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1

Correlation between TMD and Cervical Spine Pain and Mobility: Is the Whole Body Balance TMJ Related?  

PubMed Central

Temporomandibular dysfunction (TMD) is considered to be associated with imbalance of the whole body. This study aimed to evaluate the influence of TMD therapy on cervical spine range of movement (ROM) and reduction of spinal pain. The study group consisted of 60 patients with TMD, cervical spine pain, and limited cervical spine range of movements. Subjects were interviewed by a questionnaire about symptoms of TMD and neck pain and had also masticatory motor system physically examined (according to RDC-TMD) and analysed by JMA ultrasound device. The cervical spine motion was analysed using an MCS device. Subjects were randomly admitted to two groups, treated and control. Patients from the treated group were treated with an occlusal splint. Patients from control group were ordered to self-control parafunctional habits. Subsequent examinations were planned in both groups 3 weeks and 3 months after treatment was introduced. The results of tests performed 3 months after the beginning of occlusal splint therapy showed a significant improvement in TMJ function (P > 0.05), cervical spine ROM, and a reduction of spinal pain. The conclusion is that there is a significant association between TMD treatment and reduction of cervical spine pain, as far as improvement of cervical spine mobility.

Walczynska-Dragon, Karolina; Baron, Stefan; Nitecka-Buchta, Aleksandra; Tkacz, Ewaryst

2014-01-01

2

Pediatric cervical spine instability  

PubMed Central

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.

El Hage, Samer; Rachkidi, Rami; Kharrat, Khalil; Dagher, Fernand; Kreichati, Gabi

2008-01-01

3

Finite element modeling of potential cervical spine pain sources in neutral position low speed rear impact.  

PubMed

The rate of soft tissue sprain/strain injuries to the cervical spine and associated cost continue to be significant; however, the physiological nature of this injury makes experimental tests challenging while aspects such as occupant position and musculature may contribute to significant variability in the current epidemiological data. Several theories have been proposed to identify the source of pain associated with whiplash. The goal of this study was to investigate three proposed sources of pain generation using a detailed numerical model in rear impact scenarios: distraction of the capsular ligaments; transverse nerve root compression through decrease of the intervertebral foramen space; and potential for damage to the disc based on the extent of rotation and annulus fibre strain. There was significant variability associated with experimental measures, where the range of motion data overlapped ultimate failure data. Average data values were used to evaluate the model, which was justified by the use of average mechanical properties within the model and previous studies demonstrating predicted response and failure of the tissues was comparable to average response values. The model predicted changes in dimension of the intervertebral foramen were independent of loading conditions, and were within measured physiological ranges for the impact severities considered. Disc response, measured using relative rotation between intervertebral bodies, was below values associated with catastrophic failure or avulsion but exceeded the average range of motion values. Annulus fibre strains exceeded a proposed threshold value at three levels for 10g impacts. Capsular ligament strain increased with increasing impact severity and the model predicted the potential for injury at impact severities from 4g to 15.4g, when the range of proposed distraction corresponding to sub-catastrophic failure was exceeded, in agreement with the typically reported values of 9-15g. This study used an enhanced neck finite element model with active musculature to investigate three potential sources of neck pain resulting from rear impact scenarios and identified capsular ligament strain and deformation of the disc as potential sources of neck pain in rear impact scenarios. PMID:23466282

Cronin, Duane S

2014-05-01

4

Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple-level anterior cervical discectomy and fusion: a case report.  

PubMed

Study Design Case report. Background Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. Case Description The patient was a 46-year-old woman referred to outpatient physical therapy 2 months following multiple-level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6-week episode of care. Outcomes Immediate reductions in cervical-region pain (mean ± SD, 2.0 ± 1.1) and headache (2.0 ± 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work-related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16%, with an associated global rating of change scale score of +7 ("a very great deal better"). Discussion This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2014;44(6):440-449. Epub 10 May 2014. doi:10.2519/jospt.2014.5026. PMID:24816502

Salvatori, Renata; Rowe, Robert H; Osborne, Raine; Beneciuk, Jason M

2014-06-01

5

Pediatric cervical spine fractures: predominantly subtle presentation.  

PubMed

Previous description of cervical spine fractures in children have emphasized high mortality injuries to the upper cervical vertebra. Our experience suggests a much wider spectrum of injury. The medical records of all children with cervical spine fractures admitted to Children's Hospital between January 1, 1985 and December 31, 1989 were reviewed. The average age of the 50 patients was 11 years (range, 2.7 to 18.8 years) and 62% were boys. Motor vehicle-related accidents (54%), sports injuries (18%), and falls (12%) accounted for the majority of the fractures. Twenty-nine patients (58%) had an associated head injury. Fifty percent of the patients were transported from the accident scene and 44% were interhospital transfers. All patients receiving medical care prior to referral had appropriate cervical spine stabilization. On admission 30% of the patients were unresponsive. Thirty-one children were alert and verbal at the time of evaluation and 30 complained of neck pain and tenderness (97%). Twenty-five of the 31 patients (83%) had no demonstrable neurological deficit on initial physical examination. Lateral cervical spine radiographs were diagnostic in 49 children (98%). A relatively even distribution of fractures occurred at all levels of the cervical spine. The anatomic site of the injury did not correlate with age. Sixteen patients (32%) died. Of the 34 who survived, only 6 had a persistent neurological deficit. Children with cervical spine fractures have two distinct patterns of presentation: lethal or intact. The majority of children with cervical spine fractures presented with no complaints of neck pain and/or tenderness need a complete radiographic evaluation of their cervical spine. PMID:1919996

Dietrich, A M; Ginn-Pease, M E; Bartkowski, H M; King, D R

1991-08-01

6

Tennis elbow and the cervical spine.  

PubMed Central

The exact cause of tennis elbow, a common condition, is still obscure. While the condition may well be entirely due to a local disorder at the elbow, the results of a study of 50 patients whose condition was resistant to 4 weeks of treatment directed to the elbow suggest that the underlying condition may have been (at least in these patients) a reflex localization of pain from radiculopathy at the cervical spine. Clinical, radiologic and electromyographic findings supported this suggestion. The pain was demonstrated to be muscular tenderness, which was maximal and specific at motor points. Treatment directed to the cervical spine appeared to give relief in the majority of patients. The more resistant the condition, the more severe were the radiologic and electromyographic findings in the cervical spine. Images FIG. 3 FIG. 4

Gunn, C. C.; Milbrandt, W. E.

1976-01-01

7

Cervical spine: sport injuries biomechanics  

Microsoft Academic Search

An improved and detailed 3-D FE model of human cervical spine was created using digitized geometric measurement. The model was validated with the in-vivo studies of Moroney [5], Panjabi [6] and Fuller [7]. Clinical instability of the spine for two cases involving flexion and compression loading (simulating injuries in motorcycle vaulting, football and diving accidents) were analyzed. The instability was

Abraham Tchako; Ali M. Sadegh

2005-01-01

8

Occult fracture-dislocation of the cervical spine  

Microsoft Academic Search

Occult injuries of the cervical spine in certain patients may lead to misdiagnosis or delayed diagnosis and treatment. The authors present a patient with an occult cervical spinal fracture-dislocation and review the literature. A 37 year-old male was involved in a motor vehicle accident. At his admission, the patient was alert and denied any pain in the cervical region, as

D. S. Korres; P. J. Papagelopoulos; H. G. Petrou; G. P. Tzagarakis; P. G. Triantafyllidis; J. Tsarouchas; G. Koundis

1999-01-01

9

Cervical spine injury: tiger attack.  

PubMed

Reports of tiger attacks in the United States are rare. This article presents a case of a young woman who was violently attacked by a Siberian tiger and sustained penetrating trauma to the neck, cervical spine, and bilateral lower extremities. This article presents both diagnostic and therapeutic management of patients who may present with similar injuries. Animal bites from large animals are prone to infection in 10% to 20% of cases. Most infections are polymicrobial, with Pasteurella multicida being the most common isolate. Animal bites also mandate consideration of tetanus and rabies prophylaxis. The decision to administer postexposure rabies prophylaxis is dependent on the type of animal involved, whether the exposure was provoked, the local epidemiology of rabies, and the availability of the animal for observation or testing. Assessment of patients with cervical spine injury requires knowledge of possible associated injuries. Evaluation involves assessment of plain radiographs and computed tomography for evaluation of the cervical spine for bony injury. Furthermore, computed angiography is advantageous to noninvasively evaluate carotid or vertebral artery injury at the same setting in patients with deep cervical puncture wounds. Surgical treatment of unstable cervical spine fractures with lateral mass screw and rod fixation has been reported in the literature to have superior biomechanical properties compared to anterior and posterior instrumentation and fusion. In recent clinical studies, the use of lateral mass screws for traumatic injury of the cervical spine has been associated with excellent maintenance of alignment and minimal complications. PMID:19226051

Anderson, Meredith; Utter, Philip; Szatkowski, Jan; Patrick, Todd; Duncan, William; Turner, Norman; Dekutoski, Mark

2008-12-01

10

Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions  

Microsoft Academic Search

BACKGROUND: Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. METHODS: Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The

Laxmaiah Manchikanti; Mark V Boswell; Vijay Singh; Vidyasagar Pampati; Kim S Damron; Carla D Beyer

2004-01-01

11

The Effect of an Analgesic Mobilization Technique When Applied at Symptomatic or Asymptomatic Levels of the Cervical Spine in Subjects with Neck Pain: A Randomized Controlled Trial  

PubMed Central

The purpose of this single-blinded, randomized controlled trial was to compare the effects of a manual treatment technique on neck pain and movement sensation when applied in different segments of the cervical spine. Consecutive patients with neck pain (n=126) were recruited and randomly allocated to two groups (A or B). Group A received a single 4-minute pain-alleviating traction at the most symptomatic zygopophyseal joint of the cervical segment, where movement was correlated with pain. Group B received the same treatment 3 segments away from the concordant segment. Pain intensity and sensation of movement were assessed with a numeric rating scale (NRS). Statistical analysis included a t-test for paired and unpaired samples. Pre- and post-test findings demonstrated significant improvements in both types of mobilization although there was no significant difference between the two groups. Similar results have been reported in the literature for cervical manipulation. The findings of this study question the necessity of precise symptom localization tests for a pain treatment. however, limitations of the study prevent generalization of these results.

Schomacher, Jochen

2009-01-01

12

Cervical spine injuries in American football.  

PubMed

American football is a high-energy contact sport that places players at risk for cervical spine injuries with potential neurological deficits. Advances in tackling and blocking techniques, rules of the game and medical care of the athlete have been made throughout the past few decades to minimize the risk of cervical injury and improve the management of injuries that do occur. Nonetheless, cervical spine injuries remain a serious concern in the game of American football. Injuries have a wide spectrum of severity. The relatively common 'stinger' is a neuropraxia of a cervical nerve root(s) or brachial plexus and represents a reversible peripheral nerve injury. Less common and more serious an injury, cervical cord neuropraxia is the clinical manifestation of neuropraxia of the cervical spinal cord due to hyperextension, hyperflexion or axial loading. Recent data on American football suggest that approximately 0.2 per 100,000 participants at the high school level and 2 per 100,000 participants at the collegiate level are diagnosed with cervical cord neuropraxia. Characterized by temporary pain, paraesthesias and/or motor weakness in more than one extremity, there is a rapid and complete resolution of symptoms and a normal physical examination within 10 minutes to 48 hours after the initial injury. Stenosis of the spinal canal, whether congenital or acquired, is thought to predispose the athlete to cervical cord neuropraxia. Although quite rare, catastrophic neurological injury is a devastating entity referring to permanent neurological injury or death. The mechanism is most often a forced hyperflexion injury, as occurs when 'spear tackling'. The mean incidence of catastrophic neurological injury over the past 30 years has been approximately 0.5 per 100,000 participants at high school level and 1.5 per 100,000 at the collegiate level. This incidence has decreased significantly when compared with the incidence in the early 1970s. This decrease in the incidence of catastrophic injury is felt to be the result of changes in the rules in the mid-1970s that prohibited the use of the head as the initial contact point when blocking and tackling. Evaluation of patients with suspected cervical spine injury includes a complete neurological examination while on the field or the sidelines. Immobilization on a hard board may also be necessary. The decision to obtain radiographs can be made on the basis of the history and physical examination. Treatment depends on severity of diagnosed injury and can range from an individualized cervical spine rehabilitation programme for a 'stinger' to cervical spine decompression and fusion for more serious bony or ligamentous injury. Still under constant debate is the decision to return to play for the athlete. PMID:19691361

Rihn, Jeffrey A; Anderson, David T; Lamb, Kathleen; Deluca, Peter F; Bata, Ahmed; Marchetto, Paul A; Neves, Nuno; Vaccaro, Alexander R

2009-01-01

13

Infections of the Cervical Spine  

Microsoft Academic Search

\\u000a Spinal infections are relatively rare, accounting for only 2–4% of all osteomyelitis infections, and are located preferentially\\u000a in the thoracic and lumbar segments. Although the cervical segment is the less common spine localization, cervical spinal\\u000a infections present the highest incidence of neurological involvement [6].\\u000a \\u000a \\u000a Recent advances in diagnosis and management — with the introduction of antibiotics and more aggressive surgery

Luca Denaro; Umile Giuseppe Longo; Vincenzo Denaro

14

Cervical spine in Treacher Collins syndrome.  

PubMed

Treacher Collins syndrome is a congenital syndrome with characteristic craniofacial malformations, which are well described in the literature. However, the presence of cervical spine dysmorphology in this syndrome has been minimally described. This study reviews cervical spine radiographs of 40 patients with Treacher Collins syndrome. In this sample, 7 of 40 patients displayed cervical spine anomalies, with 3 of these patients displaying multiple cervical spine anomalies. The patterns of spinal anomalies were variable, suggesting that the underlying genetic mutation has variable expressivity in cervical spine development as it does elsewhere in the craniofacial skeleton. PMID:22627438

Pun, Amy Hoi-Ying; Clark, Bruce Eric; David, David John; Anderson, Peter John

2012-05-01

15

Biomechanics of the cervical spine Part 3: minor injuries  

Microsoft Academic Search

Minor injuries of the cervical spine are essentially defined as injuries that do not involve a fracture. Archetypical of minor cervical injury is the whiplash injury. Among other reasons, neck pain after whiplash has been controversial because critics do not credit that an injury to the neck can occur in a whiplash accident. In pursuit of the injury mechanism, bioengineers

Nikolai Bogduk; Narayan Yoganandan

2001-01-01

16

Sagittal alignment of the cervical spine after neck injury.  

PubMed

The normal sagittal alignment of the cervical spine is lordotic and is affected by the posture of the head and neck. The question of whether loss of cervical lordosis is the result of muscle spasm after injury or a normal variation, and the clinical significance of such changes in sagittal profile of the cervical spine has been an issue of several studies. The purpose of this paper is to study the incidence of normal cervical lordosis and its changes after neck injury compared to the healthy population. We studied the lateral radiographs of the cervical spine of 60 patients with neck injury compared to 100 patients without a neck injury. Lateral radiographs were obtained in the standing or sitting position, and the curvature of the cervical spine was measured using the angle formed between the inferior end plates of the C2 and C7 vertebrae. In the patients without neck injury, lordotic and straight cervical spine sagittal alignment was observed in 36.5% each, double curvature in 17%, and kyphotic in 10%. In the patients with neck injury, lordotic sagittal alignment was observed in 36%, straight in 34%, double curvature in 26% and kyphotic in 4%. No significant difference between the two groups regarding all types of sagittal alignment of the cervical spine was found (p > 0.100). The alterations in normal cervical lordosis in patients with neck injury must be considered coincidental. These alterations should not be associated with muscle spasm caused by neck pain. PMID:23412281

Beltsios, Michail; Savvidou, Olga; Mitsiokapa, Evanthia A; Mavrogenis, Andreas F; Kaspiris, Angelos; Efstathopoulos, Nikolaos; Papagelopoulos, Panayiotis J

2013-07-01

17

Progressive dysphagia and neck pain due to diffuse idiopathic skeletal hyperostosis of the cervical spine: a case report and literature review  

PubMed Central

Diffuse idiopathic skeletal hyperostosis (DISH) is considered an underdiagnosed and mostly asymptomatic nonprimary osteoarthritis. The etiology of DISH remains unknown and the validated diagnostic criteria are absent. This condition is still recognized radiologically only. Rarely, large projecting anterior osteophytes result in esophageal impingement and distortion leading to dysphagia. We report the case of progressive dysphagia and neck pain due to DISH of the cervical spine in a 70-year-old man, which was surgically removed with excellent postoperative results and complete resolution of symptoms. Imaging studies, surgical findings, and histopathological examinations were used to support the diagnosis. The patient was successfully treated with total excision of the anterior osteophytes with no evidence of recurrence 12 months after surgery. In this report, we also discuss the clinical features and perioperative considerations in combination with a literature review. Our patient illustrates that clinicians should be aware of this rare clinical manifestation as the presenting feature of DISH in cervical spine. Surgical decompression through osteophytectomy is effective for patients who fail conservative treatment.

Zhang, Chao; Ruan, Dike; He, Qing; Wen, Tianyong; Yang, Pushan

2014-01-01

18

Intraosseous Schwannoma (Neurilemmoma) of the Cervical Spine  

PubMed Central

Purpose: To report on an extremely rare tumour located in the cervical spine, its treatment and result. Review of the literature. Patient: Case report of a 38-year-old woman with an intraosseous schwannoma of the cervical spine. Results: After local curettage no evidence for local recurrence at long-term follow-up.

Veth, Rene P. H.; Pruszczynski, Maciej; Lemmens, J. Albert M.; van Laarhoven, Erik W.

2001-01-01

19

Cervical Spine MRI in Abused Infants.  

ERIC Educational Resources Information Center

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…

Feldman, Kenneth W.; And Others

1997-01-01

20

Biomechanics of Upper Cervical Spine Injuries.  

National Technical Information Service (NTIS)

Cervical spine injuries continue to form a significant problem in the U.S.A., in spite of major advances in their medical management. The goal of the study was to produce clinical fractures experimentally, using fresh cadaveric cervical spine specimens. T...

M. Panjabi

1993-01-01

21

Cervical Spine Injuries and the Return to Football  

PubMed Central

Background: The literature dealing with the diagnosis and treatment of cervical spine injuries is considerable. Absent, however, are comprehensive criteria or guidelines for permitting or prohibiting return to collusion activities such as tackle football. Objective: The purpose of this report is to describe developmental and posttraumatic conditions of the cervical spine as presenting (1) no contraindication, (2) relative contraindication, or (3) an absolute contraindication to continued participation in tackle football and other contact activities. Study Design: Systematic review. Methods: Analysis of data compiled from more than 1200 cervical spine injuries documented by the National Football Head and Neck Registry, in addition to a review of the limited published literature, plus an understanding of the recognized axial load injury mechanism and extensive anecdotal experience. Conclusion: The one overriding principle regarding the return to football or, for that matter, any collusion activity is that the individual be asymptomatic, pain-free, and neurologically intact and have full strength and full range of cervical motion.

2009-01-01

22

Mobilizations of the asymptomatic cervical spine can reduce signs of shoulder dysfunction in adults.  

PubMed

Generalized shoulder pain is a common problem that is difficult to treat and frequently recurrent. The asymptomatic cervical spine must be ruled out as a cause of any shoulder pain, as it can have a similar presentation to an isolated shoulder disorder. Previous studies have shown that lateral cervical glide mobilizations to the asymptomatic cervical spine at C5/6 can affect peripheral pain, but none have examined shoulder pain. A randomized, blinded, placebo-controlled, cross-over trial was used to examine the immediate effects of cervical lateral glide mobilizations on pain intensity and shoulder abduction painful arc in subjects with shoulder pain. Twenty-one subjects received interventions of both cervical mobilization and placebo over two sessions. Pain intensity using a visual analog scale (VAS) and painful arc were assessed prior to and following application of cervical mobilization or placebo intervention. Evaluation of cervical mobilization revealed the shoulder abduction painful arc (12.5 degrees +/-15.6 degrees, p=0.002) and shoulder pain intensity (1.3+/-1.1cm, p<0.001) were significantly decreased. The results of this study suggest that any immediate change in shoulder pain or active shoulder range of motion following cervical mobilizations indicate that treatment directed toward the asymptomatic cervical spine may expedite recovery. PMID:18752983

McClatchie, Lynda; Laprade, Judi; Martin, Shelley; Jaglal, Susan B; Richardson, Denyse; Agur, Anne

2009-08-01

23

Airway management in cervical spine injury  

PubMed Central

To minimize risk of spinal cord injury, airway management providers must understand the anatomic and functional relationship between the airway, cervical column, and spinal cord. Patients with known or suspected cervical spine injury may require emergent intubation for airway protection and ventilatory support or elective intubation for surgery with or without rigid neck stabilization (i.e., halo). To provide safe and efficient care in these patients, practitioners must identify high-risk patients, be comfortable with available methods of airway adjuncts, and know how airway maneuvers, neck stabilization, and positioning affect the cervical spine. This review discusses the risks and benefits of various airway management strategies as well as specific concerns that affect patients with known or suspected cervical spine injury.

Austin, Naola; Krishnamoorthy, Vijay; Dagal, Arman

2014-01-01

24

Fractures of the articular processes of the cervical spine  

SciTech Connect

Fractures of the articular processes occurred in 16 (20.8%) of 77 patients with cervical spine fractures as demonstrated by multidirectional tomography. Plain films demonstrated the fractures in only two patients. Acute cervical radiculopathy occurred in five of the patients with articular process fractures (superior process, two cases; inferior process, three cases). Persistent neck pain occurred in one other patient without radiculopathy. Three patients suffered spinal cord damage at the time of injury, which was not the result of the articular process fracture itself. In the other seven cases, no definite sequelae occurred. However, disruption of the facet joint may predispose to early degenerative joint disease and chronic pain; unilateral or bilateral facet dislocation was present in five patients. In patients with cervical trauma who develop cervical radiculopathy, tomography should be performed to evaluate the articular processes.

Woodring, J.H.; Goldstein, S.J.

1982-08-01

25

Cervical biomechanics and neck pain of "head-spinning" breakdancers.  

PubMed

The cervical spine of breakdancers is at great risk due to reversed body loading during headspin manoeuvers. This study focused on the cervical biomechanics of breakdancers and a correlation with neck pain. A standardized interview and biomechanical testing of the cervical spine of 25 participants with "headspin" ability ages 16-34 years and an age-matched cohort of 25 participants without any cervical spine problems was conducted. Neck pain history, Neck Disability Index (NDI), cervical range of motion (CROM) and cervical torque were recorded. The "headspin" group reported significantly better subjective fitness, more cervical complaints, higher pain intensity, a longer history of neck pain and a worse NDI compared to the "normal" collective. The "headspin" group showed a 2-2.5 times higher rate of neck pain than the normal population, with increased cervical flexion (p<0.05) and increased cervical torque in all planes (p<0.001). The CROM showed a negative moderate to strong correlation with NDI, pain intensity and history of neck pain. Sports medicine practitioners should be aware of headspin maneuver accidents that pose the risk of fractures, dislocations and spinal cord injuries of breakdancers. PMID:24399685

Kauther, M D; Piotrowski, M; Hussmann, B; Lendemans, S; Wedemeyer, C; Jaeger, M

2014-05-01

26

Management of Cervical Spine Injuries in Athletes  

PubMed Central

Objective: Although the incidence of catastrophic cervical spine injury in sport has been significantly reduced over the past 3 decades, the injury warrants continued attention because of the altered quality of life that often accompanies such an injury. The purpose of our literature review was to provide athletic trainers with an understanding of the mechanisms, anatomical structures, and complications often associated with sport-related cervical spine injury. We also present the most current recommendations for management and treatment of these potentially catastrophic injuries. Data Sources: A review of the most pertinent literature between 1970 and 2005 was conducted using MEDLINE and the search terms spinal cord injury, cervical spine injury, neurosurgical trauma, cervical spinal stenosis, and catastrophic spine injury. Data Synthesis: Flexion of the head places the cervical spine into a straight line and prevents the neck musculature from assisting in force absorption. This mechanism is the primary cause of cervical fracture, dislocation, and quadriplegia. The most serious of the syndromes described in the literature involves a complete spinal cord injury with transverse myelopathy. This injury typically results in total loss of spinal function below the level of the lesion. Conclusions/Recommendations: Spinal trauma may result in a variety of clinical syndromes, according to the type and severity of the impact and bony displacement, as well as subsequent secondary insults such as hemorrhage, ischemia, and edema. Athletic trainers should be prepared to promptly recognize these potentially catastrophic injuries and follow the recommendations of the Inter-Association Task Force for the Appropriate Care of the Spine Injured Athlete in managing such injuries.

Bailes, Julian E; Petschauer, Meredith; Guskiewicz, Kevin M; Marano, Gary

2007-01-01

27

Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions  

PubMed Central

Background Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. Methods Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine), in accordance with the criteria established by the International Association for the Study of Pain (IASP). The study was performed in the United States in a non-university based ambulatory interventional pain management setting. Results The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%), with thoracic spine pain was 42% (95% CI, 30% – 53%), and in with lumbar spine pain was 31% (95% CI, 27% – 36%). The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72%) in the cervical spine, 55% (95% CI, 39% – 78%) in the thoracic spine, and 27% (95% CI, 22% – 32%) in the lumbar spine. Conclusion This study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain.

Manchikanti, Laxmaiah; Boswell, Mark V; Singh, Vijay; Pampati, Vidyasagar; Damron, Kim S; Beyer, Carla D

2004-01-01

28

Synovial cyst of the cervical spine.  

PubMed

Synovial cyst herniations, typically observed in the lumbar region in conjunction with degenerative changes of the facet joints, only rarely present as space occupying lesions in the cervical spine. The case of a 47-year-old white man with a C7-T1 synovial cyst impinging on the spinal cord and right C8 nerve root is presented. PMID:8504232

Epstein, N E; Hollingsworth, R

1993-04-01

29

Glycopyrrolate induced bilateral angle closure glaucoma after cervical spine surgery.  

PubMed

To report a case of bilateral acute angle closure glaucoma (AACG) that occurred after cervical spine surgery with the use of glycopyrolate. A 59-year-old male who presented with severe bilateral bifrontal headache and eye pain that started 12 h postextubation from a cervical spine surgery. Neostigmine 0.05 mg/kg (4.5 mg) and glycopyrrolate 0.01 mg/kg (0.9 mg) were used as muscle relaxant reversals at the end of the surgery. Ophthalmic examination revealed he had bilateral AACG with plateau iris syndrome that was treated medically along with laser iridotomies. Thorough examination of anterior chamber should be performed preoperatively on all patients undergoing surgeries in the prone position and receiving mydriatic agents under general anesthesia. PMID:23741140

Jaroudi, Mahmoud; Fadi, Maalouf; Farah, Fadi; El Mollayess, Georges M

2013-01-01

30

Biomechanics of the cervical spine 4: major injuries  

Microsoft Academic Search

This review presents considerations regarding major cervical spine injury, including some concepts that are presently undergoing evaluation and clarification. Correlation of certain biomechanical parameters and clinical factors associated with the causation and occurrence of traumatic cervical spine injuries assists in clarifying the pathogenesis and treatment of this diverse group of injuries. Instability of the cervical column based on clinical and

Joseph F Cusick; Narayan Yoganandan

2002-01-01

31

Biomechanics of the cervical spine. I: Normal kinematics  

Microsoft Academic Search

This review constitutes the first of four reviews that systematically address contemporary knowledge about the mechanical behavior of the cervical vertebrae and the soft-tissues of the cervical spine, under normal conditions and under conditions that result in minor or major injuries. This first review considers the normal kinematics of the cervical spine, which predicates the appreciation of the biomechanics of

Nikolai Bogduk; Susan Mercer

2000-01-01

32

Tapia Syndrome after Cervical Spine Surgery  

PubMed Central

Tapia syndrome is a rare entity characterized by unilateral paralysis of the tongue and vocal cord caused by Xth and XIIth cranial nerve lesions. However, there has been no report of Tapia syndrome immediately following spine surgery. A 47-year-old man underwent posterior decompressive laminectomy for cervical stenosis. The surgery took about 117 minutes and it was uneventful. Postoperatively he developed hoarseness of voice during speech, with deviation of tongue protrusion. On laryngoscopic examination, paralysis of the left side of the tongue and the soft palate was found and complete palsy of the left vocal cord was noted. After excluding surgical cause and craniocervical lesion, a clinical diagnosis of Tapia syndrome was made. Here we report a rare case of Tapia syndrome developed after posterior approach for cervical spine surgery and discuss the possible mechanisms of this uncommon syndrome.

Kang, Jung Hoon; Kim, Dong Min

2013-01-01

33

[Cervical spine injury. Diagnosis, prognosis and management].  

PubMed

Cervical spine injuries are a common occurrence in multi-trauma patients and should be taken into account when planning further clinical management. This review describes in detail upper and lower cervical spine injuries and introduces the sub-axial injury classification (SLIC) that is based on three components: injury morphology, integrity of the discoligamentous complex and the neurologic status of the patient. If the total SLIC score is <3, non-surgical treatment is recommended. If the total is > or =5, operative treatment is indicated as such a score is associated with instability and probably neurologic deficits. The precise diagnosis of the radiologist, which would include the SLIC classification, should facilitate clinical decision-making about further management. PMID:18414827

Schüller-Weidekamm, C

2008-05-01

34

Treatment of metastases of the cervical spine.  

PubMed

On the experience of 73 patients, the authors state their guidelines on the treatment of bone metastases on the cervical spine. Most of the cases on which no vertebral collapse occur neither neurological deficit, radiation therapy and external support are suggested. Surgery is necessary on case of severe bone destruction, collapse with or without subsequent neurological impairment. Anterior excision is considered the best approach, sometimes complemented by posterior stabilisation. PMID:9718821

Denaro, V; Gulino, G; Papapietro, N; Denaro, L

1998-01-01

35

Pharyngocutaneous fistula after anterior cervical spine surgery  

PubMed Central

Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19 year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closure and esophageal exclusion with a Jpeg tube. The patient was eventually successfully treated with a three-stage procedure consisting of firstly a posterior approach to reinforce the posterior stabilization of the cervical spine that was felt to be inadequate, secondly an anterior approach with removal of all the anterior instrumentation followed by iliac crest bone graft and thirdly a superior based sternocleidomastoid flap that was interposed between the esophagus and the anterior cervical spine. The patient's fistula healed successfully. However, yet asymptomatic, the anterior iliac crest bone graft resorbed almost completely at 16 months follow up. In light of this complication, we discuss the surgical options for the treatment of pharyngocutaneous fistulae and the closure of this fistula using a superiorly based sternocleidomastoid muscle flap.

Sansur, Charles A.; Early, Stephen; Reibel, James

2009-01-01

36

Cervical spine injury in child abuse: report of two cases  

Microsoft Academic Search

Pediatric cervical spine injuries have rarely been reported in the setting of child abuse. We report two cases of unsuspected\\u000a lower cervical spine fracture-dislocation in twin infant girls who had no physical examination findings to suggest cervical\\u000a spine injury. Classic radiographic findings of child abuse were noted at multiple other sites in the axial and appendicular\\u000a skeleton. Magnetic resonance (MR)

Veronica J. Rooks; Cheryl Sisler; Bradford Burton

1998-01-01

37

Cervical Spine Surgery: An Historical Perspective  

Microsoft Academic Search

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

Vincenzo Denaro; Alberto Di Martino

2011-01-01

38

Intramedullary hydatid cyst of the cervical spine.  

PubMed

Hydatid disease (Echinococcosis) is a common parasitic infection caused by Echinococcus granulosus mainly in sheep-raising areas of the world. Liver, lungs and brain are the predominantly involved organs. However, 0.5-1% of the hydatid disease involves the spine and in 90% of the cases it is confined to the bone and the epidural space. Although intramedullary involvement is extremely rare, in this report, we present a 55-year-old female patient who was diagnosed with a cervical intramedullary hydatid cyst during magnetic resonance imaging of the cervical vertebrae. Accordingly, we imply that particularly in endemic areas, hydatid cyst disease should be kept in mind for the differential diagnosis of spinal mass lesions. PMID:23183479

Senol, M G; Güney, Mehmet; Tekeli, H; Kendirli, M T; Kendirli, Hakan; Tansel, Mustafa; Kaya, S; Turhan, V; Vedat, Turhan; Sonmez, G; Güner, Sonmez; Saracoglu, M

2012-01-01

39

Dysphagia associated with cervical spine and postural disorders.  

PubMed

Difficulties with swallowing may be both persistent and life threatening for the majority of those who experience it irrespective of age, gender, and race. The purpose of this review is to define oropharyngeal dysphagia and describe its relationship to cervical spine disorders and postural disturbances due to either congenital or acquired disorders. The etiology and diagnosis of dysphagia are analyzed, focusing on cervical spine pathology associated with dysphagia as severe cervical spine disorders and postural disturbances largely have been held accountable for deglutition disorders. Scoliosis, kyphosis–lordosis, and osteophytes are the primary focus of this review in an attempt to elucidate the link between cervical spine disorders and dysphagia. It is important for physicians to be knowledgeable about what triggers oropharyngeal dysphagia in cases of cervical spine and postural disorders. Moreover, the optimum treatment for dysphagia, including the use of therapeutic maneuvers during deglutition, neck exercises, and surgical treatment, is discussed. PMID:23959456

Papadopoulou, Soultana; Exarchakos, Georgios; Beris, Alexander; Ploumis, Avraam

2013-12-01

40

Cost-effectiveness of MRI to assess for posttraumatic ligamentous cervical spine injury.  

PubMed

Magnetic resonance imaging (MRI) has been shown to be sensitive in identifying ligamentous injury to the cervical spine. The major drawbacks to its routine use are cost and availability. The purpose of this study was to compare the cost of using MRI to rule out ligamentous injury of the cervical spine with the cost of immobilization in a cervical collar and outpatient follow-up. Neurologically intact and nonobtunded patients with neck pain and normal findings on radiographs evaluated for ligamentous injury of the cervical spine were studied. Patients were either evaluated with MRI or immobilized in a cervical collar and followed up for repeat clinical and radiographic evaluation as outpatients. The authors gathered year 2011 fees from their institution and 2011 Medicare reimbursement data and compared the costs of MRI with the costs of cervical collar and outpatient follow-up. In addition, the median income of the local community was used to estimate opportunity costs associated with cervical collar immobilization. After 7 days of lost wages at the median local income, MRI became a less costly option when comparing hospital fees. Alternatively, when considering Medicare reimbursement, MRI became less costly after only 2 days of lost wages at the median local income. On the basis of these findings, MRI of the cervical spine is less costly than other current management strategies when opportunity costs are considered. PMID:24679200

Murphy, Joshua M; Park, Paul; Patel, Rakesh D

2014-02-01

41

Flexion-extension cervical spine radiography in pediatric blunt trauma  

Microsoft Academic Search

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

William A. Woods; William J. Brady; Gary Pollock; Narendra Kini; Jeffrey S. Young

1998-01-01

42

Stroke, cerebral artery dissection, and cervical spine manipulation therapy.  

PubMed

Stroke represents an infrequent adverse reaction associated with cervical spine manipulation therapy. Attempts to identify the patient at risk and the type of manipulation most likely to result in these complications of manipulation have not been successful. A retrospective review of 64 medical legal cases of stroke temporally associated with cervical spine manipulation was performed to evaluate characteristics of the treatment rendered and the presenting complaints in patients reporting these complications. These files included records from the practitioner who administered the manipulation therapy, post stroke testing and treatment records usually by a neurologist, and depositions of the patient and the practitioner of manipulation as well as expert and treating physicians. A retrospective review of the files was carried out by three (two in 11 cases) researchers using the same data abstraction instrument to independently assess each case. These independent reviews were followed by a consensus review in which all reviewers reached agreement on file content. Ninety two percent of cases presented with a history of head and/or neck pain and 16 (25 %) cases presented with sudden onset of new and unusual headache and neck pain often associated with other neurological symptoms that may represent a dissection in progress. The strokes occurred at any point during the course of treatment. Certain patients reporting onset of symptoms immediately after first treatment while in others the dissection occurred after multiple manipulations. There was no apparent dose-response relationship to these complications. These strokes were noted following any form of standard cervical manipulation technique including rotation, extension, lateral flexion and non-force and neutral position manipulations. The results of this study suggest that stroke, particularly vertebrobasilar dissection, should be considered a random and unpredictable complication of any neck movement including cervical manipulation. They may occur at any point in the course of treatment with virtually any method of cervical manipulation. The sudden onset of acute and unusual neck and/or head pain may represent a dissection in progress and be the reason a patient seeks manipulative therapy that then serves as the final insult to the vessel leading to ischemia. PMID:12195461

Haldeman, Scott; Kohlbeck, Frank J; McGregor, Marion

2002-08-01

43

Low-power laser in osteoarthritis of the cervical spine.  

PubMed

Patients with symptomatic osteoarthritis of the cervical spine were treated with very low-power modulated laser (LPL). Two applications were performed at an interval of 20 days. Changes in pain and ultrasound thickness of the soft connective tissue layer above the right and the left superior trapezium were studied. No worsening of pain was observed. Pain improved after the first application of LPL in 9 out of 14 patients, but the difference was not significant. Pain improvement remained stable between the first assessment and the second assessment, which was performed after 20 days. In comparison with the first application, at the second application the number of patients with improved pain after LPL increased to 12 out of 14 (p < 0.01). An appreciable difference in the thickness of the subcutaneous soft tissue layer overlying the two superior trapezia was demonstrated in all patients at the first examination. Comparison of the measurements before and after the application of LPL showed significant differences. PMID:15244318

Monteforte, P; Baratto, L; Molfetta, L; Rovetta, G

2003-01-01

44

Modern posterior screw techniques in the pediatric cervical spine  

PubMed Central

Treatment of children with cervical spine disorders requiring fusion is a challenging endeavor for a variety of reasons. The size of the patients, the corresponding abnormal bony anatomy, the inherent ligamentous laxity of children, and the relative rarity of the disorders all play a part in difficulty of treatment. The benefits of modern posterior cervical instrumentation in children, defined as rigid screw-rod systems, have been shown to be many including: improved arthrodesis rates, diminished times in halo-vest immobilization, and improved reduction of deformities. The anatomy of children and the corresponding pathology seen frequently is at the upper cervical spine and craniocervical junction given the relatively large head size of children and the horizontal facets at these regions predisposing them to instability or deformity. Posterior screw fixation, while challenging, allows for a rigid base to allow for fusion in these upper cervical areas which are predisposed to pseudarthrosis with non-rigid fixation. A thorough understanding of the anatomy of the cervical spine, the morphology of the cervical spine, and the available screw options is paramount for placing posterior cervical screws in children. The purpose of this review is to discuss both the anatomical and clinical descriptions related to posterior screw placement in the cervical spine in children.

Hedequist, Daniel J

2014-01-01

45

Modern posterior screw techniques in the pediatric cervical spine.  

PubMed

Treatment of children with cervical spine disorders requiring fusion is a challenging endeavor for a variety of reasons. The size of the patients, the corresponding abnormal bony anatomy, the inherent ligamentous laxity of children, and the relative rarity of the disorders all play a part in difficulty of treatment. The benefits of modern posterior cervical instrumentation in children, defined as rigid screw-rod systems, have been shown to be many including: improved arthrodesis rates, diminished times in halo-vest immobilization, and improved reduction of deformities. The anatomy of children and the corresponding pathology seen frequently is at the upper cervical spine and craniocervical junction given the relatively large head size of children and the horizontal facets at these regions predisposing them to instability or deformity. Posterior screw fixation, while challenging, allows for a rigid base to allow for fusion in these upper cervical areas which are predisposed to pseudarthrosis with non-rigid fixation. A thorough understanding of the anatomy of the cervical spine, the morphology of the cervical spine, and the available screw options is paramount for placing posterior cervical screws in children. The purpose of this review is to discuss both the anatomical and clinical descriptions related to posterior screw placement in the cervical spine in children. PMID:24829871

Hedequist, Daniel J

2014-04-18

46

Vertebrobasilar ischemia after cervical spine manipulation: A case report  

Microsoft Academic Search

IntroductionThe most serious accidents after cervical spine manipulation are vertebrobasilar ischemia. Their incidence is underestimated. Their risk of apparition is lower if the contraindications are respected and if they are realised according to suitable practice.

D. Tinel; E. Bliznakova; C. Juhel; P. Gallien; R. Brissot

2008-01-01

47

Fracture and Viscoelastic Characteristics of the Human Cervical Spine.  

National Technical Information Service (NTIS)

Cervical spine segments were tested both nondestructively and destructively to determine the load-displacement relationships and vertebral strength. For this study, a servo-hydraulic multi-degree of freedom material testing machine was designed and constr...

W. T. Edwards W. C. Hayes Y. F. Kou M. S. Coffee A. A. White

1986-01-01

48

Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries  

PubMed Central

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.

Hong, Rick; Meenan, Molly; Prince, Erin; Murphy, Ronald; Tambussi, Caitlin; Rohrbach, Rick; Baumann, Brigitte M

2014-01-01

49

Paravertebral muscles in disease of the cervical spine.  

PubMed Central

OBJECTIVES: Cervical spine disorders are common in the older population. The paravertebral muscles are essential to the support and stabilisation of the cervical spine but have been little studied. The aim was to determine whether pathological changes develop in these muscles in patients with severe cervical spine disease, which, if present, might contribute to the pathogenesis and symptomatology of their disorder. METHODS: Open biopsies of superficial and deep paravertebral muscles were obtained during the course of surgical procedures to alleviate cervical myelopathy. Most of these patients had cervical spondylosis or rheumatoid arthritis involving the cervical spine. The biopsies were compared with muscle obtained at necropsy from patients without a history of cervical spine or neuromuscular disorder. RESULTS: Muscle from both the study and control groups showed a similar range and severity of abnormalities. In several patients, grouped fibre atrophy suggested chronic partial denervation. Most biopsies showed type 1 fibre predominance and selective type 2 fibre atrophy. Ragged red fibres were a frequent finding and electron microscopy disclosed accumulations of mitochondria, a small proportion of which contained rounded, or longitudinally oriented, single osmiophilic inclusions. Fibres containing core-like areas were also frequent. These pathological features were seen with increasing severity and frequency with increasing age. CONCLUSIONS: The paravertebral cervical muscles develop pathological abnormalities with increasing age with both neurogenic and myopathic features, the pathogenesis of which is probably multifactorial. Such a muscle disorder would be expected to be accompanied by functional impairment which may contribute to the development and symptomatology of cervical spine disease with increasing age. Images

Wharton, S B; Chan, K K; Pickard, J D; Anderson, J R

1996-01-01

50

Anatomical and functional perspectives of the cervical spine: Part III: the "unstable" cervical spine  

PubMed Central

In this, the last of the three part series on the anatomical and functional perspectives of the cervical spine, the clinical entity-instability-is addressed. A summative definition of instability, addressing both the clinical and radiographic issues, is presented based on current available literature. The etiology of instability is discussed as it pertains to three possible mechanisms: acute trauma, latent evidence of trauma and repetitive microtrauma. The anatomical, clinical and radiographic aspects in each of these meachanisms is discussed. A case report is presented to illustrate the salient features of this potentially disastrous condition. The conclusion emphasizes the importance of defineable limits in each of the presented definitions, calling for future research into the clinical and radiographic correlations of abnormal cervical motion. ImagesFigure 4Figure 5Figure 6

McGregor, Marion

1990-01-01

51

Impaired health status, sleep disorders, and pain in the craniomandibular and cervical spinal regions  

Microsoft Academic Search

This study investigated the relationship between health status (i.e., physical well-being and quality of life), sleep disorders (e.g., insomnia, sleep-related depression and anxiety), and musculoskeletal pain in the craniomandibular and cervical spinal regions. The number of painful body areas below the cervical spine (i.e., widespread pain) was also taken into account. Two questionnaires, viz., the RAND 36-item Health Survey Questionnaire

Frank Lobbezoo; Corine M. Visscher; Machiel Naeije

2004-01-01

52

Cervical Spine Osteomyelitis and Epidural Abscess after Chemoradiotherapy for Hypopharyngeal Carcinoma: A Case Report  

PubMed Central

Osteomyelitis of mandible as a delayed adverse event following radiation therapy has been widely reported; however, osteomyelitis of the cervical spine has rarely been reported. In this study, we reported our experience with a case of cervical spine osteomyelitis and epidural abscess after concurrent chemoradiotherapy (CCRT) for hypopharyngeal carcinoma. The case involved a 68-year old man who underwent radical CCRT after a diagnosis of stage IVb, T4bN2cM0 posterior hypopharyngeal wall carcinoma. At 7 months after completing the initial therapy, the patient complained of severe pain in the neck and both shoulders and reduced muscular strength in the extremities. A large defect was found on the mucosa of posterior hypopharyngeal wall. On cervical magnetic resonance imaging, cervical spine osteomyelitis and an epidural abscess were observed. Because antimicrobial therapy was not effective, hyperbaric oxygen therapy was administered. Abscess reduction and improvement of the mucosal defect were observed. Because cervical spine complications after CCRT can be fatal upon worsening, adequate attention must be given.

Watanabe, Jun; Hashimoto, Shigehisa; Takahashi, Sugata

2014-01-01

53

Cervical spine osteomyelitis and epidural abscess after chemoradiotherapy for hypopharyngeal carcinoma: a case report.  

PubMed

Osteomyelitis of mandible as a delayed adverse event following radiation therapy has been widely reported; however, osteomyelitis of the cervical spine has rarely been reported. In this study, we reported our experience with a case of cervical spine osteomyelitis and epidural abscess after concurrent chemoradiotherapy (CCRT) for hypopharyngeal carcinoma. The case involved a 68-year old man who underwent radical CCRT after a diagnosis of stage IVb, T4bN2cM0 posterior hypopharyngeal wall carcinoma. At 7 months after completing the initial therapy, the patient complained of severe pain in the neck and both shoulders and reduced muscular strength in the extremities. A large defect was found on the mucosa of posterior hypopharyngeal wall. On cervical magnetic resonance imaging, cervical spine osteomyelitis and an epidural abscess were observed. Because antimicrobial therapy was not effective, hyperbaric oxygen therapy was administered. Abscess reduction and improvement of the mucosal defect were observed. Because cervical spine complications after CCRT can be fatal upon worsening, adequate attention must be given. PMID:24711945

Ueki, Yushi; Watanabe, Jun; Hashimoto, Shigehisa; Takahashi, Sugata

2014-01-01

54

Symptomatic intravertebral disc herniation (Schmorl's node) in the cervical spine.  

PubMed Central

A case of a Schmorl's node in the cervical vertebra causing neck pain is reported. An inflammatory focus was found on histological examination of Schmorl's node indicating a possible mechanism of pain production. Images

Lipson, S J; Fox, D A; Sosman, J L

1985-01-01

55

Symptomatic intravertebral disc herniation (Schmorl's node) in the cervical spine  

Microsoft Academic Search

A case of a Schmorl's node in the cervical vertebra causing neck pain is reported. An inflammatory focus was found on histological examination of Schmorl's node indicating a possible mechanism of pain production.

S J Lipson; D A Fox; J L Sosman

1985-01-01

56

Cervical osteoid osteoma: a cause of chronic upper back pain.  

PubMed

A case of an osteoid osteoma occurring in the cervical spine and presenting as scapular and arm pain has been described. Correct diagnosis was delayed for 2 years. Plain radiographs may fail to demonstrate a lesion in the spine. Radiographic evaluation, when osteoid osteoma is a possibility, should include bone scanning. If the bone scan is abnormal, tomography of the area is indicated. If the diagnosis is still unclear, selective angiography may reveal the tumor blush typical of osteoid osteoma. In certain instances, a myelogram may be helpful to establish whether there is encroachment on the spinal canal or nerve root. PMID:147150

Goldstein, G S; Dawson, E G; Batzdorf, U

1977-01-01

57

Surgical resection of neoplastic cervical spine lesions in relation to the vertebral artery V2 segment.  

PubMed

Neoplastic cervical spine lesions are seen infrequently by the spinal surgeon. The surgical management of these tumors, particularly with associated neurovascular compromise, is challenging in terms of achieving proper resection and spinal stabilization and ensuring no subsequent recurrence or failure of fixation. In this report we highlight some of the problems encountered in the surgical management of tumors involving the cervical spine with techniques applied for gross total resection of the tumor without compromising the vertebral arteries. Ten patients with neoplastic cervical spine lesions were managed in our study. The common cardinal presentation was neck and arm pain with progressive cervical radiculo-myelopathy. All patients had plain X-rays, computer tomography scans, and magnetic resonance imaging of the cervical spine. Digital subtraction or magnetic resonance angiograms were performed on both vertebral arteries when the pathology was found to be in proximity to the vertebral artery. When a tumor blush with feeders was evident, endovascular embolization to minimize intraoperative bleeding was also considered. A single approach or a combined anterior cervical approach for corpectomy and cage-with-plate fixation and posterior decompression for resection of the rest of the tumor with spinal fixation was then accomplished as indicated. All cases made a good neurological recovery and had no neural or vascular complications. On the long-term follow-up of the survivors there was no local recurrence or surgical failure. Only three patients died: two from the primary malignancy and one from pulmonary embolism. This report documents a safe and reliable way to deal with neoplastic cervical spine lesions in proximity to vertebral arteries with preservation of both arteries. PMID:21577335

Al Barbarawi, Mohamed; Odat, Ziad; Alheis, Mwaffaq; Qudsieh, Suhair; Qudsieh, Tareq

2010-01-01

58

Region-based enhancement of chest and cervical spine radiographs  

NASA Astrophysics Data System (ADS)

We have developed a region-based image processing method to enhance selective radiodense regions on digital radiographs. We employ a wavelet filtering technique to locate the radiodense regions-of-interest and then apply different degrees of enhancement procedure to them. The enhancement procedure is based on an unsharp masking technique controlled by a set of sigmoidal functions. The method was tested on computed chest radiographs to improve the visualization of the mediastinum and radiodense spine areas. The enhanced chest images showed improved visualization in the mediastinum area, and the visibility of vascular structures which were obscured by the diaphragm and mediastinum was improved. To demonstrate the method's potential in other medical image processing tasks, we applied it to cervical spine images. The processed cervical spine images also showed better visualization of the seventh cervical vertebrae and the first thoracic vertebrae in the high radiodense area caused by the superimposition of the patient's shoulder tissue over these regions of interest.

Lin, Jyh-Shyan; Steller Artz, Dorothy E.; Li, Huai; Legendre, Kevin; Freedman, Matthew T.; Mun, Seong K.

1996-04-01

59

Biomechanics of Pediatric Cervical Spine: Compression, Flexion and Extension Responses  

Microsoft Academic Search

The objective of the present study was to develop three separate age-specific one, three, and six year old pediatric human cervical spine (C4-CS-C6) three-dimensional nonlinear finite element models and to quantify the biomechanical responses. The adult model was modified to create one, three, and six year old pediatric spines by incorporating the local geometrical and material characteristics of the developmental

Srirangam Kumaresan; Narayan Yoganandan; Frank A. Pintar; Wade M. Mueller

2000-01-01

60

Risk of injury of the cervical spine in sled tests in female volunteers  

Microsoft Academic Search

BackgroundThe description of cervical spine motion and the risk to sustain a cervical spine injury is mainly based on cadaver studies. As the active influence of soft tissue is neglected in cadaver studies, our understanding of the kinematic model for whiplash is limited. Therefore the objective of this study was, to describe the in vivo cervical spine motion and acceleration

Christoph Dehner; Martin Elbel; Sylvia Schick; Felix Walz; Wolfram Hell; Michael Kramer

2007-01-01

61

[Cervical spine instability: Point of view of the anesthesiologist].  

PubMed

The experience in airway management permits the anesthesiologist to participate in cases of cervical spine instability in the operating room when the patient is subjected to surgical procedures, or in cases of difficulty to access or keep the airway open in emergencies. This article reviews the epidemiology, definition, etiology, diagnostic criteria, methods of approach to airway management, and current recommendations on handling cervical instability in different scenarios. There is no approach to the airway that ensures complete immobility of the cervical spine, but there are methods that are better adapted to specific contexts; at the end, the reader will be able to identify the virtues and defects of the various options that the anesthesiologists have to address the airway in cases of cervical instability. PMID:23787370

Poveda Jaramillo, R; Paredes Sanín, P; Carvajal, H; Carrasquilla, R; Murillo Deluquez, M

2014-01-01

62

Is posterior fusion necessary with laminectomy in the cervical spine?  

PubMed Central

Background: Cervical decompressive laminectomy is a common procedure for addressing multilevel cervical spine pathology. The most common reasons for performing simultaneous posterior cervical fusion include the prevention of progressive postlaminectomy kyphotic deformity or other types of instability which can contribute to late neurological deterioration. Methods: The medical literature (Pub Med with MeSH) concerning cervical laminectomy, posterior cervical fusion, and complications of laminectomy/fusion was reviewed. Additionally, references from the articles were queried to find additional literature. Results: Multiple studies concluded that cervical laminectomy versus laminectomy and fusion produced similar short-term postoperative outcomes. Careful patient selection was warranted to minimize the complications associated with cervical laminectomy alone; these included postoperative kyphosis (6–46%) and late deterioration (10–37%). The addition of a posterior cervical fusion was associated with relatively low complication rates, and avoided the evolution of late deformity or delayed neurological deterioration. Conclusion: Although the short-term results of cervical laminectomy versus laminectomy and fusion are similar, there appear to be more complications associated with performing laminectomy alone over the long term. Here, we reviewed the pros and cons of posterior cervical decompression alone versus decompression with fusion/instrumentation to treat cervical pathology, highlighting the complications associated with each surgical alternative.

McAllister, Beck D.; Rebholz, Brandon J.; Wang, Jeffery C.

2012-01-01

63

Minimum 2-year outcome of cervical laminoplasty with deep extensor muscle-preserving approach: impact on cervical spine function and quality of life  

Microsoft Academic Search

In this retrospective cohort study, two surgical methods of conventional open-door laminoplasty and deep extensor muscle-preserving\\u000a laminoplasty were allocated for the treatment of cervical myelopathy, and were specifically compared in terms of axial pain,\\u000a cervical spine function, and quality of life (QOL) with a minimum follow-up period of 2 years. Eighty-four patients were divided\\u000a into two groups and received either

Yoshihisa Kotani; Kuniyoshi Abumi; Manabu Ito; Hideki Sudo; Masahiko Takahata; Shigeki Ohshima; Yoshihiro Hojo; Akio Minami

2009-01-01

64

Cervical Exercise: The Backbone of Spine Treatment  

MedlinePLUS

... you have had an accident that started your neck pain or if you have pain, numbness, tingling or ... that physical activity is important for people with neck pain. This brochure will show you how to stay ...

65

Developmental biomechanics of the cervical spine: Tension and compression  

Microsoft Academic Search

Epidemiological data and clinical indicia reveal devastating consequences associated with pediatric neck injuries. Unfortunately, neither injury prevention nor clinical management strategies will be able to effectively reduce these injuries or their effects on children, without an understanding of the cervical spine developmental biomechanics. Thus, we investigated the relationship between spinal development and the functional (stiffness) and failure biomechanical characteristics of

David J. Nuckley; Randal P. Ching

2006-01-01

66

Spontaneous regression after extensive recurrence of a pediatric cervical spine aneurysmal bone cyst.  

PubMed

Aneurysmal bone cyst is a pseudotumoral lesion. Complete resection prior to selective arterial embolization seems to be the treatment of choice for the more extensive and destructive lesions. In these cases maintaining stability of the cervical spine is critical. This can be very challenging in children and adolescents in whom the axial skeleton is still growing. In this case a young girl presented with a voluminous cervical aneurysmal bone cyst encaging both vertebral arteries and spinal cord. The lesion was treated with aggressive surgical resection, followed by cervical vertebral fusion with instrumentation. After nine months the patient referred no pain and no neurological deficit. MRI scans showed an extensive local recurrence. The family of the young girl refused any other therapy and any other followup. The patients returned to our attention after five years with no pain and neurological deficit. Cervical spine radiographs and MRI scans showed a complete regression of the extensive local recurrence. In the literature, the possibility of spontaneous regression of residual part or local recurrence is reported. The case of this young girl provided the chance to attend a spontaneous regression in an extensive recurrence of aneurismal bone cyst. PMID:24707421

Brembilla, Carlo; Lanterna, Luigi Andrea; Bosisio, Michela; Gritti, Paolo; Risso, Andrea; Signorelli, Antonio; Biroli, Francesco

2014-01-01

67

Tapia's Syndrome after Posterior Cervical Spine Surgery under General Anesthesia  

PubMed Central

We present a case report to remind surgeons of this unusual complication that can occur in any surgery, even posterior cervical spine surgery under general anesthesia and discuss its causes, treatment methods, and the follow-up results in the literature. The peripheral Tapia's syndrome is a rare complication of anesthetic airway management. Main symptoms are hoarseness of voice and difficulty of tongue movement. Tapia's syndrome after endotracheal general anesthesia is believed to be due to pressure neuropathy of the vagus nerve and the hypoglossal nerve caused by the endotracheal tube. To our knowledge, no report has been published or given an explanation for Tapia's syndrome after posterior cervical spine surgery. Two patients who underwent posterior cervical surgery complained hoarseness and tongue palsy postoperatively. There is no direct anatomical relation between the operation, the vagus nerves and the hypoglossal nerves, and there is no record of displacement or malposition of the endotracheal tube. After several months, all symptoms are resolved. To avoid this problem in posterior cervical spine surgery, we suggest paying special attention to the position of the endotracheal tube to avoid excessive neck flexion before and during the positioning of the patient.

Park, Chang Kyu; Park, Chan Joo; Hwang, Jang Hoe

2013-01-01

68

Management of difficult airway in penetrating cervical spine injury  

PubMed Central

Management of airway in trauma victim with penetrating cervical/thoracic spine injury has always been a challenge to the anaesthesiologist. Stabilisation of spine during airway manipulation, to prevent any further neural damage, is of obvious concern to the anaesthesiologist. Most anaesthesiologists are not exposed to direct laryngoscopy and intubation in lateral position during their training period. Tracheal intubation in the lateral position may be unavoidable in some circumstances. Difficult airway in an uncooperative patient compounds the problem to secure airway in lateral position. We present a 46-year-old alcoholic, hypertensive, morbidly obese person who suffered a sharp instrument (screwdriver) spinal injury with anticipated difficult intubation; the case was managed successfully.

Prasad, Mukesh Kumar; Sinha, Ajay Kumar; Bhadani, Umesh Kumar; Chabra, Balbir; Rani, Kanchan; Srivastava, Bhavana

2010-01-01

69

A biomechanical study of a cervical spine stabilization device  

Microsoft Academic Search

The biomechanical properties of surgically destabilized cervical spine motion segments are evaluated. The segments were fixed with spinal fixation plates and tested. The Roy-Camille spinal fixation plates were utilized as the stabilizing device. Results are compared with intact motion segments. It is shown that segments C3-4 and C4-5, when severely destabilized by a surgically created defect, can effectively be restabilized

M. E. Smith; J. R. Parsons; N. A. Langrana; M. Cibischino; C. K. Lee; L. Gustavson; K. Kaiser

1991-01-01

70

Gunshot wound to the upper cervical spine leading to instability.  

PubMed

Gunshot wounds (GSW) to the cervical spine leading to instability are rare. Also, the presence of vital vascular and neurological structures in the surround area lead to death or severe disability in the vast majority of cases. In this brief report, we present a rare case of C1 fracture due to GSW leading to instability of the atlanto-occipital joint in a neurologically intact patient. PMID:24753780

Paiva, Wellingson Silva; Amorim, Robson Luis; Menendez, Djalma Felipe; Brock, Roger Schmidt; Andrade, Almir Ferreira De; Teixeira, Manoel Jacobsen

2014-01-01

71

Virchow's Triad and spinal manipulative therapy of the cervical spine  

PubMed Central

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.

Symons, Bruce P; Westaway, Michael

2001-01-01

72

Managing patients with cervical spine injury.  

PubMed

Common measures to establish spinal immobilisation at the scene of an accident include keeping the patient's head still, applying a rigid cervical collar and transporting the patient on a rigid spinal board to an emergency department. This article reviews the literature about spinal immobilisation practices in emergency settings, including best-practice guidance and papers on immobilisation, imaging, rapport with patients and complications. PMID:24806864

Montgomery, Nadine; Goode, Debbie

2014-05-01

73

Solitary juvenile xanthogranuloma in cervical spine: case report and review of the literature.  

PubMed

Solitary juvenile xanthogranuloma (JXG) in the spinal column is extremely rare. Here, we report and characterize the case of xanthogranuloma of the upper cervical spine. A 18-year-old male presented with neck pain for 3 months, along with progressive quadriparesis and sensory loss of 2 months duration with urinary retention. Motor examination revealed spastic quadriparesis with power of 2/5 in all the 4 limbs. Magnetic Resonance Imaging (MRI) spine with contrast showed a dorsally placed intradural extramedullary lesion at the level of C2-C4 vertebral body. The lesion, measuring 2.9x1.7x1.4 cm, was isointense on T1WI, hypointense on T2WI, and enhanced homogenously on contrast. He underwent an emergency C2-C4 laminectomy and complete excision of the lesion. At 3-month follow-up, he was asymptomatic except for mild neck pain. MRI scan of the cervical spine done at follow-up, revealed complete excision of tumor without any residual lesion. Histopathological examination of the mass revealed a polymorphous population of sheets of bloated pale foamy histiocytes (xanthoma cells), numerous admixed mature lymphocytes and several Touton giant cells. The cells were positive for CD68, a histiocytic marker, and negative for CD1a (excludes LCH) and S-100 (excludes RDD). PMID:24535803

Konar, Subhas; Pandey, Paritosh; Yasha, T C

2014-01-01

74

Complications of transpedicular screw fixation in the cervical spine.  

PubMed

Today, posterior stabilization of the cervical spine is most frequently performed by lateral mass screws or spinous process wiring. These techniques do not always provide sufficient stability, and anterior fusion procedures are added secondarily. Recently, transpedicular screw fixation of the cervical spine has been introduced to provide a one-stage stable posterior fixation. The aim of the present prospective study is to examine if cervical pedicle screw fixation can be done by low risk and to identify potential risk factors associated with this technique. All patients stabilized by cervical transpedicular screw fixation between 1999 and 2002 were included. Cervical disorders included multisegmental degenerative instability with cervical myelopathy in 16 patients, segmental instability caused by rheumatoid arthritis in three, trauma in five and instability caused by infection in two patients. In most cases additional decompression of the spinal cord and bone graft placement were performed. Pre-operative and post-operative CT-scans (2-mm cuts) and plain X-rays served to determine changes in alignment and the position of the screws. Clinical outcome was assessed in all cases. Ninety-four cervical pedicle screws were implanted in 26 patients, most frequently at the C3 (26 screws) and C4 levels (19 screws). Radiologically 66 screws (70%) were placed correctly (maximal breach 1 mm) whereas 20 screws (21%) were misplaced with reduction of mechanical strength, slight narrowing of the vertebral artery canal (<25%) or the lateral recess without compression of neural structures. However, these misplacements were asymptomatic in all cases. Another eight screws (9%) had a critical breach. Four of them showed a narrowing of the vertebral artery canal of more then 25%, in all cases without vascular problems. Three screws passed through the intervertebral foramen, causing temporary paresis in one case and a new sensory loss in another. In the latter patient revision surgery was performed. The screw was loosened and had to be corrected. The only statistically significant risk factor was the level of surgery: all critical breaches were seen from C3 to C5. Percutaneous application of the screws reduced the risk for misplacement, although this finding was not statistically significant. There was also a remarkable learning curve. Instrumentation with cervical transpedicular screws results in very stable fixation. However, with the use of new techniques like percutaneous screw application or computerized image guidance there remains a risk for damaging nerve roots or the vertebral artery. This technique should be reserved for highly selected patients with clear indications and to highly experienced spine surgeons. PMID:15912352

Kast, E; Mohr, K; Richter, H-P; Börm, W

2006-03-01

75

The Immediate Effects of Upper Thoracic Translatoric Spinal Manipulation on Cervical Pain and Range of Motion: A Randomized Clinical Trial  

PubMed Central

This study examined the effect of translatoric spinal manipulation (TSM) on cervical pain and cervical active motion restriction when applied to upper thoracic (T1-T4) segments. Active cervical rotation range of motion was measured re- and post-intervention with a cervical inclinometer (CROM), and cervical pain status was monitored before and after manipulation with a Faces Pain Scale. Study participants included a sample of convenience that included 32 patients referred to physical therapy with complaints of pain in the mid-cervical region and restricted active cervical rotation. Twenty-two patients were randomly assigned to the experimental group and ten were assigned to the control group. Pre- and post-intervention cervical range of motion and pain scale measurements were taken by a physical therapist assistant who was blinded to group assignment. The experimental group received TSM to hypomobile upper thoracic segments. The control group received no intervention. Paired t-tests were used to analyze within-group changes in cervical rotation and pain, and a 2-way repeated-measure ANOVA was used to analyze between-group differences in cervical rotation and pain. Significance was accepted at p = 0.05. Significant changes that exceeded the MDC95 were detected for cervical rotation both within group and between groups with the TSM group demonstrating increased mean (SD) in right rotation of 8.23° (7.41°) and left rotation of 7.09° (5.83°). Pain levels perceived during post-intervention cervical rotation showed significant improvement during right rotation for patients experiencing pain during bilateral rotation only (p=.05). This study supports the hypothesis that spinal manipulation applied to the upper thoracic spine (T1-T4 motion segments) significantly increases cervical rotation ROM and may reduce cervical pain at end range rotation for patients experiencing pain during bilateral cervical rotation.

Krauss, John; Creighton, Doug; Ely, Jonathan D.; Podlewska-Ely, Joanna

2008-01-01

76

Simple cervical spine traction using a halo vest apparatus: technical note  

Microsoft Academic Search

BackgroundA halo vest apparatus, commonly used for external immobilization and protection of the cervical spine, offers several advantages. We present here a simple, accurate, easy, and safe cervical traction technique using a halo vest apparatus.

Kazuhiko Kyoshima; Yukinari Kakizawa; Kazuo Tokushige

2003-01-01

77

Cervical spine intradural-extramedullary hematoma presenting as ipsilateral hemiparesis  

PubMed Central

A 75-year-old Taiwanese man suffered from acute onset of right-sided extremity weakness while talking to his neighbors. He was transferred to the hospital within three-hour time after symptom onset. Initial acute ischemic cerebral infarct was diagnosed based on his symptom and cerebral computed tomography. Thrombolytic therapy was held after his symptom improved promptly and could not excluded other etiology. Thorough history taking unraveled previous Chinese medicine clinic visit because of neck sore. However, he received limited improvement after several times of massage treatment. Magnetic resnance imaging (MRI) of the cervical spine demonstrated hematoma compressing right side intradural-extramedullary space at the C2/C3 level. Through his clinical course, muscle weakness was the sole neurological finding with sparing of sensory defects. Given the close anatomy relationship between sensory and motor lamina distribution in the cervical spinal cord, our patient presented a rare manifestation. Cases of cervical spine intradural-extramedullary hematoma are not often seen and only sporadic in the documented literature. We wish, through the report of this article, to inform the first- line physicians with the following information. Among the elderly, neck sore is a common symptom. Over- stretching or overt local massage is not suggested due to relatively fragile musculature. In the clinical diagnosis and localization of lesion, cerebral or cervical spine lesion could mimic with each other and manifest hemiparesis as their first symptom. Meticulous history taking, neurological/ physical examination and pertinent laboratory work-up should be done before initiation of intravenous thrombolytic therapy as it could cause catastrophic consequences if not used properly.

Lin, Chih Ming

2011-01-01

78

Development of a finite element model of the human cervical spine.  

PubMed

The finite element model has been used as an effective tool in human spine biomechanics. Biomechanical finite element models have provided basic insights into the workings of the cervical spine system. Advancements in numerical methods during the last decade have enabled researchers to propose more accurate models of the cervical spine. The new finite element model of the cervical spine considers the accurate representation of each tissue regarding the geometry and material. The aim of this paper is to address the new advancements in the finite element model of the human cervical spine. The procedures for creating a finite element model are introduced, including geometric construction, material-property assignment, boundary conditions and validation. The most recent and published finite element models of the cervical spine are reviewed. PMID:24848166

Zafarparandeh, Iman; Erbulut, Deniz U; Lazoglu, Ismail; Ozer, Ali Fahir

2014-01-01

79

[Cervicogenic dysphagia: swallowing difficulties caused by functional and organic disorders of the cervical spine].  

PubMed

Cervical spine disorders which can cause swallowing difficulties (cervicogenic dysphagia; CD) are: chronic multisegmental/MS dysfunction (dysfunction=functional blockade) of the facet joints, changes in physiological curvature of the cervical spine, degenerative changes (anterior osteophytes, anterior disc herniation, osteochondrosis, osteoarthritis), inflammatory rheumatic diseases, diffuse idiopathic skeletal hyperostosis, injuries, conditions after anterior cervical spine surgery, congenital malformations and tumors. According to our clinical observations, degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints are disorders which can cause swallowing difficulties. However, these disorders have not been recognized enough as the causes of dysphagia and they are not even mentioned in differential diagnosis. Because of the close anatomical relationship of cervical spine with the pharynx and cervical part of esophagus, the consequences of the degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints such as the changes in the physiological curvature of the cervical spine, changes in elasticity and contractility in the neck muscles and decreased mobility of the cervical spine, adversely affect the dimensions of the pharynx and cervical part of esophagus, that is, swallowing capacity which can result in dysphagia. Degenerative changes in the cervical discs and facet joints are common additional cause of dysphagia in elderly people with disorders of the central control of swallowing (stroke, Parkinson's disease, senile dementia etc). The most important therapeutic options in patients with CD are: medicamentous therapy, physical therapy, manual therapy, kinesiotherapy and surgical treatment. The aim of the conservative therapy in patients with CD is to improve the swallowing capacity (for example, soft tissue techniques, stretching of the shortened muscles, passive and active mobilization of the facet joints). As the patients with CD usually respond well to the appropriate therapy, cervical causes of dysphagia cannot be overlooked in patients with difficulty swallowing, including patients with disorders of the central control of swallowing. PMID:23671976

Grgi?, Vjekoslav

2013-01-01

80

Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report  

PubMed Central

Introduction Cervical disc herniation often results in neck and arm pain in patients as a result of direct impingement of nerve roots and associated inflammatory processes. The clinical presentation usually corresponds with the side of herniation and ipsilateral symptoms predominate the clinical picture. Case presentation A 35-year-old Caucasian man presented to our facility with neck pain and left-sided upper and lower extremity pain. A magnetic resonance imaging scan revealed a right paramedian herniated disc at the C5 to C6 level. All other cervical levels were normal without central canal stenosis or neural foraminal stenosis. Results from magnetic reasonance imaging scans of the brain and lumbar spine were negative. An anterior cervical discectomy was performed at the C5 to C6 level, and an inter-body graft and plate were placed. Our patient had complete resolution of his neck and left arm pain. Conclusions Anterior discectomy and fusion of the cervical spine resulted in complete resolution of our patient’s neck and left arm symptoms and improvement of his contralateral left leg pain. Cervical disc herniation may present with contralateral symptoms that are different from the current perception of this disease.

2012-01-01

81

[Anesthesia for surgery of degenerative and abnormal cervical spine].  

PubMed

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

Béal, J L; Lopin, M C; Binnert, M

1993-01-01

82

Biomechanical comparison of anterior cervical spine locked and unlocked plate-fixation systems  

Microsoft Academic Search

Three different anterior plate-fixation systems are available for the stabilisation of the cervical spine: (1) the cervical spine locking plate (CSLP), (2) dynamic plates allowing vertical migration of the fixation screws, and (3) various types of plates that are secured with either monocortical or bicortical unlocked screws. Unicortical screw purchase does not involve the risk of posterior cortex penetration and

Wolfgang Lehmann; Daniel Briem; Michael Blauth; Ulf Schmidt

2005-01-01

83

CT evaluation of the pattern of odontoid fractures in the elderly—relationship to upper cervical spine osteoarthritis  

Microsoft Academic Search

Odontoid fractures are common in the elderly following minor falls. Almost all of them have osteoarthritis of the cervical spine below the axis vertebra. As a result, there is increased stress on the spared upper cervical spine, resulting in a higher incidence of injuries. As movement in the upper cervical spine involves participation of five joints, degeneration in any one

Palaniappan Lakshmanan; Alwyn Jones; John Howes; Kathleen Lyons

2005-01-01

84

Function and structure of the deep cervical extensor muscles in patients with neck pain.  

PubMed

The deep cervical extensors are anatomically able to control segmental movements of the cervical spine in concert with the deep cervical flexors. Several investigations have confirmed changes in cervical flexor muscle control in patients with neck pain and as a result, effective evidence-based therapeutic exercises have been developed to address such dysfunctions. However, knowledge on how the deep extensor muscles behave in patients with neck pain disorders is scare. Structural changes such as higher concentration of fat within the muscle, variable cross-sectional area and higher proportions of type II fibres have been observed in the deep cervical extensors of patients with neck pain compared to healthy controls. These findings suggest that the behaviour of the deep extensors may be altered in patients with neck pain. Consistent with this hypothesis, a recent series of studies confirm that patients display reduced activation of the deep cervical extensors as well as less defined activation patterns. This article provides an overview of the various different structural and functional changes in the deep neck extensor muscles documented in patients with neck pain. Relevant recommendations for the management of muscle dysfunction in patients with neck pain are presented. PMID:23849933

Schomacher, Jochen; Falla, Deborah

2013-10-01

85

Bone morphogenetic protein in complex cervical spine surgery: A safe biologic adjunct?  

PubMed Central

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.

Lebl, Darren R

2013-01-01

86

Imaging current spine hardware: part 1, cervical spine and fracture fixation.  

PubMed

OBJECTIVE. The goals of this article are to review the indications for use, the materials, and the designs of hardware more commonly used in the cervical spine; to discuss alternatives for each of the different types of hardware; to review normal postoperative imaging findings; to describe the appropriateness of different imaging modalities for postoperative evaluation; and to illustrate examples of hardware complications. This article will also review vertebral body fracture fixation. CONCLUSION. Stabilization and fusion of the spine with intervertebral disk replacement, artificial ligaments, spinous process distraction devices, plate-and-rod systems, dynamic posterior fusion devices, and implants composed of new types of material are increasingly more common in the contemporary surgical practice. These spinal hardware devices will be seen more often in radiology practice. Successful postoperative radiologic evaluation of spinal hardware necessitates an understanding of the fundamental design of the hardware, the physiologic objective of the hardware, normal and abnormal postoperative imaging appearances, and complications unique to the hardware. PMID:25055276

Petscavage-Thomas, Jonelle M; Ha, Alice S

2014-08-01

87

Laryngeal dislocation after ventral fusion of the cervical spine  

PubMed Central

We report on a 70-year-old patient who underwent ventral fusion of the cervical spine (C3/4 and C4/5) for spinal canal stenosis performed by the neurosurgery department. The patient suffered an exceedingly rare complication of the surgery – laryngeal dislocation. Had the deformed laryngeal structures been overlooked and the patient extubated as usual after surgery, reintubation would have been impossible due to the associated swelling, which might have had disastrous consequences. Leftward dislocation of the larynx became apparent post-operatively, but prior to extubation. Extubation was therefore postponed and a subsequent computed tomography (CT) scan revealed entrapment of laryngeal structures within the osteosynthesis. A trial of repositioning using microlaryngoscopy performed by otolaryngology (ears, nose and throat) specialists failed, making open surgical revision necessary. At surgery, the entrapped laryngeal tissue was successfully mobilised. Laryngeal oedema developed despite prompt repositioning; thus, necessitating tracheotomy and long-term ventilation. Laryngeal dislocation may be an unusual cause of post-operative neck swelling after anterior cervical spine surgery and should be considered in the differential diagnosis if surgical site haematoma and other causes have been ruled out. Imaging studies including CT of the neck may be needed before extubation to confirm the suspicion and should be promptly obtained to facilitate specific treatment.

Krauel, Jenny; Winkler, Dietrich; Munscher, Adrian; Tank, Sascha

2013-01-01

88

Laryngeal dislocation after ventral fusion of the cervical spine.  

PubMed

We report on a 70-year-old patient who underwent ventral fusion of the cervical spine (C3/4 and C4/5) for spinal canal stenosis performed by the neurosurgery department. The patient suffered an exceedingly rare complication of the surgery - laryngeal dislocation. Had the deformed laryngeal structures been overlooked and the patient extubated as usual after surgery, reintubation would have been impossible due to the associated swelling, which might have had disastrous consequences. Leftward dislocation of the larynx became apparent post-operatively, but prior to extubation. Extubation was therefore postponed and a subsequent computed tomography (CT) scan revealed entrapment of laryngeal structures within the osteosynthesis. A trial of repositioning using microlaryngoscopy performed by otolaryngology (ears, nose and throat) specialists failed, making open surgical revision necessary. At surgery, the entrapped laryngeal tissue was successfully mobilised. Laryngeal oedema developed despite prompt repositioning; thus, necessitating tracheotomy and long-term ventilation. Laryngeal dislocation may be an unusual cause of post-operative neck swelling after anterior cervical spine surgery and should be considered in the differential diagnosis if surgical site haematoma and other causes have been ruled out. Imaging studies including CT of the neck may be needed before extubation to confirm the suspicion and should be promptly obtained to facilitate specific treatment. PMID:23983289

Krauel, Jenny; Winkler, Dietrich; Münscher, Adrian; Tank, Sascha

2013-05-01

89

Microsurgical anatomy of the lower cervical spine and cord.  

PubMed

The authors dissected the cervical spine and its surrounding structures from 40 adult cadavers under a surgical microscope. The anterior part of the spine and spinal cord was examined after vertebrectomy. The posterior longitudinal ligament (PLL) consists of two layers; the anterior one is termed the deep layer, and the posterior one is termed the superficial layer. These two layers adhered together loosely. In the lateral portion of the spinal canal, the superficial layer joined the periradicular sheath at the level of the intervertebral disc spaces and joined the dura mater at the level of the vertebral bodies. After the removal of the deep layer, the anterior internal vertebral venous plexus was seen on top of the lateral part of the superficial layer. The venous plexus was embedded between the double-layered PLLs, was not located in the epidural space, and was not seen in the medial part of the PLL. The PLL without venous channels on top of it was about 10 mm in width at the levels of the intervertebral disc and about 5 mm at the levels of the vertebral body. The anterior root exit zone (AREZ) was an elliptical shape; the transverse length of the AREZ was about 2 mm, and the longitudinal length was 10 to 15 mm. The average number of anterior rootlets on the AREZ was 17 to 25 and tended to decrease in the lower cervical spinal cord. The posterior structures were examined after en bloc laminectomy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8052389

Kubo, Y; Waga, S; Kojima, T; Matsubara, T; Kuga, Y; Nakagawa, Y

1994-05-01

90

Posterior Stabilization of the Cervical and Upper Thoracic Spine with the CerviFix ®  

Microsoft Academic Search

Objective: Posterior stabilization of the occipitocervical junction, the upper and lower cervical spine (C-spine), and the upper thoracic spine (T-spine) using the Cervi-Fix ® rod system, a modular tension band system made of titanium. Various connectors are attached to the pliable rod. 3.5-mm screws are inserted through the connectors into the occiput and into each motion segment of C- and

Bernard Jeanneret; Stefan Schären

2004-01-01

91

Congenital Stenosis of the Cervical Spine: Diagnosis and Management  

PubMed Central

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

Countee, Roger W.; Vijayanathan, Thurairasah

1979-01-01

92

Pain perception in idiopathic cervical dystonia (spasmodic torticollis)  

Microsoft Academic Search

Cervical spinal pain is frequently found in conjuction with idiopathic cervical dystonia (ICD), a focal dystonia characterized by sustained deviation of the head. Since the perception of noxious stimuli has never been studied in ICD, we performed a controlled study to obtain more insight into the psychophysics of dystonia-related muscle pain by evaluating pressure-induced pain levels. In nine ICD patients

F. Lobbezoo; R. Tanguay; M. Thu Thon; G. J. Lavigne

1996-01-01

93

Leiomyosarcoma metastatic to the cervical spine causing a C6 compression fracture: A case report  

PubMed Central

Leiomyosarcoma is a rare malignant tumor derived from smooth muscle cells, which commonly metastasizes to the lungs, liver, kidney, brain and skin. The current study presents the case of a 42-year-old male who presented with progressive neck pain and numbness of the left arm. Spinal computed tomography and magnetic resonance imaging revealed osteolytic lesions of numerous vertebrae (C2, C3, C4, C5, C6, C7, T1 and T2). With regard to the C6 vertebra, total destruction of the vertebral body resulted in vertebral collapse and subsequent spinal cord compression. The patient underwent an anterior C6 corpectomy, reconstruction with a mesh cage filled with polymethyl methacrylate (PMMA) and open PMMA infusion to C5 and C7. The surgical procedure significantly alleviated the symptoms and obtained a reliable reconstruction. The clinical follow-up examination at 13 months was uneventful with the exception of mild numbness of the left hand since the surgery. To the best of our knowledge, this is the first case of leiomyosarcoma recurrence presenting in the cervical spine, and the present study provides insight into the use of a surgical technique that has rarely been used in the cervical spine.

SUN, ZHENZHONG; WANG, HENG; YANG, HUILIN; JIANG, WEIMIN

2014-01-01

94

Maintenance of graft compression in the adult cervical spine.  

PubMed

It is generally advised that the graft inserted in adult cervical spine should be pre-loaded with a compressive force or that the screws are inserted in a divergent orientation, in order to maximise compression and the chance of graft incorporation (Truumees et al. in Spine 28:1097-1102, 2003). However, there is little evidence that a compressive force is maintained once the force applicator has been removed, or that the divergent screws enhance compression. This study compared the maintenance of applied pre-load force, across cervical spine graft, between standard anterior plating technique with pre-load and divergent screws and a novel plate technique, which allows its application prior to removal of the force applicator. Six intact adult cadaveric human cervical spines were exposed by standard surgical technique. A Casper type distracter was inserted across the disc space of interest, the disc was removed. In 14 experiments, following the disc removal, an autologous iliac crest bone graft was inserted under distraction, together with a strain gauge pressure transducer. A resting output from the transducer was recorded. The voltage output has a linear relationship with compressive force. A standardised compressive force was applied across the graft through the "Casper type" distracter/compressor (7.5 kg, torque). The pre-load compressive force was measured using a torque drill. Then two different procedures were used in order to compare the final applied strain on the bone graft. In eight experiments (procedure 1), the "Casper type" distracter/compressor was removed and a standard anterior cervical plate with four divergent screws was inserted. In six experiments (procedure 2), a novel plate design was inserted prior to removal of the distracter/compressor, which is not possible with the standard plate design. A final compressive force across the graft was measured. For the standard plate construct (procedure 1), the applied compression force is significantly greater than resting (SO/SC)--P=0.01, but the compression force is not maintained once the compressor is removed (SO/SR)--P=0.27. Final bone graft compression after plate insertion is not significantly different to the resting state (SO/SF)--P=0.16 (Wilcoxon's sign test for paired observation). Application of the plate tended to offload the graft; the final compressive force is 170+/-100% less than the resting force. None of the applied force was maintained (mean 9.5+/-8.8%). For the new plate (procedure 2), the end compressive force (SF) measured across the graft was greater than the resting force (SO) (P<0.001). Further, the novel plate application increased the compressive force on the graft by 712+/-484%. The final bone graft compression using a novel plate, which allows its application prior to removal of the force applicator, is significant (SO/SF)--P=0.01. Here, 77+/-10% of the applied pre-load was maintained. The difference between the plates is significant (P<0.001). Conclusions are as follows: (1) Applied pre-load is not maintained across a graft once the force applicator is removed. (2) Divergent screws with a plate do not compress graft and rather tend to offload it. (3) Compressive force may be maintained if the plate is applied prior to the force applicator removal. PMID:16421744

Bolger, Ciaran; Bourlion, Maurice; Leroy, Xavier; Petit, Dominique; Vanacker, Gerard; McEvoy, Linda; Nagaria, Jabir

2006-08-01

95

Giant Cervical Spine Osteochondroma in an Adolescent Female  

PubMed Central

Osteochondroma or osteocartolaginous exostosis is by far the most common benign bone tumour, which accounts for 35% to 50% of benign bone neoplasms and 10% to 15% of all primary bone tumours. Osteochondroma represents a developmental enchondromatous hyperplasia which leads to formation of cartilage capped bony protrusions on bony surfaces. We present a case report of a 14-year- old female, who presented to us with a hard, gradually progressing, large painless swelling, over the left side of her neck. Swelling was nontender, extending from dorsal to ventral aspect, measuring 6 x 8 cm. Therefore, we are interested in introducing our case to medical fraternity, in which a giant lower cervical spine osteochondroma was seen in an adolescent female patient.

Huda, N.; Pant, Ajay; Jameel, Tariq

2014-01-01

96

Deceleration during 'real life' motor vehicle collisions - a sensitive predictor for the risk of sustaining a cervical spine injury?  

PubMed Central

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.

Elbel, Martin; Kramer, Michael; Huber-Lang, Markus; Hartwig, Erich; Dehner, Christoph

2009-01-01

97

Treatment of a Patient with Cervical Radiculopathy Using Thoracic Spine Thrust Manipulation, Soft Tissue Mobilization, and Exercise  

PubMed Central

While there is currently little evidence to suggest which non-operative treatment approach is best for the management of patients with cervical radiculopathy, emerging evidence suggests that these patients benefit from a multimodal treatment approach. The purpose of this case report is to describe the physical therapy management of a patient with cervical radiculopathy. Diagnosis was based on the patient's meeting three of the four criteria in the diagnostic test cluster currently used to identify patients with cervical radiculopathy. Treatment included thrust manipulation of the thoracic spine, soft tissue mobilization, and therapeutic exercise. After three visits, patient-perceived disability, as measured by the Patient-Specific Functional Scale, improved from 5/10 to 10/10. The Numeric Pain Rating Score decreased from 4.66/10 to 0/10. The patient rated his improvement as a very great deal better on the Global Rating of Change Scale. These clinically meaningful improvements were maintained at the 14-week follow-up. While a cause-and-effect relationship may not be established from a case report, a multimodal approach including thoracic spine manipulation, soft tissue mobilization, and therapeutic exercise was associated with decreased pain and perceived disability in a patient with cervical radiculopathy. Further research is needed to investigate benefits of the components of this approach.

Costello, Michael

2008-01-01

98

Multimodal intraoperative monitoring (MIOM) during cervical spine surgical procedures in 246 patients  

PubMed Central

A prospective study of 246 patients who received multimodal intraoperative monitoring during cervical spine surgery between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during cervical spine surgery. It is appreciated that complication rate of cervical spine surgery is low, however, there is a significant risk of neurological injury. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information and/or alert regarding any neurological changes during the operation to the surgeon. Intraoperative somatosensory spinal and cerebral evoked potentials combined with continuous EMG and motor-evoked potentials of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. A total of 246 consecutive patients with cervical pathologies, majority spinal stenosis due to degenerative changes of cervical spine were monitored by means of MIOM during the surgical procedure. About 232 patients presented true negative while 2 patients false negative responses. About ten patients presented true positive responses where neurological deficit after the operation was predicted and two patients presented false positive findings. The sensitivity of MIOM applied during cervical spine procedure (anterior and/or posterior) was 83.3% and specificity of 99.2%. MIOM is an effective method of monitoring the spinal cord functional integrity during cervical spine surgery and can help to reduce the risk of neurological deficit by alerting the surgeon when monitoring changes are observed.

Sutter, Martin A.; Grob, Dieter; Jeszenszky, Dezso; Porchet, Francois; Dvorak, Jiri

2007-01-01

99

Endonasal Access to the Upper Cervical Spine, Part One: Radiographic Morphometric Analysis  

PubMed Central

Objectives To determine the anatomical relationships that may influence endonasal access to the upper cervical spine. Setting We retrospectively analyzed computed tomography of 100 patients at a single institution. Participants Participants included adults with imaging of the hard palate, clivus, and cervical spine without evidence of fracture, severe spondylosis, or previous instrumentation. Main Outcome Measures Morphometric analyses of hard palate length and both distance and angle between the hard palate and odontoid process were based on radiographic measurements. Descriptive zones were assigned to cervical spine levels, and endoscopic visualization was simulated with projected lines at 0, 30, and 45 degrees from the hard palate to the cervical spine. Results We found an inverse relationship between hard palate length and the lowest zone of the cervical spine potentially visualized by nasal endoscopy. The distance between the posterior tip of the hard palate and the odontoid tip, and the angle formed between the two, directly influenced the lowest possible cervical exposure. Conclusions Radiographic relationships between hard palate length, distance to the odontoid, and the angle formed between the two predict the limits of endonasal access to the cervical spine. These results are supported by cadaveric data in Part Two of this study.

Singh, Harminder; Grobelny, Bartosz T.; Harrop, James; Rosen, Marc; Lober, Robert M.; Evans, James

2013-01-01

100

Gadolinium Use in Spine Pain Management Procedures for Patients with Contrast Allergies: Results in 527 Procedures  

SciTech Connect

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.

Safriel, Yair [Yale University School of Medicine, Neuroradiology Section, Department of Radiology (United States)], E-mail: safriel@yale.edu; Ang, Roberto [Center for Diagnostic Imaging (United States); Ali, Muhammed [Kaiser Permanente Woodland Hills Medical Center (United States)

2008-03-15

101

Severe neurologic manifestations from cervical spine instability in spondylo-megaepiphyseal-metaphyseal dysplasia.  

PubMed

Spondylo-megaepiphyseal-metaphyseal dysplasia (SMMD; OMIM 613330) is a dysostosis/dysplasia caused by recessive mutations in the homeobox-containing gene, NKX3-2 (formerly known as BAPX1). Because of the rarity of the condition, its diagnostic features and natural course are not well known. We describe clinical and radiographic findings in six patients (five of which with homozygous mutations in the NKX3-2 gene) and highlight the unusual and severe changes in the cervical spine and the neurologic complications. In individuals with SMMD, the trunk and the neck are short, while the limbs, fingers and toes are disproportionately long. Radiographs show a severe ossification delay of the vertebral bodies with sagittal and coronal clefts, missing ossification of the pubic bones, large round "balloon-like" epiphyses of the long bones, and presence of multiple pseudoepiphyses at all metacarpals and phalanges. Reduced or absent ossification of the cervical vertebrae leads to cervical instability with anterior or posterior kinking of the cervical spine (swan neck-like deformity, kyknodysostosis). As a result of the cervical spine instability or deformation, five of six patients in our series suffered cervical cord injury that manifested clinically as limb spasticity. Although the number of individuals observed is small, the high incidence of cervical spine deformation in SMMD is unique among skeletal dysplasias. Early diagnosis of SMMD by recognition of the radiographic pattern might prevent of the neurologic complications via prophylactic cervical spine stabilization. PMID:22791571

Simon, Marleen; Campos-Xavier, Ana Belinda; Mittaz-Crettol, Lauréane; Valadares, Eugenia Ribeiro; Carvalho, Daniel; Speck-Martins, Carlos Eduardo; Nampoothiri, Sheela; Alanay, Yasemin; Mihci, Ercan; van Bever, Yolande; Garcia-Segarra, Nuria; Cavalcanti, Denise; Mortier, Geert; Bonafé, Luisa; Superti-Furga, Andrea

2012-08-15

102

Estimation of CSF flow resistance in the upper cervical spine.  

PubMed

Chiari I patients have increased CSF velocities in the foramen magnum due hypothetically to increased pressure gradients or reduced flow resistance. We calculated flow resistance in the cervical spinal canal in a group of subjects with and without the Chiari malformation. Eight subjects including healthy volunteers and Chiari I patients were studied. From 3D high resolution MR images of the cervical spine mathematical models of the subarachnoid spaces were created by means of standard programs for segmentation and discretization. Oscillatory flow through the subarachnoid space was simulated. Cross-sectional area of the subarachnoid space was computed at each level from C1 through C4 and the length of this spinal canal segment was measured. Peak caudad CSF flow velocity at each level was plotted against cross-section area. CSF volumetric flux and resistance were calculated for each subject. The correlation between velocity and resistance was calculated. In all subjects, peak velocities increased progressively from C1 to C4 by 0.6 to 0.7 cm/s per level. Spinal canal areas diminished from C1 to C5 in each subject at a rate of -0.25 to -0.29 cm(2) per level. Resistance averaged 4.3 pascal/ml/s in the eight subjects; 3.8 pascal/ml/s in patients with tonsilar herniation and 6.0 pascal/ml/s in volunteers. Velocity correlated inversely with resistance (R(2) = 0.6). CSF velocities correlated inversely with the flow resistance in the upper cervical spinal canal. Resistance tends to be lower in Chiari I patients than in healthy volunteers. PMID:23859177

Mardal, K-A; Rutkowska, G; Linge, S; Haughton, V

2013-02-01

103

[Imaging with magnetic resonance imaging of the operated cervical spine].  

PubMed

The Authors report their personal experience with postoperative neuroradiologic studies in surgical patients with a herniated disk and/or degenerative cervical spondylosis. Twenty-six patients were enrolled: 16 of them underwent anterior diskectomy, 7 posterior decompressive laminectomy and 3 vertebral body removal. The patients were submitted to pre- and postoperative MRI with high field equipment (Signa 1.5 T, General Electrics), using sagittal SE T1- (TR/TE 360/15), PD and T2-weighted (TR/TE/FA 2000/40/120) sequences and T2-weighted GE axial sequences (TR/TE/FA 400/34/30). FSE sequences (TR/TE/ETL 4000/95/8) were used in 15 cases instead of the above T2-weighted SE sequences. The main postoperative MR findings were analyzed. In particular, the morphological and signal features of bone grafts, of vertebral end-plates, of the subchondral bone and of the surgical site were studied. After anterior diskectomy, the most frequent MR features were massive signal changes in the bone graft and lower vertebral plates, which were hypointense in T1 and hyperintense in T2; the adjacent subchondral bone also exhibited signal changes. Other postoperative MR findings accounted for early postoperative mobility (4 cases of persistent myelomalacia and 3 of bone graft fracture with consequent spinal instability) and late mobility (2 cases of herniated disk, 5 of spinal stenosis and one pseudomeningocele). The main limitation of MRI in postoperative cervical spine studies was the presence of ferromagnetic artifacts during SE, and even more GE, sequences; these artifacts were the main cause of misdiagnoses. In our experience, this troublesome limitation was overcome with FSE sequences but diagnostic accuracy remained poor in 4 patients. MRI, thanks to its multiparametric and multiplanar yield, is the gold standard for the examination of several early and late postoperative features and of postoperative mobility in the cervical spine. Moreover, T2-weighted FSE acquisitions are better than conventional SE to this purpose, because examination time is shorter, myelographic effect is improved and the sensitivity to ferromagnetic artifacts reduced. PMID:9122452

Scarabino, T; Perfetto, F; Giannatempo, G M; Ceddia, A; D'Angelo, V; Cammisa, M; Salvolini, U

1996-12-01

104

Occipito-cervico-thoracic spine fusion in a patient with occipito-cervical dislocation and survival.  

PubMed

A 16-year-old man with occipito-cervical dislocation and survival was treated at Rancho Los Amigos Medical Center. The patient had ligamentous instability between the occiput and the cervical spine. His neurologic level was complete at the C1 level, and he was dependent on a mechanical respirator. Sternocleidomastoid and other neck musculature were not functional. A fusion of the occiput to cervical spine and cervical spine to thoracic spine was performed to obviate the need for external neck support. The patient went on to fuse and is now independently mobile with a tongue-switch driven wheelchair with a respirator trailer 2 years after injury. The patient has no need for external support as a result of his fusion. PMID:3787336

Zigler, J E; Waters, R L; Nelson, R W; Capen, D A; Perry, J

1986-01-01

105

Primary eosinophilic granuloma of adult cervical spine presenting as a radiculomyelopathy.  

PubMed

We report a case of 29-year-old man diagnosed as a primary eosinophilic granuloma (EG) lesion of the seventh cervical vertebra. He had paresthesia on both arms, and grasping weakness for 10 days. Cervical magnetic resonance image (MRI) showed an enhancing mass with ventral epidural bulging and cord compression on the seventh cervical vertebra. Additionally, we performed spine series MRI, bone scan and positive emission tomography for confirmation of other bone lesions. These studies showed no other pathological lesions. He underwent anterior cervical corpectomy of the seventh cervical vertebra and plate fixation with iliac bone graft. After surgical management, neurological symptoms were much improved. Histopathologic evaluation confirmed the diagnosis of EG. There was no evidence of tumor recurrence at 12 months postoperative cervical MRI follow-up. We reported symptomatic primary EG of cervical spine successfully treated with surgical resection. PMID:24044083

Bang, Woo-Seok; Kim, Kyoung-Tae; Cho, Dae-Chul; Sung, Joo-Kyung

2013-07-01

106

Adult acute calcific discitis confined to the nucleus pulposus in the cervical spine: case report.  

PubMed

Acute calcific discitis is a rare condition in the pediatric population and has been reported in only 2 instances in the adult population. This report describes a case of acute calcific discitis that uniquely presented in the adult cervical spine. A 22-year-old woman presented with the chief complaint of sudden-onset neck pain. Nonsurgical management, including nonsteroidal antiinflammatory drugs, provided moderate symptom relief. Radiography revealed nucleus pulposus calcification at the C2-3 level. Contrast-enhanced MRI did not reveal any additional abnormalities. Further nonsurgical management, including physical therapy and nonsteroidal antiinflammatory drugs, led to complete symptom relief within 6 months. Follow-up imaging demonstrated that the calcification had nearly resolved. Acute calcific discitis should be managed conservatively; the prognosis for a complete recovery is excellent. The pathophysiology of the disorder is yet to be elucidated, and the disorder is not exclusive to the pediatric population. PMID:23746089

Azizaddini, Shahrzad; Arefanian, Saeed; Redjal, Navid; Walcott, Brian P; Mollahoseini, Reza

2013-08-01

107

Cervical Spine Alignment in the Youth Football AthleteRecommendations for Emergency Transportation  

Microsoft Academic Search

Background: Substantial literature exists regarding recommendations for the on-field treatment and subsequent transportation of adult collision-sport athletes with a suspected injury to the cervical spine.Purpose: To develop an evidence-based recommendation for transportation of suspected spine-injured youth football players.Study Design: Descriptive laboratory study.Methods: Three lateral radiographs were obtained in supine to include the occiput to the cervical thoracic junction from 31

Gehron Treme; David R. Diduch; Jennifer Hart; Mark J. Romness; Michael S. Kwon; Joseph M. Hart

2008-01-01

108

Cervical spine injuries in pediatrics: are children small adults or not?  

Microsoft Academic Search

Diagnosis of cervical spine injuries is crucial whether in children or adults. It is necessary to understand the injuries\\u000a unique to the developing spine. Equally important is an insight to similarities in injury patterns between adults and children.

Joseph J. Junewick

2010-01-01

109

Soft tissue injuries associated with traumatic locked facets in the cervical spine  

Microsoft Academic Search

The clinical, radiological and operative findings in 10 consecutive patients with cervical spine trauma presenting with locked facets (bilaterally in nine patients) are reported. The treatment was cervical traction until reduction of the locked facets was achieved, followed by anterior surgical decompression and ostheosynthesis. Intervertebral disc herniation was present in nine of the patients, and ruptured calcified posterior longitudinal ligament

A C Moraes; A Serdeira; A Pereira Filho; E Zardo; J Deitos

1995-01-01

110

Treatment of an Unusual Case of Tuberculosis of the Cervical Spine.  

National Technical Information Service (NTIS)

The treatment of a patient with severe kyphosis of the cervical spine due to tuberculosis involving C2 to T2 inclusive has been outlined. It included antituberculous agents, cervical traction for reduction of the kyphosis and an anterior approach for simu...

M. R. Cressman S. Hoppenfeld

1968-01-01

111

Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis  

PubMed Central

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.

Heyde, Christoph-E; Fakler, Johannes K; Hasenboehler, Erik; Stahel, Philip F; John, Thilo; Robinson, Yohan; Tschoeke, Sven K; Kayser, Ralph

2008-01-01

112

C2/C3 pathologic fractures from polyostotic fibrous dysplasia of the cervical spine treated with percutaneous vertebroplasty  

PubMed Central

We will discuss a potential role of percutaneous vertebroplasty (PVP) in the management of patients with severe fibrous dysplasia of the spine with multiple cervical lesions and C2–C3 pathologic fractures that may not be a good surgical candidate. Polyostotic fibrous dysplasia involvement of the cervical spine is rare. Review of literature indicates only few reported cases of surgical management with one case of mortality indicating increased risks associated with surgical intervention. While PVP is commonly used for the treatment of osteoporotic thoracolumbar vertebral compression fractures, its role in vertebral stabilization for fibrous dysplasia has not been reported. A 35-year-old man with McCune–Albright syndrome and severe polyostotic fibrous dysplasia of C2 and C3 vertebrae presented with severe neck pain, radiculopathy, quadriparesis and myelopathy. The lesion had pathologic fractures, and there was an os odontoideum with cervical cord atrophy at the C1 level. After discussing need for aggressive surgical management and potential complications, we offered PVP due to surgical risks involved. PVP was performed with a posterolateral transpedicular approach without complication. The patient had remarkable improvement in clinical relief of neck pain and improvement of myelopathic symptoms at 1-year follow-up. We present a case that illustrates a potential use of PVP in the management of a patient with symptomatic spinal fibrous dysplasia with associated pathologic fractures who was poor surgical candidate.

Dang, David; Christoforidis, Greg; Chiocca, E. Antonio; Gabriel, Joshue

2007-01-01

113

Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review comparing multilevel versus single-level surgery  

PubMed Central

Study design:?Systematic review. Clinical questions:?What is the effectiveness of multilevel cervical artificial disc replacement (C-ADR) compared with multilevel fusion with respect to pain and functional outcomes, and are the two procedures comparable in terms of safety? What is the effectiveness of multilevel C-ADR compared with single-level C-ADR with respect to pain and functional outcomes, and are the two procedures comparable in terms of safety? Methods:?A systematic review was undertaken for articles published up to October 2011. Electronic databases and reference lists of key articles were searched to identify studies comparing multilevel C-ADR with multilevel anterior cervical discectomy and fusion (ACDF) or comparing multilevel C-ADR with single-level C-ADR. Studies which compared these procedures in the lumbar or thoracic spine or that reported alignment outcomes only were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results:?Two studies compared multilevel C-ADR with multilevel ACDF. While both reported improved Neck Disability Index (NDI) and Short-Form 36 (SF-36) scores after C-ADR compared with ACDF, only one study reported statistically significant results. Seven studies compared single-level C-ADR with multilevel C-ADR. Results were similar in terms of overall success, NDI and SF-36 scores, and patient satisfaction. There is discrepant information regarding rates of heterotopic ossification; dysphagia rate may be higher in multilevel C-ADR. Conclusions:?The literature suggests that outcomes are at least similar for multilevel C-ADR and ACDF and may favor C-ADR. Future studies are necessary before firm recommendations can be made favoring one treatment strategy. Multilevel C-ADR seems to have similar results to single-level C-ADR but may have higher rates of heterotopic ossification and dysphagia.

Kepler, Christopher K.; Brodt, Erika D.; Dettori, Joseph R.; Albert, Todd J.

2012-01-01

114

Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review comparing multilevel versus single-level surgery.  

PubMed

Study design:?Systematic review.Clinical questions:?What is the effectiveness of multilevel cervical artificial disc replacement (C-ADR) compared with multilevel fusion with respect to pain and functional outcomes, and are the two procedures comparable in terms of safety? What is the effectiveness of multilevel C-ADR compared with single-level C-ADR with respect to pain and functional outcomes, and are the two procedures comparable in terms of safety?Methods:?A systematic review was undertaken for articles published up to October 2011. Electronic databases and reference lists of key articles were searched to identify studies comparing multilevel C-ADR with multilevel anterior cervical discectomy and fusion (ACDF) or comparing multilevel C-ADR with single-level C-ADR. Studies which compared these procedures in the lumbar or thoracic spine or that reported alignment outcomes only were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus.Results:?Two studies compared multilevel C-ADR with multilevel ACDF. While both reported improved Neck Disability Index (NDI) and Short-Form 36 (SF-36) scores after C-ADR compared with ACDF, only one study reported statistically significant results. Seven studies compared single-level C-ADR with multilevel C-ADR. Results were similar in terms of overall success, NDI and SF-36 scores, and patient satisfaction. There is discrepant information regarding rates of heterotopic ossification; dysphagia rate may be higher in multilevel C-ADR.Conclusions:?The literature suggests that outcomes are at least similar for multilevel C-ADR and ACDF and may favor C-ADR. Future studies are necessary before firm recommendations can be made favoring one treatment strategy. Multilevel C-ADR seems to have similar results to single-level C-ADR but may have higher rates of heterotopic ossification and dysphagia. PMID:23236310

Kepler, Christopher K; Brodt, Erika D; Dettori, Joseph R; Albert, Todd J

2012-02-01

115

Spinal posture and prior loading history modulate compressive strength and type of failure in the spine: a biomechanical study using a porcine cervical spine model  

Microsoft Academic Search

Objective. The purpose of this study was to investigate the effect of posture and loading history on the compressive strength and site of failure in the spine.Design. An in vitro experiment was performed using a porcine cervical model that provided a homogenous population of young healthy spines.Background. The distribution of stresses amongst the many load bearing tissues of the spine

Jennifer L Gunning; Jack P Callaghan; Stuart M McGill

2001-01-01

116

Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers.  

PubMed

A random allocation single blind block design pillow field study was undertaken to investigate the behaviour of cervico-thoracic spine pain in relation to pillow use. Participants (N=106) who reported preference for side sleep position with one pillow were recruited via a telephone survey and newspaper advertisement. They recorded sleep quality and pillow comfort ratings, frequency of retiring and waking cervical pain and duration of waking cervical pain while sleeping for a week on their usual pillow, polyester, foam, feather and rubber pillows of regular shape and a foam contour pillow. Analysis was undertaken comparing sleep quality, pillow comfort, waking and temporal cervical pain reports, between the usual pillow and the trial pillows, between pillows of differing content and foam pillows of differing shape. This study provides evidence to support recommendation of rubber pillows in the management of waking cervical pain, and to improve sleep quality and pillow comfort. The rubber pillow performed better than subjects' own pillow in most instances. Subjects' own pillow performed similarly to foam and polyester pillows, and there is no evidence that the use of a foam contour pillow has advantages over the regular shaped pillows. Feather pillows should not be recommended. PMID:19427257

Gordon, Susan J; Grimmer-Somers, Karen; Trott, Patricia

2009-12-01

117

Biomechanical study of pediatric human cervical spine: a finite element approach.  

PubMed

Although considerable effort has been made to understand the biomechanical behavior of the adult cervical spine, relatively little information is available on the response of the pediatric cervical spine to external forces. Since significant anatomical differences exist between the adult and pediatric cervical spines, distinct biomechanical responses are expected. The present study quantified the biomechanical responses of human pediatric spines by incorporating their unique developmental anatomical features. One-, three-, and six-year-old cervical spines were simulated using the finite element modeling technique, and their responses computed and compared with the adult spine response. The effects of pure overall structural scaling of the adult spine, local component developmental anatomy variations that occur to the actual pediatric spines, and structural scaling combined with local component anatomy variations on the responses of the pediatric spines were studied. Age- and component-related developmental anatomical features included variations in the ossification centers, cartilages, growth plates, vertebral centrum, facet joints, and annular fibers and nucleus pulposus of the intervertebral discs. The flexibility responses of the models were determined under pure compression, pure flexion, pure extension, and varying degrees of combined compression-flexion and compression-extension. The pediatric spine responses obtained with the pure overall (only geometric) scaling of the adult spine indicated that the flexibilities consistently increase in a uniform manner from six- to one-year-old spines under all loading cases. In contrast, incorporation of local anatomic changes specific to the pediatric spines of the three age groups (maintaining the same adult size) not only resulted in considerable increases in flexibilities, but the responses also varied as a function of the age of the pediatric spine and type of external loading. When the geometric scaling effects were added to these spines, the increases in flexibilities were slightly higher; however, the pattern of the responses remained the same as found in the previous approach. These results indicate that inclusion of developmental anatomical changes characteristic of the pediatric spines has more of a predominant effect on biomechanical responses than extrapolating responses of the adult spine based on pure overall geometric scaling. PMID:10790831

Kumaresan, S; Yoganandan, N; Pintar, F A; Maiman, D J; Kuppa, S

2000-02-01

118

Biomechanical effect of anterior cervical spine fusion on adjacent segments.  

PubMed

The biomechanical effects of superior (C4-C5) and inferior (C5-C6) level fusions with different graft materials on the adjacent unaltered components were quantified using an anatomically accurate and experimentally validated C4-C5-C6 finite element model. Smith-Robinson and Bailey-Badgley fusion procedures were analyzed with five different types of inter-body fusion materials with varying stiffnesses. Intact and surgically altered finite element models were subjected to physiologic compression, flexion, extension and lateral bending. The external axial and angular stiffness, and the internal unaltered intervertebral disc (C5-C6 for the superior and C4-C5 for inferior fusion) and C5 vertebral body stresses were determined. The superior level fusion resulted in the highest increase in external response in lateral bending for all implant materials in both surgical procedures. In contrast, the inferior level fusion produced a higher increase in the C4-C5 disc and C5 vertebral body stresses in compression than the superior level fusion in both surgical procedures. The increased internal stress responses reflecting the changes in the load-sharing following inferior level fusion may explain clinical observations such as enhanced degeneration subsequent to surgery. Because of the inclusion of three levels in the present multi-segment finite element model, it was possible to determine these responses in the unaltered adjacent components of the cervical spine. PMID:10436851

Maiman, D J; Kumaresan, S; Yoganandan, N; Pintar, F A

1999-01-01

119

[Surgical tactics in treatment of cervical spine injuries].  

PubMed

Surgical tactics were analyzed in 1350 patients with cervical spine injuries treated during 1972-2009 years. In 80% of cases injuries were caused by car accidents. 855 patients were admitted in acute or early period of trauma. In other cases old injuries were observed. Vertebral neurological syndromes were revealed in most cases and were absent only in 80 patients. All patients were operated using anterior access. Authors consider that reposition of dislocated vertebras can be carried out in acute and early periods of trauma. Unsuccessful reposition, fractures or fracture-dislocations with spinal stenosis served as indications for transcorporal spinal decompression. This operation is considered to be a method of choice for late periods of trauma. Stabilization of spinal column was achieved using carbonic implant (950 patients), bone auto-transplant (400) combined with utilized auto-bone (960) or biocomposite material "KollapAn" (390 patients). Good results were achieved in 1150 patients, satisfactory - in 190, poor - in 10 patients. Long term results with catamnesis more than 25 years were traced in 120 patients. Results were not revalued. PMID:21350403

Protsenko, A I; Nikuradze, V K; Mekhtikhanov, D S

2011-01-01

120

Accuracy of ICD-9-CM coding of cervical spine fractures: Implications for research using administrative databases  

PubMed Central

Objective ICD-9-CM codes are often used for trauma research due to their ready availability in administrative databases. They are also used to classify injury severity in trauma patients. However, errors in coding may limit the use of these codes. Prior studies have found coding accuracy ranging from 20 to 100%, casting doubt on the reliability of studies utilizing these codes. The goal of this study was to determine the accuracy of ICD-9-CM coding for cervical spine fractures. Methods We used ICD-9-CM codes to identify trauma admissions and cervical spine fractures at a Level I trauma center in 2006. Cervical spine CT or CTA reports were reviewed by two independent observers. Data were compared to ICD-9-CM codes to determine accuracy. Results Of 1620 trauma admissions, 174 (11%) included a cervical spine fracture defined by ICD-9-CM codes. A cervical spine fracture was the primary diagnosis in 79 admissions and a secondary diagnosis in 63 admissions. Of the 142 cervical spine fractures defined by ICD-9-CM code, there were 133 (94%) cervical fractures by radiology report. Accuracy varied by primary diagnosis (97%) versus secondary diagnosis (89%). By cervical level, there were 230 fractures by CT report. Of these, 7% of ICD-9-CM codes documented a fractured level not noted in the CT report. Conversely, 14% of fractured levels noted by CT report did not have a corresponding ICD-9-CM code. Implications We found an overall 94% accuracy of ICD-9-CM coding compared to radiology reports. Inaccuracy of coding fracture level ranged from 7 to 14%. Researchers using these codes should refer back to the medical record or perform a sensitivity analysis to improve reliability.

Miller, Matthew L.; Wang, Marjorie C.

2008-01-01

121

Cervical instability presenting as thoracic pain: Case report and literature review  

PubMed Central

Study design Case report. Objective To report a case of cervical instability from an os odontoideum that presented as posterior thoracic pain and to present a review of the literature. Background Thoracic posterior paraspinal spasms and pain are common chief complaints in individuals with spinal abnormalities. Methods A 19-year-old man presented with posterior thoracic pain for nearly 1 year following a college sports-related injury (lacrosse). Computed tomography and magnetic resonance imaging did not reveal any significant thoracic or lumbar spinal cord or nerve root pathology, but did reveal an incidental finding of an os odontoideum. Results Surgical stabilization of the atlantoaxial instability resulting from the os odontoideum resulted in complete resolution of the patient's thoracic pain. Conclusions Thoracic back pain without a clear thoracic spine etiology warrants further workup to rule out the possibility of spinal instability.

Zussman, Benjamin M.; Saldua, Nelson S.; Harrop, James S.

2012-01-01

122

Spinal Cord Injury With a Narrow Spinal Canal: Utilizing Torg’s Ratio Method of Analyzing Cervical Spine Radiographs  

Microsoft Academic Search

A 65-year-old inebriated mancrashed his car and presented with spinal shock and neurogenic shock from a cervical spinal cord injury without cervical spine fracture or dislocation. The lateral cervical spine radiography was initially read as normal, except for degenerative disk disease; however, Torg’s ratio method of analyzing cervical spinal canal sagittal width indicated the spinal canal was congenitally narrow. Magnetic

Tareg Bey; Amy Waer; Frank G Walter; John Fortune; Joachim Seeger; Karsten Fryburg; William Smith

1998-01-01

123

The anatomic variability of human cervical pedicles: considerations for transpedicular screw fixation in the middle and lower cervical spine.  

PubMed

Transpedicular screw fixation has recently been shown to be successful in stabilizing the middle and lower cervical spine. Controversy exists, however, over its efficacy, due to the smaller size of cervical pedicles and the proximity of significant neurovascular structures to both lateral and medial cortical walls. To aid the spinal surgeon in the insertion of pedicle screws, a number of studies have been performed to quantify the gross dimensions and angulations of the cervical pedicle. Notwithstanding these quantitative studies, there has been a conspicuous absence of research reporting the qualitative characteristics of the cervical pedicle. The purpose of our study was to provide comparative graphical data that would systematically document the anatomic variability in cervical pedicle morphology. Such information should better elucidate the complexity of the pedicle as a three-dimensional structure and provide the spinal surgeon with a more complete understanding of cervical pedicle architecture. Twenty-six human cervical vertebrae (C3-C7) from six fresh-frozen spines were secured to a thin sectioning apparatus to produce three 0.7-mm-thick pedicle slices along its axis. Radiographs taken of these pedicle slices were scanned, digitized, and traced to facilitate visual comparison. The pedicle slices were found to exhibit substantial variability in composition and shape, not only between individual spines and vertebral levels, but also within the pedicle axis. However, the lateral cortex was consistently found to be thinner than the medial cortex in all samples. These physical findings must be noted by surgeons attempting transpedicular screw fixation in the cervical spine. PMID:10766079

Shin, E K; Panjabi, M M; Chen, N C; Wang, J L

2000-02-01

124

The anatomic variability of human cervical pedicles: considerations for transpedicular screw fixation in the middle and lower cervical spine  

Microsoft Academic Search

Transpedicular screw fixation has recently been shown to be successful in stabilizing the middle and lower cervical spine.\\u000a Controversy exists, however, over its efficacy, due to the smaller size of cervical pedicles and the proximity of significant\\u000a neurovascular structures to both lateral and medial cortical walls. To aid the spinal surgeon in the insertion of pedicle\\u000a screws, a number of

Eon K. Shin; Manohar M. Panjabi; Neal C. Chen; Jaw-Lin Wang

2000-01-01

125

Cervical spine anomalies in Menkes disease: a radiologic finding potentially confused with child abuse  

PubMed Central

Background Menkes disease is an X-linked recessive disorder of copper transport caused by mutations in ATP7A, a copper-transporting ATPase. Certain radiologic findings reported in this condition overlap with those caused by child abuse. However, cervical spine defects simulating cervical spine fracture, a known result of nonaccidental pediatric trauma, have not been reported previously in this illness. Objective To assess the frequency of cervical spine anomalies in Menkes disease after discovery of an apparent C2 posterior arch defect in a child participating in a clinical trial. Materials and methods We examined cervical spine radiographs obtained in 35 children with Menkes disease enrolled in a clinical trial at the National Institutes of Health Clinical Center. Results Four of the 35 children with Menkes disease had apparent C2 posterior arch defects consistent with spondylolysis or incomplete/delayed ossification. Conclusion Defects in C2 were found in 11% of infants and young children with Menkes disease. Discovery of cervical spine defects expands the spectrum of radiologic findings associated with this condition. As with other skeletal abnormalities, this feature simulates nonaccidental trauma. In the context of Menkes disease, suspicions of child abuse should be considered cautiously and tempered by these findings to avoid unwarranted accusations.

Hill, Suvimol C.; Dwyer, Andrew J.

2012-01-01

126

In-vivo kinematics of the cervical spine in frontal sled tests.  

PubMed

The description of cervical spine motion and the risk to sustain a cervical spine injury in traffic accidents is mainly based on rear-end collisions. The knowledge about frontal collisions is comparable low. Therefore the objective of this exploratory study was, to describe the in-vivo cervical spine motion and acceleration during simulated frontal sled collisions and to identify sequences of motion in which the risk of injury is increased. A frontal collision with a speed change of 10.2km/h was simulated in a sled test with ten volunteers. Cervical spine kinematics was assessed by the simultaneous analysis of the angular head motion and acceleration as well as the simultaneous analysis of the relative motion and acceleration between the head and the first thoracic vertebral body. The motion sequence was divided into five phases. The combination of peak values of the angular head acceleration to ventral and the relative horizontal head acceleration to dorsal between the time period of 90ms and 110ms (early flexion phase) included - potential injury generating - shear forces. Although a hyperflexion (late rebound phase) as injury pattern didn't occur, dorsal soft tissue injuries due to eccentric muscle-sprain could not be ruled out completely. In conclusion the study showed under simulated test conditions that during the early flexion phase and the late rebound phase, acceleration and movement pattern occur that could lead to cervical spine injuries. PMID:23618481

Dehner, Christoph; Schick, Sylvia; Hell, Wolfram; Richter, Peter; Kraus, Michael; Kramer, Michael

2013-05-01

127

Exclusion of cervical spine instability in patients with blunt trauma with normal multidetector CT (MDCT) and radiography.  

PubMed

The objective of the study was to determine if negative multidetector computed tomography (MDCT) and lateral radiography of the cervical spine effectively excludes patients with unstable cervical spine injuries. Over a period of 40 months, 6558 people were admitted to our trauma service with blunt injury and 447 (6.8%) were found to have cervical fractures. Fractures were identified by CT and/or lateral radiography. In order to rule out clinically significant instability in the absence of fracture, we identified nine patients who required any type of stabilization of the cervical spine including anterior fusion, posterior fusion and external orthosis. These patients also underwent MR of the cervical spine. Radiography, CT, and MR images and reports of these nine patients were reviewed. Nine patients without a fracture required cervical stabilization. These patients had the following abnormalities: disc herniation with canal stenosis in three, unilateral jumped facet in three, and various other soft tissue abnormalities in three, all of which were evident on CT or radiography. All nine patients had evidence for cervical spine injury or instability by MDCT. Normal MDCT and radiography appears adequate to 'clear' the cervical spine. We recommend that patients requiring cervical spine clearance undergo a complete MDCT and lateral radiograph of the cervical spine. If these studies are entirely normal, then the cervical spine may be cleared. If any abnormalities, including disc herniation, soft tissue swelling and bony malalignments are noted by radiography and/or MDCT, further studies, including MR, are indicated prior to clearance of the cervical spine. PMID:19016118

Sekula, R F; Daffner, R H; Quigley, M R; Rodriguez, A; Wilberger, J E; Oh, M Y; Jannetta, P J; Protetch, Jack

2008-10-01

128

Cervical Facet Joint Injections in the Neck and Shoulder Pain  

PubMed Central

The effects from cervical facet joint injections in those patients who have been complaining cervical zygapophyseal joint pain were compared. The patients were diagnosed originally as myofascial pain syndrome (MPS), cervical herniated nucleus pulposus (HNP), and whiplash-associated disorders (WAD). Patients with the zygapophyseal joints pain of C5-6 and C6-7 were classified by their pain origin as MPS, HNP, and WAD. All patients had been undergone cervical zygapophyseal joints injections with the mixture of lidocaine and triamcinolone unilaterally or bilaterally through the posterior approach under C-arm imaging guide. The therapeutic effects were compared with reduction of numeric rating scale (NRS) of pain before and immediately after blockade and symptom-free periods in each group after 12 months. Symptom durations before injections were 16.1±9.6, 4.6±1.9 and 4.1±1.1 months in each MPS, HNP, and WAD groups. The reductions of NRS immediately after the blockade among the three groups were not different. However, the symptom-free duration after blockade lasted longer in the HNP group than the other two groups. In patients with cervical zygapophyseal pain syndromes, the analgesic effect from cervical facet joint blocks lasted longer in cervical HNP than MPS or WAD.

Choi, Sung-Hwan; Kim, Tae-Kyun; Shin, Sang-Wook; Kim, Cheul-Hong; Kim, Jeung-Il

2005-01-01

129

Brown-Sequard syndrome associated with Horner's syndrome following a penetrating drill bit injury to the cervical spine.  

PubMed

We report a 41-year-old male who presented with a partial Brown-Sequard syndrome and Horner's syndrome following a penetrating drill bit injury to his mid cervical spine. As the injury was not a complete hemisection of the spinal cord, the patient presented with ipsilateral motor deficit and hyperesthesia and diminished contralateral fine touch sensation; however, proprioception, vibration and temperature were all initially intact. A cervical CT and MRI scan showed a damaged spinal cord at the C5/6 level with posterior cord compression secondary to haematoma. A decompressive laminectomy and evacuation of the haematoma was performed. Over the following 5 days the patient's right-sided motor deficit improved daily; however, he developed a contralateral deficit to pain and temperature upon wakening from the operation which did not resolve. The right-sided Horner's syndrome also persisted. PMID:19386500

Russell, Jeremy H; Joseph, Samuel J; Snell, Broughton J; Jithoo, Rondhir

2009-07-01

130

Computer-assisted surgery in posterior instrumentation of the cervical spine: an in-vitro feasibility study  

Microsoft Academic Search

Transarticular C1\\/2 screws are widely used in posterior cervical spine instrumentation. The use of pedicle screws in the cervical spine remains uncommon. Due to superior biomechanical stability compared to lateral mass screws, pedicle screws can be used, especially for patients with poor bone quality or defects in the anterior column. Nevertheless there are potential risks of iatrogenic damage to the

M. Richter; L.-P. Amiot; S. Neller; P. Kluger; W. Puhl

2000-01-01

131

Relationship between cervical spine injury and helmet use in motorcycle road crashes.  

PubMed

Motorcycle helmets have been proven to prevent head injury and reduce fatality in road crashes. However, certain studies indicate that the helmet increases the mass to the head, and thus the potential of neck injury due to the flexion/extension of the head-neck segment in a road crash may increase. This study was conducted to evaluate the effects of motorcycle helmets and the ways in which the accidents that occurred affected the incidence of cervical spine injury. Nevertheless, it is not intended to and does not discredit the fact that helmet use prevents many motorcyclists from sustaining serious and fatal head injuries. A total of 76 cases were collected and analyzed based on the data collected from real-world crashes. The Abbreviated Injury Scale (AIS) was used to assess the severity of injury, whereas the statistical Pearson ?(2) correlation method was used for analysis. The results showed that motorcycle helmets did not affect the severity of cervical spine injury. However, when the samples were further subcategorized into different crash modes, it was found that helmets affect the incidence of a severe cervical spine injury. In frontal collisions, the use of helmets significantly reduces the severity of cervical spine injury, whereas in rear-end, side impact, and skidded accidents, the use of helmets increases the probability of a severe cervical spine injury. However, in the latter crash modes, a motorcyclist without a helmet will have to trade-off with head injury. A logistic regression model has been developed with respective crash modes and the probabilities of risk in having severe cervical spine injury have been calculated. Future designs in motorcycle helmets should therefore consider the significance of nonfrontal accidents and the interaction of helmet with other parts of the body by possibly considering the weight of the helmet. PMID:21768134

Ooi, S S; Wong, S V; Yeap, J S; Umar, Radin

2011-07-01

132

Development and validation of a 10-year-old child ligamentous cervical spine finite element model.  

PubMed

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

Dong, Liqiang; Li, Guangyao; Mao, Haojie; Marek, Stanley; Yang, King H

2013-12-01

133

Monostotic fibrous dysplasia of the spine: report of a case involving a cervical vertebra  

Microsoft Academic Search

Monostotic fibrous dysplasia of the spine is a rare entity. Only 26 cases, of which 11 were located in the cervical spine,\\u000a are to be found in the literature. We report a 56-year-old male patient with cervicobrachialgia of half year’s duration. Radiographs\\u000a showed a diffuse destruction of the vertebral body and the spinous process of C4. A biopsy of the

D. Proschek; R. Orler; E. Stauffer; P. Heini

2007-01-01

134

Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine  

Microsoft Academic Search

Posterior instrumentation of the cervical spine has become increasingly popular in recent years. Dissatisfaction with lateral mass fixation, especially at the cervico-thoracic junction, has led spine surgeons to use pedicle screws. The improved biomechanical stability of pedicle screws and transarticular C1\\/2 screws allows for shorter instrumentations and improves the repositioning possibilities. Nevertheless, there are potential risks of iatrogenic damage to

Marcus Richter; Thomas Mattes; Balkan Cakir

2004-01-01

135

MR imaging features of pigmented villonodular synovitis of the cervical spine.  

PubMed

Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder primarily occurring in the large joints of the appendicular skeleton such as the knee and hip joints. We present an unusual case of PVNS involving the cervical spine in an adult. MR imaging showed an enhancing mass lesion arising from the posterior elements of the cervical spine and hyperintensity on the T2-weighted images, without evidence of T2 susceptibility effects. Gross total excision of the tumor was performed, and the diagnosis was established by histopathology. PMID:14729546

Parmar, Hemant A; Sitoh, Yih Yian; Tan, Kheng Kooi; Teo, Jennifer; Ibet S, Marie; Hui, Francis

2004-01-01

136

Postoperative pulmonary edema after cervical spine surgery--a case report.  

PubMed

Injury of the cervical spine may cause serious complications and neurological sequelae. Recently, a patient with C1-2 spinal cord compression developed pulmonary edema postoperatively associated with unstable hemodynamics, which might result from overzealous fluid administration in order to correct neurogenic shock during anesthesia. Therefore, early recognition and timely use of vasoconstrictors, together with judicious fluid replacement are important in the anesthetic management of patients with cervical spine injury undergoing surgery. In addition, the placement of pulmonary artery catheter is crucial for assessing the cardiac function and fluid status. PMID:10609348

Tsao, C M; Yuan, H B; Neu, S H; Lan, C J; Hu, J S; Lui, P W; Lee, T Y

1999-09-01

137

Current status of bone graft options for anterior interbody fusion of the cervical and lumbar spine.  

PubMed

Anterior cervical discectomy and fusion (ACDF) and anterior lumbar interbody fusion (ALIF) are common surgical procedures for degenerative disc disease of the cervical and lumbar spine. Over the years, many bone graft options have been developed and investigated aimed at complimenting or substituting autograft bone, the traditional fusion substrate. Here, we summarise the historical context, biological basis and current best evidence for these bone graft options in ACDF and ALIF. PMID:23743981

Chau, Anthony Minh Tien; Xu, Lileane Liang; Wong, Johnny Ho-Yin; Mobbs, Ralph Jasper

2014-01-01

138

Anterior decompression, fusion and plating in cervical spine injury: Early experience in Abuja, Nigeria  

PubMed Central

Background: We present a review of the results of the current surgical management of acute cervical spine injuries in the Federal Capital Territory, Abuja, Nigeria. This is the first detailed retrospective study on the surgical management of patients with cervical spine injuries from Nigeria. Methods: The medical reports of patients with traumatic cervical spine and spinal cord injuries undergoing surgery from 1 August 2009 till 30 August 2010 were reviewed. Management and early results of outcome were ascertained and detailed consecutively in a prospective Microsoft Office Access® database (Microsoft Group of Companies). Frankel grading was used for pre- and immediate post-operative evaluation (within 48 hours). The Barthel index (BI) was used to classify patients as dependent or independent at follow-up. Results: Twenty consecutive patients presented with acute cervical spine and spinal cord injuries since August 2009. Twenty anterior cervical spine decompression and fixation with an iliac graft and an anterior cervical plate (ACDF) were performed in 18 patients. All operations were performed with general anaesthesia using standard techniques but without a microscope or a high speed drill. Of the 18 patients who were operated, 4 patients died within a short period following surgical intervention. Seven patients have made a full recovery and seven remain fully dependent. Only two of the dependent quadriplegic patients have become reintegrated back into the society. Conclusion: The management of spinal cord injuries in Abuja is evolving. The operations were performed adequately with much limited complement of equipment. Poor intensive care therapy is a major challenge and improvements in this area of care will likely lead to better patient outcomes.

Ogungbo, Biodun

2011-01-01

139

Mechanisms of cervical spine injuries for non-fatal motorcycle road crash.  

PubMed

Cervical spine injuries such as subluxation and fracture dislocation have long been known to result in severe consequences, as well as the trauma management itself. The injury to the region has been identified as one of the major causes of death in Malaysian motorcyclists involved in road crashes, besides head and chest injuries (Pang, 1999). Despite this, cervical spine injury in motorcyclists is not a well-studied injury, unlike the whiplash injury in motorcar accidents. The present study is a retrospective study on the mechanisms of injury in cervical spine sustained by Malaysian motorcyclists, who were involved in road crash using an established mechanistic classification system. This will serve as an initial step to look at the cervical injuries pattern. The information obtained gives engineer ideas to facilitate design and safety features to reduce injuries. All cervical spine injured motorcyclists admitted to Hospital Kuala Lumpur between January 1, 2000 and December 31, 2001 were included in the present study. Based on the medical notes and radiological investigations (X-rays, CT and MRI scans), the mechanisms of injuries were formulated using the injury mechanics classification. The result shows that flexion of the cervical vertebrae is the most common vertebral kinematics in causing injury to motorcyclists. This indicates that the cervical vertebrae sustained a high-energy loading at flexion movement in road crash, and exceeded its tolerance level. The high frequency of injury at the C5 vertebra, C6 vertebra and C5-C6 intervertebral space are recorded. Classification based on the Abbreviated Injury Scale (AIS) is made to give a view on injury severity, 9.1% of the study samples have been classified as AIS code 1, 51.5% with AIS 2 and 21.2% with AIS 3. PMID:15559162

Ooi, S S; Wong, S V; Radin Umar, R S; Azhar, A A; Yeap, J S; Megat Ahmad, M M H

2004-06-01

140

[Anterior cervical spine hyperostosis--a rare cause of difficult intubation in emergency].  

PubMed

DISH (Diffuse idiopathic skeletal hyperostosis) of cervical spine is a rare condition which causes dysphagia in 23% of cases and occasionally dyspnea. The authors report the case of a 74 years old male, known with progressive dysphagia and recurrent episodes of dysphonia and dyspnea, who suffered a sudden episode of respiratory distress that need finaly tracheotomy after ineffective attempts of orotracheal intubation. PMID:22276454

Stefan, Monica; Ciupilan, Corina; Mella, Corina; Scutariu, M D

2011-01-01

141

Finite element modeling of the cervical spine: role of intervertebral disc under axial and eccentric loads  

Microsoft Academic Search

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

Srirangam Kumaresan; Narayan Yoganandan; Frank A Pintar; Dennis J Maiman

1999-01-01

142

Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation  

Microsoft Academic Search

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

Srirangam Kumaresan; Narayan Yoganandan; Frank A. Pintar; Dennis J. Maiman; Vijay K. Goel

2001-01-01

143

A BIOMECHANICAL MODEL TO ANALYZE NORMAL, DEGENERATED, AND FUSED CERVICAL SPINES USING IAR'S CONCEPT  

Microsoft Academic Search

During voluntary flexion\\/extension of the head-neck system, the cervical spine undergoes a stepwise motion from upper to lower regions with a specific pattern. The motion of each vertebra is composed of a translation and rotation with respect to lower vertebrae, which may be considered as an absolute rotation about an axis called instantaneous axis of rotation (IAR). The location of

A. MEGHDARI; A. H. BAHRAMI

144

Assessment of published reliability studies for cervical spine range-of-motion measurement tools  

Microsoft Academic Search

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

Kelvin Jordan

2000-01-01

145

The epidemiologic, pathologic, biomechanical, and cinematographic analysis of football-induced cervical spine trauma  

Microsoft Academic Search

Epidemiologic, pathologic, biomechanical, and cinema tographic data on head and neck injuries occurring in tackle football have been compiled since 1971 by the National Football Head and Neck Injury Registry. Pre liminary analysis performed in 1975 indicated that the majority of serious cervical spine football injuries were caused by axial loading. Based on this observation, the National Collegiate Athletic Association

Joseph S. Torg; Joseph J. Vegso; Mary Jane ONeill; Brian Sennett

1990-01-01

146

Moving muscle points provide accurate curved muscle paths in a model of the cervical spine  

Microsoft Academic Search

Muscle paths in musculoskeletal models have been modeled using several different methods; however, deformation of soft tissue with changes in posture is rarely accounted for, and often only the neutral posture is used to define a muscle path. The objective of this study was to model curved muscle paths in the cervical spine that take into consideration soft tissue deformation

Bethany L. Suderman; Anita N. Vasavada

147

Percutaneous tracheostomy in patients with cervical spine fractures--feasible and safe.  

PubMed

The aim of this study is to evaluate the short and long-term results of percutaneous tracheostomy in patients with documented cervical spine fracture. Between June 2000 and September 2005, 38 consecutive percutaneous tracheostomy procedures were performed on multi-trauma patients with cervical spine fracture. Modified Griggs technique was employed at the bedside in the general intensive care department. Staff thoracic surgeons and anesthesiologists performed all procedures. Demographics, anatomical conditions, presence of co-morbidities and complication rates were recorded. The average operative time was 10 min (6-15). Two patients had minor complications. One patients had minor bleeding (50 cc) and one had mild cellulitis. Nine patients had severe paraparesis or paraplegia prior to the PCT procedure and 29 were without neurological damage. There was no PCT related neurological deterioration. Twenty-eight patients were discharged from the hospital, 21 were decannulated. The average follow-up period was 18 months (1-48). There was no delayed, procedure related, complication. These results demonstrate that percutaneous tracheostomy is feasible and safe in patients with cervical spine fracture with minimal short and long-term morbidity. We believe that percutaneous tracheostomy is the procedure of choice for patients with cervical spine fracture who need prolonged ventilatory support. PMID:17670607

Ben Nun, Alon; Orlovsky, Michael; Best, Lael Anson

2006-08-01

148

Magnetic Resonance Imaging of the Cervical and Thoracic Spine and the Spinal Cord.  

National Technical Information Service (NTIS)

Magnetic resonance imaging (MR), using a 0.3 T resistive scanner with an iron core and a vertical magnetic field, was evaluated in patients with different diseases affecting the cervical and thoracic spine and the spinal cord. The results indicate that MR...

E. M. Larsson

1989-01-01

149

Radiation Therapy for Chordoma and Chondrosarcoma of the Skull Base and the Cervical Spine  

Microsoft Academic Search

Background: Prospective analysis of local tumor control, survival and treatment complications in 67 consecutive patients treated with fractionated photon and proton radiation for chordoma or chondrosarcoma of the base of the skull and the cervical spine. Patients and Methods: Between December 1995 and January 2000, 67 patients with a median age of 52 years (range: 14-85 years), were treated at

Georges Noël; Jean-Louis Habrand; Eric Jauffret; Renaud de Crevoisier; Sygon Dederke; Hamid Mammar; Christine Haie-Méder; Dominique Pontvert; Dominique Hasboun; Régis Ferrand; Gilbert Boisserie; Anne Beaudré; Geneviève Gaboriaud; Ferran Guedea; Lourdes Petriz; Jean-Jacques Mazeron

2003-01-01

150

Locking screw-plate fixation of cervical spine fractures with and without ancillary posterior plating  

Microsoft Academic Search

Forty consecutive patients with 19 fractures and 21 fracture-dislocations in the lower cervical spine were treated prospectively with open reduction and interbody fusion, using the AO titanium locking screwplate system. There were 30 men and 10 women with a mean age of 36 years (range 16–90 years). Eight were admitted tetraplegic, 12 tetraparetic, and 6 had nerve root injuries. Eleven

H. Jónsson; K. Cesarini; M. Petrén-Mallmin; W. Rauschning

1991-01-01

151

An evidence-based mobile decision support system for subaxial cervical spine injury treatment.  

PubMed

Bringing evidence to practice is a key issue in modern medicine. The key barrier to information searching is time. Clinical decision support systems (CDSS) can improve guideline adherence. Mounting evidence exists that mobile CDSS on handheld computers support physicians in delivering appropriate care to their patients. Subaxial cervical spine injuries account for almost half of spine injuries, and a majority of spinal cord injuries. A valid and reliable classification exists, including evidence-based treatment algorithms. A mobile CDSS on this topic was not yet available. We developed and tested an iPhone application based on the Subaxial Injury Classification (SLIC) and 5 evidence-based treatment algorithms for the surgical approach to subaxial cervical spine injuries. The application can be downloaded for free. Users are cordially invited to provide feedback in order to direct further development and evaluation of CDSS for traumatic lesions of the spinal column. PMID:21541200

Kubben, P L; van Santbrink, H; Cornips, E M J; Vaccaro, A R; Dvorak, M F; van Rhijn, L W; Scherpbier, A J J A; Hoogland, H

2011-01-01

152

An evidence-based mobile decision support system for subaxial cervical spine injury treatment  

PubMed Central

Bringing evidence to practice is a key issue in modern medicine. The key barrier to information searching is time. Clinical decision support systems (CDSS) can improve guideline adherence. Mounting evidence exists that mobile CDSS on handheld computers support physicians in delivering appropriate care to their patients. Subaxial cervical spine injuries account for almost half of spine injuries, and a majority of spinal cord injuries. A valid and reliable classification exists, including evidence-based treatment algorithms. A mobile CDSS on this topic was not yet available. We developed and tested an iPhone application based on the Subaxial Injury Classification (SLIC) and 5 evidence-based treatment algorithms for the surgical approach to subaxial cervical spine injuries. The application can be downloaded for free. Users are cordially invited to provide feedback in order to direct further development and evaluation of CDSS for traumatic lesions of the spinal column.

Kubben, P. L.; van Santbrink, H.; Cornips, E. M. J.; Vaccaro, A. R.; Dvorak, M. F.; van Rhijn, L. W.; Scherpbier, A. J. J. A.; Hoogland, H.

2011-01-01

153

MDCT of acute subaxial cervical spine trauma: a mechanism-based approach.  

PubMed

Injuries to the spinal column are common and road traffic accidents are the commonest cause. Subaxial cervical spine (C3-C7) trauma encompasses a wide spectrum of osseous and ligamentous injuries, in addition to being frequently associated with neurological injury. Multidetector computed tomography (MDCT) is routinely performed to evaluate acute cervical spine trauma, very often as first-line imaging. MDCT provides an insight into the injury morphology, which in turn reflects the mechanics of injury. This article will review the fundamental biomechanical forces underlying the common subaxial spine injuries and resultant injury patterns or "fingerprints" on MDCT. This systematic and focused analysis enables a more accurate and rapid interpretation of cervical spine CT examinations. Mechanical considerations are important in most clinical and surgical decisions to adequately realign the spine, to prevent neurological deterioration and to facilitate appropriate stabilisation. This review will emphasise the variables on CT that affect the surgical management, as well as imaging "pearls" in differentiating "look-alike" lesions with different surgical implications. It will also enable the radiologist in writing clinically relevant CT reports of cervical spine trauma. Teaching Points • Vertebral bodies and disc bear the axial compression forces, while the ligaments bear the distraction forces.• Compressive forces result in fracture and distractive forces result in ligamentous disruption.• Bilateral facet dislocation is the most severe injury of the flexion-distraction spectrum.• Biomechanics-based CT reading will help to rapidly and accurately identify the entire spectrum of injury.• This approach also helps to differentiate look-alike injuries with different clinical implications. PMID:24554380

Raniga, Sameer B; Menon, Venugopal; Al Muzahmi, Khamis S; Butt, Sajid

2014-06-01

154

Esophageal perforation following cervical spine surgery: A review with considerations in airway management.  

PubMed

Anterior cervical discectomy and fusion (ACDF) is a commonly performed surgery for the treatment of spondylosis, radiculopathy, myelopathy, and trauma to the cervical spine. Esophageal perforation is a rare yet serious complication following ACDF with an incidence of 0.02 to 1.52%. We describe a case of a 24-year-old man who underwent ACDF and corpectomy following a motor vehicle accident who subsequently developed delayed onset esophageal perforation requiring surgical intervention. We believe that the detailed review of the surgical management of esophageal perforation following cervical spine surgery will provide a deeper understanding for the Intensivist in regards to postoperative airway management in these types of patients. Careful extubation over a soft flexible exchange catheter should take place to help reduce the risk of perforation in the event reintubation is required. PMID:24459627

Amhaz, Hassan H; Kuo, Ruth; Vaidya, Rahul; Orlewicz, Marc S

2013-10-01

155

Esophageal perforation following cervical spine surgery: A review with considerations in airway management  

PubMed Central

Anterior cervical discectomy and fusion (ACDF) is a commonly performed surgery for the treatment of spondylosis, radiculopathy, myelopathy, and trauma to the cervical spine. Esophageal perforation is a rare yet serious complication following ACDF with an incidence of 0.02 to 1.52%. We describe a case of a 24-year-old man who underwent ACDF and corpectomy following a motor vehicle accident who subsequently developed delayed onset esophageal perforation requiring surgical intervention. We believe that the detailed review of the surgical management of esophageal perforation following cervical spine surgery will provide a deeper understanding for the Intensivist in regards to postoperative airway management in these types of patients. Careful extubation over a soft flexible exchange catheter should take place to help reduce the risk of perforation in the event reintubation is required.

Amhaz, Hassan H; Kuo, Ruth; Vaidya, Rahul; Orlewicz, Marc S

2013-01-01

156

Intra-operative computer navigation guided cervical pedicle screw insertion in thirty-three complex cervical spine deformities  

PubMed Central

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.

Rajasekaran, S.; Kanna, P. Rishi Mugesh; Shetty, T. Ajoy Prasad

2010-01-01

157

[Molecular genetic background of developmental bony malformations at the craniocervical junction and cervical spine].  

PubMed

In this review a new interpretation of the origin of bony developmental malformations affecting the craniocervical junction and the cervical spine is presented based on recent advances in the understanding of embryonic development of the spine and its molecular genetic control. Radiographs, CT and MRI scans or CT myelograms of patients with Klippel-Feil syndrome were used for demonstration. Detailed clinical and radiological analysis of these patients was published earlier [David KM, Stevens JM, Thorogood P, Crockard HA. The dysmorphic cervical spine in Klippel-Feil syndrome: interpretations from developmental biology. Neurosurg Focus 1999;6(6):1.]. Homeotic transformation due to mutations or disturbed expression of Hox genes is a possible mechanism responsible for Cl assimilation. Notochordal defects and/or signalling problems, that result in reduced or impaired Pax-1 gene expression, may underlie vertebral fusions. This, together with asymmetrical distribution of paraxial mesoderm cells and a possible lack of communication across the embryonic mid-line, could cause the asymmetrical fusion patterns. The wide and flattened shape of the fused vertebral bodies, their resemblance to the embryonic cartilaginous vertebrae and the process of progressive bony fusion with age suggest that the fusions occur before or, at the latest, during chondrification of vertebrae. The authors suggest that the aforementioned mechanisms are likely to be, at least in part, responsible for the origin of the bony developmental malformations affecting the craniocervical junction and the cervical spine. PMID:12201233

Károly, Dávid; Kasó, Gábor; Thorogood, Peter V; Stevens, John M; Crockard, H Alan

2002-07-20

158

Delayed presentation of a cervical spine fracture dislocation with posterior ligamentous disruption in a gymnast.  

PubMed

Cervical spine injuries are uncommon but potentially devastating athletic injuries. We report a case of a girl gymnast who presented with a cervical spine fracture dislocation with posterior ligamentous disruption several days after injury. To our knowledge, this type of presentation with such severity of injury in a gymnast has not been reported in the literature. The patient was performing a double front tuck flip and sustained a hyperflexion, axial-loading injury. She experienced mild transient numbness in her bilateral upper and lower extremities lasting for about 5 minutes, after which it resolved. The patient was neurologically intact during her clinic visit, but she endorsed significant midline cervical tenderness. Plain radiographs and computed tomography imaging of the cervical spine revealed a C2-C3 fracture dislocation. She underwent posterior open reduction followed by C2-C3 facet arthrodesis and internal fixation. This case highlights the importance of very careful evaluations of neck injuries and the maintenance of high suspicion for significant underlying pathology. PMID:24945477

Momaya, Amit; Rozzelle, Curtis; Davis, Kenny; Estes, Reed

2014-06-01

159

Biomechanical comparison of anterior instrumentation for the cervical spine.  

PubMed

Metal fixation has been advocated to achieve immediate local stabilization during anterior cervical fusion surgery. Screw loosening, screw backout, and breakage of screws or plates remain clinical complications that warrant concern. This study examined the biomechanical characteristics of a prototype anterior cervical plating system with unique screw and plate geometries in comparison to a fixation system currently used clinically. Compared with a standard screw design, a taper screw design resulted in increased ultimate strength and fatigue life. The addition of a locking pin hole in the tapered screw made the screw's fatigue life comparable to the standard design. Pullout strength was comparable in all screw designs. The prototype fixation system had higher strength in pure compression and compression with bending than the comparative system, while also demonstrating improved fatigue characteristics. The tensile bending stiffness of the prototype was double that of the comparative system and within the anatomical range of cervical vertebrae, the bending moment was greater. Torsional yield strength was greater than the reported breaking strength of cervical disc in situ for both systems. The unique designs of the screw and plate geometry resulted in an anterior cervical plate fixation system that is stronger with decreased risk of fatigue failure than a currently used system. Clinical evaluation in patients requiring immediate stabilization is warranted. PMID:8605415

Griffith, S L; Zogbi, S W; Guyer, R D; Shelokov, A P; Contiliano, J H; Geiger, J M

1995-12-01

160

Minimally invasive spine surgery in chronic low back pain patients.  

PubMed

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

Spoor, A B; Öner, F C

2013-09-01

161

Subaxial cervical spine trauma classification: the Subaxial Injury Classification system and case examples.  

PubMed

Object The authors review a novel subaxial cervical trauma classification system and demonstrate its application through a series of cervical trauma cases. Methods The Spine Trauma Study Group collaborated to create the Subaxial Injury Classification (SLIC) and Severity score. The SLIC system is reviewed and is applied to 3 cases of subaxial cervical trauma. Results The SLIC system identifies 3 major injury characteristics to describe subaxial cervical injuries: injury morphology, discoligamentous complex integrity, and neurological status. Minor injury characteristics include injury level and osseous fractures. Each major characteristic is assigned a numerical score based upon injury severity. The sum of these scores constitutes the injury severity score. Conclusions By addressing both discoligamentous integrity and neurological status, the SLIC system may overcome major limitations of earlier classification systems. The system incorporates a number of critical clinical variables-including neurological status, absent in earlier systems-and is simple to apply and may provide both diagnostic and prognostic information. PMID:18980482

Patel, Alpesh A; Dailey, Andrew; Brodke, Darrel S; Daubs, Michael; Anderson, Paul A; Hurlbert, R John; Vacccaro, Alexander R

2008-01-01

162

THE RIDDELLTM RIPKORD SYSTEM FOR SHOULDER PAD REMOVAL IN A CERVICAL SPINE INJURED ATHLETE: A PARADIGM SHIFT  

PubMed Central

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.

Smith, Danny; Hoogenboom, Barb

2011-01-01

163

Altered Co-contraction of Cervical Muscles in Young Adults with Chronic Neck Pain during Voluntary Neck Motions  

PubMed Central

[Purpose] Muscle co-contraction is important in stabilizing the spine. The aim of this study was to compare cervical muscle co-contraction in adults with and without chronic neck pain during voluntary movements. [Subjects and Methods] Surface electromyography of three paired cervical muscles was measured in fifteen young healthy subjects and fifteen patients with chronic neck pain. The subjects performed voluntary neck movements in the sagittal and coronal plane at slow speed. The co-contraction ratio was defined as the normalized integration of the antagonistic electromyography activities divided by that of the total muscle activities. [Results] The results showed that the co-contraction ratio of patients was greater during flexion movement, lesser during extension movement, slightly greater during right lateral bending, and slightly lesser during left lateral bending compared with in the controls. [Conclusion] The results suggested that neck pain patients exhibit greater antagonistic muscle activity during flexion and dominate-side bending movements to augment spinal stability, while neuromuscular control provides relatively less protection in the opposite movements. This study helps to specify the changes of the stiffness of the cervical spine in neck pain patients and provides a useful tool and references for clinical assessment of neck disorders.

Cheng, Chih-Hsiu; Cheng, Hsin-Yi Kathy; Chen, Carl Pai-Chu; Lin, Kwan-Hwa; Liu, Wen-Yu; Wang, Shwu-Fen; Hsu, Wei-Li; Chuang, Yu-Fen

2014-01-01

164

Assessment and rehabilitation of the athlete with a "stinger". A model for the management of noncatastrophic athletic cervical spine injury.  

PubMed

Stingers are the most common athletically induced nerve injury of the cervical spine, but often underdiagnosed or inadequately assessed. In addition to neurologic dysfunction, biomechanical and postural faults are frequently associated with stingers. This article addresses the pathomechanics of the stinger, comprehensive clinical assessment, appropriate diagnostic testing, and a thorough review of rehabilitation techniques to allow return to competition. The principles and practical suggestions can be applied to most cervical spine injuries. PMID:9475977

Weinstein, S M

1998-01-01

165

Muscle Activity Influence on the Kinematics of the Cervical Spine in Rear-end Sled Tests in Female Volunteers  

Microsoft Academic Search

Objective: Although numerous research has been performed to investigate the cervical spine kinematics during rear-end collisions our understanding about the exact role of the musculature is limited. Up to now the question of muscle activity influence on cervical spine kinematics has been discussed.Methods: A rear-end collision with a speed change (?V) of 6.3 km\\/h was simulated in a sled test with

Christoph Dehner; Sylvia Schick; Michael Kraus; Wolfram Hell; Michael Kramer

2012-01-01

166

Pain and Tissue-Interface Pressures During Spine-Board Immobilization  

Microsoft Academic Search

Study objectives: Although spine boards are one of the main EMS means of immobilization and transportation, few studies have addressed the discomfort and potential harmful consequences of using this common EMS tool. We compared the levels of pain and tissue-interface (contact) pressures in volunteers immobilized on spine boards with and without interposed air mattresses.Design: Prospective crossover study. Setting: Emergency department

William H Cordell; Jason C Hollingsworth; Michael L Olinger; Steven J Stroman; David R Nelson

1995-01-01

167

The effect of cervical traction combined with neural mobilization on pain and disability in cervical radiculopathy. A case report.  

PubMed

Cervical radiculopathy is the result of cervical nerve root pathology that may lead to chronic pain and disability. Although manual therapy interventions including cervical traction and neural mobilization have been advocated to decrease pain and disability caused by cervical radiculopathy, their analgesic effect has been questioned due to the low quality of research evidence. The purpose of this paper is to present the effect of cervical traction combined with neural mobilization on pain and disability in a patient experiencing cervical radiculopathy. A 52-year-old woman presented with a 2 month history of neurological cervico-brachial pain and whose presentation was consistent with cervical radiculopathy. Cervical traction and a slider neural mobilization of the medial nerve were applied simultaneously to reduce the patient's pain and disability measured at baseline and at 2 and 4 weeks using the Numeric Pain Rating Scale, the Neck Disability Index and the Patient-Specific Functional Scale. Improvements in all outcome measures were noted over a period of four weeks. Scores in all outcome measures revealed that the patient's pain had almost disappeared and that she was able to perform her household chores and job tasks without difficulties and limitations. In conclusion, the findings of this study support that the application of cervical traction combined with neural mobilization can produce significant improvements in terms of pain and disability in cervical radiculopathy. PMID:22818658

Savva, Christos; Giakas, Giannis

2013-10-01

168

Cervical spine injuries in children: A review of 103 patients treated consecutively at a level 1 pediatric trauma center  

Microsoft Academic Search

Purpose: Cervical spine (C-spine) injuries occur infrequently in children but may be associated with significant disability and mortality. The purpose of this study was to review the experience of a level 1 pediatric trauma center to determine the epidemiology, risk factors, mechanisms, levels, types of injury, comorbid factors, and outcomes associated with these potentially devastating injuries. Methods: A retrospective analysis

Rebeccah L. Brown; Margie A. Brunn; Victor F. Garcia

2001-01-01

169

Chiropractic and Neck Pain: Conservative Care of Cervical Pain, Injury  

MedlinePLUS

... head, normal aging, and everyday wear and tear. Neck pain can be very bothersome, and it can have ... are some of the most typical causes of neck pain: Injury and Accidents: A sudden forced movement of ...

170

Axial computed tomography of the pedicle in the lower cervical spine.  

PubMed

Using axial computed tomography (CT), we measured pedicle width, pedicle axis length, pedicle transverse angle, and distance between screw entry point and vertebrae midline in the cervical spines (C3-C7) of 40 patients. All measurements were greater in men than in women, and we noted significant sex differences at most levels of pedicle inner and outer widths (P < or = .05 or P < or = .01). Mean pedicle inner and outer widths for all levels and all patients ranged from 2.3 to 3.0 mm and from 5.0 to 6.0 mm, respectively. Mean distances between screw entry point and vertebrae midline ranged from 22.2 to 23.7 mm. Results of this study-along with axial CT measurements of individual pedicle diameter, pedicle transverse angle, and screw entry point-would be useful when considering and performing transpedicular screw fixation in the cervical spine. PMID:11198831

Rezcallah, A T; Xu, R; Ebraheim, N A; Jackson, T

2001-01-01

171

[Tumors and metastases of the upper cervical spine (C0-2). A special challenge].  

PubMed

Tumors of the upper cervical spine are rare and represent less than 0.5?% of all spinal tumors. The types of tumor and the clinical presentation are as varied as the modalities used for treatment. The unique anatomy of the upper cervical spine with its high physical mobility means that biomechanical considerations and neighboring anatomical structures (e.g. vertebral artery, medulla oblongata, lower cranial nerves and pharynx) must be considered when creating a treatment plan. Finding a balance between complete tumor removal, the preservation and reestablishment of stability and function and the possible necessity for postoperative radiotherapy is of utmost importance and must be assessed on an individual basis. In this review paper some important points will be presented concerning the preparation of the patient, the planning of the operation and the surgical approach used in treating tumors of the craniocervical junction. PMID:23989592

Jeszenszky, D J; Haschtmann, D; Pröbstl, O; Kleinstück, F S; Heyde, C E; Fekete, T F

2013-09-01

172

Children presenting to a Canadian hospital with trampoline-related cervical spine injuries  

PubMed Central

BACKGROUND: Trampoline-related injuries are preventable by avoidance. There are few published reports focusing on cervical spine injuries from trampolines in the paediatric population. METHODS: Patients younger than 18 years of age who presented to Stollery Children’s Hospital (Edmonton, Alberta) between 1995 and 2006, with a cervical spine injury or death from trampoline use were identified via a medical records database search. Data were collected retrospectively from the hospital charts, and were presented using descriptive statistics. RESULTS: There were seven cases of cervical spine injury secondary to trampoline use. Four patients had lasting neurological deficits at discharge from hospital, and another patient died at the scene due to refractory cardiac arrest. Injuries were sustained both on (n=5) and off (n=2) the trampoline mat from mechanisms that included attempted somersaults on the trampoline and falls from the trampoline. All the trampolines were privately owned home trampolines. An ambulance was called for five patients, intravenous fluids were administered to two patients with hypotension and spinal shock, and cardiopulmonary resuscitation was performed on one patient. All six patients surviving the initial injury were admitted to hospital for a mean ± SD of 9.5±9.0 days. These six patients underwent imaging including x-rays, computed tomography and magnetic resonance imaging, and three patients required surgery for spinal stabilization. CONCLUSION: Cervical spine injuries from trampolines lead to severe neurological sequelae, death, hospitalization and significant resource use. The authors agree with the Canadian Paediatric Society’s statement that trampolines should not be used for recreational purposes at home, and they support a ban on all paediatric use of trampolines.

Leonard, Heather; Joffe, Ari R

2009-01-01

173

Hydrocephalus communicans after traumatic upper cervical spine injury with a cerebrospinal fluid fistula: a rare complication  

Microsoft Academic Search

Secondary hydrocephalus communicans after traumatic upper cervical spine injuries with leakage of cerebrospinal fluid is a rare and hardly described complication. A case of a 75-year-old woman sustained a type II dens axis without other injuries, especially without evidence of a hydrocephalus in the primary CT scan. Dorsal atlanto-axial fusion was performed. Postoperative drainage was prolonged and positive for ?2-transferrin.

Ladislav Mica; Valentin Neuhaus; Enrico Pöschmann; Dilek Könü-Leblebicioglu; Urs Schwarz; Guido A Wanner; Clément ML Werner; Hans-Peter Simmen

2010-01-01

174

Therapeutic effects of functional orthodontic appliances on cervical spine posture: a retrospective cephalometric study  

PubMed Central

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?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.

2014-01-01

175

Dermal sinus with dermoid cyst in the upper cervical spine: case note  

Microsoft Academic Search

We describe a 5 year-old girl who had a skin dimple of the back of her upper neck. MRI showed a dermal sinus tract in the\\u000a upper cervical spine, associated with an intramedullary dermoid cyst at C 2–3, and spina bifida. A laminectomy was performed,\\u000a the dermoid cyst and the sinus tract were completely removed. This congenital complex is very

W. C. Shen; T.-L. Chiou; T. Y. Lin

2000-01-01

176

A stiff collar can restrict atlantoaxial instability in rheumatoid cervical spine in selected cases  

Microsoft Academic Search

OBJECTIVE--To study the efficiency of a stiff collar in restricting the instability of anterior atlantoaxial subluxation (AAS). METHODS--Twenty two successive patients with an unstable AAS were studied. Lateral view radiographs were taken of the cervical spine in flexion, extension, and neutral positions without a collar, and in full flexion with a custom made stiff collar. RESULTS--The collar restricted more than

M Kauppi; P Anttila

1995-01-01

177

Chordomas: their CT appearance in the cervical, thoracic and lumbar spine  

SciTech Connect

The authors reviewed 25 CT scans of 21 patients who had chordomas in the cervical, thoracic and lumbar spine. Nine patients were studied at the time of initial presentation and 12 after after tumor recurrence. All scans showed vertebral body destruction coupled with an associated soft tissue mass located anteriorly or laterally. Additional CT findings included septated areas of low attenuation within the tumor, amorphous soft tissue calcification, tumor extensions into the spinal canal, disk space involvement, and contrast enhancement.

Meyer, J.E.; Lepke, R.A.; Lindfors, K.K.; Pagani, J.J.; Hirschy, J.C.; Hayman, L.A.; Momose, K.J.; McGinnis, B.

1984-12-01

178

Neurophysiological Identification of Position-Induced Neurologic Injury During Anterior Cervical Spine Surgery  

Microsoft Academic Search

This study was a retrospective review of 3,806 patients who underwent anterior cervical spine surgery with multi-modality\\u000a neurophysiological monitoring consisting of transcranial electric motor evoked potentials, somatosensory evoked potentials\\u000a and spontaneous electromyography between 1999–2003. The objectives of this study were twofold: (1) to evaluate the role of\\u000a transcranial electric motor evoked potential tceMEP and ulnar nerve somatosensory evoked potential (SSEP)

Daniel M. Schwartz; Anthony K. Sestokas; Alan S. Hilibrand; Alexander R. Vaccaro; Bikash Bose; Mark Li; Todd J. Albert

2006-01-01

179

Upper cervical spine injuries: a management of a series of 70 cases  

PubMed Central

Traumatic injuries of the upper cervical spine are often encountered, and may be associated to severe neurological outcome. This is a retrospective study of 70 patients, admitted over a 14 years period (1996 to 2010), for management of upper cervical spine injuries. Data concerning epidemiology, radiopathology and treatment was reviewed, and clinical and radiological evaluation was conducted. Men are more affected than women, with traffic accidents being the major traumatic cause. A cervical spine syndrome of varied intensity was found in about 90% of patients; neurological deficit was noted in 10 patients (21%). Radiological analysis discovered varied and many combined lesions: C1-C2 dislocation (7 cases), C2-C3 dislocation (9 cases), C1 fracture (10 cases) and C2 fracture (44 cases) including 28 odontoid fractures. Orthopedic treatment was carried out exclusively for 31 patients, and surgical treatment for 38 patients. One patient died before surgery because of a polytraumatisme. Posterior approach was performed in 29 cases including hooks and rods in 18 patients, wiring in 9 cases, and 2 transarticular screw fixations. In 9 cases anterior approach was performed: 5 odontoid screwing and 4 cases of C2-C3 discectomy with bone graft. Nearly all patients were improved in post-operative. Elsewhere, the operating results were marked by a persistent neurological deficit in 2 cases, and infection in 2 cases controlled by medical treatment. Mean follow-up was 23 months and showed good clinical and radiological improvement. Early management of cervical spine injuries can optimize outcome. Treatment modalities are well codified; however controversy remains especially with type II odontoid fractures.

Nizare, El Fatemi; Abdelali, Bouchaouch; Fahd, Derkaoui Hassani; Yassad, Oudrhiri Mohammed; Rachid, Gana; Rachid, El Maaqili; Fouad, Bellakhdar

2013-01-01

180

Diffusion-weighted imaging of an atypical teratoid/rhabdoid tumor of the cervical spine.  

PubMed

Spinal atypical teratoid/rhabdoid tumor (AT/RT) is a rare, aggressive malignant neoplasm of the central nervous system usually seen in young children and infants. We present diffusion-weighted imaging (DWI) findings for an intradural extramedullary AT/RT in the cervical spine of a 6-year-old boy. High signal on DWI and low apparent diffusion coefficients may represent high cellularity of the tumor. These findings indicated a highly malignant tumor. PMID:19783876

Niwa, Tetsu; Aida, Noriko; Tanaka, Mio; Okubo, Jun; Sasano, Mari; Shishikura, Ayako; Fujita, Kazutoshi; Ito, Susumu; Tanaka, Yukichi; Kigasawa, Hisato

2009-01-01

181

Random Positional Variation Among the Skull, Mandible, and Cervical Spine With Treatment Progression During Head-and-Neck Radiotherapy  

SciTech Connect

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.

Ahn, Peter H. [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (United States)], E-mail: phahn@mdanderson.org; 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)

2009-02-01

182

Intermittent cervical traction for cervical radiculopathy caused by large-volume herniated disks  

Microsoft Academic Search

Objective: To describe the use of intermittent cervical traction in managing 4 patients with cervical radiculopathy and large-volume herniated disks. Clinical Features: Four patients had neck pain radiating to the arm. The clinical examination was typical in all cases for radiculopathy of cervical origin. Magnetic resonance imaging (MRI) of the cervical spine revealed large-volume herniated disks in all patients. Intervention

Constantine Constantoyannis; Demetres Konstantinou; Harry Kourtopoulos; Nicolas Papadakis

2002-01-01

183

Finite element modeling of the cervical spine: role of intervertebral disc under axial and eccentric loads.  

PubMed

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 fluid and synovial membrane of the facet joints; and the anterior and posterior longitudinal ligaments, interspinous ligaments, capsular ligaments and ligamentum flavum. The finite element model was validated with experimental results: force-displacement and localized strain responses of the vertebral body and lateral masses under pure compression, and varying eccentric anterior-compression and posterior-compression loading modes. This experimentally validated finite element model was used to study the biomechanics of the cervical spine intervertebral disc by quantifying the internal axial and shear forces resisted by the ventral, middle, and dorsal regions of the disc under the above axial and eccentric loading modes. Results indicated that higher axial forces (compared to shear forces) were transmitted through different regions of the disc under all loading modes. While the ventral region of the disc resisted higher variations in axial force, the dorsal region transmitted higher shear forces under all loading modes. These findings may offer an insight to better understand the biomechanical role of the human cervical spine intervertebral disc. PMID:10717549

Kumaresan, S; Yoganandan, N; Pintar, F A; Maiman, D J

1999-12-01

184

Spontaneous CSF Collection in the Cervical Spine may Cause Neurological Deficit and Intra-cranial Hypotension  

PubMed Central

Objective: a case is described of a spontaneously occurring cerebrospinal fluid collection in the ventral cervical spine which caused radiculopathy and spontaneous intracranial hypotension. Case: a sixty eight year old Caucasian man presented with a 2 year history of proximal upper limb weakness with a his-tory of trivial cervical trauma many years previously. Methods: the patient was investigated with blood tests for causes of peripheral neuropathy, nerve conduction and electro-myography studies, lumbar puncture and MRI of the brain and spine with contrast. Results: a cerebrospinal fluid collection was identified in the ventral cervical spinal cord causing mass effect associated with cord atrophy and there were signs of spontaneous intracranial hypotension on the MRI brain including subdural cere-brospinal fluid collections, meningeal enhancement and slumped posterior fossa. Conclusions: this is the first description of a spontaneous spinal fluid collection causing direct compression and cord sig-nal change, manifest as a motor deficit, with intracranial signs of spontaneous hypotension. Spinal imaging is recom-mended in cases of spontaneous intracranial hypotension and cerebrospinal fluid collections in the spine may rarely be a cause of radiculopathy in such cases.

Zakaria, Rasheed; Wilby, Martin; Fletcher, Nicholas A

2013-01-01

185

Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine  

Microsoft Academic Search

Objective. To calculate and compare combined axial and flexural stresses in lordosis versus buckled configurations of the sagittal cervical curve.Design. Digitized measurements from lateral cervical radiographs of four different shapes were used to calculate axial loads and bending moments on the vertebral bodies of C2–C7.Background. Osteoarthritis and spinal degeneration are factors in neck and back pain. Calculations of stress in

Deed E. Harrison; Donald D. Harrison; Tadeusz J. Janik; E. William Jones; Rene Cailliet; Martin Normand

2001-01-01

186

Comparing precision of distortion-compensated and stereophotogrammetric Roentgen analysis when monitoring fusion in the cervical spine  

Microsoft Academic Search

Two methods to measure sagittal plane segmental motion in the cervical spine are compared. Translational and rotational motion was measured in nine cervical motion segments of nine patients by distortion-compensated (DCRA) as well as by stereophotogrammetric Roentgen analysis (RSA). To compare measurement precision of the new DCRA protocol with the established RSA technique under realistic clinical conditions and to discuss

Gunnar Leivseth; Frode Kolstad; Øystein P. Nygaard; Björn Zoega; W. Frobin; P. Brinckmann

2006-01-01

187

Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq ® and LMA CTrach™ devices  

Microsoft Academic Search

Summary The aim of this study was to evaluate the effectiveness of the Airtraqand CTrachTM in lean patients with simulated cervical spine injury after application of a rigid cervical collar. Eighty-six consenting adult patients of ASA physical status 1 or 2, who required elective tracheal intubation were included in this study in a randomised manner. Anaesthesia was induced using 1

Z. I. Arslan; T. Yildiz; Z. N. Baykara; M. Solak; K. Toker

2009-01-01

188

Pain Flare Is a Common Adverse Event in Steroid-Naïve Patients After Spine Stereotactic Body Radiation Therapy: A Prospective Clinical Trial  

SciTech Connect

Purpose: To determine the incidence of pain flare after spine stereotactic body radiation therapy (SBRT) in steroid-naïve 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.

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: arjun.sahgal@sunnybrook.ca [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)

2013-07-15

189

Airway management in cervical spine ankylosing spondylitis: Between a rock and a hard place  

PubMed Central

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.

Eipe, Naveen; Fossey, Susan; Kingwell, Stephen P

2013-01-01

190

The need to add motor evoked potential monitoring to somatosensory and electromyographic monitoring in cervical spine surgery  

PubMed Central

Intraoperative neural monitoring (IONM), utilizing somatosensory evoked potentials (SEP) and electromyography (EMG), was introduced to cervical spine surgery in the late 1980's. However, as SEP only provided physiological data regarding the posterior cord, new motor deficits were observed utilizing SEP alone. This prompted the development of motor evoked potential monitoring (MEP) which facilitated real-time assessment of the anterior/anterolateral spinal cord. Although all three modalities, SEP, EMG, and MEP, are routinely available for IONM of cervical spine procedures, MEP are not yet routinely employed. The purpose of this review is to emphasize that MEP should now routinely accompany SEP and EMG when performing IONM of cervical spine surgery. Interestingly, one of the most common reasons for malpractice suits involving the cervical spine, is quadriparesis/quadriplegia following a single level anterior cervical diskectomy and fusion (ACDF). Previously, typical allegations in these suits included; negligent surgery, lack of informed consent, failure to diagnose/treat, and failure to brace. Added to this list, perhaps, as the 5th most reason for a suit will be failure to monitor with MEP. This review documents the value of MEP monitoring in addition to SEP and EMG monitoring in cervical spine surgery. The addition of MEP0 should minimize major motor injuries, and more accurately and reliably detect impending anterior cord deterioration that may be missed with SEP monitoring alone.

Epstein, Nancy E.

2013-01-01

191

Short communication: Traits unique to genus Homo within primates at the cervical spine (C2-C7).  

PubMed

From a comparative study of 222 human and 261 nonhuman primates complete cervical spines, two bony variants associated to the course of the vertebral artery are proposed as unique to genus Homo within primates. First, the opening of the foramen transversarium at C2, a trait present at low frequency in humans (3 to 5.6%). Second, the presence of a bipartite foramen transversarium in the cervical segment C3-C6, a trait that can be observed fully formed in human fetal skeletons, with a clear frequency pattern along the cervical spine (C3>C4>C5>C6spines studied, practically absent in Strepsirrhini, at low frequency in Platyrrhini, and generalized in Catarrhini. These findings, together with previous data regarding absence and presence of foramina at C1, indicate a pattern of gain and loss of foramina in the transverse process of the cervical vertebrae for genus Homo. The test of a possible explanation of these differences as associated to anatomical changes of the cervical spine due to erect posture and bipedal locomotion needs further research in the morphology and function of the primate cervical spine. PMID:24439363

Rios, Luis; Muñoz, Alexandra; Cardoso, Hugo; Pastor, Francisco

2014-05-01

192

Upper cervical spine chordoma of C2-C3  

PubMed Central

Chordoma is a rare low-grade malignant neoplasm derived from the remnants of the embryonic notochord. This locally invasive neoplasm is subject to recurrence after treatment. The median survival time is estimated to be 6.3 years. Various treatment approaches have been attempted, including radical excision, radiotherapy and chemotherapy. Treatment outcome is significantly influenced by the size and site of the chordoma. Recently, Imatinib, a molecular-targeted agent, has been shown to have antitumor activity in chordoma. Proton radiotherapy, stereotactic radiotherapy and intensity-modulated radiotherapy have also been used. Surgical treatment is still the primary choice for chordoma. It has become more aggressive in recent years, evolving from intralesional or partial excision to en bloc resection. However, upper cervical localizations make such en bloc resection in most cases not possible. We present and discuss the therapeutic challenges of a young female with large retropharyngeal chordoma who presented to our institution after conventional photon beam radiotherapy. This C2/3 tumor was classified IB according to the Enneking classification. It distributed to layers A–D and sectors 1–6 according to the Weinstein Boriani Biagini Classification. The left vertebral artery (VA) was encapsulated and displaced. One stage intralesional extracapsular tumor excision and reconstruction was achieved by combined bilateral high anterior cervical approaches and posterior approach. No recurrence or metastasis was observed 3 years after the operation. She returned to her previous occupation as office worker.

Jiang, Liang; Liu, Xiao Guang; Ma, Qing Jun; Wei, Feng; Lv, Yang; Dang, Geng Ting

2009-01-01

193

The characteristics of bony ankylosis of the facet joint of the upper cervical spine in rheumatoid arthritis patients  

PubMed Central

This study investigated the bony ankylosis of the upper cervical spine facet joints in patients with a cervical spine involvement due to rheumatoid arthritis (RA) using computed tomography (CT) and then examined the characteristics of the patients showing such ankylosis. Forty-six consecutive patients who underwent surgical treatment for RA involving the cervical spine were reviewed. The radiographic diagnoses included atlanto-axial subluxation in 30 cases, vertical subluxation (VS) in 10 cases, VS + subaxial subluxation in 3 cases and cervical spondylotic myelopathy in 3 cases. The patients were classified into two groups, those developing bony ankylosis or not and then the differences in the patient characteristics between the two groups was investigated. Furthermore, cervical spine disorders and surgeries were also evaluated in patients who demonstrated such bony ankylosis. The CT reconstruction image demonstrated bony ankylosis in 12 patients (group BA), and the remaining 34 cases (group NB) showed no bony ankylosis. The level at which bony ankylosis occurred was atlanto-occipital joint (AOJ) in eight cases, atlanto-axial joint (AAJ) in two cases and AOJ, AAJ in two cases. No differences were observed between the two groups (age P > 0.54, gender P > 0.39, duration of RA P > 0.72). There was a significant difference between two groups in the patients showing obvious neurological impairment (P = 0.017). In BA group, arthrodesis or decompression was adapted for a caudal region of bony ankylosis. In conclusion, bony ankylosis of the facet joint of the upper cervical spine was detected in 12 of 46 RA patients with involvement of the cervical spine who thus required surgery. These findings showed that the patients demonstrating such ankylosis showed severe cervical myelopathy. In addition, we suggest that the occurrence of bony ankylosis was a risk factor for instability of AAJ, and subaxial instability or stenosis.

Nishinome, Masahiro; Sorimachi, Yasunori; Ara, Tsuyoshi; Nakajima, Takashi; Iizuka, Yoichi; Takagishi, Kenji

2009-01-01

194

Variations in Entrance of Vertebral Artery in Korean Cervical Spine: MDCT-based Analysis  

PubMed Central

Background Knowledge of the anatomical variation of the vertebral artery has clinical importance not only for the performance of interventional or surgical procedures itself but also to ensure their safety. We conducted a study of the anatomical variation by reviewing multi-detector computed tomography (MDCT) images of the cervical spine from 460 Korean patients. Methods 16-row MDCT data from 460 patients were used in this study. We observed 920 vertebral arteries. Examination points included level of entrance of the artery into the transverse foramen of the cervical vertebra, origin site of the vertebral artery, course of a vertebral artery with aberrant entrance. Result The vertebral artery in 2 (0.2%) cases in this study entered into the transverse foramen of the 7th cervical vertebra from the left. In 45 (4.9%) cases, the vertebral artery entered into the transverse foramen of the 5th cervical vertebra. Of these, the entrance was on the right in 15 (1.6%) and on the left in 30 (3.3%). We found 17 (1.8%) cases in which the artery entered into the transverse foramen of the 4th cervical vertebra, 10 (1.1%) on the right and 7 (0.7%) on the left side. As is commonly acknowledged, the 6th cervical vertebra was the most common site of entry; the vertebral artery entered the transverse foramen of the 6th cervical vertebra in the remaining 855 (93.0%) cases, on the right in 434 (47.2%) and on the left in 421 (45.8%). Conclusions In conclusion, the possibility of an atypical course of the vertebral artery in segments V1 and V2 should be evaluated with magnetic resonance imaging (MRI) or CT images before carrying out procedures involving the anterior cervical vertebrae.

Shin, Hye Young; Park, Ji Kang; Park, Sun Kyung; Jung, Gyu Seo

2014-01-01

195

Incidental detection of thyroid nodules at magnetic resonance imaging of the cervical spine.  

PubMed

The incidental detection of thyroid lesions in patients undergoing magnetic resonance (MR) imaging of the cervical spine was prospectively evaluated on 389 MR images. Sagittal images extended from the cranio-cervical junction to the upper thoracic level, and axial images from C3-4 to C7-T1 intervertebral levels. Twenty patients (5.1%) had a total of 26 thyroid nodules. Eighteen patients presented with a single dominant nodule, of whom 2 had a multinodular gland with a single dominant nodule (one had 3 and the other had 5 nodules). Two patients had diffusely enlarged gland without a dominant nodule. The mean size of the nodules was 11.6 mm. One thyroid nodule was detected at the C5-6 intervertebral level, 14 at the C6-7, and 11 at the C7-T1. T(2)-weighted imaging was more useful than T(1)-weighted imaging for the detection of thyroid nodules because of the hyperintense versus isointense appearance of the lesions. Thyroid carcinoma was identified at surgery in one patient. The detection rate was low compared with computed tomography with contrast medium and ultrasonography. Our results suggest that MR imaging has limited value for the detection of thyroid lesions and that the presence of such lesions cannot be denied based only on MR imaging of the cervical spine. However, asymptomatic thyroid lesions, including thyroid cancer, can be identified on MR images of the cervical spine, so we recommend that evaluation of these images should consider such lesions. PMID:23438656

Kim, Kyongsong; Emoto, Naoya; Mishina, Masahiro; Okada, Susumu; Isu, Toyohiko; Yoshida, Daizo; Kobayashi, Shiro; Teramoto, Akira

2013-01-01

196

[Prevalence of cervical spine inflammatory changes in rheumatoid arthritis patients and the value of neurological examination in their diagnosis].  

PubMed

The aim of the study was to evaluate prevalence of cervical spine inflammatory changes, especially atlantoaxial pathology, and their possible relation to subjective and objective neurological symptoms in rheumatoid arthritis patients. 100 patients (88 female and 12 male) aged 23 to 85 (61.4 +/- 12.9), with the mean disease duration of 12.5 +/- 9.5 years were included in the study. According to radiological examination (lateral and antero-posterior X-ray of the cervical spine) supplemented by MR of the cervical spine or CT of the atlanto-axial joint in suspected cases, 26% of patients had only inflammation, next 15% of patients presented with instability of the atlanto-axial joint and 9% developed basilar invagination of the dens of axis. 18% of patients presented subaxial cervical instability. Neurological examitation was performed by independent neurologist in 99 patients, only 14 presented abnormalities suggesting cervical myelopathy. Two of them showed no patology of the cervical spine. Remaining patients presented: C1/C2 inflammation in 4 cases, anterior atlanto-axial subluxation (AAS) in two cases, basilar invagination in 4 cases and instability with medullary compression on lower cervical levels only--in two cases. There were 4 cases of coexisting C1/C2 changes with medullary compression due to discopathy and (in 3 of them) instability on lower cervical levels. In 6 cases surgical stabilisation was proposed (5 patients with basilar invagination and 1 patient with AAS and myelopathy). There was statistically significant correlation between symptoms (like: paraesthesiae, intermittent problems with hearing and seeing), neurological examination and degree of radiological damage of atlanto-axial joint. The authors concluded that careful medical history and neurological examination can be useful in making decision of further radiological diagnostic procedures of the cervical spine in rheumatoid arthritis. PMID:18416295

Raczkiewicz-Papierska, Anna; Bachta, Artur; Naga?ska, Ewa; Zagrodzka, Magdalena; Skrobowska, Ewa; T?ustochowicz, Ma?gorzata; Dudek, Anna; T?ustochowicz, Witold

2006-10-01

197

Subarachnoid hematoma of the craniocervical junction and upper cervical spine after traumatic cerebral contusion: case report.  

PubMed

Spinal subarachnoid hematoma (SSH) is a rare condition, more commonly occurring after lumbar puncture for diagnostic or anesthesiological procedures. It has also been observed after traumatic events, in patients under anticoagulation therapy or in case of arteriovenous malformation rupture. In a very small number of cases no causative agent can be identified and a diagnosis of spontaneous SSH is established. The lumbar and thoracic spine are the most frequently involved segments and only seven cases of cervical spine SSH have been described until now. Differential diagnosis between subdural and subarachnoid hematoma is complex because the common neuroradiological investigations, including a magnetic resonance imaging (MRI), are not enough sensitive to exactly define clot location. Actually, confirmation of the subarachnoid location of bleeding is obtained at surgery, which is necessary to resolve the fast and sometimes dramatic evolution of clinical symptoms. Nonetheless, there are occasional reports on successful conservative treatment of these lesions. We present a peculiar case of subarachnoid hematoma of the craniocervical junction, developing after the rupture of a right temporal lobe contusion within the adjacent arachnoidal spaces and the following clot migration along the right lateral aspect of the foramen magnum and the upper cervical spine, causing severe neurological impairment. After surgical removal of the hematoma, significant symptom improvement was observed. PMID:24067775

Di Rienzo, Alessandro; Iacoangeli, Maurizio; Alvaro, Lorenzo; Colasanti, Roberto; Moriconi, Elisa; Gladi, Maurizio; Nocchi, Niccolò; Scerrati, Massimo

2013-01-01

198

Improved magnetic resonance myelography of the cervical spine using image fusion and volumetry.  

PubMed

Background and Aims?Discrepancies between symptoms and imaging findings may be significant in spinal diseases. The relative advantages and disadvantages of postmyelographic CT (pmCT) and magnetic resonance myelography (MRM) in measuring cervical cerebrospinal fluid dimensions and volumes are poorly understood. This study investigated the usefulness of an improved MRM approach and compared its findings of dural areas and volumes of normal and pathologic cervical spine levels with those obtained by pmCT. Materials and Method?Sixty patients with suspected cervical spinal stenosis underwent myelography, pmCT, and an improved MRM approach using a dedicated heavily T2-weighted magnetic resonance (MR) sequence in combination with image fusion. Cross-sectional areas and volumes of the dural sac from C2-3 to C7-T1 were compared for significance of differences between mean values. Pearson correlations between pmCT and MRM values were analyzed. Then 99% confidence intervals for normal levels and levels with obvious stenosis were calculated. Results?For normal cervical levels we found no significant differences for both dural areas and volumes between pmCT and MRM. For cervical spine levels C3-4 to C6-7 with pathologic alterations, we found significant larger areas and volumes on MRM when compared with pmCT but not for the levels C2-3 and C7-T1. Both dural area and volume of normal and pathologic levels showed strong correlation between pmCT and MRM. We found no overlap between 99% confidence intervals for normal levels and stenotic levels. Conclusions?The optimized MRM approach (i.e., a dedicated MRM sequence in combination with image fusion) and pmCT demonstrated excellent quantitative volumetric agreement. Image fusion with conventional T2 may be used to aid in diagnosis. PMID:24570306

Eberhardt, Knut; Ganslandt, Oliver; Stadlbauer, Andreas

2014-07-01

199

Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up.  

PubMed

Cervical spine spondylodiscitis is a rare, but serious manifestation of spinal infection. We present a retrospective study of 20 consecutive patients between 01/1994 and 12/1999 treated because of cervical spondylodiscitis. Mean age at the time of treatment was 59.7 (range 34-81) years, nine of them female. In all cases, diagnosis had been established with a delay. All patients in this series underwent surgery such as radical debridement, decompression if necessary, autologous bone grafting and instrumentation. Surgery was indicated if a neurological deficit, symptoms of sepsis, epidural abscess formation with consecutive stenosis, instability or severe deformity were present. Postoperative antibiotic therapy was carried out for 8-12 weeks. Follow-up examinations were performed a mean of 37 (range 24-63) months after surgery. Healing of the inflammation was confirmed in all cases by laboratory, clinical and radiological parameters. Spondylodesis was controlled radiologically and could be achieved in all cases. One case showed a 15 degrees kyphotic angle in the proximal adjacent segment. Spontaneous bony bridging of the proximal adjacent segment was observed in one patient. In the other cases the adjacent segments radiologically showed neither fusion nor infection related changes. Preoperative neurological deficits improved in all cases. Residual neurological deficits persisted in three of eight cases. The results indicate that spondylodiscitis in cervical spine should be treated early and aggressive to avoid local and systemic complications. PMID:16868782

Heyde, Christoph E; Boehm, Heinrich; El Saghir, Hesham; Tschöke, Sven K; Kayser, Ralph

2006-09-01

200

An accurate finite element model of the cervical spine under quasi-static loading.  

PubMed

Cervical disc injury due to impact has been observed in clinical and biomechanical investigations; however, there is a lack of data that helps to elucidate the mechanisms of disc injury during these collisions. Therefore, it is necessary to understand the behavior of the cervical spine under different types of loading situations. A three dimensional finite element (FE) model for the multi-level cervical spine segment (C0-C7) was developed using computed tomography (CT) data and applied to study the internal stresses and strains of the intervertebral discs under quasi-static loading conditions. The intervertebral discs were treated as nonlinear, anisotropic and incompressible subjected to large deformations. The model accuracy was validated by comparing it with previously published experimental and numerical results for different movements. It was shown that the use of a fiber reinforced model to describe the behavior of the annulus of the discs would predict higher maximum shear strains than an isotropic one, being therefore important the use of complex constitutive models in order to be able to detect the appearance of injured zones, since those strains and stresses are supposed to be related with damage to soft tissues. Several movements were analyzed: flexion, extension and axial rotation, obtaining that the maximum shear stresses in the disc were higher for a flexo-extension movement. PMID:18061196

del Palomar, A Pérez; Calvo, B; Doblaré, M

2008-01-01

201

Pattern of premature degenerative changes of the cervical spine in patients with spasmodic torticollis and the impact on the outcome of selective peripheral denervation  

PubMed Central

OBJECTIVES—To characterise the pattern of and risk factors for degenerative changes of the cervical spine in patients with spasmodic torticollis and to assess whether these changes affect outcome after selective peripheral denervation.?METHODS—Preoperative CT of the upper cervical spine of 34 patients with spasmodic torticollis referred for surgery were reviewed by two radiologists blinded to the clinical findings. Degenerative changes were assessed for each joint separately and rated as absent, minimal, moderate, or severe. Patients were clinically assessed before surgery and 3 months postoperatively by an independent examiner using standardised clinical rating scales. For comparison of means a t test was carried out. To determine whether an association exists between the side of degenerative changes and type of spasmodic torticollis a ?2 test was used. Changes in severity, disability, and pain before and after surgery were calculated using a Wilcoxon matched pairs signed ranks test.?RESULTS—Fourteen out of 34 patients had moderate or severe degenerative changes. They were predominantly found at the C2/C3 and C3/C4 level and were significantly more likely to occur on the side of the main direction of the spasmodic torticollis (p=0.015). There was no significant difference in age, sex, duration of torticollis, overall severity, degree of disability, or pain between the group with either no or minimal changes and the group with moderate or severe changes. However, in the second group the duration of inadequate treatment was longer (10.1 v 4.8 years; p=0.009), head mobility was more restricted (p=0.015), and head tremor was more severe (p=0.01). At 3 months postoperatively, patients with no or minimal degenerative changes showed a significant improvement in pain and severity whereas no difference was found in those with moderate or severe changes.?CONCLUSIONS—Patients with spasmodic torticollis have an increased risk of developing premature degenerative changes of the upper cervical spine that tend to be on the side towards which the head is turned or tilted and compromise outcome after surgery. Effective early treatment of spasmodic torticollis with botulinum toxin seems to have a protective effect. Patients with spasmodic torticollis and restricted head mobility who do not adequately respond to treatment should undergo imaging of the upper cervical spine. Patients with imaging evidence of moderate or severe degenerative changes seem to respond poorly to selective peripheral denervation.??

Chawda, S; Munchau, A; Johnson, D; Bhatia, K; Quinn, N; Stevens, J; Lees, A; Palmer, J

2000-01-01

202

Use of diagnostic imaging in the emergency department for cervical spine injuries in Kingston, Ontario.  

PubMed

ABSTRACTObjectives:This study assessed the use and clinical yield of diagnostic imaging (radiography, computed tomography, and medical resonance imaging) ordered to assist in the diagnosis of acute neck injuries presenting to emergency departments (EDs) in Kingston, Ontario, from 2002-2003 to 2009-2010.Methods:Acute neck injury cases were identified using records from the Kingston sites of the Canadian National Ambulatory Care Reporting System. Use of radiography was analyzed over time and related to proportions of cases diagnosed with clinically significant cervical spine injuries.Results:A total of 4,712 neck injury cases were identified. Proportions of cases referred for diagnostic imaging to the neck varied significantly over time, from 30.4% in 2002-2003 to 37.6% in 2009-2010 (ptrend ?=? 0.02). The percentage of total cases that were positive for clinically significant cervical spine injury ("clinical yield") also varied from a low of 5.8% in 2005-2006 to 9.2% in 2008-2009 (ptrend ?=? 0.04), although the clinical yield of neck-imaged cases did not increase across the study years (ptrend ?=? 0.23). Increased clinical yield was not observed in association with higher neck imaging rates whether that yield was expressed as a percentage of total cases positive for clinically significant injury (p ?=? 0.29) or as a percentage of neck-imaged cases that were positive (p ?=? 0.77).Conclusions:We observed increases in the use of diagnostic images over time, reflecting a need to reinforce an existing clinical decision rule for cervical spine radiography. Temporal increases in the clinical yield for total cases may suggest a changing case mix or more judicious use of advanced types of diagnostic imaging. PMID:24423998

Pickett, William; Kukaswadia, Atif; Thompson, Wendy; Frechette, Mylene; McFaull, Steven; Dowdall, Hilary; Brison, Robert J

2014-01-01

203

Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation  

PubMed Central

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.

2014-01-01

204

Early results of the surgical treatment of patients with traumatic injuries to the cervical spine.  

PubMed

In the period 1997-1999, 51 patients were surgically treated for injury to the cervical spine at the Rzeszów Voivodeship Hospital. There were 46 men and 5 women, with the majority in the age group 15-20 years. The most common causes of injury were diving and automobile accidents. Most of these patients were referred to our Department for treatment 1-3 days after the injury was incurred. The treatment method of choice was surgery. The majority of the patients were referred to the Department or Rehabilitation at our hospital as soon as their surgical wounds had healed. PMID:18034111

Surmacz, L; Sklepowicz, A; Gamracki, B; Kusibab, M; Szuber, J

2000-06-30

205

Cervical spine immobilization in sports related injuries: review of current guidelines and a case study of an injured athlete.  

PubMed

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

Bhamra, Js; Morar, Y; Khan, Ws; Deep, K; Hammer, A

2012-01-01

206

Cervical Spine Immobilization in Sports Related Injuries: Review of Current Guidelines and a Case Study of an Injured Athlete  

PubMed Central

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.

Bhamra, JS; Morar, Y; Khan, WS; Deep, K; Hammer, A

2012-01-01

207

A selected annotated bibliography of the core biomedical literature pertaining to stroke, cervical spine, manipulation and head/neck movement  

PubMed Central

This manuscript’s purpose was to establish a knowledge base of information related to stroke and the cervical spine vascular structures, from both historical and current perspectives. The scientific biomedical literatures both indexed (ie. Index Medicus, CRAC) and non-indexed literature systems were scanned and the pertinent manuscripts were annotated. Citation is by occurence in the literature so that historical trends may be viewed more easily. No analysis of the reference material is offered. Suggested however is that: 1. complications to cervical spine manipulation are being recognized and reported with increasing frequency, 2. a cause and effect relationship between stroke and cervical spine manipulation has not been established, 3. a screening mechanism that is valid, reliable and reasonable needs to be established.

Gotlib, Allan C.; Thiel, Haymo

1985-01-01

208

Pattern of premature degenerative changes of the cervical spine in patients with spasmodic torticollis and the impact on the outcome of selective peripheral denervation  

Microsoft Academic Search

OBJECTIVESTo characterise the pattern of and risk factors for degenerative changes of the cervical spine in patients with spasmodic torticollis and to assess whether these changes affect outcome after selective peripheral denervation.METHODSPreoperative CT of the upper cervical spine of 34 patients with spasmodic torticollis referred for surgery were reviewed by two radiologists blinded to the clinical findings. Degenerative changes were

S J Chawda; A Münchau; D Johnson; K Bhatia; N P Quinn; J Stevens; A J Lees; J D Palmer

2000-01-01

209

Airway Compromise Due to Wound Hematoma Following Anterior Cervical Spine Surgery  

PubMed Central

One of the most serious adverse events associated with anterior cervical spine surgery is wound hematoma resulting in airway compromise. The reported incidence of this postoperative complication has varied from 0.2% to 1.9%. Obstruction of the airway secondary to bleeding presents a challenging clinical scenario given the rapidity of onset, distorted anatomy of the upper respiratory tract, urgent need to act and potential for catastrophic consequences. This high-risk, life-threatening clinical scenario requires specialized knowledge and a well-designed treatment protocol to achieve a positive outcome. In this review, we report a case of airway compromise secondary to wound hematoma following anterior cervical discectomy and fusion, followed by a review of relevant literature, anatomy, etiologic factors and diagnostic considerations. We also propose guidelines for the prevention and management of postoperative airway obstruction due to wound hematoma.

Palumbo, Mark A; Aidlen, Jessica Pelow; Daniels, Alan H; Thakur, Nikhil A; Caiati, Joseph

2012-01-01

210

Outcomes of C1 and C2 posterior screw fixation for upper cervical spine fusion.  

PubMed

To achieve stable fixation of the upper cervical spine in posterior fusions, the occiput is often included. With the newer techniques, excluding fixation to the occiput will retain the occiput-cervical motion, while still allowing a stable fixation. Harms's technique has been adapted at our institution and its effectiveness for indications such as C2 complex fractures and tumors using C1 or C2 as endpoints of a posterior fixation are reviewed. Fourteen cases were identified, consisting of one os odontoideum; four acute fractures and four non-unions of the odontoid; three tumors and two complex fractures of C2 vertebral body, and one C2-C3 post-traumatic instability. One misplaced screw without clinical consequences was the only complication recorded. Screw loosening or migration was not observed at follow-up, showing a stable fixation. PMID:19387696

De Iure, F; Donthineni, R; Boriani, S

2009-06-01

211

Outcomes of C1 and C2 posterior screw fixation for upper cervical spine fusion  

PubMed Central

To achieve stable fixation of the upper cervical spine in posterior fusions, the occiput is often included. With the newer techniques, excluding fixation to the occiput will retain the occiput–cervical motion, while still allowing a stable fixation. Harms’s technique has been adapted at our institution and its effectiveness for indications such as C2 complex fractures and tumors using C1 or C2 as endpoints of a posterior fixation are reviewed. Fourteen cases were identified, consisting of one os odontoideum; four acute fractures and four non-unions of the odontoid; three tumors and two complex fractures of C2 vertebral body, and one C2–C3 post-traumatic instability. One misplaced screw without clinical consequences was the only complication recorded. Screw loosening or migration was not observed at follow-up, showing a stable fixation.

Donthineni, R.; Boriani, S.

2009-01-01

212

[Novelties in pathophysiology, radiology diagnostics and conservative treatment of painful spine conditions and deformities].  

PubMed

Spinal pain, especially chronic low-back pain is one of the most prominent health and healthcare problems. Better understanding of pain pathophysiology and more precise visualization using modern imaging techniques help us to focus our intervention and obtain better outcome. In most patients with spine conditions symptoms and function resolve with conservative treatment. In this article we report on novelties in pathophysiology of spinal pain, magnetic resonance imaging and conservative treatment options (medications, therapeutic exercise, physical therapy and orthoses) of painful spine conditions and scoliosis. Apart from being informative, together with the corresponding article about novelties in invasive/surgical treatment, this special focus article on recent developments in this area can be used as an aid in decision making when approaching these patients. PMID:21612109

Grazio, Simeon; Jeli?, Miroslav; Basi?-Kes, Vanja; Bori?, Igor; Grubisi?, Frane; Nemci?, Tomislav; Mustapi?, Matej; Demarin, Vida

2011-01-01

213

A new low-cost method for difficult airway management in non-missile-penetrating cervical spine injury  

PubMed Central

Accessing and maintaining the airway in penetrating cervical spine injury is a challenge for anaesthetists globally. This is more so in resource-poor settings, where advanced techniques for intubation in difficult airway situations are unavailable. We describe a new, low-cost, easily adaptable method of managing the airway used in a middle-aged man who sustained screw driver injury to the cervical spine with C4 Brown-Séquard syndrome. The deployment of readily available and cheap materials led to successful anaesthesia management of the patient.

Rabiu, Taopheeq B; Fadare, Amos E

2012-01-01

214

MR and CT image fusion of the cervical spine: a noninvasive alternative to CT-myelography  

NASA Astrophysics Data System (ADS)

CT-Myelography (CTM) is routinely used for planning surgery for degenerative disease of the spine, but its invasive nature, significant potential morbidity, and high costs make a noninvasive substitute desirable. We report our work on evaluating CT and MR image fusion as an alternative to CTM. Because the spine is only piecewise rigid, a multi-rigid approach to the registration of spinal CT and MR images was developed (SPIE 2004), in which the spine on CT images is first segmented into separate vertebrae, each of which is then rigidly registered with the corresponding vertebra on MR images. The results are then blended to obtain fusion images. Since they contain information from both modalities, we hypothesized that fusion images would be equivalent to CTM. To test this we selected 34 patients who had undergone MRI and CTM for degenerative disease of the cervical spine, and used the multi-rigid approach to produce fused images. A clinical vignette for each patient was created and presented along with either CT/MR fusion images or CTM images. A group of spine surgeons are asked to formulate detailed surgical plans based on each set of images, and the surgical plans are compared. A similar study assessing diagnostic agreement is being performed with neuroradiologists, who also assess the accuracy of registration. Our work to date has demonstrated the feasibility of segmentation and multi-rigid fusion in clinical cases and the acceptability of the questionnaire to physicians. Preliminary analysis of one surgeon's and one neuroradiologist"s evaluation has been performed.

Hu, Yangqiu; Mirza, Sohail K.; Jarvik, Jeffrey G.; Heagerty, Patrick J.; Haynor, David R.

2005-04-01

215

BONE GRAFT SUBSTITUTES Dr. S.M. Tuli, Consultant Orthopaedic Surgeon, VIMHANS, New Delhi Indications, Biomechanics and Techniques of Lower Cervical Spine Instrumentation  

Microsoft Academic Search

Basically the indications for instrumentation of the lower cervical spine (C3-C7) are to provide immediate stability or to enhance stability to the unstable spine. To access the instability of the spine the three column model was introduced. The anterior column comprises the anterior half of the vertebral body and anterior half of the intervertebral disc as well as the anterior

Wee Fu Tan

216

Spinal surgery -- cervical - series (image)  

MedlinePLUS

... problems include: pain that interferes with daily activities neck pain that extends (radiates) to the shoulder or arm ... done while the patient is deep asleep and pain-free (general anesthesia). For the neck (cervical spine), an incision may be made either ...

217

Upper gastrointestinal hemorrhage after nonresponsive thoracic spine pain: a case report  

PubMed Central

Abstract Objective This case study reports the findings of an upper gastrointestinal hemorrhage in a patient with thoracic spine pain reporting to a chiropractic clinic. The purpose of this article is to highlight the importance of identifying a patient's medication history as well as reviewing the signs and symptoms of gastrointestinal bleeding from a nonvariceal lesion. Clinical Features A 61-year–old woman presented with worsening middle thoracic spine pain of 3 months' duration along with recent abdominal pain. Medications, physical therapy, and spinal manipulation did not provide considerable improvement. The patient was taking ibuprofen daily to cope with her back pain. Intervention and Outcome The initial physical examination demonstrated mild increased tissue tension in the thoracic paraspinal muscles with mild restriction of thoracic spine range of motion secondary to the patient's pain. There was pain on palpation of the T4-5 and T7-8 spinal segments. The physical examination findings did not correlate to the patient's pain presentation, and she was referred back to her primary care physician. Two days after the initial examination, the patient experienced an upper gastrointestinal hemorrhage and underwent emergency surgery. It was determined postoperatively that she had a medication-induced duodenal ulcer that subsequently ruptured. Conclusion An upper gastrointestinal bleed should be considered in the differential diagnosis of a patient with a history of prolonged aspirin or nonsteroidal anti-inflammatory drug use with nonspecific abdominal symptoms.

George, James W.; Skaggs, Clayton D.

2009-01-01

218

Analysis of biomechanical and ergonomic aspects of the cervical spine in F-16 flight situations.  

PubMed

With the help of a biomechanical neck model, several normal postures of an F-16 pilot were analysed. Measurements of accelerations and head positions were obtained during four flights, including simulated air combat. With the help of a model, muscle forces and joint reaction forces in the neck were estimated. Although at the present stage of research results of calculations must be interpreted carefully, conclusions can be drawn with respect to sitting posture, head position and helmet devices. The backward inclined back rest of the F-16 chair decrease the lordosis of the cervical spine, resulting in reduced calculated forces in the lower cervical spine. In high load situations, calculated maximal forces are of the same order of magnitude as failure loads of vertebrae and estimations of maximum muscle forces. The calculated neck load is increased substantially by the helmet and helmet-mounted devices. This load can be reduced by lightening the helmet or shifting the centre of mass of the helmet backwards. PMID:8408084

Hoek van Dijke, G A; Snijders, C J; Roosch, E R; Burgers, P I

1993-09-01

219

Factors associated with blunt cerebrovascular injury in patients with cervical spine injury.  

PubMed

Blunt cerebrovascular injury (BCVI) is known to be a potentially fatal complication of cervical spine injury (CSI). Methods for screening the appropriate population remain to be elucidated, especially in Japan. This retrospective study was conducted to predict the risk factors relevant to BCVIs. Among 92 patients with CSI transferred to our institution from April 2007 to March 2012, 40 patients (35 men, 5 women) with neurological deficits and/or significant cervical spine fracture including fracture of transversarium, facet, body, lamina, and spinous process, underwent multi-detector computed tomography angiography (MDCTA) and magnetic resonance angiography (MRA), which identified 10 patients with BCVI [2 carotid artery injuries (BCAIs) and 9 vertebral artery injuries (BVAIs); 1 patient suffered both]. Univariate analyses exploring associations between individual risk factors and BCVI and BVAI were performed using Fisher's exact test and Chi-square test for dichotomous variables and the unpaired t-test for continuous variables. Multiple logistic regression analyses for BCVI and BVAI were carried out using stepwise methods. On univariate and multivariate analysis, hyperextension injury was significantly associated with BVAI (p = 0.01 and p = 0.02), and subluxation (dislocation of vertebral body > 5 mm) was a significant predictor of BCVI (p = 0.04 and p = 0.03) and BVAI (p = 0.01 and p = 0.01). Prompt evaluation for BCVIs is recommended in CSI patients with hyperextension injury and dislocation of the vertebral body. PMID:24390186

Nakajima, Hiroyuki; Nemoto, Manabu; Torio, Tetsuya; Takeda, Ririko; Ooigawa, Hidetoshi; Araki, Ryuichiro; Kurita, Hiroki

2014-05-15

220

Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study  

Microsoft Academic Search

There has been no prospective study on age-related changes of the extensor muscles of the cervical spine in healthy subjects.\\u000a This study was conducted to elucidate any association between the changes in cross-sectional area of the extensor muscles\\u000a of the cervical spine on MRIs and cervical disc degeneration or the development of clinical symptoms. Sixty-two subjects who\\u000a underwent MR imaging

Eijiro Okada; Morio Matsumoto; Daisuke Ichihara; Kazuhiro Chiba; Yoshiaki Toyama; Hirokazu Fujiwara; Suketaka Momoshima; Yuji Nishiwaki; Takeshi Takahata

221

Spinal cord injury with a narrow spinal canal: utilizing Torg's ratio method of analyzing cervical spine radiographs.  

PubMed

A 65-year-old inebriated man crashed his car and presented with spinal shock and neurogenic shock from a cervical spinal cord injury without cervical spine fracture or dislocation. The lateral cervical spine radiography was initially read as normal, except for degenerative disk disease; however, Torg's ratio method of analyzing cervical spinal canal sagittal width indicated the spinal canal was congenitally narrow. Magnetic resonance imaging confirmed this and showed bulging and herniation of multiple invertebral disks between C2 and C7. This case illustrates the value of using Torg's ratio method of analyzing lateral cervical spine radiographs. Although Torg's method has not been prospectively validated, it may be useful to identify patients at risk for cervical spinal cord injuries without fractures or dislocations. An abnormal Torg's ratio may be the only clue to the fact that the patient is at higher risk of spinal cord injury when the patient's history or examination is questionable because of head injury, drug intoxication, or therapeutic sedation and paralysis. PMID:9472764

Bey, T; Waer, A; Walter, F G; Fortune, J; Seeger, J; Fryburg, K; Smith, W

1998-01-01

222

78 FR 65451 - Agency Information Collection (Neck (Cervical Spine) Conditions Disability Benefits Questionnaire...  

Federal Register 2010, 2011, 2012, 2013

...Spine) Conditions Disability Benefits Questionnaire) Activity Under OMB Review AGENCY...Spine) Conditions Disability Benefits Questionnaire)'' in any correspondence. FOR FURTHER...Spine) Conditions Disability Benefits Questionnaire).'' SUPPLEMENTARY...

2013-10-31

223

Cervical spinal cord compression after thyroidectomy under general anesthesia.  

PubMed

Cervical spinal cord injury is a rare but serious complication after general anesthesia. The risk factors include traumatic cervical injury, cervical spine instability, and difficult airway management. It has also occurred in the absence of cervical instability. Here we report a patient who had a history of intermittent neck pain without numbness. Preoperative radiologic examinations showed degenerative changes in the cervical spine. She developed progressive tingling and numbness in her limbs after thyroidectomy under general anesthesia. Magnetic resonance imaging showed a cervical disc protruding into the canal at C5-C6, which was considered to be induced by surgical positioning. She recovered after anterior cervical decompression and internal fixation surgery. PMID:23828450

Yao, Wenlong; Qiu, Jin; Zhou, Zhiqiang; Zhang, Lin; Zhang, Chuanhan

2014-02-01

224

Does plate profile affect postoperative dysphagia following anterior cervical spine surgery?  

PubMed

Dysphagia following anterior cervical spine surgery is a significant problem. The risk factors for such dysphagia have not been established. We examined whether plate profile affected the incidence of dysphagia. This study enrolled 50 consecutive patients undergoing one-level corpectomy or one- or two-level discectomies with plate fixation performed by the same surgeon from 2004 to 2009. The anterior cervical plates used were either the Codman (Johnson and Johnson Professional Inc., Raynham, MA, USA; width 17.58 mm, thickness 2.69 mm; 27 patients) or the Zephir (Medtronic Sofamor Danek Inc., Memphis, TN, USA; width 15 mm, thickness 1.6 mm; 23 patients). Dysphagia was assessed via telephone interviews, and was classified as short-term (occurring within 6 months postoperatively) or persistent (persisting beyond 6 months postoperatively). The overall short-term and persistent dysphagia rates were 20% and 14%, respectively. The short-term and persistent dysphagia rates were 26% and 13% for the Zephir plate, and 14.8% and 14.8% for the Codman plate, and analysis showed that the rates were similar for both types of plate. Age and sex were not found to correlate with dysphagia. In patients undergoing anterior cervical spine surgery with plate fixation, we found that postoperative dysphagia did not correlate with plate profile up to a plate size of 17.58 mm wide and 2.69 mm thick. Dysphagia occurred at the same incidence in patients with a smaller plate that was 15 mm wide and 1.6 mm thick. PMID:23993453

Jang, Jun-Won; Park, Jin-Hun; Rhim, Seung-Chul

2014-01-01

225

Cervical spine intervertebral kinematics with respect to the head are different during flexion and extension motions  

PubMed Central

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.

Anderst, William J.; Donaldson, William F.; Lee, Joon Y.; Kang, James D.

2013-01-01

226

Successful conservative treatment of rheumatoid subaxial subluxation resulting in improvement of myelopathy, reduction of subluxation, and stabilisation of the cervical spine. A report of two cases  

Microsoft Academic Search

OBJECTIVETo report the efficacy of conservative treatment with cervical traction and immobilisation with a Halo vest, in two consecutive rheumatoid arthritis patients with progressive cervical myelopathy caused by subaxial subluxation.METHODSDescription of neurological symptoms and signs and findings in plain radiography (PR) and magnetic resonance imaging (MRI) of the cervical spine before and after treatment of the subaxial subluxation by traction

Johanna C M Oostveen; Martin A F J van de Laar; Jan A G Geelen; Ron de Graaff

1999-01-01

227

Effect of occipitocervical fusion with screw-rod system for upper cervical spine tumor  

PubMed Central

Background Craniospinal junction tumors are rare but severe lesions. Surgical stabilization has been established to be an ideal treatment for upper cervical tumor pathology. The purpose of this study was to evaluate the effect of a screw-rod system for occipitocervical fusion. Methods A total of 24 cases with C1 and C2 cervical tumor underwent occipitocervical fusion with Vertex screw-rod internal fixation from January 2005 to December 2012. Preoperative X-ray and MRI examinations were performed on all patients before the operation, after the operation, and during last follow-up. The JOA score was used to assess neurological function pre and postoperatively. Results All the patients were followed up for 6 to 42 months with an average of 24 months. The result of X-ray showed that bony fusion was successful in 18 patients at 3 months and 6 patients at 6 months of follow-ups. There was no deterioration of spinal cord injury. The JOA Scores of neurological function increased significantly. Conclusion The screw-rod system offers strong fixation and good fusion for occipitocervical fusion. It is an effective and reliable method for reconstruction of upper cervical spine tumor.

2014-01-01

228

Isolated Head Injuries versus Multiple Trauma in Pediatric Patients: Do the Same Indications for Cervical Spine Evaluation Apply?  

Microsoft Academic Search

Although the recommendations to evaluate possible cervical spine injuries in patients with isolated head injuries are identical to those with multiple trauma, to date, no such study has confirmed that risk factors are the same for both injuries. We reviewed the charts of 268 pediatric patients with isolated head injuries admitted to the Intensive Care Unit at Children’s Hospital Medical

James L. Laham; Dennis H. Cotcamp; Patricia A. Gibbons; Madelyn D. Kahana; Kerry R. Crone

1994-01-01

229

[Functional changes of the cervical spine and shoulder-neck region in workers employed in textile sewing].  

PubMed

Functional disturbances of cervical spine, shoulder-nape-muscles and cervicothoracic ligamentous apparatus were examined in 100 needle-women. 105 nurses from outpatients departments served as group of comparison. In consideration of signs of occupational load clues to occupationally caused overstrain were found. PMID:2316260

Czech, C; Czech, R; Seibt, A; Freude, A D

1990-01-01

230

Wednesday, October 30, 2001 4:42–5:25 pm Concurrent Session 2A: Cervical Spine Surgery Complications  

Microsoft Academic Search

Purpose of study: Significant controversy persists regarding the ideal treatment of an isolated unilateral jumped or locked facet after cervical spine trauma. The purpose of this study was to examine the efficacy and outcomes of such a purely anterior technique for the treatment of a unilateral jumped facet.Methods used: Between 1994 and 2002, a retrospective review was conducted at the

Larry T. Khoo; K. Anthony Kim; Srinath Samudrala

2002-01-01

231

Biomechanics of Cervical Spine Injuries in Rear End Car Impacts: Influence of Car Seats and Possible Evaluation Criteria  

Microsoft Academic Search

Soft tissue neck injuries or cervical spine distortion injuries (CSD) are dominant injuries in all claimed car collisions. The injury mechanisms are currently not fully understood because some symptoms are rated subjectively and even modern radiological imaging techniques (CT, MRI, PET, etc.) cannot detect structures damaged. One attempt was made using the new internationally accepted QTF (Quebec Task Force) classification

Wolfram Hell; Sylvia Schick; Klaus Langwieder; Harald Zellmer

2002-01-01

232

Discontinuation of cervical spine immobilisation in unconscious patients with trauma in intensive care units--telephone survey of practice in south and west region.  

PubMed Central

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.

Gupta, K. J.; Clancy, M.

1997-01-01

233

The effect of soft tissue deloading tape on thoracic spine pressure pain thresholds in asymptomatic subjects.  

PubMed

The application of tape to deload soft tissue is used in the management of thoracic spine pain. A reported clinical feature of this treatment is reduced tenderness of the spine during postero-anterior mobilizations. A randomized, single blind, placebo controlled, repeated measures design study was employed to investigate the effects of deloading tape on pressure pain threshold measurements at the level of the T7 spinous process in an asymptomatic group of 24 subjects. Pressure pain thresholds were assessed prior to and following the application of deloading tape, placebo sham tape and no-tape control conditions. All subjects received all three conditions in a randomized order on three separate days. Differences between the pre- and post-measurements were used as indicators of change in a subject's pressure pain threshold. No significant change in pressure pain threshold measurements was found between conditions. In summary, this study demonstrated that deloading tape applied to the level of the T7 spinous process did not significantly change pressure pain threshold measurements in asymptomatic subjects, raising the possibility that any pain relieving effect may well be conditional upon pain being present. PMID:12372311

O' Leary, S; Carroll, M; Mellor, R; Scott, A; Vicenzino, B

2002-08-01

234

Dysphagia caused by ventral osteophytes of the cervical spine: clinical and radiographic findings.  

PubMed

The purpose of our study was to demonstrate the clinical and radiographic findings in patients with dysphagia and ventral osteophytes of the cervical spine due to degeneration or as a typical feature of diffuse idiopathic skeletal hyperostosis (DISH, Forestier Disease). Since 2003 we encountered 20 patients with such changes in the cervical spine causing an impairment of deglutition. A total of 12 patients had one solitary pair of osteophytes of neighboring vertebrae, 4 patients revealed two pairs and 4 patients had triple pairs of osteophytes. Thirty-two osteophytes were observed totally. A total of 14 of these arose from the right, 15 from the left side and 3 from the middle of the anterior face of the vertebra. Ten patients suffered from DISH, while ten patients revealed osteophytes as a part of a degenerative disorder of the cervical spine. The osteophytes had an average length of 19 mm maximum anterior posterior range. Most of the osteophytes (16) were found in the segments C5/6 and C6/7. Osteophytes of vertebrae C3/4/5 occurred in six cases. Only in one case C2/3 was affected. Functional endoscopic evaluation of swallowing (FEES) revealed an aspiration of thin liquids in seven patients with osteophytes arising from the anterior face of the vertebra C3/4/5 restricting the motility of the epiglottis, which seemed not to close the aditus laryngis. Retention of solids in the piriform sinus on the side obstructed by an osteophyte (C4/5) could also be repeatedly evidenced through FEES. In one case, a strong impairment of the voice because of an immobility of the right vocal cord due to mechanical obstruction by an osteophyte was the indication for surgical removal of the structure. Thus, the dysphagia of this patient was reduced and his voice turned to normal. The development of symptoms in patients with ventral osteophytes was very much related to the location of the structures. Moreover, the clinical symptoms were to some extent dependent on the size of the osteophytes, although there was no direct correlation between size of the structure and severity of the patient's complaint. PMID:18587593

Seidler, T O; Pèrez Alvarez, J C; Wonneberger, K; Hacki, T

2009-02-01

235

A New Concept for Quantifying the Complicated Kinematics of the Cervical Spine and Its Application in Evaluating the Impairment of Clients with Mechanical Neck Disorders  

PubMed Central

Mechanical neck disorder (MND) is one of the most common health issues and is characterized by restricted cervical mobility. However, traditional kinematic information often focuses on primary movement in the cardinal plane, which seems insufficient to fully determine the kinematics of the cervical spine because of the complexity of the anatomical structures involved. Therefore, the current investigation aimed to modify the concept of the three-dimensional workspace to propose an objective mathematical model to quantify the complicated kinematics of the cervical spine. In addition, the observation evaluated the characteristics of the cervical workspace in asymptomatic and MND groups. Seventeen healthy volunteers and twenty-five individuals with MND participated in the study and executed the motion of circumduction to establish the cervical workspace using an electromagnetic tracking system. The results produced a mathematical model to successfully quantify the cervical workspace. Moreover, MND groups demonstrated significant reduction in the normalization of the cervical workspace with respect to the length of the head-cervical complex. Accordingly, the current study provided a new concept for understanding the complicated kinematics of the cervical spine. The cervical workspace could be a useful index to evaluate the extent of impairment of the cervical spine and monitor the efficacy of rehabilitation programs for patients with MND.

Yang, Chia-Chi; Su, Fong-Chin; Guo, Lan-Yuen

2012-01-01

236

Lumbar and thoracic spine pain in the athlete: radiographic evaluation.  

PubMed

A comprehensive but basic and updated systematic radiographic approach to various pain-producing thoracolumbar diseases is presented. The advantages and limitations of available diagnostic modalities are discussed in relation to the clinically considered etiologies. PMID:3333926

Cacayorin, E D; Hochhauser, L; Petro, G R

1987-10-01

237

Cervical Myelopathy in Rheumatoid Arthritis  

PubMed Central

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.

Mukerji, N.; Todd, N. V.

2011-01-01

238

Treatment of upper cervical spine instability with posterior fusion plus atlantoaxial pedicle screw.  

PubMed

Clinical results of posterior fusion plus pedicle screw fixation in the treatment of upper cervical spine instability were taken under consideration. 24 patients with atlantoaxial instability were treated with C1-2 pedicle screws and rods fixation under general anesthesia. There were 18 males and 6 females with mean age of 49.8 years (age range 17-69 years). The postoperative radiographs verified good position of all screws, with satisfactory atlantoaxial reduction. Follow-up for 3-45 months (average 23 months) showed no spinal cord and vertebral artery injury or interfixation failure. Atlantoaxial alignment and stability were restored without complication due to instrumentation. In conclusion, posterior atlantoaxial pedicle screw and rod fixation provide immediate three-dimensional rigid fixation of atlantoaxial joint and are more effective techniques compared with previously reported techniques. PMID:24687596

Ma, Chao; Wu, Jibin; Zhao, Meng; Dai, Weixiang; Wu, Dehui; Wang, Zhaohong; Feng, Jie; Liu, Chao; Li, Yiming; Zhao, Qinghua; Tian, Jiwei

2014-07-01

239

Non-ejection cervical spine injuries due to +Gz in high performance aircraft.  

PubMed

The potential for significant neck injuries exists in today's high performance fighter aircraft. The G-loads required to produce injury need not be excessive, nor is experience level necessarily protective. Eight cervical spine injury cases, due to or aggravated by +Gz in F-15 and F-16 aircrew members are reviewed. These include two compression fractures (C5/C7), three left HNP's (C5-6/C6-7), one fracture of the spinous process (C7), one interspinous ligament tear (C6-7), and one myofascial syndrome (C6). Mechanisms of injury and evaluation are discussed. Exercise conditioning may play an important role in prevention and protection. The role of screening X-rays and improving equipment remain as areas where further work needs to be done. PMID:2730489

Schall, D G

1989-05-01

240

Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation.  

PubMed

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 anatomically accurate and validated intact finite element model of the C4-C5-C6 cervical spine was used to simulate progressive disc degeneration at the C5-C6 level. Slight degeneration included an alteration of material properties of the nucleus pulposus representing the dehydration process. Moderate degeneration included an alteration of fiber content and material properties of the anulus fibrosus representing the disintegrated nature of the anulus in addition to dehydrated nucleus. Severe degeneration included decrease in the intervertebral disc height with dehydrated nucleus and disintegrated anulus. The intact and three degenerated models were exercised under compression, and the overall force-displacement response, local segmental stiffness, anulus fiber strain, disc bulge, anulus stress, load shared by the disc and facet joints, pressure in the disc, facet and uncovertebral joints, and strain energy density and stress in the vertebral cortex were determined. The overall stiffness (C4-C6) increased with the severity of degeneration. The segmental stiffness at the degenerated level (C5-C6) increased with the severity of degeneration. Intervertebral disc bulge and anulus stress and strain decreased at the degenerated level. The strain energy density and stress in vertebral cortex increased adjacent to the degenerated disc. Specifically, the anterior region of the cortex responded with a higher increase in these responses. The increased strain energy density and stress in the vertebral cortex over time may induce the remodeling process according to Wolff's law, leading to the formation of osteophytes. PMID:11562150

Kumaresan, S; Yoganandan, N; Pintar, F A; Maiman, D J; Goel, V K

2001-09-01

241

The dysmorphic cervical spine in Klippel-Feil syndrome: interpretations from developmental biology.  

PubMed

The authors conducted a study to identify radiological patterns of Klippel-Feil syndrome (KFS), and they present a new interpretation of the origin of these patterns based on recent advances in understanding of embryonic development of the spine and its molecular genetic control. The authors studied radiographs and computerized tomography (CT) scans as well as magnetic resonance images or CT myelograms obtained in 30 patients with KFS who were referred for treatment between 1982 and 1996; the patients had complained of various neuroorthopedic complications. Homeotic transformation due to mutations or disturbed expression of Hox genes is a possible mechanism responsible for C-1 assimilation, which was found to have occurred in 19 cases (63%). Notochordal defects and/or signaling problems, which result in reduced or impaired Pax-1 gene expression, may underlie vertebral fusions. This, together with asymmetrical distribution of paraxial mesoderm cells and a possible lack of communication across the embryonic midline, could cause asymmetrical fusion patterns, which were present in 17 cases (57%). The wide and flattened shape of the fused vertebral bodies and their resemblance to the embryonic cartilaginous vertebrae as well as the process of progressive bone fusion with age suggest that the fusions occur before or, at the latest, during chondrification of vertebrae. The authors suggest that the aforementioned mechanisms are likely to be, at least in part, responsible for the observed patterns in KFS that affect the craniovertebral junction and the cervical spine. PMID:16972746

David, K M; Thorogood, P V; Stevens, J M; Crockard, H A

1999-06-15

242

Primary Leptomeningeal Melanoma of the Cervical Spine Mimicking a Meningioma--A Case Report  

PubMed Central

Background and Importance?Primary leptomeningeal melanoma (PLM) is highly malignant and exceedingly rare. Due to its rarity, diagnostic and treatment paradigms have been slow to evolve. We report the first case of a PLM that mimics a cervical spine meningioma and then discuss the current clinical, radiologic, and pathologic diagnostic methodologies as well as expected outcomes related to this disease. Clinical Presentation?A 54-year-old woman presented a dural-based extramedullary solid mass ventral to the C2–C3 spinal cord causing spinal cord compression without cord signal changes, characteristic of meningioma. Intraoperative microscopic inspection revealed numerous black spots littering the surface of the dura; the tumor itself was yellow in appearance and had a soft consistency. Pathologic analysis of the specimen revealed a malignant melanin-containing tumor. No primary site was found, so a diagnosis of primary leptomeningeal melanoma was made, and the patient subsequently received interferon therapy. To date (2 years postoperatively), no local or systemic recurrence of the tumor has been identified. Conclusion?As with most rare tumors, case reports constitute the vast majority of references to PLM. Only an increased awareness and an extensive report of each individual case can help diagnose and clarify the nature of PLM. Clinicians need to be aware of such malignant conditions when diagnosing benign tumoral lesions of the spine such as meningiomas.

Marx, Sascha; Fleck, Steffen K.; Manwaring, Jotham; Vogelgesang, Silke; Langner, Soenke; Schroeder, Henry W.S.

2014-01-01

243

Primary leptomeningeal melanoma of the cervical spine mimicking a meningioma-a case report.  

PubMed

Background and Importance?Primary leptomeningeal melanoma (PLM) is highly malignant and exceedingly rare. Due to its rarity, diagnostic and treatment paradigms have been slow to evolve. We report the first case of a PLM that mimics a cervical spine meningioma and then discuss the current clinical, radiologic, and pathologic diagnostic methodologies as well as expected outcomes related to this disease. Clinical Presentation?A 54-year-old woman presented a dural-based extramedullary solid mass ventral to the C2-C3 spinal cord causing spinal cord compression without cord signal changes, characteristic of meningioma. Intraoperative microscopic inspection revealed numerous black spots littering the surface of the dura; the tumor itself was yellow in appearance and had a soft consistency. Pathologic analysis of the specimen revealed a malignant melanin-containing tumor. No primary site was found, so a diagnosis of primary leptomeningeal melanoma was made, and the patient subsequently received interferon therapy. To date (2 years postoperatively), no local or systemic recurrence of the tumor has been identified. Conclusion?As with most rare tumors, case reports constitute the vast majority of references to PLM. Only an increased awareness and an extensive report of each individual case can help diagnose and clarify the nature of PLM. Clinicians need to be aware of such malignant conditions when diagnosing benign tumoral lesions of the spine such as meningiomas. PMID:25083399

Marx, Sascha; Fleck, Steffen K; Manwaring, Jotham; Vogelgesang, Silke; Langner, Soenke; Schroeder, Henry W S

2014-08-01

244

Multirigid registration of MR and CT images of the cervical spine  

NASA Astrophysics Data System (ADS)

We present our work on fusion of MR and CT images of the cervical spine. To achieve the required registration accuracy of approximately 1mm, the spine is treated as a collection of rigid vertebrae, and a separate rigid body transformation applied to each (Hawkes). This in turn requires segmentation of the CT datasets into separate vertebral images, which is difficult because the narrow planes separating adjacent vertebrae are parallel to the axial plane of the CT scans. We solve this problem by evolving all the vertebral contours simultaneously using a level set method, and use contour competition to estimate the position of the vertebral edges when a clean separation between adjacent vertebrae is not seen. Contour competition is based in turn on the vertical scan principle: no part of a given vertebra is vertically below any part of an inferior vertebra. Once segmentation is complete, the individual rigid body transforms are then estimated using mutual information maximization, and the CT images of the vertebrae superimposed on the MR scans. The resultant fused images contain the bony detail of CT and the soft tissue discrimination of MR and appear to be diagnostically equivalent, or superior, to CT myelograms. A formal test of these conclusions is planned for the next phase of our work.

Hu, Yangqiu; Haynor, David R.

2004-05-01

245

The use of intraoperative navigation for complex upper cervical spine surgery.  

PubMed

Imaging guidance using intraoperative CT (O-arm surgical imaging system) combined with a navigation system has been shown to increase accuracy in the placement of spinal instrumentation. The authors describe 4 complex upper cervical spine cases in which the O-arm combined with the StealthStation surgical navigation system was used to accurately place occipital screws, C-1 screws anteriorly and posteriorly, C-2 lateral mass screws, and pedicle screws in C-6. This combination was also used to navigate through complex bony anatomy altered by tumor growth and bony overgrowth. The 4 cases presented are: 1) a developmental deformity case in which the C-1 lateral mass was in the center of the cervical canal causing cord compression; 2) a case of odontoid compression of the spinal cord requiring an odontoidectomy in a patient with cerebral palsy; 3) a case of an en bloc resection of a C2-3 chordoma with instrumentation from the occiput to C-6 and placement of C-1 lateral mass screws anteriorly and posteriorly; and 4) a case of repeat surgery for a non-union at C1-2 with distortion of the anatomy and overgrowth of the bony structure at C-2. PMID:24580006

Guppy, Kern H; Chakrabarti, Indro; Banerjee, Amit

2014-03-01

246

Inertial sensor real-time feedback enhances the learning of cervical spine manipulation: a prospective study  

PubMed Central

Background Cervical Spinal Manipulation (CSM) is considered a high-level skill of the central nervous system because it requires bimanual coordinated rhythmical movements therefore necessitating training to achieve proficiency. The objective of the present study was to investigate the effect of real-time feedback on the performance of CSM. Methods Six postgraduate physiotherapy students attending a training workshop on Cervical Spine Manipulation Technique (CSMT) using inertial sensor derived real-time feedback participated in this study. The key variables were pre-manipulative position, angular displacement of the thrust and angular velocity of the thrust. Differences between variables before and after training were investigated using t-tests. Results There were no significant differences after training for the pre-manipulative position (rotation p?=?0.549; side bending p?=?0.312) or for thrust displacement (rotation p?=?0.247; side bending p?=?0.314). Thrust angular velocity demonstrated a significant difference following training for rotation (pre-training mean (sd) 48.9°/s (35.1); post-training mean (sd) 96.9°/s (53.9); p?=?0.027) but not for side bending (p?=?0.521). Conclusion Real-time feedback using an inertial sensor may be valuable in the development of specific manipulative skill. Future studies investigating manipulation could consider a randomized controlled trial using inertial sensor real time feedback compared to traditional training.

2014-01-01

247

MRI morphometric characterisation of the paediatric cervical spine and spinal cord in children with MPS IVA (Morquio-Brailsford syndrome).  

PubMed

Nearly all children with MPS IVA develop skeletal deformities affecting the spine. At the atlanto-axial spine, odontoid hypoplasia occurs. GAG deposition around the dens, leads to peri-odontoid infiltration. Transverse/alar ligament incompetence causes instability. Atlanto-axial instability is associated with cord compression and myelopathy, leading to major morbidity and mortality. Intervention is often required. Does the presence of widened bullet shaped vertebra in platyspondily encroach on the spinal canal and cause spinal stenosis in MPS IVA? So far, there have been no standardised morphometric measurements of the paediatric MPS IVA cervical spine to evaluate whether there is pre-existing spinal stenosis predisposing to compressive myelopathy or whether this is purely an acquired process secondary to instability and compression. This study provides the first radiological quantitative analysis of the cervical spine and spinal cord in a series of affected children. MRI morphometry indicates that the MPS IVA spine is narrower at C1-2 level giving an inverted funnel shape. There is no evidence of a reduction in the Torg ratio (canal-body ratio) in the cervical spine. The spinal canal does not exceed 11 mm at any level, significantly smaller than normal historical cohorts (14 mm). The sagittal diameter and axial surface area of both spinal canal and cord are reduced. C1-2 level cord compression was evident in the canal-cord ratio but the Torg ratio was not predictive of cord compression. In MPS IVA the reduction in the space available for the cord (SAC) is multifactorial rather than due to congenital spinal stenosis. PMID:23404316

Solanki, Guirish A; Lo, William B; Hendriksz, Christian J

2013-03-01

248

Surgical management of primary tumors of the cervical spine: surgical considerations and avoidance of complications.  

PubMed

Objective: Primary cervical spinal tumors are rare tumors of the spine and are associated with significant morbidity and mortality. Such tumors include multiple myeloma, chordomas, giant cell tumors, hemangiomas, osteosarcomas, chondrosarcomas, synovial sarcomas, aneurysmal bone cysts (ABC), hemangiomas, eosinophilic granulomas, osteoid osteomas, and osteoblastomas. We review the surgical decision-making process and identify critical key steps for surgical complication avoidance. We also present case illustrations demonstrating such pathological diagnoses and surgical treatments performed. Methods: We retrospectively review the literature regarding the most common primary cervical spinal tumors that have undergone surgical resection with or without adjuvant treatment. Results: En bloc resection of primary cervical tumors resulted in significantly increased progression-free survival and overall survival. From the limited data, adjuvant treatment with proton-beam therapy for chordomas has potential benefit. Neo-adjuvant chemotherapy for Ewing's sarcoma and osteogenic sarcoma has shown some promise, with en bloc resection demonstrating stronger benefit for osteogenic sarcoma. Discussion: En bloc resection for primary spinal tumors has proven to be the standard of care in spinal oncology. Adjuvant and neo-adjuvant treatments such as chemotherapy and radiotherapy variants (conventional, proton beam, cyberknife) need to be studied further in most primary tumor types to become standard of care. Chordoma management is more widely studied with en bloc resection and adjuvant proton-beam therapy demonstrating improved progression-free survival and overall survival. Surgical management and adjuvant treatment strategies are case dependent, depending on tumor histology, patient neurological examination, prior surgeries at that level, and prior adjuvant treatment. PMID:24716731

Kaloostian, Paul E; Gokaslan, Ziya L

2014-06-01

249

Development of a clinical prediction rule to identify patients with neck pain who are likely to benefit from home-based mechanical cervical traction.  

PubMed

The objective of the study was to identify the population of patients with neck pain who improved with home-based mechanical cervical traction (HMCT). A prospective cohort study was conducted in a physical therapy clinic at a local hospital. Patients with neck pain referred to the clinic for physical therapy were included in the study. A HMCT program was given to participants for 2 weeks. The patient's demographic data, Numerical Pain Scale (NPS) score, Neck Disability Index (NDI) and Fear-Avoidance Beliefs Questionnaire score were collected, and standard physical examination of the cervical spine was conducted before intervention. The NPS score, NDI and a global rating of perceived improvement were collected after the intervention was completed. A total of 103 patients participated in the study and 47 had a positive response to HMCT. A clinical prediction rule with four variables (Fear-Avoidance Beliefs Work Subscale score < 13, pre-intervention pain intensity ? 7/10, positive cervical distraction test and pain below shoulder) was identified. With satisfaction of at least three out of four variables (positive likelihood ratio = 4.77), the intervention's success rate increased from 45.6% to over 80%. It appears that patients with neck pain who are likely to respond to HMCT may be identified. PMID:21240529

Cai, Congcong; Ming, Guan; Ng, Lih Yen

2011-06-01

250

Clinical presentation of cervical ribs in the pediatric population.  

PubMed

Cervical ribs may cause thoracic outlet syndrome in adults, but symptoms are poorly described in children. In our series, 88.8% of the 322 children were asymptomatic. The most common symptoms were neck mass and pain. Useful diagnostic tools were cervical spine and chest radiographs. Differential diagnosis of a supraclavicular mass includes cervical ribs. PMID:23219244

Chan, Kenny H; Gitomer, Sarah A; Perkins, Jonathan N; Liang, Conan; Strain, John D

2013-03-01

251

Chronic lateral epicondylitis of the elbow: A prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine  

Microsoft Academic Search

Rompe JD, Riedel C, Betz U, Fink C. Chronic lateral epicondylitis of the elbow: a prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine. Arch Phys Med Rehabil 2001;82:578-82. Objective: To compare the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine

Jan D Rompe; Christiane Riedel; Ulrich Betz; Christian Fink

2001-01-01

252

Pelvic Incidence and Lumbar Spine Instability Correlations in Patients with Chronic Low Back Pain  

PubMed Central

Purpose Many factors such as lumbar instability and spinopelvic alignment are associated with low back pain. Our purpose was to analyze the pelvic incidence - one of spinopelvic alignment parameters- and spine instability correlations in patients with chronic low back pain. Methods Fifty-two patients suffering from chronic low back pain entered this case control study. Lateral spine radiography was taken from patients. pelvic incidence and L3, L4 and L5‘s vertebral body width were measured for all patients, and lumbar instability was evaluated in 3 different levels: L5-S1, L4-L5 and L3-L4. Results Thirty-two patients having lumbar instability formed group A and 20 patients without lumbar spine instability allocated to group B. Average age, mean weight, height, body mass index and mean vertebral width of both groups did not differ meaningfully. Pelvic incidence‘s mean amounts set to 53.9 in group B and 57.7 in group A without any significant difference; but pelvic incidence was significantly lower in patients with lumbar instability of L5-S1 origin (P=0.01). Conclusions Overall, pelvic incidence did not differ between two groups. However, separate evaluation of each level revealed lumbar instability of L5-S1 segment to be associated with lower pelvic incidence.

Golbakhsh, Mohammad-Reza; Hamidi, Majid Attar; Hassanmirzaei, Bahar

2012-01-01

253

Growing heterotopic calcification in the prevertebral space of a cervical spine as a late complication of irradiation: case report.  

PubMed

Heterotopic calcification following head and neck irradiation has rarely been reported. It usually develops as a late complication of radiotherapy in patients with malignancies, including breast cancer, lymphoma, and genitourinary malignancies. The occurrence of heterotopic calcification in the prevertebral space of the cervical spine has not been described as a late complication of irradiation. Here, we report a case of prevertebral heterotopic calcification in a patient with history of chemotherapy and radiotherapy for tonsil cancer 21 years ago. PMID:24497804

Park, Jina; Lee, Seunghun; Joo, Kyung Bin

2014-01-01

254

Prevalence of joint-related pain in the extremities and spine in five groups of top athletes  

Microsoft Academic Search

Purpose  Joint-related pain conditions from the spine and extremities are common among top athletes. The frequency of back pain has,\\u000a however, been studied in more detail, and the frequency of low-back pain in top athletes in different high-load sports has\\u000a been reported to be as high as 85%. Sport-related pain from different joints in the extremities is, however, infrequently\\u000a reported on

Pall Jonasson; Klas Halldin; Jon Karlsson; Olof Thoreson; Jonas Hvannberg; Leif Swärd; Adad Baranto

255

Systematic review of clinical trials of cervical manipulation: control group procedures and pain outcomes  

Microsoft Academic Search

OBJECTIVE: To characterize the types of control procedures used in controlled clinical trials of cervical spine manipulation and to evaluate the outcomes obtained by subjects in control groups so as to improve the quality of future clinical trials METHODS: A search of relevant clinical trials was performed in PubMed 1966-May 2010 with the following key words: \\

Howard Vernon; Aaron Puhl; Christine Reinhart

2011-01-01

256

Postnatal progression of bone disease in the cervical spines of mucopolysaccharidosis I dogs  

PubMed Central

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.

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

2013-01-01

257

Validation, in healthy adults, of the reproducibility of the elongation of the cervical spine, under constant traction, in function of time and breathing. Pilot study  

Microsoft Academic Search

Introduction: The region of the neck is vulnerable. In case of pathology, the cervical traction is suggested to put under stress its constituent elements. We consider that the elongation of the cervical spine is constant and reproducible under the influence of a given traction power. We suggest studying the validation of a measuring instrument to objectivize the pathological damages and

Jad Wehbe; Mohamad Khalil; Mohamad Halimi

2012-01-01

258

LMA C Trach aided endotracheal intubation in simulated cases of cervical spine injury: A series of 30 cases  

PubMed Central

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.

Tripathi, Deepshikha C.; Jha, Pramila S.; Trivedi, Lopa P.; Doshi, Shilpa M.; Modia, Brijesh

2013-01-01

259

Quantitative analyses of pediatric cervical spine ossification patterns using computed tomography.  

PubMed

The objective of the present study was to quantify ossification processes of the human pediatric cervical spine. Computed tomography images were obtained from a high resolution scanner according to clinical protocols. Bone window images were used to identify the presence of the primary synchondroses of the atlas, axis, and C3 vertebrae in 101 children. Principles of logistic regression were used to determine probability distributions as a function of subject age for each synchondrosis for each vertebra. The mean and 95% upper and 95% lower confidence intervals are given for each dataset delineating probability curves. Posterior ossifications preceded bilateral anterior closures of the synchondroses in all vertebrae. However, ossifications occurred at different ages. Logistic regression results for closures of different synchondrosis indicated p-values of <0.001 for the atlas, ranging from 0.002 to <0.001 for the axis, and 0.021 to 0.005 for the C3 vertebra. Fifty percent probability of three, two, and one synchondroses occurred at 2.53, 6.97, and 7.57 years of age for the atlas; 3.59, 4.74, and 5.7 years of age for the axis; and 1.28, 2.22, and 3.17 years of age for the third cervical vertebrae, respectively. Ossifications occurring at different ages indicate non-uniform maturations of bone growth/strength. They provide an anatomical rationale to reexamine dummies, scaling processes, and injury metrics for improved understanding of pediatric neck injuries. PMID:22105393

Yoganandan, Narayan; Pintar, Frank A; Lew, Sean M; Rao, Raj D; Rangarajan, Nagarajan

2011-01-01

260

Temporomandibular Joint Status, Occlusal Attrition, Cervical Erosion And Facial Pain Among Substance Abusers  

Microsoft Academic Search

Summary Statement of the problem: Drug addiction or substance abuse is an endemic habit globally. At present there is no data available regarding the temporomandibular joint status, Occlusal and cervical tooth wear and facial pain among substance abusers from the Saudi Arabia. Purpose: The aim of the study was to investigate the temporomandibular joint status, occlusal and cervical tooth wear

Khalid Almas; K. Al Wazzan; I. Al Hussaini; K. Y. Al-Ahdal; N. B. Khan

2007-01-01

261

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  

PubMed Central

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.

Dunham, C Michael; Brocker, Brian P; Collier, B David; Gemmel, David J

2008-01-01

262

A study of chronic pelvic pain after radiotherapy in survivors of locally advanced cervical cancer  

Microsoft Academic Search

Introduction  Chronic pelvic pain (persisting pain in hips, groins or lower back) is poorly described in studies of cervical cancer survivors\\u000a (CCSs). The aims of this study were to describe chronic pelvic pain and associated variables in CCSs surveyed >5 years post-radiotherapy,\\u000a and to compare the presence of pain in hips and lower back in CCSs with findings in the general female

Ingvild Vistad; Milada Cvancarova; Gunnar Balle Kristensen; Sophie Dorothea Fosså

2011-01-01

263

Clinical characteristics of rheumatoid arthritis patients undergoing cervical spine surgery: an analysis of National Database of Rheumatic Diseases in Japan  

PubMed Central

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?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.

2014-01-01

264

Can a Specific Neck Strengthening Program Decrease Cervical Spine Injuries in a Men's Professional Rugby Union Team? A Retrospective Analysis.  

PubMed

Cervical spine injuries in Rugby Union are a concerning issue at all levels of the game. The primary aim of this retrospective analysis conducted in a professional Rugby Union squad was to determine whether a 26-week isometric neck strengthening intervention program (13-week strengthening phase and 13-week maintenance phase) was effective in reducing the number and severity of cervical spine injuries. The secondary aim was to determine whether at week five, where the program had been the similar for all players, there was increased isometric neck strength. All 27 players who were common to both the 2007-2008 and 2008-2009 seasons were included in this analysis and data was extracted from a Sports Medicine/Sports Science database which included the squad's injury records. Primary outcome variables included; the number of cervical spine injuries and the severity of these injuries as determined by the total number of days lost from training and competition. Secondary outcome variables included isometric neck strength in flexion, extension and left and right lateral flexion. Using non-parametric statistical methods, no significant differences were evident for the total number of cervical spine injuries (n = 8 in 2007-2008, n = 6 in 2008-2009) or time loss due to these injuries (100 days in 2007-2008, 40 days in 2008-2009). However, a significant (p = 0.03) reduction in the number of match injuries was evident from 2007-2008 (n = 11) to 2008-09 (n = 2). Non-significant increases in isometric neck strength were found in all directions examined. A significant reduction in the number of match injuries was evident in this study. However, no other significant changes to primary outcome variables were achieved. Further, no significant increases in isometric neck strength were found in this well-trained group of professional athletes. Key PointsWhile many authors have proposed that neck strengthening could be an effective strategy in preventing cervical spine injuries in Rugby Union, there is currently little information in the literature pertaining to how such a study might be conducted.A significant decrease in the number of injuries recorded in matches can be achieved using a specific neck strengthening program at the elite level.In an elite rugby union team as investigated in this study a significant increase in neck strength is difficult to achieve in a short period of time such as five weeks. PMID:24149163

Naish, Robert; Burnett, Angus; Burrows, Sally; Andrews, Warren; Appleby, Brendyn

2013-01-01

265

Hyperextension soft tissue injuries of the cervical spine--a review.  

PubMed Central

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.

Johnson, G

1996-01-01

266

Optimization of three-dimensional T1-weighted gradient-echo imaging of the cervical spine.  

PubMed

Various parameters of the three-dimensional (3D) T1-weighted magnetization-prepared rapid acquisition gradient-echo (MP-RAGE) sequence were evaluated to improve spatial resolution while maintaining T1 contrast and a short examination time in imaging of the cervical spine in volunteers. The most dramatic improvements in image resolution occurred by decreasing section thickness to 1.2 mm and increasing the in-plane matrix to 192 x 256, with a 230-mm field of view. The increase in imaging time due to the increased matrix was offset by the elimination of the preparation pulse and wait time, without dramatic changes in contrast-to-noise ratio or overall image quality. Optimum parameters included elimination of the preparation pulse and wait time, 12 degrees flip angle, 192 x 256 matrix, 1.2-mm section thickness, nonselective excitation (coronal acquisition), RF spoiling, and standard k-space ordering, for an examination time of 5 minutes 21 seconds. PMID:1627873

Ross, J S; Tkach, J A; Dillinger, J; Ruggieri, P M; Masaryk, T J; Modic, M T

1992-01-01

267

Moving muscle points provide accurate curved muscle paths in a model of the cervical spine.  

PubMed

Muscle paths in musculoskeletal models have been modeled using several different methods; however, deformation of soft tissue with changes in posture is rarely accounted for, and often only the neutral posture is used to define a muscle path. The objective of this study was to model curved muscle paths in the cervical spine that take into consideration soft tissue deformation with changes in neck posture. Two subject-specific models were created from magnetic resonance images (MRI) in 5 different sagittal plane neck postures. Curved paths of flexor and extensor muscles were modeled using piecewise linear lines-of-action in two ways; (1) using fixed via points determined from muscle paths in the neutral posture and (2) using moving muscle points that moved relative to the bones determined from muscle paths in all 5 postures. Accuracy of each curved modeled muscle path was evaluated by an error metric, the distance from the anatomic (centroid) muscle path determined from the MRI. Error metric was compared among three modeled muscle path types (straight, fixed via and moving muscle point) using a repeated measures one-way ANOVA (?=0.05). Moving muscle point paths had 21% lower error metric than fixed via point paths over all 15 pairs of neck muscles examined over 5 postures (3.86 mm vs. 4.88 mm). This study highlights the importance of defining muscle paths in multiple postures in order to properly define the changing curvature of a muscle path due to soft tissue deformation with posture. PMID:22033046

Suderman, Bethany L; Vasavada, Anita N

2012-01-10

268

Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review  

Microsoft Academic Search

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

Andrew M Briggs; Anne J Smith; Leon M Straker; Peter Bragge

2009-01-01

269

Percutaneous vertebroplasty in adult degenerative scoliosis for spine support: study for pain evaluation and mobility improvement.  

PubMed

We evaluate the efficacy-safety of percutaneous vertebroplasty (PV) as primary treatment in adult degenerative scoliosis. During the last 4 years, PV was performed in 18 adult patients (68 vertebral bodies) with back pain due to degenerative scoliotic spine. Under anaesthesia and fluoroscopy, direct access to most deformed vertebral bodies was obtained by 13G needles, and PMMA for vertebroplasty was injected. Scoliosis' inner arch was supported. Clinical evaluation included immediate and delayed studies of patient's general condition and neurological status. An NVS scale helped assessing pain relief, life quality, and mobility improvement. Comparing patients' scores prior to (mean value 8.06 ± 1.3?NVS units), the morning after (mean value 3.11 ± 1.2?NVS units), at 12 (mean value 1.67 ± 1.5?NVS units), and 24 months after vertebroplasty (mean value 1.67 ± 1.5?NVS units) treatment, patients presented a mean decrease of 6.39 ± 1.6?NVS units on terms of life quality improvement and pain relief (P = 0.000). Overall mobility improved in 18/18 (100%) patients. No complications were observed. During follow-up period (mean value 17.66 months), all patients underwent a mean of 1.3 sessions for facet joint and nerve root infiltrations. Percutaneous vertebroplasty in the inner arch seems to be an effective technique for supporting adult degenerative scoliotic spine. PMID:24260742

Filippiadis, Dimitrios K; Papagelopoulos, Panagiotis; Kitsou, Maria; Oikonomopoulos, Nikolaos; Brountzos, Elias; Kelekis, Nikolaos; Kelekis, Alexis

2013-01-01

270

SPECT/CT imaging of the lumbar spine in chronic low back pain: a case report  

PubMed Central

Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT) allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localisation to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was more quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies.

2011-01-01

271

SPECT/CT imaging of the lumbar spine in chronic low back pain: a case report.  

PubMed

Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT) allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localisation to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was more quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies. PMID:21247412

Carstensen, Michael H; Al-Harbi, Mashael; Urbain, Jean-Luc; Belhocine, Tarik-Zine

2011-01-01

272

Spine day 2012: spinal pain in Swiss school children- epidemiology and risk factors  

PubMed Central

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.

2013-01-01

273

Estimated Probability of a Cervical Spine Injury During an ISS Mission  

NASA Technical Reports Server (NTRS)

Introduction: The Integrated Medical Model (IMM) utilizes historical data, cohort data, and external simulations as input factors to provide estimates of crew health, resource utilization and mission outcomes. The Cervical Spine Injury Module (CSIM) is an external simulation designed to provide the IMM with parameter estimates for 1) a probability distribution function (PDF) of the incidence rate, 2) the mean incidence rate, and 3) the standard deviation associated with the mean resulting from injury/trauma of the neck. Methods: An injury mechanism based on an idealized low-velocity blunt impact to the superior posterior thorax of an ISS crewmember was used as the simulated mission environment. As a result of this impact, the cervical spine is inertially loaded from the mass of the head producing an extension-flexion motion deforming the soft tissues of the neck. A multibody biomechanical model was developed to estimate the kinematic and dynamic response of the head-neck system from a prescribed acceleration profile. Logistic regression was performed on a dataset containing AIS1 soft tissue neck injuries from rear-end automobile collisions with published Neck Injury Criterion values producing an injury transfer function (ITF). An injury event scenario (IES) was constructed such that crew 1 is moving through a primary or standard translation path transferring large volume equipment impacting stationary crew 2. The incidence rate for this IES was estimated from in-flight data and used to calculate the probability of occurrence. The uncertainty in the model input factors were estimated from representative datasets and expressed in terms of probability distributions. A Monte Carlo Method utilizing simple random sampling was employed to propagate both aleatory and epistemic uncertain factors. Scatterplots and partial correlation coefficients (PCC) were generated to determine input factor sensitivity. CSIM was developed in the SimMechanics/Simulink environment with a Monte Carlo wrapper (MATLAB) used to integrate the components of the module. Results: The probability of generating an AIS1 soft tissue neck injury from the extension/flexion motion induced by a low-velocity blunt impact to the superior posterior thorax was fitted with a lognormal PDF with mean 0.26409, standard deviation 0.11353, standard error of mean 0.00114, and 95% confidence interval [0.26186, 0.26631]. Combining the probability of an AIS1 injury with the probability of IES occurrence was fitted with a Johnson SI PDF with mean 0.02772, standard deviation 0.02012, standard error of mean 0.00020, and 95% confidence interval [0.02733, 0.02812]. The input factor sensitivity analysis in descending order was IES incidence rate, ITF regression coefficient 1, impactor initial velocity, ITF regression coefficient 2, and all others (equipment mass, crew 1 body mass, crew 2 body mass) insignificant. Verification and Validation (V&V): The IMM V&V, based upon NASA STD 7009, was implemented which included an assessment of the data sets used to build CSIM. The documentation maintained includes source code comments and a technical report. The software code and documentation is under Subversion configuration management. Kinematic validation was performed by comparing the biomechanical model output to established corridors.

Brooker, John E.; Weaver, Aaron S.; Myers, Jerry G.

2013-01-01

274

Impact of cervical spine management brain injury on functional survival outcomes in comatose, blunt trauma patients with extremity movement and negative cervical spine CT: application of the Monte Carlo simulation.  

PubMed

Cervical spine (CS) magnetic resonance imaging (MRI) and collar use may prevent quadriplegia, yet create brain injury. We developed a computer model to assess the effect of CS management strategies on outcomes in comatose, blunt trauma patients with extremity movement and a negative CS CT scan. Strategies include early collar removal (ECR), ECR & MRI, late collar removal (LCR), and LCR & MRI. MRI risks include hypoxia, hypotension, increased intracranial pressure (?ICP), and ventilator-associated pneumonia (VAP). LCR risks include ?ICP, VAP, and delirium. Model elements include Quadriplegia and Primary, Secondary, LCR, and MRI Brain Injury. The Monte Carlo simulation determines health outcomes (Functional Survival versus Quadriplegia, Severe Brain Disability, or Dead). Utility values are Functional Survival 0.90, Quadriplegia 0.20, Severe Brain Disability 0.10, and Dead 0.00. Years of life expectancy are Functional Survival 39.5, Quadriplegia 20.0, Severe Brain Disability 20.0, and Dead 0.0. Unstable CS rate 2.5%: Functional Survival/1,000: Unstable Patients: ECR 384, LCR 350, LCR & MRI 332, ECR & MRI 331; High-Risk Patients: ECR 161, LCR 151, LCR & MRI 140, ECR & MRI 153; Stable Patients: ECR 596, LCR 587, LCR & MRI 573, ECR & MRI 595. Quality-Adjusted Life Months for Unstable, High-Risk, and Stable Patients are greater with ECR; Stable Patient ECR and ECR & MRI are similar. Unstable CS rate 0.5%: Functional Survival/1000: Unstable Patients: ECR 394, LCR 352, LCR & MRI 332, ECR & MRI 332; High-Risk Patients: ECR 164, LCR 151, LCR & MRI 140, ECR & MRI 152; Stable Patients: ECR 611, LCR 592, LCR & MRI 576, ECR & MRI 598. Quality-Adjusted Life Months for Unstable, High-Risk, and Stable Patients are greater with ECR. LCR and MRI brain injury results in losses of functional survivorship that exceed those from quadriplegia. Model results suggest that early collar removal without cervical spine MRI is a reasonable, and likely the preferable, cervical spine management strategy for comatose, blunt trauma patients with extremity movement and a negative cervical spine CT scan. PMID:21083417

Dunham, C Michael; Carter, Kimbroe J; Castro, Frank; Erickson, Barbara

2011-06-01

275

Importance of precise positioning for proton beam therapy in the base of skull and cervical spine.  

PubMed

Using proton beam therapy, high doses have been delivered to chordomas and chondrosarcomas of the base of skull and cervical spine. Dose inhomogeneity to the tumors has been accepted in order to maintain normal tissue tolerances, and detailed attention to patient immobilization and to precise positioning has minimized the margins necessary to ensure these dose constraints. This study examined the contribution of precise positioning to the better dose localization achieved in these treatments. Three patients whose tumors represented different anatomic geometries were studied. Treatment plans were developed which treated as much of the tumor as possible to 74 Cobalt-Gray-Equivalent (CGE) while maintaining the central brain stem and central spinal cord at less than or equal to 48 CGE, the surface of the brain stem, surface of the spinal cord, and optic structures at less than or equal to 60 CGE, and the temporal lobes at less than or equal to 5% likelihood of complication using a biophysical model of normal tissue complication probability. Two positioning accuracies were assumed: 3 mm and 10 mm. Both proton beam plans and 10 MV X ray beam plans were developed with these assumptions and dose constraints. In all cases with the same positioning uncertainties, the proton beam plans delivered more dose to a larger percentage of the tumor volume and the estimated tumor control probability was higher than with the X ray plans. However, without precise positioning both the proton plans and the X ray plans deteriorated, with a 12% to 25% decrease in estimated tumor control probability. In all but one case, the difference between protons with good positioning and poor positioning was greater than the difference between protons and X rays, both with good positioning. Hence in treating these tumors, which are in close proximity to critical normal tissues, attention to immobilization and precise positioning is essential. With good positioning, proton beam therapy permits higher doses to significantly more of the tumor in these sites than do X rays. PMID:1651308

Tatsuzaki, H; Urie, M M

1991-08-01

276

CERVICAL SPINE INJURY: ANALYSIS AND COMPARISON OF PATIENTS BY MODE OF TRANSPORTATION  

PubMed Central

Background Cervical spine injury (CSI) studies have identified different factors contributing to CSI, but none compares the incidence and pattern of injury of patients arriving at the Emergency Department (ED) by private vehicle (PV). Objective We compared the characteristics and injury patterns in CSI patients who were transported to the ED via Emergency Medical Services (EMS) versus PV. Methods We conducted a three-hospital retrospective review of patients with CSI from January 1, 2000 to December 31, 2007. We excluded transfers and followup visits. Using a standardized data collection form, we reviewed demographics, mode of transport, mechanism of injury, imaging results, injury type and level, and neurologic deficits. Means and proportions were compared using t-tests and chi-squared as appropriate. Results Of 1174 charts identified, 718 met all study criteria; 671 arrived by EMS and 47 by PV. There was no difference between groups in age or gender. Ground-level fall was more likely in PV patients (32%, 95% confidence interval [CI] 20–46% vs. 6%, 95% CI 4–9%), whereas motor vehicle collision was less likely (32%, 95% CI 20–46% vs. 67%, 95% CI 63–70%). PV patients more often sustained a stable injury (66%, 95% CI 52–78% vs. 40%, 95% CI 36–44%), and were more often triaged to a lower-acuity area (25%, 95% CI 15–40% vs. 4%, 95% CI 3–6%). The incidence of neurologic deficit was similar (32%, 95% CI 20–46% vs. 24%, 95% CI 21–28%), though more PV patients had spinal cord injury without radiographic abnormality (21%, 95% CI 12–35% vs. 5%, 95% CI 4–7%). Conclusion A small proportion of patients with CSI present to the ED by PV. Although most had stable injuries, a surprising number had unstable injuries with neurologic deficits, and were triaged to lower-acuity areas in the ED.

Urdaneta, Alfredo E.; Stroh, Geoff; Teng, James; Snowden, Brandy; Barrett, Tyler W.; Hendey, Gregory W.

2013-01-01

277

The efficacy of intermittent cervical traction in patents with chronic neck pain  

Microsoft Academic Search

Previous studies about the usefulness of traction therapy have concluded with conflicting results. The aim of this study was\\u000a to examine its efficacy in chronic neck pain. Forty-two patients with at least 6 weeks of nonspecific neck pain were selected\\u000a for the study. Data about demographic characteristics including age, sex, body mass index, duration of cervical pain, working\\u000a status, smoking status,

Pinar Borman; Dilek Keskin; Betul Ekici; Hatice Bodur

2008-01-01

278

Quantification of cervical spine muscle fat: a comparison between T1-weighted and multi-echo gradient echo imaging using a variable projection algorithm (VARPRO)  

PubMed Central

Background Previous data using T1-weighted MRI demonstrated neck muscle fat infiltration (MFI) in patients with poor functional recovery following whiplash. Such findings do not occur in those with milder symptoms of whiplash, chronic non-traumatic neck pain or healthy controls, suggesting traumatic factors play a role. Muscle degeneration could potentially represent a quantifiable marker of poor recovery, but the temporal constraints of running a T1-weighted sequence and performing the subsequent analysis for muscle fat may be a barrier for clinical translation. The purpose of this preliminary study was to evaluate, quantify and compare MFI for the cervical multifidus muscles with T1-weighted imaging and a more rapid quantitative 3D multi-echo gradient echo (GRE) Dixon based method in healthy subjects. Methods 5 asymptomatic participants with no history of neck pain underwent cervical spine MRI with a Siemens 3 Tesla system. The muscle and fat signal intensities on axial spin-echo T1-weighted images were quantitatively classified for the cervical multifidii from C3-C7, bilaterally. Additional axial GRE Dixon based data for fat and water quantification were used for comparison via paired t-tests. Inter-tester reliability for fat and water measures with GRE images were examined using 1) Pearson’s Intra-class correlation coefficient 2) Bland-Altman Plots and 3) Lin’s-Concordance Coefficient. P?cervical musculature is comparable to T1-weighted images. Inclusion of larger samples of symptomatic data and histological comparison with the reference standard biopsy is warranted.

2013-01-01

279

An Observational Study on the Prevalence and Pattern of Opioid Use in 25,479 Patients With Spine and Radicular Pain  

Microsoft Academic Search

Study Design. A cross-sectional analysis of data ob- tained from patients with spinal and radicular pain and their spine center treating physicians was performed. Objectives. To identify characteristics of patients treated with opioids that distinguish them from similar patients not treated with opioids in a large population of patients with spine and radicular pain, and to determine the prevalence of

Gilbert J. Fanciullo; Perry A. Ball; Gisele Girault; Robert J. Rose; Brett Hanscom; James N. Weinstein

2002-01-01

280

Investigation of the effect of GaAs laser therapy on cervical myofascial pain syndrome  

Microsoft Academic Search

Low-energy laser therapy has been applied in several rheumatoid and soft tissue disorders with varying rates of success. The objective of our study was to investigate the effect of laser therapy on cervical myofascial pain syndrome with a placebo-controlled double-blind prospective study model. It was performed with a total of 53 patients (35 females and 18 males) with cervical myofascial

Lale Altan; Umit Bingöl; Mehtap Aykaç; Merih Yurtkuran

2005-01-01

281

[Algorithm of diagnostics and surgery of trauma and degenerative diseases of cervical spine].  

PubMed

A retrospective analysis of diagnostics and surgery in 240 patients was made. The vertebral spinal trauma took place in 168 patients (average age 31 +/- 5 years), degenerative dystrophic diseases of spine were in 72 patients (average age 52 +/- 7 years). The clinicodiagnostic complex included survey and functional radiography of the spine, magnetic resonance image and helical computer tomography of the spine with spondylometric measurements and color duplex scanning of the vertebral artery. Stabilization of the spine was performed in 137 (57%) cases. The variants were determined on the basis of predominate injury of 1 out of 3 supporting complexes. The rigid and dynamic methods and their combination were used for fixation of the spine. More favorable results were registered using dynamic fixation and the arthroplasty of intervertebral disks with nitinol constructions. An algorithm of radiodiagnostics and surgery methods were proposed. PMID:23808231

Shchedrenok, V V; Zakhmatova, T V; Zuev, I V; Moguchaia, O V; Tiul'kin, O N; Topol'skova, N V; Sebelev, K I

2013-01-01

282

The Biomechanics of Cervical Spondylosis  

PubMed Central

Aging is the major risk factor that contributes to the onset of cervical spondylosis. Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss along the ventral margin of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. The altered posture of the cervical spine will progress into kyphosis and continue if the load balance and lordosis is not restored. The content of this paper will address the physiological and biomechanical pathways leading to cervical spondylosis and the biomechanical principles related to the surgical correction and treatment of kyphotic progression.

Ferrara, Lisa A.

2012-01-01

283

The Intubating Laryngeal Mask Airway Allows Tracheal Intubation When the Cervical Spine Is Immobilized by a Rigid Collar  

PubMed Central

Summary An intubating laryngeal mask airway (ILMA) facilitates tracheal intubation with the neck in neutral position, which is similar to the neck position maintained by a rigid cervical collar. However, a cervical collar virtually obliterates neck movement, even the small movements that normally facilitate airway insertion. We therefore tested the hypothesis that the ILMA facilitates tracheal intubation even in patients wearing a rigid cervical collar. In 50 cervical spine surgery patients with a rigid Philadelphia collar in place and 50 general surgery patients under general anaesthesia, we performed blind tracheal intubation via an ILMA. The time required for intubation, intubation success rate, and numbers and type of adjusting manoeuvres employed were recorded. Inter-incisor distance was significantly smaller (4.1 [0.8] cm vs. 4.6 [0.7] cm, mean [SD], P<0.01) and Mallampati scores were significantly greater (P<0.001) in the collared patients. ILMA insertion took longer (30 [25] vs. 22 [6] seconds), more patients required 2 insertion attempts (15 vs. 3; P<0.005), and ventilation adequacy with ILMA was worse (P<0.05) in collared patients. However, there were no significant differences between the collared and control patients in terms of total time required for intubation (60 [41] vs. 50 [30] seconds), number of intubation attempts, overall intubation success rate (96 vs. 98%), or the incidence of intubation complications. Blind intubation through an ILMA is thus a reasonable strategy for controlling the airway in patients who are immobilized with a rigid cervical collar, especially when urgency precludes a fiberoptic approach.

Komatsu, Ryu; Nagata, Osamu; Kamata, Kotoe; Yamagata, Katsuyuki; Sessler, Daniel I.; Ozaki, Makoto

2005-01-01

284

The effect of balance training on cervical sensorimotor function and neck pain.  

PubMed

The authors' aim was to evaluate the effect of balance training on cervical joint position sense in people with subclinical neck pain. Thirty-four participants were randomly assigned to balance training or to stay active. Sensorimotor function was determined before and after 5 weeks of training by assessing the ability to reproduce the neutral head position and a predefined rotated head position. After balance training, the intervention group showed improved joint repositioning accuracy and decreased pain whereas no effects were observed in the control group. A weak correlation was identified between reduced neck pain intensity and improved joint repositioning. The present data demonstrate that balance training can effectively improve cervical sensorimotor function and decrease neck pain intensity. PMID:23663191

Beinert, Konstantin; Taube, Wolfgang

2013-01-01

285

Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity  

Microsoft Academic Search

Hou C-R, Tsai L-C, Cheng K-F, Chung K-C, Hong C-Z. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002;83:1406-14. Objective: To investigate the immediate effect of physical therapeutic modalities on myofascial pain in the upper trapezius muscle. Design: Randomized controlled trial. Setting: Institutional practice. Patients: One hundred nineteen subjects with

Chuen-Ru Hou; Li-Chen Tsai; Kuang-Feng Cheng; Kao-Chi Chung; Chang-Zern Hong

2002-01-01

286

Application of an asymmetric finite element model of the C2-T1 cervical spine for evaluating the role of soft tissues in stability.  

PubMed

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

Erbulut, D U; Zafarparandeh, I; Lazoglu, I; Ozer, A F

2014-07-01

287

Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise  

Microsoft Academic Search

The objective of the study was to develop a clinical prediction rule (CPR) to identify patients with neck pain likely to improve\\u000a with cervical traction. The study design included prospective cohort of patients with neck pain referred to physical therapy.\\u000a Development of a CPR will assist clinicians in classifying patients with neck pain likely to benefit from cervical traction.\\u000a Eighty

Nicole H. Raney; Evan J. Petersen; Tracy A. Smith; James E. Cowan; Daniel G. Rendeiro; Gail D. Deyle; John D. Childs

2009-01-01

288

Painful cervical lymphadenopathy: An unusual presentation of chikungunya.  

PubMed

Chikungunya is an arboviral disease transmitted by Aedes mosquito that represents a major public health burden worldwide including India. The disease presents as sudden onset of high-grade fever, severe arthralgias, and rash. Here, we describe a case of a patient who presented with cervical lymphadenopathy, fever, and myalgia and later was diagnosed as chikungunya. Lymphadenopathy has been described before as a less common symptom of chikungunya. But this is probably, the first case of chikungunya with cervical lymphadenopathy as a presenting feature. PMID:24600579

Keny, Mukundraj S; Pereira, Ian A; Desa, Sunita B; Gomes, Edwin J

2014-01-01

289

Development of a System for In Vitro Neck Muscle Force Replication in Whole Cervical Spine Experiments  

Microsoft Academic Search

nematics, kinetics, and trauma using isolated spine spec- imens (head-T1 vertebra) have usually applied upward force to the head, resulting in tensile spine forces, con- trary to the physiological compressive forces present in vivo. Further, the in vitro load-displacement curves have never been compared with the corresponding in vivo data. Methods. A novel muscle force replication (MFR) sys- tem is

Manohar M. Panjabi; Takehiko Miura; Peter A. Cripton; Jaw-Lin Wang; Amrinder S. Nain; Christian DuBois

290

Validation of a Non-Invasive Technique to Precisely Measure In Vivo Three-Dimensional Cervical Spine Movement  

PubMed Central

Study Design In vivo validation during functional loading. Objective To determine the accuracy and repeatability of a model-based tracking technique that combines subject-specific CT models and high-speed biplane X-ray images to measure three-dimensional (3D) in vivo cervical spine motion. Summary of Background Data Accurate 3D spine motion is difficult to obtain in vivo during physiological loading due to the inability to directly attach measurement equipment to individual vertebrae. Previous measurement systems were limited by two-dimensional (2D) results and/or their need for manual identification of anatomical landmarks, precipitating unreliable and inaccurate results. All previous techniques lack the ability to capture true 3D motion during dynamic functional loading. Methods Three subjects had 1.0 mm diameter tantalum beads implanted into their fused and adjacent vertebrae during ACDF surgery. High resolution CT scans were obtained following surgery and used to create subject-specific 3D models of each cervical vertebra. Biplane X-rays were collected at 30 frames per second while the subjects performed flexion/extension and axial rotation movements six months after surgery. Individual bone motion, intervertebral kinematics, and arthrokinematics derived from dynamic RSA served as a gold standard to evaluate the accuracy of the model-based tracking technique. Results Individual bones were tracked with an average precision of 0.19 mm and 0.33 mm in non-fused and fused bones, respectively. Precision in measuring 3D joint kinematics in fused and adjacent segments averaged 0.4 mm for translations and 1.1° for rotations, while anterior and posterior disc height above and below the fusion were measured with a precision ranging between 0.2 mm and 0.4 mm. The variability in 3D joint kinematics associated with tracking the same trial repeatedly was 0.02 mm in translation and 0.06° in rotation. Conclusions 3D cervical spine motion can be precisely measured in vivo with sub-millimeter accuracy during functional loading without the need for bead implantation. Fusion instrumentation did not diminish the accuracy of kinematic and arthrokinematic results. The semi-automated model-based tracking technique has excellent repeatability.

Anderst, William J; Baillargeon, Emma; Donaldson, William F; Lee, Joon Y; Kang, James D

2011-01-01

291

Pain and cervical traction variation during manual turning  

Microsoft Academic Search

An experiment using a dummy with a cervical traction recorder was used in place of a patient. Nurses and orderlies from the Spinal Unit carried out manual lifting and turning techniques, used in the conservative treatment of spinal injury. Variation in manual traction continues throughout a turn. Traction force may be quadrupled or quartered. Inco-ordination between the individuals lifting, causes

F X Keane

1978-01-01

292

A comparison of McCoy, TruView, and Macintosh laryngoscopes for tracheal intubation in patients with immobilized cervical spine  

PubMed Central

Background: Cervical spine immobilization results in a poor laryngeal view on direct laryngoscopy leading to difficulty in intubation. This randomized prospective study was designed to compare the laryngeal view and ease of intubation with the Macintosh, McCoy, and TruView laryngoscopes in patients with immobilized cervical spine. Materials and Methods: 60 adult patients of ASA grade I-II with immobilized cervical spine undergoing elective cervical spine surgery were enrolled. Anesthesia was induced with propofol, fentanyl, and vecuronium and maintained with isoflurane and nitrous oxide in oxygen. The patients were randomly allocated into three groups to achieve tracheal intubation with Macintosh, McCoy, or TruView laryngoscopes. When the best possible view of the glottis was obtained, the Cormack-Lehane laryngoscopy grade and the percentage of glottic opening (POGO) score were assessed. Other measurements included the intubation time, the intubation difficulty score, and the intubation success rate. Hemodynamic parameters and any airway complications were also recorded. Results: TruView reduced the intubation difficulty score, improved the Cormack and Lehane glottic view, and the POGO score compared with the McCoy and Macintosh laryngoscopes. The first attempt intubation success rate was also high in the TruView laryngoscope group. However, there were no differences in the time required for successful intubation and the overall success rates between the devices tested. No dental injury or hypoxia occurred with either device. Conclusion: The use of a TruView laryngoscope resulted in better glottis visualization, easier tracheal intubation, and higher first attempt success rate as compared to Macintosh and McCoy laryngoscopes in immobilized cervical spine patients.

Bharti, Neerja; Arora, Suman; Panda, Nidhi B

2014-01-01

293

Surgical management of giant multilevel aneurysmal bone cyst of cervical spine in a 10-year-old boy: case report with review of literature  

PubMed Central

Background:?Aneurysmal bone cysts are rare occurrences in the cervical spine. Surgical treatment in pediatric patients is a challenge. Complete tumor resection offers the best chance for cure. Description:?Diagnosis and surgical management of an expansile aneurysmal bone cyst of the cervical spine involving all three spinal columns in a 10-year-old boy. Results:?Surgical treatment included tumor excision and circumferential fusion, and produced no neurological or vascular sequelae. This approach minimizes the risk of recurrence and the possibility of postoperative spinal instability. Conclusion:?Spinal instability is preferably addressed with reconstruction and stabilization. Cervical aneurismal bone cyst lesions are ideally treated with complete resection to minimize the chance of recurrence. In pediatric cases, defects created by resection should be corrected by fusion to minimize the risk of postoperative instability and growth abnormality.

Gurjar, Hitesh Kumar; Sarkari, Avijit; Chandra, P. Sarat

2012-01-01

294

Breast size, thoracic kyphosis & thoracic spine pain - association & relevance of bra fitting in post-menopausal women: a correlational study  

PubMed Central

Background Menopause would seem to exist as a period of accelerated changes for women and their upper torso mechanics. Whether these anthropometric changes reflect changes in pain states remains unclear. Plausible mechanisms of pain exist for the independent and combined effect of increasing breast size and thoracic kyphosis. Bra fit has the potential to change when the anthropometric measures (chest circumference and bust circumference) used to determine bra size change, such as postmenopausally. Identifying an association between breast size, thoracic kyphosis and thoracic spine pain in postmenopausal women and identifying the relevance of bra fit to this association may be of importance to the future management and education of post-menopausal women presenting clinically with thoracic spine pain. Methods A cross-sectional study design. Fifty-one postmenopausal bra-wearing women were recruited. Measures included breast size (Triumph International), thoracic kyphosis (flexible curve), bra fitted (Y/N) and pain (Short Form McGill Pain Questionnaire) and tenderness on palpation (posteroanterior pressure testing). These measures were collected in one session at a physiotherapy clinic. Results The majority of the women in this study were overweight or obese and wearing an incorrect sized bra. Pain was significantly related to breast size, body weight and BMI at mid thoracic levels (T7-8). In contrast self-reported thoracic pain was not correlated with age or index of kyphosis (thoracic kyphosis). Women with thoracic pain were no more likely to have their bra professionally fitted whereas women with a higher BMI and larger breasts were more likely to have their bra professionally fitted. Conclusion The findings of this study show that larger breasts and increased BMI are associated with thoracic pain in postmenopausal women. This is unrelated to thoracic kyphosis. Increasing breast size and how a bra is worn may have biomechanical implications for the loaded thoracic spine and surrounding musculature. Post-menopause women present with a spectrum of anthropometrical changes that have the potential to contribute to altered biomechanics and affect pain states in the thoracic spine.

2013-01-01

295

Care related and transit neuronal injuries after cervical spine trauma: state of care and practice in Nigeria.  

PubMed

Suboptimal care during extraction and transfer after spinal trauma predisposes patients to additional spinal cord injury. This study examines the factors that contribute to care related and transit injuries and suggests steps to improve standard of care in spinal trauma patients in Nigeria. It is a questionnaire-based prospective study of patients admitted with cervical cord injury to two neurosurgical centers in Enugu, Nigeria, between March 2008 and October 2010. Demography, mechanism of injury, mode of extraction from the scene and transportation to first visited hospital, precautions taken during transportation, and treatment received before arriving at the neurosurgical unit were analyzed. There were 53 (77.9%) males, the mean age was 33.9 years, and 23.5% had concomitant head injury. Average delay was 3.5 h between trauma and presentation to initial care and 10.4 days before presentation to definitive care. Only 26.5% presented primarily to tertiary centers with trauma services. About 94.1% were extracted by passersby. None of the patients received cervical spine protection either during extrication or in the course of transportation to initial care, and 35.3% were sitting in a motor vehicle or supported on a motorbike during transport. Of the 43 patients transported lying down, 41.9% were in the back seat of a sedan, and only 11.8% were transported in an ambulance. Neurological dysfunction was first noticed after removal from the scene by 41.2% of patients, while 7.4% noticed it on the way to or during initial care. During subsequent transfer to definitive centers, only 36% had cervical support, although 78% were transported in ambulances. Ignorance of pre-hospital management of cervically injured patients exists in the general population and even among medical personnel and results in preventable injuries. There is need for urgent training, provision of paramedical services, and public enlightenment. PMID:23758277

Mezue, Wilfred C; Onyia, Ephraim; Illoabachie, Izuchukwu C; Chikani, Mark C; Ohaegbulam, Samuel C

2013-09-15

296

Total Disc Arthroplasty and Anterior Cervical Discectomy and Fusion in Cervical Spine: Competitive or Complimentary? Review of the Literature  

PubMed Central

Anterior cervical discectomy and arthrodesis has come to represent standard of care for patients with persistent radicular and/or myelopathic symptoms that have failed to improve with conservative treatments. One potential complication of the procedure is the accelerated degeneration of the vertebrae and the intervertebral discs adjacent to the level fused and the effects of fusion on those levels. The concern that fusion may be a contributing factor to accelerated adjacent segment degeneration led to increased interest in cervical disc replacement after anterior decompressive surgery. Several studies analyzing the short-term outcomes of the disc replacement procedure have been published since then, and the pros and cons of both procedures continue to remain a topic of debate among the scientific community. The analysis of published literature and our own experience has convinced us that the overall longer-term clinical outcomes after anterior cervical discectomy and fusion (ACDF) and total disc replacement (TDR) in the general patient population are not significantly different in terms of symptomatic improvement, neurological improvement, and restoration to better quality of life. Age of the patients and number of affected levels may impact the outcomes and hence determine the choice of optimum procedure. To definitely compare the incidence of adjacent segment disease after these procedures, multi-institutional studies with predetermined and unanimously agreed upon clinical and radiological criteria should be undertaken and the results analyzed in an unbiased fashion. Until that time, it is reasonable to assume that ACDF as well as cervical TDR are both safe and effective procedures that may have outcome benefits in specific patient subgroups based upon demographics and clinical/radiological parameters at the time of surgery.

Jawahar, Ajay; Nunley, Pierce

2012-01-01

297

Effect of Cervical Spine Manipulative Therapy on Judo Athletes' Grip Strength  

Microsoft Academic Search

ObjectiveThe objective of this study was to perform an investigation evaluating if cervical spinal manipulative therapy (SMT) can increase grip strength on judo athletes in a top 10 national-ranked team.

Marcelo B. Botelho; Bruno B. Andrade

298

Applying Joint Mobilization at Different Cervical Vertebral Levels does not Influence Immediate Pain Reduction in Patients with Chronic Neck Pain: A Randomized Clinical Trial  

PubMed Central

The aim of the present study was to compare the effects of applying joint mobilization at symptomatic and asymptomatic cervical levels in patients with chronic nonspecific neck pain. Forty-eight patients aged between 18 and 65 years and presenting nonspecific neck pain with a minimum duration of 3 months were recruited for the study. Included patients were randomized to one of two treatment groups: (i) control group: the most symptomatic vertebral level was mobilized; (ii) experimental group: a randomly selected vertebral level was chosen and mobilized. All patients received one treatment session. Pain intensity in resting position during the most painful active cervical movement as well as during vertebral palpation was quantified using an 11-point pain scale. Follow-up measures were taken immediately after intervention by a blinded assessor. The results showed no significant difference in pain intensity immediately after treatment between groups (symptomatic level treated vs. randomly chosen cervical vertebral level treated) during resting position, painful active movement, or vertebral palpation. Within-group comparisons showed significant pain relief after treatment during the most painful active movement as well as during vertebral palpation for both groups, but not during resting position. Significant change in immediate pain intensity during painful active movement and vertebral palpation was achieved after vertebral mobilization. however, both groups presented similar pain reductions suggesting that pain reduction due to joint mobilization is not specific to the vertebral level being mobilized.

Aquino, Rafaela L; Caires, Priscila M; Furtado, Fernanda C; Loureiro, Aline V; Ferreira, Paulo H; Ferreira, Manuela L

2009-01-01

299

Diode laser in cervical myofascial pain: a double-blind study versus placebo.  

PubMed

We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myofascial pain in the cervical region. The patients were submitted to 12 sessions on alternate days to a total energy dose of 5 J each. At each session, the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated. Those in the placebo group submitted to the same number of sessions following an identical procedure, the only difference being that the laser apparatus was nonoperational. Pain was monitored using the Italian version of the McGill pain questionnaire and the Scott-Huskisson visual analogue scale. The results show a pain attenuation in the treated group and a statistically significant difference between the two groups of patients, both at the end of therapy and at the 3-month follow-up examination. PMID:2520419

Ceccherelli, F; Altafini, L; Lo Castro, G; Avila, A; Ambrosio, F; Giron, G P

1989-12-01

300

Cervical Lidocaine for IUD Insertional Pain: a Randomized Controlled Trial  

PubMed Central

Objective Anticipated pain with intrauterine device (IUD) insertion may be a barrier to widespread use. Our objective was to evaluate the efficacy of intracervical 2% lidocaine gel for pain relief with IUD insertion. Study Design We performed a double-blind, randomized controlled trial of women undergoing IUD insertion. Participants were randomly assigned to 2% lidocaine or placebo gel. Study gel (3ccs) wase placed 3 minutes prior to IUD insertion. Pain scores were measured at various time points using a 10-point visual analog scale. Results Of the 200 participants randomized, 199 completed the study. Pain scores among lidocaine and placebo arms were similar at tenaculum placement (lidocaine and placebo; median 4, range 0–10 p=0.15) as well as with insertion (lidocaine: median 5 range 1–10, placebo: median 6 range 0–10 p=0.16). These results did not differ by parity. Conclusions Topical or intracervical 2% lidocaine gel prior to IUD insertion does not decrease pain scores.

McNicholas, Colleen P.; Madden, Tessa; Zhao, Qiuhong; Secura, Gina; Allsworth, Jenifer E.; Peipert, Jeffrey F.

2012-01-01

301

Stability of cervical spine after one-level corpectomy using different numbers of screws and plate systems.  

PubMed

Anterior corpectomy and reconstruction using a plate with locking screws are standard procedures for the treatment of cervical spondylotic myelopathy. Although adding more screws to the construct will normally result in improved fixation stability, several issues need to be considered. Past reports have suggested that increasing the number of screws can result in the increase in spinal rigidity, decreased spine mobility, loss of bone and, possibly, screw loosening. In order to overcome this, options to have constrained, semi-constrained or hybrid screw and plate systems were later introduced. The purpose of this study is to compare the stability achieved by four and two screws using different plate systems after one-level corpectomy with placement of cage. A three-dimensional finite-element model of an intact C1-C7 segment was developed from computer tomography data sets, including the cortical bone, soft tissue and simulated corpectomy fusion at C4-C5. A spinal cage and an anterior cervical plate with different numbers of screws and plate systems were constructed to a fit one-level corpectomy of C5. Moment load of 1.0 N m was applied to the superior surface of C1, with C7 was fixed in all degrees of freedom. The kinematic stability of a two-screw plate was found to be statistically equivalent to a four-screw plate for one-level corpectomy. Thus, it can be a better option of fusion and infers comparable stability after one-level anterior cervical corpectomy, instead of a four-screw plate. PMID:24622982

Rosli, Ruwaida; Abdul Kadir, Mohammed R; Kamarul, Tunku

2014-04-01

302

Paraplegia caused by posture during MRI in a patient with cervical disk herniation.  

PubMed

A 48-year-old man presented with numbness in the lower left extremity of 4 months' duration. One month earlier, he presented to an orthopedic clinic and magnetic resonance imaging (MRI) revealed cervical disk herniation. Because the pain did not subside, he visited the clinic again and MRI was performed. His neck was slightly extended and fixed to the headrest of the MRI instrument. Because of the posture of his cervical spine, he suffered severe pain in the scapular region during the MRI. After 15 minutes the pain was unbearable and the MRI examination was aborted. As the patient tried to descend from the MRI table, he was unable to move his bilateral lower extremities. No muscle contraction was observed in his lower limbs. Following MRI with flexion posture of the cervical spine, he was diagnosed with paraplegia caused by cervical disk herniation. Emergency surgery consisting of anterior decompression and fusion was performed. The patient showed good neurological recovery. Three weeks postoperatively, the patient could walk without assistance and he was discharged. The extension posture of the cervical spine during MRI was considered to be the cause of acute paraplegia in this patient. Care should be taken with the posture of the cervical spine, when performing MRI in patients with cervical disk herniation. Extended posture of the cervical spine during MRI may lead to acute neurological deterioration. PMID:20806756

Kato, Yoshihiko; Nishida, Norihiro; Taguchi, Toshihiko

2010-06-01

303

Thursday, October 31, 2001 3:47–4:17 pm Focused Review: Cervical Spine Surgery Complications  

Microsoft Academic Search

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

Alexander Simotas; Timothy Shen

2002-01-01

304

Differential diagnosis of shoulder and cervical pain: a case report  

PubMed Central

Patients are frequently referred to physical therapy with the diagnosis of shoulder and arm pain. During examination and evaluation of the patient, the physical therapist must consider all potential causes of the patient’s symptoms. Three questions are used as the conceptual basis for a diagnosis-based clinical decision rule in the management of mechanical and non-mechanical musculoskeletal pain when addressing the differential diagnosis of a patient’s condition. This single patient case report describes the use of these three questions in the differential diagnosis of shoulder and arm pain. A 44-year-old male was referred with a diagnosis of shoulder impingement syndrome. Each of the three questions for differential diagnosis was addressed, and clinical tests and examination findings were used to differentiate the origin of the patient’s symptoms. The intervention provided is outlined along with the patient’s response to the different treatment strategies provided. This case identifies the need for a systematic method of differential diagnosis so that patients are appropriately managed.

Slaven, Emily Joan; Mathers, Jessie

2010-01-01

305

Influence of surgical treatment for disc degeneration disease at C5–C6 on changes in some biomechanical parameters of the cervical spine  

Microsoft Academic Search

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

Yuan Li; Gladius Lewis

2010-01-01

306

Epidemiology of cervical spine abnormalities in asymptomatic adult professional rugby union players using static and dynamic MRI protocols: 2002 to 2006  

Microsoft Academic Search

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

B H Castinel; P Adam; P D Milburn; A Castinel; K L Quarrie; J-C Peyrin; J D Yeo

2010-01-01

307

Influence of anthropometry on the kinematics of the cervical spine and the risk of injury in sled tests in female volunteers  

Microsoft Academic Search

The objective of this study was to investigate the influence of anthropometric data on the kinematics of the cervical spine and the risk factors for sustaining a neck injury during rear-end collisions occurring in a sled test.A rear-end collision with a velocity change (?V) of 6.3km\\/h was simulated in a sled test with eight healthy female subjects. The study analysed

Christoph Dehner; Sylvia Schick; Markus Arand; Martin Elbel; Wolfram Hell; Michael Kramer

2008-01-01

308

Solitary Xanthogranuloma of the Upper Cervical Spine in a Male Adult  

PubMed Central

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.

Lee, Sun Joo; Lee, Seung Hwan; Kim, Sung Min

2012-01-01

309

Solitary xanthogranuloma of the upper cervical spine in a male adult.  

PubMed

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

Lee, Sun Joo; Jo, Dae Jean; Lee, Seung Hwan; Kim, Sung Min

2012-01-01

310

Optimal Use of the Halo-Vest Orthosis for Upper Cervical Spine Injuries  

PubMed Central

Purpose Upper cervical fractures can heal with conservative treatments such as halo-vest immobilization (HVI) and Minerva jackets without surgery. The most rigid of these, HVI, remains the most frequently used treatment in many centers despite its relatively high frequency of orthosis-related complications. We conducted this study to investigate the clinical outcome, effectiveness, patient satisfaction, and associated complications of HVI. Materials and Methods From April 1997 to December 2008, we treated 23 patients for upper cervical spinal injuries with HVI. For analysis, we divided high cervical fractures into four groups, including C1 fracture, C2 dens fracture, C2 hangman's fracture, and C1-2 associated fracture. We evaluated the clinical outcome, complications, and patient satisfaction through chart reviews and a telephone questionnaire. Results The healing rate for upper cervical fracture using HVI was 60.9%. In most cases, bony healing occurred within 16 weeks. Older patients required longer fusion time. We observed a 39.1% failure rate, and 60.9% of patients experienced complications. The most common complications were frequent pin loosening (34.8%; 8/23) and pin site infection (17.4%; 4/23). The HVI treatment failed in 66.7% of patients with pin site problems. The patient approval rate was 31.6%. Conclusion The HVI produced frequent complications and low patient satisfaction. Bony fusion succeeded in 60.9% of patients. Pin site complications showed a tendency to influence the outcome of HVI, and would be promptly addressed to prevent treatment failure if they develop. The decision to use HVI requires an explanation to the patient of potential complications and constant vigilance to prevent such complications and unsatisfactory outcomes.

Kim, Sang Jin; Kim, Tae Hong; Shin, Hyung Shik; Hwang, Yong Soon; Park, Sang Keun

2010-01-01

311

Three-dimensional biomechanical properties of the human cervical spine in vitro  

Microsoft Academic Search

Nous voulions connaître le comportement mécanique du rachis cervical humain présentant des lésions ligamentaires. Les déplacements tridimensionnels dus à quatre moments de couple purs: flexion, extension, inflexion latérale gauche-droite et torsion axiale gauche-droite sont mesurés sur 18 unités fonctionnelles rachidiennes (UF) prélevées sur 9 sujets. Les tests sont d'abord effectués sur les UF intactes, puis différentes sections ligamentaires sont effectuées.

N. Wen; F. Lavaste; J. J. Santin; J. P. Lassau

1993-01-01

312

Three-dimensional biomechanical properties of the human cervical spine in vitro  

Microsoft Academic Search

L'objectif de notre étude est de déterminer le comportement mécanique du rachis cervical humain soumis á des charges physiologiques statiques. Les déplacements tridimensionnels dus à trois moments de couple purs (flexion-extension, inflexion latérale gauche-droite et torsion axiale gauche-droite), sont mesurés sur 56 unités fonctionnelles rachidiennes intactes (UF) de C2 à C7 prélevées sur 29 sujets. Les courbes effort-déplacement sont tracées

N. Wen; F. Lavaste; J. J. Santin; J. P. Lassau

1993-01-01

313

Cervical surgery for ossification of the posterior longitudinal ligament: One spine surgeon's perspective  

PubMed Central

Background: The selection, neurodiagnostic evaluation, and surgical management of patients with cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. Whether for prophylaxis or treatment, the decision to perform anterior vs. posterior vs. circumferential cervical OPLL surgery is complex. MR and CT Documentation of OPLL: Together, MR and CT cervical studies best document the full extent of OPLL. While MR provides the optimal soft-tissue overview (e.g. hyperintense signals reflecting edema/myelomalacia in the cord), CT's directly demonstrate the ossification of OPLL often “missed” by MR (e.g. documents the single or double layer signs of dural penetration. Patient Selection: Patients with mild myelopathy/cord compression rarely require surgery, while those with moderate/severe myelopathy/cord compression often warrant anterior, posterior, or circumferential approaches. Operative Approaches: Anterior corpectomies/fusions, warranted in patients with OPLL and kyphosis/loss of lordosis, also increase the risks of cerebrospinal fluid (CSF) leaks (e.g. single/double layer sign), and vascular injuries (e.g. carotid, vertebral). Alternatively, with an adequate lordosis, posterior procedures (e.g. often with fusions), may provide adequate multilevel decompression while minimizing risk of anterior surgery. Occasionally, combined pathologies may warrant circumferential approaches. Anesthetic and Intraoperative Monitoring Protocols: The utility of awake nasotracheal fiberoptic intubation/awake positioning, intraoperative somatosensory/motor evoked potential, and electromyographic monitoring, and the requirement for total intravenous anesthesia (TIVA) for OPLL surgery is also discussed. Conclusion: Anterior, posterior, or circumferential surgery may be warranted to treat patients with cervical OPLL, and must be based on careful patient selection, and both MR and CT documentation of the full extent of OPLL.

Epstein, Nancy E.

2014-01-01

314

Assessment of nerve involvement in the lumbar spine: agreement between magnetic resonance imaging, physical examination and pain drawing findings  

PubMed Central

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.

2010-01-01

315

Pain assessment during conscious sedation for cervical cancer high-dose-rate brachytherapy  

PubMed Central

Background This observational study set out to evaluate the effectiveness of conscious sedation anesthesia for pain control during high-dose-rate (hdr) brachytherapy using a ring-and-tandem applicator system for patients with cervical cancer. Methods At the time of initiation of the hdr cervical cancer brachytherapy program at our institution, patients received a detailed symptom assessment during the procedures. Brachytherapy was carried out using a Smit sleeve, together with a ring-and-tandem applicator. Midazolam and an opioid—hydromorphone, morphine, or fentanyl—were the main agents used to achieve conscious sedation. Results From January 2009 to October 2010, 20 patients (median age: 45 years) underwent 57 procedures. All patients received chemoradiation with curative intent. The median duration of the procedures was 1.4 hours, and no significant cardiovascular events were noted. The total dose of intravenous midazolam used ranged from 0.5 mg to 8.5 mg (median: 2.5 mg). The total dose of intravenous morphine equivalent used ranged from 2.5 mg to 60 mg (median: 8 mg). The mean and median pain scores during the procedures were 1.4 and 1.1 respectively. Brief moments of moderate to severe incidental pain were noted at the time of certain events during the procedure—specifically during insertion of the ring-and-tandem applicator. The maximal pain score during the entire procedure ranged from 0 to 10 (median: 4.7). The period of recovery from conscious sedation was relatively brief (median discharge time: 1 hour). Conclusions We were able to demonstrate that patients undergoing hdr brachytherapy for cervical cancer can achieve good pain control with conscious sedation.

Bhanabhai, H.; Samant, R.; E, C.; Grenier, L.; Lowry, S.

2013-01-01

316

The Choice of the Best Surgery After Single Level Anterior Cervical Spine Discectomy: A Systematic Review  

PubMed Central

Background: The anterior cervical discectomy (ACD) is often used to treat spinal cord and nerve root compressions and the frequent use of interbody fusion (ACDF) has popularized it as a common practice associated or not with cages or plates for maintaining the intervertebral disc height. Objective: The aim of this study is to clarify the effectiveness of ACD compared with ACDF, with or without the use of anterior cervical spacer (Cage) or instrumentation with plate fixation (ACDFI). Methods: randomized controlled trials or quasi-randomized trials were selected for analysis in one segmental level. The comparison criteria were the rates of success and failure with surgery (Odom’s’ criteria), fusion rates and kyphosis rates. Electronic search was made in the MEDLINE database (Pubmed), in the Central Registry of randomized trials of Cochrane database and EMBASE. Results: Seven studies were selected for analysis. Conclusion: Implications for practice: There is moderate evidence that clinical results of ACD and ACDF are not significant different. There is moderate evidence that addition of intervertebral cage enhance clinical results.There is moderate evidence that anterior cervical plate does not change the clinical results of ACD. There is moderate evidence that ACD produce more segmental kyphosis than ACDF and ACDFI, with use of cage or plate.There is moderate evidence that ACD produce lower rate of fusion than ACDF and than the cages. There is limited evidence of the lower capacity of PMMA to produce fusion. There is limited evidence that fused patients have better outcome than non fused patients.

Botelho, Ricardo Vieira; dos Santos Buscariolli, Yuri; de Barros Vasconcelos Fernandes Serra, Marcus Vinicius Flores; Bellini, Marcia Nogueira Pires; Bernardo, Wanderley Marques

2012-01-01

317

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results  

PubMed Central

In the future, there will be an increased number of cervical revision surgeries, including 4- and more-levels. But, there is a paucity of literature concerning the geometrical and clinical outcome in these challenging reconstructions. To contribute to current knowledge, we want to share our experience with 4- and 5-level anterior cervical fusions in 26 cases in sight of a critical review of literature. At index procedure, almost 50% of our patients had previous cervical surgeries performed. Besides failed prior surgeries, indications included degenerative multilevel instability and spondylotic myelopathy with cervical kyphosis. An average of 4.1 levels was instrumented and fused using constrained (26.9%) and non-constrained (73.1%) screw-plate systems. At all, four patients had 3-level corpectomies, and three had additional posterior stabilization and fusion. Mean age of patients at index procedure was 54 years with a mean follow-up intervall of 30.9 months. Preoperative lordosis C2-7 was 6.5° in average, which measured a mean of 15.6° at last follow-up. Postoperative lordosis at fusion block was 14.4° in average, and 13.6° at last follow-up. In 34.6% of patients some kind of postoperative change in construct geometry was observed, but without any catastrophic construct failure. There were two delayed unions, but finally union rate was 100% without any need for the Halo device. Eleven patients (42.3%) showed an excellent outcome, twelve good (46.2%), one fair (3.8%), and two poor (7.7%). The study demonstrated that anterior-only instrumentations following segmental decompressions or use of the hybrid technique with discontinuous corpectomies can avoid the need for posterior supplemental surgery in 4- and 5-level surgeries. However, also the review of literature shows that decreased construct rigidity following more than 2-level corpectomies can demand 360° instrumentation and fusion. Concerning construct rigidity and radiolographic course, constrained plates did better than non-constrained ones. The discussion of our results are accompanied by a detailed review of literature, shedding light on the biomechanical challenges in multilevel cervical procedures and suggests conclusions.

Koller, Heiko; Ferraris, Luis; Maier, Oliver; Hitzl, Wolfgang; Metz-Stavenhagen, Peter

2007-01-01

318

Sensitivity, Reliability and Accuracy of the Instant Center of Rotation Calculation in the Cervical Spine During In Vivo Dynamic Flexion-Extension  

PubMed Central

The instant center of rotation (ICR) has been proposed as an alternative to range of motion (ROM) for evaluating the quality, rather than the quantity, of cervical spine movement. The purpose of the present study was to assess the sensitivity, reliability and accuracy of cervical spine ICR path calculations obtained during dynamic in vivo movement. The reliability and sensitivity of in vivo cervical spine ICR calculations were assessed by evaluating the effects of movement direction (flexion versus extension), rotation step size, filter frequency, and motion tracking error. The accuracy of the ICR path calculations was assessed through a simulation experiment that replicated in vivo movement of cervical vertebrae. The in vivo assessment included 20 asymptomatic subjects who performed continuous head flexion-extension movements while biplane radiographs were collected at 30 frames/s. In vivo motion of C2 through C7 cervical vertebrae was tracked with sub-millimeter accuracy using a volumetric model-based tracking technique. The finite helical axis method was used to determine ICRs between each pair of adjacent vertebra. The in vivo results indicate ICR path is not different during the flexion movement and the extension movement. In vivo, the path of the ICR can reliably be characterized within 0.5 mm in the SI and 1.0 mm in the AP direction. The inter-subject variability in ICR location averaged ±1.2 mm in the SI direction and ±2.2 mm in the AP direction. The computational experiment estimated the in vivo accuracy in ICR location was between 1.1 mm and 3.1 mm.

Baillargeon, Emma

2013-01-01

319

Clinical decision making in spinal fusion for chronic low back pain. Results of a nationwide survey among spine surgeons  

PubMed Central

Objectives To assess the use of prognostic patient factors and predictive tests in clinical decision making for spinal fusion in patients with chronic low back pain. Design and setting Nationwide survey among spine surgeons in the Netherlands. Participants Surgeon members of the Dutch Spine Society were questioned on their surgical treatment strategy for chronic low back pain. Primary and secondary outcome measures The surgeons' opinion on the use of prognostic patient factors and predictive tests for patient selection were addressed on Likert scales, and the degree of uniformity was assessed. In addition, the influence of surgeon-specific factors, such as clinical experience and training, on decision making was determined. Results The comments from 62 surgeons (70% response rate) were analysed. Forty-four surgeons (71%) had extensive clinical experience. There was a statistically significant lack of uniformity of opinion in seven of the 11 items on prognostic factors and eight of the 11 items on predictive tests, respectively. Imaging was valued much higher than predictive tests, psychological screening or patient preferences (all p<0.01). Apart from the use of discography and long multisegment fusions, differences in training or clinical experience did not appear to be of significant influence on treatment strategy. Conclusions The present survey showed a lack of consensus among spine surgeons on the appreciation and use of predictive tests. Prognostic patient factors were not consistently incorporated in their treatment strategy either. Clinical decision making for spinal fusion to treat chronic low back pain does not have a uniform evidence base in practice. Future research should focus on identifying subgroups of patients for whom spinal fusion is an effective treatment, as only a reliable prediction of surgical outcome, combined with the implementation of individual patient factors, may enable the instalment of consensus guidelines for surgical decision making in patients with chronic low back pain.

de Bie, Rob; Oner, Cumhur; Castelein, Rene; de Kleuver, Marinus

2011-01-01

320

Lower cervical spine loading in frontal sled tests using inverse dynamics: potential applications for lower neck injury criteria.  

PubMed

Lower cervical spine injuries are more common in survivors of motor vehicle crashes sustaining neck trauma. Injury criteria are determined using upper neck loads in dummies although a lower neck load cell exists. Due to a paucity of lower neck data from post mortem human subject (PMHS) studies, this research was designed to determine the head-neck biomechanics with a focus on lower neck metrics and injuries. Sixteen frontal impact tests were conducted using five belted PMHS. Instrumentation consisted of a pyramid shaped nine accelerometer package on the head, tri-axial accelerometer on T1, and uniaxial accelerometer on the sled. Three-dimensional kinematics of the head-neck complex were obtained using a 20- camera high-speed motion analysis system. Testing sequence was: low (3.6 m/s), medium (6.9 m/s), repeat low, and high (15.8 m/s) velocities. Trauma evaluations were made between tests. Testing was terminated upon confirmation of injuries. Autopsy was conducted, and geometric and inertial properties of the head were determined. Using inverse dynamics, upper and lower neck loads were determined, along with head and T1 kinematics. Lower cervical injuries occurred in four specimens during the loading phase and were attributed to the flexion mechanism. Peak upper and lower neck loading magnitudes and head-neck and T1 kinematics are given for each test. Sagittal plane head center of gravity and T1 kinematic data along with upper and lower neck forces and moments, hitherto not reported in literature, may be used to determine the biofidelity responses of frontal impact dummies and establish lower neck injury criteria. PMID:21512907

Pintar, Frank A; Yoganandan, Narayan; Maiman, Dennis J

2010-11-01

321

C5 nerve root palsy following decompression of the cervical spine: a systematic evaluation of the literature.  

PubMed

C5 nerve root palsy is a rare and potentially debilitating complication of cervical spine surgery. Currently, however, there are no guidelines to help surgeons to prevent or treat this complication. We carried out a systematic review of the literature to identify the causes of this complication and options for its prevention and treatment. Searches of PubMed, Embase and Medline yielded 60 articles for inclusion, most of which addressed C5 palsy as a complication of surgery. Although many possible causes were given, most authors supported posterior migration of the spinal cord with tethering of the nerve root as being the most likely. Early detection and prevention of a C5 nerve root palsy using neurophysiological monitoring and variations in surgical technique show promise by allowing surgeons to minimise or prevent the incidence of C5 palsy. Conservative treatment is the current treatment of choice; most patients make a full recovery within two years. Cite this article: Bone Joint J 2014;96-B:950-5. PMID:24986950

Guzman, J Z; Baird, E O; Fields, A C; McAnany, S J; Qureshi, S A; Hecht, A C; Cho, S K

2014-07-01

322

Implementation and validation of probabilistic models of the anterior longitudinal ligament and posterior longitudinal ligament of the cervical spine.  

PubMed

The objective of this investigation was to develop probabilistic finite element (FE) models of the anterior longitudinal ligament (ALL) and posterior longitudinal ligament (PLL) of the cervical spine that incorporate the natural variability of biological specimens. In addition to the model development, a rigorous validation methodology was developed to quantify model performance. Experimental data for the geometry and dynamic properties of the ALL and PLL were used to create probabilistic FE models capable of predicting not only the mean dynamic relaxation response but also the observed experimental variation of that response. The probabilistic FE model uses a quasilinear viscoelastic material constitutive model to capture the time-dependent behaviour of the ligaments. The probabilistic analysis approach yields a statistical distribution for the model-predicted response at each time point rather than a single deterministic quantity (e.g. ligament force) and that response can be statistically compared to experimental data for validation. A quantitative metric that compares the cumulative distribution functions of the experimental data and model response is computed for both the ALL and PLL throughout the time histories and is used to quantify model performance. PMID:23113530

Francis, W Loren; Eliason, Travis D; Thacker, Ben H; Paskoff, Glenn R; Shender, Barry S; Nicolella, Daniel P

2014-06-01

323

Evaluation of a single-dose, extended-release epidural morphine formulation for pain control after lumbar spine surgery.  

PubMed

DepoDur, an extended-release epidural morphine, has been used effectively for postoperative pain control following many orthopaedic and general surgery procedures and has provided prolonged analgesia when compared with Duramorph. The goal of this article was to compare the safety and analgesic efficacy of DepoDur versus Duramorph after lumbar spine surgery. A prospective, randomized, double-blind clinical study was completed at a single extended-stay ambulatory surgery center. All patients over 18 undergoing posterior lumbar spine fusions were considered for the study. Sixty patients were randomly assigned to a control or treatment group. The control group received DepoDur before surgery, while the treatment group received Duramorph. Although results show no significant differences between the two groups in postoperative visual analog pain scale scores, use of pain medication, and adverse events, subjects receiving DepoDur were less likely to receive Naloxone and oxygen supplementation, experience nausea or fever, and were more likely to experience hypotension. DepoDur proved to be safe and effective, offering similar prolonged analgesic activity when compared with Duramorph. PMID:24641892

Vineyard, Joseph C; Toohey, John S; Neidre, Arvo; Fogel, Guy; Joyner, Robert

2014-01-01

324

Malignant degeneration of multilevel monostotic Paget's disease involving the thoracic spine: an unusual presentation.  

PubMed

Paget's disease is the second most common metabolic bone disease after osteoporosis and is characterized by abnormal bone turnover and remodeling that can lead to pain, pathological fracture, bony deformity and nerve compression syndromes. The lumbar region is the most commonly affected site within the spine followed by the thoracic and cervical spine. Even though the spine is affected very commonly in Paget's disease, malignant degeneration is exceptionally rare. Multilevel monostotic spine involvement due to Paget's disease is very uncommon. An unusual clinico-radiological manifestation of multilevel thoracic Paget's disease with sarcomatous degeneration presenting as a neurosurgical emergency is reported with a pertinent review of the literature. PMID:24411323

Tan, Lee A; Kasliwal, Manish K; Harbhajanka, Aparna; Miller, Ira J; Deutsch, Harel

2014-07-01

325

Spontaneous cervical intradural disc herniation.  

PubMed

Cervical intradural disc herniation (IDH) is a rare condition with very few case reports in the literature. We report a 64-year-old man who presented with sudden onset neck pain and rapidly progressing weakness in the left upper and lower limb. There was no history of trauma. MRI of the cervical spine showed a C6-C7 disc prolapse, for which he underwent a C6-C7 discectomy and fusion with bone graft through an anterior cervical approach. To our knowledge, all patients with a cervical IDH reported in the literature have a traumatic etiology. To the best of our knowledge, we report the first patient with a spontaneous cervical IDH. PMID:24210799

Warade, Abhijit G; Misra, Basant K

2014-05-01

326

Multiplanar CT of the spine  

SciTech Connect

This book contains 16 chapters. Some of the topics are: CT of the Sacrum, The Postoperative Spine, Film Organizations and Case Reporting, Degeneration and Disc Disease of the Intervertebral Joint, Lumbar Spinal Stenosis, and Cervical and Thoracic Spine.

Rothman, S.L.G.; Glenn, W.V.

1985-01-01

327

Cervical Spondylotic Myelopathy presenting as mechanical neck pain: A case report.  

PubMed

Cervical Spondylotic Myelopathy (CSM) is the most common type of myelopathy in adults over 55 years of age. In the early stages symptoms may include local neck pain and stiffness that might mimic the presentation of non-specific mechanical neck pain (NSMNP). The patient was a 79 year old male, who complained of eight weeks of neck pain. He had been referred for physiotherapy by his family physician with a diagnosis of NSMNP. Initial presentation was consistent with the referral, but further assessment by the physiotherapist revealed findings suggestive of CSM. He was referred for an urgent cervical MRI scan, which revealed myelomalacic changes at C3/4 due to spondylotic changes. The patient was unsuitable for manual therapy intervention and was referred to a spinal orthopaedic surgeon who performed a posterior decompression and stabilisation at C3-C5, 2 months after the initial presentation. This case report highlights the importance of considering CSM in adults over 55 years of age presenting with NSMNP, particularly as the prevalence of both increases with age. It demonstrates the need for health professionals to carry out detailed examination where CSM may be a potential differential diagnosis. Outcomes are less favourable for patients over the age of 70, therefore an urgent surgical opinion was required for this patient. Deterioration of symptoms whilst he awaited surgery demonstrates how missed diagnosis may lead to possible long term spinal cord damage, with potential medico-legal concerns for the therapist. PMID:24815593

Smith, Benjamin E; Diver, Claire J; Taylor, Alan J

2014-08-01

328

Riluzole attenuates neuropathic pain and enhances functional recovery in a rodent model of cervical spondylotic myelopathy.  

PubMed

Cervical spondylotic myelopathy (CSM) is the commonest cause of spinal cord impairment worldwide and despite surgical treatment, it is commonly associated with chronic neuropathic pain and neurological impairment. Based on data suggesting a key role of sodium and glutamate mediated cellular injury in models of spinal cord compression, we examined whether riluzole, a sodium channel/glutamate blocker, could improve neurobehavioral outcomes in a rat model of CSM. To produce chronic progressive compression of the cervical spinal cord, we used an established model of graded mechanical cord compromise developed in our laboratory. The chronic (8weeks) mechanical compression of the cervical spinal cord resulted in persistent mechanical allodynia and thermal hyperalgesia at 8weeks. Moreover, we found increased expression of phosphorylated NR1 and NR2B in the dorsal horns as well as astrogliosis and increased microglia expression in the dorsal horns after mechanical compression. Following daily systemic administration for 7weeks after the induction of compression, riluzole (8mg/kg) significantly attenuated forelimb and hindlimb mechanical allodynia and alleviated thermal hyperalgesia in the tail. Importantly, riluzole led to a decrease in swing phase duration, an increase in hind leg swing speed and an increase paw intensity in gait analysis. Riluzole also decreased the number of phosphorylated NR1 and phosphorylated NR2B positive cells in the dorsal horns and the microglia activation in the dorsal horns. Together, our results indicate that systemic riluzole administration during chronic cervical spinal cord compression is effective at protecting spinal cord tissue, preserving neurobehavioral function and alleviating neuropathic pain, possibly by decreasing NMDA receptor phosphorylation in astrocytes and by eliminating microglia activation. As such, riluzole represents a promising clinical treatment for CSM. PMID:24184328

Moon, Eun Su; Karadimas, Spyridon K; Yu, Wen-Ru; Austin, James W; Fehlings, Michael G

2014-02-01

329

Skip laminectomy—a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processes  

Microsoft Academic Search

Background context: Techniques in current use for expansive laminoplasty operations (ELAP) on the cervical spine damage the extensor mechanisms, resulting in restriction of neck motion, loss of lordosis and persistent axial pains.Purpose: This article introduces a new surgical technique called skip laminectomy, which reduces morbidity after decompression of the cervical spinal canal. Study design\\/setting: A prospective study is presented of

Tateru Shiraishi

2002-01-01

330

Reliability of a measure of total lumbar spine range of motion in individuals with low back pain.  

PubMed

Measuring lumbar spine range of motion (ROM) using multiple movements is impractical for clinical research, because finding statistically significant effects requires a large proportion of subjects to present with the same impairment. The purpose of this study was to develop a single measure representing the total available lumbar ROM. Twenty participants with low back pain performed three series of eight lumbar spine movements, in each of two sessions. For each series, an ellipse and a cubic spline were fit to the end-range positions, measured based on the position of the twelfth thoracic vertebra in the transverse plane of the sacrum. The area of each shape provides a measure of the total available ROM, whereas their center reflects the movements' symmetry. Using generalizability theory, the index of dependability for the area and anterior-posterior center position was found to be 0.90, but was slightly lower for the mediolateral center position. Slightly better values were achieved using the spline-fitting approach. Further analysis also indicated that excellent reliability, and acceptable minimal detectable change values, would be achieved with a single testing session. These data indicate that the proposed measure provides a reliable and easily interpretable measure of total lumbar spine ROM. PMID:23270840

Al-Zoubi, Fadi M; Preuss, Richard A

2013-12-01

331

Endurance and fatigue characteristics of the neck flexor and extensor muscles during isometric tests in patients with postural neck pain  

Microsoft Academic Search

Sustained postural loading of the cervical spine during work or recreational tasks may contribute to the development of neck pain. The aim of this study was to compare neck muscle endurance and fatigue characteristics during sub-maximal isometric endurance tests in patients with postural neck pain, with asymptomatic subjects. Thirteen female patients with postural neck pain and 12 asymptomatic female control

Stephen Edmondston; Guðný Björnsdóttir; Thorvaldur Pálsson; Hege Solgård; Kasper Ussing; Garry Allison

2011-01-01

332

Vertebral Distraction during Anterior Cervical Discectomy and Fusion Causes Postoperative Neck Pain  

PubMed Central

Objective Vertebral distraction is routinely performed during anterior cervical discectomy and fusion (ACDF). Overdistraction can injure the facet joints and may cause postoperative neck pain consequently. The purpose of this study was to investigate the clinical relevance of distraction force during ACDF. Methods This study included 24 consecutive patients with single level cervical disc disease undergoing single level ACDF. We measure the maximum torque just before the the arm of the Caspar retractor was suspended by the rachet mechanism by turning the lever on the movable arm using a torque meter. In order to turn the lever using the torque driver, we made a linear groove on the top of the lever. We compared the neck disability index (NDI) and visual analogue scale (VAS) scores between the high torque group (distraction force>6 kgf·cm) and the low torque group (distraction force?6 kgf·cm) at routine postoperative intervals of 1, 3, 5 days and 1, 3, 6 months. Results The VAS scores for posterior neck pain had a linear correlation with torque at postoperative 1st and 3rd days (y=0.99×-1.1, r2=0.82; y=0.77×-0.63, r2=0.73, respectively). VAS scores for posterior neck pain were lower in the low torque group than in the high torque group on both 1 and 3 days postoperatively (3.1±1.3, 2.6±1.0 compared with 6.0±0.6, 4.9±0.8, p<0.01). However, the difference in NDI scores was not statistically significant in all postoperative periods. Conclusion Vertebral distraction may cause posterior neck pain in the immediate postoperative days. We recommend not to distract the intervertebral disc space excessively with a force of more than 6.0 kgf·cm.

Ha, Seung Man; Kim, Jeong Hoon; Oh, Seung Hun; Song, Ji Hwan; Kim, Hyoung Ihl

2013-01-01

333

Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: Pros, cons, and costs  

PubMed Central

Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the “value-added” of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent “post hoc analysis of data from a prospective multicenter trial” (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the “value added” of these increasingly expensive graft constructs.

Epstein, Nancy E.

2012-01-01

334

Effect of the Spacing of Backpack Shoulder Straps on Cervical Muscle Activity, Acromion and Scapular Position, and Upper Trapezius Pain  

PubMed Central

[Purpose] This study investigated the effect of the spacing of backpack shoulder straps on cervical muscle activity, acromion and scapular position, and upper trapezius (UT) pain. [Subjects] Fourteen males aged 20–32?years, were recruited. [Methods] We measured the MPS (midcervical paraspinal) activity, acromial angle, scapular distance, and UT pain after gait carrying a backpack with different shoulder strap spacings. [Results] The MPS, scapular inferior distance, and UT pressure pain threshold was significantly decreased and the acromion angle was significantly increased when carrying a backpack with wide shoulder straps compared to narrow shoulder straps. [Conclusion] A backpack with wide shoulder straps may cause scapular depression syndrome and chronic UT pain.

Kim, Min-hee; Yoo, Won-gyu

2013-01-01

335

A Randomized Trial of Chiropractic Manipulation and Mobilization for Patients With Neck Pain: Clinical Outcomes From the UCLA Neck-Pain Study  

PubMed Central

Objectives. This study compared the relative effectiveness of cervical spine manipulation and mobilization for neck pain. Methods. Neck-pain patients were randomized to the following conditions: manipulation with or without heat, manipulation with or without electrical muscle stimulation, mobilization with or without heat, and mobilization with or without electrical muscle stimulation. Results. Of 960 eligible patients, 336 enrolled in the study. Mean reductions in pain and disability were similar in the manipulation and mobilization groups through 6 months. Conclusions. Cervical spine manipulation and mobilization yield comparable clinical outcomes.

Hurwitz, Eric L.; Morgenstern, Hal; Harber, Philip; Kominski, Gerald F.; Yu, Fei; Adams, Alan H.

2002-01-01

336

'Iatrogenic' brain stem infarction. A complication of x-ray examination of the cervical spine and following posterior tamponation of the nose.  

PubMed

Two patients sustained an ischemic brain stem infarction during medical examination and treatment. The first patient lost consciousness and the spontaneous respiration ceased during X-ray examination of the cervical spine when the neck was hyperextended. After some minutes he regained conciousness but was found to be tetraplegic, and the patient deceased 4 months later. The angiogram revealed thrombosis of the basilar artery. The other patient had profuse nosebleed and was treated with posterior tamponation during which she sat for about 10 min with the neck hyperextended. Some hours after this procedure symptoms and signs of lateral caudal brain stem infarction emerged. PMID:1126348

Fogelholm, R; Karli, P

1975-01-01

337

Chronic At- and Below-Level Pain after Moderate Unilateral Cervical Spinal Cord Contusion in Rats  

PubMed Central

Abstract Chronic neuropathic pain is a significant consequence of spinal cord injury (SCI) that is associated with evoked pain, including allodynia and/or hyperalgesia. Allodynia is defined as a painful response to normally innocuous stimuli, and hyperalgesia occurs when there is an amplified pain response to normally noxious stimuli. We describe a model of a unilateral cervical level (C5) contusion injury where sensory recovery was assessed weekly for 6 weeks in 32 adult, female, Sprague-Dawley rats. Bilateral thermal hyperalgesia and tactile allodynia are detectable in the fore- and hindpaws as early as 7 days post-injury (dpi) and persist for at least 42 days. Paw withdrawal latency in response to a noxious thermal stimulus significantly intra-animal pre-operative values. Change in paw withdrawal latency plateaued at 21?dpi. Interestingly, bilateral forepaw allodynia develops in fewer than 40% of rats as measured by von Frey monofilament testing. Similar results occur in the hindpaws, where bilateral allodynia occurs in 46% of rats with SCI. The contralesional forepaw and both hindpaws of rats showed a slight increase in paw withdrawal threshold to tactile stimuli acutely after SCI, corresponding to ipsilesional forelimb motor deficits that resolve over time. That there is no difference among allodynic and non-allodynic groups in overall spared tissue or specifically of the dorsal column or ventrolateral white matter where ascending sensory tracts reside suggests that SCI-induced pain does not depend solely on the size or extent of the lesion, but that other mechanisms are in play. These observations provide a valid model system for future testing of therapeutic interventions to prevent the onset or to reduce the debilitating effects of chronic neuropathic pain after SCI.

Wade, Rodel E.; Houle, John D.

2013-01-01

338

Pregabalin and Radicular Pain Study (PARPS) for Cervical Spondylosis in a Multiracial Asian Population  

PubMed Central

Background Pain from cervical spondylosis (CS) may result from degenerative spinal canal stenosis (cervical spondylotic myelopathy (CSM)) or lateral recesses compromise, leading to nerve root compression (cervical spondylotic radiculopathy (CSR)). Pregabalin was shown to be effective in randomized, placebo-controlled trials for post-herpetic neuralgia and diabetic neuropathy. We evaluate its efficacy in CS with underlying CSR or CSM in a prospective study comprising Asian patients for the first time. Methods Patients with CS and CSR or CSM (clinical, MRI, or electrophysiological evidence) presenting with neuropathic pain were recruited. We excluded patients with diabetes, underlying neurological disease or who were previously on antiepileptics. Pregabalin 75 mg bd was administered for 4 weeks, after which dosage was increased to 150 mg bd for another 4 weeks if the visual analog scale (VAS) was not reduced by 50%. In addition, we monitored the short form McGill pain questionnaire (SFMPQ) at baseline, 4 weeks and 8 weeks. Mood changes were monitored using the hospital anxiety and depression score (HADS) with an identical timeline. Results We recruited 50 patients, of which 23 completed the trial. Of the 27 who withdrew, 12 (44%) were for somnolence. Thirteen patients’ (54%) dosages remained at 75 mg and 11 patients’ (46%) dosages were escalated to 150 mg bd. There were significantly reducing trends from baseline for VAS (ANOVA, F(1, 21) = 25.4, P < 0.0005), SFMPQ (sensory) (F(1, 22) = 11.2, P = 0.003), and SFMPQ (affective) (F(1, 21) = 10.9, P = 0.008). For VAS, there was significant reduction at 4 weeks (P = 0.001) and 8 weeks (P < 0.0005) compared to baseline. For SFMPQ (sensory), there was significant reduction at 4 weeks (P = 0.01) and 8 weeks (P = 0.006) in scores compared to baselines. For SFMPQ (affective), there was significant reduction at 4 weeks (P = 0.04) and 8 weeks (P = 0.008) in scores compared to baseline. No significant anxiety (F(1, 4) = 1.3, P = 0.32) or depression (F(1, 4) = 0.06, P = 0.82) changes were observed in the HADS. Conclusion Pregabalin is efficacious in alleviation of pain symptoms related to CSR as a first-line single agent, evaluated by quantitative severity and other experiential scales. No significant mood changes reported in other studies were demonstrated. Somnolence was commonest adverse effect leading to high dropout rates, occurring early even at the lowest dose. The findings suggest the need for further studies of efficacy at lower dosages, particularly in the Asian population.

Lo, Yew Long; Cheong, Priscilia Woon Ting; George, Jane Mary; Tan, Seang Beng; Yue, Wai Mun; Guo, Chang Ming; Fook-Chong, Stephanie

2014-01-01

339

A randomized controlled trial on the efficacy of intermittent cervical traction for patients with chronic neck pain  

Microsoft Academic Search

Objective: To investigate the efficacy of intermittent cervical traction in the treatment of chronic neck pain over a 12-week follow-up.Design: A randomized controlled trial.Setting: Hospital-based outpatient practice.Subjects: Seventy-nine patients with chronic neck pain.Interventions: Subjects were randomly assigned to either experimental group (n = 39, mean age = 50.5 ± 9.8) or control group (n = 40, mean age = 48.8

Thomas TW Chiu; Joseph Kim-Fai Ng; Barbro Walther-Zhang; Rex JH Lin; Luc Ortelli; Siew Kuan Chua

2011-01-01

340

Geriatric Trauma Patients With Cervical Spine Fractures due to Ground Level Fall: Five Years Experience in a Level One Trauma Center  

PubMed Central

Background It has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered “minor trauma” with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these geriatric trauma patients. Methods Data were reviewed from the institutional trauma registry of our local level 1 trauma center. All patients had sustained C-spine fracture(s). Basic clinical characteristics, the distribution of C-spine fracture(s), and mechanism of injury in geriatric patients (65 years or older) were compared with those less than 65 years old. Furthermore, different clinical variables including age, gender, Glasgow coma scale (GCS), blood alcohol level, and co-existing injuries were analyzed by multivariate logistic regression in geriatric trauma patients due to GLF and internally validated by random bootstrapping technique. Results From 2006 - 2010, a total of 12,805 trauma patients were included in trauma registry, of which 726 (5.67%) had sustained C-spine fracture(s). Among all C-spine fracture patients, 19.15% (139/726) were geriatric patients. Of these geriatric patients 27.34% (38/139) and 53.96% (75/139) had C1 and C2 fractures compared with 13.63% (80/587) and 21.98% (129/587) in young trauma patients (P < 0.001). Of geriatric trauma patients 13.67% (19/139) and 18.71% (26/139) had C6 and C7 fractures compared with 32.03% (188/587) and 41.40% (243/587) in younger ones separately (P < 0.001). Furthermore, 53.96% (75/139) geriatric patients had sustained C-spine fractures due to GLF with more upper C-spine fractures (C1 and C2). Only 3.2% of those had positive blood alcohol levels compared with 52.9% of younger patients (P < 0.001). In addition, 6.34% of geriatric patients due to GLF had intracranial pathology (ICP) which was one of the most common co-injuries with C-spine fractures. Logistic regression analysis showed the adjusted odds ratios of 1.17 (age) and 91.57 (male) in geriatric GLF patients to predict this co-injury pattern of C-spine fracture and ICP. Conclusion Geriatric patients tend to sustain more upper C-spine fractures than non-geriatric patients regardless of the mechanisms. GLF or less not only can cause isolated C-spines fracture(s) but also lead to other significant injuries with ICP as the most common one in geriatric patients. Advanced age and male are two risk factors that can predict this co-injury pattern. In addition, it seems that alcohol plays no role in the cause of GLF in geriatric trauma patients.

Wang, Hao; Coppola, Marco; Robinson, Richard D.; Scribner, James T.; Vithalani, Veer; de Moor, Carrie E.; Gandhi, Raj R.; Burton, Mandy; Delaney, Kathleen A.

2013-01-01

341

Effect of Deep Cervical Flexor Training vs. Conventional Isometric Training on Forward Head Posture, Pain, Neck Disability Index In Dentists Suffering from Chronic Neck Pain  

PubMed Central

Neck pain accounts for 15% of all soft tissue problems seen in general practice and are a common reason for referral to physiotherapy treatment. The prevalence of neck pain in dentists is 74.3%. Musculoskeletal symptoms in dentists are caused due to many reasons for e.g., prolonged static posture, repetitive movements, suboptimal lighting, and genetic predisposition. Since deep cervical muscle activity is required in synergy with superficial muscle activity to stabilize the cervical segments, a study is needed, to compare the effectiveness of deep cervical flexor (DCF) training and posture correction training on neck pain and neck disability index and forward head posture. Aim: To determine and compare the effect of DCF training on forward head posture, neck pain and neck disability index in dentists suffering from chronic non severe neck pain. Material and Methods: Total of 30 subjects were selected, based on inclusion and exclusion criteria, who were further divided into Experimental and Control groups. Baseline information of dependent variables was taken at the beginning of study on day one, for Visual Analogue Scale (VAS) and Neck disability Index (NDI). Forward head posture was measured on day one using digital photograph technique. Then, Experimental group was given DCF training and Control group was given conventional isometrics training (CIT) for 4 weeks under supervision of examiner. All measurements were repeated at end of 4th week, on completion of study. Results: It was observed that pain and disability had reduced in both groups on group analysis. But the forward head posture had improved significantly in experimental group only. Conclusion: DCF training is more effective than CIT in improving forward head posture, decreasing pain and disability in dentists suffering from chronic neck pain.

Gupta, Bhuvan Deep; Aggarwal, Shagun; Gupta, Bharat; Gupta, Madhuri; Gupta, Neha

2013-01-01

342

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  

PubMed Central

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.

Cao, Lu; Duan, Ping-Guo; Li, Xi-Lei; Yuan, Feng-Lai; Zhao, Ming-Dong; Che, Wu; Wang, Hui-Ren; Dong, Jian

2012-01-01

343

Spinal manipulative therapy versus Graston Technique in the treatment of non-specific thoracic spine pain: Design of a randomised controlled trial  

PubMed Central

Background The one year prevalence of thoracic back pain has been estimated as 17% compared to 64% for neck pain and 67% for low back pain. At present only one randomised controlled trial has been performed assessing the efficacy of spinal manipulative therapy (SMT) for thoracic spine pain. In addition no high quality trials have been performed to test the efficacy and effectiveness of Graston Technique® (GT), a soft tissue massage therapy using hand-held stainless steel instruments. The objective of this trial is to determine the efficacy of SMT and GT compared to a placebo for the treatment of non specific thoracic spine pain. Methods Eighty four eligible people with non specific thoracic pain mid back pain of six weeks or more will be randomised to one of three groups, either SMT, GT, or a placebo (de-tuned ultrasound). Each group will receive up to 10 supervised treatment sessions at the Murdoch University Chiropractic student clinic over a 4-week period. Treatment outcomes will be measured at baseline, one week after their first treatment, upon completion of the 4-week intervention period and at three, six and twelve months post randomisation. Outcome measures will include the Oswestry Back Pain Disability Index and the Visual Analogue Scale (VAS). Intention to treat analysis will be utilised in the statistical analysis of any group treatment effects. Trial Registration This trial was registered with the Australia and New Zealand Clinical Trials Registry on the 7th February 2008. Trial number: ACTRN12608000070336

Crothers, Amy; Walker, Bruce; French, Simon D

2008-01-01

344

Rigid Spine Syndrome and Rigid Spine Sign in Myopathies  

Microsoft Academic Search

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

Luciano Merlini; Claudia Granata; Alessandro Ballestrazzi; Maria Letizia Marini

1989-01-01

345

C Spine Fracture on OPG.  

PubMed

Maxillofacial injuries are common and they occur in a variety of situations. All patients who undergo maxillofacial or head trauma, are presumed to sustain cervical spine injuries. Identification of cervical spine injuries is essential in management of trauma, because a missed injury can result in a catastrophic spinal cord injury. Advanced Trauma Life Support (ATLS) guidelines have suggested that routine use of cervical spine radiographs may not be required in an asymptomatic patient. We are presenting here a case with a cervical spine injury with no clinical deficits, found incidentally on panoramic radiographs which were advised for evaluation of the mandibular fracture. We suggest that importance has to be given to examination of the cervical spine on the panoramic radiographs as well. PMID:24086924

N S, Kedarnath; N S, Mamatha; R, Shruthi

2013-08-01

346

C Spine Fracture on OPG  

PubMed Central

Maxillofacial injuries are common and they occur in a variety of situations. All patients who undergo maxillofacial or head trauma, are presumed to sustain cervical spine injuries. Identification of cervical spine injuries is essential in management of trauma, because a missed injury can result in a catastrophic spinal cord injury. Advanced Trauma Life Support (ATLS) guidelines have suggested that routine use of cervical spine radiographs may not be required in an asymptomatic patient. We are presenting here a case with a cervical spine injury with no clinical deficits, found incidentally on panoramic radiographs which were advised for evaluation of the mandibular fracture. We suggest that importance has to be given to examination of the cervical spine on the panoramic radiographs as well.

N.S., Kedarnath; N.S., Mamatha; R., Shruthi

2013-01-01

347

The Cervical Spine of the American Barn Owl (Tyto furcata pratincola): I. Anatomy of the Vertebrae and Regionalization in Their S-Shaped Arrangement  

PubMed Central

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.

Krings, Markus; Nyakatura, John A.; Fischer, Martin S.; Wagner, Hermann

2014-01-01

348

Effect of laser acupuncture versus traditional acupuncture in neck pain of cervical spondylosis  

NASA Astrophysics Data System (ADS)

This prospective cohort study aimed to compare the efficiency of laser versus traditional acupuncture in treating cervical spondylosis (CS) pain. Forty female patients were randomized into two equal groups that received 3 sessions / week for 4 weeks. Group A received needle acupuncture therapy with electrical stimulation for 20 min at standard acupoints, ear points and Ashi point on the average 3 points. Group B received low level laser therapy (LLLT) acupuncture at the same acupoints. The results demonstrated that tenderness disappeared in 65% of patients in group A and 75% of patients in group B with improved percentage of 85.5% and 89.2%. Pain on VAS related to direction of motion at 6 directions was improved in all cases where with improvement percentage 76.45% and 85.88%. Pain on VAS at rest was improved in all patients with improvement percentage of 80.41% and 84.28%. NDIQ score improved in all patients with improvement percentage of 69.78% and 73.77%. Follow up of VAS after 6 months from the last session revealed persistent improvement in 55% of patients of group A vs 80% of patients of group B. Mean serum TNF-? was decreased in 85% of patients of group A vs 95% of patients of group B where serum beta endorphins was increased in all patients. It is concluded that both modes of treatment for CS gave improvement regarding pain intensity, disability and quality of life being more evident in LLLT followed for 6 months supported with improved serum TNF? and beta endorphin.

El-Kharbotly, Ahmed M.; El-Gendy, Alyaa A.; Mohammed, Mouchira A.; El-Masry, Manal R.; Daoud, Eitedal M.; Hassan, Nagwa; Abdel-Wahab, Khaled G.; Helmy, Ghada; Mostafa, Taymour

2014-02-01

349

Development of the young spine questionnaire  

PubMed Central

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.

2013-01-01

350

Validation protocol for assessing the upper cervical spine kinematics and helical axis: An in vivo preliminary analysis for axial rotation, modeling, and motion representation  

PubMed Central

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.

Dugailly, Pierre-Michel; Sobczak, Stephane; Lubansu, Alphonse; Rooze, Marcel; Jan, SergeVan Sint; Feipel, Veronique

2013-01-01

351

Visualization of the Foramen Intervertebral Nerve Root of Cervical Spine with 3.0 Tesla Magnetic Resonance Imaging: A Comparison of Three-dimensional Acquisition Techniques.  

PubMed

Identification of the compression factor in cervical disc herniation and cervical spondylotic radioculopathy is often problematic when using two-dimensional magnetic resonance imaging (MRI). This prompted us to compare and examined three-dimensional sequences, coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC), fast imaging employing steady state acquisition (FIESTA) and T2 star weighted MR angiography (SWAN) with 3.0-Tesla (T) MRI to visualize the foramen intervertebral nerve root for the cervical spine. Fat-suppressed COSMIC (FS-COSMIC) sequence gave the highest signal intensity ratio (1.85±0.06) of the nerve root and vertebral arch. A significant difference in signal intensity ratio of the nerve root was found between FS-COSMIC and FIESTA sequences. No significant difference was found between the FS-COSMIC and FIESTA sequences in the cerebrospinal fluid and the spinal cord. The FS-COSMIC sequence proved to be the most suitable sequence for intra and extra dura matter. PMID:25055947

Shishido, Hiroki; Takashima, Hiroyuki; Takebayashi, Tsuneo; Akatsuka, Yoshihiro; Imamura, Rui; Nagahama, Hiroshi; Shirase, Ryuzi

2014-07-01

352

Reliability and validity of spinal coordination patterns during treadmill walking in persons with thoracic spine pain - a preliminary study  

PubMed Central

Background Persons with low back pain fail to show the same transition as healthy individuals from in-phase to anti-phase rotation of the thorax and pelvis as walking speed increases. The purpose of this study was to determine if the relative phase of the thorax and pelvis during walking was a reliable (within day test-retest) and valid measure for persons with thoracic pain. Methods The time series motion of the spine over C7, T8 and sacrum were measured at five treadmill walking speeds (0.67, 0.89, 1.12, 1.34, 1.56 m/s) in 19 persons with thoracic spine pain and 19 healthy control subjects. After a 20 minute rest, all tests were repeated. The average relative phases of the transverse plane rotation between C7-T8, C7-sacrum and T8-sacrum during a one-minute walk were calculated. The standard error of measurement (SEM) and the intra-class correlation coefficient (ICC) were used to estimate test-retest reliability. Three-way repeated measures analyses of variance were performed to determine the influence of group, walking speed and session on the relative phases. Results The minimum transverse plane motion amplitudes, across all participants and speeds, for the C7-T8, C7-sacrum, and T8-sacrum were 2.9, 5.1 and 2.8 degrees, respectively. The C7-T8 relative phase changed little with speed. The C7-sacrum and T8-sacrum relative phases showed increases as subjects walked faster, but both groups had similar patterns of change. Only the C7-T8 relative phase at 0.67 and 0.89 m/s exhibited good reliability (ICC?>?0.80, SEM 4.2-5.7, no significant time effects) for both groups. The C7-T8 and T8-sacrum relative phases demonstrated significant group by speed effects. Conclusions The C7-T8 relative phase showed reasonable reliability and some discrimination between groups, but changes in response to walking speed were small. The T8-sacrum relative phase showed some discriminative ability, but reliability was not adequate.

2013-01-01

353

Cervical spine CT scan  

MedlinePLUS

... type of contrast given into a vein contains iodine. If a person with an iodine allergy is given this type of contrast, nausea ... steroids before the test. The kidneys help remove iodine out of the body. People with kidney disease ...

354

Predominant Leg Pain Is Associated With Better Surgical Outcomes in Degenerative Spondylolisthesis and Spinal Stenosis: Results from the Spine Patient Outcomes Research Trial (SPORT)  

PubMed Central

Study Design As-treated analysis of the Spine Patient Outcomes Research Trial (SPORT). Objective To compare baseline characteristics and surgical and nonoperative outcomes in degenerative spondylolisthesis (DS) and spinal stenosis (SpS) patients stratified by predominant pain location (i.e. leg vs. back). Summary of Background Data Evidence suggests that degenerative spondylolisthesis (DS) and spinal stenosis (SpS) patients with predominant leg pain may have better surgical outcomes than patients with predominant low back pain (LBP). Methods The DS cohort included 591 patients (62% underwent surgery), and the SpS cohort included 615 patients (62% underwent surgery). Patients were classified as leg pain predominant, LBP predominant or having equal pain according to baseline pain scores. Baseline characteristics were compared between the three predominant pain location groups within each diagnostic category, and changes in surgical and nonoperative outcome scores were compared through two years. Longitudinal regression models including baseline covariates were used to control for confounders. Results Among DS patients at baseline, 34% had predominant leg pain, 26% had predominant LBP, and 40% had equal pain. Similarly, 32% of SpS patients had predominant leg pain, 26% had predominant LBP, and 42% had equal pain. DS and SpS patients with predominant leg pain had baseline scores indicative of less severe symptoms. Leg pain predominant DS and SpS patients treated surgically improved significantly more than LBP predominant patients on all primary outcome measures at one and two years. Surgical outcomes for the equal pain groups were intermediate to those of the predominant leg pain and LBP groups. The differences in nonoperative outcomes were less consistent. Conclusions Predominant leg pain patients improved significantly more with surgery than predominant LBP patients. However, predominant LBP patients still improved significantly more with surgery than with nonoperative treatment.

Pearson, Adam; Blood, Emily; Lurie, Jon; Abdu, William; Sengupta, Dilip; Frymoyer, John W.; Weinstein, James

2010-01-01

355

A diagnostic and therapeutic challenge involving a case of dysphagia in association with cervical osteophytosis and a dental pain  

PubMed Central

Herein, presenting a case of a 42-year-old female with the chief complaint of dysphagia. The problem was assumed to be of dental origin, due to the onset of dental pain followed by dysphagia. A cervical radiograph revealed the presence of osteophytic lipping which proved to be the cause of dysphagia. Confusing and overlapping disease entities showing similar symptoms need thorough investigation. Dysphagia related to cervical spondylosis may have a direct connection with the person's occupation. Dentistry is considered a potentially hazardous occupation with regard to musculoskeletal disorders. However, additional studies are required to understand the occupational hazards faced by dentists.

Dable, Rajani A.; Wasnik, Pradnya B.; Nagmode, Sunilkumar L.; Ali, Mukkaram Faridi

2013-01-01

356

Bilateral vocal cord paralysis after anterior cervical discoidectomy and fusion in a case of whiplash cervical spine injury: a case report  

Microsoft Academic Search

BACKGROUNDBilateral vocal cord paralysis is a risk of anterior cervical discoidectomy and fusion. We discuss the mechanism of vocal cord paralysis and the precautions necessary to avoid this catastrophic complication. A rare case of bilateral vocal cord paralysis after anterior cervical discoidectomy and fusion (ACD\\/F) is reported.CASE DESCRIPTIONThe patient, a 37-year-old male, was paraplegic, had bilateral intrinsic hand muscle weakness

D. P Muzumdar; C. E Deopujari; S. Y Bhojraj

2000-01-01

357

Use of fluoroscopically guided intra-articular hip injection in differentiating the pain source in concomitant hip and lumbar spine arthritis.  

PubMed

We retrospectively tested the effectiveness of fluoroscopically guided intra- articular hip injection in differentiating the pain generator in patients with atypical lower extremity pain and concomitant radiographic hip and spine arthritis. After the hip injection, 74 of 83 patients had pain relief (pain score improvement, 7.2 to 2.7) and functional improvement (Harris hip score [HHS] improvement, 54.3 to 80.4). Of those 74 patients, 50 (mean preoperative HHS, 60.3) went on to hip arthroplasty (for 48 of these 50, mean HHS increased to 84.4); the other 24 patients are being treated nonoperatively so far. The 11 patients who did not experience pain relief (9 after initial injection plus 2 after total hip arthroplasty) were found to have spinal pathology and were treated accordingly. Statistics: sensitivity, 100%; specificity, 81%; positive predictive value, 97%; negative predictive value, 100%. PMID:18075606

Pateder, Dhruv B; Hungerford, Marc W

2007-11-01

358

PREDICTION OF LOW BACK PAIN REPORTING IN INDUSTRY FROM ESTIMATES OF CUMULATIVE LOADING ON THE SPINE  

Microsoft Academic Search

Adverse effects of excessive accumulative loading on spinal structures, from either high repetition or prolonged static loading of even relatively low loads, have been known from in vitro studies for many years. However, cumulative compression and shear on low back tissues, although suspected to be risk factors for the reporting of low back pain at work, have been epidemiologically confirmed

R. W. Norman; M. B. Frazer; R. P. Wells; W. P. Neumann

359

The Effect of a New Neck Support Tying Method Using Thera-Band on Cervical ROM and Shoulder Muscle Pain after Overhead Work  

PubMed Central

[Purpose] This study proposed a new neck support tying (NST) method using Thera-Band for the prevention of neck and shoulder pain in workers doing overhead work. The purpose of this study was to investigate the effect of the new NST method using Thera-Band on cervical ROM and shoulder pain after overhead work. [Subjects] Fourteen male subjects were recruited. [Methods] This study measured the cervical ROM and pressure pain threshold (PPT) of the upper and middle trapezius (UT and MT) muscles after the control and NST groups had performed overhead work. [Results] The cervical flexion, extension, and lateral flexion angles of the NST group were significantly larger than those of the control group. The PPTs of UT and MT of the NST group were significantly higher than those of the control group [Conclusion] The NST prevented ROM reduction and pain in the cervical and shoulder regions.

Yoo, In-Gyu; Yoo, Won-gyu

2013-01-01

360

Neck Pain Following Cervical Laminoplasty: Does Preservation of the C2 Muscle Attachments and/or C7 Matter?  

PubMed Central

Study Design?Systematic review. Objective?In patients aged 18 years or older, with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament (OPLL), does sparing the C2 muscle attachments and/or C7-preserving cervical laminoplasty lead to reduced postoperative axial pain compared with conventional C3 to C7 laminoplasty? Do these results vary based on early active postoperative cervical motion? Methods?A systematic review of the English-language literature was undertaken for articles published between 1970 and August 17, 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating C2/C3- or C7-preserving cervical laminoplasty for the treatment of cervical spondylotic myelopathy (CSM) or OPLL in adults. Studies involving traumatic onset, cervical fracture, infection, deformity, or neoplasms were excluded, as were noncomparative studies. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results?We identified 11 articles meeting our inclusion criteria. Only the randomized controlled trial (RCT) showed no significant difference in late axial pain (at 12 months) when C7 spinous muscle preservation was compared with no preservation. However, seven other retrospective cohort studies showed significant pain relief in the preserved group compared with the nonpreserved group. The preservation group included those with preservation of the C7 spinous process and/or attached muscles, the deep extensor muscles, or C2 muscle attachment and/or C3 laminectomy (as opposed to laminoplasty). One study that included preservation of either the C2 or C7 posterior paraspinal muscles found that only preservation of the muscles attached to C2 resulted in reduced postoperative pain. Another study that included preservation of either the C7 spinous process or the deep extensor muscles found that only preservation of C7 resulted in reduced postoperative pain. Conclusion?Although there is conflicting data regarding the importance of preserving C7 and/or the semispinalis cervicis muscle attachments to C2, there is enough evidence to suggest that surgeons should make every attempt to preserve these structures whenever possible since there appears to be little downside to doing so, unless it compromises the neurologic decompression.

Riew, K. Daniel; Raich, Annie L.; Dettori, Joseph R.; Heller, John G.

2013-01-01

361

Biomechanics of the flexion of spine  

NASA Astrophysics Data System (ADS)

Low back pain is a common problem and it involves different kinds of injury to the spine. In this article the forces and torques experienced by the spine are examined in order to understand, and possibly avoid, low back pain.

Hobbs, H. K.; Aurora, T. S.

1991-03-01

362

Use of McKenzie cervical protocol in the treatment of radicular neck pain in a machine operator  

PubMed Central

A case of mechanical neck pain with radiation into the upper extremity in a 53-year-old man is presented. The use of standard chiropractic manipulative therapy was not an option due to patient apprehension. A reduction of symptoms was reported with certain spinal movements. This made the patient a candidate for the use of spinal loading strategies as described by McKenzie. The application of McKenzie cervical therapy resulted in improved symptoms and function in this individual. The McKenzie protocol, and its use in the management of neck pain, is discussed. ImagesFigure 1Figure 2Figure 3

Rathore, Sundeep

2003-01-01

363

Multi-level spinal fusion and postoperative prevertebral thickness increase the risk of dysphagia after anterior cervical spine surgery.  

PubMed

The present study aimed to determine the risk factors for dysphagia after anterior cervical spinal surgery. We reviewed clinical records of 45 patients after anterior cervical spinal surgery to identify the factors that influence dysphagia symptoms, and followed up the symptoms using a one-on-one telephone survey. The risk of dysphagia was greater in the anterior cervical discectomy and fusion group than in the anterior artificial disc insertion group, and in the group who underwent multi-level rather than single-level surgery. There were greater differences in prevertebral soft tissue thickness within 48 hours of surgery in patients with dysphagia than in patients without dysphagia at 1 month, 3 months, and 6 months after surgery, but these differences were not significant. The risk of dysphagia was significantly higher in patients who had their highest operative levels at C3 or C4 compared to those with their highest levels at C5 to C7. PMID:21798743

Kang, Si Hyun; Kim, Don-Kyu; Seo, Kyung Mook; Kim, Kyung-Tae; Kim, Yong-Baeg

2011-10-01

364

Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study.  

PubMed

There has been no prospective study on age-related changes of the extensor muscles of the cervical spine in healthy subjects. This study was conducted to elucidate any association between the changes in cross-sectional area of the extensor muscles of the cervical spine on MRIs and cervical disc degeneration or the development of clinical symptoms. Sixty-two subjects who underwent MR imaging by a 1.5-Tesla machine between 1993 and 1996 as asymptomatic volunteers in a previous study were recruited again 10 years later for this follow-up study. The mean interval between the studies was 11.0 ± 0.7 years. The cross-sectional areas of the multifidus, semispinalis cervicis, semispinalis capitis, and splenius capitis at C3-C4, C4-C5, and C5-C6 intervertebral levels were measured on T2-weighted axial images using Image J 1.42. The mean cross-sectional areas of the deep extensor muscles were 1,396.8 ± 337.6 mm(2) at the C3-C4 level, 1,514.7 ± 381.0 mm(2) at the C4-C5 level, and 1,542.8 ± 373.5 mm(2) at the C5-C6 level in the previous investigation. The cross-sectional areas were 1,498.7 ± 374.4 mm(2) at the C3-C4 level, 1,569.9 ± 390.9 mm(2) at the C4-C5 level, and 1,599.6 ± 364.3 mm(2) at the 10-year follow-up. An increase in the cross-sectional area of the muscles was more frequently observed in subjects in their tens to thirties in the initial study, while a decrease was more frequently observed in those in their forties and older in the initial study. Disc degeneration was not correlated with a change in extensor muscle volume. Development of shoulder stiffness during follow-up was significantly negatively correlated with a change in the cross-sectional area of the deep extensor muscles. PMID:21431426

Okada, Eijiro; Matsumoto, Morio; Ichihara, Daisuke; Chiba, Kazuhiro; Toyama, Yoshiaki; Fujiwara, Hirokazu; Momoshima, Suketaka; Nishiwaki, Yuji; Takahata, Takeshi

2011-09-01

365

Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review  

PubMed Central

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.

Briggs, Andrew M; Smith, Anne J; Straker, Leon M; Bragge, Peter

2009-01-01

366

Preliminary results, methodological considerations and recruitment difficulties of a randomised clinical trial comparing two treatment regimens for patients with headache and neck pain  

Microsoft Academic Search

BACKGROUND: Headache is a highly prevalent disorder. Irrespective of the headache diagnosis it is often accompanied with neck pain and -stiffness. Due to this common combination of headache and neck pain, physical treatments of the cervical spine are often considered. The additional value of these treatments to standard medical care or usual care (UC) is insufficiently documented. We therefore wanted

Willem De Hertogh; Peter Vaes; Dirk Devroey; Paul Louis; Hans Carpay; Steven Truijen; William Duquet; R. A. B. Oostendorp

2009-01-01

367

Changes in the cross-sectional area of deep posterior extensor muscles of the cervical spine after anterior decompression and fusion: 10-year follow-up study using MRI  

Microsoft Academic Search

Purpose  To evaluate changes in the transverse area of deep posterior muscles of the cervical spine 10 years after anterior cervical\\u000a decompression and fusion (ACDF), in comparison with healthy volunteers.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Thirty-one patients (22 males, 9 females, mean age at follow-up 59.3 years, mean follow-up 12.1 years) who had undergone preoperative\\u000a MRI and non-instrumented ACDF within levels C3-4 to C5-6 were enrolled. 32 asymptomatic volunteers

Morio Matsumoto; Eijiro Okada; Daisuke Ichihara; Kota Watanabe; Kazuhiro Chiba; Yoshiaki Toyama; Hirokazu Fujiwara; Suketaka Momoshima; Yuji Nishiwaki; Takeshi Hashimoto; Akio Iwanami; Takeshi Ikegami; Takeshi Takahata

368

Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck-arm pain.  

PubMed

The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were compared to healthy control (HC) subjects and a positive control group comprising patients with fibromyalgia (FM). Quantitative sensory testing (QST) of thermal and mechanical detection and pain thresholds, pain sensitivity and responsiveness to repetitive noxious mechanical stimulation was performed in the maximal pain area, the corresponding dermatome and foot of 23 patients with painful C6 or C7 cervical radiculopathy, 8 patients with NSNAP in a C6/7 dermatomal pain distribution, 31 HC and 22 patients with FM. For both neck-arm pain groups, all QST parameters were within the 95% confidence interval of HC data. Patients with cervical radiculopathy were characterised by localised loss of function (thermal, mechanical, vibration detection P<.009) in the maximal pain area and dermatome (thermal detection, vibration detection, pressure pain sensitivity P<.04), consistent with peripheral neuronal damage. Both neck-arm pain groups demonstrated increased cold sensitivity in their maximal pain area (P<.03) and the foot (P<.009), and this was also the dominant sensory characteristic in patients with NSNAP. Both neck-arm pain groups differed from patients with FM, the latter characterised by a widespread gain of function in most nociceptive parameters (thermal, pressure, mechanical pain sensitivity P<.027). Despite commonalities in pain characteristics between the 2 neck-arm pain groups, distinct sensory profiles were demonstrated for each group. PMID:22980746

Tampin, Brigitte; Slater, Helen; Hall, Toby; Lee, Gabriel; Briffa, Noelle Kathryn

2012-12-01

369

Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial  

Microsoft Academic Search

Objectives To assess the clinical effectiveness of surgical stabilisation (spinal fusion) compared with intensive rehabilitation for patients with chronic low back pain. Design Multicentre randomised controlled trial. Setting 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom. Participants 349 participants aged 18-55 with chronic low back pain of at least one year's duration who were considered candidates for

Jeremy Fairbank; Helen Frost; James Wilson-MacDonald; Ly-Mee Yu; Karen Barker

2005-01-01

370

3D MRI of the cervical spine: low flip angle FISP vs. Gd-DTPA TurboFLASH in degenerative disk disease.  

PubMed

The authors undertook this study to compare bright and dark CSF three-dimensional (3D) gradient-echo (GE) MR techniques to answer the following questions: Could a single Gd-DTPA enhanced T1-weighted GE volume sequence (with multiplanar reformats) be diagnostically equivalent for degenerative cervical disk disease to a standard sequence consisting of sagittal T1-weighted spin echo and axial low flip angle volume GE images (with reformatted images)? Does performing oblique coronal reformats perpendicular to the course of exiting cervical nerve roots improve diagnostic confidence over axial images alone? Thirty-one consecutive patients received a "routine" MR examination consisting of a sagittal T1-weighted spin echo and axial low flip angle volume sequence (FISP) [(35/7/5), 64 slices, 2 mm slice thickness, 192 x 256 matrix, 7.2 min]. Each patient was then given 0.1 mmol/kg Gd-DTPA intravenously, and reimaged with a T1-weighted volume GE sequence [(13/6/12), acquired as 128-1.2 mm coronal partitions, 192 x 256 matrix, 5.5 min]. Sequences were reconstructed on the standard diagnostic console in 1 mm increments. Sets of examinations (routine vs T1-weighted volume) were independently interpreted by three neuroradiologists for location, type, and severity of extradural degenerative disease. There was no strong or consistent trend for increased detection of disease by one imaging sequence over the other. For lateral disk disease, only 3% of the observations were in discordance. For disk disease, there was close agreement in the severity scores. All readers indicated that additional information was provided by the reformatted images more frequently with TurboFLASH (fast low angle shot) than with FISP. All readers indicated that increased confidence was provided by the reformatted images more frequently with TurboFLASH than with FISP. A single 3D contrast-enhanced TurboFLASH sequence is diagnostically equivalent to a set of two-dimensional T1-weighted sagittal spin echo and 3D axial low flip angle sequences for assessing the location and degree of cervical extradural degenerative disease. A screening examination of the cervical spine could be performed with a single contrast-enhanced 5.2 min study, and then relying on computer postprocessing to provide additional imaging planes. PMID:8419435

Ross, J S; Ruggieri, P M; Glicklich, M; Obuchowski, N; Dillinger, J; Masaryk, T J; Qu, Y; Modic, M T

1993-01-01

371

What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review  

PubMed Central

What are the risks, benefits, alternatives, and pitfalls for operating on cervical ossification of the posterior longitudinal ligament (OPLL)? To successfully diagnose OPLL, it is important to obtain Magnetic Resonance Images (MR). These studies, particularly the T2 weighted images, provide the best soft-tissue documentation of cord/root compression and intrinsic cord abnormalities (e.g. edema vs. myelomalacia) on sagittal, axial, and coronal views. Obtaining Computed Tomographic (CT) scans is also critical as they best demonstrate early OPLL, or hypertrophied posterior longitudinal ligament (HPLL: hypo-isodense with punctate ossification) or classic (frankly ossified) OPLL (hyperdense). Furthermore, CT scans reveal the “single layer” and “double layer” signs indicative of OPLL penetrating the dura. Documenting the full extent of OPLL with both MR and CT dictates whether anterior, posterior, or circumferential surgery is warranted. An adequate cervical lordosis allows for posterior cervical approaches (e.g. lamionplasty, laminectomy/fusion), which may facilitate addressing multiple levels while avoiding the risks of anterior procedures. However, without lordosis and with significant kyphosis, anterior surgery may be indicated. Rarely, this requires single/multilevel anterior cervical diskectomy/fusion (ACDF), as this approach typically fails to address retrovertebral OPLL; single or multilevel corpectomies are usually warranted. In short, successful OPLL surgery relies on careful patient selection (e.g. assess comorbidities), accurate MR/CT documentation of OPLL, and limiting the pros, cons, and complications of these complex procedures by choosing the optimal surgical approach. Performing OPLL surgery requires stringent anesthetic (awake intubation/positioning) and also the following intraoperative monitoring protocols: Somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and electromyography (EMG).

Epstein, Nancy E.

2014-01-01

372

What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review.  

PubMed

What are the risks, benefits, alternatives, and pitfalls for operating on cervical ossification of the posterior longitudinal ligament (OPLL)? To successfully diagnose OPLL, it is important to obtain Magnetic Resonance Images (MR). These studies, particularly the T2 weighted images, provide the best soft-tissue documentation of cord/root compression and intrinsic cord abnormalities (e.g. edema vs. myelomalacia) on sagittal, axial, and coronal views. Obtaining Computed Tomographic (CT) scans is also critical as they best demonstrate early OPLL, or hypertrophied posterior longitudinal ligament (HPLL: hypo-isodense with punctate ossification) or classic (frankly ossified) OPLL (hyperdense). Furthermore, CT scans reveal the "single layer" and "double layer" signs indicative of OPLL penetrating the dura. Documenting the full extent of OPLL with both MR and CT dictates whether anterior, posterior, or circumferential surgery is warranted. An adequate cervical lordosis allows for posterior cervical approaches (e.g. lamionplasty, laminectomy/fusion), which may facilitate addressing multiple levels while avoiding the risks of anterior procedures. However, without lordosis and with significant kyphosis, anterior surgery may be indicated. Rarely, this requires single/multilevel anterior cervical diskectomy/fusion (ACDF), as this approach typically fails to address retrovertebral OPLL; single or multilevel corpectomies are usually warranted. In short, successful OPLL surgery relies on careful patient selection (e.g. assess comorbidities), accurate MR/CT documentation of OPLL, and limiting the pros, cons, and complications of these complex procedures by choosing the optimal surgical approach. Performing OPLL surgery requires stringent anesthetic (awake intubation/positioning) and also the following intraoperative monitoring protocols: Somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and electromyography (EMG). PMID:24843819

Epstein, Nancy E

2014-01-01

373

Cervical Spinal Motion During Intubation.  

National Technical Information Service (NTIS)

Ten fresh human cadavers were intubated while recording cervical motion using a cinefluoroscopic technique. Segmental cervical motion from the occiput through C5 was measured in both the intact spine and following the creation of a Type II odontoid fractu...

V. C. Traynelis

2000-01-01

374

Cervical spondylosis. An update.  

PubMed Central

Cervical spondylosis is caused by degenerative disc disease and usually produces intermittent neck pain in middle-aged and elderly patients. This pain usually responds to activity modification, neck immobilization, isometric exercises, and medication. Neurologic symptoms occur infrequently, usually in patients with congenital spinal stenosis. For these patients, magnetic resonance imaging is the preferred initial diagnostic study. Because involvement of neurologic structures on imaging studies may be asymptomatic, consultation with a neurologist is advised to rule out other neurologic diseases. In most cases of spondylotic radiculopathy, the results of conservative treatment are so favorable that surgical intervention is not considered unless pain persists or unless there is progressive neurologic deficit. If indicated, a surgical procedure may be done through the anterior or posterior cervical spine; results are gratifying, with long-term improvement in 70% to 80% of patients. Cervical spondylotic myelopathy is the most serious and disabling condition of this disease. Because many patients have nonprogressive minor impairment, neck immobilization is a reasonable treatment in patients presenting with minor neurologic findings or in whom an operation is contraindicated. This simple remedy will result in improvement in 30% to 50% of patients. Surgical intervention is indicated for patients presenting with severe or progressive neurologic deficits. Anterior cervical approaches are generally preferred, although there are still indications for laminectomy. Surgical results are modest, with good initial results expected in about 70% of patients. Functional outcome noticeably declines with long-term follow-up, which raises the question of whether, and how much, surgical treatment affects the natural course of the disease. Prospective randomized studies are needed to answer these questions. Images Figure 1. Figure 2. Figure 3.

McCormack, B M; Weinstein, P R

1996-01-01

375

Thoracic disk herniation manifesting as sciatica-like pain--two case reports.  

PubMed

Two patients presented with sciatica-like pain caused by thoracic disk herniation. Sciatica-like pain was the initial and major symptom in both patients, but careful neurological examination showed vague signs of upper motor neuron disturbance, and thoracic magnetic resonance (MR) imaging revealed disk herniations at the mid-thoracic level. After video-assisted thoracoscopic discectomy, the pain was completely improved. Thorough neurological examination and MR imagery of the thoracic spine, and if needed, even the cervical spine, are required if lumbar image findings do not correlate with the symptoms or physical examination. PMID:21273750

Cho, Hyung-Lea; Lee, Sang-Ho; Kim, Jin-Sung

2011-01-01

376

[A missed unstable cervical vertebra fracture in a patient with ankylosing spondylitis].  

PubMed

A 53-year-old man with a 13-year history ofankylosing spondylitis presented to the emergency clinic of another hospital because of neck pain after a fall from a low stepladder. The patient was put at ease and discharged after physical examination and X-ray of the cervical spine revealed nothing out of the ordinary. Because his neck pain persisted, the patient contacted his rheumatologist. New cervical X-rays revealed fractures of the body and articular process of CVI and CVII. The patient was referred to our hospital for orthopaedic treatment. The fractures healed during 2.5 months' treatment with halotraction and a halovest. All patients with ankylosing spondylitis with neck pain after trauma have an unstable cervical fracture until proven otherwise. Cervical fractures should be excluded in all cases and other diagnostic tools (CT-scan or MRI) must be used whenever necessary. PMID:16136744

Graat, H C A; van Bommel, E; Pöll, R G

2005-08-20

377

The case for early treatment of dislocations of the cervical spine with cord involvement sustained playing rugby.  

PubMed

The most common injury in rugby resulting in spinal cord injury (SCI) is cervical facet dislocation. We report on the outcome of a series of 57 patients with acute SCI and facet dislocation sustained when playing rugby and treated by reduction between 1988 and 2000 in Conradie Hospital, Cape Town. A total of 32 patients were completely paralysed at the time of reduction. Of these 32, eight were reduced within four hours of injury and five of them made a full recovery. Of the remaining 24 who were reduced after four hours of injury, none made a full recovery and only one made a partial recovery that was useful. Our results suggest that low-velocity trauma causing SCI, such as might occur in a rugby accident, presents an opportunity for secondary prevention of permanent SCI. In these cases the permanent damage appears to result from secondary injury, rather than primary mechanical spinal cord damage. In common with other central nervous system injuries where ischaemia determines the outcome, the time from injury to reduction, and hence reperfusion, is probably important. In order to prevent permanent neurological damage after rugby injuries, cervical facet dislocations should probably be reduced within four hours of injury. PMID:22161928

Newton, D; England, M; Doll, H; Gardner, B P

2011-12-01

378

Surgical Treatment of Aneurysmal Bone Cysts of the Spine  

PubMed Central

Objective Our goal was to document the presentation, location, diagnostic modalities, preoperative embolization status, treatment, histology, complications, and recurrence rates for aneurysmal bone cysts of the mobile spine. Methods We reviewed our institution's database to identify patients diagnosed with aneurysmal bone cysts of the mobile spine (excluding the sacrum) from 1995 through 2006. Of those 17 patients, three were treated elsewhere and 14 underwent surgical treatment at our institution. Of those 14 patients, the nine (mean age at presentation, 17.2 years; range, 5?32 years) with at least 2 years of follow-up (average, 49.6 months; range, 24?88 months) formed our study group. For those nine patients, we tabulated the presentation, location, diagnostic modalities, preoperative embolization status, treatment, histology, complications, and recurrence rates. Results Pain was the presenting symptom in all nine patients. The lesion most commonly occurred in the cervical spine (five); two occurred in the lumbar spine, and two occurred in the thoracic spine. Patients underwent resection and combined anterior and posterior spinal arthrodesis (six) or resection and posterior spinal arthrodesis (three). There were four complications: one iliac crest donor site infection, one incidental durotomy, and two neurologic defcits. We noted two recurrences (both within 3 months). Conclusions Aneurysmal bone cysts of the spine can be successfully treated with surgical resection and instrumentation.

Mesfin, Addisu; McCarthy, Edward F.; Kebaish, Khaled M.

2012-01-01

379

Two-Year Follow-Up Results of Fluoroscopic Cervical Epidural Injections in Chronic Axial or Discogenic Neck Pain: A Randomized, Double-Blind, Controlled Trial  

PubMed Central

Study Design: A randomized, double-blind, active-controlled trial. Objective: To assess the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of axial or discogenic pain in patients without disc herniation, radiculitis, or facet joint pain. Summary of Background Data: Cervical discogenic pain without disc herniation is a common cause of suffering and disability in the adult population. Once conservative management has failed and facet joint pain has been excluded, cervical epidural injections may be considered as a management tool. Despite a paucity of evidence, cervical epidural injections are one of the most commonly performed nonsurgical interventions in the management of chronic axial or disc-related neck pain. Methods: One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain as determined by means of controlled diagnostic medial branch blocks were randomly assigned to one of the 2 treatment groups. Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL), whereas Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL or 6 mg of nonparticulate betamethasone. The primary outcome measure was ? 50% improvement in pain and function. Outcome assessments included numeric rating scale (NRS), Neck Disability Index (NDI), opioid intake, employment, and changes in weight. Results: Significant pain relief and functional improvement (? 50%) was present at the end of 2 years in 73% of patients receiving local anesthetic only and 70% receiving local anesthetic with steroids. In the successful group of patients, however, defined as consistent relief with 2 initial injections of at least 3 weeks, significant improvement was illustrated in 78% in the local anesthetic group and 75% in the local anesthetic with steroid group at the end of 2 years. The results reported at the one-year follow-up were sustained at the 2-year follow-up. Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and functioning in patients with chronic discogenic or axial pain that is function-limiting and not related to facet joint pain.

Manchikanti, Laxmaiah; Cash, Kimberly A.; Pampati, Vidyasagar; Malla, Yogesh

2014-01-01

380

Applying psychological theories to evidence-based clinical practice: identifying factors predictive of lumbar spine x-ray for low back pain in UK primary care practice  

PubMed Central

Background Psychological models predict behaviour in a wide range of settings. The aim of this study was to explore the usefulness of a range of psychological models to predict the health professional behaviour 'referral for lumbar spine x-ray in patients presenting with low back pain' by UK primary care physicians. Methods Psychological measures were collected by postal questionnaire survey from a random sample of primary care physicians in Scotland and north England. The outcome measures were clinical behaviour (referral rates for lumbar spine x-rays), behavioural simulation (lumbar spine x-ray referral decisions based upon scenarios), and behavioural intention (general intention to refer for lumbar spine x-rays in patients with low back pain). Explanatory variables were the constructs within the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Weinstein's Stage Model termed the Precaution Adoption Process (PAP), and knowledge. For each of the outcome measures, a generalised linear model was used to examine the predictive value of each theory individually. Linear regression was used for the intention and simulation outcomes, and negative binomial regression was used for the behaviour outcome. Following this 'theory level' analysis, a 'cross-theoretical construct' analysis was conducted to investigate the combined predictive value of all individual constructs across theories. Results Constructs from TPB, SCT, CS-SRM, and OLT predicted behaviour; however, the theoretical models did not fit the data well. When predicting behavioural simulation, the proportion of variance explained by individual theories was TPB 11.6%, SCT 12.1%, OLT 8.1%, and II 1.5% of the variance, and in the cross-theory analysis constructs from TPB, CS-SRM and II explained 16.5% of the variance in simulated behaviours. When predicting intention, the proportion of variance explained by individual theories was TPB 25.0%, SCT 21.5%, CS-SRM 11.3%, OLT 26.3%, PAP 2.6%, and knowledge 2.3%, and in the cross-theory analysis constructs from TPB, SCT, CS-SRM, and OLT explained 33.5% variance in intention. Together these results suggest that physicians' beliefs about consequences and beliefs about capabilities are likely determinants of lumbar spine x-ray referrals. Conclusions The study provides evidence that taking a theory-based approach enables the creation of a replicable methodology for identifying factors that predict clinical behaviour. However, a number of conceptual and methodological challenges remain.

2011-01-01

381

Low level laser therapy for patients with cervical disk hernia.  

PubMed

Background and Aims: In previous studies we have reported the benefits of low level laser therapy (LLLT) for chronic shoulder joint pain, elbow, hand and finger pain, and low back pain. The present study is a report on the effects of LLLT for chronic neck pain. Materials and Methods: Over a 3 year period, 26 rehabilitation department outpatients with chronic neck pain, diagnosed as being caused by cervical disk hernia, underwent treatment applied to the painful area with a 1000 mW semi-conductor laser device delivering at 830 nm in continuous wave, 20.1 J/cm(2)/point, and three shots were given per session (1 treatment) with twice a week for 4 weeks. Results: 1. A visual analogue scale (VAS) was used to determine the effects of LLLT for chronic pain and after the end of the treatment regimen a significant improvement was observed (p<0.001). 2. After treatment, no significant differences in cervical spine range of motion were observed. 3. Discussions with the patients revealed that in order to receive continued benefits from treatment, it was important for them to be taught how to avoid postures that would cause them neck pain in everyday life. Conclusion: The present study demonstrates that LLLT was an effective form of treatment for neck and back pain caused by cervical disk hernia, reinforced by postural training. PMID:24511189

Takahashi, Hiroshi; Okuni, Ikuko; Ushigome, Nobuyuki; Harada, Takashi; Tsuruoka, Hiroshi; Ohshiro, Toshio; Sekiguchi, Masayuki; Musya, Yoshiro

2012-09-30

382

Low Level Laser Therapy for Patients with Cervical Disk Hernia  

PubMed Central

Background and Aims: In previous studies we have reported the benefits of low level laser therapy (LLLT) for chronic shoulder joint pain, elbow, hand and finger pain, and low back pain. The present study is a report on the effects of LLLT for chronic neck pain. Materials and Methods: Over a 3 year period, 26 rehabilitation department outpatients with chronic neck pain, diagnosed as being caused by cervical disk hernia, underwent treatment applied to the painful area with a 1000 mW semi-conductor laser device delivering at 830 nm in continuous wave, 20.1 J/cm2/point, and three shots were given per session (1 treatment) with twice a week for 4 weeks. Results: 1. A visual analogue scale (VAS) was used to determine the effects of LLLT for chronic pain and after the end of the treatment regimen a significant improvement was observed (p<0.001). 2. After treatment, no significant differences in cervical spine range of motion were observed. 3. Discussions with the patients revealed that in order to receive continued benefits from treatment, it was important for them to be taught how to avoid postures that would cause them neck pain in everyday life. Conclusion: The present study demonstrates that LLLT was an effective form of treatment for neck and back pain caused by cervical disk hernia, reinforced by postural training.

Takahashi, Hiroshi; Okuni, Ikuko; Ushigome, Nobuyuki; Harada, Takashi; Tsuruoka, Hiroshi; Ohshiro, Toshio; Sekiguchi, Masayuki; Musya, Yoshiro

2012-01-01

383

The Impact of Spinal Cord Nerve Roots and Denticulate Ligaments on Cerebrospinal Fluid Dynamics in the Cervical Spine  

PubMed Central

Cerebrospinal fluid (CSF) dynamics in the spinal subarachnoid space (SSS) have been thought to play an important pathophysiological role in syringomyelia, Chiari I malformation (CM), and a role in intrathecal drug delivery. Yet, the impact that fine anatomical structures, including nerve roots and denticulate ligaments (NRDL), have on SSS CSF dynamics is not clear. In the present study we assessed the impact of NRDL on CSF dynamics in the cervical SSS. The 3D geometry of the cervical SSS was reconstructed based on manual segmentation of MRI images of a healthy volunteer and a patient with CM. Idealized NRDL were designed and added to each of the geometries based on in vivo measurments in the literature and confirmation by a neuroanatomist. CFD simulations were performed for the healthy and patient case with and without NRDL included. Our results showed that the NRDL had an important impact on CSF dynamics in terms of velocity field and flow patterns. However, pressure distribution was not altered greatly although the NRDL cases required a larger pressure gradient to maintain the same flow. Also, the NRDL did not alter CSF dynamics to a great degree in the SSS from the foramen magnum to the C1 level for the healthy subject and CM patient with mild tonsillar herniation (?6 mm). Overall, the NRDL increased fluid mixing phenomena and resulted in a more complex flow field. Comparison of the streamlines of CSF flow revealed that the presence of NRDL lead to