesses the presence of opportunistic CT scans of the abdomen, which potentially reduces the need for the extra time and cost that may be associated with dual x-ray absorptiometry scanning. PMID:25860516
Risk of Cervical Spine Injury and Other Complications Seen with Skull Fractures in the Setting of Mild Closed Head Injury in Young Children: A Retrospective Study
Peter D. Kim; Jennifer S. Jennings; Mariah Fisher; Adnan H. Siddiqui
We have reviewed records for patients under 2 years of age who presented at our hospital with mild closed head injuries and nondisplaced skull fractures, specifically to examine methods utilized for spine clearance, associated cervical injuries, involvement and findings of child protective services and delayed complications. Of 42 patients included in the series, none were found to have cervical spine
Cervical Spine Immobilization in Sports Related Injuries: Review of Current Guidelines and a Case Study of an Injured Athlete
Bhamra, JS; Morar, Y; Khan, WS; Deep, K; Hammer, A
Cervical spine immobilization is an essential component of the ATLS® system. Inadequate training in the management of trauma calls and failure of early recognition can have disastrous consequences. Pre-hospital personnel are routinely involved more in the assessment and stabilization of patients in comparison to other health care professionals. This case study and review highlights the importance of early recognition, assessment and correct stabilization of cervical spine injuries both in the field and during the initial assessment in hospital. Inadequate assessment, immobilization and lack of standard guidelines on the management of suspected cervical spine trauma can result in secondary injury. Regular assessment and training of pre-hospital and medical personnel is essential to the proper management of these potentially devastating injuries. PMID:23248726
Neuraxial anesthesia for labor and delivery in a parturient with unstable cervical spine fracture.
Peterson-Layne, Cathleen; Sandler, Aaron J
We report the successful anesthetic management of labor and passive second-stage delivery in a parturient requiring cervical spine stabilization with a halo. A 25-year-old, Gravida 1, Para 0 at 37 weeks of gestation, admitted for observation after a recent motor vehicle collision, required induction of labor for preeclampsia. The mode of delivery was dependent on a successful anesthetic technique for a passive second stage of labor. The injury and halo presented concerns for access to her airway and preservation of neurologic status. An epidural placed early in labor allowed for adequate analgesia, as well as sacral extension for a forceps-assisted delivery. PMID:26035219
Intraosseous pneumatocysts of the cervical spine: a report of four cases and review of literature.
Husain, Mohammed A; Tetradis, Sotirios; Mallya, Sanjay M
Pneumatocysts are benign, gas-containing lesions, most commonly observed affecting the vertebrae, sacrum, and ileum. Most often, these lesions are asymptomatic and are detected incidentally during imaging examinations. Although once believed to be a rare lesion, recent studies suggest that it is more common than previously thought. We present four cases of pneumatocysts affecting the cervical vertebrae detected as incidental findings on cone beam computed tomography (CBCT). Given the increased use of CBCT in dentistry to evaluate the maxillofacial structures, it is likely that dentists will encounter this lesion on CBCT scans that encompass the superior cervical spine. Recognition of the pathognomonic features of this benign, innocuous lesion is important to avoid unnecessary investigations and causing alarm to the patient. We also present a comprehensive review of the literature on the demographic characteristics and clinical presentation of this relatively unknown lesion. PMID:25446506
Synovial chondromatosis of the cervical spine: a case report and review of the literature.
Shaw, Andrew; Zibly, Zion; Prasad, Vinay; Ikeda, Daniel; Boue, Daniel; Governale, Lance S
Synovial chondromatosis is a benign condition characterized by metaplastic changes of the synovial membrane typically affecting large joints. Cervical spine involvement is rare and has not been reported in a teenager. The authors report a case of cervical synovial chondromatosis in a 19-year-old male presenting with left-sided weakness and numbness from spinal cord compression. After gross total resection was accomplished via laminoplasty, the patient's presenting symptoms improved and continued to do so over the follow-up period. The likely cause of the synovial chondromatosis in this patient was repetitive neck trauma as a child from a motor vehicle accident and football. This case demonstrates that the pathophysiology of this rare entity can initiate in the pediatric population. Although rare, synovial chondromatosis should be considered in the differential diagnosis of calcified extradural masses in the teenage population. PMID:24650324
Comparison of tracheal intubation using the Airtraq® and Mc Coy laryngoscope in the presence of rigid cervical collar simulating cervical immobilisation for traumatic cervical spine injury
Durga, Padmaja; Kaur, Jasleen; Ahmed, Syed Younus; Kaniti, Geeta; Ramachandran, Gopinath
Background: It is difficult to visualise the larynx using conventional laryngoscopy in the presence of cervical spine immobilisation. Airtraq® provides for easy and successful intubation in the neutral neck position. Objective: To evaluate the effectiveness of Airtraq in comparison with the Mc Coy laryngoscope, when performing tracheal intubation in patients with neck immobilisation using hard cervical collar and manual in-line axial cervical spine stabilisation. Methods: A randomised, cross-over, open-labelled study was undertaken in 60 ASA I and II patients aged between 20 and 50 years, belonging to either gender, scheduled to undergo elective surgical procedures. Following induction and adequate muscle relaxation, they were intubated using either of the techniques first, followed by the other. Intubation time and Intubation Difficulty Score (IDS) were noted using Mc Coy laryngoscope and Airtraq. The anaesthesiologist was asked to grade the ease of intubation on a Visual Analogue Scale (VAS) of 1–10. Chi-square test was used for comparison of categorical data between the groups and paired sample t-test for comparison of continuous data. IDS score and VAS were compared using Wilcoxon Signed ranked test. Results: The mean intubation time was 33.27 sec (13.25) for laryngoscopy and 28.95 sec (18.53) for Airtraq (P=0.32). The median IDS values were 4 (interquartile range (IQR) 1–6) and 0 (IQR 0–1) for laryngoscopy and Airtraq, respectively (P=0.007). The median Cormack Lehane glottic view grade was 3 (IQR 2–4) and 1 (IQR 1–1) for laryngoscopy and Airtraq, respectively (P=0.003). The ease of intubation on VAS was graded as 4 (IQR 3–5) for laryngoscopy and 2 (IQR 2–2) for Airtraq (P=0.033). There were two failures to intubate with the Airtraq. Conclusion: Airtraq improves the ease of intubation significantly when compared to Mc Coy blade in patients immobilised with cervical collar and manual in-line stabilisation simulating cervical spine injury. PMID:23325936
Congenital dermal sinus of the cervical spine: clinical characteristics and management.
Huang, S L; Shi, W; Zhang, L G
Congenital dermal sinus (CDS) in the cervical region is extremely rare with only few cases reported in the literature. This study reports a young case of CDS, by which we demonstrate the clinical characteristics and management of cervical CDS, particularly in kids. A 2-year and 7-month-old male child who presented with a one-year history of difficulty in holding objects by hands was diagnosed to have harbored a CDS in the cervical spine since birth. Neurological examination demonstrated mild weakness in both hands and also atrophy in intrinsic hand muscles. Surgery was performed right after diagnosis. Intraoperatively, the sinus tract was totally excised, and untethering was performed. No complications were found after operation. Histopathological examination suggested dorsal dermal sinus. During the follow-up of three years, the patient presented a stable neurologic deficit but did not suffer from an aggravation or improvement of nervous symptoms. At three-year follow-up, the patient was a stable neurologic deficit, and MRI revealed no evidence of the untethered cervical spinal cord and dermal sinus tract. The management strategies of CDS are early surgical treatment to prevent the development of neurological defects. PMID:22415384
Sub-axial cervical spine injuries: Modified Stellerman's algorithm
Shetty, Arjun; Kini, Abhishek R; Muthappa, Deepak
Background: Global fusion is recommended in sub-axial cervical spine injuries with retrolisthesis, translation rotation injuries associated with end plate or tear drop fractures. We propose a modification of Stellerman's algorithm which we have used where in patients are primarily treated via anterior decompression and fixation. Global fusion was done only in cases where post-decompression traction does not achieve reduction in cases with locked facets. Materials and Methods: Two hundred and thirty consecutive patients with sub-axial cervical spine injuries were studied in a prospective trial over a 7 year period. Seven cases with posterior compression alone were not subjected to our protocol. Of the other 223 cases, 191 cases who on radiological evaluation needed surgery were initially approached anteriorly. Decompression was effected through a corpectomy in 14 cases and a single or multiple level disc excisions were performed in the others. Cases with cervical listhesis (n=36) where on table reduction could not be achieved following decompression were subjected to progressive skeletal traction for 48 h. Posterior facetectomy and global fixation was done for patients in whom reduction could not be achieved despite post-decompression traction (n=11). Results: Of the 223 cases, 20 cases were managed conservatively, 12 cases expired pre-operatively, and the remaining 191 cases needed surgical intervention. Out of the 154 cases of distraction/rotation/translation injuries on table reduction could be achieved in 118 cases (76.6%). Thirty-six patients had locked facets (23 cases were bifacetal, 13 cases unifacetal) and of these 36 cases reduction could be achieved with post-anterior decompression traction in 25 patients (16.2%); however, only 11 cases (7.1%)–8 bifacetal and 3 unifacetal dislocations–needed posterior facetectomy and global fusion. One hundred and forty-three patients were followed up for a minimum period of 6 months. One hundred and twenty-six patients showed evidence of complete fusion (88.1%) while the remaining 17 (11.8) showed evidence of partial fusion. There were no signs of instability on clinical and radiological evaluation in any of the cases. Reduction of graft height was noted in 18 patients (12.5%). There were eight cases of immediate postoperative mortality and two cases of delayed mortality in our series of cases. Conclusion: We feel that on table decompression and reduction followed by anterior stabilization can be used as the initial surgical approach to manage most types of cervical injuries. In rotation/translational cases where reduction cannot be achieved, monitored cervical traction on the decompressed spine can safely achieve reduction and hence avoid the need for a posterior facetectomy in a large percentage of cases. PMID:21559107
A Clinical Model for the Diagnosis and Management of Patients with Cervical Spine Syndromes
Murphy, Donald R.
Background: Disorders of the cervical spine are common and often disabling. The etiology of these disorders is often multifactorial and a comprehensive approach to both diagnosis and management is essential to successful resolution. Objective: This article provides an overview of a clinical model of the diagnosis and management of patients with disorders related to the cervical spine. This model is based in part on the scientific literature, clinical experience, and communication with other practitioners over the course of the past 20 years. Discussion: The clinical model presented here involves taking a systematic approach to diagnosis, and management. The diagnostic process is one that asks three essential questions. The answers to these questions then guides the management process, allowing the physician to apply specific methods that address the many factors that can be involved in each individual patient. This clinical model allows the physician to individualize the management strategy while utilizing principles that can be applied to all patients. At times, the management strategy must be multidisciplinary, and cooperation with other physicians and therapists is often necessary for effective patient care. This model is currently being used by the author in practice, as well as forming the basis upon which further research can be conducted to refine or, if necessary, abandon any of its aspects, as the evidence dictates. It is the purpose of this paper to present this clinical model and the clinical and scientific evidence, or lack thereof, of its components. PMID:17987214
Cervical Myelopathy in Rheumatoid Arthritis
Mukerji, N.; Todd, N. V.
Involvement of the cervical spine is common in rheumatoid arthritis. Clinical presentation can be variable, and symptoms may be due to neck pain or compressive myeloradiculopathy. We discuss the pathology, grading systems, clinical presentation, indications for surgery and surgical management of cervical myelopathy related to rheumatoid arthritis in this paper. We describe our surgical technique and results. We recommend early consultation for surgical management when involvement of the cervical spine is suspected in rheumatoid arthritis. Even patients with advanced cervical myelopathy should be discussed for surgical treatment, since in our experience improvement in function after surgery is common. PMID:22203899
Cervical spine intervertebral kinematics with respect to the head are different during flexion and extension motions
Anderst, William J.; Donaldson, William F.; Lee, Joon Y.; Kang, James D.
Previous dynamic imaging studies of the cervical spine have focused entirely on intervertebral kinematics while neglecting to investigate the relationship between head motion and intervertebral motion. Specifically, it is unknown if the relationship between head and intervertebral kinematics is affected by movement direction. We tested the hypothesis that there would be no difference in sagittal plane intervertebral angles at identical head orientations during the flexion and extension movements. Nineteen asymptomatic subjects performed continuous head flexion-extension movements while biplane radiographs were collected at 30 images per second. A previously validated model-based volumetric tracking process determined three-dimensional vertebral position with sub-millimeter accuracy throughout the flexion–extension motion. Head movement was recorded at 60 Hz using conventional motion analysis and reflective markers. Intervertebral angles were determined at identical head orientations during the flexion and extension movements. Cervical motion segments were in a more extended orientation during flexion and in a more flexed orientation during extension for any given head orientation. The results suggest that static radiographs cannot accurately represent vertebral orientation during dynamic motion. Further, data should be collected during both flexion and extension movements when investigating intervertebral kinematics with respect to global head orientation. Also, in vitro protocols that use intervertebral total range of motion as validation criteria may be improved by assessing model fidelity using continuous intervertebral kinematics in flexion and in extension. Finally, musculoskeletal models of the head and cervical spine should account for the direction of head motion when determining muscle moment arms because vertebral orientations (and therefore muscle attachment sites) are dependent on the direction of head motion. PMID:23540377
Deceleration during 'real life' motor vehicle collisions – a sensitive predictor for the risk of sustaining a cervical spine injury?
Martin Elbel; Michael Kramer; Markus Huber-Lang; Erich Hartwig; Christoph Dehner
BACKGROUND: The predictive value of trauma impact for the severity of whiplash injuries has mainly been investigated in sled- and crash-test studies. However, very little data exist for real-life accidents. Therefore, the predictive value of the trauma impact as assessed by the change in velocity of the car due to the collision (?V) for the resulting cervical spine injuries were
Discontinuation of cervical spine immobilisation in unconscious patients with trauma in intensive care units--telephone survey of practice in south and west region.
Gupta, K. J.; Clancy, M.
OBJECTIVE: To study how the cervical spine is assessed before discontinuation of cervical spine immobilisation in unconscious trauma patients in intensive care units. DESIGN: Telephone interview of consultants responsible for adult intensive care units. SETTING: All 25 intensive care units in the South and West region that admit victims of major trauma. MAIN OUTCOME MEASURES: The clinical and radiological basis on which the decision is made to stop cervical spine immobilisation in unconscious patients with trauma. RESULTS: In 19 units cervical spine immobilisation was stopped in unconscious patients on the basis of radiology alone, and six units combined radiology with clinical examination after the patient had regained consciousness. Sixteen units relied on a normal lateral radiological view of the cervical spine alone, five required a normal lateral and anteroposterior view, and four required a normal lateral, anteroposterior, and open mouth peg view. CONCLUSIONS: There are inconsistencies in the clinical and radiological approach to assessing the cervical spine in unconscious patients with trauma before the removal of immobilisation precautions. There is an overreliance on the lateral cervical spine view alone, which has been shown to be insensitive in this setting. PMID:9180066
Symptom relief after treatment of temporomandibular and cervical spine disorders in patients with Meniere's disease: a three-year follow-up.
Bjorne, Assar; Agerberg, Göran
This study describes the coordinated treatment of temporomandibular disorders (TMD) and cervical spine disorders in patients diagnosed with Meniere's disease. The aim was to follow up treatment outcomes for three years with regular follow-up examinations every six months. Of the 31 patients with Meniere's disease who participated in a controlled comparative study on the signs and symptoms of TMD, 24 participated in a subsequent controlled comparative study on the signs and symptoms of cervical spine disorders (CSD). These 24 Meniere's disease patients (ten males and 14 females) agreed to participate in this longitudinal study. At each follow-up, their symptoms were evaluated using self-administered questionnaires and visual analog scales (VAS). The results of the coordinated treatment showed simultaneous decreases in the intensities of vertigo, nonwhirling dizziness, tinnitus, feeling of fullness in the ear, pain in the face and jaws, pain in the neck and shoulders, and headache that were both longitudinal and highly significant. Significant longitudinal reductions in the frequencies of vertigo, nonwhirling dizziness, and headache were also reported by the patients as well as a complete disappearance of pain located in the vertex area. A significant relief of TMD symptoms and a decrease in nervousness was also achieved. The results showed that a coordinated treatment of TMD and CSD in patients with Meniere's disease is an effective therapy for symptoms of this disease. The results also suggested that Meniere's disease has a clear association with TMD and CSD and that these three ailments appeared to be caused by the same stress, nervousness, and muscular tension. PMID:12555932
Lateral Cervical Spine Radiography to Demonstrate Absence of Bony Displacement After Intubation in a Patient with an Acute Type III Odontoid Fracture.
Easker, David D; Policeni, Bruno A; Hindman, Bradley J
A 72-year-old patient with an acute traumatic Type III odontoid fracture presented to the operating room for an urgent orthopedic procedure with a history of uncontrolled gastroesophageal reflux, a full stomach, and active vomiting. Rather than fiberoptic intubation, a rapid sequence intubation with manual inline stabilization was performed using a videolaryngoscope. A lateral cervical spine radiograph immediately after intubation showed no change in alignment of the fracture of C1-C2. In the presence of cervical spine instability, a postintubation radiograph provides assurance that the cervical spine is appropriately aligned during subsequent surgery. PMID:26171739
Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study
Agrawal, Deepak; Sinha, Tej Prakash; Bhoi, Sanjeev
Background: Early cervical spine clearance is extremely important in unconscious trauma patients and may be difficult to achieve in emergency setting. Objectives: The aim of this study was to assess the feasibility of standard portable ultrasound in detecting potentially unstable cervical spine injuries in severe traumatic brain injured (TBI) patients during initial resuscitation. Materials and Methods: This retro-prospective pilot study carried out over 1-month period (June–July 2013) after approval from the institutional ethics committee. Initially, the technique of cervical ultrasound was standardized by the authors and tested on ten admitted patients of cervical spine injury. To assess feasibility in the emergency setting, three hemodynamically stable pediatric patients (?18 years) with isolated severe head injury (Glasgow coma scale ?8) coming to emergency department underwent an ultrasound examination. Results: The best window for the cervical spine was through the anterior triangle using the linear array probe (6–13 MHz). In the ten patients with documented cervical spine injury, bilateral facet dislocation at C5–C6 was seen in 4 patients and at C6–C7 was seen in 3 patients. C5 burst fracture was present in one and cervical vertebra (C2) anterolisthesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise and ligamental injury in all cases. Ultrasound examination of the cervical spine was possible in the emergency setting, even in unstable patients and could be done without moving the neck. Conclusions: Cervical ultrasound may be a useful tool for detecting potentially unstable cervical spine injury in TBI patients, especially those who are hemodynamically unstable.
Posterolateral approach for anterior resection and posterior stabilization of the upper cervical spine: a case report.
Hart, R. A.; Weinstein, J. N.; Menezes, A. H.
Surgical approaches to atlanto-axial lesions are generally accomplished by either anterior (transoral) or posterior approaches as dictated by the location of the lesion. In certain patients, these approaches are combined, either in a single or staged procedure. Mechanical stabilization is much more readily accomplished posteriorly, as this allows easy incorporation of the occiput. While the transoral approach allows excellent exposure of the bodies of C1 and C2, it entails substantial surgical trauma. We describe the case of a woman with destruction of the anterior portions of the C1 and C2 vertebrae by metastatic breast cancer addressed by simultaneous anterior tumor debulking and posterior instrumentation through a posterolateral approach to the upper cervical spine. Images Figure 1 Figure 2 Figure 3 Figure 5 PMID:9129289
[Special considerations in therapy of injuries of the cervical spine in ankylosing spondylitis (Bechterew disease)].
Einsiedel, T; Kleimann, M; Nothofer, W; Neugebauer, R
Cervical spine changed by Bechterew's disease is severely endangered with any increased load. Even decent trauma is enough to produce a fracture with affection of spinal cord. Because of little knowledge in these special items, late diagnosis of overlooked injury is not rare, especially in two-level injuries. Neurolesions following secondary fracture dislocations may occur ("fatal pause"). From january 1990 to february 2000 12 patients underwent surgery (dorsoventral stabilisation, ventral stabilisation, laminectomy). Diagnostic procedures, levels of injury, pre- and postoperative neurostatus (following Frankel's score), operative technique, typical complications and follow-up (Ř 17.8 months) were analyzed and compared with the literature. 11 patients showed preoperative neurodeficits. They were better in five cases and disappeared at all in another five cases after surgery (83% positive neurological outcome). There was no increase of neurology failure. Two patients died (ARDS and cerebral ischemia with destruction of vertebral arteries). One patient had to be reoperated because of implant dislocation. MRI is obvious in diagnostic for these lesions. There is also an absolute need for total (both clinical and radiological) examination of the whole spinal column, because there is often injury of more than one level (three times in our study). Therapy should be operative (dorsoventral stabilisation, in certain cases only anterior procedure or laminectomy). Late diagnosis and therapy with secondary worsening after fracture dislocation is not rare because of "overlooked injury". There were four patients, that would not have suffered cervical spine fracture (minimal injury force) without Bechterew's changes. There is often pulmonary failure through limitation of thoracic movement and cerebral ischemia following rupture of vertebral arteries as typical complications. Mortality (2 cases; 16%) in our collective is less than literature's medium rates (35-57%). PMID:11803718
Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes.
Devin, Clinton J; McGirt, Matthew J
Multimodal approaches to pain management have arisen with the goal of improving postoperative pain and reducing opioid analgesic use. We performed a comprehensive literature review to determine grades of recommendation for commonly used agents in multimodal pain management and provide a best practice guideline. To evaluate common drugs used in multimodal treatment of pain, a search was performed on English language publications on Medline (PubMed; National Library of Medicine, Bethesda, MD, USA). Manuscripts were rated as Level I-V according to the North American Spine Society's (NASS) standardized levels of evidence tables. Grades of recommendation were assigned for each drug based on the NASS Clinical Guidelines for Multidisciplinary Spine Care. There is good (Grade A) evidence gabapentinoids, acetaminophen, neuraxial blockade and extended-release local anesthetics reduce postoperative pain and narcotic requirements. There is fair (Grade B) evidence that preemptive analgesia and nonsteroidal anti-inflammatory drugs (NSAID) result in reduced postoperative pain. There is insufficient and/or conflicting (Grade I) evidence that muscle relaxants and ketamine provide a significant reduction in postoperative pain or narcotic usage. There is fair (Grade B) evidence that short-term use of NSAID result in no long-term reduction in bone healing or fusion rates. Comprehensive assessment of the effectiveness of perioperative pain control can be accomplished through the use of validated measures. Multimodal pain management protocols have consistently been demonstrated to allow for improved pain control with less reliance on opioids. There is good quality evidence that supports many of the common agents utilized in multimodal therapy, however, there is a lack of evidence regarding optimal postoperative protocols or pathways. PMID:25766366
Vertebral height, disc height, posteroanterior displacement and dens–atlas gap in the cervical spine: precision measurement protocol and normal data
W Frobin; G Leivseth; M Biggemann; P Brinckmann
Objective. (1) Precise measurement of vertebral height, disc height, posteroanterior displacement and dens–atlas gap from lateral radiographic views of the cervical spine. (2) Compilation of a normative database for these parameters, specifying dependence on gender and age.Design. Descriptive study, based on measurements from lateral radiographic views of the cervical spine of healthy subjects.Background. Normal data of vertebral height, disc height,
The use of flexion and extension MR in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects
Vincenzo Giuliano; Concetta Giuliano; Fabio Pinto; Mariano Scaglione
. The purpose of this study was to determine the value of flexion and extension MR in traumatized cervical spines following\\u000a rear low-impact acceleration–deceleration injury. The cervical spines of 100 consecutive uninjured normal asymptomatic adults\\u000a and 100 adult accident victims following rear low-impact motor vehicle accidents were evaluated using rapid T2-weighted MRI.\\u000a Subjects were matched for age but not gender.
Pain, Transportation Issues and Whiplash
Michele Sterling
The development of pain following a motor vehicle crash (MVC) is a common occurrence. The most frequently reported and investigated pain condition following such trauma is neck pain or whiplash associated disorders (WAD), which are usually associated with rear-end collision. However, WAD can also be caused by any event that results in the hyperextension and flexion of the cervical spine
Complications during and after surgery of the lower cervical spine by isolated anterior approach with CSLP implant
J. Ko?iš; P. Wendsche; R. Veselý; R. Hart; I. ?ižmá?
Background The merits of different operative approaches in the management of spinal injury is debated. The aim of this study was to assess,\\u000a retrospectively, the outcome of treatment of injuries of the lower cervical spine by an anterior approach, in terms of fusion\\u000a rate and complications.\\u000a \\u000a \\u000a \\u000a Materials and methods Between 1995 and 2004, 270 patients with an injury of the lower cervical
Improving the imaging diagnosis of cervical spine injury in the very elderly: implications of the epidemiology of injury
F. A. Mann; Wayne S. Kubal; C. Craig Blackmore
Purpose: To enumerate host and vector factors that affect each phase of cervical spine injury (CSI) among the elderly, and to attribute\\u000a specific pathoanatomic characteristics of CSI to host and\\/or vector factors. Methods: Structured review of English literature references selected from MEDLINE keyword search using PUBMED and OVID search engines.\\u000a Only articles addressing the role of "aging" or being "elderly"
Sagittal plane segmental motion of the cervical spine. A new precision measurement protocol and normal motion data of healthy adults
W. Frobin; G. Leivseth; M. Biggemann; P. Brinckmann
Objective. (1) Precise documentation of sagittal plane segmental rotational and posteroanterior translational motion of segments C0\\/C1–C6\\/C7 of the human cervical spine from lateral radiographic views. (2) Compilation of a database describing normal motion. (3) Comparison of individual motion patterns with the normal database.Design. Descriptive study based on computer-aided measurements from lateral radiographic views taken in flexion and extension.Background. Previous studies
The feasibility of a video-based motion analysis system in measuring the segmental movements between upper and lower cervical spine
Shyi-Kuen Wu; Howard H. C. Lan; Li-Chieh Kuo; Sen-Wei Tsai; Chiung-Ling Chen; Fong-Chin Su
The evaluation of the range of motion (ROM) and static posture in the cervical spine are important in physical examination. Despite offering dynamic assessment without radiation, the video-based motion analysis system has not yet been applied to measure the cervical segmental movements. The purposes of this study were to develop a neck model to differentiate the movements and posture between
Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit
Dunham, C Michael; Brocker, Brian P; Collier, B David; Gemmel, David J
Introduction In blunt trauma, comatose patients (Glasgow Coma Scale score 3 to 8) with a negative comprehensive cervical spine (CS) computed tomography assessment and no apparent spinal deficit, CS clearance strategies (magnetic resonance imaging [MRI] and prolonged cervical collar use) are controversial. Methods We conducted a literature review to delineate risks for coma, CS instability, prolonged cervical collar use, and CS MRI. Results Based on our search of the literature, the numbers of functional survivor patients among those who had sustained blunt trauma were as follows: 350 per 1,000 comatose unstable patients (increased intracranial pressure [ICP], hypotension, hypoxia, or early ventilator-associated pneumonia); 150 per 1,000 comatose high-risk patients (age > 45 years or Glasgow Coma Scale score 3 to 5); and 600 per 1,000 comatose stable patients (not unstable or high risk). Risk probabilities for adverse events among unstable, high-risk, and stable patients were as follows: 2.5% for CS instability; 26.2% for increased intensive care unit complications with prolonged cervical collar use; 9.3% to 14.6% for secondary brain injury with MRI transportation; and 20.6% for aspiration during MRI scanning (supine position). Additional risk probabilities for adverse events among unstable patients were as follows: 35.8% for increased ICP with cervical collar; and 72.1% for increased ICP during MRI scan (supine position). Conclusion Blunt trauma coma functional survivor (independent living) rates are alarming. When a comprehensive CS computed tomography evaluation is negative and there is no apparent spinal deficit, CS instability is unlikely (2.5%). Secondary brain injury from the cervical collar or MRI is more probable than CS instability and jeopardizes cerebral recovery. Brain injury severity, probability of CS instability, cervical collar risk, and MRI risk assessments are essential when deciding whether CS MRI is appropriate and for determining the timing of cervical collar removal. PMID:18625041
LMA C Trach aided endotracheal intubation in simulated cases of cervical spine injury: A series of 30 cases
Tripathi, Deepshikha C.; Jha, Pramila S.; Trivedi, Lopa P.; Doshi, Shilpa M.; Modia, Brijesh
Background: Laryngeal mask airway (LMA) C Trach is a novel device designed to intubate trachea without conventional laryngoscopy. The aim of the study was to evaluate the clinical efficacy of C trach in the simulated scenario of cervical spine injury where conventional laryngoscopy is not desirable. Methods: This prospective pilot study was carried out in 30 consenting adults of either gender, ASAPS I or II, scheduled for surgery requiring endotracheal intubation. An appropriate sized rigid cervical collar was positioned around the patient's neck to restrict the neck movements and simulate the scenario of cervical spine injury. After induction of anesthesia, various technical aspects of C Trach facilitated endotracheal intubation, changes in hemodynamic variables, and complications were recorded. Results: Mask ventilation was easy in all the patients. Successful insertion of C Trach was achieved in 27 patients at first attempt, while 3 patients required second attempt. Majority of patients required one of the adjusting maneuvers to obtain acceptable view of glottis (POGO score >50%). Intubation success rate was 100% with 26 patients intubated at first attempt and the rest required second attempt. Mean intubation time was 69.8±27.40 sec. With experience, significant decrease in mean intubation time was observed in last 10 patients as compared to first 10 (46±15.77 sec vs. 101.3±22.91 sec). Minor mucosal injury was noted in four patients. Conclusion: LMA C Trach facilitates endotracheal intubation under direct vision and can be a useful technique in patients with cervical spine injury with cervical collar in situ. PMID:23956717
Risk factors for cervical spine injury among patients with traumatic brain injury
Fujii, Tomoko; Faul, Mark; Sasser, Scott
Background: Diagnosis of cervical spine injury (CSI) is difficult in patients with an altered level of consciousness as a result of a traumatic brain injury (TBI). Patients with TBI and older adults are at increased risk for CSI. This study examined the various risk factors for CSI among trauma patients with TBI and whether adults who were older (?55 years) were at higher risk for CSI when they sustained a fall-related TBI. Materials and Methods: Data used was the 2007 National Trauma Data Bank (NTDB), National Sample Project (NSP) for adults who sustained a TBI. This dataset contains 2007 admission records from 82 level I and II trauma centers. Logistic regression was used to identify potential risk factors for CSI and to test for interaction between age and injury mechanism. Additional model variables included gender, race, Glasgow Coma Score, multiple severe injuries, hypotension and respiratory distress. Results: An analysis of the NTDB NSP identified 187,709 adults with TBI, of which 16,078 were diagnosed with a concomitant CSI. In motor vehicle traffic injuries, the older age group had significantly higher odds of CSI (odds ratio [OR] = 1.26 [1.15-1.39]). In fall-related injuries the older age group did not have a higher odds of CSI compared to the younger age group. Skull/face fracture, other spine fracture/dislocation, upper limb injury, thorax injury, and hypotension were significantly associated with CSI. Pelvic injuries had an inverse association with CSI (OR = 0.60 [0.54-0.67]). Black had significantly higher odds of CSI compared to Whites (OR = 1.25 [1.07-1.46]). Conclusion: The identification of associated injuries and factors may assist physicians in evaluating CSI in patients with TBI. PMID:24339657
Postnatal progression of bone disease in the cervical spines of mucopolysaccharidosis I dogs
Chiaro, Joseph A; Baron, Matthew D; del Alcazar, Chelsea; O'Donnell, Patricia; Shore, Eileen M; Elliott, Dawn M; Ponder, Katherine P; Haskins, Mark E; Smith, Lachlan J
Introduction Mucopolysaccharidosis I (MPS I) is a lysosomal storage disorder characterized by deficient ?-L-iduronidase activity leading to accumulation of poorly degraded dermatan and heparan sulfate glycosaminoglycans (GAGs). MPS I is associated with significant cervical spine disease, including vertebral dysplasia, odontoid hypoplasia, and accelerated disc degeneration, leading to spinal cord compression and kypho-scoliosis. The objective of this study was to establish the nature and rate of progression of cervical vertebral bone disease in MPS I using a canine model. Methods C2 vertebrae were obtained post-mortem from normal and MPS I dogs at 3, 6 and 12 months-of-age. Morphometric parameters and mineral density for the vertebral trabecular bone and odontoid process were determined using micro-computed tomography. Vertebrae were then processed for paraffin histology, and cartilage area in both the vertebral epiphyses and odontoid process were quantified. Results Vertebral bodies of MPS I dogs had lower trabecular bone volume/total volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) and bone mineral density (BMD) than normals at all ages. For MPS I dogs, BV/TV, Tb.Th and BMD plateaued after 6 months-of-age. The odontoid process appeared morphologically abnormal for MPS I dogs at 6 and 12 months-of-age, although BV/TV and TMD were not significantly different from normals. MPS I dogs had significantly more cartilage in the vertebral epiphyses at both 3 and 6 months-of-age. At 12 months-of-age, epiphyseal growth plates in normal dogs were absent, but in MPS I dogs they persisted. Conclusions In this study we report reduced trabecular bone content and mineralization, and delayed cartilage to bone conversion in MPS I dogs from 3 months-of-age, which may increase vertebral fracture risk and contribute to progressive deformity. The abnormalities of the odontoid process we describe likely contribute to increased incidence of atlanto-axial subluxation observed clinically. Therapeutic strategies that enhance bone formation may decrease incidence of spine disease in MPS I patients. PMID:23563357
Quantification of Pediatric Cervical Growth: Anatomical Changes in the Sub-Axial Spine
Lee, Jung Jae; Hong, Jae Taek; Kim, Jong Tae
Objective In order to provide normal values of the pediatric sub-axial cervical spinal canal and vertebral body growth pattern using computed tomographic scans, a total of 318 patients less than 10 years old were included. Methods The growth of the vertebral body and canal space was investigated using four different age groups. The Torg ratio (TR) was calculated and all patients were classified into a low TR group and a high TR group according to a cutoff value of 1.0. To account for spinal curvature, the C3-7 angle was measured. Results Very little axial expansion and growth in height were observed (2.9 mm and 3.4 mm, respectively), and the spinal canal increments (1.8 mm) were much smaller than the dimensions of the vertebral body. The mean TR values were 1.03±0.14 at the C3 vertebral level, 1.02±0.13 at C4, 1.05±0.13 at C5, 1.04±0.13 at C6, and 1.02±0.12 at C7 in all patients. The mean sub-axial angle (C3-7) was 7.9±10.6° (range: -17-47°). Conclusion The upper sub-axial spinal canal continuously increased in size compared to the lower sub-axial spine after 8 years of age. Considerable decrements in the TR was found after late childhood compared to younger ages. Generally, there were no significant differences between boys and girls in vertical length of the cervical vertebrae. However, the axial dimension of the vertebral body and the spinal canal space varied according to gender. PMID:25810858
Clinical characteristics of rheumatoid arthritis patients undergoing cervical spine surgery: an analysis of National Database of Rheumatic Diseases in Japan
Background The aim of this study was to examine the clinical characteristics of rheumatoid arthritis (RA) patients who underwent cervical spine surgery using a multicenter observational database. Methods We obtained data from a nationwide observational cohort database of patients with rheumatic diseases (National Database of Rheumatic Diseases by iR-net in Japan (NinJa)) for the fiscal years 2003 to 2011. A total of 39 out of 60 patients who underwent cervical spine surgery for a RA-related cause and whose data were available for two consecutive years (to assess the preoperative patient status) were chosen as cases. Patients with a non-RA-related cause of surgery (e.g., trauma) were excluded. First, we compared the patient characteristics between the cases and total patients in the same fiscal year. Next, 106 eligible controls, who were defined as RA patients enrolled in the same fiscal year as the case subjects, who were matched for age, gender and disease duration (within ±1 year), were selected. We compared the demographic data between the two groups. We also calculated the percentage of patients who underwent cervical spine surgery (surgeries/total number of patients) in fiscal years 2003 to 2011. Results Although the proportion of patients using biologics linearly increased during study period, the percentage of patients undergoing cervical spine surgeries remained unchanged, at approximately 0.15%. These cases had more tender joints (3 vs. 1, p?0.01) and exhibited a significantly higher Modified Health Assessment Questionnaire (MHAQ) score (1.13 vs. 0.5, p?0.01), C-reactive protein (CRP) (1.5 vs. 0.36, p?0.01), and disease activity score (DAS) 28-CRP (3.63 vs. 2.81, p?0.01) compared to the controls. Conclusions Our study revealed that RA patients requiring cervical spine surgery have a higher disease activity (as represented by the DAS28-CRP) and are more functionally disabled (as represented by the MHAQ) than control patients. PMID:24925126
Hyperextension soft tissue injuries of the cervical spine--a review.
Johnson, G
While a full understanding of continuing symptoms following a soft tissue hyperextension injury of the cervical spine remains elusive, recent research has shown that the explanation may lie with occult lesions beyond the musculoskeletal structures of the neck. The balance of the roles of injury, psychological factors, and the effects of litigation has shifted towards the former. However this injury would be unique if the latter two played only a minor role in determining recovery. It seems likely that among the large numbers of patients presenting with symptoms after hyperextension soft tissue injuries, a proportion will have occult bone, joint, or intervertebral disc lesions. Improvements in medical imaging techniques may allow better definition of these specific injuries and the development of more appropriate treatment. The search for a central nervous system lesion in humans continues and until this is demonstrated, many will dispute the existence of an organic brain syndrome. Evidence for significant injury to the temporomandibular joints, ear, and ophthalmic system has been found and this may be amenable to specialist intervention. While there is little evidence for effective treatments of the established injury, reduction in related disability appears most likely to be achieved by prevention. Improvements in automobile design, with particular reference to head restraints, could limit the cost to society of this common and disabling injury. PMID:8821214
Negative effects of smoking, workers' compensation, and litigation on pain/disability scores for spine patients
Prasarn, Mark L.; Horodyski, Mary B.; Behrend, Caleb; Wright, John; Rechtine, Glenn R.
Background: When initiating treatment for patients with spinal disorders, we examined the impact of smoking, workers compensation, and litigation on disability and pain scores. Methods: With Institutional Review Board approval, the medical records of 13,704 consecutive patients with spinal disorders treated at two university spine centers were reviewed. Particular attention was focused on the pretreatment impact of three variables: smoking, workers compensation, and litigation. All patients completed a questionnaire that included a modified Oswestry Disability Index (ODI), a visual analog pain scale (VAS) and a history of smoking, workers compensation, and/or litigation issues. Analysis of Variance (ANOVA) with Bonferroni (when appropriate) was used to analyze the data. Results: ODI scores significantly correlated with a smoking history: Current Smoker > Previous Smoker > Never Smoked (44.22 > 38.11 > 36.02, respectively). Pain scores and ODI scores had a direct correlation to workers compensation and litigation status. Workers compensation, litigation and smoking combined created even higher scores. There was no significant difference between previous smokers and nonsmokers. Conclusions: This study demonstrates that a history of smoking, workers compensation, and/or litigation, considered alone or worse, combined, negatively impacted outcomes for patients seeking treatment at our spine centers. For optimal outcomes in spine patients, cessation of smoking and treatment of attendant psychological and social factors prove critical. PMID:23248756
The effect of lateral eccentricity on failure loads, kinematics, and canal occlusions of the cervical spine in axial loading.
Van Toen, C; Melnyk, A D; Street, J; Oxland, T R; Cripton, P A
Current neck injury criteria do not include limits for lateral bending combined with axial compression and this has been observed as a clinically relevant mechanism, particularly for rollover motor vehicle crashes. The primary objectives of this study were to evaluate the effects of lateral eccentricity (the perpendicular distance from the axial force to the centre of the spine) on peak loads, kinematics, and spinal canal occlusions of subaxial cervical spine specimens tested in dynamic axial compression (0.5 m/s). Twelve 3-vertebra human cadaver cervical spine specimens were tested in two groups: low and high eccentricity with initial eccentricities of 1 and 150% of the lateral diameter of the vertebral body. Six-axis loads inferior to the specimen, kinematics of the superior-most vertebra, and spinal canal occlusions were measured. High speed video was collected and acoustic emission (AE) sensors were used to define the time of injury. The effects of eccentricity on peak loads, kinematics, and canal occlusions were evaluated using unpaired Student t-tests. The high eccentricity group had lower peak axial forces (1544 ± 629 vs. 4296 ± 1693 N), inferior displacements (0.2 ± 1.0 vs. 6.6 ± 2.0 mm), and canal occlusions (27 ± 5 vs. 53 ± 15%) and higher peak ipsilateral bending moments (53 ± 17 vs. 3 ± 18 Nm), ipsilateral bending rotations (22 ± 3 vs. 1 ± 2°), and ipsilateral displacements (4.5 ± 1.4 vs. -1.0 ± 1.3 mm, p<0.05 for all comparisons). These results provide new insights to develop prevention, recognition, and treatment strategies for compressive cervical spine injuries with lateral eccentricities. PMID:24411098
Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment.
Núńez-Pereira, Susan; Hitzl, Wolfgang; Bullmann, Viola; Meier, Oliver; Koller, Heiko
OBJECT Sagittal malalignment of the cervical spine has been associated with worsened postsurgical outcomes. For better operative planning of fusion and alignment restoration, improved knowledge of ideal fusion angles and interdependences between upper and lower cervical spine alignment is needed. Because spinal and spinopelvic parameters might play a role in cervical sagittal alignment, their associations should be studied in depth. METHODS The authors retrospectively analyzed digital lateral standing cervical radiographs of 145 patients (34 asymptomatic, 74 symptomatic; 37 surgically treated), including full-standing radiographs obtained in 45 of these patients. Sagittal measurements were as follows: C2-7, occiput (Oc)-C2, C1-2 Cobb angles, and C-7 slope (the angle between the horizontal line and the superior endplate of C-7), as well as T4-12 and L1-S1 Cobb angles, sacral slope, pelvic incidence, and C-7 sagittal vertical axis (SVA). A correlation analysis was performed, and linear regression models were developed. RESULTS Statistical analyses revealed significant correlations between C2-7 and Oc-C2 (r = -0.4, p < 0.01), Oc-C2 (r = -0.3, p < 0.01), and C1-2 angle (r = -0.3, p < 0.01). C-7 slope was significantly correlated with C2-7 (r = -0.5, p < 0.01) and with Oc-C2 angle (r = 0.2, p = 0.02). Total cervical (Oc-C7) lordosis was 30.2° and did not differ significantly among asymptomatic, symptomatic, and surgically treated patients. Correlations between C2-7 and Oc-C2 alignment were stronger in asymptomatic patients (r = -0.5, p < 0.01) and surgically treated patients (r = -0.5, p < 0.01) than in symptomatic patients (r = -0.3, p = 0.01), but the between-group difference was not significant (p > 0.1). Comparing cervical and spinopelvic alignment revealed a significant correlation between sacral slope and C-7 slope (r = -0.3, p = 0.04) and C2-7 (r = 0.4, p < 0.01). The C-7 SVA correlated significantly with the C-7 slope (r = -0.4, p < 0.01). The interdependences were stronger within the occipitocervical parameters than between the cervical and remaining spinal parameters. CONCLUSIONS Significant correlations between the upper and lower cervical spine exist, confirming the existence of inherent compensatory mechanisms to maintain overall balance; no significant differences were found among asymptomatic, symptomatic, and surgically treated patients. The C-7 slope is a useful marker of overall sagittal alignment, acting as a link between the occipitocervical and thoracolumbar spine. PMID:25909271
The effects of core muscle release technique on lumbar spine deformation and low back pain
Lee, Myounggi; Song, Changho; Jo, Younggwan; Ha, Donghun; Han, Dongwook
[Purpose] The purpose of this study was to examine the effects of the core muscle release technique on correction of lumbar deformation and alleviation of low back pain. [Subjects] Ninety patients diagnosed with lumbar deformation and low back pain participated in this study. [Methods] The participants were divided into three groups according to method of treatment. The first group was treated with the core muscle release technique (CRT), the second group was treated with general exercise, and the third group was treated with electrotherapy. The core muscle release technique group received 50-minute of the core muscle release technique 5 times a week for 2 weeks, and the participants in this group were instructed not to receive any other treatments. After the 2 weeks of treatment, the patients were reexamined. The general exercise group performed Williams flexion exercises and McKenzie extension exercises 5 times a week for 2 weeks. The electrotherapy group was treated by application of electrotherapy with an interferential current therapy machine (TM-301. TOPMED. Seongnam, Republic of Korea) to the abdominal muscles and back muscles of the lumbar region. [Results] The data suggest that the core muscle release technique, general exercise, and electrotherapy all helped to decrease the alignment angle and VAS score. Of these treatment methods, however, the core muscle release technique was the most effective for treatment of lumbar spine deformation and low back pain. [Conclusion] The core muscle release technique was most effective for correction of lumbar spine deformation and pain alleviation.
Motor Cortex Stimulation for the Treatment of Chronic Facial, Upper Extremity, and Throat Pain.
Trigeminal Neuralgia (Burchiel Type I); Trigeminal Neuralgia (Burchiel Type II); Trigeminal Neuropathic Pain; Trigeminal Deafferentation Pain; Complex Regional Pain Syndrome (Types I and II, Involving the Upper Extremity); Glossopharyngeal Neuralgia; Upper Extremity Pain Due to Deafferentation of the Cervical Spine; Central Pain Syndromes
Effect of Deep Cervical Flexor Muscles Training Using Pressure Biofeedback on Pain and Disability of School Teachers with Neck Pain
Iqbal, Zaheen Ahmed; Rajan, Reena; Khan, Sohrab Ahmed; Alghadir, Ahmad H.
[Purpose] The job of secondary school teachers involves a lot of head down posture as frequent reading, assignment correction, computer use and writing on a board put them at risk of developing occupational related neck pain. Available studies of neck pain experienced by teachers are limited. The purpose of this study was to determine whether training of deep cervical flexor muscles with pressure biofeedback has any significant advantage over conventional training for pain and disability experienced by school teachers with neck pain. [Subjects] Thirty teachers aged 25–45 years with neck pain and poor craniocervical flexion test participated in this study. [Methods] A pretest posttest experimental group design was used in which experimental group has received training with pressure biofeedback and conventional exercises while control group received conventional exercises only. Measurements of dependent variables were taken at baseline, and after 2 and 4 weeks of training. Pain intensity was assessed using a numeric pain rating scale and functional disability was assessed using the neck disability index. [Results] The data analysis revealed that there was significant improvement in pain and disability in both the groups and the results were better in the experimental group. [Conclusion] Addition of pressure biofeedback for deep cervical flexor muscles training gave a better result than conventional exercises alone. Feedback helps motor learning which is the set of processes associated with practice or experience leading to permanent changes in ability to respond. PMID:24259822
Cervical spinal cord stimulation treatment of deafferentation pain from brachial plexus avulsion injury complicated by complex regional pain syndrome.
Chang Chien, George C; Candido, Kenneth D; Saeed, Kashif; Knezevic, Nebojsa Nick
Brachial plexus avulsion is a rare and debilitating condition frequently associated with severe, intractable neuropathic pain. Interventional treatment modalities include dorsal root entry zone lesioning, stellate ganglion blockade, and neuromodulation such as spinal cord stimulation. We present a case of a 42-year-old woman with a traumatic left upper extremity brachial plexus avulsion injury after a motor vehicle accident and treatment of deafferentation pain complicated by complex regional pain syndrome type II. Previous unsuccessful interventions included repeated stellate ganglion blocks, transcutaneous electrical nerve stimulation, and opioid medication. After a successful trial of cervical spinal cord stimulator lead placement, she went on to an uneventful permanent implantation procedure. Spinal cord stimulation is an effective treatment for deafferentation pain and complex regional pain syndrome type II secondary to brachial plexopathy refractory to pharmacotherapy and conventional interventional attempts to modulate pain. PMID:25611136
Biomechanical analysis of expansion screws and cortical screws used for ventral plate fixation on the cervical spine
Ullrich, Bernhard; Huber, Gerd; Morlock, Michael M.
Compared to bicortical screws, the surgical risk of injuring intraspinal structures can be minimized with the use of monocortical screws. However, this reduction should not be achieved at the expense of the stability of the fixation. With monocortical stabilization, the expansion screws have the potential of absorbing high loads. Therefore, they are expected to be a suitable alternative to bicortical screws for revision surgeries and in osteoporotic bone. The purpose of this in vitro study was to investigate the stiffness of the two screw-plate systems used for ventral stabilization of the cervical spine, by focusing on the suitability of expansion screws as tools for revision treatments. The study was conducted in ten functional units of human cervical spines. The device sample stiffness was determined for four conditions using a turning moment of 2.25 N m each around one of the three principle axes. The conditions were native, destabilized, primarily stabilized with one of the screw-plate systems, followed by secondary stabilization using the expansion screw implant. The stabilized samples achieved a comparable, in most cases higher stiffness than the native samples. The samples undergoing secondary stabilization using expansion screws tend to display greater stiffness for all three axes compared to the primarily stabilized samples. The achieved tightening moment of the screws was higher than the one achieved with primary fixation. Both plates revealed similar primary stability. Revision surgeries with secondary instrumentation achieve a high stiffness of the screwed up segments. Monocortical expansion screws combined with a trapezoidal plate allow ventral stabilization of the cervical spine that is comparable to the plate fixation using bicortical screws. PMID:19588171
Short-Term Effects of Pulsed Radiofrequency on Chronic Refractory Cervical Radicular Pain
Choi, Gyu-Sik; Cho, Yun-Woo; Lee, Dong-Kyu
Objective To evaluate the short-term effectiveness of pulsed radiofrequency on the dorsal root ganglion (DRG) in patients with chronic refractory cervical radicular pain. Method Fifteen patients (13 males, 2 females; mean age, 55.9 years) with chronic radicular pain due to cervical disc herniation or foraminal stenosis refractory to active rehabilitative management, including transforaminal cervical epidural steroid injection and exercise, were selected. All patients received pulsed radiofrequency on the symptomatic cervical dorsal root ganglion and were carefully evaluated for neurologic deficits and side effects. The clinical outcomes were measured using a visual analogue scale (VAS) and a neck disability index (NDI) before treatment, one and three months after treatment. Successful pain relief was defined as a 50% or greater reduction in the VAS score as compared with the pre-treatment score. After three months, we categorized the patients' satisfaction. Results The average VAS for radicular pain was reduced significantly from 5.3 at pretreatment to 2.5 at 3 months post-treatment (p<0.05). Eleven of 15 patients (77.3%) after cervical pulsed RF stimulation reported pain relief of 50% or more at the 3 month follow-up. The average NDI was significantly reduced from 44.0% at pretreatment to 35.8% 3 months post-treatment (p<0.05). At 3 months post-treatment, eleven of fifteen patients (73.3%) were satisfied with their status. No adverse effects were observed. Conclusion The results demonstrate that the application of pulsed radiofrequency on DRG might be an effective short-term intervention for chronic refractory cervical radicular pain. Further studies, including a randomized controlled trial with long-term follow-up, are now needed. PMID:22506211
Spine day 2012: spinal pain in Swiss school children– epidemiology and risk factors
Background The key to a better understanding of the immense problem of spinal pain seems to be to investigate its development in adolescents. Based on the data of Spine Day 2012 (an annual action day where Swiss school children were examined by chiropractors on a voluntary basis for back problems), the aim of the present study was to gain systematic epidemiologic data on adolescent spinal pain in Switzerland and to explore risk factors per gender and per spinal area. Method Data (questionnaires and physical examinations) of 836 school children were descriptively analyzed for prevalence, recurrence and severity of spinal pain. Of those, 434 data sets were included in risk factor analysis. Using logistic regression analysis, psycho-social parameters (presence of parental back pain, parental smoking, media consumption, type of school bag) and physical parameters (trunk symmetry, posture, mobility, coordination, BMI) were analyzed per gender and per spinal area. Results Prevalence of spinal pain was higher for female gender in all areas apart from the neck. With age, a steep increase in prevalence was observed for low back pain (LBP) and for multiple pain sites. The increasing impact of spinal pain on quality of life with age was reflected in an increase in recurrence, but not in severity of spinal pain. Besides age and gender, parental back pain (Odds ratio (OR)=3.26, p=0.011) and trunk asymmetry (OR=3.36, p=0.027) emerged as risk factors for spinal pain in girls. Parental smoking seemed to increase the risk for both genders (boys: OR=2.39, p=0.020; girls: OR=2.19, p=0.051). Risk factor analysis per spinal area resulted in trunk asymmetry as risk factor for LBP (OR=3.15, p=0.015), while parental smoking increased the risk for thoracic spinal pain (TSP) (OR=2.83, p=0.036) and neck pain (OR=2.23, p=0.038). The risk for TSP was further enhanced by a higher BMI (OR=1.15, p=0.027). Conclusion This study supports the view of adolescent spinal pain as a bio-psycho-social problem that should be investigated per spinal area, age and gender. The role of trunk asymmetry and passive smoking as risk factors as well as the association between BMI and TSP should be further investigated, preferably in prospective studies. PMID:24094041
Four lateral mass screw fixation techniques in lower cervical spine following laminectomy: a finite element analysis study of stress distribution
Background Lateral mass screw fixation (LSF) techniques have been widely used for reconstructing and stabilizing the cervical spine; however, complications may result depending on the choice of surgeon. There are only a few reports related to LSF applications, even though fracture fixation has become a severe complication. This study establishes the three-dimensional finite element model of the lower cervical spine, and compares the stress distribution of the four LSF techniques (Magerl, Roy-Camille, Anderson, and An), following laminectomy -- to explore the risks of rupture after fixation. Method CT scans were performed on a healthy adult female volunteer, and Digital imaging and communication in medicine (Dicom) data was obtained. Mimics 10.01, Geomagic Studio 12.0, Solidworks 2012, HyperMesh 10.1 and Abaqus 6.12 software programs were used to establish the intact model of the lower cervical spines (C3-C7), a postoperative model after laminectomy, and a reconstructive model after applying the LSF techniques. A compressive preload of 74 N combined with a pure moment of 1.8 Nm was applied to the intact and reconstructive model, simulating normal flexion, extension, lateral bending, and axial rotation. The stress distribution of the four LSF techniques was compared by analyzing the maximum von Mises stress. Result The three-dimensional finite element model of the intact C3-C7 vertebrae was successfully established. This model consists of 503,911 elements and 93,390 nodes. During flexion, extension, lateral bending, and axial rotation modes, the intact model's angular intersegmental range of motion was in good agreement with the results reported from the literature. The postoperative model after the three-segment laminectomy and the reconstructive model after applying the four LSF techniques were established based on the validated intact model. The stress distribution for the Magerl and Roy-Camille groups were more dispersive, and the maximum von Mises stress levels were lower than the other two groups in various conditions. Conclusion The LSF techniques of Magerl and Roy-Camille are safer methods for stabilizing the lower cervical spine. Therefore, these methods potentially have a lower risk of fixation fracture. PMID:25106498
Clinical reasoning: a 51-year-old man with cervical pain and progressively deteriorating gait.
Rallis, Dimitrios; Tsirigotis, Panagiotis; Arvaniti, Chryssa; Sgouros, Spiros; Foukas, Periclis G; Oikonomopoulos, Nikolaos; Andronas, Nikolaos; Panayiotides, Ioannis G; Kouloulias, Vasilios; Papageorgiou, Sotirios; Voumvourakis, Konstantinos; Stamboulis, Eleftherios
A 51-year-old Caucasian man presented with cervical pain, right hand weakness, and progressively deteriorating gait. Onset of symptoms occurred 1 month before admission with cervical pain that worsened during neck flexion. A few days later he noticed reduced dexterity and numbness of his right hand. During the following 3 weeks, his gait became increasingly unstable. Additionally, he reported erectile dysfunction and urinary hesitancy. No previous trauma was recalled. His medical and family history was unremarkable except for hypertension that was treated with angiotensin-converting enzyme inhibitors. PMID:23713091
Movement coordination of the lumbar spine and hip during a picking up activity in low back pain subjects
Gary L. K. Shum; Jack Crosbie; Raymond Y. W. Lee
The effect of low back pain, with or without nerve root signs, on the joint coordination and kinematics of the lumbar spine\\u000a and hips during everyday activities, such as picking up an object from the floor, are largely unknown. An experimental study\\u000a was designed to compare lumbar spine and hip joint kinematics and coordination in subjects with and without sub-acute
Comparison of the C-MAC(®) and GlideScope(®) videolaryngoscopes in patients with cervical spine disorders and immobilisation.
Brück, S; Trautner, H; Wolff, A; Hain, J; Mols, G; Pakos, P; Roewer, N; Lange, M
In-line stabilisation of the neck can increase the difficulty of tracheal intubation with direct laryngoscopy. We randomly assigned 56 patients with cervical spine pathology scheduled for elective surgery to tracheal intubation using either the C-MAC(®) (n = 26) or GlideScope(®) (n = 30), when the head and neck were stabilised in-line. There was no significant difference in the median (IQR [range]) intubation times between the C-MAC (19 (14-35 [9-90]) s and the GlideScope (23, (15-32 [8-65]) s. The first-attempt failure rate for the C-MAC was 42% (95% CI 23-63%) compared with 7% (95% CI 1-22%) for the GlideScope, p = 0.002. The laryngeal view was excellent and comparable with both devices, with the C-MAC requiring significantly more attempts and optimising manoeuvers (11 vs 5, respectively, p = 0.04). There were no significant differences in postoperative complaints e.g. sore throat, hoarseness and dysphagia. Both devices provided an excellent glottic view in patients with cervical spine immobilisation, but tracheal intubation was more often successful on the first attempt with the GlideScope. PMID:25265994
Cervical Spine Motion During Football Equipment-Removal Protocols: A Challenge to the All-or-Nothing Endeavor
Jacobson, Bradley; Cendoma, Michael; Gdovin, Jacob; Cooney, Kevin; Bruening, Dustin
Context The National Athletic Trainers' Association position statement on acute management of the cervical spine-injured athlete recommended the all-or-nothing endeavor, which involves removing or not removing both helmet and shoulder pads, from equipment-laden American football and ice hockey athletes. However, in supporting research, investigators have not considered alternative protocols. Objective To measure cervical spine movement (head relative to sternum) produced when certified athletic trainers (ATs) use the all-or-nothing endeavor and to compare these findings with the movement produced using an alternative pack-and-fill protocol, which involves packing the area under and around the cervical neck and head with rolled towels. Design Crossover study. Setting Movement analysis laboratory. Patients or Other Participants Eight male collegiate football players (age = 21.4 ± 1.4 years; height = 1.87 ± 0.02 m; mass = 103.6 ± 12.5 kg). Intervention(s) Four ATs removed equipment under 4 conditions: removal of helmet only followed by placing the head on the ground (H), removal of the helmet only followed by pack-and-fill (HP), removal of the helmet and shoulder pads followed by placing the head on the ground (HS), and removal of the helmet and shoulder pads followed by pack-and-fill (HSP). Motion capture was used to track the movement of the head with respect to the sternum during equipment removal. Main Outcome Measure(s) We measured head movement relative to sternum movement (translations and rotations). We used 4 × 4 analyses of variance with repeated measures to compare discrete motion variables (changes in position and total excursions) among protocols and ATs. Results Protocol HP resulted in a 0.1 ± 0.6 cm rise in head position compared with a 1.4 ± 0.3 cm drop with protocol HS (P < .001). Protocol HP produced 4.9° less total angular excursion (P < .001) and 2.1 cm less total vertical excursion (P < .001) than protocol HS. Conclusions The pack-and-fill protocol was more effective than shoulder pad removal in minimizing cervical spine movement throughout the equipment-removal process. This study provides evidence for including the pack-and-fill protocol in future treatment recommendations when helmet removal is necessary for on-field care. PMID:24377964
E. C. Teo; H. W. Ng
In hu man spine, any ligamentous injury, degenerated d isc or facetectomy leads to certain d egrees of spinal instability. There are limited studies using finite element method (FEM) simulating these effects to evaluate the biomechanical response of spine under various physiological load configurations. This parametric study was conducted to evaluate the roles of ligaments, facets, and disc nucleus in
Post-surgical lumbar spine pain treated with Cox flexion-distraction manipulation: A retrospective chart review in a private practice setting
Ralph Kruse; Jerrilyn A. Cambron
Objective: Although chiropractic manipulation is commonly utilized for low back pain, applying this procedure to the post lumbar spine surgery patient has not been adequately studied. The purpose of this retrospective chart review is to report on the results of chiropractic management (including Cox flexion distraction technique) of patients with post-surgical lumbar spine pain to determine the change in reported
Efficacy of Zero-Profile Implant in Anterior Fusion to Treat Degenerative Cervical Spine Disease: Comparison with Techniques Using Bone Graft and Anterior Plating.
Chang, Han; Baek, Dong-Hoon; Choi, Byung-Wan
Background?The efficacy of anterior fusion using zero-profile implant (Zero-P) in the surgical treatment of degenerative cervical disease was investigated through radiographic and clinical comparisons with existing treatments using autograft or allograft and anterior plating. Material and Methods?A total of 130 patients who underwent anterior decompression and fusion for degenerative cervical spine disease with a follow-up of at least 1?year were analyzed retrospectively. The cases were divided into three groups: autograft and plate (38 cases, group A), allograft and plate (44 cases, group B), and Zero-P (48 cases, group C). Maintenance of lordosis, extent of subsidence, and fusion were evaluated radiologically and compared among preoperative, postoperative, and final follow-up time points. In addition, changes in Visual Analog Scale (VAS) and Neurologic Disability Index (NDI) scores and the presence of complications were evaluated for clinical analysis. Results?Operation time was significantly less in group C (p?=?0.007, 0.002). Maintenance of entire and segmental lordosis after surgery was better in groups A and B compared with group C (p?=?0.002, 0.001); however, the extent of loss of lordosis from the surgery to the final follow-up did not show any significant differences. Regarding the extent of subsidence, the increase of height between the vertebral bodies after the surgery was 3.10, 2.89, and 2.68?mm in group A, group B, and group C, respectively (p?=?0.14), and changed to?-?1.27,?-?2.41, and?-?1.2?mm at the final follow-up (p?=?0.012). VAS and NDI scores were improved from 7.2 to 3 and 34 to 12, respectively, but there were no significant differences. Nonunion occurred in two cases in both group B and group C. In terms of clinical complications, two cases of persistent donor site pain were found in group A; one case of persistent dysphagia was found in both group A and group B. Conclusion?Anterior cervical fusion using Zero-P has a shorter operation time and less subsidence compared with conventional surgical techniques. Thus it can be considered a useful technique for the surgical treatment of degenerative cervical disease. PMID:26140339
Application of an asymmetric finite element model of the C2-T1 cervical spine for evaluating the role of soft tissues in stability.
Erbulut, D U; Zafarparandeh, I; Lazoglu, I; Ozer, A F
Different finite element models of the cervical spine have been suggested for evaluating the roles of ligaments, facet joints, and disks in the stability of cervical spine under sagittal moments. However, no comprehensive study on the response of the full cervical spine that has used a detailed finite element (FE) model (C2-T1) that considers the asymmetry about the mid-sagittal plane has been reported. The aims of this study were to consider asymmetry in a FE model of the full cervical spine and to investigate the influences of ligaments, facet joints, and disk nucleus on the stability of the asymmetric model during flexion and extension. The model was validated against various published in vitro studies and FE studies for the three main loading planes. Next, the C4-C5 level was modified to simulate different cases to investigate the role of the soft tissues in segmental stability. The FE model predicted that excluding the interspinous ligament (ISL) from the index level would cause excessive instability during flexion and that excluding the posterior longitudinal ligament (PLL) or the ligamentum flavum (LF) would not affect segmental rotation. During extension, motion increased when the facet joints were excluded. The model without disk nucleus was unstable compared to the intact model at lower loads and exhibited a similar rotation response at higher loads. PMID:24641811
Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain
Uthaikhup, Sureeporn; Prasert, Romchat; Paungmali, Aatit; Boontha, Kritsana
Background Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders. Methods Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle. Results Elders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p < 0.05). There were no between group differences in heat pain thresholds and suprathreshold heat pain responses (p > 0.05). Conclusion The presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age. PMID:26039149
Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial
Dominik Irnich; Nicolas Behrens; Jochen M Gleditsch; Wolfram Stör; Martin A Schreiber; Peter Schöps; Andrew J Vickers; Antje Beyer
To evaluate immediate effects of two different modes of acupuncture on motion-related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure. Thirty-six patients with chronic neck pain and limited cervical spine mobility participated in a prospective, randomized, double-blind, sham-controlled crossover trial. Every patient was treated once with needle acupuncture at distant points, dry needling
Cervical spine motion in the sagittal plane (I) range of motion of actually performed movements, an X-ray cinematographic study.
Van Mameren, H; Drukker, J; Sanches, H; Beursgens, J
A fast method has been developed to determine the position of the outlines of bony structures on X-ray photographs of the cervical spine movements in the sagittal plane (105 mm spot film camera; 4 frames per second; about 10 seconds per complete anteflexion-retroflexion or vice versa). This method corrects for incongruity of the vertebral contours on consecutive frames due to motion in another than the sagittal plane. It also automatically corrects erroneously marked points. This method has been used to determine segmental range of motion (SROM) and total range of motion of the head with respect to the seventh cervical vertebra (TROM). It is shown that SROM may be larger when frames of intermediate instead of extreme positions of the film are considered. In ten test persons without cervical complaints the interindividual variability of SROM turned out to be comparable to the ones found with older methods. Intraindividual variability of SROM and TROM was determined by registration at three different measuring sessions (0, 2 and 10 weeks). This intraindividual variability is high, especially in the cranial and caudal parts of the cervical spine. It is concluded that SROM and TROM are unsuitable to be used as a parameter of cervical spine mobility. PMID:2390411
Cervical and thoracic spine injury from interactions with vehicle roofs in pure rollover crashes.
Bambach, M R; Grzebieta, R H; McIntosh, A S; Mattos, G A
Around one third of serious injuries sustained by belted, non-ejected occupants in pure rollover crashes occur to the spine. Dynamic rollover crash test methodologies have been established in Australia and the United States, with the aims of understanding injury potential in rollovers and establishing the basis of an occupant rollover protection crashworthiness test protocol that could be adopted by consumer new car assessment programmes and government regulators internationally. However, for any proposed test protocol to be effective in reducing the high trauma burden resulting from rollover crashes, appropriate anthropomorphic devices that replicate real-world injury mechanisms and biomechanical loads are required. To date, consensus regarding the combination of anthropomorphic device and neck injury criteria for rollover crash tests has not been reached. The aim of the present study is to provide new information pertaining to the nature and mechanisms of spine injury in pure rollover crashes, and to assist in the assessment of spine injury potential in rollover crash tests. Real-world spine injury cases that resulted from pure rollover crashes in the United States between 2000 and 2009 are identified, and compared with cadaver experiments under vertical load by other authors. The analysis is restricted to contained, restrained occupants that were injured from contact with the vehicle roof structure during a pure rollover, and the role of roof intrusion in creating potential for spine injury is assessed. Recommendations for assessing the potential for spine injury in rollover occupant protection crash test protocols are made. PMID:23149322
Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: A pilot randomized clinical trial
Linda Schiller
Background: To date, no substantiated studies have been performed to investigate the efficacy of spinal manipulative therapy on thoracic spinal syndromes. Objective: To investigate the effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain. Study Design: A single-blind, randomized, comparative, controlled pilot study. Setting: Technikon Natal Chiropractic Clinic in Durban, South Africa. Participants: Thirty subjects selected
Anterior transpedicular screw fixation of cervical spine: Is it safe? Morphological feasibility, technical properties, and accuracy of manual insertion.
Koktekir, Ender; Toktas, Zafer Orkun; Seker, Askin; Akakin, Akin; Konya, Deniz; Kilic, Turker
OBJECT Due to lack of construct stability of the current anterior cervical approaches, supplemental posterior cervical approaches are frequently employed. The use of an anterior-only approach with anterior transpedicular screws (ATPSs) has been proposed as a means of providing 3-column fixation. This study was designed to investigate the feasibility of anterior transpedicular screw (ATPS) fixation of cervical spine, to obtain the morphological measurements for technical prerequisites, and to evaluate the accuracy of the ATPS using fluoroscopy. METHODS The study included both radiological and anatomical investigations. The radiological investigations were based on data from cervical spine CT scans performed in 65 patients. Technical prerequisites of ATPS were calculated using OsiriX for Mac OS. In the anatomical part of the study, 30 pedicles (C3-7) from 6 formalin-preserved cadavers were manually instrumented. Measurements obtained included pedicle width (PW), pedicle height (PH), pedicle transverse angle (PTA), distance of the entry point from the midline (DEPM), and distance of the entry point from the superior endplate (DEPSEP). The authors also analyzed screw position in the manually instrumented vertebrae. RESULTS The mean PW and PH values showed a tendency to increase from C-3 to C-7 in both males and females. The means were significantly larger for both PW and PH in males than in females at all levels (p = 0.001). The overall mean PTA value was significantly lower at C-7 (p < 0.0001). The mean value for the distance of entry point from the midline (DEPM) represented a point at the contralateral side of the pedicle for every level except C-7. The mean DEPSEP values showed significant differences between all levels (p < 0.0001). Seven of the 30 screws were identified as breaching the pedicle (23.3%); these screw malplacements were seen at C-3 (3 screws), C-4 (2 screws), and C-5 (2 screws). CONCLUSIONS The morphological measurements of this study demonstrated that ATPS fixation is feasible in selected cases. They indicate that ATPS insertion using a fluoroscopy-assisted pedicle axis view is safe at the C-6 and C-7 levels, but the results at the other levels did not prove the safety of this technique. PMID:25815805
Reduction in sick leave and costs to society of patients with Meniere's disease after treatment of temporomandibular and cervical spine disorders: a controlled six-year cost-benefit study.
Bjorne, Assar; Agerberg, Göran
This study compares the frequency of sick leave between the three-year period after and the three-year period before coordinated treatment of temporomandibular and cervical spine disorders in 24 patients (ten males and 14 females) diagnosed with Meniere's disease. The frequency of sick leave for the patients was also compared with the frequency of sick leave in a control group from the population. A cost-benefit analysis was made regarding the costs to society of sick leave related to the treatment costs of the patients. In a previous study the same patients were treated for their severe signs and symptoms of temporomandibular and cervical spine disorders, and they reported a substantial reduction in their vertigo, non-whirling dizziness, tinnitus, feeling of fullness in the ear, pain in the face and jaws, pain in the neck and shoulders, and headache. The number of days of sick leave and the year the patient began to receive disability pension due to the symptoms of Meniere's disease were obtained from the National Health Insurance Service in Sweden. Two of the patients received disability pension benefits due to Meniere's disease 17 years prior to their normal retirement pension. A third patient received disability pension for another reason and two were receiving a retirement pension. Data on the remaining 19 patients showed a considerable reduction in number of days of sick leave during the three-year period after coordinated treatment (270 days) compared with the three-year period before the treatment (1,536 days). The control subjects used a total of 14 days sick leave for the same symptoms during the same six-year period. Vertigo (nine days) was the dominant cause followed by pain in the neck and shoulders, and headache. The reduction in sick leave for the 19 nonretired patients and the treatment costs for the 24 patients can be used for a simple cost-benefit calculation for the subgroup of nonretired patients. During the first three years after treatment the reduction in sick leave was on average 66.6 days for each of the 19 nonretired patients. Within the limits of this study, it can be concluded that the costs to society for sick leave and disability pension due to Meniere's disease are substantial. A coordinated treatment of temporomandibular and cervical spine disorders appears to substantially reduce these costs. PMID:12723860
Cervical Meningomyelitis After Lumbar Epidural Steroid Injection
Kim, Joon-Sung; Kim, Ji Yeon
Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement.
Using CT of the Cervical Spine for Early Evaluation of Pediatric Patients with Head Trauma
Heather T. Keenan; Michael C. Hollingshead; Charles J. Chung; Michele K. Ziglar
OBJECTIVE. The purpose of this study was to assess the effectiveness of CT of the cervi- cal spine in addition to radiography in pediatric patients with suspected head trauma at the time of the CT head examination. MATERIALS AND METHODS. We identified 63 pediatric patients admitted to the emergency department who had head trauma and who underwent both head CT
A case of symptomatic cervical perineural (Tarlov) cyst: clinical manifestation and management
Keewon Kim; Se Woong Chun; Sun G. Chung
Perineural (Tarlov) cysts are most often found in the sacral region and are rare in the cervical spine. Although they are\\u000a usually asymptomatic, a small number of those at the lumbosacral level have been known to produce localized or radicular pain.\\u000a Few reports are available on symptomatic perineural cysts in the cervical spine and it has not been discussed how
A comparison of conventional tube and EndoFlex tube for tracheal intubation in patients with a cervical spine immobilisation
Background The EndoFlex is a new type of tracheal tube with an adjustable distal tip that can be bent without the use of a stylet. The aim of this study was to compare a standard endotracheal tube with the EndoFlex tracheal tube for intubation in patients with simulated cervical spine injury. Methods A group of 60 patients without any kind of the cervical spine injury, classified as the ASA physiological scale I or II and qualified for elective surgery procedures were intubated with the use of classical Macintosh laryngoscope, and either a standard endotracheal tube with the intubation stylet in it or EndoFlex tube without stylet. The subjects were randomized into two subgroups. All patients have had the cervical collar placed on their neck for the simulation of intubation procedure in case of the spinal injury. Results The intubation procedure was performed by 16 anesthetists with different experience (5-19 yrs). Time of intubation with the use of EndoFlex tube was similar to that with a the use of standard endotracheal tube and intubation stylet: Me (median) 19.5 s [IQR (interquatile range) 18-50] vs. Me 20 s [IQR 17-60] respectively (p?=?0.9705). No significant additional maneuvers were necessary during intubation with the use of EndoFlex tube in comparison with standard endotracheal tube (70% vs. 56.6%) (p?=?0.4220). Subjective assessment of the usability of both tubes revealed that more anesthesiologists found intubations with the use of EndoFlex more demanding than intubation with conventional tracheal tube and intubation stylet. The assessment of usability: very easy 3.3% vs. 20%, easy 83.4% vs. 56.7%, difficult 10% vs. 20% and very difficult 3.3% vs. 3.3% for standard endotracheal tube with stylet and EndoFlex, respectively. Conclusion In conclusion we asses, that the EndoFlex tube does not improve intubation success rate, in fact it requires more maneuvers facilitating intubation and was found to be more difficult to use. PMID:24267640
Incidence of Vertebral Artery Thrombosis in Cervical Spine Trauma: Correlation with Severity of Spinal Cord Injury
Philip J. Torina; Adam E. Flanders; John A. Carrino; Anthony S. Burns; David P. Friedman; James S. Harrop; Alexander R. Vacarro
BACKGROUND AND PURPOSE: The incidence of blunt traumatic vertebral artery dissec- tion\\/thrombosis varies widely in published trauma series and is associated with spinal trauma. The purpose of this study was to determine the frequency of traumatic vertebral artery thrombosis (VAT) in cervically injured patients by using routine MR angiography (MRA) and MR imaging and identify associations with the severity of
Active range of motion in the cervical spine increases after spinal manipulation (toggle recoil)
Wayne Whittingham; Niels Nilsson
Background: It has generally been assumed that spinal manipulation has the biomechanical effect of increasing spinal range of motion. Past research has shown that there are likely no lasting changes to passive range of motion, and it is unclear whether there is an increase in active range of motion after manipulation. Objective: To study changes in active cervical range of
A clinical tool to determine the necessity of spine radiography in postmenopausal women with osteoporosis presenting with back pain
Roux, C; Priol, G; Fechtenbaum, J; Cortet, B; Liu?Léage, S; Audran, M
Background Vertebral fractures are underdiagnosed, although the resulting mortality and morbidity in postmenopausal women with osteoporosis is now recognised. In a population of postmenopausal women with osteoporosis and back pain, symptoms may be related to vertebral fractures or degenerative changes of the spine. Aim To evaluate a population of postmenopausal women presenting with back pain and factors associated with vertebral fractures which were assessable in a clinical setting in order to determine the necessity for spine radiography. Methods Patient questioning and physical examination were carried out and spinal radiographic data collected from 410 postmenopausal women with osteoporosis, with an average age of 74?years, who consulted a rheumatologist for back pain. Of these, 215 (52.4%) patients were diagnosed with at least one vertebral fracture. Logistic regression was used to identify the most relevant clinical features associated with existing vertebral fractures, and to derive a quantitative index of risk. Results The model included six parameters: age, back pain intensity, height loss, history of low trauma non?vertebral fractures, thoracic localisation of back pain and sudden occurrence of back pain. The scoring system, or the quantitative index, had a maximal score of 16. For a score ?7, the probability of existing vertebral fracture was ?43%. The correlation between this quantitative index and the logistic model probability was 0.98, suggesting an excellent and highly significant approximation of the original prediction equation. Conclusions : From six clinical items, an index was built to identify women with osteoporosis and back pain who should have spine radiography. This simple tool may help clinicians to optimise vertebral fracture diagnosis and to make a proper therapeutic decision. PMID:16793842
Thursday, October 31, 2001 3:47–4:17 pm Focused Review: Cervical Spine Surgery Complications
Alexander Simotas; Timothy Shen
Purpose of study: The purpose of this study was to investigate the incidence of neck pain and associated symptoms in an unusual population of car drivers with high-risk behaviors for whiplash disorder.Methods used: Fifty members of the Demolition Derby Association returned a neck pain questionnaire that had been contacted through the association's internet website. Questions included the participant's exposure to
European Spine Society —The Acromed Prize for Spinal Research 1995 Unexpected load and asymmetric posture as etiologic factors in low back pain
M. L. Magnusson; A. Aleksiev; D. G. Wilder; M. H. Pope; K. Spratt; S. H. Lee; V. K. Goel; J. N. Weinstein
Unexpected loads, which often occur in the working environment, can lead to high forces in the spine and, thus, may be a cause of low back injury. This paper discusses the effect of "sudden load" on the erector spine reaction and amplitude. Muscle responses were mediated by several factors, including fatigue, posture, expectation and rehabilitation, in chronic low back pain
Maintaining endotracheal tube cuff pressure at 20 mm Hg to prevent dysphagia after anterior cervical spine surgery; protocol of a double-blind randomised controlled trial
Background In anterior cervical spine surgery a retractor is obligatory to approach the spine. Previous studies showed an increase of endotracheal tube cuff pressure after placement of a retractor. It is known that high endotracheal tube cuff pressure increases the incidence of postoperative dysphagia, hoarseness, and sore throat. However, until now no evidence supports the fact whether adjusting the endotracheal tube cuff pressure during anterior cervical spine surgery will prevent this comorbidity. We present the design of a randomized controlled trial to determine whether adjusting endotracheal tube cuff pressure after placement of a retractor during anterior cervical spine surgery will prevent postoperative dysphagia. Methods/design 177 patients (aged 18–90 years) scheduled for anterior cervical spine surgery on 1 or more levels will be included. After intubation, endotracheal tube cuff pressure is manually inflated to 20 mm Hg in all patients. Patients will be randomized into two groups. In the control group endotracheal tube cuff pressure is not adjusted after retractor placement. In the intervention group endotracheal tube cuff pressure after retractor placement is maintained at 20 mm Hg and air is withdrawn when cuff pressure exceeds 20 mm Hg. Endotracheal tube cuff pressure is measured after intubation, before and after placement and removal of the retractor. Again air is inflated if cuff pressure sets below 20 mmHg after removal of the retractor. The primary outcome measure is postoperative dysphagia. Other outcome measures are postoperative hoarseness, postoperative sore throat, degree of dysphagia, length of hospital stay, and pneumonia. The study is a single centre double blind randomized trial in which patients and research nurses will be kept blinded for the allocated treatment during the follow-up period of 2 months. Discussion Postoperative dysphagia occurs frequently after anterior cervical spine surgery. This may be related to high endotracheal tube cuff pressure. Whether adaptation and maintaining the pressure after placement of the retractor will decrease the incidence of dysphagia, has to be determined by this trial. Trial registration Netherlands Trial Register (NTR) 3542: http://www.trialregister.nl. PMID:24067111
Influence of surgical treatment for disc degeneration disease at C5–C6 on changes in some biomechanical parameters of the cervical spine
Yuan Li; Gladius Lewis
A detailed three-dimensional solid model of the full cervical spine (C1–C7 levels) and the finite element analysis method were used to investigate the extent of changes in various biomechanical properties brought about when surgical methods are used to treat condition(s) caused by or are a sequela of disc degeneration disease at the C5–C6 level. The surgical methods simulated were anterior
Epidemiology of cervical spine abnormalities in asymptomatic adult professional rugby union players using static and dynamic MRI protocols: 2002 to 2006
B H Castinel; P Adam; P D Milburn; A Castinel; K L Quarrie; J-C Peyrin; J D Yeo
ObjectiveIn this study, the prevalence of abnormalities in the cervical spine of asymptomatic professional rugby players using both static and dynamic magnetic resonance imaging (MRI) in order to improve the detection of abnormalities and prevention of related injuries was investigated.DesignProspective observational study.SettingFrench professional rugby union clubs, between 2002 and 2006.Participants206 elite male adult players.InterventionStatic sagittal T2 and axial T2* fast
In vivo kinematics of the cervical spine. Part I: Development of a roentgen stereophotogrammetric technique using metallic markers and assessment of its accuracy.
Lee, S; Harris, K G; Nassif, J; Goel, V K; Clark, C R
A technique for simultaneous roentgen stereophotogrammetry (RS) was developed, and its accuracy was assessed. In vitro models fabricated from dried cadaveric C4 and C5 vertebrae were used to simulate the motion behavior of the cervical spine. Metallic markers made of Vitallium beads (diameter < 0.3 mm) were implanted into the posterior and anterior surfaces of each vertebra at surgically accessible locations to simulate the bead placement for both posterior and anterior surgical approaches to the cervical spine. A series of roentgen stereo pairs were obtained to systematically assess the accuracy (validity) of displacement measurements in anteroposterior (AP) translation, axial rotation, and flexion/extension. In addition, the effects of soft tissue density on the accuracy of the system were investigated by obtaining a series of roentgen stereo pairs with the experimental model immersed in a water bath. The coordinates of the metallic markers on the radiographs were then digitized by two raters who were not informed of the actual motion (i.e., blind study). The results indicated a high accuracy throughout the study. Overall root mean square errors were 0.07 mm for AP translation, 0.08 degrees for axial rotation, and 0.14 degrees for flexion/extension. The corresponding accuracy estimates (R2 values by linear regression analysis) were very high (0.992, 0.998, and 0.995) when the measurement results were compared with the actual displacements. The water bath did not affect measurement accuracy, indicating that soft tissue density should have little effect on the accuracy of the technique for in vivo applications. This system appears to be an accurate and reliable method for assessment of simulated in vivo cervical spine motion, regardless of the rater. The technique has been further used in in vivo assessment of cervical spine kinematics in one patient to confirm the efficacy of the developed technique. PMID:8130401
Acute hydrocephalus as a complication of cervical spine fracture and dislocation: a case report.
Chung, Yoon Young; Ju, Chang Il; Kim, Seok Won; Kim, Dong Min
Hydrocephalus is a well-known complication of head injury, but an uncommon complication of a spinal lesion. Here, we present a rare case of acute obstructive hydrocephalus secondary to a cervical fracture and dislocation. A 60-year-old female patient was transferred to the emergency department with quadriplegia and respiratory difficulty. Imaging studies showed a cervical fracture and dislocation at the C3-4 level. She required intubation and mechanical ventilation. Twenty-four hours after admission, her mental status had deteriorated and both pupils were dilated. Computed tomography of the brain showed acute hydrocephalus; therefore, extraventricular drainage (EVD) was performed. After the EVD, her mental status recovered and she became alert, but she remained quadriplegic and dependent on the ventilator. Two months after injury, she died because of respiratory failure caused by pneumonia. PMID:25110487
Acute Hydrocephalus as a Complication of Cervical Spine Fracture and Dislocation: A Case Report
Chung, Yoon Young; Ju, Chang Il; Kim, Dong Min
Hydrocephalus is a well-known complication of head injury, but an uncommon complication of a spinal lesion. Here, we present a rare case of acute obstructive hydrocephalus secondary to a cervical fracture and dislocation. A 60-year-old female patient was transferred to the emergency department with quadriplegia and respiratory difficulty. Imaging studies showed a cervical fracture and dislocation at the C3-4 level. She required intubation and mechanical ventilation. Twenty-four hours after admission, her mental status had deteriorated and both pupils were dilated. Computed tomography of the brain showed acute hydrocephalus; therefore, extraventricular drainage (EVD) was performed. After the EVD, her mental status recovered and she became alert, but she remained quadriplegic and dependent on the ventilator. Two months after injury, she died because of respiratory failure caused by pneumonia. PMID:25110487
Solitary xanthogranuloma of the upper cervical spine in a male adult.
Lee, Sun Joo; Jo, Dae Jean; Lee, Seung Hwan; Kim, Sung Min
We present the rare case of solitary xanthogranuloma in the upper cervical column mimicking a Brown-Sequard syndrome. A 29-year-old man complained with right hemiparesis and left hypoesthesia after a car accident. Computed tomography and magnetic resonance images revealed a lobulated homogenously well-enhancing mass in between posterior arch of the atlas (C1) and spinous process of the axis (C2) resulting in a marked spinal canal narrowing with cortical erosions. The patient was managed by complete resection of the tumor with partial laminectomy with lower half of C1 posterior arch and upper half of C2 spinous process. The authors advise complete removal of the xanthogranuloma and consideration as a differential diagnosis of lesions among upper cervical lesions. PMID:22396846
Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders
Macnab, A; Smith, T; Gagnon, F; Macnab, M
Purpose: To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders. Methods: During one ski season (1998–99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified. On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event. Physicians documented the site and severity of injury, investigations, and disposition of each patient. Concurrently, counts were made at the entry to the ski area of the number of skiers and snowboarders wearing helmets. Results: Seventy children were evaluated at the clinic following ski/snowboard related head, neck, and face injuries. Fourteen did not require investigation or treatment. Of the remaining 56, 17 (30%) were wearing helmets and 39 (70%) were not. No serious neck injury occurred in either group. Using helmet-use data from the hill, among those under 13 years of age, failure to wear a helmet increased the risk of head, neck, or face injury (relative risk (RR) 2.24, 95% confidence interval (CI) 1.23 to 4.12). When corrected for activity, RR was 1.77 and 95% CI 0.98 to 3.19. There was no significant difference in the odds ratio for collisions. The two groups may have been different in terms of various relevant characteristics not evaluated. No separate analysis of catastrophic injuries was possible. Conclusion: This study suggests that, in skiers and snowboarders under 13 years of age, helmet use does not increase the incidence of cervical spine injury and does reduce the incidence of head injury requiring investigation and/or treatment. PMID:12460972
Fluoroscopic cervical epidural injections in chronic axial or disc-related neck pain without disc herniation, facet joint pain, or radiculitis
Manchikanti, Laxmaiah; Cash, Kimberly A; Pampati, Vidyasagar; Malla, Yogesh
Background While chronic neck pain is a common problem in the adult population, with a typical 12-month prevalence of 30%–50%, there is a lack of consensus regarding its causes and treatment. Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain. Methods A randomized, double-blind, active, controlled trial was conducted to evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of chronic neck pain with or without upper extremity pain in patients without disc herniation, radiculitis, or facet joint pain. Results One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of two treatment groups, ie, injection of local anesthetic only (group 1) or local anesthetic mixed with nonparticulate betamethasone (group 2). The primary outcome of significant pain relief and improvement in functional status (?50%) was demonstrated in 72% of group 1 and 68% of group 2. The overall average number of procedures per year was 3.6 in both groups with an average total relief per year of 37–39 weeks in the successful group over a period of 52 weeks. Conclusion Cervical interlaminar epidural injections of local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic or axial pain. PMID:22826642
Solitary Cervical Neurenteric Cyst in an Adolescent Patient
Choi, Doo Yong; Lee, Ho Jin; Shin, Myung Hoon
Spinal neurenteric cysts are uncommon congenital lesions, furthermore solitary neurenteric cysts of the upper cervical spine are very rare. A 15-year-old boy having an intraspinal neurenteric cyst located at cervical spine presented with symptoms of neck pain and both shoulders pain for 2 months. Cervical spine magnetic resonance (MR) imaging demonstrated an intradural extramedullary cystic mass at the C1-3 level without enhancement after gadolinium injection. There was no associated malformation on the MR imaging, computed tomography, and radiography. Hemilaminectomy at the C1-3 levels was performed and the lesion was completely removed through a posterior approach. Histological examination showed the cystic wall lined with ciliated pseudostratified columnar epithelium containing mucinous contents. Neurenteric cyst should be considered in the diagnosis of spinal solitary cystic mass. PMID:25733997
Late migration of threaded wire (schanz screw) from right distal clavicle to the cervical spine.
Tsai, Chun-Hao; Hsu, Horng-Chaung; Huan, Chun-Yin; Chen, Hsien-Te; Fong, Yi-Chin
We report a 49-year-old man who had undergone osteosynthesis to treat right distal clavicular fracture with a threaded wire (Schanz screw). The wire could not be removed due to its firm fixation within the bone. Eight years later, migration of the broken wire to the right 7th cervical vertebra punctured the lamina, with no spinal cord injury noted. The threaded wire was extracted from the C7 lamina emergently. No complication occurred after pin removal or during the 1-year postoperative follow-up. PMID:19181599
Corrective surgery for deformity of the upper cervical spine due to ankylosing spondylitis
Lin, Bin; Zhang, Bi; Li, Zhu-mei; Li, Qiu-sheng
Rotational and flexion deformity of C1-C2 due to ankylosing spondylitis is rare. We did surgical correction in one such case by lateral release, resection of the posterior arch of C1 and mobilization of the vertebral arteries, wedge osteotomy of the lateral masses of C1 and internal fixation under general anesthesia. There were no vascular and neurological complications during the surgery. After operation the atlantoaxial rotational deformity was corrected and the normal cervical lordosis was restored. At 1 year followup his visual field and feeding became normal and internal fixation was stable. PMID:24741145
The effects of cervical joint manipulation, based on passive motion analysis, on cervical lordosis, forward head posture, and cervical ROM in university students with abnormal posture of the cervical spine
Gong, Wontae
[Purpose] The aim of this study was to determine the effect of cervical posture manipulation, based on passive motion analysis (MBPMA) and general mobilization, on cervical lordosis, forward head posture (FHP), and cervical ROM in university students with problems in cervical posture and range of motion (ROM). [Subjects] The Subjects were 40 university students in their 20s who displayed problems in cervical posture and ROM; they were divided into an MBPMA group (n=20) and a mobilization group (n=20). [Methods] Each group underwent MBPMA or mobilization three times a week for four weeks. The effects of MBPMA and mobilization on cervical lordosis, FHP, and cervical ROM were analyzed by radiography. [Results] MBPMA was effective in increasing the cervical lordosis, cervical extension ROM (CER), and ranges of flexion and extension motion (RFEM) and in decreasing FHP. Mobilization was effective in increasing CER and decreasing FHP. [Conclusion] MBPMA can be utilized as an effective method for decreasing FHP and improving cervical lordosis and cervical ROM.
Magnetic resonance imaging of the cervical spine: technical and clinical observations
Modic, M.T.; Weinstein, M.A.; Pavlicek, W.; Boumphrey, F.; Starnes, D.; Duchesneau, P.M.
Seventy-two patients were examined to determine the clinical potential for magnetic resonance imaging (MRI) of the spine. MRI using different pulse sequences was compared with plain radiography, high-resolution computed tomography, and myelography. There were 35 normal patients; pathologic conditions studied included canal stenosis, herniated disk, metastatic tumor, neurofibroma, trauma, Chiari malformation, syringomyelia, arteriovenous malformation, and rheumatoid arthritis. MRI provided sharply defined anatomic delineation and tissue characterization. It was diagnostic in syringomyelia and Chiari malformation and was useful in the evaluation of trauma and spinal canal block from any cause. MRI was sensitive to degenerative disk disease and infection. The spin-echo technique, with three pulse sequence variations, seems very promising. A short echo time (TE) produces the best signal-to-noise ratio and spatial resolution. Lengthening the TE enhances differentiation of various tissues by their signal intensity, whil the combined increase of TE and recovery time (TR) produces selective enhancement of the cerebrospinal fluid signal intensity.
Assessment of nerve involvement in the lumbar spine: agreement between magnetic resonance imaging, physical examination and pain drawing findings
Background Detection of nerve involvement originating in the spine is a primary concern in the assessment of spine symptoms. Magnetic resonance imaging (MRI) has become the diagnostic method of choice for this detection. However, the agreement between MRI and other diagnostic methods for detecting nerve involvement has not been fully evaluated. The aim of this diagnostic study was to evaluate the agreement between nerve involvement visible in MRI and findings of nerve involvement detected in a structured physical examination and a simplified pain drawing. Methods Sixty-one consecutive patients referred for MRI of the lumbar spine were - without knowledge of MRI findings - assessed for nerve involvement with a simplified pain drawing and a structured physical examination. Agreement between findings was calculated as overall agreement, the p value for McNemar's exact test, specificity, sensitivity, and positive and negative predictive values. Results MRI-visible nerve involvement was significantly less common than, and showed weak agreement with, physical examination and pain drawing findings of nerve involvement in corresponding body segments. In spine segment L4-5, where most findings of nerve involvement were detected, the mean sensitivity of MRI-visible nerve involvement to a positive neurological test in the physical examination ranged from 16-37%. The mean specificity of MRI-visible nerve involvement in the same segment ranged from 61-77%. Positive and negative predictive values of MRI-visible nerve involvement in segment L4-5 ranged from 22-78% and 28-56% respectively. Conclusion In patients with long-standing nerve root symptoms referred for lumbar MRI, MRI-visible nerve involvement significantly underestimates the presence of nerve involvement detected by a physical examination and a pain drawing. A structured physical examination and a simplified pain drawing may reveal that many patients with "MRI-invisible" lumbar symptoms need treatment aimed at nerve involvement. Factors other than present MRI-visible nerve involvement may be responsible for findings of nerve involvement in the physical examination and the pain drawing. PMID:20831785
Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the american society of regional anesthesia and pain medicine, the European society of regional anaesthesia and pain therapy, the american academy of pain medicine, the international neuromodulation society, the north american neuromodulation society, and the world institute of pain.
Narouze, Samer; Benzon, Honorio T; Provenzano, David A; Buvanendran, Asokumar; De Andres, José; Deer, Timothy R; Rauck, Richard; Huntoon, Marc A
Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures.In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine.The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations. PMID:25899949
Feasibility of Translaminar Screw Placement in Korean Population: Morphometric Analysis of Cervical Spine
Ji, Gyu Yeul; Oh, Chang Hyun; Park, Sang Hyuk; Kurniawan, Ferry; Lee, Junho; Jeon, Jae Kyun; Kim, Keung Nyun
Purpose To analyze the feasibility of unilateral and bilateral translaminar screw placement in Koran population, and compare the acceptance rate using previously reported data in American population. Materials and Methods The translaminar lengths, thickness, heights, and sagittal-diagonal measurements were performed. The feasibility analysis was performed using unilateral and bilateral 3.5 mm cervical screw placement on the CT scans within 0.5 mm of safety margin. We also performed radiographic analysis of the morphometric dimensions and the feasibility of unilateral and bilateral translaminar screw placement at C3-C7. Results Korean population had similar or significantly shorter translaminar lengths and thickness (lengths and thickness in C7 among males; lengths in C6-C7 and thickness in C4 among females) than American population, but had similar or significantly longer translaminar heights and sagittal-diagonal measurements (heights in C3-C7 and sagittal-diagonal measurements in C3-C6 among males; heights in C7 and sagittal-diagonal measurements in C3-C7 among females). Unilaterally, translaminar screw acceptance rates in C3-C7 were similar between Korean and American male population, but the rates in C4-C6 were significantly smaller between Korean and American female population. Bilaterally, translaminar screw acceptance rates in C3 and C5-C6 were significantly larger between Korean and American male population, but the rates in C3-C7 were similar between Korean and American female population. Conclusion The feasibility of unilateral and bilateral translaminar screw placement is different depending on different ethnics. Subaxial cervical unilateral translaminar screw placement among Korean male population and bilateral placement at C4-C7 among Korean female population are more acceptable than American population. PMID:25510760
Trend of Pharmacopuncture Therapy for Treating Cervical Disease in Korea
Kim, Seok-Hee; Jung, Da-Jung; Choi, Yoo-Min; Kim, Jong-Uk; Yook, Tae-Han
Objectives: The purpose of this study is to analyze trends in domestic studies on pharmacopuncture therapy for treating cervical disease. Methods: This study was carried out on original copies and abstracts of theses listed in databases or published until July 2014. The search was made on the Oriental medicine Advanced Searching Integrated System (OASIS) the National Digital Science Library (NDSL), and the Korean traditional knowledge portal. Search words were 'pain on cervical spine', 'cervical pain', 'ruptured cervical disk', 'cervical disc disorder', 'stiffness of the neck', 'cervical disk', 'whiplash injury', 'cervicalgia', 'posterior cervical pain', 'neck disability', 'Herniated Nucleus Pulposus (HNP)', and 'Herniated Intervertebral Disc (HIVD)'. Results: Twenty-five clinical theses related to pharmacopuncture were selected and were analyzed by year according to the type of pharmacopuncture used, the academic journal in which the publication appeared, and the effect of pharmacopuncture therapy. Conclusion: The significant conclusions are as follows: (1) Pharmacopunctures used for cervical pain were Bee venom pharmacopuncture, Carthami-flos pharmacopuncture, Scolopendra pharmacopuncture, Ouhyul pharmacopuncturen, Hwangryun pharmacopuncture, Corpus pharmacopuncture, Soyeom pharmacopuncture, Hwangryunhaedoktang pharmacopuncture, Shinbaro phamacopuncture. (2) Randomized controlled trials showed that pharmacopuncture therapy combined with other methods was more effective. (3) In the past, studies oriented toward Bee venom pharmacopuncture were actively pursued, but the number of studies on various other types of pharmacopuncture gradually began to increase. (4) For treating a patient with cervical pain, the type of pharmacopuncture to be used should be selected based on the cause of the disease and the patient's condition. PMID:25780714
Botulinum Toxin Type A Injections for Cervical and Shoulder Girdle Myofascial Pain Using an Enriched Protocol Design
Nicol, Andrea L.; Wu, Irene I.; Ferrante, F. Michael
Background Myofascial pain syndrome is a regional condition of muscle pain and stiffness and is classically characterized by the presence of trigger points in affected musculature. Botulinum toxin type A (BoNT-A) has been shown to have antinociceptive properties and elicit sustained muscle relaxation, thereby possibly affording even greater relief than traditional strategies. Our goal in this study was to determine whether direct injection of BoNT-A into painful muscle groups is effective for cervical and shoulder girdle myofascial pain. Methods An enriched protocol design was used wherein 114 patients with cervical and shoulder girdle myofascial pain underwent injection of BoNT-A to determine their response to the drug. Fifty-four responders were then enrolled in a twelve-week, randomized, double-blind, placebo-controlled trial. Pain scales and quality of life measures were assessed at baseline and at routine follow-up visits until completion of the study after 26 weeks. Results Injection of BoNT-A into painful muscle groups improved average visual numerical pain scores in subjects who received a second dose of BoNT-A compared to placebo (p = 0.019 (0.26, 2.78)). Subjects who received a second dose of BoNT-A had a reduced number of headaches per week (p = 0.04 (0.07, 4.55)). Brief Pain Inventory interference scores for general activity and sleep were improved (p = 0.046 (0.038, 3.7) and 0.02 (0.37, 4.33), respectively) in those who received a second dose of BoNT-A. Conclusion Botulinum toxin type A injected directly into painful muscle groups improves average pain scores and certain aspects of quality of life in patients suffering from severe cervical and shoulder girdle myofascial pain. PMID:24842179
Pain intensity and cervical range of motion in women with myofascial pain treated with acupuncture and electroacupuncture: a double-blinded, randomized clinical trial
Aranha, Maria F. M.; Müller, Cristina E. E.; Gaviăo, Maria B. D.
BACKGROUND: Acupuncture stimulates points on the body, influencing the perception of myofascial pain or altering physiologic functions. OBJECTIVE: The aim was to evaluate the effect of electroacupuncture (EAC) and acupuncture (AC) for myofascial pain of the upper trapezius and cervical range of motion, using SHAM acupuncture as control. METHOD: Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were randomized into EAC, AC, and SHAM groups. Eight sessions were scheduled and a follow-up was conducted after 28 days. The Visual Analog Scale assessed the intensity of local and general pain. A fleximeter assessed cervical movements. Data were analyzed using paired t or Wilcoxon's tests, ANOVA or Friedman or Kruskal-Wallis tests and Pearson's correlation (?=0.05). RESULTS: There was reduction in general pain in the EAC and AC groups after eight sessions (P<0.001). A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups. Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group (P<0.05), which showed an increase in left rotation (P=0.049). The AC group showed increases in inclination (P=0.005) sustained until follow-up and rotation to the right (P=0.032). CONCLUSION : EAC and AC were effective in reducing the pain intensity compared with SHAM. EAC was better than AC for local pain relief. These treatments can assist in increasing cervical range of motion, albeit subtly. PMID:25714602
Risk factors in cervical spondylosis
Singh, Sudhir; Kumar, Dharmendra; Kumar, Sanjeev
Background Cervical spondylosis is essentially a degenerative disorder common after fourth decade. It has been seen that radiological evidence of cervical spondylosis do not necessarily co-relate with clinical findings. This discrepancy has been attributed to the morphometric dimensions of the vertebrae, age, sex, race, occupation, weight and height of the patients. Objective The objective of this study is to co-relate the variables like age, sex, race, occupation, vertebral body diameter, canal diameter, canal body ratio of cervical spine vertebrae with cervical spondylosis cases with normal population. Methods In this hospital based, case control, consent based, cross-sectional, clinico-radiological study 200 individuals (controls-100, cases-100) who were subjected to lateral projection radiographs of cervical spine. Their age, sex, race, occupation, height, weight and mid-sagittal canal diameter (CD), sagittal vertebral body diameter (VBD) and the canal-body ratio (CBR) of the cervical vertebrae was recorded and analyzed statistically. Results There was no relation between vertebral dimensions and clinical groups. In radiculopathy group, age and height showed significance on univariate analysis. While only age remained significant on multivariate analysis. In neck pain group age, sex, and height showed significance on univariate analysis while in multivariate analysis age, sex and occupation were significant risk factors. PMID:25983502
SU-E-I-51: Use of Blade Sequences in Cervical Spine MR Imaging for Eliminating Motion, Truncation and Flow Artifacts
Mavroidis, P [University of Texas Health Science Center, UTHSCSA, San Antonio, TX (United States); Lavdas, E; Kostopoulos, S; Ninos, C; Strikou, A; Glotsos, D; Vlachopoulou, A; Oikonomou, G [Technological Education Institute of Athens, Athens, Athens (Greece); Economopoulos, N [General University Hospital ATTIKON, Athens, Athens (Greece); Roka, V [Health Center of Farkadona, Trikala (Greece); Sakkas, G [Center for Research and Technology of Thessaly, Trikala (Greece); Tsagkalis, A; Batsikas, G [IASO Thessalias Hospital, Larissa (Greece); Statkahis, S [Cancer Therapy and Research Center, San Antonio, TX (United States); Papanikolaou, N [University of Texas HSC SA, San Antonio, TX (United States)
Purpose: To assess the efficacy of the BLADE technique to eliminate motion, truncation, flow and other artifacts in Cervical Spine MRI compared to the conventional technique. To study the ability of the examined sequences to reduce the indetention and wrap artifacts, which have been reported in BLADE sagittal sequences. Methods: Forty consecutive subjects, who had been routinely scanned for cervical spine examination using four different image acquisition techniques, were analyzed. More specifically, the following pairs of sequences were compared: a) T2 TSE SAG vs. T2 TSE SAG BLADE and b) T2 TIRM SAG vs. T2 TIRM SAG BLADE. A quantitative analysis was performed using the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and relative contrast (ReCon) measures. A qualitative analysis was also performed by two radiologists, who graded seven image characteristics on a 5-point scale (0:non-visualization; 1:poor; 2:average; 3:good; 4:excellent). The observers also evaluated the presence of image artifacts (motion, truncation, flow, indentation). Results: Based on the findings of the quantitative analysis, the ReCON values of the CSF (cerebrospinal fluid)/SC (spinal cord) between TIRM SAG and TIRM SAG BLADE were found to present statistical significant differences (p<0.001). Regarding motion and truncation artifacts, the T2 TSE SAG BLADE was superior compared to the T2 TSE SAG and the T2 TIRM SAG BLADE was superior compared to the T2 TIRM SAG. Regarding flow artifacts, T2 TIRM SAG BLADE eliminated more artifacts compared to the T2 TIRM SAG. Conclusion: The use of BLADE sequences in cervical spine MR examinations appears to be capable of potentially eliminating motion, pulsatile flow and trancation artifacts. Furthermore, BLADE sequences are proposed to be used in the standard examination protocols based on the fact that a significantly improved image quality could be achieved.
Cine phase-contrast MRI measurement of CSF flow in the cervical spine: a pilot study in patients with spinal cord injury
NASA Astrophysics Data System (ADS)
Negahdar, MJ; Shakeri, M.; McDowell, E.; Wells, J.; Vitaz, T.; Harkema, S.; Amini, A.
MRI velocimetry (also known as phase-contrast MRI) is a powerful tool for quantification of cerebrospinal fluid (CSF) flow in various regions of the brain and craniospinal junction and has been accepted as a diagnostic tool to assist with the diagnosis of certain conditions such as hydrocephalus and chiari malformations. Cerebrospinal fluid is continually produced in the ventricles of the brain, flows through the ventricular system and then out and around the brain and spinal cord and is reabsorbed over the convexity of the brain. Any disease process which either impedes the normal pattern of flow or restricts the area where flow occurs can change the pattern of these waveforms with the direction and velocity of flow being determined by the pressure transmitted from the pulsation of the heart and circulation of blood within the central nervous system. Therefore, we hypothesized that phase-contrast MRI could eventually be used as a diagnostic aid in determining the degree of spinal cord compression following injury to the cervical or thoracic spine. In this study, we examined CSF flow in 3 normal subjects and 2 subjects with non-acute injuries in the cervical spine using Cine phasecontrast MRI. CSF flow analysis was performed using an in-house developed software. The flow waveform was calculated in both normal subjects (n=3) as well as subjects with spinal cord injury in the cervical spine (n=2). The bulk flow at C2 was measured to be 0.30 +/- 0.05 cc, at 5 cm distal to C2, it was 0.19+/- 0.07 cc, and at 10 cm distal to C2, it was 0.17+/- 0.05 cc. These results were in good agreement with previously published results. In patients with spinal cord injury, at the site of injury in the cervical spine, bulk flow was found to be 0.08 +/- 0.12 cc, at 5 cm proximal to the site of injury it was found to be 0.18 +/- 0.07 cc, and at 5 cm distal to the site of injury, it was found to be 0.12 +/- 0.01 cc.
Biomechanical stability of a bioabsorbable self-retaining polylactic acid/nano-sized ?-tricalcium phosphate cervical spine interbody fusion device in single-level anterior cervical discectomy and fusion sheep models
Cao, Lu; Duan, Ping-Guo; Li, Xi-Lei; Yuan, Feng-Lai; Zhao, Ming-Dong; Che, Wu; Wang, Hui-Ren; Dong, Jian
Purpose The aim of this study was to investigate the biomechanical stability provided by a novel, polylactic acid/nano-sized, ?-tricalcium phosphate, bioabsorbable, self-retaining cervical fusion cage (BCFC). Methods Quasistatic nonconstraining torques (maximum 1.5 NM) induced flexion, extension, lateral bending (±1.5 NM), and axial rotation (±1.5 NM) on 32 sheep cervical spines (C2–C5). The motion segment C3–C4 was first tested intact; the following groups were tested after complete discectomy: autologous tricortical iliac crest bone graft, Medtronic–Wego polyetheretherketone (PEEK) cage, Solis PEEK cage, and BCFC. The autologous bone graft group was tested with an anterior plate. The mean range of motion (ROM) was calculated from the load-displacement curves. Results BCFC significantly decreased ROM in lateral bending and axial rotation compared to other implants, and no significant difference in ROM between two types of PEEK cages and BCFC could be observed in flexion and extension. Anterior cervical plate (ACP) significantly decreased ROM in flexion and extension, but no significant difference in ROM between BCFC and bone graft plus ACP could be determined in lateral bending and axial rotation. Conclusion The BCFC device showed better stability to autologous tricortical iliac crest bone graft and PEEK cages in single-level anterior cervical discectomy and fusion models and thus may be a potential alternative to the current PEEK cages. PMID:23226018
Surgical treatment of cervical unilateral locked facet in a 9-year-old boy: A case report
Cobanoglu, Mutlu; Enercan, Meric; Yilar, Sinan; Hamzaoglu, Azmi
Most of the cervical spine injuries in the pediatric population are typically seen in the upper cervical region. Unilateral cervical facet dislocation (UFD) in subaxial region is a rare injury in pediatric population. In this paper, a rare case of delayed locked UFD in a 9-year-old boy with rare injury mechanism treated surgically is reported. Clinical and radiological findings were described. The patient with C6-7 UFD without neurologic deficit was underwent open reduction and internal fixation via anterior and posterior combined approaches. Significant improvement of pain and free motion in cervical spine was obtained. There was no complication during the follow up. Only three case reports presented about the lower cervical spine injury with UFD under the age of 10 were found in the literature. PMID:25788821
Neck Strength, Position Sense, and Motion in Military Helicopter Crew With and Without Neck Pain
Oord van den M. H. A. H; Loose de V; J. K. Sluiter; M. H. W. Frings-Dresen
Introduction: Neck pain in military helicopter pilots and rear aircrew is an occupational health problem that may interfere with flying performance. The aim of the present study was to investigate possible differences in the physical abilities of the cervical spines of helicopter pilots and rear aircrew with and without neck pain during the previous year. Methods: The study included 61
The Cervical Spine of the American Barn Owl (Tyto furcata pratincola): I. Anatomy of the Vertebrae and Regionalization in Their S-Shaped Arrangement
Krings, Markus; Nyakatura, John A.; Fischer, Martin S.; Wagner, Hermann
Background Owls possess an extraordinary neck and head mobility. To understand this mobility it is necessary to have an anatomical description of cervical vertebrae with an emphasis on those criteria that are relevant for head positioning. No functional description specific to owls is available. Methodology/Principal findings X-ray films and micro-CT scans were recorded from American barn owls (Tyto furcata pratincola) and used to obtain three-dimensional head movements and three-dimensional models of the 14 cervical vertebrae (C1?C14). The diameter of the vertebral canal, the zygapophyseal protrusion, the distance between joint centers, and the pitching angle were quantified. Whereas the first two variables are purely osteological characteristics of single vertebrae, the latter two take into account interactions between vertebrae. These variables change in characteristic ways from cranial to caudal. The vertebral canal is wide in the cranial and caudal neck regions, but narrow in the middle, where both the zygapophyseal protrusion and the distance between joint centers are large. Pitching angles are more negative in the cranial and caudal neck regions than in the middle region. Cluster analysis suggested a complex regionalization. Whereas the borders (C1 and C13/C14) formed stable clusters, the other cervical vertebrae were sorted into 4 or 5 additional clusters. The borders of the clusters were influenced by the variables analyzed. Conclusions/Significance A statistical analysis was used to evaluate the regionalization of the cervical spine in the barn owl. While earlier measurements have shown that there appear to be three regions of flexibility of the neck, our indicators suggest 3–7 regions. These many regions allow a high degree of flexibility, potentially facilitating the large head turns that barn owls are able to make. The cervical vertebral series of other species should also be investigated using statistical criteria to further characterize morphology and the potential movements associated with it. PMID:24651767
Spinal cord infarction with cervical angina.
Nakae, Yoshiharu; Johkura, Ken; Kudo, Yosuke; Kuroiwa, Yoshiyuki
Cervical angina is defined as chest pain resembling true cardiac angina but originating from disorders of the cervical spine. Cervical angina is caused by cervical spondylosis in most cases. A 66-year-old man presented with bilateral arm palsy after chest pain resembling angina pectoris. Neurological examination revealed motor and sensory disturbances of the C7 to T1 level, and magnetic resonance imaging showed a hyperintense spinal cord lesion on T2-weighted imaging. Spinal cord infarction was diagnosed. Severe sinus bradycardia was identified on admission, and improved over the course of 5 weeks. Sympathetic afferent fibers from the heart and coronary arteries generally have their cell bodies in the dorsal root ganglia of the C8 to T9 spinal segments. Electrical stimulation of cardiopulmonary afferent fibers excites spinothalamic tract cells in the T1 to T6 segments of the spinal cord. Spinal cord injury can result in the loss of supraspinal control of the sympathetic system and can cause bradycardia, as commonly seen in patients with severe lesions of the cervical or high-thoracic (T6 or above) spinal cord. Bradycardia in the present case suggested impairment of the sympathetic system at the cervical and thoracic levels. These findings indicated that cervical angina in this case was mediated through the sympathetic nervous system. This represents only the second report of cervical angina caused by spinal cord infarction. PMID:23199591
Validation protocol for assessing the upper cervical spine kinematics and helical axis: An in vivo preliminary analysis for axial rotation, modeling, and motion representation
Dugailly, Pierre-Michel; Sobczak, Stéphane; Lubansu, Alphonse; Rooze, Marcel; Jan, SergeVan Sint; Feipel, Véronique
Context: The function of the upper cervical spine (UCS) is essential in the kinematics of the whole cervical spine. Specific motion patterns are described at the UCS during head motions to compensate coupled motions occurring at the lower cervical segments. Aims: First, two methods for computing in vitro UCS discrete motions were compared to assess three-dimensional (3D) kinematics. Secondly, the same protocol was applied to assess the feasibility of the procedure for in vivo settings. Also, this study attempts to expose the use of anatomical modeling for motion representation including helical axis. Settings and Design: UCS motions were assessed to verify the validity of in vitro 3D kinematics and to present an in vivo procedure for evaluating axial rotation. Materials and Methods: In vitro kinematics was sampled using a digitizing technique and computed tomography (CT) for assessing 3D motions during flexion extension and axial rotation. To evaluate the feasibility of this protocol in vivo, one asymptomatic volunteer performed an MRI kinematics evaluation of the UCS for axial rotation. Data processing allowed integrating data into UCS 3D models for motion representation, discrete joint behavior, and motion helical axis determination. Results: Good agreement was observed between the methods with angular displacement differences ranging from 1° to 1.5°. Helical axis data were comparable between both methods with axis orientation differences ranging from 3° to 6°. In vivo assessment of axial rotation showed coherent kinematics data compared to previous studies. Helical axis data were found to be similar between in vitro and in vivo evaluation. Conclusions: The present protocol confirms agreement of methods and exposes its feasibility to investigate in vivo UCS kinematics. Moreover, combining motion analysis, helical axis representation, and anatomical modeling, constitutes an innovative development to provide new insights for understanding motion behaviors of the UCS. PMID:24381450
Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain
J Cholewicki; SM McGill
One important mechanical function of the lumbar spine is to support the upper body by transmitting compressive and shearing forces to the lower body during the performance of everyday activities. To enable the successful transmission of these forces, mechanical stability of the spinal system must be assured. The purpose of this study was to develop a method and to quantify
Radhesh Krishna Lalam; Victor N. Cassar-Pullicino; Prudencia N. M. Tyrrell
Paediatric spinal trauma is an uncommon form of injury. Spinal injuries in children and adolescents account for 1%–9% of total\\u000a reported spinal injuries. Spinal fractures represent 1%–2% of all paediatric fractures and the cervical spine is the commonest\\u000a region involved accounting for 60%–80% of paediatric spinal injuries (Kokoska et al. 2001). This in turn means that the average general radiologist
Development of the young spine questionnaire
Background Back pain in children is common and early onset of back pain has been shown to increase the risk of back pain significantly in adulthood. Consequently, preventive efforts must be targeted the young population but research relating to spinal problems in this age group is scarce. Focus has primarily been on the working age population, and therefore specific questionnaires to measure spinal pain and its consequences, specifically aimed at children and adolescents are absent. The purpose of this study was to develop a questionnaire for schoolchildren filling this gap. Methods The Young Spine Questionnaire (YSQ) was developed in three phases – a conceptualisation, development and testing phase. The conceptualisation phase followed the Wilson and Cleary model and included questions regarding spinal prevalence estimates, pain frequency and intensity, activity restrictions, care seeking behaviour and influence of parental back trouble. Items from existing questionnaires and the "Revised Faces Pain Scale" (rFPS) were included during the development phase. The testing phase consisted of a mixed quantitative and qualitative iterative method carried out in two pilot tests using 4th grade children and focusing on assessment of spinal area location and item validity. Results The testing phase resulted in omission of the pain drawings and the questions and answer categories were simplified in several questions. Agreement between the questionnaire prevalence estimates and the interviews ranged between 83.7% (cervical pain today) and 97.9% (thoracic pain today). To improve the understanding of the spinal boundaries we added bony landmarks to the spinal drawings after pilot test I. This resulted in an improved sense of spinal boundary location in pilot test II. Correlations between the rFPS and the interview pain score ranged between 0.67 (cervical spine) and 0.79 (lumbar spine). Conclusions The Young Spine Questionnaire contains questions that assess spinal pain and its consequences. The items have been tested for content understanding and agreement between questionnaire scores and interview findings among target respondents. These preliminary results suggest that the YSQ is feasible, has content validity and is a well understood questionnaire to be used in studies of children aged 9 to 11 years. PMID:23758965
Rigid Spine Syndrome and Rigid Spine Sign in Myopathies
Luciano Merlini; Claudia Granata; Alessandro Ballestrazzi; Maria Letizia Marini
We studied eight patients with rigid spine syndrome aged 8 to 20 years at the time of first examination. Muscle weakness, rigid spine, and flexion contracture of elbows and ankles were noted in the first 6 years of age. Radiological study of the cervical spine revealed considerable reduction not only of flexion, but also of extension, of the neck. The
A Broken Drill-bit Fragment Causing Severe Radiating Pain after Cervical Total Disc Replacement: A Case Report.
Lee, Chong-Suh; Chung, Sung-Soo; Park, Jae-Chul; Shin, Seong-Kee; Park, Yong-Serk; Kang, Kyung-Chung
This is a case report of a 38-year-old man with severe radiating pain on upper extremity after cervical total disc replacement (TDR). We faced an unusual complication that has not been reported yet. He underwent cervical TDR for left central disc protrusion on C5-6. After the surgery, preoperative symptom disappeared. However, at postoperative 1 year, he complained severe right-sided radiating pain that had a sudden onset. On postoperative X-ray, a metal fragment which seemed like a broken drill bit was shown within the spinal canal. To remove that, right-sided anterior microforaminotomy on C5-6 was performed and the metal fragment was removed successfully. After that, anterior fusion was done because the motion of the artificial disc was minimal and the removed structure seemed to attenuate stability during cervical motion. The operation resulted in prompt symptomatic relief. During cervical TDR, particular attention should be paid to the procedures that require using drill-bits. PMID:21629488
Kras, Jeffrey V.; Dong, Ling; Winkelstein, Beth A.
Study Design This study implemented immunohistochemistry to assay prostaglandin E2 (PGE2) receptor EP2 expression in the dorsal root ganglion (DRG) of rats after painful cervical facet joint injury. Objective The objective of this study was to identify if inflammatory cascades are induced in association with cervical facet joint distraction-induced pain by investigating the time course of EP2 expression in the DRG. Summary of Background Data The cervical facet joint is a common source of neck pain and non-physiological stretch of the facet capsular ligament can initiate pain from the facet joint via mechanical injury. PGE2 levels are elevated in painful inflamed and arthritic joints, and PGE2 sensitizes joint afferents to mechanical stimulation. Although in vitro studies suggest the EP2 receptor subtype contributes to painful joint disease the EP2 response has not been investigated for any association with painful mechanical joint injury. Methods Separate groups of male Holtzman rats underwent either a painful cervical facet joint distraction injury or sham procedure. Bilateral forepaw mechanical allodynia was assessed, and immunohistochemical techniques were used to quantify EP2 expression in the DRG at days 1 and 7. Results Facet joint distraction induced mechanical allodynia that was significant (p<0.024) at all time points. Painful joint injury also significantly elevated total EP2 expression in the DRG at day 1 (p=0.009), which was maintained also at day 7 (p<0.001). Neuronal expression of EP2 in the DRG was only increased over sham levels at day 1 (p=0.013). Conclusions Painful cervical facet joint distraction induces an immediate and sustained increase of EP2 expression in the DRG, implicating peripheral inflammation in the initiation and maintenance of facet joint pain. The transient increase in neuronal EP2 suggests, as in other painful joint conditions, that after joint injury non-neuronal cells may migrate to the DRG, some of which likely express EP2. PMID:22789984
Leprotic cervical spondylodiscitis.
Kim, Sang Jin; Lee, Tae Hoon; Shin, Jun Jae; Chae, Gue Tae
Leprosy is a chronic infectious disease caused by the Mycobacterium leprae that leads to leprotic neuropathy involving the peripheral nerve and several characteristic skin lesions. Skeletal involvement can occur in peripheral joints, such as the wrist and the ankle. However, there is no report of an axial leprotic lesion involving the spine or paraspinal soft tissue. The authors report the first case of a leprotic cervical lesion involving the axial skeletal system. A 48-year-old male presented with neck pain and severe pain in the right suprascapular area and left arm. Preoperative MRI of the cervical spine revealed signal changes in the prevertebral soft tissue at the level of the C3, 4, 5 vertebral bodies. There were a lower signal intensity on T1-weighted image and high signal intensity on T2WI of the bone marrow at the level of the C5 and C6 vertebral bodies, and a C5/6 segmental ossification of the posterior longitudinal ligament. There were herniated cervical disc on the left C5/6 with C6 root and the right side of C6/7 with a C7 root compression. He was previously diagnosed with leprosy when he was 14 years old and received treatment intermittently over the course of 7 years. But patient did not disclose his past history. Surgical intervention was conducted using an anterior cervical approach. An incision was made in the anterior longitudinal ligament at C5/6, and a pinkish gray friable gelatinous material was observed on the C5/6 disc and on the anterior lower one-third surface of the C5 vertebral body. Specimens were obtained and subjected to pathological evaluation and microbiological culture. After C5/6 and C6/7 discectomies, nerve root decompression and autologous iliac bone grafting were performed at the C5/6 and C6/7 levels. The C5-6-7 vertebrae were fixed with an Atlantis cervical locking plate and a screw system. The pathological report indicated chronic inflammation with heavy plasma cell infiltration on the specimen. We sent the specimens to the Institute of Hansen's Disease, and polymerase chain reaction for leprosy tested positive. After surgery, his pain disappeared and he was given a prescription for antileprotic drugs. The authors describe the first case of leprotic cervical spondylodiscitis that was operatively treated in a 48-year-old patient with known leprosy history since his 14 years old. PMID:20372941
Comparison of spine motion in elite golfers with and without low back pain
D. Lindsay; J. Horton
Low back pain is a common musculoskeletal disorder affecting golfers, yet little is known of the specific mechanisms responsible for this injury. The aim of this study was to compare golf swing spinal motion in three movement planes between six male professional golfers with low back pain (age 29.2 - 6.4 years; height 1.79 - 0.04 m; body mass 78.2
Chiropractic management of a patient with lumbar spine pain due to synovial cyst: a case report
Cox, James M.
Introduction The purpose of this study is to report the findings resulting from chiropractic care using flexion distraction spinal manipulation for a patient with low back and radicular pain due to spinal stenosis caused by a synovial cyst. Case Report A 75-year-old man presented with low back pain radiating to the right anterior thigh and down the left posterior leg of 3 years' duration. Physical and imaging examinations showed a synovial cyst–induced spinal stenosis at the right L3-L4 level and bilateral L4-L5 spinal stenosis. Intervention and Outcomes Flexion distraction spinal manipulation and physiological therapeutics were applied at the levels of stenosis. After 4 visits, the patient noted total absence of the right and left lower extremity pain and no adverse reaction to treatment. After 3 months of treatment and 16 visits, his low back and buttock pain were minimal; and he had no leg pain. Conclusion Lumbar synovial cyst and stenosis–generated low back and radicular pain was 80% relieved in a 75-year-old man following Cox flexion distraction spinal manipulation. PMID:22942836
A simple method to ensure proper screw position and plate size selection using the Morscher cervical spine locking plate. Technical note.
Ball, P A; Benzel, E C; Baldwin, N G
The use of bone plate instrumentation with screw fixation has proved to be a useful adjunctive measure in anterior cervical spine fusion surgery. Proper fitting, positioning, and attachment of this instrumentation have been shown to be frequently suboptimal if done without radiographic guidance. The most commonly used method of radiographic assistance for placement of this instrumentation is fluoroscopy. While this gives satisfactory technical results, it is expensive and time-consuming, and exposes the patient and the operating room personnel to ionizing radiation. The authors present a simple technique to ensure screw placement and plate fitting using Kirschner wires and a single lateral radiograph. This technique saves time, reduces exposure to radiation, and has led to satisfactory results in over 20 operative cases. PMID:8151358
Imaging of Herniated Discs of the Cervical Spine: Inter-Modality Differences between 64-Slice Multidetector CT and 1.5-T MRI
Yi, Ji Sook; Han, Jong Kyu; Kim, Hyun-Joo
Objective To assess inter-modality variability when evaluating cervical intervertebral disc herniation using 64-slice multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Materials and Methods Three musculoskeletal radiologists independently reviewed cervical spine 1.5-T MRI and 64-slice MDCT data on C2-3 though C6-7 of 51 patients in the context of intervertebral disc herniation. Interobserver and inter-modality agreements were expressed as unweighted kappa values. Weighted kappa statistics were used to assess the extents of agreement in terms of the number of involved segments (NIS) in disc herniation and epicenter measurements collected using MDCT and MRI. Results The interobserver agreement rates upon evaluation of disc morphology by the three radiologists were in fair to moderate agreement (k = 0.39-0.53 for MDCT images; k = 0.45-0.56 for MRIs). When the disc morphology was categorized into two and four grades, the inter-modality agreement rates were moderate (k-value, 0.59) and substantial (k-value, 0.66), respectively. The inter-modality agreements for evaluations of the NIS (k-value, 0.78) and the epicenter (k-value, 0.79) were substantial. Also, the interobserver agreements for the NIS (CT; k-value, 0.85 and MRI; k-value, 0.88) and epicenter (CT; k-value, 0.74 and MRI; k-value, 0.70) evaluations by two readers were substantial. MDCT tended to underestimate the extent of herniated disc lesions compared with MRI. Conclusion Multidetector-row computed tomography and MRI showed a moderate-to-substantial degree of inter-modality agreement for the assessment of herniated cervical discs. MDCT images have a tendency to underestimate the anterior/posterior extent of the herniated disc compared with MRI. PMID:26175589
Spinal surgery -- cervical - series (image)
The cervical spinal column is made up of vertebral bodies which protect the spinal cord. ... Cervical spine disease is usually caused by herniated intervertebral discs, abnormal growth of bony processes on the ...
Rehabilitation of chronic whiplash: treatment of cervical dysfunctions or chronic pain syndrome?
Jo Nijs; Jessica Van Oosterwijck; Willem De Hertogh
Chronic whiplash-associated disorders (WAD) remains a challenging condition for clinicians. There is substantial evidence\\u000a for the presence of various cervical dysfunctions (e.g., increased cervical muscle tone and impaired cervical movement control),\\u000a but their contribution to the complex clinical picture of subjects with chronic WAD seems rather limited. There is consistent\\u000a evidence for increased responsiveness of the central nervous system in
Successful management of concommitant blunt injury to the trachea, esophagus, and cervical spine in a 6-year-old girl
Oscar D Guillamondegui; Michael L Nance; J. William Gaynor; John M Flynn; Perry W Stafford; Timothy M Crombleholme
A 6-year-old girl sustained an unusual constellation of injuries after blunt trauma sustained in a motor vehicle accident. Transection of the trachea and esophagus were managed successfully by repair through a median sternotomy while the patient was on cardiopulmonary bypass. A cervical spinal injury was fixated with halo traction and a femur fracture with internal fixation.
Clinical feasibility of cervical exercise to improve neck pain, body function, and psychosocial factors in patients with post-traumatic stress disorder: a randomized controlled trial
Park, Seong Doo; Kim, Suhn Yeop
[Purpose] To investigate the effect of cervical exercise on neck pain, disability, and psychosocial factors in patients with post-traumatic stress disorder. [Subjects] Thirty patients with post-traumatic stress disorder, who also complained of neck pain. [Methods] The cervical exercise group (n = 15) participated in cervical exercises for 30?min, 3 times/week for 6 weeks, and the control group (n = 16) underwent conventional physical therapy alone, without exercise. The exercises were performed in the following order: cervical relaxation, local muscle stabilization, and global muscle stabilization using a sling system. [Results] Compared to the control group, the cervical exercise group demonstrated significant decreases as follows: Visual analogue scale score, 4.2 vs. 1.0; Neck disability index, 3.9 vs. 1.9; and depression on the Symptom checklist-90-revised, 9.4 vs. 4.3 and on the Hopkins symptom checklist-25, 6.3 vs. 2.8. However, anxiety on the Symptom checklist-90-revised (3.1 vs. 1.3) was not significantly different. Effect sizes were as follows: Visual analogue scale score, 1.8; Neck disability index, 0.9; depression, 1.0; and anxiety on Symptom checklist-90-revised and Hopkins symptom checklist-25, 0.6 and 0.8, respectively. [Conclusion] Cervical exercise is effective in improving neck pain, disability, and efficacy of psychological treatment for depression in patients with post-traumatic stress disorder.
Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review
Briggs, Andrew M; Smith, Anne J; Straker, Leon M; Bragge, Peter
Background Thoracic spine pain (TSP) is experienced across the lifespan by healthy individuals and is a common presentation in primary healthcare clinical practice. However, the epidemiological characteristics of TSP are not well documented compared to neck and low back pain. A rigorous evaluation of the prevalence, incidence, correlates and risk factors needs to be undertaken in order for epidemiologic data to be meaningfully used to develop evidence-based prevention and treatment recommendations for TSP. Methods A systematic review method was followed to report the evidence describing prevalence, incidence, associated factors and risk factors for TSP among the general population. Nine electronic databases were systematically searched to identify studies that reported either prevalence, incidence, associated factors (cross-sectional study) or risk factors (prospective study) for TSP in healthy children, adolescents or adults. Studies were evaluated for level of evidence and method quality. Results Of the 1389 studies identified in the literature, 33 met the inclusion criteria for this systematic review. The mean (SD) quality score (out of 15) for the included studies was 10.5 (2.0). TSP prevalence data ranged from 4.0–72.0% (point), 0.5–51.4% (7-day), 1.4–34.8% (1-month), 4.8–7.0% (3-month), 3.5–34.8% (1-year) and 15.6–19.5% (lifetime). TSP prevalence varied according to the operational definition of TSP. Prevalence for any TSP ranged from 0.5–23.0%, 15.8–34.8%, 15.0–27.5% and 12.0–31.2% for 7-day, 1-month, 1-year and lifetime periods, respectively. TSP associated with backpack use varied from 6.0–72.0% and 22.9–51.4% for point and 7-day periods, respectively. TSP interfering with school or leisure ranged from 3.5–9.7% for 1-year prevalence. Generally, studies reported a higher prevalence for TSP in child and adolescent populations, and particularly for females. The 1 month, 6 month, 1 year and 25 year incidences were 0–0.9%, 10.3%, 3.8–35.3% and 9.8% respectively. TSP was significantly associated with: concurrent musculoskeletal pain; growth and physical; lifestyle and social; backpack; postural; psychological; and environmental factors. Risk factors identified for TSP in adolescents included age (being older) and poorer mental health. Conclusion TSP is a common condition in the general population. While there is some evidence for biopsychosocial associations it is limited and further prospectively designed research is required to inform prevention and management strategies. PMID:19563667
The Prevalence of Lumbar Spine Facet Joint Osteoarthritis and Its Association with Low Back Pain in Selected Korean Populations
Vaccaro, Alexander R.; Lee, Sangwook; Lee, Jaekun; Chang, Hojin
Background This study was to evaluate the association of lumbar spine facet joint osteoarthritis (LSFJOA) identified by multi-detector computed tomography (MDCT) with age and low back pain (LBP) in an adult community-based population in Korea. Methods A sample of 472 participants (age range, 20 to 84 years) who underwent MDCT imaging for abdominal or urological lesions, not for chief complaints of LBP, were included in this study. LSFJOA based on MDCT findings was characterized using four grades of osteoarthritis of the facet joints. The prevalence of LSFJOA according to age group (below 40 years, 40-49 years, 50-59 years, 60-69 years, and above 70 years), gender, and spinal level was analyzed using chi-square tests and the association between LBP and LSFJOA adjusting for age, gender, and spine level was analyzed using multiple binary logistic regression test. Results Eighty-three study subjects (17.58%) had LSFJOA (grade ? 2). The prevalence of LSFJOA was not associated with gender (p = 0.092). The prevalence of LSFJOA increased with age (p = 0.015). The highest prevalence of LSFJOA was observed at L4-5 in men (p = 0.001) and at L5-S1 in women (p = 0.003), and at L5-S1 in the overall population (p = 0.000). LSFJOA was not associated with LBP in men (p = 0.093) but was associated with LBP in women (p = 0.003), especially at L3-4 (p = 0.018) and L5-S1 (p = 0.026). Conclusions The prevalence of LSFJOA based on the computed tomography imaging was 17.58% in the adult community Korean population. The prevalence of LSFJOA increased with age, and the highest prevalence was noted at L5-S1. LSFJOA was not associated with LBP at any spinal level and age except at L3-4 and L5-S1 in women. PMID:25436061
Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation.
Li, Jian; Yan, Deng-lu; Zhang, Zai-Heng
Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors' clinic and treated by PCN. The patients' gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 +/- 10.2 years). The levels of involvement were 21 cases at C3-4, 30 cases at C4-5, 40 cases at C5-6, and 35 cases at C6-7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) > or =11 degrees or horizontal displacement (HD) > or =3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no significant difference in stability either preoperatively or postoperatively (P > 0.05). Our findings confirm that PCN for the treatment of cervical disc herniation results in a good outcome without any tampering of the stability of the cervical spine. Hence, PCN as a procedure is safe, minimally invasive, less traumatic, requiring less time with an excellent clinical outcome. PCN should be performed for those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery. PMID:18830638
The Effect of Various Types of Motorcycle Helmets on Cervical Spine Injury in Head Injury Patients: A Multicenter Study in Taiwan
Lin, Mau-Roung; Chu, Shu-Fen; Tsai, Shin-Han; Bai, Chyi-Huey; Chiu, Wen-Ta
Introduction. The relationship between cervical spine injury (CSI) and helmet in head injury (HI) patients following motorcycle crashes is crucial. Controversy still exists; therefore we evaluated the effect of various types of helmets on CSI in HI patients following motorcycle crashes and researched the mechanism of this effect. Patients and Methods. A total of 5225 patients of motorcycle crashes between 2000 and 2009 were extracted from the Head Injury Registry in Taiwan. These patients were divided into case and control groups according to the presence of concomitant CSI. Helmet use and types were separately compared between the two groups and the odds ratio of CSI was obtained by using multiple logistic regression analysis. Results. We observed that 173 (3.3%) of the HI patients were associated with CSI. The HI patients using a helmet (odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.19?0.49), full-coverage helmet (0.19, 0.10?0.36), and partial-coverage helmet (0.35, 0.21?0.56) exhibited a significantly decreased rate of CSI compared with those without a helmet. Conclusion. Wearing full-coverage and partial-coverage helmets significantly reduced the risk of CSI among HI patients following motorcycle crashes. This effect may be due to the smooth surface and hard padding materials of helmet. PMID:25705663
A Biomechanical Comparison of Intralaminar C7 Screw Constructs with and without Offset Connector Used for C6-7 Cervical Spine Immobilization : A Finite Element Study
Qasim, Muhammad; Natarajan, Raghu N.; An, Howard S.
Objective The offset connector can allow medial and lateral variability and facilitate intralaminar screw incorporation into the construct. The aim of this study was to compare the biomechanical characteristics of C7 intralaminar screw constructs with and without offset connector using a three dimensional finite element model of a C6-7 cervical spine segment. Methods Finite element models representing C7 intralaminar screw constructs with and without the offset connector were developed. Range of motion (ROM) and maximum von Mises stresses in the vertebra for the two techniques were compared under pure moments in flexion, extension, lateral bending and axial rotation. Results ROM for intralaminar screw construct with offset connector was less than the construct without the offset connector in the three principal directions. The maximum von Misses stress was observed in the C7 vertebra around the pedicle in both constructs. Maximum von Mises stress in the construct without offset connector was found to be 12-30% higher than the corresponding stresses in the construct with offset connector in the three principal directions. Conclusion This study demonstrated that the intralaminar screw fixation with offset connector is better than the construct without offset connector in terms of biomechanical stability. Construct with the offset connector reduces the ROM of C6-7 segment more significantly compared to the construct without the offset connector and causes lower stresses around the C7 pedicle-vertebral body complex. PMID:24003366
Influence of setup errors on spinal cord dose and treatment plan quality for cervical spine tumours: a phantom study for photon IMRT and heavy charged particle radiotherapy
NASA Astrophysics Data System (ADS)
Karger, Christian P.; Schulz-Ertner, Daniela; Didinger, Bernd H.; Debus, Jürgen; Jäkel, Oliver
Tumours partly surrounding the cervical spine may be treated by conformal radiotherapy (RT) using intensity-modulated RT (IMRT) with photons or heavy charged particle RT. For both, a high setup accuracy is required to spare the radiosensitive spinal cord, if a high dose is to be delivered. A phantom study was performed to determine the variation of the dose to the spinal cord surface by predefined setup errors. The measured doses were compared to those calculated by the treatment planning programme. The influence of systematic setup errors on characteristic parameters of the treatment plan quality was quantified. The largest variation of the mean and maximum doses to the spinal cord due to setup errors was significantly larger for carbon ions than for IMRT (mean: 11.9% versus 3.9%, max: 29.2% versus 10.8% of the prescribed dose). For the comparison of measured and calculated doses, mean deviations of 3% (IMRT) and 6% (carbon ions) of the prescribed dose were obtained. These deviations have to be considered, when the spinal cord dose is assessed from the treatment plan and they may also influence the dose prescription. Carbon ions yield better values for coverage (99.9% versus 93.1%) and conformality (110% versus 126%) of the PTV as compared to IMRT, while the spinal cord is better spared. Dose distributions produced with carbon ions, however, are more sensitive to setup errors, which have to be considered during treatment.
Cervical spondylosis is a disorder that results from abnormal growth of the bones of the neck and ... Progressive neck pain is a key indication of cervical spondylosis. It may be the only symptom in ...
Assessment of nerve involvement in the lumbar spine: agreement between magnetic resonance imaging, physical examination and pain drawing findings
Bo C Bertilson; Eva Brosjö; Hans Billing; Lars-Erik Strender
BACKGROUND: Detection of nerve involvement originating in the spine is a primary concern in the assessment of spine symptoms. Magnetic resonance imaging (MRI) has become the diagnostic method of choice for this detection. However, the agreement between MRI and other diagnostic methods for detecting nerve involvement has not been fully evaluated. The aim of this diagnostic study was to evaluate
Minimally invasive posterior cervical decompression using tubular retractor: The technical note and early clinical outcome
Hur, Jung-Woo; Kim, Jin-Sung; Shin, Myeong-Hoon; Ryu, Kyeong-Sik
Background: The aim of this work is to present a novel decompression technique that approaches cervical spine posteriorly, but through minimal invasive method using tubular retractor avoiding detachment of posterior musculature. Methods: Six patients underwent minimally invasive posterior cervical decompression using the tubular retractor system and surgical microscope. Minimally invasive access to the posterior cervical spine was performed with exposure through a paramedian muscle-splitting approach. With the assistance of a specialized tubular retraction system and deep soft tissue expansion mechanism, multilevel posterior cervical decompression could be accomplished. This approach also allows safe docking of the retractor system on the lateral mass, thus avoiding the cervical spinal canal during exposure. A standard operating microscope was used with ×10 magnification and 400 mm focal length. The hospital charts, magnetic resonance imaging studies, and follow-up records of all the patients were reviewed. Outcome was assessed by neurological status and visual analog scale (VAS) for neck and arm pain. Results: There was no significant complication related to operation. The follow-up time was 4-12 months (mean, 9 months). Muscle weakness improved in all patients; sensory deficits resolved in four patients and improved in two patients. Analysis of the mean VAS for radicular pain and VAS for neck pain showed significant improvement. Conclusions: The preliminary experiences with good clinical outcome seem to promise that this minimally invasive technique is a valid alternative option for the treatment of cervical spondylotic myelopathy. PMID:24778922
Cervicothoracic Spinal Epidural Hematoma after Anterior Cervical Spinal Surgery
Lee, Sang-Ho
The purpose of this case report is to describe a rare case of a cervicothoracic spinal epidural hematoma (SEH) after anterior cervical spine surgery. A 60-year-old man complained of severe neck and arm pain 4 hours after anterior cervical discectomy and fusion at the C5-6 level. Magnetic resonance imaging revealed a postoperative SEH extending from C1 to T4. Direct hemostasis and drainage of loculated hematoma at the C5-6 level completely improved the patient's condition. When a patient complains of severe neck and/or arm pain after anterior cervical spinal surgery, though rare, the possibility of a postoperative SEH extending to non-decompressed, adjacent levels should be considered as with our case. PMID:21430984
Posterior Cervical Foraminotomy and Laminectomy
John E. O'Toole; Kurt M. Eichholz; Richard G. Fessler
\\u000a Posterior decompressive procedures are fundamental tools in the surgical treatment of symptomatic cervical degenerative spine\\u000a disease [1–4]. Even as anterior cervical procedures have gained prominence, posterior cervical laminoforaminotomy still provides\\u000a symptomatic relief in 92–97% of patients with radiculopathy from foraminal stenosis or lateral herniated discs [3, 5]. Similarly,\\u000a posterior cervical decompression for cervical stenosis achieves neurological improvement in 62.5–83% of
Operative management of traumatic cervical spine distraction and complete cord transection in a 3-year-old patient.
Davern, Monica Salazar; Garg, Sumeet; Hankinson, Todd C
This report describes the presentation and operative treatment of a 3-year-old boy who survived a motor vehicle accident that resulted in a C6-7 distraction injury, complete avulsion of the spinal cord, and gross spinal instability. Only 5%-10% of all spinal cord and vertebral column injuries occur in children. Survival after such an injury is exceptionally rare in very young patients and is associated with severe neurological deficits. The authors discuss the substantial ethical challenges involved in the care of a patient with this injury. To their knowledge, only two other cases of survival have been reported in pediatric patients following motor vehicle trauma resulting in complete injury to the lower cervical spinal cord. PMID:25415253
Is a single low dose of intrathecal morphine a useful adjunct to patient-controlled analgesia for postoperative pain control following lumbar spine surgery? A preliminary report
Yen, David; Turner, Kim; Mark, David
BACKGROUND: Several studies addressing intrathecal morphine (ITM) use following spine surgery have been published either involving the pediatric population, using mid- to high-dose ITM, or not in conjunction with morphine patient-controlled analgesia (PCA). OBJECTIVES: To determine whether low-dose ITM is a useful adjunct to PCA for postoperative pain control following elective lumbar spine surgery in adults. METHODS: Thirty-two patients were enrolled in a double-blinded randomized controlled trial, and received either ITM or intrathecal placebo. Postoperatively, all patients were given a PCA pump and observed for the first 24 h in a step-down unit. Measurements of: total PCA morphine consumed in the first 24 h; intensity of pain; pruritus; nausea at 4 h, 8 h and 24 h; time to first ambulation; length of hospital stay; and occurrences of respiratory depression were recorded. RESULTS: The total PCA use was significantly lower in the ITM group. There were lower average pain scores in the ITM group, which increased to that of the intrathecal placebo group over 24 h; however, this failed to attain statistical significance. There were no differences in nausea, pruritus, time to first ambulation or hospital length stay. There were no cases of respiratory depression in either group. CONCLUSIONS: ITM may be a useful adjunct to PCA, but did not decrease time to ambulation or length of stay. PMID:25996764
Analgesic therapy for major spine surgery.
Puvanesarajah, Varun; Liauw, Jason A; Lo, Sheng-Fu; Lina, Ioan A; Witham, Timothy F; Gottschalk, Allan
Pain following spine surgery is often difficult to control and can persist. Reduction of this pain requires a multidisciplinary approach that depends on contributions of both surgeons and anesthesiologists. The spine surgeon's role involves limiting manipulation of structures contributing to pain sensation in the spine, which requires an in-depth understanding of the specific anatomic etiologies of pain originating along the spinal axis. Anesthesiologists, on the other hand, must focus on preemptive, multimodal analgesic treatment regimens. In this review, we first discuss anatomic sources of pain within the spine, before delving into a specific literature-supported pain management protocol intended for use with spinal surgery. PMID:25680636
The optimized acupuncture treatment for neck pain caused by cervical spondylosis: a study protocol of a multicentre randomized controlled trial
Background Neck pain is one of the chief symptoms of cervical spondylosis (CS). Acupuncture is a well-accepted and widely used complementary therapy for the management of neck pain caused by CS. In this paper, we present a randomized controlled trial protocol evaluating the use of acupuncture for CS neck pain, comparing the effects of the optimized acupuncture therapy in real practice compared with sham and shallow acupuncture. Methods/Design This trial uses a multicentre, parallel-group, randomized, sham acupuncture and shallow acupuncture, controlled single-blind design. Nine hospitals are involved as trial centres. 945 patients who meet inclusion criteria are randomly assigned to receive optimized acupuncture therapy, sham acupuncture or shallow acupuncture by a computerized central randomization system. The interventions past for 4 weeks with eight to ten treatments in total. The group allocations and interventions are concealed to patients and statisticians. The Northwick Park Neck Pain Questionnaire (NPQ) is used as the primary outcome measure, and the McGill Pain Questionnaire (MPQ) and The Short Form (36) Health Survey (SF-36) are applied as secondary outcome measures. The evaluation is performed at baseline, at the end of the intervention, and at the end of the first month and the third month during follow-up. The statistical analyses will include baseline data comparison and repeated measures of analysis of variance (ANOVA) for primary and secondary outcomes of group and time differences. Adverse events (AEs) will be reported if they occur. Discussion This trial is a multicentre randomized control trial (RCT) on the efficacy of acupuncture for CS neck pain and has a large sample size and central randomization in China. It will strictly follow the CONSORT statement and STRICTA extension guideline to report high-quality study results. By setting the control groups as sham and shallow acupuncture, this study attempts to reveal the effects of real acupuncture versus placebo or non-classic acupuncture treatment and evaluate whether classic Chinese medical acupuncture is effective on CS neck pain. This study will provide evidence for the effects of acupuncture on CS neck pain. Trial Registration Chinese Clinical Trial Registry: ChiCTR-TRC-00000184. PMID:22776567
A case of symptomatic cervical perineural (Tarlov) cyst: clinical manifestation and management.
Kim, Keewon; Chun, Se Woong; Chung, Sun G
Perineural (Tarlov) cysts are most often found in the sacral region and are rare in the cervical spine. Although they are usually asymptomatic, a small number of those at the lumbosacral level have been known to produce localized or radicular pain. Few reports are available on symptomatic perineural cysts in the cervical spine and it has not been discussed how they should be managed. We present here a case of cervical perineural cysts with persistent radicular pain where the pain was adequately managed with repetitive transforaminal epidural steroid injection (TFESI). The patient had experienced intractable pain in the posterior neck and left upper extremity for more than 7 years. The nature of the pain was cramping and a tingling sensation, which was aggravated in the supine position. Magnetic resonance imaging revealed a perineural cyst in the neural foramen of left C7 root. The patient underwent three repetitive TFESIs targeted at the root. Each injection provided incremental relief, which lasted more than 6 months. Follow-up image revealed shrinkage of the cyst. This case illustrates in detail the clinical manifestation of a rare symptomatic perineural cyst in the cervical region and to our knowledge is the first to report the beneficial effect of repetitive TFESI. PMID:21830055
Cervical Perineural Cyst Masquerading as a Cervical Spinal Tumor
Joshi, Vijay P; Zanwar, Atul; Karande, Anuradha
Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor. PMID:24761204
Cervical perineural cyst masquerading as a cervical spinal tumor.
Joshi, Vijay P; Zanwar, Atul; Karande, Anuradha; Agrawal, Amit
Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor. PMID:24761204
Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review
Boyles, Robert; Toy, Patrick; Mellon, James; Hayes, Margaret; Hammer, Bradley
Study design Systematic review of randomized clinical trials. Objective Review of current literature regarding the effectiveness of manual therapy in the treatment of cervical radiculopathy. Background Cervical radiculopathy (CR) is a clinical condition frequently encountered in the physical therapy clinic. Cervical radiculopathy is a result of space occupying lesions in the cervical spine: either cervical disc herniations, spondylosis, or osteophytosis. These affect the pain generators of bony and ligamentous tissues, producing radicular symptoms (i.e. pain, numbness, weakness, paresthesia) observed in the upper extremity of patients with cervical nerve root pathology. Cervical radiculopathy has a reported annual incidence of 83·2 per 100?000 and an increased prevalence in the fifth decade of life among the general population. Results Medline and CINAHL via EBSCO, Cochrane Library, and Google Scholar were used to retrieve the randomized clinical trial studies for this review between the years of 1995 and February of 2011. Four studies met inclusion criteria and were considered to be high quality (PEDro scores of ?5). Manual therapy techniques included muscle energy techniques, non-thrust/thrust manipulation/mobilization of the cervical and/or thoracic spine, soft-tissue mobilization, and neural mobilization. In each study, manual therapy was either a stand-alone intervention or part of a multimodal approach which included therapeutic exercise and often some form of cervical traction. Although no clear cause and effect relationship can be established between improvement in radicular symptoms and manual therapy, results are generally promising. Conclusion Although a definitive treatment progression for treating CR has not been developed a general consensus exists within the literature that using manual therapy techniques in conjunction with therapeutic exercise is effective in regard to increasing function, as well as AROM, while decreasing levels of pain and disability. High quality RCTs featuring control groups are necessary to establish clear and effective protocols in the treatment of CR. PMID:22851876
Dropped Shoulder Syndrome: A Cause of Lower Cervical Radiculopathy
Background and Purpose Cervical radiculopathy is a pathological process involving a nerve root of the cervical spine. The most common causes of radiculopathy are cervical disc herniation followed by cervical spondylosis. The aim of this study was to determine the effect of dropped shoulder as a cause of lower cervical radiculopathy. Methods In total, 132 patients, comprising 105 women (79.5%) and 27 men (20.5%; female : male ratio of 4 : 1) and a mean age of 36.7 years (range 18-58 years), were included in this study. All of the patients presented with shoulder pain, and were investigated by cervical X-ray, cervical magnetic resonance imaging, serum muscle enzymes, and electromyography (EMG)/nerve-conduction studies. Results Ninety six patients (72.7%) exhibited visually detectable dropped shoulder. The lateral view X-ray of the cervical region revealed eight or more vertebrae. In 119 patients (90.2%), the EMG revealed a mild-to-moderate or moderate denervation patterns in the abductor digiti minimi, first dorsal interosseous, and flexor carpi ulnaris muscles, while the abductor pollicis brevis, extensor carpi radialis, and triceps brachii were denervated in 102 patients (77.3%). All of the patients had lower cervical paraspinal muscles with a denervation pattern. Conclusions Three criteria for diagnosing dropped shoulder syndrome have been suggested: pain with consistent anatomical distribution, X-ray abnormalities, and EMG abnormalities. Compression of the cervical roots by muscle spasm has been proposed as the cause of dropped shoulder syndrome; this possibility is discussed herein. PMID:21779296
Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects.
Griegel-Morris, P; Larson, K; Mueller-Klaus, K; Oatis, C A
The purposes of this study were to identify the incidence of postural abnormalities of the thoracic, cervical, and shoulder regions in two age groups of healthy subjects and to explore whether these abnormalities were associated with pain. Eighty-eight healthy subjects, aged 20 to 50 years, were asked to answer a pain questionnaire and to stand by a plumb line for postural assessment of forward head, rounded shoulders, and kyphosis. Subjects were divided into two age groups: a 20- to 35-year-old group (mean = 25, SD = 63) and a 36- to 50-year-old group (mean = 47, SD = 2.6). Interrater and intrarater reliability (Cohen's Kappa coefficients) for postural assessment were established at .611 and .825, respectively. Frequency counts revealed postural abnormalities were prevalent (forward head = 66%, kyphosis = 38%, right rounded shoulder = 73%, left rounded shoulder = 66%). No relationship was found between the severity of postural abnormality and the severity and frequency of pain. Subjects with more severe postural abnormalities, however, had a significantly increased incidence of pain, as determined by chi-square analysis (critical chi 2 = 6, df = 2, P less than .05). Subjects with kyphosis and rounded shoulders had an increased incidence of interscapular pain, and those with a forward-head posture had an increased incidence of cervical, interscapular, and headache pain. PMID:1589462
Spine Journal Twenty-five years with the biopsychosocial model of low back pain -is it time to
Royal Holloway, University of London
, Surrey UNITED KINGDOM Corresponding Author Secondary Information: Corresponding Author's Institution the editor-in-Chief Spine Dear Sir, We thank the reviewers for their comments and have amended the manuscript added the following in the introduction: The evidence reviewed constitutes a synthesis of key
Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note.
Das, K; Couldwell, W T; Sava, G; Taddonio, R F
After performing anterior cervical corpectomy or discectomy for cervical spondolytic myelopathy or radiculopathy, iliac crest bone graft and fibular auto- or allograft is often used to achieve arthrodesis in the cervical spine. The purpose of this study was to evaluate the use of a cylindrical titanium mesh and locking plate system as an alternative technique in achieving anterior cervical fusion and maintaining lordosis. Hospital records and radiographs of 38 patients who underwent anterior cervical discectomies (28 patients) or corpectomies (10 patients) from 1995 to 1997 were reviewed retrospectively. All patients had undergone arthrodesis in which autograft and a cylindrical titanium mesh and anterior locking plate fixation were used after discectomy or corpectomy. There were 20 men and 18 women (mean age 46.1 years; range 34-72 years). Presenting symptoms included radiculopathy (61%), myelopathy (37%), and neck pain (2%). Preoperative and postoperative radiographs were studied, and data were obtained on the following: overall lordosis or kyphosis of the cervical spine, segmental lordosis or kyphosis at each surgically treated level, and evidence of fusion. In all of the patients in whom lordosis was present preoperatively, lordosis was maintained during the follow-up period. The overall fusion rate was 100%. The average change in overall lordosis or kyphosis related to the fixation devices was 1.2 degrees (range 1-5 degrees) the average segmental change was 2.3 degrees (range 0-5 degrees); and the mean follow up was 16 months (range 12-36 months). Anterior cervical fusion with cylindrical titanium mesh and cervical locking plate system is an effective method of achieving arthrodesis and maintaining alignment in the cervical spine. The construct may provide additional load-sharing function, and it avoids the use of cadaveric bone or the need for harvesting tricortical iliac crest autograft. PMID:11147858
The potential for salmon fibrin and thrombin to mitigate pain subsequent to cervical nerve root injury
Weisshaar, Christine L.; Winer, Jessamine P.; Guarino, Benjamin B.; Janmey, Paul A.; Winkelstein, Beth A.
Nerve root compression is a common cause of radiculopathy and induces persistent pain. Mammalian fibrin is used clinically as a coagulant but presents a variety of risks. Fish fibrin is a potential biomaterial for neural injury treatment because it promotes neurite outgrowth, is non-toxic, and clots readily at lower temperatures. This study administered salmon fibrin and thrombin following nerve root compression and measured behavioral sensitivity and glial activation in a rat pain model. Fibrin and thrombin each significantly reduced mechanical allodynia compared to injury alone (p<0.02). Painful compression with fibrin exhibited allodynia that was not different from sham for any day using stimulation by a 2 g filament; allodynia was only significantly different (p<0.043) from sham using the 4 g filament on days 1 and 3. By day 5, responses for fibrin treatment decreased to sham levels. Allodynia following compression with thrombin treatment were unchanged from sham at any time point. Macrophage infiltration at the nerve root and spinal microglial activation were only mildly modified by salmon treatments. Spinal astrocytic expression decreased significantly with fibrin (p<0.0001) but was unchanged from injury responses for thrombin treatment. Results suggest that salmon fibrin and thrombin may be suitable biomaterials to mitigate pain. PMID:21944723
Cervical Syndrome – the Effectiveness of Physical Therapy Interventions
Kasumovic, Mersija; Gorcevic, Emir; Gorcevic, Semir; Osmanovic, Jasna
ABSTRACT Introduction: The cervical syndrome refers to a set of disorders caused by the changes in the cervical spine and the soft-tissue surrounding it, with pain as the predominant symptom. Sore neck has been a common problem among a large section of today`s population. The factors contributing to this issue include the modern lifestyle, prolonged sitting and incorrect, fixed or constrained working postures. The root of these difficulties is found in the mechanical disorders of the cervical spine structures, poor body posture and jerky body movements. In the Scandinavian countries neck pain is considered to be a public health problem. Methods: The study evaluated 25 patients with an established diagnosis of cervical syndrome. The research was conducted at the PI Institute of Occupational and Sports Medicine of Zenica–Doboj Canton. Each patient received twenty physical therapy treatment sessions. Results and conclusions: The study included 25 patients suffering from the cervical syndrome. The statistical analysis of gender distribution indicated that 36% of the patients were male, while 64% were female. The mean age of study participants was 46.76±4,23. The patients ranged in age from 39 to 54 years, with no statistically significant difference in the mean age of male and female patients, p=0.691. Analysing the types of occupational activities performed by the patients, the study found a positive relation between neck pain and prolonged sitting at work. The patients who performed office work made up 76% of the total number. Each method of physical therapy applied in the treatment of neck pain patients proved useful. However, the combination of electrotherapy, kinesiotherapy and manual massage proved to be most effective. Conclusion: The cervical syndrome is a common medical condition primarily affecting adult population, with prevalence being higher among women and office workers. The condition places a considerable socioeconomic burden on the afflicted. Cervical pain ranges greatly in severity – from moderate to unbearable, thus leading to high levels of work absence as well as to a decrease in the quality of life. Proper physical therapy program can help the patients with neck pain return to their normal everyday activities, improve their quality of life, as well as reduce the absence from work. PMID:25568511
Charcot Spine and Parkinson's Disease
Loriaut, Philippe; Rozenberg, Sylvie; Boyer, Patrick; Dallaudičre, Benjamin; Khiami, Frederic; Sariali, Elhadi; Pascal-Moussellard, Hugues
Charcot spine is rare condition whose association with Parkinson's disease (PD) has not been reported yet. The authors reported the cases of two patients with PD who developed Charcot spine. Both patients presented with a history of back pain and bilateral radicular leg pain. They had complete clinical and radiological assessment. Lumbar spine was involved in both patients. Clinical features and response to treatment were described. In the first case, circumferential fusion and stabilization were performed on the dislocated vertebral levels. A solid and stable fusion of the spine was obtained with satisfactory clinical outcome. Surgical treatment has been recommended to the other patient. In both cases, no other neurological etiology was found to account for Charcot spine. In conclusion, Charcot spine is associated with several neurological affections but has not previously been reported in association with Parkinson's disease. PMID:25165591
Baastrup's disease: The kissing spine.
Singla, Amit; Shankar, Vivek; Mittal, Samarth; Agarwal, Abhinav; Garg, Bhavuk
A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiation of pain or any features suggestive of claudication. There was no history of any comorbidity. The pain was aggravated with extension of the spine and relieved with flexion. There was no swelling or neurological deficit, but muscle spasm was present. Radiographs of the spine revealed degenerative changes in the lumbosacral spine, along with articulation of spinous processes at in lumbar spine at all levels level suggestive of Baastrup's disease, commonly known as "kissing spine". Routine blood investigations were within normal limits. The patient was managed conservatively. He was given a week's course of analgesics and muscle relaxants and then started on spinal flexion exercises, with significant improvement being noted at 6 months follow up. PMID:24579072
Cervical Epidural Abscess: Rare Complication of Bacterial Endocarditis with Streptococcus Viridans: A Case Report
Oh, Jae-Sang; Shim, Jai-Joon; Lee, Kyeong-Seok
Although many patients with infective endocarditis (IE) complain of joint, muscle, and back pain, infections at these sights are rare. The incidence of spinal abscess in cervical spine complicating endocarditis is very rare. Although the surgical management is the mainstay of treatment, conservative treatment can get success in selected patients. We report a patient with cervical epidural abscess due to Streptococcus viridans endocarditis. Both epidural abscess and IE were managed conservatively with intravenous antibiotics for 8 weeks, with recovery. It is important to remind spinal epidural abscess can occur in those patients with bacterial endocarditis. PMID:25883665
Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial Effet de la stabilisation en ligne de la colonne cervicale sur l'incidence d'intubations orotracheales difficiles par laryngoscopie directe chez l'adulte: une etude randomisee controlee
Francois Thiboutot; Pierre C. Nicole; Claude A. Trepanier; Alexis F. Turgeon; Martin R. Lessard
Purpose Although manual in-line stabilization (MILS) is commonly used during endotracheal intubation in patients with either known or suspected cervical spine instability, the effect of MILS on orotracheal intubation is poorly documented. This study evaluated the rate of failed tra- cheal intubation in a fixed time interval with MILS. Methods Two hundred elective surgical patients were randomized into two groups.
Occupational Overuse Syndrome (Technological Diseases): Carpal Tunnel Syndrome, a Mouse Shoulder, Cervical Pain Syndrome
Tiric-Campara, Merita; Krupic, Ferid; Biscevic, Mirza; Spahic, Emina; Maglajlija, Kerima; Masic, Zlatan; Zunic, Lejla; Masic, Izet
ABSTRACT Technological diseases are diseases of the modern era. Some are caused by occupational exposures, and are marked with direct professional relation, or the action of harmful effects in the workplace. Due to the increasing incidence of these diseases on specific workplaces which may be caused by one or more causal factors present in the workplace today, these diseases are considered as professional diseases. Severity of technological disease usually responds to the level and duration of exposure, and usually occurs after many years of exposure to harmful factor. Technological diseases occur due to excessive work at the computer, or excessive use of keyboards and computer mice, especially the non-ergonomic ones. This paper deals with the diseases of the neck, shoulder, elbow and wrist (cervical radiculopathy, mouse shoulder and carpal tunnel syndrome), as is currently the most common diseases of technology in our country and abroad. These three diseases can be caused by long-term load and physical effort, and are tied to specific occupations, such as occupations associated with prolonged sitting, working at the computer and work related to the fixed telephone communication, as well as certain types of sports (tennis, golf and others). PMID:25568584
Occupational overuse syndrome (technological diseases): carpal tunnel syndrome, a mouse shoulder, cervical pain syndrome.
Tiric-Campara, Merita; Krupic, Ferid; Biscevic, Mirza; Spahic, Emina; Maglajlija, Kerima; Masic, Zlatan; Zunic, Lejla; Masic, Izet
Technological diseases are diseases of the modern era. Some are caused by occupational exposures, and are marked with direct professional relation, or the action of harmful effects in the workplace. Due to the increasing incidence of these diseases on specific workplaces which may be caused by one or more causal factors present in the workplace today, these diseases are considered as professional diseases. Severity of technological disease usually responds to the level and duration of exposure, and usually occurs after many years of exposure to harmful factor. Technological diseases occur due to excessive work at the computer, or excessive use of keyboards and computer mice, especially the non-ergonomic ones. This paper deals with the diseases of the neck, shoulder, elbow and wrist (cervical radiculopathy, mouse shoulder and carpal tunnel syndrome), as is currently the most common diseases of technology in our country and abroad. These three diseases can be caused by long-term load and physical effort, and are tied to specific occupations, such as occupations associated with prolonged sitting, working at the computer and work related to the fixed telephone communication, as well as certain types of sports (tennis, golf and others). PMID:25568584
Correlation of Computed Tomography Imaging Features With Pain Response in Patients With Spine Metastases After Radiation Therapy
Mitera, Gunita, E-mail: firstname.lastname@example.com [Rapid Response Radiotherapy Program, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Probyn, Linda [Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Ford, Michael [Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Donovan, Andrea; Rubenstein, Joel [Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Finkelstein, Joel [Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Christakis, Monique [Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Zhang, Liying; Campos, Sarah; Culleton, Shaelyn; Nguyen, Janet; Sahgal, Arjun; Barnes, Elizabeth; Tsao, May; Danjoux, Cyril; Holden, Lori [Rapid Response Radiotherapy Program, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Yee, Albert [Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Khan, Luluel; Chow, Edward [Rapid Response Radiotherapy Program, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)
Purpose: To correlate computed tomography (CT) imaging features of spinal metastases with pain relief after radiotherapy (RT). Methods and Materials: Thirty-three patients receiving computed tomography (CT)-simulated RT for spinal metastases in an outpatient palliative RT clinic from January 2007 to October 2008 were retrospectively reviewed. Forty spinal metastases were evaluated. Pain response was rated using the International Bone Metastases Consensus Working Party endpoints. Three musculoskeletal radiologists and two orthopaedic surgeons evaluated CT features, including osseous and soft tissue tumor extent, presence of a pathologic fracture, severity of vertebral height loss, and presence of kyphosis. Results: The mean patient age was 69 years; 24 were men and 9 were women. The mean worst pain score was 7/10, and the mean total daily oral morphine equivalent was 77.3 mg. Treatment doses included 8 Gy in one fraction (22/33), 20 Gy in five fractions (10/33), and 20 Gy in eight fractions (1/33). The CT imaging appearance of spinal metastases included vertebral body involvement (40/40), pedicle involvement (23/40), and lamina involvement (18/40). Soft tissue component (10/40) and nerve root compression (9/40) were less common. Pathologic fractures existed in 11/40 lesions, with resultant vertebral body height loss in 10/40 and kyphosis in 2/40 lesions. At months 1, 2, and 3 after RT, 18%, 69%, and 70% of patients experienced pain relief. Pain response was observed with various CT imaging features. Conclusions: Pain response after RT did not differ in patients with and without pathologic fracture, kyphosis, or any other CT features related to extent of tumor involvement. All patients with painful spinal metastases may benefit from palliative RT.
SPINE Volume 26, Number 17, pp 19041909 2001, Lippincott Williams & Wilkins, Inc.
Delp, Scott
SPINE Volume 26, Number 17, pp 1904Â1909 ©2001, Lippincott Williams & Wilkins, Inc. Three in the cervical spine. Further, it is not clear how subject size, gender, and neck geometry relate to variations at different locations in the cervical spine. Results. When moments were resolved about axes through
SPINE Volume 32, Number 19, pp 20922098 2007, Lippincott Williams & Wilkins, Inc.
Wisconsin at Madison, University of
SPINE Volume 32, Number 19, pp 2092Â2098 ©2007, Lippincott Williams & Wilkins, Inc. A Method to Measure Cervical Spine Motion Over Extended Periods of Time Faiz I. Syed, MS, Ashish L. Oza, MS, Ray. Objective. To develop and validate a motion sensor system for measuring cervical spine motion over ex
Spine Imaging: History,Achievements, Remaining Frontiers
John R. Hesselink
Imaging the spine presents a special challenge. The vertebral column is a complex bony structure. The vertebrae have irregular contours and shapes with multiple bony processes projecting in various directions. Moreover, the anatomic configu- rations of the vertebrae are different in the cervical, thoracic, and lumbosacral regions. This variable anatomy, along with the natural curvature of the spine, results in
de Jonge, Milko C; Kramer, Josef
The spine, in athletes is a relatively frequent origin of problems. Chronic spine problems are much more common compared to acute injuries. Chronic injuries to the spine most often occur in low-contact sports like gymnastics and are most commonly the result of overuse. Acute injuries are more common in high-speed and full contact sports and are traumatic in origin. Injuries to the spinal cord can be devastating but are fortunately very uncommon. Although imaging of the spine appears to be straightforward, any radiologist will acknowledge that the optimal imaging strategy is often unclear due to several reasons. For the cervical spine much has improved since the NEXUS and CCR studies appeared in which clear rules were defined when to image the C-spine in acute trauma situations. For the thoracic and lumbar spines such rules are not defined. Although conventional imaging has long been the primary imaging modality of choice there is ample evidence that this should be abandoned in favor of multidetector CT for the C-spine. This is reflected in the ACR criteria in which conventional imaging of tile C-spine in trauma is rated as the least appropriate imaging method. However, this is not true in children and adolescents although a strict age criterion is not defined. It is also not true for injuries to the thoracic and lumbar spine in which conventional imaging still plays a large role as primary imaging modality followed by evaluation by CT in trauma situations. The role for MRI in acute situations is increasing especially with the increasing use of the TLICS system to classify injuries of the thoracic and lumbar spine in which the evaluation of the integrity of the posterior ligamentous structures is included. For the evaluation of chronic complaints, the roles of CT and MRI are basically reversed in which MRI will become the prime imaging modality of choice after conventional imaging after which CT can be reserved for a selected patient group. The merit of the different imaging modalities will be discussed together with a spectrum of acute and chronic injuries often encountered in the spine in athletes. PMID:24896742
The surgical management of the rheumatoid spine: Has the evolution of surgical intervention changed outcomes?
Bhatia, Robin; Haliasos, Nikolas; Vergara, Pierluigi; Anderson, Caroline; Casey, Adrian
Context: Surgery for the rheumatoid cervical spine has been shown to stabilize the unstable spine; arrest/improve the progression of neurological deficit, help neck pain, and possibly decelerate the degenerative disease process. Operative intervention for the rheumatoid spine has significantly changed over the last 30 years. Aims: The purpose of this study was to review all cases of cervical rheumatoid spine requiring surgical intervention in a single unit over the last 30 years. Materials and Methods: A prospectively-maintained spine database was retrospectively searched for all cases of rheumatoid spine, leading to a review of indications, imaging, Ranawat and Myelopathy Disability Index measures, surgical morbidity, and survival curve analysis. Results: A total of 224 cases were identified between 1981 and 2011. Dividing the data into three time-epochs, there has been a significant increase in the ratio of segment-saving Goel-Harms C1-C2: Occipitocervical fixation (OCF) surgery and survival has increased between 1981 and 2011 from 30% to 51%. Patients undergoing C1-C2 fixation were comparatively less myelopathic and in a better Ranawat class preoperatively, but postoperative outcome measures were well-preserved with favorable mortality rates over mean 39.6 months of follow-up. However, 11% of cases required OCF at mean 28 months post-C1-C2 fixation, largely due to instrumentation failure (80%). Conclusion: We present the largest series of surgically managed rheumatoid spines, revealing comparative data on OCF and C1-C2 fixation. Although survival has improved over the last 30 years, there have been changes in medical, surgical and perioperative management over that period of time too confounding the interpretation; however, the analysis presented suggests that rheumatoid patients presenting early in the disease process may benefit from C1 to C2 fixation, albeit with a proportion requiring OCF at a later time. PMID:25013346
Iwanami, Akio; Toyama, Yoshiaki
Japan has now become an aging society. In 2014, people aged more than 65 years old accounted for 25.1% of Japan's entire population. Aging is associated with an increased risk of problems related to the locomotive organs. Deterioration of locomotive ability causes falls or tumbles, which would be a threat to good health and longevity of aged people. To maintain the locomotive ability of the elderly, therefore, the Japanese Orthopaedic Association starts a campaign to promote awareness and prevention of "locomotive syndrome". Cervical spondylosis is a disorder for age-related wear affecting the disks and vertebrae of cervical spine. It would also be a cause of "locomotive syndrome". Here, we give an outline of this disease and introduce its diagnosis and treatment. PMID:25509798
Operative Technique for En Bloc Resection of Upper Cervical Chordomas: Extended Transoral Transmandibular Approach and Multilevel Reconstruction
Ortega-Porcayo, Luis Alberto; Cabrera-Aldana, Eibar Ernesto; Arriada-Mendicoa, Nicasio; Gómez-Amador, Juan Luis; Granados-García, Martín
Anterior exposure for cervical chordomas remains challenging because of the anatomical complexities and the restoration of the dimensional balance of the atlanto-axial region. In this report, we describe and analyze the transmandibular transoral approach and multilevel spinal reconstruction for upper cervical chordomas. We report two cases of cervical chordomas (C2 and C2-C4) that were treated by marginal en bloc resection with a transmandibular approach and anterior-posterior multilevel spinal reconstruction/fixation. Both patients showed clinical improvement. Postoperative imaging was negative for any residual tumor and revealed adequate reconstruction and stabilization. Marginal resection requires more extensive exposure to allow the surgeon access to the entire pathology, as an inadequate tumor margin is the main factor that negatively affects the prognosis. Anterior and posterior reconstruction provides a rigid reconstruction that protects the medulla and decreases axial pain by properly stabilizing the cervical spine. PMID:25558326
Thoracic spine sports-related injuries.
Menzer, Heather; Gill, G Keith; Paterson, Andrew
Although sports-related injuries to the thoracic spine are relatively uncommon, they are among the most feared due to the potential for catastrophic neurologic injury. The increased biomechanical support of the thoracic spine makes injuries in this region particularly rare compared with the cervical and lumbar spine. As a result, thoracic spine injuries can be missed easily, difficult to diagnose, and problematic to treat. Recognition of mechanism and awareness of injury patterns help physicians determine a diagnosis and create an index of suspicion for unstable thoracic spine injuries. Aggressive full-contact sports receive the most attention for spinal injury; however several sports with repetitive loading of the spine can cause severe injuries, including rowing, gymnastics, and golf. The goal of this article was to provide an overview of the unique anatomic and biomechanical features of the thoracic spine and to discuss some of the more common thoracic injuries that can affect athletes. PMID:25574880
Cervical Discitis in Children.
Scheuerman, Oded; Landau, Daniel; Schwarz, Michael; Hoffer, Vered; Marcus, Nufar; Hoffnung, Liat Ashkenazi; Levy, Itzhak
Cervical discitis, though rare, should be included in the differential diagnosis of torticollis, neck pain and neurodevelopmental regression in motor skills in children and infants. Magnetic resonance imaging is the diagnostic method of choice. Treatment should be conservative with antibiotics only. The aim of this study was to describe the 10-year experience of a tertiary pediatric medical center with cervical discitis. PMID:25886786
Three-dimensional assessment of the intervertebral kinematics after Mobi-C total disc replacement at the cervical spine in vivo using the EOS stereoradiography system
Marc-Antoine Rousseau; Sébastien Laporte; Thierry Dufour; Jean-Paul Steib; Jean-Yves Lazennec; Wafa Skalli
BackgroundBecause 3-dimensional computed tomography and magnetic resonance imaging analysis of the spinal architecture is done with the patient in the supine position, stereoradiography may be more clinically relevant for the measurement of the relative displacements of the cervical vertebrae in vivo in the upright position. The innovative EOS stereoradiography system was used for measuring the relative angular displacements of the
Cervical Total Disc Arthroplasty
Basho, Rahul; Hood, Kenneth A.
Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc arthroplasty devices have come onto the market and completed Food and Drug Administration Investigational Device Exemption trials. Though some of the early results demonstrate equivalency of arthroplasty to fusion, compelling evidence of benefits in terms of symptomatic adjacent segment degeneration are lacking. In addition, non-industry-sponsored studies indicate that these devices are equivalent to fusion in terms of adjacent segment degeneration. Longer-term studies will eventually provide the definitive answer. PMID:24353955
Surgical treatment of myeloradiculopathy in cervical spondylosis. A report on 438 operations.
Samii, M; Völkening, D; Sepehrnia, A; Penkert, G; Baumann, H
In the past eleven years we have performed 438 microsurgical ventral discectomies with bilateral foraminotomy followed by fusion with palacos in the cervical spine in our clinic. An analysis of the preoperative symptoms shows a great variability and overlapping of the various segments. To determine the right level for the operation it is crucial that the results of the clinical and the radiological examinations be evaluated. The results of ascending myelography and CT scans are of great value. In cases of cervical myelopathy a multisegmental operation is often necessary to obtain good results. The complication rate was small in our patients and a second operation was only necessary in a few cases. We had very good postoperative results in radicular pain and muscle weakness. In patients with symptoms of cervical myelopathy we achieved considerable improvement. PMID:2594204
Anatomy of deer spine and its comparison to the human spine.
Kumar, N; Kukreti, S; Ishaque, M; Mulholland, R
The anatomical parameters of the thoracic and lumbar regions of the deer spine were evaluated and compared with the existing data of the human spine. The objective was to create a database for the anatomical parameters of the deer spine, with a view to establish deer spine as a valid model for human spine biomechanical experiments in vitro. To date, the literature has supported the use of both calf and sheep spines as a suitable model for human spine experiments as the difficulty in procuring the human cadaveric spines is well appreciated. With the advent of Bovine Spongiform Encephalopathy (BSE) and its likely transmission to human in form of new variant Creutzfeld Jakob disease (CJD), there is a slight risk of transmission to humans through food chain if proper precautions for disposal of specimen are not adhered to. There is also a significant risk of transmission through direct inoculation to the researchers (Wells et al. Vet. Rec., 1998:142:103-106), working with infected bovine and sheep spine. The deer spines are readily available and there are no reported cases of deer being carriers of prion diseases (Ministry of Agriculture, Fisheries and Food, 1998). Six complete deer spines were measured to determine 22 dimensions from the vertebral bodies, endplates, disc, pedicles, spinal canal, transverse and spinous processes, articular facets. This was compared with the existing data of the human spine in the literature. The deer and human vertebrae show many similarities in the lower thoracic and upper lumbar spine, although they show substantial differences in certain dimensions. The cervical spine was markedly different in comparison. The deer spine may represent a suitable model for human experiments related to gross anatomy of the thoracic and lumbar spine. A thorough database has been provided for deciding the validity of deer spine as a model for the human spine biomechanical in vitro experiments. PMID:10993955
[Frequency and manifestations of back pain in the dental profession].
Zitzmann, Nicola Ursula; Chen, Monika Danzkay; Zenhäusern, René
Dentists, dental hygienists and dental assistants due to the nature of their work-related physical activity often have to deal with physical stress that will cause actual physical damage. The aim of the current survey was to analyse the frequency of job-related pain and associated impairment. The questionnaire for the cervical and lumbal region of the North American Spine Society was modified and used in the present investigation. Out of 6962 subjects, 2025 returned the questionnaire (response rate 34.5%). Between 20% and 36% of the participants suffered from pain in the cervical and lumbal region and were impaired in their daily activities, particularly during the lifting of objects, while standing or sleeping. Almost 40% of the dentists and 53% of the dental hygienists/dental assistants experienced problems related to perceived pain during or after dental treatments. More than half of the participants had already sought out medical help and/or physiotherapy due to job-related pain. The present data indicate that prophylactic and therapeutically based preventative measures should be encouraged in order to prevent cervical and back pain in this affected occupational group. PMID:18720645
Cervical spondylotic myelopathy and radiculopathy.
Truumees, E; Herkowitz, H N
Appropriate management of degenerative cervical spine conditions requires careful elucidation of the presenting clinical syndrome. Because of the pervasiveness of degenerative changes in asymptomatic patients, a clear correlation of symptoms, physical signs, and imaging findings is required before any specific diagnosis can be made. At this time, surgery is not recommended for prophylactic decompression in asymptomatic patients or in those patients with neck pain in the absence of extremity symptoms. In most patients with radiculopathy or mild myelopathy, a trial of nonsurgical management is recommended. Ultimately, patients with neurologic complaints and in whom nonsurgical measures have failed, as well as those with more pronounced myelopathy, should be offered surgical intervention. Selection of the safest, yet sufficient, approach requires a clear understanding of the benefits and expected outcomes. The outlook for patients with both cervical radiculopathy and early myelopathy is good. Radicular symptoms usually improve, but gait and hand changes may not. LF is preferred in younger patients with posterolateral or lateral soft disk herniations, or focal foraminal osteophyte impingement and predominance of upper extremity symptoms. More central 1- or 2-level pathology should be treated with ACDF. Anterior cervical corpectomy should be entertained in patients with nondisk level encroachment and in those with 3 contiguous levels of pathology. This approach is also required in cases of kyphosis and instability. Laminoplasty is indicated in patients with 4 or more levels of stenosis, particularly in those with global conditions such as continuous OPLL or congenital stenosis. In these patients, kyphosis or severe deformity may be addressed with a circumferential approach. PMID:10829188
... that may be adding to your pain l deep breathing exercises —helps you to relax l guided ... Independence Ave SW, Room 712E Washington, DC 20201 web site: www.womenshealth.gov/faq/ carpal.htm www. ...
Rosai-Dorfman Disease in Thoracic Spine: A Rare Case of Compression Fracture
Kim, Do Young; Park, Ji Hye; Shin, Dong Ah; Yi, Seung; Ha, Yoon; Yoon, Do Heum; Kim, Keung Nyun
Sinus histiocytosis with massive lymphadenopathy known as Rosai-Dorfman disease is characterized by painless bilateral cervical lymphadenopathy. Extranodal manifestations are uncommon and spinal involvement is rare. A 15-year-old man presented with intermittent midthoracic back pain only. He had no specific findings on neurologic examinations, hematologic and biochemical laboratory tests. Radiological examination of thoracic spine revealed collapse of T6 vertebrae with thoracic kyphosis and osteolytic lesion of T12 vertebra body. He underwent a removal of bone tumor, anterior reconstruction with mesh and pedicle screw fixation via posterior approach for pathologic confirmation and stabilization. Histopathologic study of the lesion revealed focal infiltration of large histiocytes showing emperipolesis. Immunochemistry stain of histiocytes was positive for CD68 and S-100 but negative for CD1a. This report presents a rare case and literature review of extranodal Rosai-dorfman disease in thoracic spine. PMID:25346769
Metabotropic glutamate receptor 5 contributes to inflammatory tongue pain via extracellular signal-regulated kinase signaling in the trigeminal spinal subnucleus caudalis and upper cervical spinal cord
Background In the orofacial region, limited information is available concerning pathological tongue pain, such as inflammatory pain or neuropathic pain occurring in the tongue. Here, we tried for the first time to establish a novel animal model of inflammatory tongue pain in rats and to investigate the roles of metabotropic glutamate receptor 5 (mGluR5)-extracellular signal-regulated kinase (ERK) signaling in this process. Methods Complete Freund's adjuvant (CFA) was submucosally injected into the tongue to induce the inflammatory pain phenotype that was confirmed by behavioral testing. Expression of phosphorylated ERK (pERK) and mGluR5 in the trigeminal subnucleus caudalis (Vc) and upper cervical spinal cord (C1-C2) were detected with immunohistochemical staining and Western blotting. pERK inhibitor, a selective mGluR5 antagonist or agonist was continuously administered for 7 days via an intrathecal (i.t.) route. Local inflammatory responses were verified by tongue histology. Results Submucosal injection of CFA into the tongue produced a long-lasting mechanical allodynia and heat hyperalgesia at the inflamed site, concomitant with an increase in the pERK immunoreactivity in the Vc and C1-C2. The distribution of pERK-IR cells was laminar specific, ipsilaterally dominant, somatotopically relevant, and rostrocaudally restricted. Western blot analysis also showed an enhanced activation of ERK in the Vc and C1-C2 following CFA injection. Continuous i.t. administration of the pERK inhibitor and a selective mGluR5 antagonist significantly depressed the mechanical allodynia and heat hyperalgesia in the CFA-injected tongue. In addition, the number of pERK-IR cells in ipsilateral Vc and C1-C2 was also decreased by both drugs. Moreover, continuous i.t. administration of a selective mGluR5 agonist induced mechanical allodynia in naive rats. Conclusions The present study constructed a new animal model of inflammatory tongue pain in rodents, and demonstrated pivotal roles of the mGluR5-pERK signaling in the development of mechanical and heat hypersensitivity that evolved in the inflamed tongue. This tongue-inflamed model might be useful for future studies to further elucidate molecular and cellular mechanisms of pathological tongue pain such as burning mouth syndrome. PMID:23181395
... Home » Osteoporosis and Your Spine Osteoporosis and Your Spine Your spine is made up of small bones ... called kyphosis. Kyphosis and Bone Breaks in the Spine The bones in the spine are called vertebrae. ...
Multimodal Management of Mechanical Neck Pain Using a Treatment Based Classification System
Heintz, Megan M.; Hegedus, Eric J.
The purpose of this case study was twofold: 1) to illustrate the use of a treatment-based classification (TBC) system to direct the early intervention of a patient with mechanical neck pain, and 2) to show the progression of this patient with multimodal-modal intervention. The patient exhibited axial neck pain with referral into her upper extremity. Her pain peripheralized with cervical range of motion and centralized with joint mobilization placing her primarily in the centralization category. Her poor posture and associated muscle weakness along with the chronicity of symptoms placed her secondarily into the exercise and conditioning group resulting in a multi-modal treatment as the patient progressed. Although the design of this case report prevents wide applicability, this study does illustrate the effective use of the TBC system for the cervical spine as captured by accepted outcomes measures. PMID:19771194
SPINET: A Parallel Computing Approach to Spine Simulations
Schneider, Jean-Guy
SPINET: A Parallel Computing Approach to Spine Simulations Peter G. Kropf 1 , Edgar F.A. Lederer 2, and symbolic and modern functional programming. The target application is the human spine. Simulations of the spine help to investigate and better understand the mechanisms of back pain and spinal injury. Two
Beavis, A
A biomechanical study is presented to compare the effectiveness of three types of off-the-shelf cervical orthoses and one custom-fit collar in restricting cervical spine motion. A group of 10 normal subjects was studied. The measurements of flexion and extension, lateral side flexion and axial rotation were recorded using various measurement techniques. Interface pressures at the chin and occiput were also measured, along with the warming effect of the collars. The results indicated that all the collars restricted neck movements, for example, the Plastazote collar by 50% of flexion and extension, and that there was no significant difference between off-the-shelf Plastazote and custom-fit collars in restricting movement. Significantly high interface pressures were recorded at the chin, with the subjects wearing the hard and Plastazote orthoses. The warming effect of the soft collar was equal to that of a wool scarf. The study was aimed at improving prescription and although the subjective observations were not validated, the subjects concluded that the custom-fit collars were more comfortable; an important point with such a high rejection rate. PMID:2717386
MR Imaging of the Spine in Epidermal Nevus Syndrome
Timothy N. Booth; Nancy K. Rollins
Summary: We report two cases of epidermal nevus syn- drome (ENS) involving the spine. MR imaging of the spine demonstrated intraspinal lipomas in both cases. Abnormal, enhancing, enlarged cervical and lumbosacral nerve roots were present in one patient. Spinal imaging for patients with ENS may help in the diagnosis of subtle intracranial manifestations, as it did in both of our
Cervical Interlaminar Epidural Steroid Injection for Unilateral Cervical Radiculopathy: Comparison of Midline and Paramedian Approaches for Efficacy
Yoon, Ji Young; Yoon, Young Cheol; Lee, Jongseok
Objective The objective of this study was to compare the clinical outcomes of the cervical interlaminar epidural steroid injection (CIESI) for unilateral radiculopathy by the midline or paramedian approaches and to determine the prognostic factors of CIESI. Materials and Methods We retrospectively analyzed 182 patients who underwent CIESI from January 2009 to December 2012. Inclusion criteria were no previous spinal steroid injection, presence of a cross-sectional image, and presence of follow-up records. Exclusion criteria were patients with bilateral cervical radiculopathy and/or dominant cervical axial pain, combined peripheral neuropathy, and previous cervical spine surgery. Short-term clinical outcomes were evaluated at the first follow-up after CIESI. We compared the clinical outcomes between the midline and paramedian approaches. Possible prognostic factors for the outcome, such as age, gender, duration of radiculopathy, and cause of radiculopathy were also analyzed. Results Cervical interlaminar epidural steroid injections were effective in 124 of 182 patients (68.1%) at the first follow-up. There was no significant difference in the clinical outcomes of CIESI, between midline (69.6%) and paramedian (63.7%) approaches (p = 0.723). Cause of radiculopathy was the only significant factor affecting the efficacy of CIESI. Patients with disc herniation had significantly better results than patients with neural foraminal stenosis (82.9% vs. 56.0%) (p < 0.001). Conclusion There is no significant difference in treatment efficacy between the midline and paramedian approaches in CIESI, for unilateral radiculopathy. The cause of the radiculopathy is significantly associated with the treatment efficacy; patients with disc herniation experience better pain relief than those with neural foraminal stenosis. PMID:25995690
Recurrent Laryngeal Edema Imitating Angioedema Caused by Dislocated Screw after Anterior Spine Surgery
Wójtowicz, Piotr; Szafarowski, Tomasz; Migacz, Ewa; Krzeski, Antoni
The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis. PMID:25755901
Dorsal spine injuries in Saudi Arabia—an unusual cause
Sohail A Ansari; Mohammed Mandoorah; Mahamed Abdalrahim; Khalaf R Al Moutaery
BACKGROUNDMotor vehicle accidents are the most common cause of spinal injuries in Saudi Arabia. Camel collisions usually result in cervical spine injuries. Although extremely rare, dorsal spine injuries have also resulted from these accidents.METHODRetrospective analysis of the type of accident of all the patients with dorsal spine injuries was conducted at the supra-regional spinal injuries rehabilitation unit in Riyadh.RESULTSOf all
Aches, pains and headache: an unusual combination of hypothyroidism, vitamin D deficiency, cervical radiculopathy and cortical vein sinus thrombosis.
Ittyachen, Abraham M; Vijayan, Anuroopa; Kottam, Pratheep; Jose, Appu
A young obese woman was admitted with vague aches and pains, including a headache. At first a provisional diagnosis of depression/myofacial pain syndrome was considered. Later, on evaluation, she was diagnosed to have hypothyroidism and vitamin D deficiency. One week into treatment, her neck pain and headache got worse. Examination of the fundus showed tortuous vessels, papilloedema and intraretinal haemorrhages. MR venogram of the brain was performed, which revealed the presence of thrombosis in the left transverse sinus, left sigmoid sinus and left internal jugular vein. This report is an unusual presentation of neuropsychiatric symptoms in a patient where overlapping diagnoses confound the clinical picture and test the clinical acumen of the physician. A careful history followed by a focused clinical examination and evaluation will help to delineate potential confounders. The report further highlights the importance of clinical medicine even in this era of 'investigative medicine'. PMID:26156835
Combined surgical and radiosurgical treatment for a symptomatic cervical metastasis in a case of malignant paraganglioma: a case report
Background Paragangliomas of the head and neck are rare tumors. Moreover, malignant paragangliomas of the cervical spine are extremely rare. Currently, the combination of curative surgical resection and secondary adjuvant radiotherapy is the gold standard for treating symptomatic malignant paragangliomas. However, traditional treatments for malignant paraganglioma remain unsuccessful. The purpose of this study is to report an exceedingly rare case involving cervical metastasis of a malignant paraganglioma. Case presentation In this case report, we present a case involving a 72-year-old male with a history of paraganglioma of the neck. He had been experiencing bilateral shoulder pain, neck pain and weakness in the upper extremities for more than six months. Magnetic resonance imaging of the cervical spine revealed a metastasis at C4 with severe vertebral body destruction. To avoid serious complications associated with surgical resection, CyberKnife® radiosurgery (Accuray, Inc., Sunnyvale, CA, USA) was performed on the parapharyngeal and cervical lesions. A secondary surgery, which involved a posterior laminectomy at C3-6 and posterior fusion at C1-T1, was performed two weeks after the radiosurgery. A histological examination of the surgical specimen demonstrated a malignant paraganglioma. The patient regained strength in all extremities in the postoperative field, and his pain was dramatically reduced. A magnetic resonance imaging study performed three months after the surgery showed a reduced tumor size and spinal cord decompression. Conclusion This case study is the first report of a patient with symptomatic cervical metastasis of a malignant paraganglioma treated with a combination of radiosurgery and posterior spinal surgery. Although the optimal treatment for these conditions remains unclear, concomitant treatment with radiosurgery and reconstructive surgery appeared to be both safe and effective in this challenging case. PMID:24289190
A universal spine tester for in vitro experiments with muscle force simulation
H.-J. Wilke; L. Claes; H. Schmitt; S. Wolf
Summary We report a new apparatus to determine the quasistatic, three-dimensional, load-displacement characteristics of spines including muscle forces. The loading frame can be adapted to mono- and polysegmental specimens from the lumbar or cervical spine as well as to entire spines. Three force and three moment components can be applied in either direction individually or in combination with no constraint
Subsidence of stand-alone cervical cages in anterior interbody fusion: warning
Erol Gercek; Vincent Arlet; Josee Delisle; Dante Marchesi
Anterior cervical decompression and fusion with anterior plating of the cervical spine is a well-accepted treatment for cervical radiculopathy. Recently, to minimise the extent of surgery, anterior interbody fusion with cages has become more common. While there are numerous reports on the primary stabilising effects of the different cervical cages, little is known about the subsidence behaviour of such cages
CAT scan - lumbar spine; Computed axial tomography scan - lumbar spine; Computed tomography scan - lumbar spine; CT - lower back ... stopping.) A computer creates separate images of the spine area, called slices. These images can be stored, ...
Two different courses of impaired cervical kinaesthesia following a whiplash injury. A one-year prospective study.
Oddsdottir, Gudny Lilja; Kristjansson, Eythor
A longitudinal study was conducted to observe persons with neck pain after motor vehicle collisions. The aims were to reveal the prospective development of cervical kinaesthesia and to investigate the association between the test results and self-reported pain and disabilities. Two different cervical kinaesthetic tests, the Fly test and the Head-Neck Relocation test, measured movement control and the relocation accuracy of the cervical spine, respectively. Self-assessment measures included pain intensity (VAS), neck pain and disability (NDI), fear of re-injury (TAMPA) and psychological distress (GHQ-28). Seventy-four subjects entered the study, but 47 were eligible, as they participated in all 4 measurements at 1, 3, 6 and 12 months post-collision. According to the performances on the two kinaesthetic tests, the subjects could be classified into improvement and non-improvement groups, respectively. The result revealed, for the first time, two different courses of deficient cervical kinaesthesia. About half of the participants showed significant deteriorating performances in both kinaesthetic tests throughout the year (p < 0.002), while the other half improved their performances (p < 0.02). Generally, the relationships between the kinaesthetic tests and the self-assessment scores were not significant, irrespective of the performances on the two kinaesthetic tests. Accordingly, the results of the questionnaires correlated poorly or weakly with the kinaesthetic test results at all assessment points. The need for developing a new questionnaire, capturing the symptoms prevalent in patients with neck pain and cervical sensorimotor impairments is urgent. What determines the two different kinaesthetic courses need to be scrutinised in future research. PMID:21955671
Concomitant lower thoracic spine disc disease in lumbar spine MR imaging studies
Estanislao Arana; Luis Martí-Bonmatí; Rosa Dosdá; Enrique Mollá
. Our objective was to study the coexistence of lower thoracic-spine disc changes in patients with low back pain using a large\\u000a field of view (FOV) in lumbar spine MR imaging. One hundred fifty patients with low back pain were referred to an MR examination.\\u000a All patients were studied with a large FOV (27 cm), covering from the coccyx to at
Inclusion of Mechanical Diagnosis and Therapy (MDT) in the Management of Cervical Radiculopathy: A Case Report
Schenk, Ronald; Bhaidani, Talisha; Melissa, Boswell; Kelley, James; Kruchowsky, Timothy
Various interventions are used by physical therapists to treat neck conditions. Treatments may include exercises based on a direction of preference, cervical spine stabilization, neuromobilization, or traction. The purpose of this case study was to describe the use of mechanical diagnosis and therapy (MDT) in the management of a patient diagnosed with cervical radiculopathy. The case study involved a 39-year-old male (subject), classified with cervical derangement, hypermobility, and adverse neural tension. The subject's intervention included MDT, deep neck flexor muscle strengthening, and neuromobilization. This subject's scores on the Neck Disability Index, Numerical Pain Rating Scale (NPRS), and range of motion were assessed at initial examination, discharge, and 3-month follow-up. The subject improved on all outcome measures and was discharged after four visits with a NPRS of 0/10. Percent improvement per visit was 17.5%. This case describes a positive outcome for a patient diagnosed with cervical radiculopathy in which MDT, deep neck flexor strengthening, and neuromobilization were used as an alternative to cervical traction. PMID:19119376
Are cervical multifidus muscles active during whiplash and startle? An initial experimental study
Siegmund, Gunter P; Blouin, Jean-Sébastien; Carpenter, Mark G; Brault, John R; Inglis, J Timothy
Background The cervical multifidus muscles insert onto the lower cervical facet capsular ligaments and the cervical facet joints are the source of pain in some chronic whiplash patients. Reflex activation of the multifidus muscle during a whiplash exposure could potentially contribute to injuring the facet capsular ligament. Our goal was to determine the onset latency and activation amplitude of the cervical multifidus muscles to a simulated rear-end collision and a loud acoustic stimuli. Methods Wire electromyographic (EMG) electrodes were inserted unilaterally into the cervical multifidus muscles of 9 subjects (6M, 3F) at the C4 and C6 levels. Seated subjects were then exposed to a forward acceleration (peak acceleration 1.55 g, speed change 1.8 km/h) and a loud acoustic tone (124 dB, 40 ms, 1 kHz). Results Aside from one female, all subjects exhibited multifidus activity after both stimuli (8 subjects at C4, 6 subjects at C6). Neither onset latencies nor EMG amplitude varied with stimulus type or spine level (p > 0.13). Onset latencies and amplitudes varied widely, with EMG activity appearing within 160 ms of stimulus onset (for at least one of the two stimuli) in 7 subjects. Conclusion These data indicate that the multifidus muscles of some individuals are active early enough to potentially increase the collision-induced loading of the facet capsular ligaments. PMID:18534030
Occipito-Cervical Fusion with the Cervical Cotrel-Dubousset Rod System
V. Heidecke; N. G. Rainov; W. Burkert
Summary ?Diseases and conditions which cause instability of the cranio-cervical junction and the adjacent upper cervical spine are\\u000a relatively common and potentially life-threatening. Direct internal occipito-cervical fusion (OCF) is a modern means of surgical\\u000a treatment in such cases, and has some advantages over simple immobilization of the affected segments. The present study was\\u000a designed to evaluate surgical handling, results, and complications
The Out-of-Hospital Validation of the Canadian C-Spine Rule by Paramedics
Christian Vaillancourt; Ian G. Stiell; Tammy Beaudoin; Justin Maloney; Andrew R. Anton; Paul Bradford; Ed Cain; Andrew Travers; Matt Stempien; Martin Lees; Doug Munkley; Erica Battram; Jane Banek; George A. Wells
Study objective: We designed the Canadian C-Spine Rule for the clinical clearance of the cervical spine, without need for diagnostic imaging, in alert and stable trauma patients. Emergency physicians previously validated the Canadian C-Spine Rule in 8,283 patients. This study prospectively evaluates the performance characteristics, reliability, and clinical sensibility of the Canadian C-Spine Rule when used by paramedics in the
Development and application of a non invasive image matching method to study spine biomechanics
Wang, Shaobai
Research on spine biomechanics is critical to understand pathology such as degenerative changes and low back pain. However, current study on in-vivo spine biomechanics is limited by the complex anatomy and invasive ...
Immediate Effects of the Audible Pop From a Thoracic Spine Thrust Manipulation on the Autonomic Nervous System and Pain: A Secondary Analysis of a Randomized Clinical Trial
Rob Sillevis; Joshua Cleland
PurposeThis study investigated the immediate effects of audible joint sounds following a supine T3-T4 spinal thrust manipulation on the autonomic nervous system activity using a fully automated pupillometry system in patients with chronic neck pain. An additional aim was to determine if audible sounds as perceived by the therapist were associated with the reduction of pain following manipulation.
Effect of head and limb orientation on trunk muscle activation during abdominal hollowing in chronic low back pain
Background Individuals with chronic low back pain (CLBP) have altered activations patterns of the anterior trunk musculature when performing the abdominal hollowing manśuvre (attempt to pull umbilicus inward and upward towards the spine). There is a subgroup of individuals with CLBP who have high neurocognitive and sensory motor deficits with associated primitive reflexes (PR). The objective of the study was to determine if orienting the head and extremities to positions, which mimic PR patterns would alter anterior trunk musculature activation during the hollowing manoeuvre. Methods This study compared surface electromyography (EMG) of bilateral rectus abdominis (RA), external oblique (EO), and internal obliques (IO) of 11 individuals with CLBP and evident PR to 9 healthy controls during the hollowing manoeuvre in seven positions of the upper quarter. Results Using magnitude based inferences it was likely (>75%) that controls had a higher ratio of left IO:RA activation with supine (cervical neutral), asymmetrical tonic neck reflex (ATNR) left and right, right cervical rotation and cervical extension positions. A higher ratio of right IO:RA was detected in the cervical neutral and ATNR left position for the control group. The CLBP group were more likely to show higher activation of the left RA in the cervical neutral, ATNR left and right, right cervical rotation and cervical flexion positions as well as in the cervical neutral and cervical flexion position for the right RA. Conclusions Individuals with CLBP and PR manifested altered activation patterns during the hollowing maneuver compared to healthy controls and that altering cervical and upper extremity position can diminish the group differences. Altered cervical and limb positions can change the activation levels of the IO and EO in both groups. PMID:24558971
The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma
Ian G. Stiell; Catherine M. Clement; R. Douglas McKnight; Robert Brison; Michael J. Schull; Brian H. Rowe; James R. Worthington; Mary A. Eisenhauer; Daniel Cass; Gary Greenberg; Iain MacPhail; Jonathan Dreyer; Jacques S. Lee; Glen Bandiera; Mark Reardon; Brian Holroyd; Howard Lesiuk; George A. Wells
background The Canadian C-Spine (cervical-spine) Rule (CCR) and the National Emergency X-Radi- ography Utilization Study (NEXUS) Low-Risk Criteria (NLC) are decision rules to guide the use of cervical-spine radiography in patients with trauma. It is unclear how the two decision rules compare in terms of clinical performance. methods We conducted a prospective cohort study in nine Canadian emergency departments comparing
Revision of anterior cervical pseudoarthrosis with anterior allograft fusion and plating.
Coric, D; Branch, C L; Jenkins, J D
Anterior cervical discectomy and fusion is an efficacious procedure used to treat a variety of cervical spinal disorders, including spondylosis, myelopathy, herniated discs, trauma, and degenerative disc disease. Pseudarthrosis, or failure of fusion, may be the most common complication of spinal fusion procedures. Nineteen consecutive patients with symptomatic pseudarthrosis following failed anterior cervical fusions were treated with anterior cervical revision using iliac crest allografts and either the Cervical Spine Locking Plate system (10 patients) or the Trapezial Osteosynthetic Plate system (nine patients). The mean age of the nine men and 10 women undergoing treatment was 49.1 years (range 25-72 years). Eleven patients (57.9%) exhibited pseudarthrosis at one level, six (31.5%) at two levels, and two (10.5%) at three levels. The indications for revision were intractable neck pain with radiculopathy (17 patients) or myelopathy (two patients), with evidence of pseudarthrosis on plain cervical radiography as well as computerized tomography (CT) or single-photon emission computerized tomography (SPECT) scanning, or both. All eight patients evaluated with SPECT showed increased focal uptake consistent with pseudarthrosis, which was subsequently confirmed intraoperatively in all eight. The average follow-up period was 22.4 months (range 12-42 months). Solid osseous fusion was achieved over all 28 levels in all 18 patients available for follow-up review (100%). One patient died 4 months postoperatively from myocardial infarction related to preexisting coronary artery disease. There were no intraoperative complications; postoperatively, two patients (10.5%) experienced transient hoarseness. Anterior revision of failed cervical fusions using allograft interbody fusion material and anterior plating is a safe and efficacious procedure. In this series, the use of allografts avoided donor site morbidity without adversely affecting fusion rates. Rigid internal fixation was achieved by means of anterior plating without increasing surgical morbidity rates. The SPECT imaging technique has the potential to reliably confirm the diagnosis of pseudarthrosis. PMID:9171175
Occipito-cervical fusion using posterior titanium plates
I. H. Lieberman; J. K. Webb
Occipito-cervical fusion may be indicated for instability of the occipito-cervical junction or atlanto-axial spine secondary\\u000a to a wide spectrum of pathology. Many techniques exist to stabilize the spine until fusion is achieved. Recent reports of\\u000a plate fixation have been favorable. In this study we set out to determine the effectiveness and advantages of titanium plate\\u000a fixation when used to stabilize
Unusual Clinical Presentations of Cervical or Lumbar Dorsal Ramus Syndrome
Kim, Shin Jae; Ko, Myeong Jin; Lee, Young Seok; Kim, Young Baeg; Chung, Chan
Objective Patients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS. Methods This study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years. We diagnosed by using double diagnostic blocks for medial branches of dorsal rami of cervical or lumbar spine with 1% lidocaine or 0.5% bupivacaine for each block with an interval of more than 1 week between the blocks. Greater than 80% reduction of the symptoms, including unusual symptoms, was considered as a positive response. The patients with a positive response were treated with radiofrequencyneurotomy. Results The number of patients diagnosed with CDRS and LDRS was 86 and 120, respectively. Nine patients (10.5%) in the CDRS group had unusual symptoms, including 4 patients with motor weakness of the arm, 3 patients with tremors, and rotatory torticollis in 2 patients. Ten patients (8.3%) in the LDRS group showed unusual symptoms, including 7 patients with motor weakness of leg, 2 patients with leg tremor, and urinary incontinence in 1 patient. All the unusual symptoms combined with CDRS or LDRS were resolved after treatment. Conclusion It seems that the clinical presentationssuch as motor weakness, tremor, urinary incontinence without any other etiologic origin need to be checked for unusual symptoms of CDRS or LDRS. PMID:25110484
Whiplash causes increased laxity of cervical capsular ligament
Ivancic, Paul C.; Ito, Shigeki; Tominaga, Yasuhiro; Rubin, Wolfgang; Coe, Marcus P.; Ndu, Anthony B.; Carlson, Erik J.; Panjabi, Manohar M.
Background Previous clinical studies have identified the cervical facet joint, including the capsular ligaments, as sources of pain in whiplash patients. The goal of this study was to determine whether whiplash caused increased capsular ligament laxity by applying quasi-static loading to whiplash-exposed and control capsular ligaments. Methods A total of 66 capsular ligament specimens (C2/3 to C7/T1) were prepared from 12 cervical spines (6 whiplash-exposed and 6 control). The whiplash-exposed spines had been previously rear impacted at a maximum peak T1 horizontal acceleration of 8 g. Capsular ligaments were elongated at 1 mm/s in increments of 0.05 mm until a tensile force of 5 N was achieved and subsequently returned to neutral position. Four pre-conditioning cycles were performed and data from the load phase of the fifth cycle were used for subsequent analyses. Ligament elongation was computed at tensile forces of 0, 0.25, 0.5, 0.75, 1.0, 2.5, and 5.0 N. Two factor, non-repeated measures ANOVA (P<0.05) was performed to determine significant differences in the average ligament elongation at tensile forces of 0 and 5 N between the whiplash-exposed and control groups and between spinal levels. Findings Average elongation of the whiplash-exposed capsular ligaments was significantly greater than that of the control ligaments at tensile forces of 0 and 5 N. No significant differences between spinal levels were observed. Interpretation Capsular ligament injuries, in the form of increased laxity, may be one component perpetuating chronic pain and clinical instability in whiplash patients. PMID:17959284
Pigmented villonodular synovitis of the thoracic spine.
Roguski, Marie; Safain, Mina G; Zerris, Vasilios A; Kryzanski, James T; Thomas, Christine B; Magge, Subu N; Riesenburger, Ron I
Pigmented villonodular synovitis (PVNS) is a proliferative lesion of the synovial membranes. Knees, hips, and other large weight-bearing joints are most commonly affected. PVNS rarely presents in the spine, in particular the thoracic segments. We present a patient with PVNS in the thoracic spine and describe its clinical presentation, radiographic findings, pathologic features, and treatment as well as providing the first comprehensive meta-analysis and review of the literature on this topic, to our knowledge. A total of 28 publications reporting 56 patients were found. The lumbar and cervical spine were most frequently involved (40% and 36% of patients, respectively) with infrequent involvement of the thoracic spine (24% of patients). PVNS affects a wide range of ages, but has a particular predilection for the thoracic spine in younger patients. The mean age in the thoracic group was 22.8 years and was significantly lower than the cervical and lumbar groups (42.4 and 48.6 years, respectively; p=0.0001). PVNS should be included in the differential diagnosis of osteodestructive lesions of the spine, especially because of its potential for local recurrence. The goal of treatment should be complete surgical excision. Although the pathogenesis is not clear, mechanical strain may play an important role, especially in cervical and lumbar PVNS. The association of thoracic lesions and younger age suggests that other factors, such as neoplasia, derangement of lipid metabolism, perturbations of humoral and cellular immunity, and other undefined patient factors, play a role in the development of thoracic PVNS. PMID:24938389
Signaling in dendritic spines and spine microdomains
Chen, Yao; Sabatini, Bernardo L.
The specialized morphology of dendritic spines creates an isolated compartment that allows for localized biochemical signaling. Recent studies have revealed complexity in the function of the spine head as a signaling domain and indicate that (1) the spine is functionally subdivided into multiple independent microdomains and (2) not all biochemical signals are equally compartmentalized within the spine. Here we review these findings as well as the developments in fluorescence microscopy that are making possible direct monitoring of signaling within spines and, in the future, within sub-spine microdomains. PMID:22459689
Congenital Insensitivity to Pain: A Case Report and Review of the Literature
Oberoi, Kinsi; Grewal, Raji P.
Congenital insensitivity to pain (CIP) is a rare autosomal recessive genetic disease caused by mutations in the SCN9A gene. We report a patient with the clinical features consistent with CIP in whom we detected a novel homozygous G2755T mutation in exon 15 of this gene. Routine electrophysiological studies are typically normal in patients with CIP. In our patient, these studies were abnormal and could represent the consequences of secondary complications of cervical and lumbosacral spine disease and associated severe Charcot's joints. PMID:25309764
Cervical Spine Immobilization Device for Emergency Response
, and large; but a continuously adjustable device that is intuitive and easy to apply is desired. The design of the head. The aluminum plate is coated with a 2" thick layer of foam (open- cell Polyurethane) for better conformability and comfort to the patient's head. The bottom of the fingers is coated with Neoprene (1/16", 40A
Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain
Benjamin K. Brooks; Samuel L. Southam; Gary W. Mlady; Jeremy Logan; Matthew Rosett
Objective To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related\\u000a prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back\\u000a pain.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods The records of 2,555 patients who had undergone abdominal and pelvic CT in 2008 were reviewed electronically. In order
NASA Technical Reports Server (NTRS)
2006-01-0126 June 2006 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a spine of material exposed in the Sisyphi Planum region of Mars. Gullies can be seen on the deeply-shadowed ridge slope. Mass movement (landsliding) has contributed to the erosion of this ridge and the creation of the apron of talus that surrounds it. Location near: 70.7oS, 357.0oW Image width: 3 km (1.9 mi) Illumination from: upper left Season: Southern Summer
Position of the cervical vertebrae during helmet removal and cervical collar application in football and hockey.
Prinsen, R K; Syrotuik, D G; Reid, D C
There is lack of consensus among prehospital personnel (athletic therapists, paramedics, sport physiotherapists) concerning specific aspects of initial care and assessment of injured athletes presenting signs and symptoms of a cervical spine injury (CSI). In instances of serious injury involving the head and/or spine, complicated by altered levels of consciousness, protective equipment such as helmets and shoulder pads may provide a hinderance to prompt, safe and efficient management. Specifically, there is disagreement concerning the need or advisability of removing protective head gear, as in the case of football and hockey athletes. Using the technique of fluoroscopy, the cervical spine displacement of 21 male football and hockey athletes was determined while wearing protective shoulder pads and protective head equipment at the following times (a) during helmet removal, (b) during cervical collar application, and (c) as the helmetless head was allowed to rest. Subsequent frame-by-frame video arthokinematic analysis, using computer-assisted digitization, showed significant alterations in the position of adjacent cervical vertebrae during helmet removal, cervical collar application, and head rest. Results suggest that stabilization and transportation of football and hockey athletes with suspected CSI in their respective protective equipment is recommended in order to reduce the risk of further trauma by unnecessary cervical spine motion. PMID:7670970
Vertebral Arteriovenous Fistula Presenting as Cervical Myelopathy: A Rapid Recovery with Balloon Embolization
Modi, Manish, E-mail: firstname.lastname@example.com [PGIMER, Department of Neurology (India); Bapuraj, J. Rajiv [University Hospital, Department of Neuroradiology (United States); Lal, Anupam [PGIMER, Department of Radiodiagnosis (India); Prabhakar, S. [PGIMER, Department of Neurology (India); Khandelwal, N. [PGIMER, Department of Radiodiagnosis (India)
A 24-year-old male presented with progressive cervical myelopathy of 2 months' duration. Magnetic resonance imaging of the cervical spine and angiography revealed a large arteriovenous fistula arising from the left vertebral artery. The present case highlights the clinical features and dramatic recovery following endovascular balloon occlusion of a giant cervical arteriovenous fistula.
MR imaging of the spine in epidermal nevus syndrome.
Booth, Timothy N; Rollins, Nancy K
We report two cases of epidermal nevus syndrome (ENS) involving the spine. MR imaging of the spine demonstrated intraspinal lipomas in both cases. Abnormal, enhancing, enlarged cervical and lumbosacral nerve roots were present in one patient. Spinal imaging for patients with ENS may help in the diagnosis of subtle intracranial manifestations, as it did in both of our cases. ENS has features similar to those of other neurocutaneous syndromes, such as neurofibromatosis type 1 and encephalocraniocutaneous lipomatosis. PMID:12372757
Neurophysiological and biomechanical characterization of goat cervical facet joint capsules.
Lu, Ying; Chen, Chaoyang; Kallakuri, Srinivasu; Patwardhan, Ajit; Cavanaugh, John M
Cervical facet joints have been implicated as a major source of pain after whiplash injury. We sought to identify facet joint capsule receptors in the cervical spine and quantify their responses to capsular deformation. The response of mechanosensitive afferents in C5-C6 facet joint capsules to craniocaudal stretch (0.5 mm/s) was examined in anaesthetized adult goats. Capsular afferents were characterized into Group III and IV based on their conduction velocity. Two-dimensional strains across the capsules during stretch were obtained by a stereoimaging technique and finite element modeling. 17 (53%) Group III and 14 (56%) Group IV afferents were identified with low strain thresholds of 0.107+/-0.033 and 0.100+/-0.046. A subpopulation of low-strain-threshold afferents had discharge rate saturation at the strains of 0.388+/-0.121 (n=9, Group III) and 0.341+/-0.159 (n=9, Group IV). Two (8%) Group IV units responded only to high strains (0.460+/-0.170). 15 (47%) Group III and 9 (36%) Group IV units could not be excited even by noxious capsular stretch. Simple linear regressions were conducted with capsular load and principal strain as independent variables and neural response of low-strain-threshold afferents as the dependent variable. Correlation coefficients (R2) were 0.73+/-0.11 with load, and 0.82+/-0.12 with principal strain. The stiffness of the C5-C6 capsules was 16.8+/-11.4 N/mm. Our results indicate that sensory receptors in cervical facet joint capsules are not only capable of signaling a graded physiological mechanical stimulus, but may also elicit pain sensation under excessive deformation. PMID:16022990
Cervical Spinal Epidural Hematoma Following Cervical Posterior Laminoforaminotomy
Choi, Jeong Hoon; Lee, Sang-Ho
A 65-year-old man who had lateral cervical disc herniation underwent cervical posterior laminoforaminotomy at C5-6 and C6-7 level right side. During the operation, there was no serious surgical bleeding event. After operation, he complained persistent right shoulder pain and neck pain. Repeated magnetic resonance image (MRI) showed diffuse cervical epidural hematoma (EDH) extending from C5 to T1 level right side and spinal cord compression at C5-6-7 level. He underwent exploration. There was active bleeding at muscular layer. Muscular active bleeding was controlled and intramuscular hematoma was removed. The patient's symptom was reduced after second operation. Symptomatic postoperative spinal EDH requiring reoperation is rare. Meticulous bleeding control is important before wound closure. In addition, if patient presents persistent or aggravated pain after operation, rapid evaluation using MRI and second look operation is needed as soon as possible. PMID:23560180
Low back pain as the presenting sign in a patient with primary extradural melanoma of the thoracic spine - A metastatic disease 17 Years after complete surgical resection
Primary spinal melanomas are extremely rare lesions. In 1906, Hirschberg reported the first primary spinal melanoma, and since then only 40 new cases have been reported. A 47-year-old man was admitted suffering from low back pain, fatigue and loss of body weight persisting for three months. He had a 17-year-old history of an operated primary spinal melanoma from T7-T9, which had remained stable for these 17 years. Routine laboratory findings and clinical symptoms aroused suspicion of a metastatic disease. Multislice computed tomography and magnetic resonance imaging revealed stage-IV melanoma with thoracic, abdominal and skeletal metastases without the recurrence of the primary process. Transiliac crest core bone biopsy confirmed the diagnosis of metastatic melanoma. It is important to know that in all cases of back ore skeletal pain and unexplained weight loss, malignancy must always be considered in the differential diagnosis, especially in the subjects with a positive medical history. Patients who have back, skeletal, or joint pain that is unresponsive to a few weeks of conservative treatment or have known risk factors with or without serious etiology, are candidates for imaging studies. The present case demonstrates that complete surgical resection alone may result in a favourable outcome, but regular medical follow-up for an extended period, with the purpose of an early detection of a metastatic disease, is highly recommended. PMID:22093436
An unusual case of high cervical spinal cord injury.
Velnar, Tomaz; Smrkolj, Vladimir; Cerovic, Ognjen; Pecaric Meglic, Nuska; Tauscher, Gloria
Isolated spinal cord injuries can rarely be found in patients with no traumatic radiological abnormalities of the spine. Stenoses of the medullary canal and degeneration of cervical spine are the predisposing factors. A case report of a 68-year-old patient is described, who developed quadriplegia with cardiac arrest due to isolated cervical spinal cord injury while jumping on a trampoline. Compressions of the spinal cord with intramedullary and epidural haemorrhage between vertebrae C3 and C6 were observed with no traumatic radiological abnormalities of the spine skeleton. PMID:20602295
... the place where a baby grows during pregnancy. Cervical cancer is caused by a virus called HPV. ... for a long time, or have HIV infection. Cervical cancer may not cause any symptoms at first. ...
Hydrogen sulfide inhibits opioid withdrawal-induced pain sensitization in rats by down-regulation of spinal calcitonin gene-related peptide expression in the spine.
Yang, Hai-Yu; Wu, Zhi-Yuan; Bian, Jin-Song
Hyperalgesia often occurs in opioid-induced withdrawal syndrome. In the present study, we found that three hourly injections of DAMGO (a ?-opioid receptor agonist) followed by naloxone administration at the fourth hour significantly decreased rat paw nociceptive threshold, indicating the induction of withdrawal hyperalgesia. Application of NaHS (a hydrogen sulfide donor) together with each injection of DAMGO attenuated naloxone-precipitated withdrawal hyperalgesia. RT-PCR and Western blot analysis showed that NaHS significantly reversed the gene and protein expression of up-regulated spinal calcitonin gene-related peptide (CGRP) in naloxone-treated animals. NaHS also inhibited naloxone-induced cAMP rebound and cAMP response element-binding protein (CREB) phosphorylation in rat spinal cord. In SH-SY5Y neuronal cells, NaHS inhibited forskolin-stimulated cAMP production and adenylate cyclase (AC) activity. Moreover, NaHS pre-treatment suppressed naloxone-stimulated activation of protein kinase C (PKC) ?, Raf-1, and extracellular signal-regulated kinase (ERK) 1/2 in rat spinal cord. Our data suggest that H2S prevents the development of opioid withdrawal-induced hyperalgesia via suppression of synthesis of CGRP in spine through inhibition of AC/cAMP and PKC/Raf-1/ERK pathways. PMID:24824948
Visualizing the spine using anatomical knowledge
NASA Astrophysics Data System (ADS)
Cornelius, Craig W.; Fellingham, Linda L.
In vivo anatomy is now routinely displayed as 2-D and 3-D images obtained from Computed X-ray Tomograpy (CT), Magnetic Resonance Imaging (MRI), and other diagnostic modalities. Most current medical visualization methods rely on pixel intensities to segment the data into tissues. However, structural features must be differentiated by a human operator, and geometric measurements of the anatomy are tedious and error prone to compute. This paper describes processing and imaging methods to aid the interpretation of CT studies of the spine. These procedures incorporate knowledge of the symmetry, shapes, and spatial relationships of vertebrae to locate the spinal cord and major components of vertebral bone from CT slices of the spine and automatically compute anatomical measurements. Results of these methods are shown as applied to the cervical (neck) and lumbar (lower back) regions of the spine.
Marek Gzik
This paper presents modelling process and numerical analysis of human body behaviour during accidents in contact sports and its consequences for human cervical and lumbar spine. The researches contain creation of model which enables human body motion analysis in a situation corresponding to real falls with simultaneous analysis of internal physiological phenomena in human spine. The model of falling man
Malignant Rhabdoid Tumor of the Spine in an Infant: Case Report and Review of the Literature
Jared S. Fridley; Roukoz B. Chamoun; William E. Whitehead; Daniel J. Curry; Thomas G. Luerssen; Adekunle Adesina; Andrew Jea
Malignant rhabdoid tumors of the spine are rare pediatric neoplasms that have a poor prognosis. The histological, ultrastructural, and immunohistochemical features are essential elements used in their diagnosis. We report the case of a malignant rhabdoid tumor of the cervical spine in a 13-month-old infant. Tumor cells were vimentin positive with prominent nucleoli indented by eosinophilic cytoplasmic inclusions containing intermediate
The Fullendoscopic Anterior Cervical Fusion: A New Horizon for Selective Percutaneous Endoscopic Cervical Decompression
S. Hellinger
\\u000a As a bridge between open and percutaneous therapy, endoscopy of the cervical spine started to be used at the beginning of\\u000a the 1990s, following good experiences on the lumbar spine. The principle of microsurgery is combined with the minimally invasive\\u000a principles by bringing the optical level to the forefront of pathology. Access morbidity has been significantly reduced by\\u000a the percutaneous
The relationship of cervical joint position error to balance and eye movement disturbances in persistent whiplash
Julia Treleaven; Gwendolen Jull; Nancy LowChoy
Cervical joint position error (JPE) has been used as a measure of cervical afferent input to detect disturbances in sensori-motor control as a possible contributor to a neck pain syndrome. This study aimed to investigate the relationship between cervical JPE, balance and eye movement control. It was of particular interest whether assessment of cervical JPE alone was sufficient to signal
Biomechanical analysis of the anterior cervical fusion.
Fernandes, P C; Fernandes, P R; Folgado, J O; Levy Melancia, J
This paper presents a biomechanical analysis of the cervical C5-C6 functional spine unit before and after the anterior cervical discectomy and fusion. The aim of this work is to study the influence of the medical procedure and its instrumentation on range of motion and stress distribution. First, a three-dimensional finite element model of the lower cervical spine is obtained from computed tomography images using a pipeline of image processing, geometric modelling and mesh generation software. Then, a finite element study of parameters' influence on motion and a stress analysis at physiological and different post-operative scenarios were made for the basic movements of the cervical spine. It was confirmed that the results were very sensitive to intervertebral disc properties. The insertion of an anterior cervical plate influenced the stress distribution at the vertebral level as well as in the bone graft. Additionally, stress values in the graft decreased when it is used together with a cage. PMID:21806410
Quantification of Acute Neck Pain Following Whiplash Injury by Computer-Aided Pressure Algesimetry
P Stude; K Nebel; C Lüdecke; H Wiese; H-C Diener; M Keidel
Until now the clinical investigation of cervical pain due to whiplash injury is mainly based on finger palpation. The present study introduces a PC-interactive pressure algesimetry to standardize cervical pain measurement. Pressure pain scores of the splenius and trapezius muscles of 23 patients with an acute cervical syndrome after whiplash injury were compared to those of 24 healthy subjects. The
Solid radiographic fusion with a nonconstrained device 5 years after cervical arthroplasty.
Heary, Robert F; Goldstein, Ira M; Getto, Katarzyna M; Agarwal, Nitin
Cervical disc arthroplasty (CDA) has been gaining popularity as a surgical alternative to anterior cervical discectomy and fusion. Spontaneous fusion following a CDA is uncommon. A few anecdotal reports of heterotrophic ossification around the implant sites have been noted for the BRYAN, ProDisc-C, Mobi-C, PRESTIGE, and PCM devices. All CDA fusions reported to date have been in devices that are semiconstrained. The authors reported the case of a 56-year-old man who presented with left C-7 radiculopathy and neck pain for 10 weeks after an assault injury. There was evidence of disc herniation at the C6-7 level. He was otherwise healthy with functional scores on the visual analog scale (VAS, 4.2); neck disability index (NDI, 16); and the 36-item short form health survey (SF-36; physical component summary [PSC] score 43 and mental component summary [MCS] score 47). The patient underwent total disc replacement in which the DISCOVER Artificial Cervical Disc (DePuy Spine, Inc.) was used. The patient was seen at regular follow-up visits up to 60 months. At his 60-month follow-up visit, he had complete radiographic fusion at the C6-7 level with bridging trabecular bone and no motion at the index site on dynamic imaging. He was pain free, with a VAS score of 0, NDI score of 0, and SF-36 PCS and MCS scores of 61 and 55, respectively. Conclusions This is the first case report that identifies the phenomenon of fusion around a nonconstrained cervical prosthesis. Despite this unwanted radiographic outcome, the patient's clinical outcome was excellent. PMID:25303618
Your backbone, or spine, is made up of 26 bone discs called vertebrae. The vertebrae protect your spinal cord and allow you to ... of problems can change the structure of the spine or damage the vertebrae and surrounding tissue. They ...
Spinal CT; CT - lumbosacral spine ... table that slides into the center of the CT scanner. You will need to lie on your ... creates a clearer image. In other cases, a CT of the lumbosacral spine may be done after ...
Reduction mammoplasty improves body posture and decreases the perception of pain
Goulart, Remi; Detanico, Daniele; Vasconcellos, Roberta Pires; Schütz, Gustavo Ricardo; dos Santos, Saray Giovana
Women with hypertrophic breasts often experience body pain and posture problems, which tend to be reduced or even eliminated after reduction mammoplasty. The present study aimed to analyze the effects of reduction mammoplasty on anthropometric variables, body posture and pain in women with breast hypertrophy. Eleven women (mean [± SD] age 31.3±10.4 years) participated in the present study. Anthropometric variables, body posture and pain perception were evaluated pretest, and 60 (post60) and 90 (post90) days after reduction mammoplasty. Commercially available posture analysis software was used to analyze the following variables: acromial horizontal alignment (AHA), angle between acromial and anterior superior iliac spines (A-AAIS), vertical alignment of right (R) and left (L) trunk (VAT), vertical alignment of R and L body (VAB) and horizontal alignment of R and L pelvis (HAP). Descriptive statistics and ANOVA for repeated measures were used, and effect sizes (ES) were measured; the level of significance was set at P<0.05. There were no significant differences in anthropometric variables among the assessments. Only HAP-R showed a significant decrease; however, when analyzed, ES, VAT- L and HAP- L in post60, and VAT-R, VAT-L, HAP-R, HAP-L and VAB-L in post90 showed large ES after mammoplasty (ES>0.70). There were significant reductions in pain at post60 and post90 in the neck, cervical spine, back, shoulder and arm (P<0.05). Following mammoplasty, an improvement in body posture, primarily in the alignment of shoulders, trunk and pelvis, and a decrease in pain in the upper limbs and spine, were observed. PMID:24431933
Reduction mammoplasty improves body posture and decreases the perception of pain.
Goulart, Remi; Detanico, Daniele; Vasconcellos, Roberta Pires; Schütz, Gustavo Ricardo; Dos Santos, Saray Giovana
Women with hypertrophic breasts often experience body pain and posture problems, which tend to be reduced or even eliminated after reduction mammoplasty. The present study aimed to analyze the effects of reduction mammoplasty on anthropometric variables, body posture and pain in women with breast hypertrophy. Eleven women (mean [± SD] age 31.3±10.4 years) participated in the present study. Anthropometric variables, body posture and pain perception were evaluated pretest, and 60 (post60) and 90 (post90) days after reduction mammoplasty. Commercially available posture analysis software was used to analyze the following variables: acromial horizontal alignment (AHA), angle between acromial and anterior superior iliac spines (A-AAIS), vertical alignment of right (R) and left (L) trunk (VAT), vertical alignment of R and L body (VAB) and horizontal alignment of R and L pelvis (HAP). Descriptive statistics and ANOVA for repeated measures were used, and effect sizes (ES) were measured; the level of significance was set at P<0.05. There were no significant differences in anthropometric variables among the assessments. Only HAP-R showed a significant decrease; however, when analyzed, ES, VAT- L and HAP- L in post60, and VAT-R, VAT-L, HAP-R, HAP-L and VAB-L in post90 showed large ES after mammoplasty (ES>0.70). There were significant reductions in pain at post60 and post90 in the neck, cervical spine, back, shoulder and arm (P<0.05). Following mammoplasty, an improvement in body posture, primarily in the alignment of shoulders, trunk and pelvis, and a decrease in pain in the upper limbs and spine, were observed. PMID:24431933
Lindhardt, Christian; Kristensen, Sřren
We describe the case of a 3-year-old girl with a cervical teratoma. Cervical teratomas are rare tumors in infancy and childhood, commonly presenting as large cervical masses and often diagnosed before birth. In the actual case the teratoma was present at birth but was very small and had a little pseudoduct, which was mistaken for a median cervical cyst. It is emphasized that knowledge of teratomas although often benign in infants and children is essential since they have a malignant potential. If detected early surgical removal is curative provided it is complete. PMID:12768909
Cervical myelopathy from retro-odontoid calcium pyrophosphate dihydrate mass: a case report.
Luksanapruksa, Panya; Chotivichit, Areesak; Wilartratsami, Sirichai
Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is one of the most common forms of crystal-associated arthropathy in the elderly. However, cervical spine is rarely affected, especially in upper cervical area. There have been previous reported cases of symptomatic retro-odontoid CPPD deposition disease in English literature but this case is the first reported in Thai patients. This is a case report of a 67-year-old man who presented with neck pain with progressive myelopathy. Neurologic examination demonstrated a cervical myelopathy with muscle weakness and sensory disturbance of both extremities. Imaging studies showed extradural retro-odontoid mass compressing the spinal cord. The patient underwent occiput to C3 fusion with plating, posterior arch of atlas resection, transoral odontoidectomy, and mass removal. Histological examination of the mass revealed fibrocartilage tissue and rhomboid shaped crystals that showed positive biferingent in polarized light microscopy consistent with CPPD crystals. After surgery, no complication was found, and his neurological function had improved. PMID:24350422
Vascular disease of the spine.
Munyon, Charles N; Hart, David J
Vascular insults to the spinal cord are substantially less common than their corresponding events in the brain; it has been estimated, for example, that spinal cord infarcts make up ?1% of ischemic events in the central nervous system. Although the public health burden of spinal cord injury remains severe, the majority of this burden stems from traumatic rather than vascular events. Still, vascular injuries in the spine are common enough and their consequences devastating enough that a familiarity with the pathophysiology, diagnosis, and treatment of the more common etiologies is essential to any practitioner of the clinical neurosciences. In this educational review, we will briefly outline the normal development and anatomy of the spinal vasculature, then focus on specific mechanisms of vascular injury to the spine. In particular, we will examine spontaneous and iatrogenic ischemic insults and their associated clinical syndromes, and then review vascular neoplasms and malformations of the spine with attention to the various management strategies that currently exist for these complex lesions. Finally, we will briefly address the future areas for exploration, including investigative avenues for neuroprotection, as well as the possible influence of atherosclerotic disease on spinal degenerative disease and low back pain. PMID:25970833
Cervical polyps are fingerlike growths on the lower part of the uterus that connects with the vagina ( ... The exact cause of cervical polyps is not known. They may occur with: An abnormal response to increased levels of the female hormone estrogen Chronic ...
Three-dimensional analysis of active cervical motion: the effect of age and gender
PH Trott; MJ Pearcy; SA Ruston; I Fulton; C Brien
Objective. To describe the effects of age and gender on three-dimensional (3D) active cervical spine motion.Design. This was a descriptive study. Background. This study expanded on previous investigations of age and gender effects on single plane motion of the cervical spine.Methods. Sixty female and 60 male asymptomatic, normal volunteers, aged between 20 and 59 years, were examined in a standardized
Acute experimentally induced neck pain does not affect fatigability of the peripheral biceps brachii muscle.
Hung, Laurie Y; Maracle, Emmalee; Srbely, John Z; Brown, Stephen H M
Evidence has shown that upper limb muscles peripheral to the cervical spine, such as the biceps brachii, can demonstrate functional deficits in the presence of chronic neck pain. However, few studies have examined how neck pain can affect the fatigability of upper limb muscles; therefore we were motivated to investigate the effects of acutely induced neuropathic neck pain on the fatigability of the biceps brachii muscle during isometric contraction to exhaustion. Topical capsaicin was used to induce neck pain in 11 healthy male participants. Surface EMG signals were recorded from the biceps brachii during an isometric elbow flexion fatigue task in which participants held a weight equivalent to 30% of their MVC until exhaustion. Two experimental sessions, one placebo and one capsaicin, were conducted separated by two days. EMG mean power frequency and average normalized activation values were calculated over the course of the fatigue task. In the presence of pain, there was no statistically significant effect on EMG parameters during fatigue of the biceps brachii. These results demonstrate that acutely induced neuropathic neck pain does not affect the fatigability, under the tested conditions, of the biceps brachii. PMID:24718930
Risk of cervical injuries in mixed martial arts
Kochhar, T; Back, D; Mann, B; Skinner, J
Background: Mixed martial arts have rapidly succeeded boxing as the world's most popular full contact sport, and the incidence of injury is recognised to be high. Objective: To assess qualitatively and quantitatively the potential risk for participants to sustain cervical spine and associated soft tissue injuries. Methods: Four commonly performed manoeuvres with possible risks to the cervical spine were analysed with respect to their kinematics, and biomechanical models were constructed. Results: Motion analysis of two manoeuvres revealed strong correlations with rear end motor vehicle impact injuries, and kinematics of the remaining two suggested a strong risk of injury. Mathematical models of the biomechanics showed that the forces involved are of the same order as those involved in whiplash injuries and of the same magnitude as compression injuries of the cervical spine. Conclusions: This study shows that there is a significant risk of whiplash injuries in this sport, and there are no safety regulations to address these concerns. PMID:15976168
Reuler, James B.
Low back pain is one of the most common and costly afflictions of our Society. The majority of adults will have at least one episode of acute low back pain that will likely resolve regardless of treatment. Lumbar spine radiographs are overused and there is little scientific support for many of the therapeutic interventions advocated. Even for those patients with symptomatic herniated disc, only a small fraction will ultimately require surgical intervention. PMID:2930949
Resection of an upper cervical aneurysmal bone cyst and spinal reconstruction using a midline mandibular osteotomy in a pediatric patient.
McDowell, Michael M; Hanft, Simon J; Greenberg, Sophie A; Rahmati, Rahmatullah; Carrao, Vincent; Eisig, Sidney; Anderson, Richard C E
The authors report on the surgical management of an extensive lesion of the upper cervical spine that required an uncommon transmandibular approach to facilitate exposure, resection, and stabilization in a pediatric patient. A 6-year-old boy with a large aneurysmal bone cyst of the C-2 vertebra presented with progressive weakness and right-sided neck pain. The lesion extended laterally into the soft tissue of the neck, inferiorly to C-4, and posteriorly around the spinal cord. A transmandibular osteotomy was performed to provide adequate exposure for complete resection of the mass and anterior C1-3 instrumentation and fusion. Subsequently, the patient underwent occiput to C-4 posterior instrumentation and fusion. The patient tolerated the operation well and had regained all function at 3 and 11 months' follow-up. No neurological complications or problems of speech, swallowing, or respiration occurred. Even in pediatric patients, the transmandibular approach for the treatment of upper cervical spine lesions is an effective method of maximizing exposure for complex lesions requiring resection and stabilization. PMID:24702619
Spines, backbones and orthopedic surgery. Spines, backbones and orthopedic surgery.
1/ 17 Spines, backbones and orthopedic surgery. Spines, backbones and orthopedic surgery. Simon;2/ 17 Spines, backbones and orthopedic surgery. Motivation #12;2/ 17 Spines, backbones and orthopedic motion with a near critical drift towards an absorbing barrier at the origin. #12;3/ 17 Spines, backbones
Airway management of patients with traumatic brain injury/C-spine injury.
Jung, Jin Yong
Traumatic brain injury (TBI) is usually combined with cervical spine (C-spine) injury. The possibility of C-spine injury is always considered when performing endotracheal intubation in these patients. Rapid sequence intubation is recommended with adequate sedative or analgesics and a muscle relaxant to prevent an increase in intracranial pressure during intubation in TBI patients. Normocapnia and mild hyperoxemia should be maintained to prevent secondary brain injury. The manual-in-line-stabilization (MILS) technique effectively lessens C-spine movement during intubation. However, the MILS technique can reduce mouth opening and lead to a poor laryngoscopic view. The newly introduced video laryngoscope can manage these problems. The AirWay Scope® (AWS) and AirTraq laryngoscope decreased the extension movement of C-spines at the occiput-C1 and C2-C4 levels, improving intubation conditions and shortening the time to complete tracheal intubation compared with a direct laryngoscope. The Glidescope® also decreased cervical movement in the C2-C5 levels during intubation and improved vocal cord visualization, but a longer duration was required to complete intubation compared with other devices. A lightwand also reduced cervical motion across all segments. A fiberoptic bronchoscope-guided nasal intubation is the best method to reduce cervical movement, but a skilled operator is required. In conclusion, a video laryngoscope assists airway management in TBI patients with C-spine injury. PMID:26045922
Airway management of patients with traumatic brain injury/C-spine injury
Traumatic brain injury (TBI) is usually combined with cervical spine (C-spine) injury. The possibility of C-spine injury is always considered when performing endotracheal intubation in these patients. Rapid sequence intubation is recommended with adequate sedative or analgesics and a muscle relaxant to prevent an increase in intracranial pressure during intubation in TBI patients. Normocapnia and mild hyperoxemia should be maintained to prevent secondary brain injury. The manual-in-line-stabilization (MILS) technique effectively lessens C-spine movement during intubation. However, the MILS technique can reduce mouth opening and lead to a poor laryngoscopic view. The newly introduced video laryngoscope can manage these problems. The AirWay Scope® (AWS) and AirTraq laryngoscope decreased the extension movement of C-spines at the occiput-C1 and C2-C4 levels, improving intubation conditions and shortening the time to complete tracheal intubation compared with a direct laryngoscope. The Glidescope® also decreased cervical movement in the C2-C5 levels during intubation and improved vocal cord visualization, but a longer duration was required to complete intubation compared with other devices. A lightwand also reduced cervical motion across all segments. A fiberoptic bronchoscope-guided nasal intubation is the best method to reduce cervical movement, but a skilled operator is required. In conclusion, a video laryngoscope assists airway management in TBI patients with C-spine injury.
Samal, Sunil Kumar; Rathod, Setu
Cervical pregnancy is a rare type of ectopic pregnancy and it represents <1% of all ectopic pregnancies. Early diagnosis and medical management with systemic or local administration of methotrexate is the treatment of choice. If the pregnancy is disturbed, it may lead to massive hemorrhage, which may require hysterectomy to save the patient. We report three cases of cervical pregnancy managed successfully with different approaches of management. Our first case, 28 years old G3P2L2 with previous two lower segment cesarean sections, presented with bleeding per vaginum following 6 weeks of amenorrhea. Clinical examination followed by transvaginal ultrasound confirmed the diagnosis of cervical pregnancy. Total abdominal hysterectomy was done in view of intractable bleeding to save the patient. The second case, a 26-year-old second gravida with previous normal vaginal delivery presented with pain abdomen and single episode of spotting per vaginum following 7 weeks of amenorrhea. Transvaginal ultrasound revealed empty endometrial cavity, closed internal os with gestational sac containing live fetus of 7 weeks gestational age in cervical canal and she was treated with intra-amniotic potassium chloride followed by systemic methotrexate. Follow up with serum beta human chorionic gonadotropin level revealed successful outcome. Our third case, a 27-year-old primigravida with history of infertility treatment admitted with complaints of bleeding per vaginum for 1 day following 8 weeks amenorrhea. She was diagnosed as cervical pregnancy by clinical examination, confirmed by transvaginal ultrasonography and subsequently managed by dilation and curettage with intracervical Foleys' ballon tamponade. PMID:25810679
Injuries of the spine sustained in rugby.
Silver, J R
Between 1952 and 1982, 67 rugby players (63 rugby union, two rugby league, and two American football) sustained serious injuries of their spine. The injuries fell predominantly on the lower cervical spine. Forty eight of the players sustained serious injuries of the spinal cord, leading to paralysis and total incapacity. The incidence of such injuries appears to have increased in recent years, particularly those incurred in tackles and mauls and rucks, and particularly among schoolboys. Changes in the laws of the game and in the attitudes of the players over the past few years should improve play and lead to a lower incidence of injuries. Images FIG 1 FIG 3 FIG 5 FIG 7 FIG 9 PMID:6418310
Lindsey, D; Lindsey, W E
Cactus spines produce injuries whose clinical significance is loosely in inverse proportion to the dimensions of the spine. Long and medium spines of saguaro and barrel cacti seldom result in embedded fragments, but when they do they are difficult to locate and remove. Other medium spines, those of prickly pear and cholla, are a nuisance but they can be removed readily by traction, as can the smaller spines (glochids) of the prickly pear. The very small spines (also glochids) of the polka dot or bunny's ear cactus (Opuntia microdasys) and the beavertail cactus (Opuntia basilaris) offer the most frustrating problem of all, but can be peeled off with a dried film of a professional facial gel. PMID:3390256
Cervical neurofibromatosis with quadriparesis: Management by fibular strut graft
Laohacharoensombat, Wichien; Wajanavisit, Wiwat; Woratanarat, Patarawan
This is a case report of an eight-year old boy with neurofibromatosis and a 120° dystrophic kyphosis of the cervical spine. He presented with progressive quadriparesis caused by spondyloptosis of the C2/C3, and was successfully treated by skull traction and one-stage anterior fibular strut graft lying between the tubercle of the atlas through the C2 body slot and lower vertebrae. At seven years follow-up there was, loosening of lower vertebral screws which allowed growth and residual mobility of lower vertebral joints while the fusion of upper cervical spines was still solid. PMID:20165684
Minimally invasive procedures on the lumbar spine
Skovrlj, Branko; Gilligan, Jeffrey; Cutler, Holt S; Qureshi, Sheeraz A
Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology and surgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine. PMID:25610845
Acute cervical cord injuries in patients with epilepsy.
Allen, J W; Kendall, B E; Kocen, R S; Milligan, N M
Seven cases with acute cervical cord lesions associated with a fit and fall, were found in approximately 500 patients with epilepsy over a period of 7 years. In all patients the epilepsy was refractory to drug therapy and six suffered tonic fits which resulted in falls and frequent head injuries. Notable radiological changes were found in the cervical spine; there was ankylosis in five, hyperostosis in four and the minimum sagittal diameter of the bony canal was less than 11mm in three cases. The findings indicate that repetitive trauma may be a factor in producing bony changes in the cervical spine which put the patient at risk of cervical cord injury, especially when the spinal canal is developmentally narrow. Images PMID:7143009
Emergency neurological life support: traumatic spine injury.
Stein, Deborah M; Roddy, Vincent; Marx, John; Smith, Wade S; Weingart, Scott D
Traumatic spine injuries (TSIs) carry significantly high risks of morbidity, mortality, and exorbitant health care costs from associated medical needs following injury. For these reasons, TSI was chosen as an ENLS protocol. This article offers a comprehensive review on the management of spinal column injuries using the best available evidence. Though the review focuses primarily on cervical spinal column injuries, thoracolumbar injuries are briefly discussed as well. The initial emergency department clinical evaluation of possible spinal fractures and cord injuries, along with the definitive early management of confirmed injuries, are also covered. PMID:22965323
... Centers for Disease Control and Prevention's (CDC) Inside Knowledge: Get the Facts About Gynecologic Cancer campaign. The ... the facts about gynecologic cancer, providing important "inside knowledge" about their bodies and health. What is cervical ...
... and chlamydia. HPV is the virus that can cause genital warts. It seems to be very closely connected with these changes. Risk factors for cervical cancer Starting to have sex early (before age 18) ...
... muscles stronger. The therapist can also use neck traction to relieve some of the pressure in your ... anti-inflammatory medications (NSAIDs) for long-term pain control. Narcotics may be prescribed if the pain is ...
Cervical stenosis in a professional rugby league football player: a case report
Henry Pollard; Lotte Hansen; Wayne Hoskins
BACKGROUND: This paper describes a case of C7 radiculopathy in a professional rugby league player after repeated cervical spine trauma. The report outlines the management of the patient following an acute cervical hyperflexion injury with chiropractic manipulation and soft tissue therapies. It also presents a change in approach to include distractive techniques on presentation of a neurological deficit following re-injury.
The Outcomes of Manipulation or Mobilization Therapy Compared with Physical Therapy or Exercise for Neck Pain: A Systematic Review
Schroeder, Josh; Kaplan, Leon; Fischer, Dena J.; Skelly, Andrea C.
Study Design?Systematic review. Study Rationale?Neck pain is a prevalent condition. Spinal manipulation and mobilization procedures are becoming an accepted treatment for neck pain. However, data on the effectiveness of these treatments have not been summarized. Objective?To compare manipulation or mobilization of the cervical spine to physical therapy or exercise for symptom improvement in patients with neck pain. Methods?A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Database, and bibliographies of key articles, which compared spinal manipulation or mobilization therapy with physical therapy or exercise in patients with neck pain. Articles were included based on predetermined criteria and were appraised using a predefined quality rating scheme. Results?From 197 citations, 7 articles met all inclusion and exclusion criteria. There were no differences in pain improvement when comparing spinal manipulation to exercise, and there were inconsistent reports of pain improvement in subjects who underwent mobilization therapy versus physical therapy. No disability improvement was reported between treatment groups in studies of acute or chronic neck pain patients. No functional improvement was found with manipulation therapy compared with exercise treatment or mobilization therapy compared with physical therapy groups in patients with acute pain. In chronic neck pain subjects who underwent spinal manipulation therapy compared to exercise treatment, results for short-term functional improvement were inconsistent. Conclusion?The data available suggest that there are minimal short- and long-term treatment differences in pain, disability, patient-rated treatment improvement, treatment satisfaction, health status, or functional improvement when comparing manipulation or mobilization therapy to physical therapy or exercise in patients with neck pain. This systematic review is limited by the variability of treatment interventions and lack of standardized outcomes to assess treatment benefit. PMID:24436697
Changes in proprioception and pain in patients with neck pain after upper thoracic manipulation.
Yang, Jinmo; Lee, Byoungkwon; Kim, Changbeom
[Purpose] The purpose of this study was to conduct cervical stability training and upper thoracic manipulation for patients with chronic neck pain and then investigate the changes of cervical proprioception and pain. [Subjects and Methods] Subjects were 30 workers with mechanical neck pain, who were randomly divided into an upper thoracic manipulation group and a cervical stability training group. Upper thoracic manipulation after cervical stability training was conducted for the upper thoracic manipulation group, and only stability training was conducted for the cervical stability training group. The intervention period was six weeks, and consisted of three sessions a week, each of which lasted for 30 minutes. For proprioception measurement, an electro-goniometer was used to measure reposition sense before and after the intervention. The visual analogue scale was used to assess pain. [Results] After the intervention, the error angle was significantly smaller in flexion and right left side-bending, and pain was significantly reduced in the upper thoracic manipulation group. According to the post intervention comparison of the two groups, there were significant differences in the proprioception and pain values. [Conclusion] Conducting both cervical stability training and upper thoracic manipulation for patients with chronic neck pain was more helpful for the improvement of proprioception and pain than cervical stability training alone. PMID:25931733
We present a method for designing spine layouts. A spine layout is a layout in which a main aisle is used for the movements between the work cells located on both side and for the temporary storage of work in process. Our objective is to find a layout that minimizes both the handling costs and the investment costs. Also, a
Hukins, D.W.L. Nelson, M.A.
This book contain 15 selections. Some of the titles are: Effects of age on the appearance of magnetic resonance images of the spine; Potential for image analysis in quantitative magnetic resonance imaging of the aging spine; Potential of x-ray diffraction computed tomography for discriminating between normal and osteoporotic bone; and Spinal fusion in the elderly.
Finite element analysis of the spondylolysis in lumbar spine.
Wang, Jung-Pin; Zhong, Zheng-Cheng; Cheng, Cheng-Kung; Chen, Chen-Sheng; Yu, Chung-hung; Chang, Ting-Kuo; Wei, Shun-Hwa
Spondylolysis is a fracture of the bone lamina in the pars interarticularis and has a high risk of developing spondylolisthesis, as well as traction on the spinal cord and nerve root, leading to spinal disorders or low back pain when the lumbar spine is subjected to high external forces. Previous studies mostly investigated the mechanical changes of the endplate in spondylolysis. However, little attention has been focused on the entire structural changes that occur in spondylolysis. Therefore, the purpose of this study was to evaluate the biomechanical changes in posterior ligaments, disc, endplate, and pars interarticularis between the intact lumbar spine and spondylolysis. A total of three finite element models, namely the intact L2-L4 lumbar spine, lumbar spine with unilateral pars defect and with bilateral pars defect were established using a software ANSYS 6.0. A loading of 10 N.m in flexion, extension, left torsion, right torsion, left lateral bending, and right lateral bending respectively were imposed on the superior surface of the L2 body. The bottom of the L4 vertebral body was completely constrained. The finite element models estimated that the lumbar spine with a unilateral pars defect was able to maintain spinal stability as the intact lumbar spine, but the contralateral pars experienced greater stress. For the lumbar spine with a bilateral pars defect, the rotation angle, the vertebral body displacement, the disc stress, and the endplate stress, was increased more when compared to the intact lumbar spine under extension or torsion. PMID:17075165
Agrawal, Vinod; Patgaonkar, P. R.; Nagariya, S. P.
Tuberculosis of the spine is one of the most common spine pathology in India. Over last 4 decades a lot has changed in the diagnosis, medical treatment and surgical procedures to treat this disorder. Further developments in diagnosis using molecular genetic techniques, more effective antibiotics and more aggressive surgical protocols have become essential with emergence of multidrug resistant TB. Surgical procedures such as single stage anterior and posterior stabilization, extrapleral dorsal spine anterior stabilization and endoscopic thoracoscopic surgeries have reduced the mortality and morbidity of the surgical procedures. is rapidly progressing. It is a challenge to treat MDR-TB Spine with late onset paraplegia and progressive deformity. Physicians must treat tuberculosis of spine on the basis of Culture and sensitivity. PMID:21572628
Rose, J D; Mendel, E; Marras, W S
The advantages and disadvantages of different methods of carrying objects on spine loading are still not fully understood. Previous studies have either examined the effects of carrying using physiological measures or examined isolated spine segments using biomechanical models. Additionally, most studies have been restricted to only a small number of carrying conditions. Very few studies have attempted to examine the various factors influencing spine loading together. To improve understanding of interacting factors on carrying, this study assessed the lumbar spine loads of 16 subjects as they assumed six styles of carrying at two weight levels and two activity levels (walking vs. standing). Concurrent with each trial, a subject-specific biomechanical model was used to assess spine forces over the full lumbar spine. Most carrying methods in the trials resulted in relatively low levels of spine loading. Anterior/posterior (A/P) shear loading was the only spine-loading dimension that reached biomechanically meaningful levels. Two carrying conditions, with bins carried in front of the body, significantly increased A/P shear compared with other carrying styles. This increase appeared to be due to the greater moment arms occurring in these conditions. Many of the other carrying styles produced A/P shears that were similar to those observed when carrying nothing at all. Of all the tasks, the backpack carry characteristically produced especially low spine loads. The findings of the study suggest that to achieve optimal carrying in terms of spine loading, loads should be positioned close to the body, even when carrying relatively light loads. PMID:24073718
THE SPINE THAT WAS NO SPINE by Alexandra Pettet
Souto, Juan
THE SPINE THAT WAS NO SPINE by Alexandra Pettet ) & Juan Souto ) ABSTRACT. Let Tn be the Teichm it is not surprising that it can be used to construct a particularly nice SLn Z-equivariant spine, i.e., deformation that S() generates a finite index subgroup of 1(Tn ) is an SLn Z-equivariant spine of Tn . A flat torus
Cervical Epidural Abscess Mimicking as Stroke - Report of Two Cases
Velpula, Jagan Mohana Reddy; Gakhar, Harinder; Sigamoney, Kohilavani; Bommireddy, Rajendra
Background: Stroke is a common provisional diagnosis in patients presenting to the emergency department (ED) with unilateral neurological deficit. Cervical epidural abscess (CEA) may also present clinically with a unilateral neurological deficit. Objects: To highlight the inherent problems with diagnosing cervical epidural abscess and possible consequences of delay in diagnosis. Case Report: We would like to highlight two cases provisionally diagnosed as stroke. Both cases turned out to be cervical epidural abscesses. The delay in diagnosis and treatment led to suboptimal outcome in both cases. Summary: Cases with suspected stroke who deteriorate while under treatment or whose diagnosis is doubtful should have MRI whole spine in order to avoid potential complications. PMID:24551026
Are cervical multifidus muscles active during whiplash and startle? An initial experimental study
Gunter P Siegmund; Jean-Sébastien Blouin; Mark G Carpenter; John R Brault; J Timothy Inglis
BACKGROUND: The cervical multifidus muscles insert onto the lower cervical facet capsular ligaments and the cervical facet joints are the source of pain in some chronic whiplash patients. Reflex activation of the multifidus muscle during a whiplash exposure could potentially contribute to injuring the facet capsular ligament. Our goal was to determine the onset latency and activation amplitude of the
Vaginitis, cervicitis, and cervical length in pregnancy
Jantien J. Boomgaard; Karin S. Dekker; Elsabet van Rensburg; Corlia van den Berg; Illse Niemand; Roosmarie H. Bam; Hendrik S. Cronjé
Objective: We sought to determine the possible association among vaginitis, cervicitis, and cervical length in pregnancy. Study Design: Primigravid volunteers, between 20 and 36 weeks' gestation (n = 210), were examined. Vaginitis was diagnosed by pH determination and wet mount smear, cervicitis was diagnosed by cervicography, and cervical length was diagnosed by vaginal ultrasonographic measurement. Patients with both vaginitis and
Prevalence of cervical and lumbar disc disorders in pilots of the German armed forces.
Pippig, T; Kriebel, J
On-duty and off-duty, military pilots of the Bundeswehr frequently complain of pains in the spine curtailing performance, reducing service hours and eventually leading even to unfitness for military flying duties. Such disorders may be caused by intervertebral disc alterations. In the period comprising August 1994 and December 1998, 286 pilots (8.1% of all A/C pilots or weapon systems officers of the Bundeswehr) with disc-related disorders in the areas of the cervical and of the lumbar spine were examined at the German Air Force Institute of Aviation Medicine. Helicopter pilots had significantly higher rate of intervertebral disc disorders compared to the group of jet pilots and transport A/C pilots (9.9% : 6.6%). The pilots had their first disorders at an average age of 39.2 yrs (jet p.: 37.6 yrs, helicopter p.: 40.4 yrs, transport A/C p.: 39.2 yrs). - Depending on the number of hours, namely after 2680 hours of flying on average, pilots had discopathies, (jet p.: 1830 h, helicopter p.: 3186 h, transport A/C p.: 2670 h). - Finally, the total group of pilots will be compared to a non-flying control group (consisting of air traffic control personnel of 11 army aviation regiments. PMID:10657281
X-ray - lumbosacral spine; X-ray - lower spine ... be placed over the lower part of your spine. You will be asked to hold your breath ... x-ray. The most common reason for lumbosacral spine x-ray is to look for the cause ...
Musculoskeletal chest wall pain
Fam, Adel G.; Smythe, Hugh A.
The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, "fibrositis" syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804
Posterior occipito-cervical fusion in rheumatoid arthritis
D. Grob; J. Dvorak; N. Gschwend; M. Froehlich
The instability of atlanto-axial subluxation remains a challenging problem in patients with rheumatoid arthritis. In order to preserve as much function of the cervical spine as possible, inclusion of the occiput into the fusion should exclusively be performed when there is a radiologically or clinically manifest pathological condition of the atlanto-occipital joint or marked upward migration of the dens axis.
Brain Contusion and Cervical Fracture in a Professional Boxer.
ERIC Educational Resources Information Center
Jordan, Barry D.; And Others
This case study of an injury sustained by a 22-year old boxer who was knocked out in the ring demonstrates two aspects of medical care for boxers: the potential for cervical spine fracture and the importance of ringside emergency medical services. The injury, diagnosis, and treatment are discussed. (Author/JL)
Effect of rigid cervical collar on tracheal intubation using Airtraq®
Durga, Padmaja; Yendrapati, Chiranjeevi; Kaniti, Geeta; Padhy, Narmada; Anne, Kiran Kumar; Ramachandran, Gopinath
Background and Aims: Cervical spine immobilisation with rigid cervical collar imposes difficulty in intubation. Removal of the anterior part of the collar may jeopardize the safety of the cervical spine. The effect of restricted mouth opening and cervical spine immobilisation that result from the application of rigid cervical collar on intubation using Airtraq® was evaluated. Methods: Seventy healthy adults with normal airways included in the study were intubated Using Airtraq® with (group C) and without rigid cervical collar (group NC). The ease of insertion of Airtraq® into the oral cavity, intubation time, intubation difficulty score (IDS) were compared using Wilcoxon sign ranked test and McNemar test, using SPSS version 13. Results: Intubation using Airtraq® was successful in the presence of the cervical collar in 96% which was comparable to group without collar (P = 0.24). The restriction of mouth opening resulted in mild difficulty in insertion of Airtraq®. The median Likert scale for insertion was - 1 in the group C and + 1 in group NC (P < 0.001). The intubation time was longer in group C (30 ± 14.3 s vs. 26.9 ± 14.8 s) compared to group NC. The need for adjusting manoeuvres was 18.5% in group C versus 6.2% in group NC (P = 0.003) and bougie was required in 12 (18.5%) and 4 (6.2%) patients in group C and NC, respectively, to facilitate intubation (P = 0.02). The modified IDS score was higher in group C but there was no difference in the number of patients with IDS < 2. Conclusion: Tracheal intubation using Airtraq® in the presence of rigid cervical collar has equivalent success rate, acceptable difficulty in insertion and mild increase in IDS. PMID:25197109
Cervical laminoplasty for cervical myeloradiculopathy
Richard M. Ozuna; Rick B. Delamarter
The role for treatment of conditions resulting in cervical spondylotic myeloradiculopathy through posterior approaches is discussed. The indications and advantages of a posterior approach andin particular laminoplasty are reviewed. Various techniques of laminoplasty are presented. The senior author's technique and series in expansive open door laminoplasty is also reviewed. The series was a prospective study performed to evaluate the clinical
Post-traumatic myofascial pain of the head and neck
Brian Freund; Marvin Schwartz
Post-traumatic myofascial pain describes the majority of chronic head and neck pain seen in clinical practice. If conditions\\u000a such as vascular headaches, neuropathic pain, degenerative cervical joint disease, and dental pain are excluded, myofascial\\u000a tissues are directly or indirectly involved in all other forms of head and neck pain. The most common of these include temporomandibular\\u000a disorders, neck pain such
[Cervical vertebra-induced hearing and equilibrium disorders. Recent clinical aspects].
Elies, W
The contribution of cervical spine disorders to cochleovestibular symptoms was based on the evaluation of patients complaining of dizziness and/or inner ear hearing loss, treated in the ENT Department of Tubingen University between 1977 and 1982. Cervicogenic vertigo was provoked by movements of the cervical spine, but the latter rarely caused tinnitus and never induced hearing loss. The diagnosis between a vascular or proprioceptive nystagmus may be made on the presence of lesions of the cervical spine. These are disorders of the cranio-cervical or the thoraco-cervical region especially and much less often due to osteochondrosis of the vertebrae. The findings of a cervical osteochondrosis has no diagnostic value unless vertigo is provoked by head movements. In cervical vertigo the thoraco-cervical region should be examined to prove a thoracic outlet syndrome. In selected cases operative treatment is possible, eg. transoral resection of the dental process of the axis, resection of the posterior arch of the atlas, myotomy of the anterior scalenus muscle or decompression of the vertebral artery. PMID:6530373
Cervical Coupling Motion Characteristics in Healthy People Using a Wireless Inertial Measurement Unit
Kim, Jeong-Kyun; Park, Young-Jae; Oh, Hwan-Sup; Park, Young-Bae
Objective. The objectives were to show the feasibility of a wireless microelectromechanical system inertial measurement unit (MEMS-IMU) to assess the time-domain characteristics of cervical motion that are clinically useful to evaluate cervical spine movement. Methods. Cervical spine movements were measured in 18 subjects with wireless IMUs. All rotation data are presented in the Euler angle system. Amount of coupling motions was evaluated by calculating the average angle ratio and the maximum angle ratio of the coupling motion to the primary motion. Reliability is presented with intraclass correlation coefficients (ICC). Results. Entire time-domain characteristics of cervical motion were measured with developed MEMS-IMU system. Cervical range of motion (CROM) and coupling motion range were measured with high ICCs. The acquired data and calculated parameters had similar tendency with the previous studies. Conclusions. We evaluated cervical motion with economic system using a wireless IMU of high reliability. We could directly measure the three-dimensional cervical motion in degrees in realtime. The characteristics measured by this system may provide a diagnostic basis for structural or functional dysfunction of cervical spine. This system is also useful to demonstrate the effectiveness of any intervention such as conventional medical treatment, and Korean medical treatment, exercise therapy. PMID:23935668
... My Pictures Browse Search Quick Search Image Details Cervical Cancer Stage IIIA View/Download: Small: 612x612 View Download Add to My Pictures Title: Cervical Cancer Stage IIIA Description: Stage IIIA cervical cancer; ...
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Cervical Cancer Stage IA View/Download: Small: 720x576 View Download Add to My Pictures Title: Cervical Cancer Stage IA Description: Stage IA1 and IA2 cervical cancer; drawing shows a cross-section of the ...
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Cervical dysplasia - series (image)
Cervical cancer is one of the most common cancers in women. It is a cancer of the ... smear is the screening procedure used to detect cervical cancer. Limited or early cervical cancer (carcinoma in ...
Upright positional MRI of the lumbar spine.
Alyas, F; Connell, D; Saifuddin, A
Supine magnetic resonance imaging (MRI) is routinely used in the assessment of low back pain and radiculopathy. However, imaging findings often correlate poorly with clinical findings. This is partly related to the positional dependence of spinal stenosis, which reflects dynamic changes in soft-tissue structures (ligaments, disc, dural sac, epidural fat, and nerve roots). Upright MRI in the flexed, extended, rotated, standing, and bending positions, allows patients to reproduce the positions that bring about their symptoms and may uncover MRI findings that were not visible with routine supine imaging. Assessment of the degree of spinal stability in the degenerate and postoperative lumbar spine is also possible. The aim of this review was to present the current literature concerning both the normal and symptomatic spine as imaged using upright MRI and to illustrate the above findings using clinical examples. PMID:18718234
Changes in Cervical Sagittal Alignment after Single-Level Posterior Percutaneous Endoscopic Cervical Diskectomy
Kim, Chi Heon; Shin, Kyung-Hyun; Chung, Chun Kee; Park, Sung Bae; Kim, Jung Hee
Study Design?Case series. Objective?Posterior percutaneous endoscopic cervical diskectomy (PECD) can preserve the disk in patients with a foraminal disk herniation. However, progressive angulation at the operated segment is a concern, especially for patients with cervical lordosis?10 degrees. The change in cervical lordosis after posterior PECD was analyzed. Methods?Medical records were reviewed of 32 consecutive patients (22 men, 10 women; mean age, 49?±?12 years) who had single-level foraminal soft disk herniation. The operation levels were as follows: C4–5 in 1 patient, C5–6 in 12, C6–7 in 18, and C7–T1 in 1. All patients were discharged the day after the operation, and neck motion was encouraged. All patients were followed for 30?±?7 months (range, 24 to 46 months), and 21/32 patients (66%) had radiographs taken at 25?±?11 months (range, 12 to 45 months). Radiologic parameters were assessed, including cervical curvature (C2–7), segmental Cobb's angle (SA), and anterior and posterior disk height (AH and PH, respectively) at the operative level. Results?At the last follow-up, 29/32 patients (91%) had no or minimal pain, and 3/32 patients had occasional pain. SA, AH, and PH were not significantly changed. Cervical lordosis?10 degrees was present in 10/21 patients preoperatively and in 3/21 patients at the last follow-up. For patients with cervical lordosis?10 degrees, cervical curvature changed from ?2.5?±?8.0 to ?11.3?±?9.3 degrees (p?=?0.01). For patients with cervical lordosis???10 degrees, cervical curvature changed from ?17.5?±?5.8 to ?19.9?±?5.7 degrees (p?=?0.24). Conclusions?Cervical curvature does not worsen after posterior PECD. PMID:25648214
Notalgia paresthetica associated with cervical spinal stenosis and cervicothoracic disk disease at C4 through C7.
Alai, Nili N; Skinner, Harry B; Nabili, Siamak T; Jeffes, Edward; Shahrokni, Seyed; Saemi, Arash M
Notalgia paresthetica (NP) is a common refractory, sensory, neuropathic syndrome with the hallmark symptom of localized pruritus of the unilateral infrascapular back. It generally is a chronic noncurable condition with periodic remissions and exacerbations. While the dermatologic syndrome may be multifactorial in etiology, a possible association with underlying cervical spine disease should be evaluated for proper treatment. Collaborative multispecialty evaluation by dermatology, radiology, orthopedic surgery, and neurology may be indicated for primary management of this condition. First-line therapy for NP with associated cervical disease may include nondermatologic noninvasive treatments such as spinal manipulation, physical therapy, massage, cervical traction, cervical muscle strengthening, and oral nonsteroidal anti-inflammatory drugs and muscle relaxants. Notalgia paresthetica may in fact be a cutaneous sign of an underlying degenerative cervical spine disease. We report a case of a patient with cervical spinal stenosis that corresponded directly with the clinical findings of NP. PMID:20349681
Operative Outcomes for Cervical Myelopathy and Radiculopathy
Galbraith, J. G.; Butler, J. S.; Dolan, A. M.; O'Byrne, J. M.
Cervical spondylotic myelopathy and radiculopathy are common disorders which can lead to significant clinical morbidity. Conservative management, such as physical therapy, cervical immobilisation, or anti-inflammatory medications, is the preferred and often only required intervention. Surgical intervention is reserved for those patients who have intractable pain or progressive neurological symptoms. The goals of surgical treatment are decompression of the spinal cord and nerve roots and deformity prevention by maintaining or supplementing spinal stability and alleviating pain. Numerous surgical techniques exist to alleviate symptoms, which are achieved through anterior, posterior, or circumferential approaches. Under most circumstances, one approach will produce optimal results. It is important that the surgical plan is tailored to address each individual's unique clinical circumstance. The objective of this paper is to analyse the major surgical treatment options for cervical myelopathy and radiculopathy focusing on outcomes and complications. PMID:22046575
Outcome of single level anterior cervical discectomy and fusion using nano-hydroxyapatite/polyamide-66 cage
Yang, Xi; Liu, Limin; Song, Yueming; Kong, Qingquan; Zeng, Jiancheng; Tu, Chongqi
Background: Cages have been widely used for the anterior reconstruction and fusion of cervical spine. Nonmetal cages have become popular due to prominent stress shielding and high rate of subsidence of metallic cages. This study aims to assess fusion with n-HA/PA66 cage following one level anterior cervical discectomy. Materials and Methods: Forty seven consecutive patients with radiculopathy or myelopathy underwent single level ACDF using n-HA/PA66 cage. We measured the segmental lordosis and intervertebral disc height on preoperative radiographs and then calculated the loss of segmental lordosis correction and cage subsidence over followup. Fusion status was evaluated on CT scans. Odom criteria, Japanese Orthopedic Association (JOA) and Visual Analog Pain Scales (VAS) scores were used to assess the clinical results. Statistically quantitative data were analyzed while Categorical data by ?2 test. Results: Mean correction of segmental lordosis from surgery was 6.9 ± 3.0° with a mean loss of correction of 1.7 ± 1.9°. Mean cage subsidence was 1.2 ± 0.6 mm and the rate of cage subsidence (>2 mm) was 2%. The rate of fusion success was 100%. No significant difference was found on clinical or radiographic outcomes between the patients (n=27) who were fused by n-HA/PA66 cage with pure local bone and the ones (n=20) with hybrid bone (local bone associating with bone from iliac crest). Conclusions: The n-HA/PA66 cage is a satisfactory reconstructing implant after anterior cervical discectomy, which can effectively promote bone graft fusion and prevent cage subsidence. PMID:24741136
Beyond the Spine: A New Clinical Research Priority
Donovan, James; Cassidy, J. David; Cancelliere, Carol; Poulsen, Erik; Stochkendahl, Mette Jensen; Kilsgaard, Jřrgen; Blanchette, Marc-André; Hartvigsen, Jan
Over the past two decades, clinical research within the chiropractic profession has focused on the spine and spinal conditions, specifically neck and low back pain. However, there is now a small group of chiropractors with clinical research training that are shifting their focus away from traditional research pursuits towards new and innovative areas. Specifically, these researchers are now delving into areas such as brain injury, work disability prevention, undifferentiated chest pain, hip osteoarthritis, and prevention of pain in children and adolescents to name a few. In this paper, we highlight recent research in these new areas and discuss how clinical research efforts in musculoskeletal areas beyond the spine can benefit patient care and the future of the chiropractic profession. PMID:25729080
The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain
James S. Thomas; Christopher R. France
Pain-related fear has been associated with avoidance behavior and increased risk for chronic low back pain; however, few studies\\u000a have examined how pain-related fear relates specifically to motion of the spine following an acute episode of back pain. Thirty-six\\u000a participants with a recent episode of low back pain were recruited from the general population using a combination of fliers\\u000a and
Occult osteoid osteoma presenting as shoulder pain: a case report
Zoboski, Robert J.
Objective The purpose of this case study is to describe the clinical course and treatment of a patient with recalcitrant shoulder pain and osteoid osteoma. Clinical Features A 28-year-old man had a 2-year history of progressively worsening shoulder and midscapular pain. Intervention and Outcome Before chiropractic consultation, he had been evaluated and treated by his family physician, an orthopedic surgeon, a neurologist, and a pain management specialist. The patient underwent arthroscopy with examination under anesthesia and debridement of a posterior labral tear and cervical spine epidural injections, but neither procedure relieved his symptoms. After seeking chiropractic care, presenting symptoms were reproducible during direct clinical examination; and an initial working diagnosis of secondary right glenohumeral impingement syndrome with coexisting scapulothoracic dyskinesis was made. After 2 weeks of chiropractic rehabilitation, therapy was stopped because of no change in symptoms. The patient was referred for orthopedic consultation. Another series of plain films were ordered, and follow-up magnetic resonance imaging revealed an osseous mass at the medial aspect of the proximal metadiaphyseal region of the right humerus, with a diagnosis of osteoid osteoma. The patient underwent radiofrequency thermoablation of the tumor nidus, which was unsuccessful and resulted in open surgical resection. Resolution of symptoms with minimal pain was reported 3 weeks after the surgery. Four years later, the patient's shoulder remains asymptomatic. Conclusion This case demonstrates that osteoid osteoma may present with clinical features that mimic common functional musculoskeletal conditions of the shoulder. Information from the patient history and diagnostic imaging are important for diagnosis and appropriate management. PMID:23450098
[Death of an infant following 'craniosacral' manipulation of the neck and spine].
Holla, Micha; Ijland, Marloes M; van der Vliet, A M; Edwards, Michael; Verlaat, Carin W M
A healthy 3-month-old girl died after manipulation of the cervical and thoracolumbar spine by a so-called craniosacral therapist. During persistent forced deep flexion of the neck and spine, the infant developed faecal incontinence, atonia and apnoea followed by an asystole. A physical examination, additional MRI studies and an autopsy indicated that the infant probably died as a consequence of local neurovascular lesions of the cervical spine or a mechanically-induced respiratory problem. This is the second reported case of an infant dying after forced manipulations of the neck. Until there is scientific evidence for the effectiveness and safety of forced manipulations of the vertebral column, we advise against this treatment in neonates and infants. PMID:19469218
Technology improvements for image-guided and minimally invasive spine procedures
Kevin Cleary; Mark Clifford; Dan Stoianovici; Matthew T. Freedman; Seong K. Mun; Vance Watson
This paper reports on technology developments aimed at improving the state of the art for image-guided min- imally invasive spine procedures. Back pain is a major health problem with serious economic consequences. Minimally invasive procedures to treat back pain are rapidly growing in popularity due to improvements in technique and the substantially reduced trauma to the patient versus open spinal
Electrical Advantages of Dendritic Spines
Allan T. Gulledge; Nicholas T. Carnevale; Greg J. Stuart
Many neurons receive excitatory glutamatergic input almost exclusively onto dendritic spines. In the absence of spines, the amplitudes and kinetics of excitatory postsynaptic potentials (EPSPs) at the site of synaptic input are highly variable and depend on dendritic location. We hypothesized that dendritic spines standardize the local geometry at the site of synaptic input, thereby reducing location-dependent variability of local
Structurestabilityfunction relationships of dendritic spines
Nakahara, Hiroyuki
StructureÂstabilityÂfunction relationships of dendritic spines Haruo Kasai1 , Masanori Matsuzaki1, Saitama 351-0198, Japan Dendritic spines, which receive most of the excitatory synaptic input in the cerebral cortex, are heterogeneous with regard to their structure, stability and function. Spines
Single-image hard-copy display of the spine utilizing digital radiography
NASA Astrophysics Data System (ADS)
Artz, Dorothy S.; Janchar, Timothy; Milzman, David; Freedman, Matthew T.; Mun, Seong K.
Regions of the entire spine contain a wide latitude of tissue densities within the imaged field of view presenting a problem for adequate radiological evaluation. With screen/film technology, the optimal technique for one area of the radiograph is sub-optimal for another area. Computed radiography (CR) with its inherent wide dynamic range, has been shown to be better than screen/film for lateral cervical spine imaging, but limitations are still present with standard image processing. By utilizing a dynamic range control (DRC) algorithm based on unsharp masking and signal transformation prior to gradation and frequency processing within the CR system, more vertebral bodies can be seen on a single hard copy display of the lateral cervical, thoracic, and thoracolumbar examinations. Examinations of the trauma cross-table lateral cervical spine, lateral thoracic spine, and lateral thoracolumbar spine were collected on live patient using photostimulable storage phosphor plates, the Fuji FCR 9000 reader, and the Fuji AC-3 computed radiography reader. Two images were produced from a single exposure; one with standard image processing and the second image with the standard process and the additional DRC algorithm. Both sets were printed from a Fuji LP 414 laser printer. Two different DRC algorithms were applied depending on which portion of the spine was not well visualized. One algorithm increased optical density and the second algorithm decreased optical density. The resultant image pairs were then reviewed by a panel of radiologists. Images produced with the additional DRC algorithm demonstrated improved visualization of previously 'under exposed' and 'over exposed' regions within the same image. Where lung field had previously obscured bony detail of the lateral thoracolumbar spine due to 'over exposure,' the image with the DRC applied to decrease the optical density allowed for easy visualization of the entire area of interest. For areas of the lateral cervical spine and lateral thoracic spine that typically have a low optical density value, the DRC algorithm used increased the optical density over that region improving visualization of C7-T2 and T11-L2 vertebral bodies; critical in trauma radiography. Emergency medicine physicians also reviewing the lateral cervical spine images were able to clear 37% of the DRC images compared to 30% of the non-DRC images for removal of the cervical collar. The DRC processed images reviewed by the physicians do not have a typical screen/film appearance; however, these different images were preferred for the three examinations in this study. This method of image processing after being tested and accepted, is in use clinically at Georgetown University Medical Center Department of Radiology for the following examinations: cervical spine, lateral thoracic spine, lateral thoracolumbar examinations, facial bones, shoulder, sternum, feet and portable chest. Computed radiography imaging of the spine is improved with the addition of histogram equalization known as dynamic range control (DRC). More anatomical structures are visualized on a single hard copy display.
Stabilization of metastatic lesions affecting the second cervical vertebra
Baker, Joseph F.; Shafqat, Asseer; Devitt, Aiden; McCabe, John P.
Purpose: Metastatic spine disease is an ever-increasing burden on health care systems. Certain levels in the spine confer unique biomechanical characteristics and hence are of interest. Isolated C2 lesions are rare. We aimed to review our results in surgical management of C2 lesions. Materials and Methods: We reviewed all surgical stabilizations of metastatic spine lesions over the preceding 4 years. Six patients with C2 lesions were identified. Of these five underwent surgical stabilization primarily for disease affecting the second cervical vertebra. Case notes and radiology were reviewed to determine presentation, outcomes and complications. Results: Cases were treated primarily by posterior instrumentation from either occiput or C1 to the subaxial cervical spine. The median survivorship after surgery was 283 days. There were no cases of infection, VTE or implant failure. There were no cases of neurologic deterioration with all maintaining Frankel E grading. Conclusion: Metastatic lesions affecting the second cervical vertebra are rare. A variety of stabilization options tailored to the individual lesions, including occipitocervical fixation, in this small series was successful in maintaining stability and resolution of symptoms. PMID:25972709
Biomechanical study of a hat type cervical intervertebral fusion cage
Jia, Lian-Shun; Chen, Tong-Yi
The purpose of this study was to evaluate the biomechanical effect of a hat type cervical intervertebral fusion cage (HCIFC). In this in vitro biomechanical study, 48 goat cervical spines (C2-5) were tested in flexion, extension, axial rotation, and lateral bending with a nondestructive stiffness method using a nonconstrained testing apparatus, and three-dimensional displacement was measured. Autologous iliac bone and cervical spine intervertebral fusion cage were implanted according to manufacturers' information after complete discectomy (C3-4). Eight spines in each of the following groups were tested: intact, autologous iliac bone graft, Harms cage, SynCage C, carbon cage, and HCIFC. The mean apparent stiffness values were calculated from the corresponding load-displacement curves. Additionally, cage volume and volume-related stiffness were determined. The stiffness of the SynCage C was statistically greatest in all directions. After implantation of the HCIFC, flexion stiffness increased compared with that of the intact motion segment. There was no significant difference in stiffness between the HCIFC and carbon cage. The stiffness of the HCIFC was statistically higher than that of the Harms cage in axial rotation and significantly lower in flexion, extension, and lateral bending. Volume-related stiffness of all cages was higher than that of iliac bone graft. The Harms cage was highest in volume-related stiffness in all directions. The HCIFC can provide enough primary stability for cervical intervertebral fusion. PMID:16763843
The anatomy of the bifurcated neural spine and its occurrence within Tetrapoda.
Woodruff, D Cary
Vertebral neural spine bifurcation has been historically treated as largely restrictive to sauropodomorph dinosaurs; wherein it is inferred to be an adaptation in response to the increasing weight from the horizontally extended cervical column. Because no extant terrestrial vertebrates have massive, horizontally extended necks, extant forms with large cranial masses were examined for the presence of neural spine bifurcation. Here, I report for the first time on the soft tissue surrounding neural spine bifurcation in a terrestrial quadruped through the dissection of three Ankole-Watusi cattle. With horns weighing up to a combined 90 kg, the Ankole-Watusi is unlike any other breed of cattle in terms of cranial weight and presence of neural spine bifurcation. Using the Ankole-Watusi as a model, it appears that neural spine bifurcation plays a critical role in supporting a large mobile weight adjacent to the girdles. In addition to neural spine bifurcation being recognized within nonavian dinosaurs, this vertebral feature is also documented within many members of temnospondyls, captorhinids, seymouriamorphs, diadectomorphs, Aves, marsupials, artiodactyls, perissodactyls, and Primates, amongst others. This phylogenetic distribution indicates that spine bifurcation is more common than previously thought, and that this vertebral adaptation has contributed throughout the evolutionary history of tetrapods. Neural spine bifurcation should now be recognized as an anatomical component adapted by some vertebrates to deal with massive, horizontal, mobile weights adjacent the girdles. PMID:24753263
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Space Stations: Sponge Spool Spine
NSDL National Science Digital Library
Dr. Diane Byerly
In this activity, learners simulate what happens to a human spine in space by making Sponge Spool Spines (alternating sponge pieces and spools threaded on a pipe cleaner). This represents a human spine on Earth, with the discs (sponges) pressed between the spinal vertebrae (the wooden spools). Learners measure the spine length, dip it in a glass of water (simulating microgravity), and then re-measure the spine. They will find it has expanded, just like in space! This activity station is part of a sequence of stations that can be set up to help learners explore how space affects the human body and why.
Corpectomy with Adjacent-Level Kyphoplasty to Treat Metastatic Lung Cancer in Three Contiguous Cervical Vertebrae Causing Focal Neurologic Compromise
Bateman, Antony H.; Way, Adam C.
Study Design?Case report. Objectives?Decompression of metastatic spinal cord compression has been shown to improve quality of life and prolong ambulation in patients undergoing palliative treatment. We report a case of metastatic cervical myelopathy treated with a combined approach using corpectomy and stabilization together with balloon kyphoplasty to allow adequate decompression and immediate stability in a patient with significant destruction of adjacent vertebral bodies. Methods?The cervical spine was approached anteriorly and decompressed with a C7 corpectomy. Subsequent stability was achieved with insertion of a trabecular metal cage. Balloon kyphoplasty was used to treat lytic lesions within the posterior body of the adjacent vertebrae for pain relief and increased stability. Additional stability was achieved through the application of an anterior plate. Results?Full limited decompression and stabilization were successfully achieved. The patient had no further neurologic deterioration and made modest improvements that allowed a return to independent ambulation. Conclusion?This limited approach may be an option for patients with metastatic spinal cord compression, lytic destruction of adjacent vertebral bodies, and limited life expectancy. PMID:25844288
Two different courses of impaired cervical kinaesthesia following a whiplash injury. A one-year prospective study
Gudny Lilja Oddsdottir; Eythor Kristjansson
A longitudinal study was conducted to observe persons with neck pain after motor vehicle collisions. The aims were to reveal the prospective development of cervical kinaesthesia and to investigate the association between the test results and self-reported pain and disabilities. Two different cervical kinaesthetic tests, the Fly test and the Head-Neck Relocation test, measured movement control and the relocation accuracy
Image-guided spine surgery: state of the art and future directions
Shafizadeh, Sven; Rixen, Dieter; Paffrath, Thomas; Bouillon, Bertil; Steinhausen, Eva S.; Baethis, Holger
Navigation technology is a widely available tool in spine surgery and has become a part of clinical routine in many centers. The issue of where and when navigation technology should be used is still an issue of debate. It is the aim of this study to give an overview on the current knowledge concerning the technical capabilities of image-guided approaches and to discuss possible future directions of research and implementation of this technique. Based on a Medline search total of 1,462 publications published until October 2008 were retrieved. The abstracts were scanned manually for relevance to the topics of navigated spine surgery in the cervical spine, the thoracic spine, the lumbar spine, as well as ventral spine surgery, radiation exposure, tumor surgery and cost-effectivity in navigated spine surgery. Papers not contributing to these subjects were deleted resulting in 276 papers that were included in the analysis. Image-guided approaches have been investigated and partially implemented into clinical routine in virtually any field of spine surgery. However, the data available is mostly limited to small clinical series, case reports or retrospective studies. Only two RCTs and one metaanalysis have been retrieved. Concerning the most popular application of image-guided approaches, pedicle screw insertion, the evidence of clinical benefit in the most critical areas, e.g. the thoracic spine, is still lacking. In many other areas of spine surgery, e.g. ventral spine surgery or tumor surgery, image-guided approaches are still in an experimental stage. The technical development of image-guided techniques has reached a high level as the accuracies that can be achieved technically meet the anatomical demands. However, there is evidence that the interaction between the surgeon ('human factor') and the navigation system is a source of inaccuracy. It is concluded that more effort needs to be spend to understand this interaction. PMID:19763640
Immediate effects of spinal manipulation on thermal pain sensitivity: an experimental study
George, Steven Z; Bishop, Mark D; Bialosky, Joel E; Zeppieri, Giorgio; Robinson, Michael E
Background The underlying causes of spinal manipulation hypoalgesia are largely unknown. The beneficial clinical effects were originally theorized to be due to biomechanical changes, but recent research has suggested spinal manipulation may have a direct neurophysiological effect on pain perception through dorsal horn inhibition. This study added to this literature by investigating whether spinal manipulation hypoalgesia was: a) local to anatomical areas innervated by the lumbar spine; b) correlated with psychological variables; c) greater than hypoalgesia from physical activity; and d) different for A-delta and C-fiber mediated pain perception. Methods Asymptomatic subjects (n = 60) completed baseline psychological questionnaires and underwent thermal quantitative sensory testing for A-delta and C-fiber mediated pain perception. Subjects were then randomized to ride a stationary bicycle, perform lumbar extension exercise, or receive spinal manipulation. Quantitative sensory testing was repeated 5 minutes after the intervention period. Data were analyzed with repeated measures ANOVA and post-hoc testing was performed with Bonferroni correction, as appropriate. Results Subjects in the three intervention groups did not differ on baseline characteristics. Hypoalgesia from spinal manipulation was observed in lumbar innervated areas, but not control (cervical innervated) areas. Hypoalgesic response was not strongly correlated with psychological variables. Spinal manipulation hypoalgesia for A-delta fiber mediated pain perception did not differ from stationary bicycle and lumbar extension (p > 0.05). Spinal manipulation hypoalgesia for C-fiber mediated pain perception was greater than stationary bicycle riding (p = 0.040), but not for lumbar extension (p = 0.105). Conclusion Local dorsal horn mediated inhibition of C-fiber input is a potential hypoalgesic mechanism of spinal manipulation for asymptomatic subjects, but further study is required to replicate this finding in subjects with low back pain. PMID:16911795
Bone mineral density in patients with cervical and trochanteric fractures of the proximal femur
E. Vega; C. Mautalen; H. Gómez; A. Garrido; L. Melo; A. O. Sahores
The bone mineral density (BMD) of the proximal femur, spine and radius shaft was determined in 75 women with atraumatic fractures of the proximal femur (FXf) (average age: 70.1±9.6 years) and 51 controls of similar age. Fractures were classified as either cervical (n=36) or trochanteric (n=39) on the basis of radiographic and surgical finding. The BMD of spine and proximal
The potential contributing effect of ketorolac and fluoxetine to a spinal epidural hematoma following a cervical interlaminar epidural steroid injection: a case report and narrative review.
Chien, George C Chang; McCormick, Zack; Araujo, Marco; Candido, Kenneth D
Cervical interlaminar epidural steroid injections (ESIs) are commonly performed as one part of a multi-modal analgesic regimen in the management of upper extremity radicular pain. Spinal epidural hematoma (SEH) is a rare complication with a reported incidence ranging from 1.38 in 10,000 to 1 in 190,000 epidurals. Current American Society of Regional Anesthesia (ASRA), American Society of Interventional Pain Physicians (ASIPP), and the International Spine Intervention Society (ISIS) recommendations are that non-steroidal anti-inflammatory drugs (NSAIDs) do not need to be withheld prior to epidural anesthesia. We report a case wherein intramuscular ketorolac and oral fluoxetine contributed to a SEH and tetraplegia following a cervical interlaminar (ESI). A 66 year-old woman with chronic renal insufficiency and neck pain radiating into her right upper extremity presented for evaluation and was deemed an appropriate CESI candidate. Cervical magnetic resonance imaging (MRI) revealed multi-level neuroforaminal stenosis and degenerative intervertebral discs. Utilizing a loss of resistance to saline technique, an 18-gauge Tuohy-type needle entered the epidural space at C6-7. After negative aspiration, 4 mL of saline with 80 mg of methyl-prednisolone was injected. Immediately thereafter, the patient reported significant spasmodic-type localized neck pain with no neurologic status changes. A decision was made to administer 30 mg intramuscular ketorolac as treatment for the spasmodic-type pain. En route home, she developed a sudden onset of acute tetraplegia. She was brought to the emergency department for evaluation including platelet and coagulation studies which were normal. MRI demonstrated an epidural hematoma extending from C5 to T7. She underwent a bilateral C5-T6 laminectomy with epidural hematoma evacuation and was discharged to an acute inpatient rehabilitation hospital. Chronic renal insufficiency, spinal stenosis, female gender, and increasing age have been identified as risk factors for SEH following epidural anesthesia. In the present case, it is postulated that after the spinal vascular system was penetrated, hemostasis was compromised by the combined antiplatelet effects of ketorolac, fluoxetine, fish oil, and vitamin E. Although generally well tolerated, the role of ketorolac, a potent anti-platelet medication used for pain relief in the peri-neuraxial intervention period, should be seriously scrutinized when other analgesic options are readily available. Although the increased risk of bleeding for the alternative medications are minimal, they are nevertheless well documented. Additionally, their additive impairment on hemostasis has not been well characterized. Withholding NSAIDs, fluoxetine, fish oil, and vitamin E in the peri-procedural period is relatively low risk and should be considered for all patients with multiple risk factors for SEH. PMID:24850120
Computed Tomography is Diagnostic in the Cervical Imaging of Helmeted Football Players With Shoulder Pads
Rothman, Michael; Foley, Jack; Heller, Michael
Objective: Prospective, observational case series evaluating the value of cervical spine computed tomography (CT) scans in the initial evaluation of a helmeted football player with suspected cervical spine injury. Subjects: Five asymptomatic male football players, fully equipped and immobilized on a backboard. Design: Multiple 3.0-mm, helically acquired, axially displayed CT images of the cervical spine were obtained from the skull base inferiorly through T1, with images filmed at soft tissue and bone windows. Sagittal and coronal reformatted images were performed. Software was used to minimize metallic artifact. Measurements: All series were reviewed by a Board-certified neuroradiologist for image clarity and diagnostic capability. Results: Lateral scout films demonstrated mild segmental degradation, depending on the location of the metallic snaps overlying the spine. Anteroposterior scout films and bone window images were of diagnostic quality. The soft tissue windows showed minimal localized artifact occurring at the same levels as in the lateral scout views. This minimal beam-hardening streak artifact did not affect the diagnostic quality of the soft tissue windows. Reconstructed images were uniformly of clinical diagnostic quality. Discussion: When CT scans were reviewed as a unit, sufficient information was available to allow reliable clinical decisions about the helmeted football player. In light of recent publications demonstrating the difficulty of obtaining adequate radiographs to evaluate cervical spine injury in equipped football players, helmeted athletes may undergo CT scanning without any significant diagnostic limitations. PMID:15496989
Cervical intramedullary schwannoma mimicking a glioma
Gupta, Ankush; Nair, Bijesh Ravindran; Chacko, Geeta; Mani, Sunithi; Joseph, Vivek
We present a case of a cervical intramedullary schwannoma (IS), which resembled a glioma on radiology. Somatic and root pain, the most common presenting complaints of IS, were lacking in our patient, and the characteristic magnetic resonance finding of an enhancing thickened nerve root in IS, was absent in our case. Preoperative diagnosis of a cervical IS is not always possible. Complete tumor resection is the ideal treatment for IS. Intraoperative frozen section can be a useful for decision making though the tumor-cord plane will ultimately decide if the tumor can be radically excised. PMID:25767576
The effects of compensatory workplace exercises to reduce work-related stress and musculoskeletal pain1
de Freitas-Swerts, Fabiana Cristina Taubert; Robazzi, Maria Lúcia do Carmo Cruz
OBJECTIVES: to assess the effect of a compensatory workplace exercise program on workers with the purpose of reducing work-related stress and musculoskeletal pain. METHOD: quasi-experimental research with quantitative analysis of the data, involving 30 administrative workers from a Higher Education Public Institution. For data collection, questionnaires were used to characterize the workers, as well as the Workplace Stress Scale and the Corlett Diagram. The research took place in three stages: first: pre-test with the application of the questionnaires to the subjects; second: Workplace Exercise taking place twice a week, for 15 minutes, during a period of 10 weeks; third: post-test in which the subjects answered the questionnaires again. For data analysis, the descriptive statistics and non-parametric statistics were used through the Wilcoxon Test. RESULTS: work-related stress was present in the assessed workers, but there was no statistically significant reduction in the scores after undergoing Workplace Exercise. However, there was a statistically significant pain reduction in the neck, cervical, upper, middle and lower back, right thigh, left leg, right ankle and feet. CONCLUSION: the Workplace Exercise promoted a significant pain reduction in the spine, but did not result in a significant reduction in the levels of work-related stress. PMID:25296147
Drugs Approved for Cervical Cancer
... Questions to Ask Your Doctor about Treatment Research Drugs Approved for Cervical Cancer This page lists cancer ... Cervical Cancer Drug Combinations Used in Cervical Cancer Drugs Approved to Prevent Cervical Cancer Cervarix (Recombinant HPV ...
Back pain and associated factors in French nurses
I. Niedhammer; F. Lert; M. J. Marne
The aim of this study was to assess, in a prospective cohort of nurses, the risk factors associated with six back pain indicators: back pain (BP), chronic or recurring BP (occurring often or lasting for more than 3 months), cervical (CP), dorsal (DP) and lumbar (LP) pain and medical treatment for BP. In 1980, a sample of 469 nurses was
Put your back into it: pathologic conditions of the spine at chest CT.
Meyer, Cristopher A; Vagal, Achala S; Seaman, Danielle
It is common to encounter pathologic processes of the lower cervical, thoracic, or upper lumbar spine in the course of routine computed tomography (CT) of the chest. Although magnetic resonance (MR) is the imaging modality of choice for evaluating known spinal disease, evaluation of the spine is an integral part of interpreting a chest CT study. Spinal diseases often have a characteristic CT appearance that allows the radiologist to make the diagnosis or provide a structured differential diagnosis. Pathologic conditions of the spine that can be identified at chest CT are categorized into benign or incidental findings, congenital anomalies, traumatic injuries, infectious spondylitis, primary or secondary neoplastic involvement, and associations with systemic disease. CT also provides information about bone mineralization and lesion calcification that complements the superior soft-tissue imaging capability of MR. In addition, chest CT data may be reformatted to create volumetric or multiplanar images of the spine to facilitate management decisions about spinal stabilization in symptomatic patients. PMID:21918053
Frank, A
The studies reviewed here show that the duration and severity of individual episodes of back pain can be lessened, reducing recurrences and their cost in terms of suffering and lost work. Frank examines differential diagnosis; acute, chronic, and intractable pain; and service implications. Modern management emphasises self care, and bed rest should usually not be longer than 48 hours. A return to physical fitness and other activities, including employment, is actively encouraged. Medication has a role in facilitating these objectives. Two points are especially emphasised: strategies to manage low back pain must be long term and preventive; and the responsibility to keep fit, maintain an exercise programme, and remain relaxed so as to avoid physically stressing the spine is that of the individual, not of the professionals. Images FIG 2 PMID:8347190
From SPINE to SPINE-2 complexes and beyond It is about a decade since SPINE Structural Proteomics IN
Sussman, Joel L.
Editorial From SPINE to SPINE-2 complexes and beyond It is about a decade since SPINE Structural of the preceding projects, SPINE took an approach different from that of the mainstream of structural genomics: a major success of SPINE was to bring the cutting-edge high-throughput (HTP) technologies to biomedically
Giant schwannoma of the lumbar spine. A case report.
Jankowski, Roman; Szmeja, Jacek; Nowak, Stanis?aw; Sokó?, Bartosz; Blok, Tomasz
Giant "invasive" schwannomas of the spine occur occasionally, most frequently in the lumbar region. We present the case of a 46-year-old woman with giant "invasive" schwannoma of the lumbar spine, with a 12-year history of illness. The tu-mour originated in the vertebral canal and passed through the paraspinal muscles and retroperitoneal area to the abdominal cavity. The part of the tumour which was in the abdominal cavity was removed by means of laparotomy during the first operation. In the second one, the remaining part of the tumour was removed completely from the vertebral canal and retroperitoneal area through posterior-lateral access. The spine was stabilized with metal implants. Histological examination revealed cellular schwannoma. During the follow-up the pain resolved while paresis of the right quadriceps muscle of the thigh was still present. Cellular schwannoma is a benign form of schwannoma, but it may cause a local recurrence if not removed completely. PMID:20358489
Cervical Vertebrae Tracking in Video-Fluoroscopy Using the Normalized Gradient Field
Rianne Reinartz; Bram Platel; Toon Boselie; Henk Van Mameren; Henk Van Santbrink; Bart M. Ter Haar Romeny
For patients with neck problems valuable functional and diagnostic information can be obtained from a fluoroscopy video of\\u000a a flexion-extension movement of the cervical spine. In most cases physicians have to manually extract the vertebrae, making\\u000a the analysis of these video sequences tedious and time consuming. In this paper we propose an automatic fast and precise method\\u000a for tracking cervical
Posterior approach for cervical fracture–dislocations with traumatic disc herniation
Hiroaki Nakashima; Yasutsugu Yukawa; Keigo Ito; Masaaki Machino; Hany El Zahlawy; Fumihiko Kato
In the treatment algorithm for cervical spine fracture–dislocations, the recommended approach for treatment if there is a\\u000a disc fragment in the canal is the anterior approach. The posterior approach is not common because of the disadvantage of potential\\u000a neurological deterioration during reduction in traumatic cervical herniation patients. However, reports about the frequency\\u000a of this deterioration and the behavior of disc
Acute pancreatitis presenting as back pain: a case report
Decina, Philip A; Vallee, Dwight; Mierau, Dale
A man with acute back pain presented to a chiropractic clinic with clinical symptoms and signs suggesting abdominal disease rather than mechanical spine pain. He was referred to a local hospital emergency where a diagnosis of acute pancreatitis secondary to chronic cholecystitis was made. The diagnostic images are compared to normal studies. The characteristic clinical examination findings found with back pain due to acute pancreatitis are compared to those typically seen with mechanical spine pain. ImagesFigure 1Figure 2aFigure 2bFigure 3Figure 4aFigure 4bFigure 5aFigure 5b
Reoperations Following Cervical Disc Replacement
Skovrlj, Branko; Lee, Dong-Ho; Caridi, John Michael
Cervical disc replacement (CDR) has emerged as an alternative surgical option to cervical arthrodesis. With increasing numbers of patients and longer follow-ups, complications related to the device and/or aging spine are growing, leaving us with a new challenge in the management and surgical revision of CDR. The purpose of this study is to review the current literature regarding reoperations following CDR and to discuss about the approaches and solutions for the current and future potential complications associated with CDR. The published rates of reoperation (mean, 1.0%; range, 0%-3.1%), revision (mean, 0.2%; range, 0%-0.5%), and removal (mean, 1.2%; range, 0%-1.9%) following CDR are low and comparable to the published rates of reoperation (mean, 1.7%; range; 0%-3.4%), revision (mean, 1.5%; range, 0%-4.7%), and removal (mean, 2.0%; range, 0%-3.4%) following cervical arthrodesis. The surgical interventions following CDR range from the repositioning to explantation followed by fusion or the reimplantation to posterior foraminotomy or fusion. Strict patient selection, careful preoperative radiographic review and surgical planning, as well as surgical technique may reduce adverse events and the need for future intervention. Minimal literature and no guidelines exist for the approaches and techniques in revision and for the removal of implants following CDR. Adherence to strict indications and precise surgical technique may reduce the number of reoperations, revisions, and removals following CDR. Long-term follow-up studies are needed, assessing the implant survivorship and its effect on the revision and removal rates.
Biologics in spine arthrodesis.
Kannan, Abhishek; Dodwad, Shah-Nawaz M; Hsu, Wellington K
Spine fusion is a tool used in the treatment of spine trauma, tumors, and degenerative disorders. Poor outcomes related to failure of fusion, however, have directed the interests of practitioners and scientists to spinal biologics that may impact fusion at the cellular level. These biologics are used to achieve successful arthrodesis in the treatment of symptomatic deformity or instability. Historically, autologous bone grafting, including iliac crest bong graft harvesting, had represented the gold standard in spinal arthrodesis. However, due to concerns over potential harvest site complications, supply limitations, and associated morbidity, surgeons have turned to other bone graft options known for their osteogenic, osteoinductive, and/or osteoconductive properties. Current bone graft selection includes autograft, allograft, demineralized bone matrix, ceramics, mesenchymal stem cells, and recombinant human bone morphogenetic protein. Each pose their respective advantages and disadvantages and are the focus of ongoing research investigating the safety and efficacy of their use in the setting of spinal fusion. Rh-BMP2 has been plagued by issues of widespread off-label use, controversial indications, and a wide range of adverse effects. The risks associated with high concentrations of exogenous growth factors have led to investigational efforts into nanotechnology and its application in spinal arthrodesis through the binding of endogenous growth factors. Bone graft selection remains critical to successful fusion and favorable patient outcomes, and orthopaedic surgeons must be educated on the utility and limitations of various biologics in the setting of spine arthrodesis. PMID:25978141
Proteomic profiling of posterior longitudinal ligament of cervical spine
Zhang, Ying; Liu, Baifeng; Shao, Jiang; Song, Jia; Zhang, Jing
Objective: To identify putative biomarkers for ossification of posterior longitudinal ligament (OPLL). Material and methods: Proteomic analysis was performed in 4 ligament samples from OPLL patients and healthy controls. RT-PCR was used to further verify the proteomic analysis results. Results: A total of 50 differentially expressed spots were detected in 2-D electrophoresis between the two groups. In protein/peptide analysis, 21 proteins or peptides were finally identified. Besides 13 hematic proteins and 2 unknown proteins, 6 other proteins were differentially expressed. Among them, carbonic anhydrase I, NAD(P) dependent steroid dehydrogenase-like, billiverdin reductase B and alpha-1 collagen VI were down-regulated, while osteoglycin and nebulin-related anchoring protein were up-regulated. The results of NAD(P) dependent steroid dehydrogenase-like, alpha-1 collagen VI and nebulin-related anchoring protein were validated by RT-PCR. Conclusion: These differentially expressed proteins could play a role in the onset and progression of OPLL.
Parameters that effect spine biomechanics following cervical disc replacement
Vijay K. GoelAhmad; Ahmad Faizan; Vivek Palepu; Sanghita Bhattacharya
Total disc replacement (TDR) is expected to provide a more physiologic alternative to fusion. However, long-term clinical\\u000a data proving the efficacy of the implants is lacking. Limited clinical data suggest somewhat of a disagreement between the\\u000a in vitro biomechanical studies and in vivo assessments. This conceptual paper presents the potential biomechanical challenges\\u000a affecting the TDR that should be addressed with
Loading of Cervical Spine when Head is Rotated
NASA Astrophysics Data System (ADS)
Shaibani, Saami J.
The neck is more susceptible to injury during an insult in the forward direction if the head is not initially facing straight ahead. (A typical example of this is when a vehicle occupant is checking traffic to the right or left at an intersection before proceeding.) However, the ability to characterize this behavior has not progressed much beyond the qualitative because practical constraints limit testing with conventional physical surrogates. This shortfall is tackled in this study by employing a model validated elsewhere to represent a range of real-world events with the power of great specificity for parameters of importance. Of primary concern is the variation in head angle, which can now be investigated across a wide spectrum of values that was not possible with previous approaches. The quantitative results computed here provide an extraordinarily high level of detail and they show how the potential for injury can change from low to significant within a matter of degrees. This explains why a seemingly harmless impact can cause trauma in some cases when none would otherwise be expected.
Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis.
Eck, Jason C; Sharan, Alok; Ghogawala, Zoher; Resnick, Daniel K; Watters, William C; Mummaneni, Praveen V; Dailey, Andrew T; Choudhri, Tanvir F; Groff, Michael W; Wang, Jeffrey C; Dhall, Sanjay S; Kaiser, Michael G
Establishing an appropriate treatment strategy for patients presenting with low-back pain, in the absence of stenosis or spondylolisthesis, remains a controversial subject. Inherent to this situation is often an inability to adequately identify the source of low-back pain to justify various treatment recommendations, such as lumbar fusion. The current evidence does not identify a single best treatment alternative for these patients. Based on a number of prospective, randomized trials, comparable outcomes, for patients presenting with 1- or 2-level degenerative disc disease, have been demonstrated following either lumbar fusion or a comprehensive rehabilitation program with a cognitive element. Limited access to such comprehensive rehabilitative programs may prove problematic when pursuing this alternative. For patients whose pain is refractory to conservative care, lumbar fusion is recommended. Limitations of these studies preclude the ability to present the most robust recommendation in support of lumbar fusion. A number of lesser-quality studies, primarily case series, also support the use of lumbar fusion in this patient population. PMID:24980584
Lumbar spine loads during education and training with self-contained breathing apparatus
T. Küpper; M. Haisch
Objective: German fire fighters often complain of lumbar back pain after training with a self-contained breathing apparatus while using\\u000a a device called `Schlag- hammer' (SH). We investigated whether this training produces an excessive load on the lumbar spine.\\u000a Method: We developed a model to estimate the load on the lumbar spine using a vector model similar to Jäger et?al.'s model.
Thoracic spine spasms secondary to hemorrhagic intestinal ulcer.
Slipman, C W; Whyte Ii, W S; Lichtenstein, G R; Lenrow, D; Braverman, D; Ellen, M; Vresilovic, E J
A case of thoracic spine spasms secondary to a bleeding duodenal ulcer is presented. A 41-year-old male with 14-week history of thoracic spine spasm was treated with bed rest, spinal manipulation, physical therapy, medication, and a thoracolumbar brace. Subsequently, a provocative thoracic discogram performed at T9-T10 created periscapular pain and also reproduced the presenting thoracic spasms. Intradiscal electrothermal annuloplasty (IDET) was performed at the T9-T10 level, but without sustained relief. The patient presented to a spine center for evaluation. The diagnosis of thoracic discogenic disease was suspected. A second provocative thoracic discogram was performed and failed to reproduce his thoracic spasms. Three weeks after being referred to a chronic pain management physician, the patient presented to a local emergency room with hema-temesis. An endoscopic evaluation revealed a bleeding duodenal ulcer. Following medical treatment of the duodenal ulcer with a proton pump inhibitor the patient had complete resolution of his thoracic spasms. This represents the first reported case of thoracic spine spasms as an initial presenting symptom of a bleeding peptic ulcer. PMID:16906172
Ultrasound Imaging of Spine: State of the Art and Utility for Space Flight
NASA Technical Reports Server (NTRS)
Sargsyan, Ashot E.; Bouffard, Antonio J.; Garcia, Kathleen; Hamilton, Douglas R.; Van Holsbeeck, Marnix; Ebert, Douglas J. W.; Dulchavsky, Scott A.
Introduction: Ultrasound imaging (sonography) has been increasingly used for both primary diagnosis and monitoring of musculoskeletal injury, including fractures. In certain injuries, sonography has been shown to equal or surpass Magnetic Resonance Imaging in accuracy. Long-term exposure to reduced gravity may be expected to cause physiological and anatomical changes of the musculoskeletal system, which are not fully described or understood. In a limited-resource environment like space flight, sonography will likely remain the only imaging modality; therefore, further attention to its potential is warranted, including its ability to image anatomical deviations as well as irregularities of vertebrae and the spinal column. Methods: A thorough review of literature was conducted on the subject. A multipurpose ultrasound system was used to identify specific vertebrae, intervertebral disks, and other structures of the cervical spine in healthy volunteers, selected to represent various age, gender, and Body Mass Index (BMI) groups. Sonographic views were sought that would parallel radiographic views and signs used in the diagnosis of cervical spine injuries. Results: While using widely accepted radiographic signs of cervical spine injury, this sonographic protocol development effort resulted in successful identification of scanning planes and imaging protocols that could serve as alternatives for radiography. Some of these views are also applicable to diagnosing degenerative disk and bone disease, and other non-traumatic spine pathology. Strong, preliminary correlation has been demonstrated in a number of clinical cases between sonography and other imaging modalities. Conclusion: In the absence of radiography, sonography can be used to diagnose or rule out certain common types of cervical spine conditions including injury. Clinical validation of the findings appears to be realistic and would facilitate establishment of new sonographic protocols for special environments with lacking radiographic capability, such as human space flight.
Segmentation and image navigation in digitized spine x rays
NASA Astrophysics Data System (ADS)
Long, L. Rodney; Thoma, George R.
The National Library of Medicine has archived a collection of 17,000 digitized x-rays of the cervical and lumbar spines. Extensive health information has been collected on the subjects of these x-rays, but no information has been derived from the image contents themselves. We are researching algorithms to segment anatomy in these images and to derive from the segmented data measurements useful for indexing this image set for characteristics important to researchers in rheumatology, bone morphometry, and related areas. Active Shape Modeling is currently being investigated for use in location and boundary definition for the vertebrae in these images.
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Evaluating the V2 Segment of the Vertebral Artery with Computed Tomography to Assess Risks During Cervical Spinal Surgery: An Anatomic Study on Cadaver
Mustafa Güvençer; Süleyman Men; Sait Naderi
Purpose: The second segment (V2) of the vertebral artery is located in the transverse foramen of the C6-2 cervical vertebrae. It is at risk of injury during anterior, anterolateral and posterior surgical approaches to the cervical spine. The aim of this study is to measure and evaluate the relationship between the V2 segment and bony landmarks of the cervical vertebrae.
Geurts, T W; van den Akker, H P; Balm, A J
Three patients, 2 men aged 21 and 39 years, respectively, and 1 woman aged 29 years, presented with a unilateral swelling of the neck, with no accompanying symptoms. In the youngest man the diagnosis of a 'plunging ranula' was made after repeated fine needle aspiration yielded viscous yellowish mucus with a high amylase content. In the oldest man the diagnosis was made during the operation and in the woman the diagnosis was finally made after two surgical explorations in the neck. In all 3, no recurrence occurred after removal of the involved salivary glands. A cervical ranula is an extension of a pseudocyst of the glandula sublingualis. Important clues for the diagnosis of a 'plunging ranula' are: the simultaneous presence of a ranula in the floor of the mouth (or a history of one), a characteristic cystic mass in the submandibular space with an extension into the sublingual space on CT and/or MRI, and the aspiration of amylase-containing mucus. Excision of the sublingual gland as the source of salivary leakage is the therapy of choice in a case of 'plunging ranula', with drainage of mucus from the ranula into the oral cavity. As the 'plunging ranula' represents a pseudocyst without an epithelial lining, excision is not indicated. PMID:15032092
Cervical elongation following sacrospinous hysteropexy: a case series.
Hyakutake, Momoe Tina; Cundiff, Geoffrey William; Geoffrion, Roxana
In recent years, pelvic floor surgeons have increasingly repaired pelvic organ prolapse around an intact uterus. Uterine conservation and hysteropexy have been driven by patient preference, less risk of mesh erosion, shorter operative time, and decreased blood loss and postoperative pain. We present a case series of patients with cervical elongation after vaginal sacrospinous hysteropexy using polypropylene mesh arms, a novel technique developed by the senior author. We defined cervical elongation as greater than or equal to a two-fold increase in cervical length compared with preoperative measurements. Of the 8 patients who underwent this procedure, 5 (62.5 %) had cervical elongation during the first year postoperatively. In the most severe case, the cervix extended to 4 cm beyond the hymenal ring. Most of the patients were mildly symptomatic and chose expectant management. The cases are reviewed in detail. A brief literature review on cervical elongation is presented. PMID:24297063
Extradiscal ultrasound thermal therapy (ExDUSTT): evaluation in ex vivo and in vivo spine models (Invited Paper)
NASA Astrophysics Data System (ADS)
Diederich, Chris J.; Kinsey, Adam; Nau, William H.; Shu, Richard; Lotz, Jeffrey C.
The application of heat to intervertebral discs is being clinically investigated for the treatment of discogenic back pain. The purpose of this study was to develop and test the feasibility of small ultrasound applicators that can be endoscopically placed adjacent to the disc, and deliver heating energy into the disc without puncturing the annular wall. Prototype devices were fabricated using curvilinear transducers (2.5-3.5 mm wide x 10 mm long, 5.4 - 6.5 MHz) that produce a narrow penetrating beam extending along the length of the ultrasound element. The transducer was affixed to either a flexible or rigid delivery catheter, and enclosed within an asymmetric coupling balloon with water-cooling flow. Bench measurements demonstrated 35-60% acoustic efficiencies, high-power output capabilities, and lightly focused beam patterns. The heating characteristics of these devices were evaluated with ex vivo and in vivo experiments within lumbar and cervical spine segments from sheep models and human cadaveric spine. The applicators were positioned adjacent to the annular wall of the surgically exposed discs. Ultrasound energy was focused directly into the disc to avoid heating the vertebral bodies. Multi-point thermocouple probes were placed throughout the disc to characterize the resultant temperature distributions. These studies demonstrated that ultrasound energy from these applicators penetrated the annular wall of the disc, and produced thermal coagulative temperatures of >60-65°C as far as 10 mm into the tissue. This study also showed that lower power levels and temperatures delivered for 10 minutes can generate a cytotoxic thermal dose of t43°C >240 min penetrating 5-10 mm from the annular wall.
Validation of spinal motion with the spine reposition sense device
Petersen, Cheryl M; Rundquist, Peter J
Background A sagittal plane spine reposition sense device (SRSD) has been developed. Two questions were addressed with this study concerning the new SRSD: 1) whether spine movement was occurring with the methodology, and 2) where movement was taking place. Methods Sixty-five subjects performed seven trials of repositioning to a two-thirds full flexion position in sitting with X and Y displacement measurements taken at the T4 and L3 levels. The thoracolumbar angle between the T4 and the L3 level was computed and compared between the positions tested. A two (vertebral level of thoracic and lumbar) by seven (trials) mixed model repeated measures ANOVA indicated whether significant differences were present between the thoracic (T4) and lumbar (L3) angular measurements. Results Calculated thoracolumbar angles between T4 and L3 were significantly different for all positions tested indicating spinal movement was occurring with testing. No interactions were found between the seven trials and the two vertebral levels. No significant findings were found between the seven trials but significant differences were found between the two vertebral levels. Conclusion This study indicated spine motion was taking place with the SRSD methodology and movement was found specific to the lumbar spine. These findings support utilizing the SRSD to evaluate changes in spine reposition sense during future intervention studies dealing with low back pain. PMID:19386126
Modic type I changes of the lumbar spine in golfers
Jason Mefford; Koichi Sairyo; Toshinori Sakai; Justin Hopkins; Madoka Inoue; Rui Amari; Nitin N. Bhatia; Akira Dezawa; Natsuo Yasui
Low back pain (LBP) is the most prevalent musculoskeletal complaint among professional and amateur golfers; however, associated\\u000a radiological changes in golf-related LBP have not been examined in the literature. We suspect that Modic Type 1 changes in\\u000a the lumbar spine are linked to golf-related LBP. In this retrospective case series, four middle-aged golfers (one professional\\u000a and three high-level amateurs) presented
The lumbar spine in Neanderthals shows natural kyphosis
Jochen Weber; Carsten Matthias Pusch
Nowadays, lumbar spondylosis is one of the most frequent causes of lower back pain. In order to improve our understanding\\u000a of the lumbar spine anatomy and functionality over time, we compared the lumbar vertebrae of Neanderthals with those of anatomically\\u000a modern humans. The fossil record reports on only two Neanderthal skeletons (i.e., Kebara 2 and Shanidar 3, both predating\\u000a the
Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department
Stiell, Ian G.; Clement, Catherine M.; O'Connor, Annette; Davies, Barbara; Leclair, Christine; Sheehan, Pamela; Clavet, Tamara; Beland, Christine; MacKenzie, Taryn; Wells, George A.
Objectives The Canadian C-Spine Rule for imaging of the cervical spine was developed for use by physicians. We believe that nurses in the emergency department could use this rule to clinically clear the cervical spine. We prospectively evaluated the accuracy, reliability and acceptability of the Canadian C-Spine Rule when used by nurses. Methods We conducted this three-year prospective cohort study in six Canadian emergency departments. The study involved adult trauma patients who were alert and whose condition was stable. We provided two hours of training to 191 triage nurses. The nurses then assessed patients using the Canadian C-Spine Rule, including determination of neck tenderness and range of motion, reapplied immobilization and completed a data form. Results Of the 3633 study patients, 42 (1.2%) had clinically important injuries of the cervical spine. The kappa value for interobserver assessments of 498 patients with the Canadian C-Spine Rule was 0.78. We calculated sensitivity of 100.0% (95% confidence interval [CI] 91.0%–100.0%) and specificity of 43.4% (95% CI 42.0%–45.0%) for the Canadian C-Spine Rule as interpreted by the investigators. The nurses classified patients with a sensitivity of 90.2% (95% CI 76.0%–95.0%) and a specificity of 43.9% (95% CI 42.0%–46.0%). Early in the study, nurses failed to identify four cases of injury, despite the presence of clear high-risk factors. None of these patients suffered sequelae, and after retraining there were no further missed cases. We estimated that for 40.7% of patients, the cervical spine could be cleared clinically by nurses. Nurses reported discomfort in applying the Canadian C-Spine Rule in only 4.8% of cases. Conclusion Use of the Canadian C-Spine Rule by nurses was accurate, reliable and clinically acceptable. Widespread implementation by nurses throughout Canada and elsewhere would diminish patient discomfort and improve patient flow in overcrowded emergency departments. PMID:20457772
Veliparib, Topotecan Hydrochloride, and Filgrastim or Pegfilgrastim in Treating Patients With Persistent or Recurrent Cervical Cancer
Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Recurrent Cervical Carcinoma; Stage III Cervical Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer
Veliparib, Topotecan Hydrochloride, and Filgrastim or Pegfilgrastim in Treating Patients With Persistent or Recurrent Cervical Cancer
Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Recurrent Cervical Carcinoma; Stage III Cervical Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer