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1

Relation between the painful shoulder and the cervical spine with narrow canal in patients without obvious radiculopathy  

Microsoft Academic Search

It is well known that cervical radiculopathy sometimes causes shoulder pain. Hypothesizing that the cause of painful shoulder is related to the cervical spine in the absence of obvious radiculopathy, we measured the anteroposterior diameter of the spinal canal and the range of motion of the cervical spine in patients with painful shoulder on lateral cervical radiographs of the spine.

Kou Mimori; Takeshi Muneta; Hiromichi Komori; Atsushi Okawa; Kenichi Shinomiya

1999-01-01

2

Prevalence of pain and dysfunction in the cervical and thoracic spine in persons with and without lateral elbow pain  

Microsoft Academic Search

The purpose of this study was to survey the prevalence of pain in the cervical and thoracic spine (C2–T7) in persons with and without lateral elbow pain. Thirty-one subjects with lateral elbow pain and 31 healthy controls participated in the study. The assessment comprised a pain drawing, provocation tests of the cervical and thoracic spine, a neurodynamic test of the

K. M. Berglund; B. H. Persson; E. Denison

2008-01-01

3

Acute neck pain: Cervical spine range of motion and position sense prior to and after joint mobilization  

Microsoft Academic Search

Despite the relatively high prevalence of cervical spine pain, the efficacy of treatment procedures is limited. In the current study, range of motion and proprioception was assessed prior to and after specific cervical spine mobilisation techniques. A 44-year-old male office worker presented with a history of cervical pain of 1 day duration. He had woken with pain, stiffness and a

Peter J. McNair; Pierre Portero; Christophe Chiquet; Grant Mawston; Francois Lavaste

2007-01-01

4

Axial pain after posterior cervical spine surgery: a systematic review  

PubMed Central

Posterior operative approach has been the standard treatment for cervical compressive myelopathy, and axial pain after laminoplasty or laminectomy as a postoperative complication is now gradually receiving more and more attention. The objective of this study was to provide a systematic review of the current understanding of axial pain after cervical laminoplasty and laminectomy, and summarize clinical features, influence factors and preventive measures of axial pain after posterior decompressive surgery based on a review of literature published in the English language. Axial pain distributes over nuchal, periscapular and shoulder regions. Posterior surgery is not the major cause of axial pain, but axial pain can be worsened by the procedure. There are many clinical factors that influence postoperative axial pain such as age, preoperative axial pain, different surgical technique and postoperative management, but most of them are still controversial. Several surgical modifications have been innovated to reduce axial pain. Less invasive surgery, reconstruction of the extensor musculature, avoiding detachment of the semispinalis cervicis muscle and early removal of external immobilization have proved to be effective. Axial pain is under the influence of multiple factors, so comprehensive methods are required to reduce and avoid the postoperative axial pain. Because of methodological shortcomings in publications included in this systematic review, different results from different studies may be produced due to differences in study design, evaluation criteria, sample size, and incidence or severity of axial pain. More high-quality studies are necessary for drawing more reliable and convincing conclusions.

Wang, Shan-Jin; Jiang, Sheng-Dan; Jiang, Lei-Sheng

2010-01-01

5

Axial pain after posterior cervical spine surgery: a systematic review.  

PubMed

Posterior operative approach has been the standard treatment for cervical compressive myelopathy, and axial pain after laminoplasty or laminectomy as a postoperative complication is now gradually receiving more and more attention. The objective of this study was to provide a systematic review of the current understanding of axial pain after cervical laminoplasty and laminectomy, and summarize clinical features, influence factors and preventive measures of axial pain after posterior decompressive surgery based on a review of literature published in the English language. Axial pain distributes over nuchal, periscapular and shoulder regions. Posterior surgery is not the major cause of axial pain, but axial pain can be worsened by the procedure. There are many clinical factors that influence postoperative axial pain such as age, preoperative axial pain, different surgical technique and postoperative management, but most of them are still controversial. Several surgical modifications have been innovated to reduce axial pain. Less invasive surgery, reconstruction of the extensor musculature, avoiding detachment of the semispinalis cervicis muscle and early removal of external immobilization have proved to be effective. Axial pain is under the influence of multiple factors, so comprehensive methods are required to reduce and avoid the postoperative axial pain. Because of methodological shortcomings in publications included in this systematic review, different results from different studies may be produced due to differences in study design, evaluation criteria, sample size, and incidence or severity of axial pain. More high-quality studies are necessary for drawing more reliable and convincing conclusions. PMID:20941514

Wang, Shan-Jin; Jiang, Sheng-Dan; Jiang, Lei-Sheng; Dai, Li-Yang

2010-10-13

6

Manipulation of the cervical spine  

Microsoft Academic Search

In New Zealand, a new approach to manual therapy of the cervical spine has integrated physiotherapy and osteopathy techniques. The combination of the philosophies of these two professions has added a new dimension to the management of cervical spine pain. Emphasis is placed on issues of safety, such as the degree of cervical rotation and comfort for both the patient

W. A Hing; D. A Reid; M Monaghan

2003-01-01

7

Fractures of the cervical spine  

PubMed Central

OBJECTIVES: The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative.

Marcon, Raphael Martus; Cristante, Alexandre Fogaca; Teixeira, William Jacobsen; Narasaki, Douglas Kenji; Oliveira, Reginaldo Perilo; de Barros Filho, Tarcisio Eloy Pessoa

2013-01-01

8

Cervical spine injury.  

PubMed

Once a child is determined to be at risk of having a cervical spine injury, clinicians must take appropriate precautions to avoid potential worsening of neurologic deficits. Occasionally these decisions are made in the absence of adequate cervical spine imaging when dealing with a child's unstable airway or other life-threatening injuries. Furthermore, clinicians have to make decisions regarding appropriate diagnostic testing to evaluate for potential injury. Decisions regarding testing should take into consideration the clinical presentation of the patient, aiming to order appropriate testing for those at risk and avoid unnecessary testing for those without signs of cervical spine injury. PMID:24093899

Leonard, Julie C

2013-08-20

9

Minimally invasive approaches to the cervical spine.  

PubMed

Minimally invasive approaches and operative techniques are becoming increasingly popular for the treatment of cervical spine disorders. Minimally invasive spine surgery attempts to decrease iatrogenic muscle injury, decrease pain, and speed postoperative recovery with the use of smaller incisions and specialized instruments. This article explains in detail minimally invasive approaches to the posterior spine, the techniques for posterior cervical foraminotomy and arthrodesis via lateral mass screw placement, and anterior cervical foraminotomy. Complications are also discussed. Additionally, illustrated cases are presented detailing the use of minimally invasive surgical techniques. PMID:22082636

Celestre, Paul C; Pazmiño, Pablo R; Mikhael, Mark M; Wolf, Christopher F; Feldman, Lacey A; Lauryssen, Carl; Wang, Jeffrey C

2011-10-13

10

Cervical and Thoracic Spine Injuries  

Microsoft Academic Search

\\u000a Cervical spine injuries are very common in contact sports such as wrestling, football, hockey, and rugby. It has been estimated\\u000a that up to 15% of football athletes suffer from some cervical spine injury. The National Center for Catastrophic Sports Injury\\u000a reported over the 12-yr period between 1982 and 1994 there were 450 catastrophic injuries, and 75% involved the cervical spine

Pierre d’Hemecourt; Jessica Flynn Deede

11

Vertebroplasty for Spine Fracture Pain  

MedlinePLUS

MENU Return to Web version Vertebroplasty for Spine Fracture Pain Vertebroplasty for Spine Fracture Pain More than 40 million people in the ... bones that puts them at risk for spine fractures (broken bones). Thinning of the bones can occur ...

12

Down syndrome. Cervical spine abnormalities and problems.  

PubMed

A review of the radiographs of 34 individuals with Down syndrome (DS), between 5 and 21 years of age, demonstrated subluxation of atlantoaxial instability (C1-C2) greater than 5 mm in three of the 34 individuals (9 percent). This is in general agreement with previously reported ranges of 10 to 20 percent. A review of the cervical spine radiographs of adults with DS, between 26 and 42 years of age, showed no subluxation but significant degenerative changes of the cervical spine with spur formation, narrowing of foramina, narrowing of the disc inner space, and osteophyte formation. In both the DS child and the DS adult, the cervical spine may be an area of significant potential problems. In all cases any complaints of cervical pain or historical/clinical findings suggestive of neurologic involvement should initiate evaluation of the cervical spine. Baseline radiographic studies of the cervical spine are indicated in all DS children older than 5 years of age and should be considered in all DS adults, particularly those 30 years of age and older. PMID:2970908

Van Dyke, D C; Gahagan, C A

1988-09-01

13

Cervical spine curvature during simulated whiplash  

Microsoft Academic Search

Objective. To develop a new method to describe cervical spine curvature and evaluate the potential for injury in the upper and lower cervical spine during simulated whiplash. Design. A method was developed to integrate the upper and lower cervical spine rotations and describe the spine curvature. Background. In vivo and in vitro whiplash simulations have documented the development of an

Manohar M. Panjabi; Adam M. Pearson; Shigeki Ito; Paul C. Ivancic; Jaw-Lin Wang

2004-01-01

14

Cervical Exercise: The Backbone of Spine Treatment  

MedlinePLUS

North American Spine Society Public Education Series Cervical Exercise: The Backbone of Spine Treatment How important is ... physician before starting any exercises. The Importance of Exercise for the Neck Spine experts agree that physical ...

15

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

16

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

17

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

18

Cervical spine curvature during simulated whiplash  

Microsoft Academic Search

Objective. To develop a new method to describe cervical spine curvature and evaluate the potential for injury in the upper and lower cervical spine during simulated whiplash.Design. A method was developed to integrate the upper and lower cervical spine rotations and describe the spine curvature.Background. In vivo and in vitro whiplash simulations have documented the development of an S-shape curvature

Manohar M. Panjabi; Adam M. Pearson; Shigeki Ito; Paul C. Ivancic; Jaw-Lin Wang

2004-01-01

19

Surgery of cervical spine metastases: A retrospective study  

Microsoft Academic Search

Summary Fifty-one consecutive patients with metastatic lesions of the cervical spine were treated surgically. The most common primary tumor types were breast cancer and myeloma. In 14 (27%) patients, the cervical lesion was the first manifestation of the malignancy. All patients suffered from severe pain but only six had long tract symptoms. Five tetraparetic patients were confined to bed. Vertebral

B. Jónsson; H. Jónsson; G. Karlstróm; L. Sjöström

1994-01-01

20

Use of cervical spine manipulation under anesthesia for management of cervical disk herniation, cervical radiculopathy, and associated cervicogenic headache syndrome  

Microsoft Academic Search

Objective: To demonstrate the benefits of cervical spine manipulation with the patient under anesthesia as an approach to treating a patient with chronic cervical disk herniation, associated cervical radiculopathy, and cervicogenic headache syndrome. Clinical Features: The patient had neck pain with radiating paresthesia into the right upper extremity and incapacitating headaches and had no response to 6 months of conservative

James Herzog

1999-01-01

21

Three-dimensional kinematic stress magnetic resonance image analysis shows promise for detecting altered anatomical relationships of tissues in the cervical spine associated with painful radiculopathy.  

PubMed

For some patients with radiculopathy a source of nerve root compression cannot be identified despite positive electromyography (EMG) evidence. This discrepancy hampers the effective clinical management for these individuals. Although it has been well-established that tissues in the cervical spine move in a three-dimensional (3D) manner, the 3D motions of the neural elements and their relationship to the bones surrounding them are largely unknown even for asymptomatic normal subjects. We hypothesize that abnormal mechanical loading of cervical nerve roots during pain-provoking head positioning may be responsible for radicular pain in those cases in which there is no evidence of nerve root compression on conventional cervical magnetic resonance imaging (MRI) with the neck in the neutral position. This biomechanical imaging proof-of-concept study focused on quantitatively defining the architectural relationships between the neural and bony structures in the cervical spine using measurements derived from 3D MR images acquired in neutral and pain-provoking neck positions for subjects: (1) with radicular symptoms and evidence of root compression by conventional MRI and positive EMG, (2) with radicular symptoms and no evidence of root compression by MRI but positive EMG, and (3) asymptomatic age-matched controls. Function and pain scores were measured, along with neck range of motion, for all subjects. MR imaging was performed in both a neutral position and a pain-provoking position. Anatomical architectural data derived from analysis of the 3D MR images were compared between symptomatic and asymptomatic groups, and the symptomatic groups with and without imaging evidence of root compression. Several differences in the architectural relationships between the bone and neural tissues were identified between the asymptomatic and symptomatic groups. In addition, changes in architectural relationships were also detected between the symptomatic groups with and without imaging evidence of nerve root compression. As demonstrated in the data and a case study the 3D stress MR imaging approach provides utility to identify biomechanical relationships between hard and soft tissues that are otherwise undetected by standard clinical imaging methods. This technique offers a promising approach to detect the source of radiculopathy to inform clinical management for this pathology. PMID:23942030

Jaumard, N V; Udupa, J K; Siegler, S; Schuster, J M; Hilibrand, A S; Hirsch, B E; Borthakur, A; Winkelstein, B A

2013-08-12

22

[Influence of manual therapy of cervical spine on typical trigeminal neuralgia: a case report].  

PubMed

This article presents the case of a 43-year-old female patient with pain in the cervical spine area and a typical trigeminal neuralgia (TN; French name "tic douloureux") in the receptive field of the second and the third branches of the left trigeminal nerve. The patient came to our medical practice for a manual therapy of the cervical spine as the application of the standard therapy had not given her any pain reduction in the cervical spine area. As the result of the manual therapy of the cervical spine (nonspecific traction mobilization, specific or segmental mobilization, manipulation), not only a significant pain reduction in the cervical spine area occurred but also a complete cessation of TN. Before manual treatment, and in spite of antiepileptic drugs therapy and acupuncture, the patient had suffered from everyday typical TN attacks. The cessation of typical TN after manual therapy of cervical spine suggests a conclusion that the painful stimuli from the cervical spine structures can be manifested not only as atypical facial pain and/or a cervicogenic headache, but also as a typical TN (painful stimuli from the cervical spine structures-->trigeminocervical nuclei-->convergence of the painful stimuli-->referred pain in the receptive field of the trigeminal nerve-->typical or atypical TN and/or cervicogenic headache). PMID:20359155

Grgi?, Vjekoslav

23

Congenital anomalies of the cervical spine.  

PubMed

There are numerous congenital anomalies of the cervical spine. They can be simple and clinically inconsequential to complex with serious neurologic and structural implications. They can occur in isolation or as one of several maldeveloped organs in the patients. Many are discovered incidentally. The more common anomalies seen by pediatric spine surgeons include defects of the anterior or posterior arches of C1, occipital assimilation of the atlas, basilar invagination or impression, os odontoideum, and Klippel-Feil syndrome. Management begins with a detailed history, physical examination, and imaging studies. In general, those lesions that are causing or have caused neurologic injury, chronic pain, or spinal deformity or place the patient at high risk for developing these require treatment. PMID:17678749

Klimo, Paul; Rao, Ganesh; Brockmeyer, Douglas

2007-07-01

24

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

25

Primary telangiectatic osteosarcoma of the cervical spine.  

PubMed

Telangiectatic osteosarcoma (TOS) is one of the 8 subtypes of osteosarcoma that infrequently affects the spine. The radiopathological features of TOS overlap with those of more benign entities, most commonly the aneurysmal bone cyst), and therefore is a significant diagnostic challenge. It is a rare but well-described entity in the thoracolumbar and sacral spine, and to the authors' knowledge has not been previously reported in the cervical spine. The authors report the case of a 15-year-old boy who presented with a 6-month history of neck pain and torticollis. He underwent preoperative glue embolization followed by a staged subtotal C-5 spondylectomy and posterior fusion for a C-5 vertebral body lytic expansile lesion. Histopathological examination showed the lesion to be TOS. The surgery was followed by adjuvant radiation and chemotherapy with a favorable outcome at the 1-year follow-up. This report reiterates that TOS is an important differential diagnosis for aneurysmal bone cyst and giant-cell tumor of the spine, as its biological behavior and clinical outcome differ from those of these more benign lesions, which it mimics. PMID:22225487

Turel, Mazda K; Joseph, Vivek; Singh, Vandita; Moses, Vinu; Rajshekhar, Vedantam

2012-01-06

26

5. Cervical facet pain.  

PubMed

More than 50% of patients presenting to a pain clinic with neck pain may suffer from facet-related pain. The most common symptom is unilateral pain without radiation to the arm. Rotation and retroflexion are frequently painful or limited. The history should exclude risk factors for serious underlying pathology (red flags). Radiculopathy may be excluded with neurologic testing. Direct correlation between degenerative changes observed with plain radiography, computerized tomography, and magnetic resonance imaging and pain has not been proven. Conservative treatment options for cervical facet pain such as physiotherapy, manipulation, and mobilization, although supported by little evidence, are frequently applied before considering interventional treatments. Interventional pain management techniques, including intra-articular steroid injections, medial branch blocks, and radiofrequency treatment, may be considered (0). At present, there is no evidence to support cervical intra-articular corticosteroid injection. When applied, this should be done in the context of a study. Therapeutic repetitive medial branch blocks, with or without corticosteroid added to the local anesthetic, result in a comparable short-term pain relief (2 B+). Radiofrequency treatment of the ramus medialis of the cervical ramus dorsalis (facet) may be considered. The evidence to support its use in the management of degenerative cervical facet joint pain is derived from observational studies (2 C+). PMID:20415728

van Eerd, Maarten; Patijn, Jacob; Lataster, Arno; Rosenquist, Richard W; van Kleef, Maarten; Mekhail, Nagy; Van Zundert, Jan

27

Outcome of cervical spine surgery in patients with rheumatoid arthritis  

PubMed Central

OBJECTIVES—Cervical spine instability in patients with rheumatoid arthritis (RA) may lead to cervical myelopathy or occipital neuralgia, or both. Morbidity and mortality in patients with RA treated with cervical spine surgery during two years of follow up were evaluated.?METHODS—Between 1992 and 1996 55 patients with RA underwent cervical spine surgery because of occipital neuralgia or cervical myelopathy, or both. Patients were classified according to the Ranawat criteria for pain and neurological assessment before operation and three months and two years postoperatively. For occipital neuralgia a successful operation was defined as complete relief of pain and for cervical myelopathy as neurological improvement.?RESULTS—Occipital neuralgia was present in 17 patients, cervical myelopathy in 14 patients, and 24 had both. Surgical treatment in the patients with symptoms of occipital neuralgia who were still alive two years after surgery was successful in 18/29 (62%). In the surviving patients with cervical myelopathy neurological improvement of at least one Ranawat class was seen in 16/24 (67%). Postoperative mortality within six weeks was 3/51 (6%). Within two years after the operation 14 /51 (27%) of the patients had died; in most patients the cause of death was not related to surgery. The highest mortality (50%) was found in the group of six patients with quadriparesis and very poor functional capacity (Ranawat IIIB).?CONCLUSION—Cervical spine surgery in patients with RA performed because of occipital neuralgia or cervical myelopathy, or both, is successful in most patients who are alive two years after surgery. However, the mortality rate during these two years is relatively high, which seems to be largely related to the severity of the underlying disease and not to the surgery itself.??

van Asselt, K M; Lems, W; Bongartz, E; Hamburger, H; Drossaers-Bakker, K; Dijkmans, B; van Soesbergen, R M

2001-01-01

28

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

29

Preoperative Embolization of Cervical Spine Tumors  

SciTech Connect

Purpose: To assess the technical success rate, complications, and effect on intraoperative blood loss of preoperative transarterial embolization of cervical spine tumors. Methods: A retrospective analysis was performed on 38 patients with tumors of the cervical spine; 69 vertebrae were affected. Polyvinyl alcohol particles, coils, gelfoam particles, either alone or in combination, were used for preoperative tumor embolization. After embolization a total of 57 corporectomies with titanium basket implantation were performed. Results: In 36 of 38 patients, complete (n= 27) or partial (n= 9) embolization was achieved. In 23 patients one vertebral artery was completely occluded by coil placement, and in one patient the ipsilateral internal and external carotid arteries were occluded in addition. No neurological complications could be directly related to the embolization, but two postoperative brain stem infarctions occurred. The mean intraoperative blood loss was 2.4 L. Conclusion: Transarterial embolization of cervical spine tumors is a safe and effective procedure to facilitate extensive surgery.

Vetter, Sylvia C.; Strecker, Ernst-Peter [Department of Radiology and Nuclear Medicine, Diakonissenkrankenhaus, Diakonissenstrasse 28, D-76199 Karlsruhe (Germany); Ackermann, Ludwig W.; Harms, Juergen [Department of Orthopedic Surgery, Klinikum Karlsbad-Langensteinbach Guttmannstrasse 1, D-76307 Karlsbad (Germany)

1997-09-15

30

Cervical spine injury in the very elderly  

Microsoft Academic Search

Background: Elderly patients are known to be at increased risk of cervical spine injuries. This propensity for injury becomes more important\\u000a as the population of mobile elderly individuals increases. The present study seeks to examine the incidence and spectrum of\\u000a spine injury among patients aged 80 years or greater, and to examine the efficacy of a decision rule for obtaining

B. Ngo; J. R. Hoffman; W. R. Mower

2000-01-01

31

Cervical spine injuries in rugby players.  

PubMed

Nine patients with serious cervical spine injuries that occurred while they were playing rugby were seen in a British Columbia acute spinal cord injury unit during the period 1975-82. All the injuries had occurred during the "scrum" or the "tackle". Two of the patients were rendered permanently quadriplegic, and one patient died. There is a need for a central registry that would record all cervical spine injuries in rugby players as well as for changes in the rules of the game. PMID:6697282

Sovio, O M; Van Peteghem, P K; Schweigel, J F

1984-03-15

32

Posterior transpedicular corpectomy for malignant cervical spine tumors  

PubMed Central

The goal of this study was to assess surgical clinical and radiographic outcomes of using a posterior transpedicular approach (posterolateral) for ventral malignant tumors of the cervical spine. Access to ventral lesions of the cervical spine can be challenging in patients with malignant tumors. Anterior approaches are the gold standard for ventral pathology in the cervical spine, however, there are cases, where a posterior approach is indicated due to multilevel disease, previous radiation, swallowing difficulty with difficulty in retraction of trachea and esophagus, and in cases where circumferential fusion cannot be done due to patients’ poor medical condition. A single approach could provide spinal stabilization and removal of tumor. Eight cases of ventral cervical spine malignant tumors (7 metastatic and 1 chordoma) underwent corpectomy through a posterior transpedicular (posterolateral) approach. Tumors involved C2 (5), C3 (1), C5 (1), and C7 (1). Six cases had anterior reconstruction and three column fusion, and two cases had posterior fusion alone. Gross total resection was achieved in all cases. No hardware failure or worsening of neurological condition was seen (4 patient were neurologically intact and remained intact after surgery and 4 patients improved in their Frankel grade). Pain improved in all patients, mean visual analog scale preoperative was 86 and improved to 22 after surgery. In two patients the vertebral artery was ligated without sequelae. We conclude that cervical spine transpedicular (posterolateral) approach is useful in cases where an anterior approach or a circumferential approach is not an option. It avoids the morbidity of anterior transcervical, transternal, and transoral procedures while providing decompression of neural elements and allowing three column stabilization when needed.

Eleraky, Mohammed; Setzer, Matthias

2009-01-01

33

A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction  

Microsoft Academic Search

Objective: To determine the relative effect of instrument-delivered thrust cervical manipulations in comparison with traditional manual-delivered thrust cervical manipulations in the treatment of cervical spine dysfunction. Design: Prospective, randomized, comparative clinical trial. Setting: Outpatient chiropractic clinic, Technikon Natal, South Africa. Patients: Thirty patients diagnosed with neck pain and restricted cervical spine range of motion without complicating pathosis for at least

Timothy G. Wood; Christopher J. Colloca; Rob Matthews

2001-01-01

34

Posterior approach to the degenerative cervical spine  

Microsoft Academic Search

Laminoplasty has been gradually accepted as a treatment for choice for cervical compression myelopathy. The historical perspective of laminoplasty is described. The aims of laminoplasty are to expand the spinal canal, to secure spinal stability, to preserve the protective function of the spine, and to preserve spinal mobility. Laminoplasty is indicated in myelopathic patients with a developmentally narrow spinal canal

Kazuo Yonenobu; Takenori Oda

2003-01-01

35

Posterior approach to the degenerative cervical spine  

Microsoft Academic Search

Laminoplasty has been gradually accepted as a treatment for choice for cervical compression myelopathy. The historical perspective of laminoplasty is described. The aims of laminoplasty are to expand the spinal canal, to secure spinal stability, to preserve the protective function of the spine, and to preserve spinal mobility. Laminoplasty is indicated in myelopathic patients with a developmentally narrow spinal canal

Kazuo Yonenobu; Takenori Oda

36

Cervical spine response in frontal crash.  

PubMed

Predicting neck response and injury resulting from motor vehicle accidents is essential to improving occupant protection. A detailed human cervical spine finite element model has been developed, with material properties and geometry determined a priori of any validation, for the evaluation of global kinematics and tissue-level response. Model validation was based on flexion/extension response at the segment level, tension response of the whole ligamentous cervical spine, head kinematic response from volunteer frontal impacts, and soft tissue response from cadaveric whole cervical spine frontal impacts. The validation responses were rated as 0.79, assessed using advanced cross-correlation analysis, indicating the model exhibits good biofidelity. The model was then used to evaluate soft tissue response in frontal impact scenarios ranging from 8G to 22G in severity. Disc strains were highest in the C4-C5-C6 segments, and ligament strains were greatest in the ISL and LF ligaments. Both ligament and disc fiber strain levels exceeded the failure tolerances in the 22G case, in agreement with existing data. This study demonstrated that a cervical spine model can be developed at the tissue level and provide accurate biofidelic kinematic and local tissue response, leading to injury prediction in automotive crash scenarios. PMID:21665513

Panzer, Matthew B; Fice, Jason B; Cronin, Duane S

2011-06-14

37

Cervical spine response in frontal crash  

Microsoft Academic Search

Predicting neck response and injury resulting from motor vehicle accidents is essential to improving occupant protection. A detailed human cervical spine finite element model has been developed, with material properties and geometry determined a priori of any validation, for the evaluation of global kinematics and tissue-level response. Model validation was based on flexion\\/extension response at the segment level, tension response

Matthew B. Panzer; Jason B. Fice; Duane S. Cronin

2011-01-01

38

Evaluation and management of acute cervical spine trauma.  

PubMed

The evaluation and management of cervical spine injuries is a core component of the practice of emergency medicine. This article focuses on evaluation and management of blunt cervical spine trauma by the emergency physician. Pertinent anatomy of the cervical spine and specific cervical spine fractures are discussed, with an emphasis on unstable injuries and associated spinal cord pathology. The association of vertebral artery injury with cervical spine fracture is addressed, followed by a review of the most recent literature on prehospital care. Initial considerations in the emergency department, including cervical spine stabilization and airway management, are reviewed. The most current recommendations for cervical spine imaging with regard to indications and modalities are covered. Finally, emergency department management and disposition of patients with spinal cord injuries are reviewed. PMID:20971389

Pimentel, Laura; Diegelmann, Laura

2010-11-01

39

Glycopyrrolate Induced Bilateral Angle Closure Glaucoma after Cervical Spine Surgery  

PubMed Central

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.

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

2013-01-01

40

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

41

Roentgenographic findings of the cervical spine in tension-type headache.  

PubMed

Roentgenographic studies were carried out on 372 patients with tension-type headache and 225 normal control subjects to determine relationships between straightened cervical spines, low-set shoulders, and cervical spine instability. A great majority of the patients with tension-type headache were found also to have straightened cervical spine. Patients with tension-type headache may have a restricted progression of the cervical spinal lordosis, which results in a straightened cervical spine. The flexor muscles of the head and neck prevent physiological lordosis of the cervical spine, and their sustained chronic contraction may be a principal cause of a straightened neck. The low-set shoulder was frequently seen in patients with tension-type headache, and it may result in traction of the brachial plexus, which gives rise to pain in the neck and shoulders. Cervical spine instability, on the other hand, was rather infrequent in patients with tension-type headache. Its relationship to tension-type headache is unclear and warrants further study. Our results suggest that both a straightened cervical spine and low-set shoulders may play an important role in the pathogenesis of tension-type headache and its accessory symptoms. PMID:8458729

Nagasawa, A; Sakakibara, T; Takahashi, A

1993-02-01

42

Hypoglossal nerve palsy from cervical spine involvement in rheumatoid arthritis: 3 case reports  

Microsoft Academic Search

Blankenship LD, Basford JR, Strommen JA, Andersen RJ. Hypoglossal nerve palsy from cervical spine involvement in rheumatoid arthritis: 3 case reports. Arch Phys Med Rehabil 2002;83:269-72. Rheumatoid arthritis (RA) involvement of the cervical spine is a well-known but perhaps underappreciated phenomenon. Neurologic complications of this involvement include pain, myelopathy, and cranial nerve (CN) palsies. However, hypoglossal nerve palsy (CN XII)

Lisa D. Blankenship; Jeffrey R. Basford; Jeffrey A. Strommen; Renee J. Andersen

2002-01-01

43

Cervical spine injury in the young child.  

PubMed

This grand rounds is about the clinical and radiological presentation, treatment and outcome of pediatric cervical spine injury. A 15-month-old girl suffers from a motor vehicle accident and is intubated on-site because of progressive agitation. Whole body trauma CT was read as normal. When sedation was discontinued after 24 h she was found to be tetraplegic below C6 level. MRI shows a total disruption between C6 and C7 that in hindsight was also visible on the initial trauma CT. She was treated surgically by an anterior and posterior reconstruction and was post-operatively treated with a halo vest. Clearing the cervical spine in young children is deceptively difficult. Meticulous review and interpretation of conventional radiographs and CT are important yet MRI should be considered in uncertain cases. Severe ligamentous injury without concomitant bony injury occurs more frequently than in older children and adults, with sometimes devastating consequences. PMID:22732825

Ramrattan, Navin N; Oner, F Cumhur; Boszczyk, Bronek M; Castelein, Rene M; Heini, Paul F

2012-06-26

44

Dysphagia following Anterior Cervical Spine Surgery  

Microsoft Academic Search

.   Although previous reports have identified dysphagia as a potential complication of anterior cervical spine surgery (ACSS),\\u000a current understanding of the nature and etiologies of ACSS-related dysphagia remains limited. The present study was undertaken\\u000a to describe the patterns of dysphagia that may occur following ACSS. Thirteen patients who exhibited new-onset dysphagia following\\u000a ACSS were studied retrospectively by means of chart

Ruth E. Martin; Mary Ann Neary; Nicholas E. Diamant

1997-01-01

45

Cervical Spine Loads and Intervertebral Motions During Whiplash  

Microsoft Academic Search

Objective. To quantify the dynamic loads and intervertebral motions throughout the cervical spine during simulated rear impacts.Methods. Using a biofidelic whole cervical spine model with muscle force replication and surrogate head and bench-top mini-sled, impacts were simulated at 3.5, 5, 6.5, and 8 g horizontal accelerations of the T1 vertebra. Inverse dynamics was used to calculate the dynamic cervical spine

Paul C. Ivancic; Manohar M. Panjabi; Shigeki Ito

2006-01-01

46

Tensile properties of the human muscular and ligamentous cervical spine.  

PubMed

Tensile neck injuries are amongst the most serious cervical injuries. However, because neither reliable human cervical tensile tolerance data nor tensile structural data are currently available, the quantification of tensile injury risk is limited. The purpose of this study is to provide previously unavailable kinetic and tolerance data for the ligamentous cervical spine and determine the effect of neck muscle on tensile load response and tolerance. Using six male human cadaver specimens, isolated ligamentous cervical spine tests (occiput - T1) were conducted to quantify the significant differences in kinetics due to head end condition and anteroposterior eccentricity of the tensile load. The spine was then separated into motion segments for tension failure testing. The upper cervical spine tolerance of 2400 +/- 270 N (occiput-C2) was found to be significantly greater (p < 0.01) than the lower cervical spine tolerance of 1780 +/- 230 N (C4-C5 and C6-C7 segments). Data from these experiments were used to develop and validate a computational model of the ligamentous spine. The model predicted the end condition and eccentricity responses for the tensile force-displacement relationship. Cervical muscular geometry data derived from cadaver dissection and MRI imaging were used to incorporate a muscular response into the model. The cervical musculature under maximal stimulation increased the tolerance of the cervical spine from 1800 N to 4160 N. In addition, the cervical musculature resulted in a shift in the site of injury from the lower cervical spine to the upper cervical spine and offers an explanation for the mechanism of upper cervical spine tension injuries observed clinically. The results from this study predict a range in tensile tolerance from 1.8 - 4.2 kN based on the varying role of the cervical musculature. PMID:17458720

Van Ee, C A; Nightingale, R W; Camacho, D L; Chancey, V C; Knaub, K E; Sun, E A; Myers, B S

2000-11-01

47

Chordomas of the upper cervical spine: radiographic evaluation. Study of two cases and review of the literature  

Microsoft Academic Search

Chordomas are rare bony tumors, usually involving the skull base and sacrococcygeal spine, while least presented in cervical\\u000a and thoracic spine. Chordomas of the cervical spine may cause variable neurological symptoms. Adult patients presenting with\\u000a neck pain, paresthesias or limb paresis are further investigated. The history of progressive tetraparesis, however, implies\\u000a a long-standing disease. Clinical presentation and imaging investigation of

K. Kokkinis; M. Vlychou; S. Stathopoulou; O. Lazoura; N. Makris; D. Evangelopoulos; I. Benetos; P. Papadaki; D. S. Korres

2008-01-01

48

Postoperative Urinary Retention Following Anterior Cervical Spine Surgery for Degenerative Cervical Disc Diseases  

PubMed Central

Background Postoperative urinary retention (POUR) may cause bladder dysfunction, urinary tract infection, and catheter-related complications. It is important to be aware and to be able to identify patients at risk of developing POUR. However, there has been no study that has investigated the incidence and risk factors for the development of POUR following anterior cervical spine surgery for degenerative cervical disc disease. Methods We included 325 patients (164 male and 161 female), who underwent anterior cervical spine surgery for cervical radiculopathy or myelopathy due to primary cervical disc herniation and/or spondylosis, in the study. We did not perform en bloc catheterization in our patients before the operation. Results There were 36 patients (27 male and 9 female) that developed POUR with an overall incidence of 11.1%. The mean numbers of postoperative in-and-out catheterizations was 1.6 times and mean urine output was 717.7 mL. Thirteen out of 36 POUR patients (36%) underwent indwelling catheterization for a mean 4.3 days after catheterization for in-and-out surgery, because of persisting POUR. Seven out of 36 POUR patients (19%) were treated for voiding difficulty, urinary tract irritation, or infection. Chi-square test showed that patients who were male, had diabetes mellitus, benign prostate hypertrophy or myelopathy, or used Demerol were at higher risk of developing POUR. The mean age of POUR patients was higher than non-POUR patients (68.5 years vs. 50.8 years, p < 0.01). Conclusions To avoid POUR and related complications as a result of anterior cervical spine surgery for degenerative cervical disc disease, we recommend that a catheter be placed selectively before the operation in at-risk patients, the elderly in particular, male gender, diabetes mellitus, benign prostate hypertrophy, and myelopathy. We recommend that Demerol not be used for postoperative pain control.

Jung, Hyun Ju; Kong, Chae-Gwan; Kim, Young-Yul; Park, Jangsu; Kim, Jong Bun

2013-01-01

49

Minimally invasive surgery for osteoid osteoma of the cervical spine using microendoscopic discectomy system.  

PubMed

We report herein the case of an 18-year-old man who underwent endoscopic resection for an osteoid osteoma in the seventh cervical facet joint. The patient had experienced right neck pain for approximately one year, but no neurological abnormalities were noted. Cervical magnetic resonance imaging suggested an osteoid osteoma in the superior articular process of the seventh cervical vertebra. The tumor was resected microendoscopically. Operative time was 1 hour 29 minutes, and blood loss was 5 mL. During the two years since surgery, the patient has remained pain free with no cervical spine instability. We thus propose microendoscopic surgery for osteoid osteoma developing in a posterior element of the cervical spine is a potentially effective operative procedure. PMID:23741555

Nakamura, Yukako; Yabuki, Shoji; Kikuchi, Shin-Ichi; Konno, Shin-Ichi

2013-05-22

50

Minimally Invasive Surgery for Osteoid Osteoma of the Cervical Spine Using Microendoscopic Discectomy System  

PubMed Central

We report herein the case of an 18-year-old man who underwent endoscopic resection for an osteoid osteoma in the seventh cervical facet joint. The patient had experienced right neck pain for approximately one year, but no neurological abnormalities were noted. Cervical magnetic resonance imaging suggested an osteoid osteoma in the superior articular process of the seventh cervical vertebra. The tumor was resected microendoscopically. Operative time was 1 hour 29 minutes, and blood loss was 5 mL. During the two years since surgery, the patient has remained pain free with no cervical spine instability. We thus propose microendoscopic surgery for osteoid osteoma developing in a posterior element of the cervical spine is a potentially effective operative procedure.

Yabuki, Shoji; Kikuchi, Shin-Ichi; Konno, Shin-Ichi

2013-01-01

51

Complications of transpedicular screw fixation in the cervical spine  

Microsoft Academic Search

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

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

2006-01-01

52

High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery  

PubMed Central

Objective To study the prevalence of cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery, and symptoms that might be associated with the disorders. Methods 194 patients with rheumatoid arthritis were referred for orthopaedic surgery at Jyväskylä Central Hospital, 154 (79%) of whom volunteered for the present study including clinical examination, laboratory tests, radiographs of the cervical spine, hands, and feet, and self report questionnaires. Definition of anterior atlantoaxial subluxation (aAAS) was >3?mm and of subaxial subluxation (SAS) ?3?mm. Atlantoaxial impaction (AAI) was analysed following to the Sakaguchi?Kauppi method. Results 67 patients (44%) had cervical spine subluxation or previous surgical fusion. The prevalence of aAAS, AAI, SAS, or previous fusion was 27 (18%), 24 (16%), 29 (19%), and 8 (5%), respectively; 69% of patients with cervical spine subluxations (those with fusions excluded) reported neck pain, compared with 65% of patients without subluxations (p?=?0.71). The prevalence of occipital, temporal, retro?orbital, and radicular pain in upper extremities was similar in patients with or without cervical spine subluxations (54% v 43%; 17% v 31%; 25% v 24%; 47% v 48%, respectively). However, patients with subluxations were older, had longer disease duration, more active disease, poorer function according to the Health Assessment Questionnaire, and had more often erosive disease. Conclusions Asymptomatic cervical spine subluxation is common in patients with rheumatoid arthritis waiting for orthopaedic surgery. Regardless of symptoms, the possibility of cervical spine subluxation in patients with severe rheumatoid arthritis should be considered in preoperative evaluation.

Neva, M H; Hakkinen, A; Makinen, H; Hannonen, P; Kauppi, M; Sokka, T

2006-01-01

53

Anterior cervical spine fusion in treatment of cervicobrachialgia.  

PubMed

Traumatic and degenerative changes in the spine at the level of the neck are frequent causes of pain in the neck, often associated with radiculopathy and sometimes even myelopathic symptoms. The signs and symptoms can generally be attributed to a problem of instability for which there are no specific criteria. If conservative treatment does not help, satisfying results can be achieved by a stable intercorporeal fusion using the modified Robinson technique. An EMG and a cervical myelogram must be carried out before surgical stabilization. In 154 patients followed for an average of 12 years, 75% observed resolution of the pain and paresthesias after surgical stabilization. These results correspond to those described in the literature. The best results are achieved if the signs and symptoms are experienced for no longer than 1 year and if the patient is under age 40. PMID:1927357

Kooijman, M A

1991-01-01

54

Pain in the spine in the context of discopathy and degenerative changes, with particular attention to post-traumatic lesions.  

PubMed

Pain of the cervical spine is either directly or indirectly dependent on degenerative changes in the cervical dinks. Traumatic injury to the cervical spine may result in a cervical syndrome some years later as a result of degenerative changes. Cervical disk protrusuion or degenerative changes can be compared to a similar condition which occurs in the lumbar spine. Differential diagnosis in cases with only local cervical syndrome is difficult. In cases with brachialgia due to disk protrusion or exostosis of the uncinate processes (with segmental syndromes), careful clinical examination is very helpful in diagnosis. Despite the various causes for cervical disk syndromes, the conservative treatment is quite uniform. In cases where results of conservative treatment are non satisfactional, surgery should be disenssed. In cases with massive neurologic deficits, operation is necessary. Authors describe new spine graft "Tibone" for anterior interbody cervical fusion. PMID:18033211

Lukawski, S; Milecki, M

2000-03-30

55

Radiographic cervical spine osteoarthritis progression rates: a longitudinal assessment.  

PubMed

Relative to other sites, the cervical spine has received little attention in the osteoarthritis (OA) literature. Using data from a longitudinal study, we provide age-specific progression rates of radiographic cervical spine OA, by gender. Data from cohort subjects (ages 40+) from the Clearwater Osteoarthritis Study were analyzed (N = 707). All study subjects' demonstrated radiographic cervical spine OA at baseline (2+). Lateral cervical spine radiographs were taken biennially. The study outcome was radiographic disease progression. A grade increase of 1, or more, by the Lawrence and Kellgren ordinal scale was considered progression. Incidence rates were calculated as per 100 person-years of observation. We show that the progression rates for cervical spine OA increase with age. For all ages combined, men demonstrated higher rates of progression compared with women. However, among subjects in their forties and fifties, women were more likely to experience worsening of their disease when compared with men. Progression rates were similar for men and women in their sixties (8.2 and 8.0, respectively). Among subjects in their seventies, men demonstrated a significantly higher rate of progression compared with women (12.5 and 8.6, respectively). As the baby-boomer population continues to increase, cervical spine OA progression assessment can be a useful tool for health-care resource planning. Cervical spine OA research offers an abundance of opportunities. Instability as a precursor to the development of cervical spine OA warrants further research. Epidemiological studies addressing demographic differences (e.g., gender, age) in the incidence of cervical spine OA will contribute to the current knowledge base. PMID:19865817

Wilder, Frances Vaughn; Fahlman, Lissa; Donnelly, Robert

2009-10-29

56

Subacromial impingement in patients with whiplash injury to the cervical spine  

Microsoft Academic Search

BACKGROUND: Impingement syndrome and shoulder pain have been reported to occur in a proportion of patients following whiplash injuries to the neck. In this study we aim to examine these findings to establish the association between subacromial impingement and whiplash injuries to the cervical spine. METHODS AND RESULTS: We examined 220 patients who had presented to the senior author for

Ali Abbassian; Grey E Giddins

2008-01-01

57

Reconstruction of a nasopharyngeal defect from cervical spine osteoradionecrosis.  

PubMed

Osteoradionecrosis of the cervical spine is a rare complication of radiation treatment of head and neck tumors that requires a multidisciplinary approach to management and reconstruction. The case of a 57-year-old man with osteoradionecrosis of the cervical spine secondary to radiation for metastatic hepatocellular carcinoma is presented. Operative debridement of the necrotic bone was performed and the nasopharyngeal soft tissue defect was reconstructed with a radial forearm free flap. The management and reconstruction options for osteoradionecrosis of the cervical spine are discussed. PMID:21311624

Kakarala, Kiran; Richmon, Jeremy D; Durand, Marlene L; Borges, Lawrence F; Deschler, Daniel G

2010-07-01

58

Hematologic Issues in Cervical Spine Surgery  

Microsoft Academic Search

\\u000a Anemia is defined as a reduction of hemoglobin (Hb) levels of <13 g\\/dL for a man and <12 g\\/dL for a woman. It is very frequent\\u000a among hospitalized patients and can be a serious problem in patients who undergo cervical spine surgery. Anemia can be classified\\u000a as:\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Mild (Hb: >10 g\\/dL)\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Moderate (Hb: 8–10 g\\/dL)\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Severe (Hb:

Giuseppe Avvisati; Ombretta Annibali; Elisabetta Cerchiara; Marianna De Muro; Rosa Greco; Francesco Marchesi; Carolina Nobile; Odoardo Olimpieri; Azzurra Romeo; Maria Cristina Tirindelli

59

Cervical spine disorders in farm workers requiring neck extension actions  

Microsoft Academic Search

Background  Cervical extension is considered a risk factor for provoking radicular and spinal cord compromise. However, there have been\\u000a no reports on the relation between extension strain (ES) and cervical spine disorders: degenerative cervical spine disorders,\\u000a dynamic canal stenosis (DCS), and cervical myelopathy. We performed a cross-sectional study to investigate the relation.\\u000a \\u000a \\u000a \\u000a Methods  Orthopedic examinations were performed on 177 grape-growers (ES-exposed group)

Yoshiaki Takamiya; Kensei Nagata; Katsuhiro Fukuda; Akira Shibata; Tatsuya Ishitake; Takajiro Suenaga

2006-01-01

60

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

61

Lateral Mass Screw Fixation in the Cervical Spine  

Center for Biologics Evaluation and Research (CBER)

Text Version... posterior cervical spine may paradoxically result in ... these devices by undertrained spinal surgeons ... Nerve root injury attributed to screw placement ... More results from www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials

62

Dynamic sagittal flexibility coefficients of the human cervical spine  

Microsoft Academic Search

The goal of the present study was to determine the dynamic sagittal flexibility coefficients, including coupling coefficients, throughout the human cervical spine using rear impacts. A biofidelic whole cervical spine model (n=6) with muscle force replication and surrogate head was rear impacted at 5g peak horizontal accelerations of the T1 vertebra within a bench-top mini-sled. The dynamic main and coupling

Paul C. Ivancic; Shigeki Ito; Manohar M. Panjabi

2007-01-01

63

Cervical spine injuries in the pediatric and adolescent athlete.  

PubMed

Injuries of the cervical spine in the pediatric and adolescent athlete are less common than other musculoskeletal injuries. Although many of these injuries are relatively minor, serious and potentially unstable or progressive spinal injury must be excluded. Important anatomic differences between the child younger than 10 years and older children and adolescents influence the types of injuries sustained and make assessment of the child's cervical spine sometimes difficult for practitioners accustomed to treating adolescent and adult athletes. Stable soft-tissue injuries of the cervical spine are the most common injuries that occur in all athletes. These injuries are responsive to symptomatic treatment and aggressive rehabilitation. Stingers are injuries of the brachial plexus and upper cervical roots that result from stretching or compressive forces associated with collision sports. Rapid return of sensory and motor dysfunction of a single upper extremity characterizes this entity; long-term disability is rare. Cervical cord neurapraxia (CCN) with transient quadriplegia is most commonly seen in football players. Most athletes fully recover. Cervical canal stenosis as defined by a Pavlov/Torg ratio of less than or equal to 0.8 is predictive of recurrent CCN. Young athletes sustain CCN secondary to hypermobility of the immature cervical spine. Return to play after these injuries is controversial. The athlete with Down syndrome and potential cervical hypermobility requires a careful cervical and neurologic evaluation prior to clearance for participation in sports. PMID:16958497

Herman, Martin J

2006-01-01

64

A Dynamic Model of the Cervical Spine and Head.  

National Technical Information Service (NTIS)

A data base of the head and cervical spine structure for a three-dimensional mathematical model of the human head-spine system has been developed on the basis of recently obtained geometric and stiffness data. The model was developed for predicting detail...

J. Williams T. Belytschko

1981-01-01

65

From anterior to lateral operations on the cervical spine  

Microsoft Academic Search

Summary New developments in the techniques of lateral operations upon the cervical spine are described; anterior operations are still considered the method of choice in the surgical treatment of traumatic deformities of the spine with the exception of irreducible unilateral locking of articular processes, traumatic primary paraspinal disc extrusions compressing the anterior rami of the spinal nerves and the vertebral

Henk Verbiest; Academisch Ziekenhuis

1978-01-01

66

Multiple muscle force simulation in axial rotation of the cervical spine  

Microsoft Academic Search

Objective. To produce axial rotation of the cervical spine in vitro bycoordinated application of eight simulated muscle forces.Design. Biomechanical testing of the cervical spine by controlled pneumatics.Background. Some muscle simulation experiments have been performed in vitro in the lumbar spine but data generally are lacking for this testing mode in the cervical spine. Thus, physiological biomechanical behavior in this region

P. Bernhardt; H. J. Wilke; K. H. Wenger; B. Jungkunz; A. Böhm; L. E. Claes

1999-01-01

67

Accountable disease management of spine pain  

Microsoft Academic Search

The health care landscape has changed with new legislation addressing the unsustainable rise in costs in the US system. Low-value service lines caring for expensive chronic conditions have been targeted for reform; for better or worse, the treatment of spine pain has been recognized as a representative example. Examining the Patient Protection and Affordable Care Act and existing pilot studies

Matthew J. Smith

2011-01-01

68

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

69

Degenerative spondylolisthesis of the cervical spine — symptoms and surgical strategies depending on disease progress  

Microsoft Academic Search

Background  Degenerative spondylolisthesis of the cervical spine is rare. Patients show signs of progredient myelopathy, radiculopathy\\u000a and pain. Treatment strategies include ventral, dorsal and combined fusion techniques with or without repositioning and decompression.\\u000a \\u000a \\u000a \\u000a Methods  In this study, we present 16 patients with degenerative cervical spondylolisthesis. The leading symptom was severe myelopathy\\u000a in 8 patients, radiculomyelopathy in 5 patients and neck pain in

Christian Woiciechowsky; Ulrich-Wilhelm Thomale; Stefan-Nikolaus Kroppenstedt

2004-01-01

70

Quantifying cervical-spine curvature using Be?zier splines.  

PubMed

Knowledge of the distributions of cervical-spine curvature is needed for computational studies of cervical-spine injury in motor-vehicle crashes. Many methods of specifying spinal curvature have been proposed, but they often involve qualitative assessment or a large number of parameters. The objective of this study was to develop a quantitative method of characterizing cervical-spine curvature using a small number of parameters. 180 sagittal X-rays of subjects seated in automotive posture with their necks in neutral, flexed, and extended postures were collected in the early 1970s. Subjects were selected to represent a range of statures and ages for each gender. X-rays were reanalyzed using advanced technology and statistical methods. Coordinates of the posterior margins of the vertebral bodies and dens were digitized. Be?zier splines were fit through the coordinates of these points. The interior control points that define the spline curvature were parameterized as a vector angle and length. By defining the length as a function of the angle, cervical-spine curvature was defined with just two parameters: superior and inferior Be?zier angles. A classification scheme was derived to sort each curvature by magnitude and type of curvature (lordosis versus S-shaped versus kyphosis; inferior or superior location). Cervical-spine curvature in an automotive seated posture varies with gender and age but not stature. Average values of superior and inferior Be?zier angles for cervical spines in flexion, neutral, and extension automotive postures are presented for each gender and age group. Use of Be?zier splines fit through posterior margins offers a quantitative method of characterizing cervical-spine curvature using two parameters: superior and inferior Be?zier angles. PMID:23387791

Klinich, Kathleen D; Ebert, Sheila M; Reed, Matthew P

2012-11-01

71

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

2010-06-21

72

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

PubMed Central

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.

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

2010-01-01

73

Anterolisthesis and retrolisthesis of the cervical spine in cervical spondylotic myelopathy in the elderly  

Microsoft Academic Search

Background  Degenerative spondylolisthesis of the cervical spine has received insufficient attention in contrast to that of the lumbar\\u000a spine. The authors analyzed the functional significance of anterior and posterior degenerative spondylolisthesis (anterolisthesis\\u000a and retrolisthesis) of the cervical spine to elucidate its role in the development of cervical spondylotic myelopathy (CSM)\\u000a in the elderly.\\u000a \\u000a \\u000a \\u000a Methods  A total of 79 patients aged 65 or

Motohiro Kawasaki; Toshikazu Tani; Takahiro Ushida; Kenji Ishida

2007-01-01

74

Prehospital clinical clearance of the cervical spine: a prospective study.  

PubMed

Physician clinical clearance of the cervical spine after blunt trauma is practiced in many trauma centers. Prehospital clinical clearance of the cervical spine (c-spine) performed by emergency medical services (EMS) personnel can decrease cost, improve patient comfort, decrease complications, and decrease prehospital time. The purpose of this study was to assess whether EMS personnel can effectively clinically clear the c-spine of injury in the prehospital setting. All paramedics from a single urban fire department were trained in clinical clearance of the c-spine. During the 14-month period from January 2008 through March 2009, clinical examination of the c-spine was performed by paramedics on blunt trauma patients in the prehospital setting. Paramedics immobilized the c-spine and delivered the patients to the University of South Alabama Medical Center. After trauma center arrival, paramedics documented their clinical examination of the c-spine in a computerized data collection form. Paramedic clinical findings were compared with trauma surgeon clinical examination findings and computed tomographic findings of the c-spine. All patients had prehospital Glasgow Coma Score 14 or greater. Patients were not excluded for distracting injuries. One hundred ninety-three blunt trauma patients were entered. Sixty-five (34%) c-spines were clinically cleared by EMS. There were no known missed injuries in this patient group. Eight (6%) patients who were not clinically cleared by EMS were diagnosed with c-spine injury. Trauma surgeons clinically cleared 135 (70%) of the patients with no known missed injury. EMS personnel in the prehospital setting may reliably and effectively perform clinical clearance of the c-spine. Further prospective study for prehospital c-spine clinical clearance is warranted. PMID:24165260

Gonzalez, Richard P; Cummings, Glenn R; Baker, Jeremy A; Frotan, Amin M; Simmons, Jon D; Brevard, Sydney B; Michon, Elizabeth; Harlan, Shanna M; Meyers, Douglas C; Rodning, Charles B

2013-11-01

75

Cervical spine segment finite element model for traumatic injury prediction.  

PubMed

Many detailed cervical spine models have been developed and primarily used to investigate kinematic response of the neck in impact scenarios. However, the goal of detailed models is to predict both kinematic response and provide insights into injury mechanisms and thresholds through tissue-level response. The objective of this study was to verify and validate an enhanced cervical spine segment finite element model to predict tissue-level failure under four load conditions: tension, flexion, and extension using a C4-C5 segment, and compression using a C5-C6-C7 segment. Mechanical tissue test data in relevant modes of loading was used in the model, and this data was also used to model ultimate tissue failure. The predicted failure locations were representative of reported cervical spine injuries for the different modes of loading, and the predicted peak failure forces were within the reported experimental corridors. The displacement to failure of the tension simulation was lower than expected in some cases, attributed to limitations in the constitutive model. This study provided a validated approach to predict tissue-level failure for cervical spine segments, predicting the location and sequence of tissue failure, and can be applied to future full cervical spine models for the prediction of injurious loading in automotive crash scenarios. PMID:22520426

DeWit, Jennifer A; Cronin, Duane S

2012-03-03

76

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

1996-04-01

77

Cervical Spine Evaluation in Obtunded or Comatose Pediatric Trauma Patients: A Pilot Study  

Microsoft Academic Search

A uniformly accepted protocol for evaluation and clearance of the cervical spine of pediatric trauma patients with altered mental status does not currently exist. We sought to detect cervical spine injuries in this group with minimal risk. Patients were evaluated with standard three-view cervical spine radiographs and CT when necessary. Those patients without radiographic abnormality and altered mental status underwent

Alan M. Scarrow; Elad I. Levy; Daniel K. Resnick; P. David Adelson; Robert J. Sclabassi

1999-01-01

78

Radiographic Clearance of Blunt Cervical Spine Injury: Plain Radiograph or Computed Tomography Scan?  

Microsoft Academic Search

Background: The purpose of this study was to evaluate the roles of cervical spine radiographs (CSR) and computed tomography of the cervical spine (CTC) in the exclusion of cervical spine injury for adult blunt trauma patients. Methods: At the authors' institution, all adult blunt trauma patients with phys- ical findings of posterior midline neck ten- derness, altered mental status, or

Margaret M. Griffen; Eric R. Frykberg; Andrew J. Kerwin; Miren A. Schinco; Joseph J. Tepas; Kathleen Rowe; Jennifer Abboud

2003-01-01

79

Cervical spine surgery in the ancient and medieval worlds.  

PubMed

The early historical literature on cervical spine surgery lacks printed material for review, and we can rely only on pathological material from the prehistoric period that has survived as a result of anthropological investigations. After the introduction of Egyptian and early Hellenic medicine, some written material became available. This paper reviews these materials, from both books and manuscripts, in an effort to understand the development of cervical spine surgery from the perspectives of the personalities involved and the early surgical practices used. The review thus considers the following five eras of medicine: 1) prehistoric; 2) Egyptian and Babylonian; 3) Greek and early Byzantine; 4) Middle Eastern; and 5) medieval. PMID:17961063

Goodrich, James Tait

2007-01-01

80

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

PubMed

Monostotic fibrous dysplasia of the spine is a rare entity. Only 26 cases, of which 11 were located in the cervical spine, are to be found in the literature. We report a 56-year-old male patient with cervicobrachialgia of half year's duration. Radiographs showed a diffuse destruction of the vertebral body and the spinous process of C4. A biopsy of the spinous process confirmed histopathologically a fibrous dysplasia. Due to minor symptoms, no surgical treatment was performed or is planned unless in case of increasing pain, an acute instability or neurological symptoms. PMID:17004074

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

2006-09-27

81

Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation  

Microsoft Academic Search

Study Objective: Orotracheal intubation (OTI) is commonly used to establish a definitive airway in major trauma victims, with several different cervical spine immobilization techniques and laryngoscope blade types used. This experimental, randomized, crossover trial evaluated the effects of manual in-line stabilization and cervical collar immobilization and 3 different laryngoscope blades on cervical spine movement during OTI in a cadaver model

Michael C. Gerling; Daniel P. Davis; Robert S. Hamilton; Gabrielle F. Morris; Gary M. Vilke; Steven R. Garfin; Stephen R. Hayden

2000-01-01

82

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

83

Rehabilitation program for traumatic chronic cervical pain associated with unsteadiness: a single case study  

Microsoft Academic Search

BACKGROUND: Neck problems are often recurring or chronic. After pain, unsteadiness and balance problems are among the most frequent symptoms reported by chronic neck pain (CNP) patients. Altered sensorimotor control of the cervical spine and sensorimotor integration problems affecting postural control have been observed in CNP patients. Very few data are available regarding the post-intervention effects of rehabilitation programs on

Danik Lafond; Annick Champagne; Rosalie Cadieux; Martin Descarreaux

2008-01-01

84

Cervical spine injuries caused by diving into water  

Microsoft Academic Search

In 1965-1978, 194 patients with cervical spine injuries, caused by diving into water, were treated. In 182 cases, spinal fracture was accompanied by spinal cord injury. This paper presents mechanism of trauma, in connection with observed degree of neurological disturbances as well as further life of this group of patients in relation to the degree of spinal cord damage.

Jerzy Kiwerski

1980-01-01

85

Cervical spine instability in children with Goldenhar's syndrome  

PubMed Central

Objective To study the vertebral involvement of the cervical spine, in particular the stability of C1–C2, in children with proven Goldenhar’s syndrome. Design A case review. Setting The Children’s Hospital of Eastern Ontario, Ottawa. Patients Eight children who had a minimum of 2 out of 3 Goldenhar criteria plus other strong associations with the syndrome and for whom detailed radiographic spinal assessment, including flexion–extension views of the cervical spine and computed tomography of the congenital anomalies, were available. Outcome measures Radiographic findings. Results Seven children demonstrated cervical spine anomalies. Of particular concern was the high incidence of C1–C2 instability in 3 children, 2 of whom required occiput to C2 fusion. The presence of hemivertebrae and failures of segmentation were most common and resulted in thoracic scoliosis, leading to spinal fusion in 2 children. Conclusions In patients with Goldenhar’s syndrome the cervical spines must be monitored carefully for C1–C2 subluxation before any proposed surgery for other malformations associated with the syndrome, so that any instability can be identified to avoid cord impingement during a general anesthetic.

Healey, David; Letts, Merv; Jarvis, James G.

2002-01-01

86

Airway Management in Adults after Cervical Spine Trauma  

Microsoft Academic Search

Cervical spinal injury occurs in 2% of victims of blunt trau- ma; the incidence is increased if the Glasgow Coma Scale score is less than 8 or if there is a focal neurologic deficit. Immobili- zation of the spine after trauma is advocated as a standard of care. A three-view x-ray series supplemented with computed tomography imaging is an effective

Edward T. Crosby

2006-01-01

87

Cervical Spine Stiffness and Geometry of the Young Human Male.  

National Technical Information Service (NTIS)

Injuries to the cervical spine incurred during emergency escape from high-performance aircraft are of concern to the Air Force. To provide for safety design, especially in view of newly considered additional head encumbrances such as helmet-mounted sights...

G. Njus K. Ueno K. W. Krieger M. Connors Y. K. Liu

1982-01-01

88

[A case of intradural xanthogranuloma in the upper cervical spine].  

PubMed

An 18-year-old female patient suffered from posterior neck pain and gait disturbance. The neurological examination revealed left hemiparesis, general hyperreflexia and hypoalgesia on the right neck and upper limb, and left trunk and lower limb. MRI showed a large mass lesion in the right side of the spinal canal at the level of the C1 cervical spine, which was obviously compressing the spinal cord. An operation was performed through a right suboccipital craniectomy and right hemilaminectomy of the first vertebra. Though the mass lesion in the subarachnoid space compressed the spinal cord, it adhered neither to the spinal cord nor to the nerve roots. However, as it clearly adhered to the dura mater, the attachment site was also completely removed. In the pathological examination, lymphocyte, foamed macrophage and the giant cell of Touton type were shown. The immunohistochemical study with CD68 (Kp1) was positive, but it was negative for the lysozyme, neuron specific enolase and S-100 protein. The diagnosis was xanthogranuloma. The patient recovered completely after the operation. This is a rare case of juvenile type xanthogranuloma. This lesion in the spinal canal has usually its onset in the adult age. PMID:9266569

Oyama, H; Ikeda, K; Inoue, S; Katsumata, T; Murakami, S; Doi, A

1997-08-01

89

The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine  

PubMed Central

A congenitally narrow cervical spinal canal has been established as an important risk factor for the development of cervical spondylotic myelopathy. However, few reports have described the mechanism underlying this risk. In this study, we investigate the relationship between cervical spinal canal narrowing and pathological changes in the cervical spine using positional magnetic resonance imaging (MRI). Two hundred and ninety-five symptomatic patients underwent cervical MRI in the weight-bearing position with dynamic motion (flexion, neutral, and extension) of the cervical spine. The sagittal cervical spinal canal diameter and cervical segmental angular motion were measured and calculated. Each segment was assessed for the extent of intervertebral disc degeneration and cervical cord compression. Based on the sagittal canal diameter, the subjects were classified into three groups: A, subjects with a congenitally narrow canal, diameter of less than 13 mm; B, subjects with a normal canal, diameter of 13–15 mm; C, subjects with a wide canal, diameter of more than 15 mm. When compared with Groups A and B, the disc degeneration grades at the C3-4, C5-6, and C6-7 segments and the cervical cord compression scores at the C3-4 and C5-6 segments showed significant differences. Additionally, when compare with Groups A and C, the disc degeneration grades at all segments, except C2-3, and the cervical cord compression scores at all segments, except C2-3, showed significant differences. With respect to the cervical kinematics, few differences in the kinematics were observed between Groups B and C, however, the kinematics in Group A was different with other two groups. In Group A, the segmental mobility at the C4-5 and C6-7 segments were significantly higher than those observed in Group B, and the segmental mobility at the C3-4 segment was significantly lower than that observed in Groups B or C. We demonstrated the unique pathological and kinematic traits of cervical spine that exist in a congenitally narrow canal. We hypothesize that kinematic trait associated with a congenitally narrow canal may greatly contribute to pathological changes in the cervical spine. Our results suggest that cervical spinal canal diameter of less than 13 mm may be associated with an increased risk for development of pathological changes in cervical intervertebral discs. Subsequently, the presence of a congenitally narrow canal can expose individuals to a greater risk of developing cervical spinal stenosis.

Morishita, Yuichiro; Naito, Masatoshi; Hymanson, Henry; Miyazaki, Masashi; Wu, Guizhong

2009-01-01

90

Le rachis cervical rhumatoïde  

Microsoft Academic Search

Cervical spine involvement occurs in over half of patients with rheumatoid arthritis (RA). The most common abnormality is atlantoaxial dislocation, followed by atlantooccipital arthritis with cranial settling and by lesions of the lower cervical spine. Cervical spine involvement usually occurs in patients with severe RA. Pain and evidence of spinal cord injury are the main symptoms. The presence of symptoms

Agnès Bouchaud-Chabot; Frédéric Lioté

2002-01-01

91

Extensive cervical spine and foregut anomaly in 'serpentine syndrome'  

PubMed Central

INTRODUCTION We report an extremely rare and challenging combination of congenital anomalies. Only five similar cases have been described in the English language medical literature to date. PRESENTATION OF CASE A male infant was born at 30+5 weeks gestation by emergency caesarian section. Cervical spine rachischisis, shortened oesophagus, intrathoracic stomach, atretic duodenum and absent spleen were noted, in addition to respiratory insufficiency. Gastrointestinal re-anastomosis, particularly oesophageal lengthening, was not feasible at the initial thoracotomy. Surgical stabilization of the cervical spine was unlikely to be successful until two years of age. Asplenia predisposed the infant to sepsis from encapsulated organisms, and recurrent respiratory infections occurred. DISCUSSION A close relationship exists between the upper gastrointestinal tract and cervical spine during embryonic development. An embryonic aberration at this level could account for all the deformities present in this infant. Tethering of the embryonic cervical oesophagus to the somites in the first trimester, preventing foregut elongation, and producing ischaemia at the coeliac axis, is suggested as the aetiology. CONCLUSION This case presented a challenge to the multi-disciplinary team involved in his management and prompted extensive consultation with international experts. After considerable counseling of the parents, care was directed towards palliation.

Dargan, D.; McMorrow, A.; Bourke, T.W.; McCallion, W.A.; Verner, A.M.; Lyons, J.; McConnell, R.S.; Lundy, C.T.; Eames, N.W.A.

2013-01-01

92

Tonsillar remnants and painful cervical lymphadenopathy  

Microsoft Academic Search

Cervical lymphadenitis is a common accompaniment of acute recurrent and chronic tonsillitis, which usually settles following medical treatment and\\/or tonsillectomy.Occasionally, painful cervical lymphadenitis affecting the jugulodigastric node persists despite apparently adequate treatment.We present a case series of seven patients where earache and\\/or painful jugulodigastric lymphadenitis were the predominant persistent symptoms in young adults (mean age of 34.5). A CT scan

Kamarjit S Mangat; Sunil N Dutt; Swarup V Chavda; Ahmes L Pahor

2003-01-01

93

Axial Neck Pain after Cervical Laminoplasty  

PubMed Central

Objective It has been demonstrated that cervical laminoplasty is an effective and safe method of treating multi-level cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. However, recent reports have suggested that axial neck pain is frequently encountered after cervical laminoplasty. The aim of the present study was to determine clinical significance of the C7 spinous process on axial neck pain after cervical laminoplasty. Methods A total of 31 consecutive patients that underwent cervical laminoplasty between March 2002 and December 2008 were reviewed. The authors evaluated and compared axial neck pain and lordotic angle in patients that underwent C7 spinous process preserving surgery (group 1, n = 16) and in patients in which the C7 spinous process was sacrificed (group 2, n = 15). Results Severe or moderate early axial pain occurred in 56.2% of patients in group 1 and in 86.6% in group 2. Severe or moderate late axial pain occurred in 12.5% in group 1 and in 73.3% in group 2. Eighty-Six percent of patients in group 2 and 43% in group 1 experienced aggravation of their axial neck pain during the early postoperative period. Aggravation of axial neck pain during early postoperative period was less common in group 1 but not statistically significant (p = 0.073). Sixty-six percent of patients in group 2 and 12% in group 1 had aggravated axial neck pain at late postoperative period and aggravation of late axial neck pain was significantly less common in group 1 (p = 0.002). Conclusion The present study demonstrates that C7 spinous process preserving laminoplasty decreases the incidence of aggravated axial neck pain after cervical laminoplasty.

Cho, Chul Bum; Oh, Jong Yang; Park, Hae Kwan; Lee, Kyung Jin; Rha, Hyoung Kyun

2010-01-01

94

Management of upper cervical spine injuries: a review.  

PubMed

Upper cervical spine injuries are commonly associated with trauma and require significant forces to produce. When these injuries occur they can have devastating functional consequences. The distinctive anatomy of the upper cervical spine leads injuries to occur in predictable patterns. Injuries can occur to the unique osseus structures or ligamentous connections. Common injuries include occipital condylar fractures, atlanto-occipital dislocation, fractures of the ring of C1, ligamentous injuries involving the ring of C1, and the three types of fractures of C2, pars fractures, odontoid fractures and C2 body fractures. We present these common injuries found in the occipital-atlantoaxial complex and their management based on the current and historical literature. PMID:23877268

Syre, P; Petrov, D; Malhotra, N R

2013-09-01

95

Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine  

Microsoft Academic Search

The sympathetic trunk is sometimes damaged during the anterior and anterolateral approach to the cervical spine, resulting\\u000a in Horner’s syndrome. No quantitative regional anatomy in fresh human cadavers describing the course and location of the cervical\\u000a sympathetic trunk (CST) and its relation to the longus colli muscle (LCM) is available in the literature. The aims of this\\u000a study are to

Erdinc Civelek; Aykut Karasu; Tufan Cansever; Kemal Hepgul; Talat Kiris; Ak?n Sabanc?; Ali Canbolat

2008-01-01

96

Vertebral artery dissection in rheumatoid arthritis with cervical spine disease.  

PubMed

A 59-year-old woman with long-standing active rheumatoid arthritis presented with posterior circulation ischemic stroke after vertebral dissection. She had severe multilevel degenerative changes of her cervical spine. She did not have classic stroke risk factors nor evidence of atherosclerotic disease or other systemic diseases. The most likely mechanism appears to be injury of the artery wall by an osteophyte, causing dissection that resulted in thrombosis and subsequent embolic strokes. PMID:23352423

Mahajan, Ritika; Huisa, Branko N

2013-01-23

97

Osteoid osteoma of the cervical spine: surgical treatment or percutaneous radiofrequency coagulation?  

PubMed Central

Osteoid osteoma (OO) of the cervical spine is frequently located close to the vertebral artery, spinal cord, or nerve roots and complete surgical excision is sometimes difficult by a limited approach and more extended surgery can require spinal fusion. Percutaneous radiofrequency coagulation (PRC) has demonstrated efficacy in the treatment of OO of the pelvis and limbs however, its role in the cervical spine is still nuclear. The Authors present a series of nine cases of OO of the cervical spine, six treated with surgical excision and three with PRC. No neurological or vascular complications occurred in both series. One case of the surgical series had only partial relief of persistent pain for 1 year due to incomplete excision, but is doing well 4 years after surgery. All the other surgical cases had complete relief of symptoms immediately after surgery and are symptom-free 3–10 years later. Two cases of PRC had complete relief of symptoms 24–48 h after surgery and are symptom-free 2 and 3 years later. One case of recurrent OO after surgery and treated with PRC with a reduced dose improved only, and still requires anti-inflammatory drugs 2 years after the procedure. Our still limited experience suggests that PRC can be safely performed in local anaesthesia with the patient awake, enabling to check for signs and symptoms of possible neurological injury. PRC can substitute extensive posterior approaches and reconstructions for OO of the posterior arch and joint pillar.

Albisinni, U.; Alfonso, C.; Zappoli, F. A.

2007-01-01

98

Osteoid osteoma of the cervical spine: surgical treatment or percutaneous radiofrequency coagulation?  

PubMed

Osteoid osteoma (OO) of the cervical spine is frequently located close to the vertebral artery, spinal cord, or nerve roots and complete surgical excision is sometimes difficult by a limited approach and more extended surgery can require spinal fusion. Percutaneous radiofrequency coagulation (PRC) has demonstrated efficacy in the treatment of OO of the pelvis and limbs however, its role in the cervical spine is still nuclear. The Authors present a series of nine cases of OO of the cervical spine, six treated with surgical excision and three with PRC. No neurological or vascular complications occurred in both series. One case of the surgical series had only partial relief of persistent pain for 1 year due to incomplete excision, but is doing well 4 years after surgery. All the other surgical cases had complete relief of symptoms immediately after surgery and are symptom-free 3-10 years later. Two cases of PRC had complete relief of symptoms 24-48 h after surgery and are symptom-free 2 and 3 years later. One case of recurrent OO after surgery and treated with PRC with a reduced dose improved only, and still requires anti-inflammatory drugs 2 years after the procedure. Our still limited experience suggests that PRC can be safely performed in local anaesthesia with the patient awake, enabling to check for signs and symptoms of possible neurological injury. PRC can substitute extensive posterior approaches and reconstructions for OO of the posterior arch and joint pillar. PMID:17874147

Laus, M; Albisinni, U; Alfonso, C; Zappoli, F A

2007-09-14

99

Occurrence of cervical spine injuries during the rugby scrum.  

PubMed

A retrospective study of cervical spine injuries that occurred during the rugby scrum in the United States was undertaken. In the U.S., from 1970 to 1996, 36 (58%) of the 62 documented injured players injured their cervical spines during the scrum. Thirty-five men (97%) and one woman (3%) were injured. Twenty-three of the injuries (64%) occurred when the opposing packs came together (engagement), and 13 (36%) occurred when the scrum collapsed. Twenty-eight (78%) hookers, seven (19%) props, and one (3%) second-row player were injured. Twenty (56%) hookers and three (8%) props were hurt during engagement. Eight hookers (22%), four props (11%), and one second-row player (3%) were injured when the scrum collapsed. Significantly more injuries occurred during engagement than during collapse, and hookers were injured significantly more than props. We conclude that in the rugby scrum in the U.S., the hooker suffers most of the cervical spine injuries (78% in this study) and this position is by far the most vulnerable. This study should be used to develop rugby law (rule) changes and educate players, coaches, and referees in United States rugby. PMID:9548109

Wetzler, M J; Akpata, T; Laughlin, W; Levy, A S

100

Clustered clinical findings for diagnosis of cervical spine myelopathy  

PubMed Central

Cervical spine myelopathy (CSM) is a clinical diagnosis made with imaging confirmation. At present, most clinical tests used to identify CSM are specific and no clusters of tests have proven more beneficial than stand alone tests in guiding treatment decision making. This study endeavored to produce a cluster of predictive clinical findings for a sample of patients using a clinical diagnosis/imaging confirmation as the reference standard for cervical spine myelopathy. Data from 249 patients with various conditions associated with cervical spine dysfunction were analyzed to determine which clinical tests and measures, when clustered together, were most diagnostic for CSM. Using multivariate regression analyses and calculations for sensitivity, specificity, and positive and negative likelihood ratios, a definitive cluster was identified. Thirteen clinical findings were investigated for capacity to diagnosis CSM. Five clinical: (1) gait deviation; (2) +Hoffmann’s test; (3) inverted supinator sign; (4) +Babinski test; and (5) age >45 years, were demonstrated the capacity when clustered into one of five positive tests to rule out CSM (negative likelihood ratio?=?0.18; 95% CI?=?0.12–0.42), and when clustered into three of five positive findings to rule in CSM (positive likelihood ratio?=?30.9; 95% CI?=?5.5–181.8). This study found clustered combinations of clinical findings that could rule in and rule out CSM. These clusters may be useful in identifying patients with this complex diagnosis in similar patient populations.

Cook, Chad; Brown, Christopher; Isaacs, Robert; Roman, Matthew; Davis, Samuel; Richardson, William

2010-01-01

101

The Effect of Protective Equipment on Cervical Spine Alignment in Collegiate Lacrosse Players  

Microsoft Academic Search

Background: Contact sports place athletes at risk for cervical spine injury. Protective helmets and shoulder pads worn by football and ice hockey athletes alter cervical spine alignment. The effect of helmet and shoulder pads on neck alignment in lacrosse athletes is not known.Hypothesis: Helmets and shoulder pads worn by lacrosse athletes alter cervical spine alignment.Study Design: Controlled laboratory study.Methods: Sagittal

Paul S. Sherbondy; Jay N. Hertel; Wayne J. Sebastianelli

2006-01-01

102

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

Microsoft Academic Search

A prospective study of 246 patients who received multimodal intraoperative monitoring during cervical spine surgery between\\u000a March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord\\u000a and nerve root function during cervical spine surgery. It is appreciated that complication rate of cervical spine surgery\\u000a is low, however, there is a significant

Andreas Eggspuehler; Martin A. Sutter; Dieter Grob; Dezsö Jeszenszky; François Porchet; Jiri Dvorak

2007-01-01

103

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

PubMed

Solitary juvenile xanthogranuloma (JXG) in the spinal column is extremely rare and there has been no report of such a lesion involving C1 and C2 in English literature so far. Here, we report and characterize the first case of xanthogranuloma of the upper cervical spine. This case report draws attention to the fact that solitary xanthogranuloma should be considered among possible diagnoses of spinal tumor in children and young adults. An 18-year-old female patient presented to the hospital with intermittent pain in the right side of the neck. MRI studies revealed a huge soft tissue mass to the right side of the C1 and C2 vertebras, and osseous destruction can be found in the cervical spine CT scan. Complete surgical removal of the tumor and occipital-cervical instrumentation with autogenous bone graft were performed with no complications. The patient was free of pain immediately after the surgery with intact neurological functions. Follow-up MRI 6 and 12 months after the surgery showed no residue or recurrence of the tumor. Our report and the literature review indicate that isolated JXG does not show any predilections of localization inside the central nervous system. So a solitary xanthogranuloma should be considered among possible diagnoses of spinal tumor in susceptible patients. Localized JXG shows isointense signals in MRI and enhances homogeneously with gadolinium. Immunohistochemical studies can ensure the diagnosis. Whenever possible, total surgical removal alone seems to be curative. PMID:18228052

Cao, Dong; Ma, Junming; Yang, Xinghai; Xiao, Jianru

2008-01-29

104

Solitary juvenile xanthogranuloma in the upper cervical spine: case report and review of the literatures  

PubMed Central

Solitary juvenile xanthogranuloma (JXG) in the spinal column is extremely rare and there has been no report of such a lesion involving C1 and C2 in English literature so far. Here, we report and characterize the first case of xanthogranuloma of the upper cervical spine. This case report draws attention to the fact that solitary xanthogranuloma should be considered among possible diagnoses of spinal tumor in children and young adults. An 18-year-old female patient presented to the hospital with intermittent pain in the right side of the neck. MRI studies revealed a huge soft tissue mass to the right side of the C1 and C2 vertebras, and osseous destruction can be found in the cervical spine CT scan. Complete surgical removal of the tumor and occipital–cervical instrumentation with autogenous bone graft were performed with no complications. The patient was free of pain immediately after the surgery with intact neurological functions. Follow-up MRI 6 and 12 months after the surgery showed no residue or recurrence of the tumor. Our report and the literature review indicate that isolated JXG does not show any predilections of localization inside the central nervous system. So a solitary xanthogranuloma should be considered among possible diagnoses of spinal tumor in susceptible patients. Localized JXG shows isointense signals in MRI and enhances homogeneously with gadolinium. Immunohistochemical studies can ensure the diagnosis. Whenever possible, total surgical removal alone seems to be curative.

Cao, Dong; Ma, Junming; Yang, Xinghai

2008-01-01

105

Chiropractic Care for a Patient with Spasmodic Dysphonia Associated with Cervical Spine Trauma  

PubMed Central

Abstract Objective To discuss the diagnosis and response to treatment of spasmodic dysphonia in a 25-year-old female vocalist following an auto accident. Clinical Features The voice disorder and neck pain appeared after the traumatic incident. Examination of the cervical spine revealed moderate pain, muscle spasm and restricted joint motion at C-1 and C-5 on the left side. Cervical range of motion was reduced on left rotation. Bilateral manual muscle testing of the trapezius and sternocleidomastoid muscles, which share innervation with the laryngeal muscles by way of the spinal accessory nerve, were weak on the left side. Pre and post accident voice range profiles (phonetograms) that measure singing voice quality were examined. The pre- and post-accident phonetograms revealed significant reduction in voice intensity and fundamental frequency as measured in decibels and hertz. Intervention and Outcome Low-force chiropractic spinal manipulative therapy to C-1 and C-5 was employed. Following a course of care, the patient's singing voice returned to normal, as well as a resolution of her musculo- skeletal complaints. Conclusion It appears that in certain cases, the singing voice can be adversely affected if neck or head trauma is severe enough. This case proposes that trauma with irritation to the cervical spine nerve roots as they communicate with the spinal accessory, and in turn the laryngeal nerves, may be contributory in some functional voice disorders or muscle tension dysphonia.

Waddell, Roger K.

2005-01-01

106

Helmet Fit and Cervical Spine Motion in Collegiate Men's Lacrosse Athletes Secured to a Spine Board  

PubMed Central

Abstract Context: Proper management of cervical spine injuries in men's lacrosse players depends in part upon the ability of the helmet to immobilize the head. Objective: To determine if properly and improperly fitted lacrosse helmets provide adequate stabilization of the head in the spine-boarded athlete. Design: Crossover study. Setting: Sports medicine research laboratory. Patients or Other Participants: Eighteen healthy collegiate men's lacrosse players. Intervention(s): Participants were asked to move their heads through 3 planes of motion after being secured to a spine board under 3 helmet conditions. Main Outcome Measure(s): Change in range of motion in the cervical spine was calculated for the sagittal, frontal, and transverse planes for both head-to-thorax and helmet-to-thorax range of motion in all 3 helmet conditions (properly fitted, improperly fitted, and no helmet). Results: Head-to-thorax range of motion with the properly fitted and improperly fitted helmets was greater than in the no-helmet condition (P < .0001). In the sagittal plane, range of motion was greater with the improperly fitted helmet than with the properly fitted helmet. No difference was observed in helmet-to-thorax range of motion between properly and improperly fitted helmet conditions. Head-to-thorax range of motion was greater than helmet-to-thorax range of motion in all 3 planes (P < .0001). Conclusions: Cervical spine motion was minimized the most in the no-helmet condition, indicating that in lacrosse players, unlike football players, the helmet may need to be removed before stabilization.

Petschauer, Meredith A.; Schmitz, Randy; Gill, Diane L.

2010-01-01

107

Nonfatal cervical spine injuries in interscholastic football.  

PubMed

The incidence of nonfatal neck injuries in high school football was determined by performing preseason examinations in 104 active high school players and 75 college freshman candidates. Coaches of all 430 Iowa high schools were asked to recall the number of players experiencing significant neck pain during the season. A detailed questionnaire for each injury was also completed by a sample population of 60 coaches. The incidence of roentgenographic evidence of neck injuries was as high as 32% and was related to years of experience. Injury was most likely to occur to a linebacker or a defensive halfback when they tackled the ball carrier. In the preseason examination, half the players who volunteered a history of significant neck pain had abnormal x-ray films. PMID:989067

Albright, J P; Moses, J M; Feldick, H G; Dolan, K D; Burmeister, L F

1976-09-13

108

Is there a difference in head posture and cervical spine movement in children with and without pediatric headache?  

PubMed

Pediatric headache is an increasingly reported phenomenon. Cervicogenic headache (CGH) is a subgroup of headache, but there is limited information about cervical spine physical examination signs in children with CGH. Therefore, a cross-sectional study was designed to investigate cervical spine physical examination signs including active range of motion (ROM), posture determined by the craniovertebral angle (CVA), and upper cervical ROM determined by the flexion-rotation test (FRT) in children aged between 6 and 12 years. An additional purpose was to determine the degree of pain provoked by the FRT. Thirty children (mean age 120.70 months [SD 15.14]) with features of CGH and 34 (mean age 125.38 months [13.14]) age-matched asymptomatic controls participated in the study. When compared to asymptomatic controls, symptomatic children had a significantly smaller CVA (p?pain during the FRT (p?pain intensity score. This study found evidence of impaired function of the upper cervical spine in children with CGH and provides evidence of the clinical utility of the FRT when examining children with CGH. PMID:23708260

Budelmann, Kim; von Piekartz, Harry; Hall, Toby

2013-05-26

109

Strain rate dependent properties of younger human cervical spine ligaments.  

PubMed

The cervical spine ligaments play an essential role in limiting the physiological ranges of motion in the neck; however, traumatic loading such as that experienced in automotive crash scenarios can lead to ligament damage and result in neck injury. The development of detailed neck models to evaluate the response and the potential for injury requires accurate ligament mechanical properties at relevant loading rates. The objective of this study was to measure the mechanical properties of the cervical spine ligaments, by performing tensile tests at elongation rates relevant to car crash scenarios, using younger specimens (?50 years), in simulated in vivo conditions, and to provide a comprehensive investigation of gender and spinal level effects. The five ligaments investigated were the anterior longitudinal ligament, posterior longitudinal ligament, capsular ligament, ligamentum flavum, and interspinous ligament. Ligaments were tested in tension at quasi-static (0.5 s(-1)), medium (20 s(-1)) and high (150-250 s(-1)) strain rates. The high strain rates represented typical car crash scenarios as determined using an existing cervical spine finite element model. In total, 261 ligament tests were performed, with approximately even distribution within elongation rate, spinal level, and gender. The measured force-displacement data followed expected trends compared to previous studies. The younger ligaments investigated in this study demonstrated less scatter, and were both stiffer and stronger than comparable data from older specimens reported in previous studies. Strain rate effects were most significant, while spinal level effects were limited. Gender effects were not significant, but consistent trends were identified, with male ligaments having a higher stiffness and failure force than female ligaments. PMID:22520433

Mattucci, Stephen F E; Moulton, Jeffrey A; Chandrashekar, Naveen; Cronin, Duane S

2012-02-16

110

[Anterior approach of cervical spine in Pott's disease. Apropos of 7 cases].  

PubMed

This study reports 7 cases of cervical Pott's disease, gathered during 6 years in the department of neuro-surgery of Ibn Rochd U.H.C. 4 females and 3 males, aged between 9 and 52 years were included. All the patients complained of cervicobrachial pain and weakness of the limbs. Clinical features were: deterioration of general status, rachidian syndrome and neurological impairement with motor and sensitive deficit. Radiological analysis found a destructive and extensive lesion, cervical kyphosis from 10 degrees to 60 degrees, retropharyngeal abscess and intraspinal canal extension of infection. Diagnosis was confirmed by histological study in all cases. In addition to antituberculous therapy and preoperative cervical traction in 4 cases, all the patients had spinal fusion using an anterior approach. Post operative immobilization in a cervical collar varied from 9 to 12 months. All 7 patients had full neurological recovery, 6 patients had an excellent bony fusion and cervical kyphosis was corrected. For the remaining patient, the bone graft was mobilized without neurological disorders. This study confirms anterior arthrodesis efficiency. This procedure in conjunction with preoperative traction, allowed stabilization of the spine and healing of vertebral lesions with excellent kyphosis correction. PMID:9452797

Achouri, M; Hilmani, S; Lakhdar, H; Ait Ben Ali, S; Naja, A; Ouboukhlik, A; el Kamar, A; el Azhari, A; Boucetta, M

1997-01-01

111

A Mathematical Model of the Cervical Spine Movement  

NASA Astrophysics Data System (ADS)

The general purpose of this study was to develop a valid and reliable laboratory tool to evaluate the cervical spine mobility in normal conditions. The paper proposes an approximation function to model the variation in time of movement angles and angular velocities. The measurements have been performed using a Zebris ultrasound-based measuring system in Motion Laboratory of the ``Politehnica'' University of Timisoara. The approximation functions were compared with the recorded data series and graphically plotted as both time and phase diagram representation.

Toth-Tascau, Mirela; Pater, Flavius; Stoia, Dan Ioan; Menyhardt, Karoly; Rosu, Serban; Rusu, Lucian; Vigaru, Cosmina

2011-09-01

112

The causes, sequelae and attempts at prevention of cervical spine injuries in Poland  

Microsoft Academic Search

There are certain differences between the causes of spinal injuries in Poland and in the developed countries of the West. The most common causes of injuries to the cervical spine in Poland are: falls from a horse-cart, diving into shallow water and automobile accidents. This paper presents an analysis of the causes of cervical spine injuries in a series of

J E Kiwerski

1993-01-01

113

Cervical spine in patients with diastrophic dysplasia - radiographic findings in 122 patients  

Microsoft Academic Search

Background. In previous studies, typical radiological findings in the cervical spine of patients with diastrophic dysplasia (DD) have been kyphosis, displacement of the vertebrae, spina bifida occulta (SBO), anterior hypoplasia of vertebrae C3-5, and hyperplasia and dysmorphism of the odontoid process. Objectives. To make a radiological analysis of the cervical spine in patients with DD. Materials and methods. The study

Ville M. Remes; Eino J. Marttinen; Mikko S. Poussa; Ilkka J. Helenius; Jari I. Peltonen

2002-01-01

114

Carotid and Vertebral Artery Injury following Severe Head or Cervical Spine Trauma  

Microsoft Academic Search

In order to determine the frequency of neck vessel injuries, Doppler investigations were performed in 60 patients following either severe head injury (n = 29), cervical spine injury (n = 26), or combined head and cervical spine injury (n = 5). The majority of patients were referred to our hospital for early rehabilitation; before admission Doppler investigations had been performed

Oliver Rommel; Andreas Niedeggen; Martin Tegenthoff; Paul Kiwitt; Uwe Bötel; Jean-Pierre Malin

1999-01-01

115

Variation in Surgical Decision Making For Degenerative Spinal Disorders. Part II: Cervical Spine  

Microsoft Academic Search

Study Design. Survey-based descriptive study. Objective. To study relationships between surgeon- specific factors and surgical approach to degenerative diseases of the cervical spine. Summary of Background Data. Geographic variations in the rates of cervical spine surgery are significant within the United States. Although surgeon density correlates with the rates of spinal surgery, other reasons for varia- tion such as surgeon-specific

Zareth N. Irwin; Alan Hilibrand; Michael Gustavel; Robert McLain; William Shaffer; Mark Myers; John Glaser; Robert A. Hart

2005-01-01

116

Mechanically simulated muscle forces strongly stabilize intact and injured upper cervical spine specimens  

Microsoft Academic Search

Although muscles are assumed to be capable of stabilizing the spinal column in vivo, they have only rarely been simulated in vitro. Their effect might be of particular importance in unstable segments. The present study therefore tests the hypothesis that mechanically simulated muscle forces stabilize intact and injured cervical spine specimens. In the first step, six human occipito-cervical spine specimens

A. Kettler; E. Hartwig; M. Schultheiß; L. Claes; H.-J. Wilke

2002-01-01

117

Biofidelic whole cervical spine model with muscle force replication for whiplash simulation  

Microsoft Academic Search

Whiplash has been simulated using volunteers, whole cadavers, mathematical models, anthropometric test dummies, and whole cervical spines. Many previous in vitro whiplash models lack dynamic biofidelity. The goals of this study were to (1) develop a new dynamic whole cervical spine whiplash model that will incorporate anterior, lateral and posterior muscle force replication, (2) evaluate its performance experimentally and (3)

P. C. Ivancic; Manohar M. Panjabi; S. Ito; P. A. Cripton; J. L. Wang

2005-01-01

118

Summary of the National Athletic Trainers' Association position statement on the acute management of the cervical spine-injured athlete  

Microsoft Academic Search

The incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, oft en involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and timeliness of transfer to a controlled

Erik E. Swartz; Laura C. Decoster; Susan A. Norkus; Barry P. Boden; Kevin N. Waninger; Robb S. Rehberg

2009-01-01

119

Comparative Analysis of Cervical Spine Management in a Subset of Severe Traumatic Brain Injury Cases Using Computer Simulation  

Microsoft Academic Search

BackgroundNo randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI) at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit

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

2011-01-01

120

Solitary fibrous tumor in the cervical spine with destructive vertebral involvement: a case report and review of the literature  

Microsoft Academic Search

Introduction  Recently, solitary fibrous tumors occurring in spine-related lesions have been reported. However, the destruction of vertebral\\u000a bodies by this type of tumor has not been reported.\\u000a \\u000a \\u000a \\u000a Materials and methods  A 71-year-old female presented with pain from a mass on the right side of her neck. Plain radiographs of the cervical spine\\u000a showed collapse of the C5 vertebral body and dislocation of

Koji Hashimoto; Kei Miyamoto; Hideo Hosoe; Gou Kawai; Kenta Kikuike; Kuniyasu Shimokawa; Naoki Suzuki; Masayuki Matsuo; Hirotaka Kodama; Katsuji Shimizu

2008-01-01

121

Surgical Anatomy of the Anterior Cervical Spine: The Disc Space, Vertebral Artery, and Associated Bony Structures  

Microsoft Academic Search

OBJECTIVE: To elucidate the relationships between the neurovascular structures and surrounding bone, which are hidden from the surgeon by soft tissue, and to aid in avoiding nerve root and vertebral artery injury in anterior cervical spine surgery. METHODS: Using six cadaveric spines, we measured important landmarks on the anterior surface of the spine, the bony housing protecting the neurovascular structures

T. Glenn Pait; James A. Killefer; Kenan I. Arnautovic

1996-01-01

122

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

123

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

124

Posterior Fixation of a Cervical Fracture Using the RRS Loop Spine System and Polyethylene Tape in an Elderly Ankylosing Spondylitis Patient: A Case Report  

PubMed Central

An 80-year-old woman presented with neck pain and paraparesis of Frankel C in her upper and lower extremities after falling. Imaging revealed an ankylosing cervical spine and a fracture line running obliquely from the anterior C3-4 to the posterior C4-5 level. Posterior fixation from the occi pit to T3 was performed using the RRS Loop Spine System and concomitant polyethylene tape fixation. This system is characterized by the uniqueness of how it screws to the occi pit and its use of a fixation rod with a larger diameter than in other instrumentation devices for use in the cervical region. Sublaminar banding using polyethylene tape was used to secure fixation. Her postoperative course was unremarkable, and her neck pain was relieved, although neurological improvement was minor. To our knowledge, this is the first report of an application of the RRS Loop Spine System to an ankylosing spondylitis patient with a cervical fracture.

Iida, Jin; Shigematsu, Hideki; Satoh, Nobuhisa; Tanaka, Masato; Kura, Tomohiko; Tsukamoto, Shinji; Kato, Yoshinobu; Tanaka, Yasuhito

2012-01-01

125

Cervical spine clearance in the traumatically injured patient: is multidetector CT scanning sufficient alone?  

PubMed

Object Clearance of the cervical spine in patients who have sustained trauma remains a contentious issue. Clinical examination alone is sufficient in neurologically intact patients without neck pain. Patients with neck pain or those with altered mental status or a depressed level of consciousness require further radiographic evaluation. However, no consensus exists as to the appropriate imaging modality. Some advocate multidetector CT (MDCT) scanning alone, but this has been criticized because MDCT is not sensitive in detecting ligamentous injuries that can often only be identified on MRI. Methods Patients were identified retrospectively from a prospectively maintained database at a Level I trauma center. All patients admitted between January 2004 and June 2011 who had a cervical MDCT scan interpreted by a board-certified radiologist as being without evidence of acute traumatic injury and who also had a cervical MRI study obtained during the same hospital admission were included. Data collected included patient demographics, mechanism of injury, Glasgow Coma Scale score at the time of MRI, the indication for and findings on MRI, and the number, type, and indication for cervical spine procedures. Results A total of 1004 patients were reviewed, of whom 614 were male, with an overall mean age of 47 years. The indication for MRI was neck pain in 662 patients, altered mental status in 467, and neurological signs or symptoms in 157. The MRI studies were interpreted as normal in 645 patients, evidencing ligamentous injury alone in 125, and showing nonspecific degenerative changes in the remaining patients. Of the 125 patients with ligamentous injuries, 66 (52.8%) had documentation of clearance (29 clinical, 37 with flexion-extension radiographs). Another 32 patients were presumed to be self-cleared, bringing the follow-up rate to 82% (98 of 119). Five patients died prior to clearance, and 1 patient was transferred to another facility prior to clearance. Based on these data, the 95% confidence interval for the assertion that clinically irrelevant ligamentous injury in the face of normal MDCT is 97%-100%. No patient with ligamentous injury on MRI was documented to require a surgical procedure or halo orthosis for instability. Thirty-nine patients ultimately underwent cervical surgical procedures (29 anterior and 10 posterior; 5 delayed) for central cord syndrome (21), quadriparesis (9), or discogenic radicular pain (9). None had an unstable spine. Conclusions In this study population, MRI did not add any additional information beyond MDCT in identifying unstable cervical spine injuries. Magnetic resonance imaging frequently detected ligamentous injuries, none of which were found to be unstable at the time of detection, during the course of admission, or on follow-up. Magnetic resonance imaging provided beneficial clinical information and guided surgical procedures in patients with neurological deficits or radicular pain. An MDCT study with sagittal and coronal reconstructions negative for acute injury in patients without an abnormal motor examination may be sufficient alone for clearance. PMID:24033302

Chew, Brandon G; Swartz, Christopher; Quigley, Matthew R; Altman, Daniel T; Daffner, Richard H; Wilberger, James E

2013-09-13

126

Normal kinematics of the neck: The interplay between the cervical and thoracic spines.  

PubMed

The movement coordination between the cervical and thoracic spine was examined in 34 asymptomatic participants (24 female and 10 male). Three-dimensional electromagnetic motion sensors were attached to the skin overlying the head, T1, T6, and T12 spinous processes to measure the angular displacement of the cervical, upper thoracic, and lower thoracic spine during active neck movements. These displacement measurements were found to have excellent reliability, with intraclass correlation coefficient ranging from 0.899 to 0.993. The angular displacement-time curves of the cervical and upper thoracic spine were also highly repeatable, with coefficient of multiple determinations ranging from 0.900 to 0.967. Both the cervical and thoracic spines were found to contribute to active neck motion, the greatest contribution being from the cervical region in all movement directions. The inter-regional movement coordination between the cervical spine and upper thoracic spine in all three planes of movement was found to be high, as determined by cross-correlation analysis of the movements of the regions. The current results suggest that the motion of the thoracic spine, in particular the upper thoracic spine, contributes to neck mobility, and that the upper thoracic spine should be included during clinical examination of neck dysfunction. PMID:23632368

Tsang, Sharon M H; Szeto, Grace P Y; Lee, Raymond Y W

2013-04-28

127

Cervical Radiculopathy (Pinched Nerve)  

MedlinePLUS

... Copyright 2010 American Academy of Orthopaedic Surgeons Cervical Radiculopathy (Pinched Nerve) Some people have neck pain that ... The medical term for this condition is cervical radiculopathy. Understanding your spine and how it works can ...

128

Microsurgery of the cervical spine in elderly patients Part 1: Surgery of degenerative disease  

Microsoft Academic Search

Summary The results of microsurgery for degenerative disease of the cervical spine are reported in 84 consecutive patients being 65 years of age or older at the time of surgery. Patients were suffering from either soft or hard disc disease or from advanced forms of cervical myelopathy. In 60 patients microsurgical resection of the involved cervical disc and posterior osteophytes

V. Seifert; F. M. van Krieken; M. Zimmermann; D. Stolke; S. D. Bao

1994-01-01

129

National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine-Injured Athlete  

PubMed Central

Objective: To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete. Background: The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment. Recommendations: Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.

Swartz, Erik E; Boden, Barry P; Courson, Ronald W; Decoster, Laura C; Horodyski, MaryBeth; Norkus, Susan A; Rehberg, Robb S; Waninger, Kevin N

2009-01-01

130

Rugby union injuries to the cervical spine and spinal cord.  

PubMed

Injuries to the cervical spine are among the most serious injuries occurring as a result of participation in rugby. Outcomes of such injuries range from complete recovery to death, depending on the degree of spinal cord damage sustained. Much information has been gained regarding the mechanisms and frequency of such injuries, from case reports and case series studies. The most commonly reported mechanism of injury has been hyperflexion of the cervical spine, resulting in fracture dislocation of C4-C5 or C5-C6. Tracking both the trends of incidence of spinal injuries, and the effectiveness of injury prevention initiatives has proved difficult because of a lack of properly conducted epidemiological studies. Within the constraints of the research published to date, it appears that hookers and props have been at disproportionate risk of cervical spine injury, predominantly because of injuries sustained during scrummaging. While the scrum was the phase of play most commonly associated with spinal injuries throughout the 1980s in most rugby playing countries, there has been a trend through the 1990s of an increasing proportion of spinal injuries occurring in the tackle situation. The majority of injuries have occurred early in the season, when grounds tend to be harder, and players are lacking both practice and physical conditioning for the physical contact phases of the sport. A number of injury prevention measures have been launched, including changes to the laws of the game regarding scrummaging, and education programmes aimed at enforcing safe techniques and eliminating illegal play. Calls for case-registers and effective epidemiological studies have been made by researchers and physicians in most countries where rugby is widespread, but it appears to be only recently that definite steps have been made towards this goal. Well-designed epidemiological studies will be able to provide more accurate information about potential risk factors for injury such as age, grade, position, gender and ethnicity. Research into the long-term effects of participation in rugby on the integrity of the spinal column is warranted. PMID:12141883

Quarrie, Kenneth L; Cantu, Robert C; Chalmers, David J

2002-01-01

131

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

PubMed Central

In this retrospective cohort study, two surgical methods of conventional open-door laminoplasty and deep extensor muscle-preserving laminoplasty were allocated for the treatment of cervical myelopathy, and were specifically compared in terms of axial pain, cervical spine function, and quality of life (QOL) with a minimum follow-up period of 2 years. Eighty-four patients were divided into two groups and received either a conventional open-door laminoplasty (CL group) or laminoplasty using a deep extensor muscle-preserving approach (MP group). The latter approach was performed by preserving multifidus and semispinalis cervicis attachments followed by open-door laminoplasty and re-suture of the bisected spinous processes at each decompression level. The average follow-up period was 38 months (25–53 months). The preoperative and follow-up evaluations included the original Japanese Orthopaedic Association (JOA) score, the new tentative JOA score including cervical spine function and QOL, and the visual analogue scale (VAS) of axial pain. Radiological analyses included cervical lordosis and flexion–extension range of motion (flex–ext ROM) (C2–7), and deep extensor muscle areas on MR axial images. The JOA recovery rates were statistically equivalent between two groups. The MP group demonstrated a statistically superior cervical spine function (84% vs 63%) and QOL (61% vs 45%) when compared to the CL group at final follow-up (P < 0.05). The average VAS scores at final follow-up were 2.3 and 4.9 in MP and CL groups (P < 0.05). The cervical lordosis and flex–ext ROM were statistically equivalent. The percent deep muscle area on MRI demonstrated a significant atrophy in CL group compared to that in MP group (56% vs 88%; P < 0.01). Laminoplasty employing the deep extensor muscle-preserving approach appeared to be effective in reducing the axial pain and deep muscle atrophy as well as improving cervical spine function and QOL when compared to conventional open-door laminoplasty.

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

2009-01-01

132

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

2006-01-19

133

THE EFFECTS OF LIGAMENTOUS INJURY IN THE HUMAN LOWER CERVICAL SPINE  

PubMed Central

Damage is often sustained by the anterior longitudinal ligament (ALL) and ligamentum flavum LF) in the cervical spine subsequent to whiplash or other cervical trauma. These ligaments afford substantial cervical stability when healthy, but the ability of the ALL and LF to stabilize the spine when injured is not as conclusively studied. In order to address this issue, the current study excised ALL and LF tissues from cadaveric spines and experimentally simulated whiplash-type damage to the isolated ligaments. Stiffnesses and toe region lengths were measured for both the uninjured and damaged states. These ligamentous mechanical properties were then inputted into a previously-validated finite element (FE) model of the cervical spine and the kinematic effects of various clinically relevant combinations of ligamentous injury were predicted. The data indicated three and five-fold increases in toe region length for the LF and ALL injury variants, respectively. These toe length distensions resulted in FE predictions of supra-physiologic ranges of motion, and these motions were comparable to spines with no ligamentous support. Finally, a set of cadaveric cervical spine ligament-sectioning experiments confirmed the FE predictions and supported the finding that partial injury to the relevant ligaments produces equivalent cervical kinematic signatures to spines that have completely compromised ALL and LF tissues.

Leahy, P Devin; Puttlitz, Christian M

2012-01-01

134

Spine and scapular pain: an unusual presentation of colon adenocarcinoma.  

PubMed

We are presenting an elderly Caucasian woman who was admitted to our hospital for severe lower back pain and scapular pain for 8 days. She had a history of spinal stenosis and we believed this was the aetiology of her pain. However, her pain was not subsiding and hence an MRI spine was performed. It revealed spinal stenosis and abnormal signal in the lower thoracic and lumbar vertebrae. Hence a bone biopsy was performed that came back as metastatic adenocarcinoma. She underwent a bone scan and revealed diffuse disease in thoracic, lumbar, sacral spine as well as third and 10th ribs. Her CT chest/abdomen/pelvis revealed no primary tumour. A mass was detected on her colonscopy, and pathology revealed adenocarcinoma. She underwent palliative radiation and one cycle of chemotherapy. She was discharged to home hospice care. It is very rare to have osseous metastases as the only manifestation of colon cancer. PMID:23861273

Padhi, Parikshit; Mackey, Christine

2013-07-16

135

Dynamic somatosensory evoked potentials to determine electrophysiological effects on the spinal cord during cervical spine extension.  

PubMed

Object The goal of this prospective study was to investigate somatosensory evoked potentials (SSEPs) during dynamic motion of the cervical spine and to evaluate the efficacy of analyzing dynamic SSEPs for predicting dynamic effects on the spinal cord in patients with cervical spondylotic myelopathy (CSM). Methods In total, 40 human subjects (20 CSM patients and 20 healthy volunteers as a control group) were examined prospectively using dynamic SSEPs with median nerve stimulation. The CSM patients showed cervical myelopathy due to cervical cord compression at the C4-5 segment. The SSEPs were examined with the cervical spine in a neutral position and at a 20° extension for 10 and 20 minutes. Changes in the N20 latency and amplitude were determined and analyzed. The authors defined the changes in the N20 latency and N20 amplitude between the neutral and extension positions of the cervical spine as percent latency and amplitude, respectively. Results In the CSM patients, SSEPs tended to deteriorate after cervical spine extension, and a statistically significant deterioration of the N20 amplitude after the extension was observed. Moreover, the percent latency and amplitude progressively increased during cervical spine extension in these patients. In the healthy controls, SSEPs tended to deteriorate with cervical spine extension, but these changes did not result in statistically significant differences. Moreover, in this group the percent latency and amplitude were almost identical during the extension. When the CSM patients and the healthy controls were compared, a significant difference in the percent amplitude was observed between the 2 groups during the cervical spine extension. Conclusions This study suggests the potential of dynamic SSEPs as a useful neurophysiological technique to detect the effect of dynamic factors on the pathogenesis of CSM. PMID:23848352

Morishita, Yuichiro; Maeda, Takeshi; Ueta, Takayoshi; Naito, Masatoshi; Shiba, Keiichiro

2013-07-12

136

Injury Mechanisms in the Pediatric Cervical Spine During Out-of-Position Airbag Deployments  

PubMed Central

The pediatric cervical spine differs considerably from the adult in both its geometry and its constitutive properties. Therefore, it is susceptible to a different set of injuries, some of which are particularly severe. Recent data from the NHTSA on cervical spine injuries in low speed out-of-position airbag deployments shows that the spectrum of injuries in children is different from that of the adult. Almost all of the children (98%) sustained head or cervical spine injuries, as compared to only 38% of the adults. In addition, the injuries in children were not gender dependent, while injuries in adults occurred in females 72% of the time. The specific loads which result in these injuries are still unclear; however, examination of the biomechanical data for the adult may yield some insights. This examination also points to the need for additional biomechanical testing in order to define tolerances for pediatric cervical spine injury.

Nightingale, Roger W.; Winkelstein, Beth A.; Van Ee, Chris A.; Myers, Barry S.

1998-01-01

137

Estimated Probability of a Cervical Spine Injury During an ISS Mission.  

National Technical Information Service (NTIS)

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 simu...

A. S. Weaver J. E. Brooker J. G. Myers

2013-01-01

138

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

2013-07-31

139

Primary Eosinophilic Granuloma of Adult Cervical Spine Presenting as a Radiculomyelopathy  

PubMed Central

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.

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

2013-01-01

140

Pulsed radiofrequency of cervical medial branches for treatment of whiplash-related cervical zygapophysial joint pain  

Microsoft Academic Search

BackgroundThe aim of this study is to assess the efficacy of pulsed RF lesioning of cervical medial branches in patients with whiplash-related chronic cervical zygapophysial joint pain in whom other conservative treatments failed.

Po-Chou Liliang; Kang Lu; Ching-Hua Hsieh; Chia-Yi Kao; Kuo-Wei Wang; Han-Jung Chen

2008-01-01

141

Lateral Mass and Pedicle Screws Fixation of Cervical Spine  

Center for Biologics Evaluation and Research (CBER)

Text Version... Nazarian Spine 1991 Levine Spine 1992 ... Spine 1992;17:S442-6. 6. Levine AM, Mazel C, Roy-Camille R. Management of fracture ... More results from www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials

142

MRI of giant cell turmor of the tendon sheath in the cervical spine  

SciTech Connect

The authors present a case of giant cell tumor of the tendon sheath (GCTTS) in the cervical spine, not previously described in the radiologic literature. Diagnostic imaging includes plain film radiographs, bone scintigraphy, CT, and MRI. Only one case of tenosynoviaI giant cell tumor of the cervical spine has been reported. The radiological features of this tumor are described along with a brief review of GCTTS. 6 refs., 3 figs.

Bui-Mansfield, L.T.; Youngberg, R.A.; Coughlin, W.; Choolijian, D. [Madigan Army Medical Center, Tacoma, WA (United States)

1996-01-01

143

Intervertebral Neck Injury Criterion for Prediction of Multiplanar Cervical Spine Injury Due to Side Impacts  

Microsoft Academic Search

Objective. Intervertebral Neck Injury Criterion (IV-NIC) is based on the hypothesis that dynamic three-dimensional intervertebral motion beyond physiological limits may cause multiplanar injury of cervical spine soft tissues. Goals of this study, using a biofidelic whole human cervical spine model with muscle force replication and surrogate head in simulated side impacts, were to correlate IV-NIC with multiplanar injury and determine

Manohar M. Panjabi; Paul C. Ivancic; Yasuhiro Tominaga; Jaw-Lin Wang

2005-01-01

144

Developmental steps of the human cervical spine: parameters for evaluation of skeletal maturation stages  

Microsoft Academic Search

The central objective of this investigation was to focus on the development of the cervical spine observed by lateral cephalometric\\u000a radiological images of children and adolescents (6–16 years old). A sample of 26 individuals (12 girls and 14 boys) was classified\\u000a according to stages of cervical spine maturation in two subcategories: group I (initiation phase) and group II (acceleration\\u000a phase). The

Marcos Fabio Henriques dos Santos; Rodrigo Lopes de Lima; Bernardo De-Ary-Pires; Mário Ary Pires-Neto; Ricardo de Ary-Pires

2010-01-01

145

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

2013-06-07

146

Dynamic Mechanical Properties of Intact Human Cervical Spine Ligaments  

PubMed Central

BACKGROUND CONTEXT Most previous studies have investigated ligaments mechanical properties at slow elongation rates of less than 25 mm/s. PURPOSE To determine the tensile mechanical properties, at a fast elongation rate, of intact human cervical anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. STUDY DESIGN/SETTING In vitro biomechanical study. METHODS A total of 97 intact bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines (average age: 80.6 years, range, 71 to 92 years) and were elongated to complete rupture at an average (SD) peak rate of 723 (106) mm/s using a custom-built apparatus. Non-linear force vs. elongation curves were plotted and peak force, peak elongation, peak energy, and stiffness were statistically compared (P<0.05) among ligament. A mathematical model was developed to determine the quasi-static physiological ligament elongation. RESULTS Highest average peak force, up to 244.4 and 220.0 N in the ligamentum flavum and capsular ligament, respectively, were significantly greater than in the anterior longitudinal ligament and middle-third disc. Highest peak elongation reached 5.9 mm in the intraspinous and supraspinous ligaments, significantly greater than in the middle-third disc. Highest peak energy of 0.57 J was attained in the capsular ligament, significantly greater than in the anterior longitudinal ligament and middle-third disc. Average stiffness was generally greatest in the ligamentum flavum and least in the intraspinous and supraspinous ligaments. For all ligaments, peak elongation was greater than average physiological elongation computed using the mathematical model. CONCLUSIONS Comparison of the present results with previously reported data indicated that high speed elongation may cause cervical ligaments to fail at a higher peak force and smaller peak elongation and may be stiffer and absorb less energy, as compared to a slow elongation rate. These comparisons may be useful to clinicians for diagnosing cervical ligament injuries based upon the specific trauma.

Ivancic, Paul C.; Coe, Marcus P.; Ndu, Anthony B.; Tominaga, Yasuhiro; Carlson, Erik J.; Rubin, Wolfgang; (FH), Dipl-Ing; Panjabi, Manohar M.

2009-01-01

147

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

148

Post radiation sarcoma (malignant fibrous histiocytoma) of the cervical spine following ependymoma (a case report).  

PubMed

A case is reported of a 36 y/o man treated with radiation therapy for cervical cord ependymoma who developed malignant fibrous histiocytoma of the cervical spine 15 years later. Pathology revealed the sarcoma adjacent to the recurrent ependymoma. Post-radiation sarcomas following treatment of central nervous system malignancies is discussed. PMID:1668408

Nadeem, S Q; Feun, L G; Bruce-Gregorios, J H; Green, B

1991-12-01

149

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

150

The thermoplastic Minerva body jacket: a clinical comparison with other cervical spine splinting techniques.  

PubMed

A retrospective analysis of the efficacy of a variety of external stabilization techniques used in 155 cases of unstable cervical spine injuries is presented. The movement at each intervertebral level was evaluated during thermoplastic Minerva body jacket stabilization in 18 additional patients. Many currently available approaches to external stabilization of the cervical spine were, thus, assessed. Thermoplastic Minerva body jacket stabilization offered superior segmental immobilization compared with published data for the halo. It is concluded that some unstable injuries to the high cervical spine might best be treated with a halo device, whereas mid to low cervical injuries and the remaining upper cervical spine injuries appear to be optimally treated with a Minerva jacket. Lesser injuries may be treated with a variety of available orthoses. The thermoplastic Minerva body jacket offers a superior limitation of intervertebral movement compared with other commonly used braces, including the halo jacket, for most cervical spine injuries. The technique of application of the thermoplastic Minerva body jacket is reviewed. PMID:1520990

Benzel, E C; Larson, S J; Kerk, J J; Millington, P J; Novak, S M; Falkner, R H; Wenninger, W J

1992-09-01

151

Cervical Spine Motion in Football Players During 3 Airway-Exposure Techniques  

PubMed Central

Objective: Immediate rescue breathing, or cardiopulmonary resuscitation, may be necessary for the cervical spine-injured football player without removal of the helmet. The purpose of our study was to compare 2 pocket-mask insertion techniques with a face-mask rotation technique to determine which allowed the quickest initiation of rescue breathing with the least cervical spine motion. Design and Setting: In a biomechanics laboratory, 3 airway-preparation techniques were tested: chin-insertion technique (pocket mask inserted between the chin and face mask), eye-hole-insertion technique (pocket mask inserted through the face mask eye hole), and screwdriver technique (side loop straps removed using manual screwdriver followed by mask rotation). Subjects: One athletic trainer team and 12 National Collegiate Athletic Association Division III football players. Measurements: Time to initiate rescue breathing and induced helmet motion. Results: Both pocket-mask techniques allowed quicker initiation of rescue breathing. Cervical spine anterior-posterior displacement was greater for the chin technique than for the screwdriver or eye-hole techniques. Lateral translation was greater for the screwdriver technique than for either pocket-mask technique. Peak displacement from initial cervical spine position was greater for the chin technique than for the eye-hole technique. Conclusions: Both pocket-mask techniques allowed quicker initiation of rescue breathing than did rotation of the face mask via loop strap screw removal. The eye-hole insertion technique was faster and produced less cervical spine motion than the other 2 techniques. Each technique produced significantly smaller amounts of cervical spine displacement than that caused by cutting face-mask loop straps as reported earlier. We suggest a protocol for field management of cervical spine injuries in football players.

Ray, Richard; Luchies, Carl; Frens, Margaret Abfall; Hughes, Wendy; Sturmfels, Richard

2002-01-01

152

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

153

Comparison of risk factors for cervical spine, head, serious, and fatal injury in rollover crashes.  

PubMed

Previous epidemiological studies of rollover crashes have focused primarily on serious and fatal injuries in general, while rollover crash testing has focused almost exclusively on cervical spine injury. The purpose of this study was to examine and compare the risk factors for cervical spine, head, serious, and fatal injury in real world rollover crashes. Rollover crashes from 1995-2008 in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) were investigated. A large data set of 6015 raw cases (2.5 million weighted) was generated. Nonparametric univariate analyses, univariate logistic regression, and multivariate logistic regression were conducted. Complete or partial ejection, a lack of seatbelt use, a greater number of roof inversions, and older occupant age significantly increased the risk of all types of injuries studied (p<0.05). Far side seating position increased the risk of fatal, head, and cervical spine injury (p<0.05), but not serious injury in general. Higher BMI was associated with an increased risk of fatal, serious, and cervical spine injury (p<0.05), but not head injury. Greater roof crush was associated with a higher rate of fatal and cervical spine injury (p<0.05). Vehicle type, occupant height, and occupant gender had inconsistent and generally non-significant effects on injury. This study demonstrates both common and unique risk factors for different types of injuries in rollover crashes. PMID:22269486

Funk, James R; Cormier, Joseph M; Manoogian, Sarah J

2011-12-26

154

Cervical Cord Compressive Myelopathy in a Man With a Primary Complaint of Knee Pain  

PubMed Central

Background: Diagnosing patients with cervical cord compressive myelopathy in a timely manner can be challenging due to varying clinical presentations, the absence of pathognomonic findings, and symptoms that are usually insidious in nature. Objective: To describe the clinical course of a patient with primary complaint of left medial knee pain that was nonresponsive to surgical and conservative measures; the patient was subsequently diagnosed with cervical cord compressive myelopathy. Design: Case report. Subject: A 63-year-old man with a primary complaint of left medial knee pain. Findings: Physical examination of the left knee was normal except for slight palpable tenderness over the medial joint line. During treatment, he noted loss of balance during activities of daily living. Reassessment revealed bilateral upper extremity hyperreflexia, bilateral Babinski reflex, and positive bilateral Hoffman reflex. Magnetic resonance imaging of the cervical spine demonstrated moderately severe spinal stenosis at the C3-C4, C5-C6, and C6-C7 levels. After C3-C7 laminoplasty for cervical cord compressive myelopathy, he reported substantial improvement of his left medial knee. Three years later, he had no complaint of knee pain. Conclusion: Appropriate diagnosis and treatment of cervical cord compressive myelopathy may avoid unnecessary diagnostic imaging, medical evaluations, invasive procedures, and potential neurologic complications.

Ross, Michael D; Elliott, Ryan

2010-01-01

155

Summary of the National Athletic Trainers' Association position statement on the acute management of the cervical spine-injured athlete.  

PubMed

The incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and timeliness of transfer to a controlled environment for diagnosis and treatment. The objective of the National Athletic Trainers' Association (NATA) position statement on the acute care of the cervical spine-injured athlete is to provide the certified athletic trainer, team physician, emergency responder, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in an athlete. Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport such as football, hockey, or lacrosse; and imaging considerations in the emergency department. PMID:20048537

Swartz, Erik E; Decoster, Laura C; Norkus, Susan A; Boden, Barry P; Waninger, Kevin N; Courson, Ronald W; Horodyski, Marybeth; Rehberg, Robb S

2009-12-01

156

Radiation therapy for chordomas of the base of skull and cervical spine: Patterns of failure and outcome after relapse  

Microsoft Academic Search

Purpose: To determine the patterns of failure and outcome following relapse of chordomas of the base of skull and cervical spine.Methods and Materials: Between November 1975 and October 1993, 204 patients were treated for chordoma of the base of skull or cervical spine, of which 63 have developed relapse. These 63 patients constitute the main focus of this study. Forty-five

Marcio A. Fagundes; Eugen B. Hug; Norbert J. Liebsch; William Daly; Jimmy Efird; John E. Munzenrider

1995-01-01

157

Pediatric Cervical Spine Injury Sustained in Falls From Low Heights  

Microsoft Academic Search

Study objective: To determine whether history and clinical examination findings can identify young children who have sustained cervical injury after falling short distances. Methods: We conducted a retrospective review of the medical records of children younger than 6 years old with the diagnosis of cervical vertebral fracture or cervical spinal cord injury after a fall of less than 5 feet.

Gary R Schwartz; Seth W Wright; Joel A Fein; Jacqueline Sugarman; Joel Pasternack; Steven Salhanick

1997-01-01

158

Fatalities from head and cervical spine injuries occurring in tackle football: 50 years' experience.  

PubMed

Football head and cervical spine fatalities have been related to 84.9% of all football fatalities from 1945 through 1994. The decade from 1965 through 1974 was responsible for the greatest number and percentage of head and cervical spine fatalities, and the two decades from 1975 through 1994 were associated with the smallest number and percentage. The data reveal that most head and cervical spine fatalities are related to high school football players either tackling or being tackled in a game. Most head fatalities are subdural hematomas, and almost all of the cervical spine fatalities are fractures, dislocations, or fracture-dislocations. There has been a dramatic reduction in these types of fatalities during the last two decades, 1975 through 1994, and the preventive measures that have received most of the credit have been the 1976 rule change that prohibits initial contact with the head and face when blocking and tackling, the NOCSAE helmet standard that went into effect in colleges in 1978 and high schools in 1980, better coaching in the techniques of blocking and tackling, and improved medical care. There has been a reduction of head and cervical spine fatalities, but the analysis of data for the next decade, 1995 through 2004, will reveal the continued effects of the preventive measures discussed and continued research efforts. A number of researchers have stated that in order for the head and cervical spine fatalities to continue decreasing, there must be increased helmet research with an emphasis on concussions and neck injuries. Will the number of fatalities continue to decrease? Only time will tell. PMID:9475981

Mueller, F O

1998-01-01

159

Posterior Hybrid Technique for Ossification of the Posterior Longitudinal Ligament Associated With Segmental Instability in the Cervical Spine.  

PubMed

STUDY DESIGN:: Retrospective case series. OBJECTIVE:: To discuss the indications for a posterior hybrid technique for ossification of the posterior longitudinal ligament (OPLL) associated with segmental instability in the cervical spine and evaluate its effectiveness and safety. SUMMARY OF BACKGROUND DATA:: Dynamic factors have been shown to play an important role in the progression of ossification and OPLL myelopathy. Laminoplasty has been widely used to treat cervical OPLL, but progressive kyphosis and progression of ossified lesions are often detected in long-term follow-up. METHODS:: Fifteen patients were treated by a posterior hybrid technique including laminoplasty and lateral mass screw fixation at unstable levels. Preoperatively, the extent and type of OPLL, spinal cord compression, and presence of high-intensity zones (HIZ) were investigated by X-ray, computed tomography, and magnetic resonance imaging. Segmental instability in the cervical spine was investigated by dynamic X-ray. Postoperatively, clinical outcomes were evaluated with the Japanese Orthopaedic Association (JOA) scoring system and visual analogue scale scores for neck pain. Radiological results included cervical alignment and progression of OPLL. RESULTS:: A total of 17 intervertebral levels in 15 patients (11 mixed-type and 4 continuous-type OPLL) had segmental instability, which was consistent with the presence of HIZ levels in 10 (66.7%) patients. Neurological function as evaluated by JOA scores was significantly improved 6 months postoperatively and well maintained 4 years postoperatively. Neck pain was significantly improved 4 years postoperatively. No patients developed progressive kyphosis or progression of ossified lesions during the follow-up. Only 1 patient developed unilateral C5 palsy and completely recovered 2 months later. CONCLUSIONS:: This hybrid posterior technique appears to be effective and safe in the treatment of selected patients with OPLL associated with segmental instability. The potential benefits of this technique include a stable environment for spinal cord recovery and prevention of progressive kyphosis and OPLL. PMID:22576720

Chen, Yu; Wang, Xinwei; Chen, Deyu; Miao, Jinghao; Liao, Xinyuan; Yu, Fengbin

2012-05-10

160

Intraosseous ultrasound for pedicle screw positioning in the subaxial cervical spine: an experimental study  

Microsoft Academic Search

Background  In contrast to other regions of the human spine, dorsal fixation with rods and pedicle screws is comparatively rarely performed\\u000a in the cervical spine. Although this technique provides a higher mechanical strength than the more frequently used lateral\\u000a mass screws, many surgeons fear the relatively high rate of misplacements. This higher incidence is mainly due to the complex\\u000a vertebral anatomy

Sven Rainer Kantelhardt; Hans Christoph Bock; Laila Siam; Jörg Larsen; Ralf Burger; Wolfgang Schillinger; Volker Bockermann; Veit Rohde; Alf Giese

2010-01-01

161

Clinical application of combined fixation in the cervical spine using posterior transfacet screws and pedicle screws.  

PubMed

The aim of the present study was to describe the clinical application of combined fixation in the cervical spine using posterior transfacet and pedicle screws. Ten patients with cervical disorders requiring stabilization were treated from May 2006 to December 2008. The operative details varied depending on indication, the need for decompression, and the number of levels to be included in the spinal construct. Radiographic analysis of the fusion was performed after surgery. A total of 23 transfacet screws were inserted at or caudal to the C4/5 facet. A total of 21 pedicle screws were placed. All patients underwent operative treatment without neurovascular complications. Fusion was achieved in all patients. When performed appropriately, the method of using posterior transfacet screws in the caudal cervical joints combined with pedicle screw fixation in the cephalic cervical spine is reliable and deserves more widespread use. PMID:23232101

Liu, Guanyi; Ma, Weihu; Xu, Rongming; Godinsky, Ryan; Sun, Shaohua; Feng, Jianxiang; Zhao, Liujun; Hu, Yong; Zhou, Leijie; Liu, Jiayong

2012-12-08

162

Time to stabilisation of the cervical spine when supported by a pillow in side lying.  

PubMed

Currently, there is little information to guide consumers, retailers and health professionals about the length of time it takes for the cervical spine to stabilise when resting on a pillow. The aim of this study was to determine the time required to achieve stabilisation of the cervical spine when supported by a polyester pillow and innerspring mattress in side lying. Twenty-four asymptomatic females rested in a standardised side lying position during the capture of 3D data from markers placed over cervical landmarks. Time to stabilisation was assessed for each axis, each landmark and globally for each participant. A large variation in global stabilisation times was identified between participants; however, 70.8% of participants had stabilised by 15 min or earlier. Fifteen minutes is the best estimate of the time to stabilisation of the cervical spine for young females in a side lying position when resting on a polyester pillow. Practitioner Summary: This study aimed to determine the time required to achieve stabilisation of the cervical spine when supported by a polyester pillow and innerspring mattress in side lying. Through a laboratory study using 3D VICON(®) motion analysis technology, we identified that 70.8% of participants had stabilised by 15 min. PMID:23875624

Hodkinson, Jennifer B; Gordon, Susan J; Crowther, Robert G; Buettner, Petra G

2013-07-22

163

Active range of motion of the head and cervical spine: a three-dimensional investigation in healthy young adults  

Microsoft Academic Search

Purpose. To define reference values for head–cervical range of motion (ROM) in healthy young adults, to assess the effect of sex, and to quantify the separate contribution of other body districts.Methods. Thirty women and 30 men performed maximal head and cervical spine flexion–extension, lateral bending, and axial rotation. Movements were detected using a digital optoelectronic instrument. Maximum head–cervical spine and

Virgilio F. Ferrario; Chiarella Sforza; Graziano Serrao; GianPiero Grassi; Erio Mossi

2002-01-01

164

An investigation into the validity of cervical spine motion palpation using subjects with congenital block vertebrae as a 'gold standard'  

PubMed Central

Background Although the effectiveness of manipulative therapy for treating back and neck pain has been demonstrated, the validity of many of the procedures used to detect joint dysfunction has not been confirmed. Practitioners of manual medicine frequently employ motion palpation as a diagnostic tool, despite conflicting evidence regarding its utility and reliability. The introduction of various spinal models with artificially introduced 'fixations' as an attempt to introduce a 'gold standard' has met with frustration and frequent mechanical failure. Because direct comparison against a 'gold standard' allows the validity, specificity and sensitivity of a test to be calculated, the identification of a realistic 'gold standard' against which motion palpation can be evaluated is essential. The objective of this study was to introduce a new, realistic, 'gold standard', the congenital block vertebra (CBV) to assess the validity of motion palpation in detecting a true fixation. Methods Twenty fourth year chiropractic students examined the cervical spines of three subjects with single level congenital block vertebrae, using two commonly employed motion palpation tests. The examiners, who were blinded to the presence of congenital block vertebrae, were asked to identify the most hypomobile segment(s). The congenital block segments included two subjects with fusion at the C2–3 level and one with fusion at C5-6. Exclusion criteria included subjects who were frankly symptomatic, had moderate or severe degenerative changes in their cervical spines, or displayed signs of cervical instability. Spinal levels were marked on the subject's skin overlying the facet joints from C1 to C7 bilaterally and the motion segments were then marked alphabetically with 'A' corresponding to C1-2. Kappa coefficients (K) were calculated to determine the validity of motion palpation to detect the congenitally fused segments as the 'most hypomobile' segments. Sensitivity and specificity of the diagnostic procedure were also calculated. Results Kappa coefficients (K) showed substantial overall agreement for identification of the segment of greatest hypomobility (K = 0.65), with substantial (K = 0.76) and moderate (K = 0.46) agreement for hypomobility at C2-3 and C5-6 respectively. Sensitivity ranged from 55% at the C5-6 CBV to 78% at the C2-3 level. Specificity of the procedure was high (91 – 98%). Conclusion This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine.

Humphreys, Barry K; Delahaye, Marianne; Peterson, Cynthia K

2004-01-01

165

The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review.  

PubMed

Abstract Purpose: The aim of this systematic review was to determine the efficacy of thoracic spine manipulation (TSM) in reducing pain and disability in patients diagnosed with non-specific neck pain. Methods: An extensive literature search of PubMed, The Cochrane Library, CINAHL and EMBASE was conducted in February 2012. Randomized controlled trials (RCTs) or controlled clinical trials evaluating the effect of TSM in patients aged 18 to 65 years with non-specific neck pain were eligible. Methodological quality of the studies was assessed according to the Physiotherapy Evidence Database scale (PEDro). Qualitative analyses were conducted by means of the best evidence synthesis of van Peppen et al. Results: The methodological quality of the 10 included RCTs (677 patients) varied between four and eight points. Eight studies reported significant reduction in pain and/or disability by TSM. Overall, according to the best evidence synthesis, there is insufficient evidence that TSM is more effective than control interventions in reducing pain and disability in patients with non-specific neck pain. Conclusions: TSM has a therapeutic benefit to some patients with neck pain, when compared to the effect of interventions such as electrotherapy/thermal programme, infrared radiation therapy, spinal mobilization and exercises. However, in comparison to cervical spine manipulation, no evidence is found that TSM is more effective in reducing pain and disability. Implications for Rehabilitation TSM is often used in the treatment of non-specific neck pain, which is a major health problem in the Western society. There is insufficient evidence that TSM is more effective in reducing pain and disability than control treatments in patients with non-specific neck pain. Despite the insufficient evidence that TSM is more effective than control treatments, TSM has a therapeutic benefit to some patients with neck pain. Therefore, TSM alone or in combination with other interventions is a suitable intervention to use in the treatment of non-specific neck pain. PMID:23339721

Huisman, Palesa A; Speksnijder, Caroline M; de Wijer, Anton

2013-01-23

166

Assessment of cervical spine movement during laryngoscopy with Macintosh and Truview laryngoscopes  

PubMed Central

Background: Truview laryngoscope provides an indirect view of the glottis and will cause less cervical spine movement since a ventral lifting force will not be required to visualize the glottis compared to Macintosh laryngoscope. Materials and Methods: A randomized crossover study to assess the degree of movement of cervical spine during endotracheal intubation with Truview laryngoscope was conducted in 25 adult ASA-I patients. After a standard anesthetic technique laryngoscopy was performed twice in each patient using in turn both the Macintosh and Truview laryngoscopes. A baseline radiograph with the head and neck in a neutral position was followed by a second radiograph taken during each laryngoscopy. An experienced radiologist analyzed and measured the cervical movement. Results: Significant cervical spine movement occurred at all segments when compared to the baseline with both the Macintosh and Truview laryngoscopes (P < 0.001). However, the movement was significantly less with Truview compared to the Macintosh laryngoscope at C0–C1 (21%; P = 0.005) and C1–C2 levels (32%; P = 0.009). The atlantooccipital distance (AOD) traversed while using Truview laryngoscope was significantly less than with Macintosh blade (26%; P = 0.001). Truview blade produced a better laryngoscopic view (P = 0.005) than Macintosh blade, but had a longer time to laryngoscopy (P = 0.04). Conclusion: Truview laryngoscope produced a better laryngoscopic view of glottis as compared with Macintosh laryngoscopy. It also produced significantly less cervical spine movement at C0–C1 and C1–C2 levels than with Macintosh laryngoscope in patients without cervical spine injury and without manual in-line stabilization (MILS). Further studies are warranted with Truview laryngoscope using MILS.

Bhardwaj, Neerja; Jain, Kajal; Rao, Madhusudan; Mandal, Arup Kumar

2013-01-01

167

Percutaneous techniques for cervical pain of discal origin.  

PubMed

Cervical discogenic pain is an important cause of suffering and disability in the adult population. Pain management in cervical disc herniation relies initially on conservative care (rest, physiotherapy, and oral medications). Once conservative treatment has failed, different percutaneous minimally invasive radiological procedures can be applied to relief pain. This article offers a systematic review on the percutaneous minimally invasive techniques that can be advocated for the treatment of cervical pain of discal origin. Periradicular steroid injection under image guidance (computed tomography or magnetic resonance imaging) is the first technique to be considered. The steroid injection aims at reducing the periradicular inflammation and thus relieves the radicular pain. The steroid injections present satisfying short-term results, but pain can recur in the long term. Whenever the steroid injections fail to relieve pain from a contained cervical disc herniation, the more invasive percutaneous disc decompression techniques should be proposed. Percutaneous radiofrequency nucleoplasty is the most often applied technique on the cervical level with a low risk of thermal damage. When the indications and instructions are respected, radiofrequency nucleoplasty presents accepted safety and efficacy levels. PMID:21500138

Gangi, Afshin; Tsoumakidou, Georgia; Buy, Xavier; Cabral, Jose Facundo; Garnon, Julien

2011-04-15

168

Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. Clinical, neuroradiological and neurophysiological study on 9 cases  

Microsoft Academic Search

Ossification of the posterior longitudinal ligament (OPLL) in the cervical spine is considered to be uncommon in western countries, although widely known and studied in Japan. We report on 9 cases of OPLL cervical myelopathy, investigated by x-ray films and cervical CT and by somatosensory evoked potentials. The patients reported spastic tetraparesis, sensory disorders of the limbs and, in one

L. Conte; T. Tassinari; M. Trucco; O. Serrato; R. Badino

1992-01-01

169

Improved medical and surgical management of cervical spine disease in patients with rheumatoid arthritis over 10 years  

Microsoft Academic Search

OBJECTIVES(1) To compare clinical outcome and symptomatology of rheumatoid cervical myelopathy between patients managed conservatively and surgically. (2) To determine if surgical outcome has improved since the series published from this unit in 1987. (3) To examine the role of magnetic resonance imaging (MRI) in the diagnosis of cervical myelopathy.METHODSPatients undergoing MRI of the cervical spine between 1991 and 1996

Jennifer D Hamilton; Margaret-Mary Gordon; Iain B McInnes; Robin A Johnston; Rajan Madhok; Hilary A Capell

2000-01-01

170

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

171

COMPARISON OF TIBIAL NERVE H-REFLEX EXCITABILITY AFTER CERVICAL AND LUMBAR SPINE MANIPULATION  

Microsoft Academic Search

Background: Previous investigations indicate that spinal manipulation leads to short-term attenuation of -motoneuron excitability, when assessed by means of the Hoffmann reflex. Past studies, however, are limited to regional effects, such as lumbar manipulation effects on lumbar -motoneuron activity. Objective: This study compared and contrasted the effects of cervical and lumbar spine manipulation on the excitability of the lumbar -motoneuronal

J. Donald Dishman; Brian M. Cunningham; Jeanmarie Burke

172

Comparison of tibial nerve H-reflex excitability after cervical and lumbar spine manipulation  

Microsoft Academic Search

Background: Previous investigations indicate that spinal manipulation leads to short-term attenuation of ?-motoneuron excitability, when assessed by means of the Hoffmann reflex. Past studies, however, are limited to regional effects, such as lumbar manipulation effects on lumbar ?-motoneuron activity. Objective: This study compared and contrasted the effects of cervical and lumbar spine manipulation on the excitability of the lumbar ?-motoneuronal

J. Donald Dishman; Brian M. Cunningham; Jeanmarie Burke

2002-01-01

173

Disabling injuries of the cervical spine in Argentine rugby over the last 20 years  

Microsoft Academic Search

OBJECTIVE: To investigate the incidence and risk factors of disabling injuries to the cervical spine in rugby in Argentina. METHODS: A retrospective review of all cases reported to the Medical Committee of the Argentine Rugby Union (UAR) and Rugby Amistad Foundation was carried out including a follow up by phone. Cumulative binomial distribution, chi 2 test, Fisher test, and comparison

F. P. Secin; E. J. Poggi; F. Luzuriaga; H. A. Laffaye

1999-01-01

174

Primary cervical spine carcinoid tumor in a woman with arm paresthesias and weakness: a case report  

PubMed Central

Introduction Carcinoid tumors are neuroendocrine neoplasms derived from the enterochromaffin cells. Central nervous system involvement is rare and has been reported either as metastases to the brain and spine or primary tumors involving the sacrococcygeal spine. We report the first case of a primary carcinoid tumor of the cervical spine. Case presentation A 50-year-old African-American woman presented with a 4-month history of numbness, paresthesias, and mild left-hand weakness. Magnetic resonance imaging of her cervical spine revealed a homogenously enhancing extradural mass, indenting the cervical cord and expanding the left neural foramen at C7–T1. A C7 corpectomy, en bloc resection of the tumor, and anterior C6–T1 fusion were performed to decompress the spinal cord and nerves and provide stability. Postoperative histopathologic examination and immunohistochemical analysis were consistent with carcinoid tumor. There has been no recurrence at the 6-year follow-up visit. Conclusions Primary cervical carcinoid tumor is extremely rare, but should be included in the differential diagnosis of enhancing expansile extradural masses compressing the spinal cord and nerves. Surgical resection may provide a definitive cure.

2013-01-01

175

Catastrophic Cervical Spine Injuries in the Collision Sport Athlete, Part 2Principles of Emergency Care  

Microsoft Academic Search

Catastrophic cervical spine injuries can lead to devastating consequences for the collision athlete. Improved understanding of these injuries can lead to identification of risk factors, early diagnosis, and effective on-field management. This article is the second in a 2-part series. The first part, published in the June 2004 issue, reviewed the current concepts regarding the epidemiology, functional anatomy, and diagnostic

Rahul Banerjee; Mark A. Palumbo; Paul D. Fadale

2004-01-01

176

A possible correlation between vertebral artery insufficiency and degenerative changes in the cervical spine.  

PubMed

We studied 130 patients, aged 20 to 81 years, with symptoms of tinnitus, vertigo or dizziness. Radiological examinations revealed degenerative changes in the cervical spines of all patients such as discopathy or osteophytes. Head and neck and neurological examinations ruled out other symptoms apart from vertebrobasilar artery flow insufficiency. The vertebrobasilar arteries were examined by means of a color Doppler ultrasonograph using duplex scanning. The correlation coefficient (CC) defining the relationship between the number of patients with abnormal blood flow and the total number of patients with radiologically confirmed changes in the cervical spine was 41.5%. When patients were separated by age, the value of the CC coefficient increased proportionally according to age, changing from 0 to 79.1%. Use of the Doppler ultrasonograph was found to be a safe and non-invasive diagnostic method that enabled us to assess the influence of degenerative changes in the cervical spine on hemodynamic disturbances in the inner ear and brain stem. Our findings demonstrated a pathological decrease of vertebral artery flow velocity in relationship to degenerative changes in the cervical spine. PMID:9833209

Strek, P; Rero?, E; Maga, P; Modrzejewski, M; Szybist, N

1998-01-01

177

Is radiography justified for the evaluation of patients presenting with cervical spine trauma?  

SciTech Connect

Conventional radiography has been for decades the standard method of evaluation for cervical spine trauma patients. However, currently available helical multidetector CT scanners allow multiplanar reconstruction of images, leading to increased diagnostic accuracy. The purpose of this study was to determine the relative benefit/risk ratio between cervical spine CT and cervical spine radiography and between cervical spine CT and cervical spine radiography, followed by CT as an adjunct for positive findings. A decision analysis model for the determination of the optimum imaging technique was developed. The sensitivity and specificity of CT and radiography were obtained by dedicated meta-analysis. Lifetime attributable risk of mortal cancer from CT and radiography was calculated using updated organ-specific risk coefficients and organ-absorbed doses. Patient organ doses from radiography were calculated using Monte Carlo techniques, simulated exposures performed on an anthropomorphic phantom, and thermoluminescence dosimetry. A prospective patient study was performed regarding helical CT scans of the cervical spine. Patient doses were calculated based on the dose-length-product values and Monte Carlo-based CT dosimetry software program. Three groups of patient risk for cervical spine fracture were incorporated in the decision model on the basis of hypothetical trauma mechanism and clinical findings. Radiation effects were assessed separately for males and females for four age groups (20, 40, 60, and 80 yr old). Effective dose from radiography amounts to 0.050 mSv and from a typical CT scan to 3.8 mSv. The use of CT in a hypothetical cohort of 10{sup 6} patients prevents approximately 130 incidents of paralysis in the low risk group (a priori fracture probability of 0.5%), 500 in the moderate risk group (a priori fracture probability of 2%), and 5100 in the high risk group (a priori fracture probability of 20%). The expense of this CT-based prevention is 15-32 additional radiogenic lethal cancer incidents. According to the decision model calculations, the use of CT is more favorable over the use of radiography alone or radiography with CT by a factor of 13, for low risk 20 yr old patients, to a factor of 23, for high risk patients younger than 80 yr old. The radiography/CT imaging strategy slightly outperforms plain radiography for high and moderate risk patients. Regardless of the patient age, sex, and fracture risk, the higher diagnostic accuracy obtained by the CT examination counterbalances the increase in dose compared to plain radiography or radiography followed by CT only for positive radiographs and renders CT utilization justified and the radiographic screening redundant.

Theocharopoulos, Nicholas; Chatzakis, Georgios; Damilakis, John [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, 71003 Crete (Greece) and Department of Natural Sciences, Technological Education Institute of Crete, P.O. Box 140, Iraklion 71004 Crete (Greece); Department of Radiology, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, 71003 Crete (Greece); Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, 71003 Crete (Greece)

2009-10-15

178

The advantages of submandibular gland resection in anterior retropharyngeal approach to the upper cervical spine  

PubMed Central

Anterior surgery to the upper cervical spine, although rare, several successful approaches were described in the literature. To avoid the risks and limitations of transoral approach, the anterior retropharyngeal approach was developed. In this study, we describe our experience with anterior retropharyngeal approach to the upper cervical spine and discuss the significance of resecting the submandibular gland. From July 2001 to July 2004, we performed six anterior prevascular retropharyngeal approaches to the upper cervical spine. The series included five males and one female, ranging in age from 26 to 60 years (mean = 46). All six patients were intubated with nasotracheal cannula. The submandibular gland was mobilized and removed in all patients allowing adequate exposure of the arch of C1, C2, and C3 vertebral bodies. The anterior retropharyngeal approach permitted an adequate access to anteriorly situated lesions from C1 to C3 in all six patients, without the risks and limitations of transmucosal surgery. This approach allowed us to perform decompression of the spinal cord and reconstruction of the anterior column of the spine with bone graft and internal fixation. Careful removal of the submandibular gland provided better visualization of the arch of C1 and C2. No facial nerve palsy was seen in any of the six patients. Anterior retropharyngeal approach to the upper cervical spine combined with removal of the submandibular gland permits exposure of the anterior spine similar to that obtained by the transmucosal route, and provides a safe simultaneous arthrodesis and instrumentation during the primary surgical procedure without the potential contamination of the oropharyngeal cavity. Removal of the submandibular gland allows better exposure with less retraction and thus avoids severe injury to the mandibular branch of the facial nerve.

Sabbagh, Amira S.; Hadi, Usamah

2006-01-01

179

Headache and the lower cervical spine: long-term, postoperative follow-up after decompressive neck surgery.  

PubMed

A retrospective search for headache sufferers was conducted among patients operated on for cervicobrachialgia, and the operative results were evaluated. We also tried to classify the preoperative headache according to current headache classification systems. A total of 187 patients were operated on with Smith-Robinson's method, or by "simple" foraminectomy/ facetectomy. Headache was present in 23, and 17 of these could be followed up for an average post-operative observation period of 8.5 years. The operation seemed to result in headache improvement in 15 patients, i.e., excellent in 7; good in 2; moderate in 6; in other words: "excellent"/"good" in 53%. Improvement of neck pain was found in 15 patients (excellent in 5; good in 4; moderate in 6). The headache characteristics were generally compatible with the criteria for cervicogenic headache (CEH) (1990 version). CEH can probably stem from a pathology in the lower cervical spine. This should probably be taken into account when evaluating the individual patient with symptoms reminiscent of CEH. This headache may benefit from operations directed towards the cervical spine. PMID:12760410

Torbjørn, A Fredriksen; Stolt-Nielsen, Andreas; Skaanes, Karl Ove; Sjaastad, Ottar

180

Thoracic spine compression fracture in a patient with back pain.  

PubMed

A 55-year-old man was referred to physical therapy because of constant mid-back pain of 1 month's duration. Because of the strong suspicion for a fracture, thoracic spine anterior-posterior and lateral radiographs were ordered, which revealed compression deformities of the T6, T8, T9, and T12 vertebral bodies. An interventional radiologist ordered magnetic resonance imaging and believed the patient was a candidate for vertebroplasty, a technique in which medical grade cement is injected into a painful fractured vertebral body in an effort to stabilize the fracture. At 1 week following his vertebroplasty the patient was pain free. Further medical evaluation indicated that the patient had underlying osteoporosis, and treatment was initiated. At 1 and 2 years after vertebroplasty, the patient reported being symptom free. However, a history of osteoporosis and multiple compression fractures led to further medical evaluation 2 years after vertebroplasty and the patient was eventually diagnosed with multiple myeloma for which treated was initiated. PMID:18434669

Ross, Michael D; Elliott, Ryan L

2008-03-31

181

Hidden discoligamentous instability in cervical spine injuries: can quantitative motion analysis improve detection?  

PubMed

PURPOSE: Recent literature shows that occult discoligamentous injuries still remain difficult to diagnose in the first instance. Thresholds as indicators for discoligamentous segmental instability were previously defined. But, since supine radiodiagnostic is prone to spontaneous reduction of a displaced injury, and even some highly unstable injuries reveal only slight radiographic displacement, these criteria might mislead in the traumatized patient. A highly accurate radiographic instrument to assess segmental motion is the computer-assisted quantitative motion analysis (QMA). The aim was to evaluate the applicability of the QMA in the setting of a traumatized patient. METHODS: Review of 154 patients with unstable cervical injuries C3-7. Seventeen patients (male/female: 1:5, age: 44.6 years) had history of initially hidden discoligamentous injuries without signs of neurologic impairment. Initial radiographs did not fulfill instability criteria by conventional analysis. Instability was identified by late subluxation/dislocation, persisting/increasing neck pain, and/or scheduled follow-up. For 16 patients plain lateral radiographs were subjected to QMA. QMA data derived were compared with normative data of 140 asymptomatic volunteers from an institutional database. RESULTS: Data analysis of measurements revealed mean spondylolisthesis of -1.0 mm (-3.7 to +3.4 mm), for segmental rotational angle mean angulation of -0.9° (-11.1° to +17.7°). Analysis of these figures indicated positive instability thresholds in 5 patients (31.3 %). Analysis of center of rotation (COR)-shifts was only accomplishable completely in 3/16 patients due to limited motion or inadequacy of radiographs. Two of these patients (12.5 %) showed a suspect shift of the COR. CONCLUSIONS: Our data show a high rate of false negative results in cases of hidden discoligamentous injuries by using conventional radiographic analysis as well as QMA in plain lateral radiographs in a trauma setting. Despite the technical possibilities in a modern trauma center, our data and recent literature indicate a thorough clinical and radiographic follow-up of patients with cervical symptoms to avoid secondary complications from missed cervical spine injuries. PMID:23760568

Mayer, M; Zenner, J; Auffarth, A; Blocher, M; Figl, M; Resch, H; Koller, H

2013-06-13

182

Reduced field-of-view DTI segmentation of cervical spine tissue.  

PubMed

The number of diffusion tensor imaging (DTI) studies regarding the human spine has considerably increased and it is challenging because of the spine's small size and artifacts associated with the most commonly used clinical imaging method. A novel segmentation method based on the reduced field-of-view (rFOV) DTI dataset is presented in cervical spinal canal cerebrospinal fluid, spinal cord grey matter and white matter classification in both healthy volunteers and patients with neuromyelitis optica (NMO) and multiple sclerosis (MS). Due to each channel based on high resolution rFOV DTI images providing complementary information on spinal tissue segmentation, we want to choose a different contribution map from multiple channel images. Via principal component analysis (PCA) and a hybrid diffusion filter with a continuous switch applied on fourteen channel features, eigen maps can be obtained and used for tissue segmentation based on the Bayesian discrimination method. Relative to segmentation by a pair of expert readers, all of the automated segmentation results in the experiment fall in the good segmentation area and performed well, giving an average segmentation accuracy of about 0.852 for cervical spinal cord grey matter in terms of volume overlap. Furthermore, this has important applications in defining more accurate human spinal cord tissue maps when fusing structural data with diffusion data. rFOV DTI and the proposed automatic segmentation outperform traditional manual segmentation methods in classifying MR cervical spinal images and might be potentially helpful for detecting cervical spine diseases in NMO and MS. PMID:23993792

Tang, Lihua; Wen, Ying; Zhou, Zhenyu; von Deneen, Karen M; Huang, Dehui; Ma, Lin

2013-08-30

183

Instrumentation for intraoperative measurement of cervical spine stiffness.  

PubMed

There is scant information on in vivo cervical biomechanics. The majority of limited data available in this area has been obtained using cadaver studies. With this in mind, simple instrumentation for analysing intraoperative cervical motion segment stiffness (load-axial displacement) was developed. The instrumentation consists of a displacement and strain transducer equipped vertebral retractor to be used with Caspar pins during anterior cervical surgery. Paramount to instrument design was incorporation of components complimentary to high electrical and mechanical repeatability, electrical safety, and creation of a sterile barrier. Preliminary studies conducted on a cadaver with this device revealed C3-C4 axial displacements (millimeters) of 1.735, 2.688, and 4.024 using, respectively, loads (newtons) of 44.482, 88,964, and 133.446. These results suggest this technique will be useful in assessing intraoperative spinal stability. PMID:8837055

Frank, E H; Chamberland, D L; Ragel, B T

1996-06-01

184

Intradural tumor and concomitant disc herniation of cervical spine  

PubMed Central

We report a rare patient of a simultaneous extradural and intradural compression of the cervical spinal cord due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. The intradural lesion was missed resulting in recurrence of myelopathy after a surprisingly complete functional recovery following anterior cervical discectomy. Retrospectively, it was noted that the initial cord swelling noticed was tumor being masked by the compression produced by the herniated disc. A contrast magnetic resonance imaging scan is important in differentiating intradural tumors of the spinal cord. A high index of suspicion is often successful in unmasking both the pathologies.

Bapat, Mihir R; Rathi, Prasanna; Pawar, Uday; Chaudhary, Kshitij

2011-01-01

185

Absent cervical spine pedicle and associated congenital spinal abnormalities - a diagnostic trap in a setting of acute trauma: case report  

PubMed Central

Background Congenital spinal abnormalities can easily be misdiagnosed on plain radiographs. Additional imaging is warranted in doubtful cases, especially in a setting of acute trauma. Case Presentation This patient presented at the emergency unit of our university hospital after a motor vehicle accident and was sent to our radiology department for imaging of the cervical spine. Initial clinical examination and plain radiographs of the cervical spine were performed but not conclusive. Additional CT of the neck helped establish the right diagnosis. Conclusion CT as a three-dimensional imaging modality with the possibility of multiplanar reconstructions allows for the exact diagnosis and exclusion of acute traumatic lesions of the cervical spine, especially in cases of doubtful plain radiographs and when congenital spinal abnormalities like absent cervical spine pedicle with associated spina bifida may insinuate severe trauma.

2010-01-01

186

The cervical spine in rheumatoid arthritis: relationship between neurologic signs and morphology on MR imaging and radiographs  

Microsoft Academic Search

Objective. Comparison of clinically observed neurologic long tract signs in a heterogeneous group of patients with rheumatoid arthritis\\u000a (RA), with morphologic abnormalities of the cervical spine as depicted on radiographs and magnetic resonance (MR) images.\\u000a Design. The patients were prospectively assigned to one of three classes on the basis of their neurologic status. Lateral cervical\\u000a spine radiographs and sagittal T1-weighted

M. Reijnierse; Johan L. Bloem; Ben A. C. Dijkmans; Herman M. Kroon; Herma C. Holscher; Bettina Hansen; Ferdinand C. Breedveld

1996-01-01

187

Relation between alignments of upper and subaxial cervical spine: a radiological study  

Microsoft Academic Search

Objective  To reveal the relation between alignments of upper and subaxial cervical spine and deduce the optimal atlantoaxial fusion\\u000a angle by a radiological study.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  414 asymptomatic volunteers (213 males, 201 females) underwent cervical lateral radiographs in neutral position. The Oc–C2\\u000a angle, C1–C2 angle and C2–C7 angle were measured. Relations among these three angles and relations between angles and age\\u000a were analyzed.

Qunfeng Guo; Bin Ni; Jian Yang; Kai Liu; Zhichao Sun; Fengjin Zhou; Jianxin Zhang

2011-01-01

188

Influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine  

Microsoft Academic Search

The influence of minor trauma to the neck on the neurological outcome in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine was evaluated retrospectively. Out of 118 patients treated in our clinic for cervical OPLL between 1976 and 1992, 27 had sustained minor trauma to the cervical spine. Of these 27 patients, 13 developed myelopathy,

S Katoh; T Ikata; N Hirai; Y Okada; K Nakauchi

1995-01-01

189

[Delayed diagnosis of odontoid fracture after whiplash trauma of the cervical spine].  

PubMed

Fractures of the odontoid process represent about 10-20% of all diagnosed cervical spine fractures. Approximately 35% of these fractures are classified as Type II according to Anderson and D'Alonzo. They can be potentially unstable especially if combined with a dens displacement of over 6 mm. In severe cervical spine trauma, these fractures do not usually cause difficulties in diagnosis. However, in whiplash injuries, which are very common and only rarely associated with such fractures, the surgical management can be complicated if they are underestimated. These patients can present without significant neurological deficits or the situation can be complicated due to intoxication or additional trauma. Under these circumstances in particular, the diagnosis can be delayed or missed, if no strict protocols for diagnostic effort in all whiplash injuries are employed. A case of delayed diagnosis of an odontoid fracture in a neurological asymptomatic patient after whiplash injury is presented. PMID:11098750

Gerstenkorn, C; Cacciola, R; Thomusch, O; Brucke, M; Talbot, D; Dralle, H

2000-10-01

190

Secondary atlanto-odontoid osteoarthritis with osteoradionecrosis of upper cervical spine mimicking metastasis.  

PubMed

Osteoradionecrosis (ORN) is a known entity in patients with head and neck malignancy treated by radiotherapy. Involvement of mandible (0.8-37%) and maxilla (2-11%) is quiet common but upper cervical spine involvement is rare. One needs to have a high index of suspicion for the diagnosis of ORN after radiotherapy in the head and neck region. It may mimic either metastasis or an infection and needs histopathology to make definitive diagnosis. We reported the successful treatment of a patient with ORN involving upper cervical spine by posterior decompression and stabilisation. In addition, a new technique of reaching the odontoid process from posterior aspect for biopsy has been described. PMID:24038287

Raza, Ali; Islam, Mueedul; Lakshmanan, Pal

2013-09-13

191

Surgical treatment for injuries of the middle and lower cervical spine  

PubMed Central

We reviewed the surgical treatment of 31 patients with burst fractures or teardrop dislocation fractures in the middle and lower cervical spine. Patients were treated with anterior instrumentation, posterior instrumentation, or a combination of both. Patients were evaluated radiographically and with the Frankel neurological outcomes grading scale. Anterior decompression and fusion restored the spinal canal diameter by approximately 60% whereas the posterior or combined approaches restored the canal diameter by only 6%. In addition, nine of 24 patients treated anteriorly gained improved neurological function whereas none of the patients treated posteriorly had neurological improvement. Based on the anatomical and neurological findings, the study demonstrates that anterior fusion is preferable to posterior fusion for the treatment of burst fractures and tear-drop dislocation fractures of the middle and lower cervical spine.

Nomura, Takeshi; Watanabe, Masahiko; Mochida, Joji

2005-01-01

192

Sagittal kinematics of the cervical spine--how constant are the motor axes?  

PubMed

The aim of this study was to establish whether or not the axes of cervical spine movement in the sagittal plane are constant (an impression conveyed by the literature). Based on 60 functional radiographs (of which 24 showed degenerative discopathy or atlas subluxations), the axes of seven motor segments (C1-D1) were determined geometrically. The axes of the segments C5/C6 proved to scatter least; the further the distance of a segment is to the latter, the larger the tendency of scattering appears. Hence, the axes are neither constant in time nor in location and thus only convey the momentary kinematic situation of the cervical spine. Clearly pathologic axis positions could not be found, except in the case of an extreme atlas subluxation. PMID:1950428

Fuss, F K

1991-01-01

193

Effect of age on cervical spine injuries in children after motor vehicle collisions: effectiveness of restraint devices  

Microsoft Academic Search

PurposeDespite the devastating consequences of cervical spine (C-spine) injury in children after motor vehicle collisions (MVC), the factors leading to the injury and the appropriateness of protective restraints remain undefined. The authors hypothesized that age-related anatomic factors contribute to inadequate restraints and therefore increase injury severity after MVC.

Brian S Zuckerbraun; Katie Morrison; Barbara Gaines; Henri R Ford; David J Hackam

2004-01-01

194

A survey to examine attitudes and patterns of practice of physiotherapists who perform cervical spine manipulation  

Microsoft Academic Search

As part of the process of developing a Clinical Practice Guideline (CPG) on cervical spine manipulation (CSM), a working group sent out an 82-item postal survey to 150 randomly selected Ontario physiotherapists (PTs) who perform spinal manipulation, to collect information on the socio-demographics, practices, opinions of risk, and attitudes towards CPGs of these PTs (n=118; response rate=79%). Of the 118

L. Hurley; K. Yardley; A. R. Gross; L. Hendry; L. McLaughlin

2002-01-01

195

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

196

Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients  

Microsoft Academic Search

Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients\\u000a hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments.\\u000a The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures\\u000a were at

Pierre-Yves Borius; Ismail Gouader; Philippe Bousquet; Louisa Draper; Franck-Emmanuel Roux

2010-01-01

197

Characterisation of the dynamic compressive mechanical properties of cancellous bone from the human cervical spine  

Microsoft Academic Search

A study was undertaken to characterise the mechanical properties of cancellous bone from the human cervical spine. Samples from eight male cadavers (aged 40–79yr) were subjected to quasi-static and dynamic compression. Results from quasi-static compression tests show that the strength of cancellous bone can be described in terms of density using a power law relationship. It is also observed that

V. P. W. Shim; L. M. Yang; J. F. Liu; V. S. Lee

2005-01-01

198

Bone mineral density in patients with ossification of the posterior longitudinal ligament in the cervical spine  

Microsoft Academic Search

:   Bone mineral density (BMD) has not been clearly determined in patients with ossification of the posterior longitudinal ligament\\u000a (OPLL) in the cervical spine. BMD in patients with OPLL was measured in the third vertebral body in the lateral projection\\u000a and in the distal part of the radius in the anteroposterior projection using dual-energy X-ray absorptiometry (DXA). Patients\\u000a with OPLL

Tsuneto Yamauchi; Eiji Taketomi; Shunji Matsunaga; Takashi Sakou

1999-01-01

199

Prediction of Cervical Spine Injury Risk for the 6YearOld Child in Frontal Crashes  

Microsoft Academic Search

This article presents a series of 49 km\\/h sled tests using the Hybrid III 6-year-old dummy in a high-back booster, a low-back booster, and a three-point belt. Although a 10-year review at a level I trauma center showed that noncontact cervical spine injuries are rare in correctly restrained booster-age children, dummy neck loads exceeded published injury thresholds in all tests.

C. P. Sherwood; C. G. Shaw; L. Van Rooij; R. W. Kent; J. R. Crandall; K. M. Orzechowski; M. R. Eichelberger; D. Kallieris

2003-01-01

200

Predicting Multiplanar Cervical Spine Injury Due to Head-Turned Rear Impacts Using IV-NIC  

Microsoft Academic Search

Objective. Intervertebral Neck Injury Criterion (IV-NIC) hypothesizes that dynamic three-dimensional intervertebral motion beyond physiological limit may cause multiplanar soft-tissue injury. Present goals, using biofidelic whole human cervical spine model with muscle force replication and surrogate head in head-turned rear impacts, were to: (1) correlate IV-NIC with multiplanar injury, (2) determine IV-NIC injury threshold at each intervertebral level, and (3) determine

Paul C. Ivancic; Manohar M. Panjabi; Yasuhiro Tominaga; George F. Malcolmson

2006-01-01

201

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

202

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

PubMed

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. PMID:24147183

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

2013-06-20

203

Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine  

Microsoft Academic Search

Purpose  The combination of a facet fracture and a contralateral facet dislocation at the same intervertebral level of the cervical\\u000a spine (a fracture and contralateral dislocation of the twin facet joints) has not been described in detail. The aims of this\\u000a study are to report a series of 11 patients with this injury, to clarify the clinical features and to discuss

Ly Minh Ngo; Toshimi Aizawa; Takeshi Hoshikawa; Yasuhisa Tanaka; Tetsuro Sato; Yushin Ishii; Shoichi Kokubun

204

A possible correlation between vertebral artery insufficiency and degenerative changes in the cervical spine  

Microsoft Academic Search

We studied 130 patients, aged 20 to 81 years, with symptoms of tinnitus, vertigo or dizziness. Radiological examinations\\u000a revealed degenerative changes in the cervical spines of all patients such as discopathy or osteophytes. Head and neck and\\u000a neurological examinations ruled out other symptoms apart from vertebrobasilar artery flow insufficiency. The vertebrobasilar\\u000a arteries were examined by means of a color Doppler

P. Str?k; E. Rero?; P. Maga; M. Modrzejewski; N. Szybist

1998-01-01

205

Sagittal Kinematics of the Cervical Spine – How Constant Are the Motor Axes?  

Microsoft Academic Search

The aim of this study was to establish whether or not the axes of cervical spine movement in the sagittal plane are constant (an impression conveyed by the literature). Based on 60 functional radiographs (of which 24 showed degenerative discopathy or atlas subluxations), the axes of seven motor segments (C1–D1) were determined geometrically. The axes of the segments C5\\/C6 proved

Franz K. Fuss

1991-01-01

206

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

2012-07-18

207

Rugby injuries to the cervical spine and spinal cord: a 10-year review.  

PubMed

A 10-year review (1987-1996) of injuries sustained to the spine and spinal cord in rugby players with resultant paralysis has been undertaken. This article reviews that the incidence of serious rugby spine and spinal cord injuries in South Africa has increased over the 10-year period reviewed, despite stringent new rules instituted in an attempt to decrease the incidence of these injuries. The mechanisms of injury, as previously reported, remain the same as well as the phases of game responsible for injury of the tight scrum, tackle, rucks, and mauls. Two new observations are reported: the first is related to the occurrence of spinal cord concussion with transient paralysis, and the second is related to the increased incidence of osteoarthritis of the cervical spine in rugby players. PMID:9475983

Scher, A T

1998-01-01

208

A comparison of the Minerva and halo jackets for stabilization of the cervical spine.  

PubMed

The motion at each intervertebral level permitted by the halo jacket and the thermoplastic Minerva body jacket was compared in 10 ambulatory patients with an unstable cervical spine. The thermoplastic Minerva body jacket is a new lightweight modification of a Minerva jacket which is fabricated from Polyform (a splinting material made of a polyester polycaprolactone) and Polycushion (a closed-cell foam for padding). Each patient served as his/her own control. The average movement from flexion to extension at each intervertebral level was significantly less in the thermoplastic Minerva body jacket (2.3 degrees +/- 1.7 degrees) than in the halo jacket (3.7 degrees +/- 3.1 degrees) (p less than 0.0025). This difference is attributable to the "snaking phenomenon" encountered with halo jacket immobilization and should be taken into account when considering an external splint for an unstable cervical spine. The thermoplastic Minerva body jacket also offered a substantial improvement in comfort for the patient over that experienced in the halo jacket. The apparent advantage with respect to stability and comfort of the thermoplastic Minerva body jacket over the halo jacket suggests that the former device is the orthosis of choice for ambulatory stabilization of most patients with an unstable posttraumatic cervical spine injury. PMID:2915248

Benzel, E C; Hadden, T A; Saulsbery, C M

1989-03-01

209

MRI of the cervical spine with neck extension: is it useful?  

PubMed Central

Objectives Standard MRI of the cervical spine is performed in a different anatomical position to that utilised for traditional contrast myelography. Those well practised in myelography are familiar with the considerable changes in configuration of the bony and soft tissues of the cervical spine that may occur with changes in the degree of neck flexion and extension. We set out to compare the findings in a select group of patients with myeloradiculopathy who had undergone myelography and MRI in both standard and neck-extended positions. These findings were correlated with the clinical status. Methods 29 patients underwent myelography with CT (CTM) and MRI in neutral and neck-extended positions. The imaging was assessed for the degree of cord compression and neural foraminal narrowing, quantified using a simple grading scheme suitable for routine clinical practice. The degree of neck extension was assessed using an angular measurement. Results For both CTM and MRI, scanning with the neck extended significantly increases the severity of cord compression compared with the standard supine position, to a degree similar to that shown during conventional prone myelography. The degree of perceived cord compression is related to the degree of neck extension achieved. Correlation of standard MRI findings and the clinical level of radiculopathy is poor. This correlation improves when the neck is extended. Conclusions The most appropriate position for routine MRI of the cervical spine in degenerative disease remains unknown, but in selected patients imaging with the neck extended may provide important additional information.

Bartlett, R J V; Hill, C A Rowland; Rigby, A S; Chandrasekaran, S; Narayanamurthy, H

2012-01-01

210

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

211

E.m.g./moment relationships in neck muscles during isometric cervical spine extension.  

PubMed

The aim of the study was to describe the e.m.gJmuscular moment (torque) relationships for neck and shoulder muscles during cervical spine extension. Ten healthy women participated. Their average age was 25·6 years. The neck extension muscular moments exerted were measured isometrically in neutral and in flexed lower-cervical spine positions with a strain gauge connected to a sling around the back of the head. The moment about the bilateral axis of the C7 ?T1 spinal motion segment was calculated as the moment balancing the sum of the moment of the sling resistance force and the moment caused by the gravity forces of the head and neck. Video images were analysed for moment arm length measurements. Simultaneously with the force recording, the e.m.g. activity was recorded through surface electrodes applied unilaterally at six locations in the neck and shoulder region. The rectified low-pass filtered e.m.g. signals were normalized against the highest activity level obtained during a series of standardized isometric test contractions. The results show that a non-linear e.m.g./moment relationship exists in axial musculature of the cervical spine, with a slightly higher increase in e.m.g. levels at high muscular moment values. PMID:23915835

Schuldt, K; Harms-Ringdahl, K

1988-05-01

212

Application of full-scale three-dimensional models in patients with rheumatoid cervical spine.  

PubMed

Full-scale three-dimensional (3D) models offer a useful tool in preoperative planning, allowing full-scale stereoscopic recognition from any direction and distance with tactile feedback. Although skills and implants have progressed with various innovations, rheumatoid cervical spine surgery remains challenging. No previous studies have documented the usefulness of full-scale 3D models in this complicated situation. The present study assessed the utility of full-scale 3D models in rheumatoid cervical spine surgery. Polyurethane or plaster 3D models of 15 full-sized occipitocervical or upper cervical spines were fabricated using rapid prototyping (stereolithography) techniques from 1-mm slices of individual CT data. A comfortable alignment for patients was reproduced from CT data obtained with the patient in a comfortable occipitocervical position. Usefulness of these models was analyzed. Using models as a template, appropriate shape of the plate-rod construct could be created in advance. No troublesome Halo-vests were needed for preoperative adjustment of occipitocervical angle. No patients complained of dysphasia following surgery. Screw entry points and trajectories were simultaneously determined with full-scale dimensions and perspective, proving particularly valuable in cases involving high-riding vertebral artery. Full-scale stereoscopic recognition has never been achieved with any existing imaging modalities. Full-scale 3D models thus appear useful and applicable to all complicated spinal surgeries. The combination of computer-assisted navigation systems and full-scale 3D models appears likely to provide much better surgical results. PMID:18247063

Mizutani, Jun; Matsubara, Takeshi; Fukuoka, Muneyoshi; Tanaka, Nobuhiko; Iguchi, Hirotaka; Furuya, Aiharu; Okamoto, Hideki; Wada, Ikuo; Otsuka, Takanobu

2008-02-05

213

Gender dependent cervical spine anatomical differences in size-matched volunteers - biomed 2009.  

PubMed

The objective was to examine significant differences in the bony structure of cervical spine vertebrae based on gender and spinal level that may influence injury risk in women following automotive rear impact. Male and female subjects were recruited for a separate study and data from two subsets were selected for inclusion in this study. Subjects were size-matched based on sitting height (17 males, 11 females) and head circumference (9 males, 18 females). Axial CT scans were obtained of the cervical spine from the C1 through C6. Bony boundaries of cervical vertebrae were defined using image-analysis software and biomechanically-relevant dimensions were derived at spinal levels C2 through C6. Six of seven vertebral dimensions were significantly dependent upon gender and spinal level in both subgroups. Male vertebrae had larger dimensions for each metric. Depth dimensions were greatest at caudal and cranial extents, whereas width dimensions were smallest at C2 and increased caudally. Greater linear and areal dimensions in size-matched male subjects indicates a more stable cervical spinal column that may be more capable of resisting inertial loading of the head-neck complex during automotive rear impacts. Although the explanation for greater injury susceptibility in females is likely multi-factorial, including differences in spinal material properties, soft tissue tolerance thresholds, occupant-seatback orientation, and neck muscle size/orientations, the present study has identified significant differences in cervical spine anatomical dimensions that may contribute to greater rates of whiplash injury in that population. PMID:19369755

Stemper, Brian D; Derosia, John J; Yogananan, Narayan; Pintar, Frank A; Shender, Barry S; Paskoff, Glenn R

2009-01-01

214

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

215

Internal fixation for osteomyelitis of cervical spine: the issue of persistence of culture positive infection around the implants  

Microsoft Academic Search

Summary ¶ Background. We describe the management of osteomyelitis of the cervical spine, utilizing internal fixation with subsequent removal and culture of the implants. Four out of five patients had evidence of bacterial colonisation in close proximity to the internal fixation device. Methods. Five consecutive patients (all female, ranging in age from 50 to 74?yrs) presenting with unstable cervical osteomyelitis

A. Shad; S. Shariff; J. Fairbank; I. Byren; P. J. M. A. D. Teddy; T. A. D. Cadoux-Hudson

2003-01-01

216

Factors affecting the interface of cervical spine facet screws placed in the technique by Roy-Camille et al  

Microsoft Academic Search

The objective of the study was to investigate the influence of bone cement, length of burr hole and bone density on pullout force and insertional screw torque of cervical spine facet screws. Both facets of 24 human cervical vertebrae were scanned for bone mineral density (BMD) and assigned to two groups for measuring of insertional screw torque and pullout strength.

T. R. Pitzen; S. Zenner; D. Barbier; T. Georg; W. I. Steudel

2004-01-01

217

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

218

The effect of cervical spine manual therapy on normal mouth opening in asymptomatic subjects  

PubMed Central

Abstract Objective Temporomandibular disorders are a group of disorders affecting the temporomandibular joint and/or masticatory muscles. One of the signs associated with temporomandibular disorders is a reduction in mouth opening. During normal mouth opening, extension occurs at the cervical-cranial junction. The purpose of this investigation was to determine if manual therapy applied to the cervical-cranial junction would significantly improve mouth-opening capacity. Methods One hundred one participants were randomly assigned to either an Active Release Technique (ART) group; high-velocity, low-amplitude manipulation (HVLA) group; or control group. A blinded investigator measured mouth opening using a TheraBite range of motion scale (TheraBite Corporation, West Chester, PA). Participants received ART to the suboccipitals or HVLA to the cervical spine at C1 or sat with an investigator for 3 minutes with no treatment. After the treatment session, mouth opening was remeasured. A repeated-measures analysis of variance was used to compare the group mean values. The a priori ? level was .05. Results The repeated-measures analysis of variance showed no significant difference between the ART, HVLA, and control groups' pretreatment and posttreatment measurements (F = 0.41, P > .05). Conclusion Manual therapy to the cervical spine did not significantly improve mouth opening in this asymptomatic population. Future trials using participants with restricted mouth-opening measures are warranted.

George, James W.; Fennema, Jason; Maddox, Adam; Nessler, Martha; Skaggs, Clayton D.

2007-01-01

219

Spine-Area Pain in Military Personnel: A Review of Epidemiology, Etiology, Diagnosis and Treatment  

Microsoft Academic Search

Background ContextNon-battle illnesses and injuries are the major causes of unit attrition in modern warfare. Spine-area pain is a common, disabling injury in service members associated with a very low return-to-duty rate.

Steven P. Cohen; Rollin M. Gallagher; Shelton Davis; Scott R. Griffith; Eugene J. Carragee

220

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

221

Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial  

Microsoft Academic Search

Mechanical neck pain is a common occurrence in the general population resulting in a considerable economic burden. Often physical therapists will incorporate manual therapies directed at the cervical spine including joint mobilization and manipulation into the management of patients with cervical pain. Although the effectiveness of mobilization and manipulation of the cervical spine has been well documented, the small inherent

Joshua A. Cleland; Maj. John D. Childs; Meghann McRae; Jessica A. Palmer; Thomas Stowell

2005-01-01

222

Contact pressure in the facet joint during sagittal bending of the cadaveric cervical spine.  

PubMed

The facet joint contributes to the normal biomechanical function of the spine by transmitting loads and limiting motions via articular contact. However, little is known about the contact pressure response for this joint. Such information can provide a quantitative measure of the facet joint's local environment. The objective of this study was to measure facet pressure during physiologic bending in the cervical spine, using a joint capsule-sparing technique. Flexion and extension bending moments were applied to six human cadaveric cervical spines. Global motions (C2-T1) were defined using infra-red cameras to track markers on each vertebra. Contact pressure in the C5-C6 facet was also measured using a tip-mounted pressure transducer inserted into the joint space through a hole in the postero-inferior region of the C5 lateral mass. Facet contact pressure increased by 67.6 ± 26.9 kPa under a 2.4 Nm extension moment and decreased by 10.3 ± 9.7 kPa under a 2.7 Nm flexion moment. The mean rotation of the overall cervical specimen motion segments was 9.6 ± 0.8° and was 1.6 ± 0.7° for the C5-C6 joint, respectively, for extension. The change in pressure during extension was linearly related to both the change in moment (51.4 ± 42.6 kPa/Nm) and the change in C5-C6 angle (18.0 ± 108.9 kPa/deg). Contact pressure in the inferior region of the cervical facet joint increases during extension as the articular surfaces come in contact, and decreases in flexion as the joint opens, similar to reports in the lumbar spine despite the difference in facet orientation in those spinal regions. Joint contact pressure is linearly related to both sagittal moment and spinal rotation. Cartilage degeneration and the presence of meniscoids may account for the variation in the pressure profiles measured during physiologic sagittal bending. This study shows that cervical facet contact pressure can be directly measured with minimal disruption to the joint and is the first to provide local pressure values for the cervical joint in a cadaveric model. PMID:21823743

Jaumard, Nicolas V; Bauman, Joel A; Weisshaar, Christine L; Guarino, Benjamin B; Welch, William C; Winkelstein, Beth A

2011-07-01

223

Compressive follower load influences cervical spine kinematics and kinetics during simulated head-first impact in an in vitro model.  

PubMed

Current understanding of the biomechanics of cervical spine injuries in head-first impact is based on decades of epidemiology, mathematical models, and in vitro experimental studies. Recent mathematical modeling suggests that muscle activation and muscle forces influence injury risk and mechanics in head-first impact. It is also known that muscle forces are central to the overall physiologic stability of the cervical spine. Despite this knowledge, the vast majority of in vitro head-first impact models do not incorporate musculature. We hypothesize that the simulation of the stabilizing mechanisms of musculature during head-first osteoligamentous cervical spine experiments will influence the resulting kinematics and injury mechanisms. Therefore, the objective of this study was to document differences in the kinematics, kinetics, and injuries of ex vivo osteoligamentous human cervical spine and surrogate head complexes that were instrumented with simulated musculature relative to specimens that were not instrumented with musculature. We simulated a head-first impact (3?m/s impact speed) using cervical spines and surrogate head specimens (n?=?12). Six spines were instrumented with a follower load to simulate in vivo compressive muscle forces, while six were not. The principal finding was that the axial coupling of the cervical column between the head and the base of the cervical spine (T1) was increased in specimens with follower load. Increased axial coupling was indicated by a significantly reduced time between head impact and peak neck reaction force (p?=?0.004) (and time to injury (p?=?0.009)) in complexes with follower load relative to complexes without follower load. Kinematic reconstruction of vertebral motions indicated that all specimens experienced hyperextension and the spectrum of injuries in all specimens were consistent with a primary hyperextension injury mechanism. These preliminary results suggest that simulating follower load that may be similar to in vivo muscle forces results in significantly different impact kinetics than in similar biomechanical tests where musculature is not simulated. PMID:23775333

Saari, Amy; Dennison, Christopher R; Zhu, Qingan; Nelson, Timothy S; Morley, Philip; Oxland, Thomas R; Cripton, Peter A; Itshayek, Eyal

2013-11-01

224

[Diagnosis of hyper- and hypomotility of the upper cervical spine using functional computerized tomography].  

PubMed

At present, there are few methods that are of any assistance in evaluating the ligaments of the upper cervical spine. It is obvious that a lesion of these ligaments could result in instability of the cranial cervical junction. Nine healthy adults and 45 patients with suspected rotatory instability of the upper cervical spine after trauma were examined using functional CT-scans. After CT scans of the upper cervical spine had been obtained with the patient in a neutral position, the head was passively rotated to the left and right and held in these positions by adhesive tape. CT scans were performed for the left and right rotation. The range of axial rotation was measured in relation to the neutral position at the level of the occiput, atlas and axis using identical bony landmarks. A mean rotation of 4.2 degrees to the right and 3.8 degrees to the left was measured at the occiput/atlas level. The mean difference between left and right rotation in individual patients was 2 degrees. The mean rotation of C1-2 was 41.8 degrees to the right and 44.3 degrees to the left. The mean difference between left and right rotation was 2.8 degrees. A 98% confidence interval for allocating a pathological case to the distribution of healthy adults was defined. According to this rule, occiput/atlas rotation of 8 degrees or more, C1-2 rotation of 56 degrees or more, a left/right OCC/C1 difference of 5 degrees or more and a left/right C1-2 difference of 8 degrees or more were considered to be pathological.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3574938

Dvorak, J; Panjabi, M M; Hayek, J

1987-02-01

225

Two different causes of acute respiratory failure in a patient with diffuse idiopathic skeletal hyperostosis and ankylosed cervical spine.  

PubMed

We report a case of 73-year-old man with massive hyperostosis of the cervical spine associated with diffuse idiopathic skeletal hyperostosis (DISH), resulting in dysphagia, hoarseness and acute respiratory insufficiency. An emergency operation was performed, which involved excision of osteophytes at the level of C6-C7, compressing the trachea against enlarged sternoclavicular joints, also affected by DISH. Approximately 3 years later, the patient sustained a whiplash injury in a low impact car accident, resulting in a C3-C4 fracture dislocation, which was not immediately diagnosed because he did not seek medical attention after the accident. For the next 6 months, he had constant cervical pain, which was growing worse and eventually became associated with dysphagia and dyspnoea, ending once again in acute respiratory failure due to bilateral palsy of the vocal cords. The patient underwent a second operation, which comprised partial reduction and combined anteroposterior fixation of the fractured vertebrae. Twenty months after the second operation, mild hoarseness was still present, but all other symptoms had disappeared. The clinical manifestations, diagnosis and treatment of the two unusual complications of DISH are discussed. PMID:19798518

Vengust, Rok; Mihalic, René; Turel, Matjaz

2009-10-02

226

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

227

Congenital stenosis and adjacent segment disease in the cervical spine.  

PubMed

Symptomatic adjacent segment disease (ASD) after anterior cervical fusion (ACF) is reported in 25% of patients at 10 years postoperatively. Debate continues as to whether this degeneration is due to the natural history of the disk or the changed biomechanics after ACF. This study explored whether congenital stenosis predisposes patients to an increased incidence of ASD after ACF. A retrospective review of 635 patients with myelopathy or radiculopathy was performed; 364 patients had complete records for review. Patients underwent 1- to 5-level ACF (94 one-level, 145 two-level, 79 three-level, 45 four-level, and 1 five-level). Radiographs were evaluated for bony congenital stenosis using validated parameters, and ASD was measured according to Hilibrand's criteria and correlated with symptomatic ASD. Congenital stenosis was found in 21.7% of patients and radiographic ASD in 33.5%, with a significant association between these parameters. However, symptomatic ASD occurred in 11.8% of patients; no association between congenital stenosis and symptomatic ASD or myelopathy and ASD was found. Clinical results demonstrated excellent or good Robinson scores in 86.2% of patients and Odom scores in 87% of patients. Despite mostly excellent to good outcomes, symptomatic ASD is common after ACF. Although congenital stenosis appears to increase the incidence of radiographic ASD, it does not appear to predict symptomatic ASD. PMID:24093699

Eubanks, Jason David; Belding, Jon; Schnaser, Erik; Rowan, Andrew; Moffitt, Gable; Weaver, John; Reich, Michael S; Bechtel, Chris; Xie, Ke; Gande, Abhiram; Hohl, Justin; Braly, Brett; Hilibrand, Alan; Kang, James D

2013-10-01

228

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

PubMed Central

The objective of the study was to develop a clinical prediction rule (CPR) to identify patients with neck pain likely to improve with cervical traction. The study design included prospective cohort of patients with neck pain referred to physical therapy. Development of a CPR will assist clinicians in classifying patients with neck pain likely to benefit from cervical traction. Eighty patients with neck pain received a standardized examination and then completed six sessions of intermittent cervical traction and cervical strengthening exercises twice weekly for 3 weeks. Patient outcome was classified at the end of treatment, based on perceived recovery according to the global rating of change. Patients who achieved a change ?+6 (“A great deal better” or “A very great deal better”) were classified as having a successful outcome. Univariate analyses (t tests and chi-square) were conducted on historical and physical examination items to determine potential predictors of successful outcome. Variables with a significance level of P ? 0.15 were retained as potential prediction variables. Sensitivity, specificity and positive and negative likelihood ratios (LRs) were then calculated for all variables with a significant relationship with the reference criterion of successful outcome. Potential predictor variables were entered into a step-wise logistic regression model to determine the most accurate set of clinical examination items for prediction of treatment success. Sixty-eight patients (38 female) were included in data analysis of which 30 had a successful outcome. A CPR with five variables was identified: (1) patient reported peripheralization with lower cervical spine (C4–7) mobility testing; (2) positive shoulder abduction test; (3) age ?55; (4) positive upper limb tension test A; and (5) positive neck distraction test. Having at least three out of five predictors present resulted in a +LR equal to 4.81 (95% CI = 2.17–11.4), increasing the likelihood of success with cervical traction from 44 to 79.2%. If at least four out of five variables were present, the +LR was equal to 23.1 (2.5–227.9), increasing the post-test probability of having improvement with cervical traction to 94.8%. This preliminary CPR provides the ability to a priori identify patients with neck pain likely to experience a dramatic response with cervical traction and exercise. Before the rule can be implemented in routine clinical practice, future studies are necessary to validate the rule. The CPR developed in this study may improve clinical decision-making by assisting clinicians in identifying patients with neck pain likely to benefit from cervical traction and exercise.

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

2009-01-01

229

Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case series and review of the literature.  

PubMed

Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronic painful conditions such as complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, peripheral ischemia, low back pain, and other conditions refractory to more conservative treatments. To date, there are very few published reports documenting the use of spinal cord stimulation in the treatment of head/neck and upper limb pain. This paper reports a case series of 5 consecutive patients outlining the use of spinal cord stimulation to treat upper extremity pain. All subjects had previously undergone cervical fusion surgery to treat chronic neck and upper limb pain. Patients were referred following failure of the surgery to manage their painful conditions. Spinal cord stimulators were placed in the cervical epidural space through a thoracic needle placement. Stimulation parameters were adjusted to capture as much of the painful area(s) as possible. In total, 4 out of 5 patients moved to implantation. In all cases, patients reported significant (70-90%) reductions in pain, including axial neck pain and upper extremity pain. Interestingly, 2 patients with associated headache and lower extremity pain obtained relief after paresthesia-steering reportedly covered those areas. Moreover, 2 patients reported that cervical spinal cord stimulation significantly improved axial low back pain. Patients continue to report excellent pain relief up to 9 months following implantation. This case series documents the successful treatment of neck and upper extremity pain following unsuccessful cervical spine fusion surgery. Given this initial success, prospective, controlled studies are warranted to more adequately assess the long term utility and cost effectiveness of electrical neuromodulation treatment of chronic neck and upper extremity pain. PMID:17387353

Vallejo, Ricardo; Kramer, Jeffery; Benyamin, Ramsin

2007-03-01

230

Exposure of emergency medicine personnel to ionizing radiation during cervical spine radiography  

SciTech Connect

We studied the potential hazard of ionizing radiation exposure to health care workers who routinely stabilize the necks of trauma patients during cervical spine radiography. A clinical trauma model was developed using an Alderson RANDO Phantom artificial torso to simulate an actual patient. A radiation monitor was placed where a health care worker's fingers, hands, arms, and thyroid gland would be, and standard cervical spine radiographs were taken. The exposures to the finger positions then were repeated with the monitor inside a 0.5 mm lead-equivalent glove. The mean exposure to the finger for a single cross-table lateral radiograph was 174.5 mrem. The use of leaded gloves reduced this exposure to 0.3 mrem (a 99.9% reduction). For a single series of lateral, anteroposterior, odontoid, and swimmer's views, the total mean measured unprotected exposure to the finger of the hand positioned nearest the radiographic tube was 681 mrem and the exposure to the finger of the opposite hand was 230 mrem. If these simulated exposures are indicative of actual patient situations, a health care worker who holds the head of a trauma patient four times each week with unshielded hands would receive more than twice the maximum allowable annual occupational radiation exposure to the extremities recommended by the National Council of Radiation Protection and Measurements. We conclude that health care workers who routinely stabilize the necks of trauma patients during cervical spine radiography may incur a radiation exposure risk and that 0.5-mm lead-equivalent gloves provide an effective barrier to ionizing radiation.

Singer, C.M.; Baraff, L.J.; Benedict, S.H.; Weiss, E.L.; Singer, B.D.

1989-08-01

231

Biofidelic whole cervical spine model with muscle force replication for whiplash simulation.  

PubMed

Whiplash has been simulated using volunteers, whole cadavers, mathematical models, anthropometric test dummies, and whole cervical spines. Many previous in vitro whiplash models lack dynamic biofidelity. The goals of this study were to (1) develop a new dynamic whole cervical spine whiplash model that will incorporate anterior, lateral and posterior muscle force replication, (2) evaluate its performance experimentally and (3) compare the results with in vivo data. To evaluate the new model, rear-impact whiplash simulations were performed using the incremental trauma approach at maximum measured T1 horizontal accelerations of 3.6 g, 4.7 g, 6.6 g, and 7.9 g. The kinematic response of the new model, e.g., peak head-T1 extension and peak intervertebral rotations, were compared with the corresponding in vivo data. The average peak head-T1 extension was within the in vivo corridor during the 3.6 g whiplash simulation (9.1 kph delta V). The peak in vivo intervertebral rotations obtained during a 4.6 g whiplash simulation of a young volunteer were within, or only marginally in excess of, the 95% confidence limits of the average peak intervertebral rotations measured during the 4.7 g whiplash simulation of the present study. Thus, the new whole cervical spine model with muscle force replication produced biofidelic dynamic responses to simulated whiplash. The new model is capable of generating important biomechanical data that may help improve our understanding of whiplash injuries and injury mechanisms. PMID:15480828

Ivancic, P C; Panjabi, Manohar M; Ito, S; Cripton, P A; Wang, J L

2004-10-12

232

Cervical cord compression presenting with sciatica-like leg pain  

Microsoft Academic Search

Sciatica-like leg pain can be the main presenting symptom in patients with cervical cord compression. It is a false localizing\\u000a presentation, which may lead to missed or delayed diagnosis, resulting in the wrong plan of management, especially in the\\u000a presence of concurrent lumbar lesions. Medical history, physical findings and the results of imaging studies were reviewed\\u000a in two cases of

Chee Keong Chan; Ho-Yeon Lee; Won-Chul Choi; Ji Young Cho; Sang-Ho Lee

2011-01-01

233

Spinal epidural haematoma after blunt trauma to the neck and hyperflection of the cervical spine.  

PubMed

Spinal epidural haematomas (sEDH) can be regarded as rare events, in principle a spontaneous and a traumatic aetiology can be distinguished. Spontaneous spinal epidural haematomas can arise, e.g. from vascular malformations, coagulopathies, etc. On the other hand, traumatic sEDH are related to, e.g. spinal trauma or intraoperative vascular injuries. With regard to clinical significance, spinal epidural haematomas accompanied by transient mild neurological symptoms up to lethal outcomes have been observed. We report on a 53-year-old male alcoholic who was found in the kitchen of his asylum in a grotesquely fixed body position, with his head and cervical spine in a maximum anteflected position. A general practitioner had ruled for a non-natural manner of death due to "broken neck" and alcohol intoxication, therefore, the prosecution authorities called for a medicolegal autopsy. At autopsy, paravertebral soft tissue haemorrhage in between the shoulder blades was disclosed. Furthermore, a spinal epidural haematoma, extending from the foramen magnum down to the middle portion of the thoracic spine was found. No fractures of vertebrae nor lesions of spine ligaments or bleedings of intervertebral discs were found. Blood alcohol concentration was determined 1.92 g/l and urine alcohol concentration was 1.76 g/l. Further morphological findings were cerebral oedema and cardiac hypertrophy; the urinary bladder was found filled to bursting. Neuropathological investigations confirmed the presence of the spinal epidural haematoma and assigned lethal significance to this finding. There were no histological signs of axonal injury. Reconstruction revealed that when sitting on a chair in a drunk condition, the individual's upper part of the body had fallen backwards in the corner and subsequently got stuck with maximum anteflection of the head and cervical spine, causing rupture of vessels and spinal epidural haematoma. Acute respiratory failure caused by impairment of the phrenic nerve following spinal epidural haematoma with potential synergism of alcohol intoxication was ascertained as the cause of death. PMID:16289414

Padosch, S A; Dettmeyer, R B; Schmidt, P H; Musshoff, F; Madea, B

2005-11-10

234

Factors predicting postoperative pain in children and adolescents following spine fusion.  

PubMed

Despite advances in research and technology, investigators around the world acknowledge the continued undertreatment and unnecessary suffering of children in pain. The dilemma of inadequate relief of children's pain may relate to the complexity of the pain phenomenon. Using the Gate Control Theory as the foundation for this work, the purpose of my study was to determine the extent to which selected variables (severity of operative procedure, postoperative use of pharmacological agents, prior experience with pain, pain tolerance, gender, and age) predicted children's and adolescents' pain following spine fusion. Using a descriptive correlational design, data were collected from 93 children (ages 8 to 21 years) who had undergone spine fusion. For four consecutive postoperative days, children were asked to rate the intensity of their pain using the Adolescent Pediatric Pain Tool and observed pain behaviors were recorded using the Child Pain Scale. Repeated measures MANOVA revealed that children continued to experience moderate to severe pain throughout the four days. Stepwise multiple regression analyses were conducted for each postoperative day on each of the dependent variables. A modest amount of variance in children's pain was explained by the variables studied. R square values suggested that age, pain tolerance, and severity of operative procedure have the greatest potential as predictors of children's postoperative pain and warrant future research. PMID:11111499

Kotzer, A M

235

Cervical radiculopathy: Pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar A prospective, controlled study  

Microsoft Academic Search

This prospective, randomised study compares the efficacy of surgery, physiotherapy and cervical collar with respect to pain, motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment, with or without an additional bulging disk, as verified by MRI or CT-myelography. Pain intensity was registered on a

L. C. G. Persson; U. Moritz; L. Brandt; C.-A. Carlsson

1997-01-01

236

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

237

Congenital dermal sinus of the cervical spine: clinical characteristics and management.  

PubMed

Congenital dermal sinus (CDS) in the cervical region is extremely rare with only few cases reported in the literature. This study reports a young case of CDS, by which we demonstrate the clinical characteristics and management of cervical CDS, particularly in kids. A 2-year and 7-month-old male child who presented with a one-year history of difficulty in holding objects by hands was diagnosed to have harbored a CDS in the cervical spine since birth. Neurological examination demonstrated mild weakness in both hands and also atrophy in intrinsic hand muscles. Surgery was performed right after diagnosis. Intraoperatively, the sinus tract was totally excised, and untethering was performed. No complications were found after operation. Histopathological examination suggested dorsal dermal sinus. During the follow-up of three years, the patient presented a stable neurologic deficit but did not suffer from an aggravation or improvement of nervous symptoms. At three-year follow-up, the patient was a stable neurologic deficit, and MRI revealed no evidence of the untethered cervical spinal cord and dermal sinus tract. The management strategies of CDS are early surgical treatment to prevent the development of neurological defects. PMID:22415384

Huang, S L; Shi, W; Zhang, L G

2012-03-01

238

Safety and efficacy of rhBMP2 in posterior cervical spinal fusion for subaxial degenerative spine disease: Analysis of outcomes in 204 patients  

PubMed Central

Background: Many studies offer excellent demonstration of the ability of bone morphogenic protein (BMP) to enhance fusion rates in anterior as well as posterior lumbar surgery. Recently, BMP has also been shown to increase arthrodesis rates in anterior cervical surgery, albeit with concomitant increases in complication rates. To date, however, few studies have investigated the safety and efficacy of BMP in cervical surgeries approached posteriorly. Methods: We retrospectively reviewed 204 consecutive patients with degenerative cervical spinal conditions necessitating posterior cervical fusion at a single institution over the past 4 years. The incidence of postoperative mechanical neck pain, fusion rates, as well as neurologic outcomes were compared between patients who received BMP vs those who did not receive BMP intraoperatively. Results: There were no significant differences in preoperative variables between the non-BMP vs the BMP cohorts. Over an average follow-up of 24.2 months, there were no significant differences between the two cohorts in duration of hospitalization, cerebrospinal fluid leakage, deep vein thrombosis, pulmonary embolism, hyperostosis, infection, pneumonia, hematoma, C5 palsy, wound dehiscence, reoperation rates, or Nurick/ASIA scores. Eleven (7.1%) patients in the non-BMP group experienced instrumentation failure vs none in the BMP group (P=0.06). Patients receiving BMP had a significantly increased rate of fusion by the chi-square test (P=0.01) and the log-rank test (P=0.02). However, patients receiving BMP also had the highest rates of recurrent/persistent neck pain by the chi-square test (P=0.003) and the log-rank test (P=0.01). Conclusions: To date, few studies have evaluated the safety and efficacy of BMP in the posterior cervical spine. Here, we show that BMP usage does not increase complication rates, but it significantly increases arthrodesis rates and also may increase the rate of recurrent/persistent neck pain.

Xu, Risheng; Bydon, Mohamad; Sciubba, Daniel M.; Witham, Timothy F.; Wolinsky, Jean-Paul; Gokaslan, Ziya L.; Bydon, Ali

2011-01-01

239

Chronic lumbar spine and radicular pain: Pathophysiology and treatment  

Microsoft Academic Search

The lumbar spine forms the foundation and infrastructure of an organic skyscraper equipped with the physiologic capacity to\\u000a act as a crane for lifting and a crankshaft for walking. Subjected to aging like other “human machinery,” the lumbar spine\\u000a adapts to the wear and tear of gravity and biomechanical loading through structural and neurochemical changes. Many of the\\u000a changes are

Anthony H. Wheeler; Daniel B. Murrey

2002-01-01

240

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

241

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

242

Osteochondroma of the cervical spine—a surprising finding in a liver transplanted patient with polyneuropathy and polyradiculitis: case report  

Microsoft Academic Search

BACKGROUNDOsteochondroma of the spine is a rare condition. We report a case of a patient with a cervical osteochondroma presenting with a polyneuropathy and polyradiculitis simultaneously.CASE DESCRIPTIONIn a liver-transplant patient with progressive neurological deficits a polyneuropathy and a polyradiculitis were diagnosed. Eventually the patient became quadraparetic and an osteochondroma compressing the cervical spinal cord was found. The patient’s neurological symptoms

Stefan-Nikolaus Kroppenstedt; Deborah T Blumenthal; Sonja Niepage; Friedrich Behse; Jorg-Wilhelm Oestmann; Andreas Wilhelm Unterberg

2002-01-01

243

Non-operative treatment of injuries of the upper cervical spine: our experience with a new carbon fibre halo system  

Microsoft Academic Search

Fractures of the upper cervical spine account for about 20% of all cervical spinal injuries. Only in a minority of cases a\\u000a neurological damage occurs. With exception of the type-2-dens fracture the treatment of choice is non-operatively in the halo-thoracic\\u000a brace. We report about our experience with Bremer® Halo System, an open ring carbon fibre design which especially facilitates the

J. Schröder; H. Wassmann

2009-01-01

244

Helmet and shoulder pad removal in football players with unstable cervical spine injuries.  

PubMed

Football, one of the country's most popular team sports, is associated with the largest overall number of sports-related, catastrophic, cervical spine injuries in the United States (Mueller, 2007). Patient handling can be hindered by the protective sports equipment worn by the athlete. Improper stabilization of these patients can exacerbate neurologic injury. Because of the lack of consensus on the best method for equipment removal, a study was performed comparing three techniques: full body levitation, upper torso tilt, and log roll. These techniques were performed on an intact and lesioned cervical spine cadaveric model simulating conditions in the emergency department. The levitation technique was found to produce motion in the anterior and right lateral directions. The tilt technique resulted in motions in the posterior left lateral directions, and the log roll technique generated motions in the right lateral direction and had the largest amount of increased instability when comparing the intact and lesioned specimen. These findings suggest that each method of equipment removal displays unique weaknesses that the practitioner should take into account, possibly on a patient-by-patient basis. PMID:19483256

Dahl, Michael C; Ananthakrishnan, Dheera; Nicandri, Gregg; Chapman, Jens R; Ching, Randal P

2009-05-01

245

Cervical Spine  

MedlinePLUS

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246

Predictive factors for arm pain, neck pain, neck specific disability and health after anterior cervical decompression and fusion  

Microsoft Academic Search

Summary  Background. Predictive factors for a low arm and neck pain, and good health after anterior cervical decompression and fusion (ACDF) with\\u000a a cervical carbon fibre intervertebral fusion cage (CIFC) are still lacking.\\u000a \\u000a Method. A prospective consecutive study to investigate which preoperative factors that could predict a good outcome with regard to\\u000a arm pain, neck pain, Neck Disability Index (NDI) and

A. Peolsson; L. Vavruch; B. Öberg

2006-01-01

247

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

Microsoft Academic Search

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

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

2009-01-01

248

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

249

Kinematics of the Human Cadaver Cervical Spine in Response to Superior-Inferior Loading of the Head.  

National Technical Information Service (NTIS)

The primary purpose of the study was to examine the effects of the prepositioned rotated head on cervical spine injuries produced by a blunt impact to the crown of the head. The superior-inferior direction impact was delivered to an instrumented unrepress...

G. S. Nusholtz P. S. Kaiker

1986-01-01

250

Strain energy density used as the biomechanical signal for osteophyte growth in the cervical spine - biomed 2009.  

PubMed

Cervical spondylosis is a degenerative disease of the cervical spine that affects over 50% of the population older than 50 years. Spondylosis is a progressive disease where the intervertebral disc degenerates and bony growths called osteophytes form. Osteophyte growth has been identified by numerous investigators as an example of Wolff's law of bone remodeling acting on the abnormal strain energy density (SED) caused by the degenerating spine. A series of finite element models of the progressively degenerating cervical spine was developed to determine the SED of normal spinal vertebral bodies and the SED of degenerating vertebral bodies. The values of SED of the degenerated vertebral bodies were used to find C and HSED, two constants used in the bone remodeling equation: ?X = C (SED-HSED). ?X is the amount of osteophyte growth normal to the vertebral body surface. A bone remodeling algorithm was developed using this equation and implemented on the FEM of the degenerated spine. C was determined to be 99 mm4/mJ and HSED was found to be 24.8 mJ/mm3. An osteophyte 3.9 mm long was grown on a FEM of a degenerated spine with a disc height loss of 37%. PMID:19369754

Wheeldon, John A; Yoganandan, Narayan; Pintar, Frank A

2009-01-01

251

Evaluation of traumatic lateral cervical spine computed radiography images: quality control acceptability of images for clinical diagnosis, hardcopy versus high-resolution monitors  

NASA Astrophysics Data System (ADS)

The computed radiography images of 100 randomly selected traumatic cervical spine series were evaluated. The studies were reviewed on the laser printed hardcopy and 2K monitor soft copy images. In addition to the cervical vertebrae, the cervico-thoracic vertebral body interface must be recognized for a lateral c-spine image to be acceptable. The level of visualization of the spine was on average, 1/2 vertebral body better on the monitor than the hardcopy image. In 8% of cases, this improve visualization allowed clearance of the lateral cervical spine thereby expediting patient care in this critical area. This presentation will cover the quality of images and techniques to improve the success rate for clearing the cervical spine.

Leckie, Robert G.; Sheehy, Monet R.; Cade, Lawrence; Goeringer, Fred; Meyers, Chris A.; Parker, James E.; Smith, Donald V.; Freedman, Matthew T.

1993-06-01

252

Cervical SNAGs: a biomechanical analysis  

Microsoft Academic Search

A sustained natural apophyseal glide (SNAG) is a mobilization technique commonly used in the treatment of painful movement restrictions of the cervical spine. In the manual therapy literature, the biological basis and empirical efficacy of cervical SNAGs have received scant attention. In particular, an examination of their potential biological basis in order to stimulate informed discussion seems overdue. This paper

A. Hearn; D. A. Rivett

2002-01-01

253

Muscle pathologies after cervical spine distortion-like exposure-a porcine model.  

PubMed

Objective: Histological evaluation of porcine posterior cervical muscles after a forceful translational and extensional head retraction simulating high-speed rear end impact. Methods: Four anesthetized pigs were exposed to a cervical spine distortion (CSD)-like motion in a lying position. After 2 different survival times of 4 and 6 h (posttrauma), the pigs were euthanized and tissue sampling of posterior cervical muscles was performed. A standard histological staining method involving paraffin-embedded sections was used to analyze the muscles, focusing on injury signs like hemorrhage and inflammatory cell reaction. A pig that was not subjected to impact was used as a control pig and was subjected to the same procedure to exclude any potential artifacts from the autopsy. Results: The differentiation of 8 different posterior neck muscles in the dissection process was successful in more than 50 percent for each muscle of interest. Staining and valid analysis was possible from all extracted samples. Muscle injuries to the deepest posterior neck muscles could be found, especially in the musculus obliquus samples, which showed laminar bleedings in 4 out of 4 samples. In addition, in 4 out of 4 samples we were able to see increased cellular reactions. The splenius muscle also showed bleeding in all 4 samples. All animals showed muscle injury signs in more than three quarters of analyzed neck muscles. Differences between survival times of 4 and 6 h in terms of muscular injury were not of primary interest and could not be found. Conclusions: By simulating a CSD-like motion we were able to confirm injuries in the posterior cervical muscles under severe loading conditions. Further studies need to be conducted to determine whether these muscle injuries also occur under lower exposure forces. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file. PMID:24073771

Gales, N; Kunz, S N; Rocksén, D; Arborelius, U P; Svensson, M Y; Hell, W; Schick, S

2013-01-01

254

Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: a novel approach--Report of six cases  

PubMed Central

A report of our experiences involving the treatment six male patients with a new method of closing perforations in the pharynx and upper esophagus, following surgery of the cervical spine region. Perforation of the pharynx and upper esophagus are rare complications following cervical spine surgery. The grave consequences of these complications necessitate in most cases immediate surgical therapy. In most cases, the first step involves the removal of the cervical plate and screws. The defect was then closed using a vascular pedicled musculofascia flap derived from the infrahyoid musculature. In all cases, the flap healed into place without complications. The patients began taking oral nutrients after an average of seven postoperative (5–12) days. In none of the cases did functional disorders or complications arise during the follow-up period (1–5 years). The infrahyoid muscle flap is well suited for reconstruction of the posterior pharyngeal wall and the upper esophagus.

Niedeggen, Andreas; Todt, Ingo; Westhofen, Martin; Ernst, Arne

2006-01-01

255

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

256

Percutaneous pulsed radiofrequency in the treatment of cervical and lumbar radicular pain  

Microsoft Academic Search

BackgroundPrevious reports of the efficacy of percutaneous pulsed radiofrequency have been confounded by fewer case numbers, poor patient selection, and limited data on cervical or lumbar radicular pain. We used percutaneous pulsed radiofrequency for cervical and lumbar radicular pain, and the study has more than 100 cases for the analysis of the efficacy of percutaneous pulsed radiofrequency.

Shao-Ching Chao; Hsu-Tung Lee; Ting-Hsien Kao; Meng-Yin Yang; Yuang-Seng Tsuei; Chiung-Chyi Shen; Hsi-Kai Tsou

2008-01-01

257

Pediatric cervical spine fracture caused by an adult 3-point seatbelt.  

PubMed

The development and use of seatbelts has saved numerous lives and prevented serious injuries in the setting of automobile crashes. However, restraints designed for adults are not necessarily effective in preventing injury to small children and may actually be harmful. Here, we present a case of upper cervical spine fracture in a 5-year-old female patient caused by neck flexion over an inappropriately applied adult 3-point seatbelt during a motor vehicle collision. The American Academy of Pediatrics currently advises against the use of vehicle safety belts until the shoulder belt can be positioned across the chest with the lap belt snug across the thighs. As clinicians who care for children, it is imperative that we continue to educate parents about proper use of age-appropriate child safety restraints. PMID:18277848

Deutsch, Robert Jay; Badawy, Mohamed K

2008-02-01

258

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

259

Quantitative Analyses of Pediatric Cervical Spine Ossification Patterns Using Computed Tomography  

PubMed Central

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

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

2011-01-01

260

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

2013-02-13

261

Anterior cervical discectomy and fusion for the management of axial neck pain in the absence of radiculopathy or myelopathy  

PubMed Central

Study design:?Systematic review Study rationale:?Anterior cervical discectomy and fusion (ACDF) is a proven, effective treatment for relieving neck pain due to degenerative conditions of the cervical spine. Since most patients also present with radiculopathy or myelopathy, little is known as to the effectiveness of ACDF to relieve pain and improve function in patients without radicular or myelopathic symptoms. Objective:?To examine the clinical outcome in patients undergoing (ACDF) for axial neck pain without radicular or myelopathic symptoms. Methods:?A systematic review was undertaken for articles published up to March 2010. Electronic databases and reference lists of key articles were searched to identify studies evaluating ACDF for the treatment of axial neck pain only. Radiculopathy and myelopathy, patients who suffered severe trauma, or with tumor/metastatic disease or infection were excluded. Two independent reviewers assessed the strength of evidence using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results:?No comparative studies were identified. Three case series met our inclusion criteria and were evaluated. All studies showed a mean improvement of pain of at least 50% approximately 4-years following surgery. Functional outcomes improved between 32% and 52% from baseline. Most patients reported satisfaction with surgery, 56% in one study and 79% in another. Complications varied among studies ranging from 1% to 10% and included pseudoarthrosis (9%), nonunion and revision (3%) and screw removal (1%). Conclusion:?There is low evidence suggesting that patients with axial neck pain without radicular or myelopathic symptoms may receive some improvement in pain and function following ACDF. However, whether this benefit is greater than nontreatment or other treatments cannot be determined with the present literature.

Riew, K Daniel; Ecker, Erika; Dettori, Joseph R.

2010-01-01

262

Revision cervical spine surgery using transarticular or pedicle screws under a computer-assisted image-guidance system  

Microsoft Academic Search

Background  The exact insertion of a cervical screw is technically demanding, especially when normal anatomic landmarks have been obscured\\u000a and are difficult to identify, such as in revision surgery. The purpose of this study was to evaluate the efficacy of an image-guidance\\u000a system to aid placement of transarticular and pedicular screws for revision cervical spine surgery.\\u000a \\u000a \\u000a \\u000a Methods  Ten patients with recurrent myelopathy,

Atsushi Seichi; Katsushi Takeshita; Susumu Nakajima; Toru Akune; Hiroshi Kawaguchi; Kozo Nakamura

2005-01-01

263

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

2011-01-15

264

CT-guided interventional procedures for pain management in the lumbosacral spine.  

PubMed

The lumbosacral spine is the source of pain, suffering, and disability more frequently than any other part of the body. Pain in the lower back can be managed with computed tomography-guided analgesic interventional procedures, such as periradicular infiltration, percutaneous laser disk decompression, facet joint block, and percutaneous vertebroplasty. Periradicular injection of steroids provides short-term and sometimes even long-term relief of low back pain. Percutaneous laser disk decompression is used to treat radiculalgia caused by disk herniation. Facet joint block is useful in diagnosis and treatment of facet syndrome. Percutaneous vertebroplasty provides short- and long-term pain relief in patients with vertebral body disease. However, precise patient selection is essential to the success of each of these techniques. The interventional radiologist has an active role to play in minimally invasive management of lower back pain and should be part of an interdisciplinary team that determines the appropriate therapy. PMID:9599387

Gangi, A; Dietemann, J L; Mortazavi, R; Pfleger, D; Kauff, C; Roy, C

265

[Updates on ossification of posterior longitudinal ligament. Clinical results and problems of posterior decompression for OPLL of the cervical spine].  

PubMed

Clinical results of expansive laminoplasty (ELAP) for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine are satisfactory and are preserved for long period. ELAP is also thought to be easier and safer procedure than anterior fusion for OPLL of the cervical spine. However, appropriate decompression can not be achieved by ELAP without sufficient dorsal shift of the spinal cord, because pathological lesion exists ventral to the spinal cord in patients with OPLL. Kyphotic alignment, high OPLL occupying ratio, hill-shaped ossification are considered to be risk factors contributing to inappropriate decompression. To acquire satisfactory operative results, careful consideration for the indication of ELAP should be necessary for each patient. PMID:19794259

Ogawa, Yuto

2009-10-01

266

Axial loading injuries to the middle cervical spine segmentAn analysis and classification of twenty-five cases  

Microsoft Academic Search

Injuries to the cervical spine at the C3-C4 level involving the bony elements, intervertebral disks, and ligamen tous structures are rare. We present 25 cases of trau matic C3-C4 injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry. Review of the cases reveals that the response of energy inputs at the C3-C4 level

Joseph S. Torg; Brian Sennett; Joseph J. Vegso; Helene Pavlov

1991-01-01

267

Three-dimensional analysis of cervical spine motion: reliability of a computer assisted magnetic tracking device compared to inclinometer  

Microsoft Academic Search

We aimed to investigate the reliability and reproducibility of a magnetic tracking technique for the assessment of overall\\u000a cervical spine motion (principal and coupled movements). Ten asymptomatic male volunteers with a mean age of 29.3 years (range\\u000a 20–37 years) were included in the study. Flexion, extension, left and right lateral bending and left and right axial rotation\\u000a were measured using a magnetic

Ioannis D. Gelalis; Louis E. DeFrate; Kosmas S. Stafilas; Emilios E. Pakos; James D. Kang; Lars G. Gilbertson

2009-01-01

268

Diagnosis and surgery of ossification of posterior longitudinal ligament associated with dural ossification in the cervical spine  

Microsoft Academic Search

Direct removal of the ossified mass via anterior approach carries good decompression to ossification of the posterior longitudinal\\u000a ligament (OPLL) in the cervical spine. Ossification occasionally involves not only the posterior longitudinal ligament but\\u000a also the underlying dura mater, which increased the opportunity of the cerebrospinal fluid (CSF) leakage or neurological damage.\\u000a The surgeon was required to recognize the dural

Yu Chen; Yongfei Guo; Deyu Chen; Xuhua Lu; Xinwei Wang; Haijun Tian; Wen Yuan

2009-01-01

269

Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients  

PubMed Central

Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments. The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures were at C5–C7 in 70%. American Spinal Injury Association class (ASIA) on admission was A for 8 patients, B for 4, C for 4, D for 1, and E for 17. There were 23 surgical spine stabilizations. Final ASIA class was A for 6 patients, B for 1, C for 3, D for 5, and E for 18. The mean duration of hospitalization was 21.3 days in our neurosurgical center (mean overall cost: 36,000 Euros/patient) plus 10.6 months in rehabilitation center for the 15 patients admitted who had an ASIA class A to C. Mean overall direct cost for a patient with class A is almost 300,000 Euros, compared to around 10,000 Euros for patients with class D and E. In addition, a profound impact on personal and professional life was seen in many cases including 11 divorces and 7 job losses. Dangerous diving into swimming pools can result in spinal injuries with drastic consequences, including permanent physical disability and a profound impact on socio-professional status. Moreover, there are significant financial costs to society. Better prevention strategies should be implemented to reduce the impact of this public health problem.

Gouader, Ismail; Bousquet, Philippe; Draper, Louisa; Roux, Franck-Emmanuel

2009-01-01

270

The Role of the Faceguard in the Production of Flexion Injuries to the Cervical Spine in Football  

PubMed Central

The precise role of the single-bar face mask in producing major flexion violence to the cervical spine has been studied by review of game movies, analysis of the radiographs and detailed interviews with two players who sustained fractures of cervical spine. The single-bar face mask can become fixed in the ground, thereby forcing a runner's head down onto his chest as the trunk moves forward. Preventive measures embodying modifications in the face mask, strict coaching in football techniques and the institution of safety factors in the playing rules are proposed. Appreciation of the mechanism of injury is urged in order to encourage careful inspection of protective head gear as well as to direct the attention of team physicians to the possibility of serious flexion injury to the cervical spine occurring without dramatic evidence. This report is not a plea for abandonment of the face mask but rather a suggestion for careful selection of a safe and efficient mask. ImagesFig. 5bFig. 6bFig. 7bFig. 8bFig. 9Fig. 10Fig. 11Fig. 12Fig. 13

Melvin, W. J. S.; Dunlop, H. W.; Hetherington, R. F.; Kerr, J. W.

1965-01-01

271

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

272

Cortical Margining Capabilities of Fins Associated with Ventral Cervical Spine Instrumentation  

PubMed Central

Fins incorporated into the design of a dynamic cervical spine implant have been employed to enhance axial load-bearing ability, yet their true biomechanical advantages, if any, have not been defined. Therefore, the goal of this study was to assess the biomechanical and axial load-bearing contributions of the fin components of the DOC ventral cervical stabilization system. Eighteen fresh cadaveric thoracic vertebrae (T1-T3) were obtained. Three test conditions were devised and studied: Condition A (DOC implants with fins were placed against the superior endplate and bone screws were not inserted); Condition B (DOC implant without fins was placed and bone screws were inserted); and Condition C (DOC implant with fins were placed against the superior endplate and bone screws were inserted). Specimens were tested by applying a pure axial compressive load to the superior platform of the DOC construct, and load-displacement data were collected. Condition C specimens had the greatest stiffness (459 ± 80 N/mm) and yield load (526±168 N). Condition A specimens were the least stiff (266±53 N/mm), and had the smallest yield loads (180±54 N). The yield load of condition A plus condition B was approximately equal to that of condition C, with condition A contributing about one-third and condition B contributing two-thirds of the overall load-bearing capacity. Although the screws alone contributed to a substantial portion of axial load-bearing ability, the addition of the fins further increased load-bearing capabilities.

Kwon, Heum-Dai; Cho, Yong-Eun

2005-01-01

273

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

274

Negative effects of smoking, workers' compensation, and litigation on pain/disability scores for spine patients  

PubMed Central

Background: When initiating treatment for patients with spinal disorders, we examined the impact of smoking, workers compensation, and litigation on disability and pain scores. Methods: With Institutional Review Board approval, the medical records of 13,704 consecutive patients with spinal disorders treated at two university spine centers were reviewed. Particular attention was focused on the pretreatment impact of three variables: smoking, workers compensation, and litigation. All patients completed a questionnaire that included a modified Oswestry Disability Index (ODI), a visual analog pain scale (VAS) and a history of smoking, workers compensation, and/or litigation issues. Analysis of Variance (ANOVA) with Bonferroni (when appropriate) was used to analyze the data. Results: ODI scores significantly correlated with a smoking history: Current Smoker > Previous Smoker > Never Smoked (44.22 > 38.11 > 36.02, respectively). Pain scores and ODI scores had a direct correlation to workers compensation and litigation status. Workers compensation, litigation and smoking combined created even higher scores. There was no significant difference between previous smokers and nonsmokers. Conclusions: This study demonstrates that a history of smoking, workers compensation, and/or litigation, considered alone or worse, combined, negatively impacted outcomes for patients seeking treatment at our spine centers. For optimal outcomes in spine patients, cessation of smoking and treatment of attendant psychological and social factors prove critical.

Prasarn, Mark L.; Horodyski, Mary B.; Behrend, Caleb; Wright, John; Rechtine, Glenn R.

2012-01-01

275

A study of cervical spine kinematics and joint capsule strain in rear impacts using a human FE model.  

PubMed

Many efforts have been made to understand the mechanism of whiplash injury. Recently, the cervical facet joint capsules have been focused on as a potential site of injury. An experimental approach has been taken to analyze the vertebral motion and to estimate joint capsule stretch that was thought to be a potential cause of pain. The purpose of this study is to analyze the kinematics of the cervical facet joint using a human FE model in order to better understand the injury mechanism. The Total Human Model for Safety (THUMS) was used to visually analyze the local and global kinematics of the spine. Soft tissues in the neck were newly modeled and introduced into THUMS for estimating the loading level in rear impacts. The model was first validated against human test data in the literature by comparing vertebrae motion as well as head and neck responses. Joint capsule strain was estimated from a maximum principal strain output from the elements representing the capsule tissues. A rear-end collision was then simulated using THUMS and a prototype seat model, assuming a delta-V of 25 km/h. The trajectory of the vertebrae was analyzed in a local coordinate system defined along the joint surface. Strain growth in the joint capsules was explained, as related to contact events between the occupant and the seat. A new seat concept was proposed to help lessen the loading level to the neck soft tissues. The foam material of the seat back was softened, the initial gap behind the head was reduced and the head restraint was stiffened for firm support. The lower seat back frame was also reinforced to withstand the impact severity at the given delta-V. Another rear impact simulation was conducted using the new seat concept model to examine the effectiveness of the new concept. The joint capsule strain was found to be relatively lower with the new seat concept. The study also discusses the influence of seat parameters to the vertebral motion and the resultant strain in the joint capsules. The meaning of the contact timing of the head to the head restraint was examined based on the results in terms of correlation with injury indicators such as NIC and the joint capsule strain. PMID:17311176

Kitagawa, Yuichi; Yasuki, Tsuyoshi; Hasegawa, Junji

2006-11-01

276

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

277

Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 2 : Cervical Spine  

PubMed Central

Objective Similar to back pain, neck pain has recently shown to have increasing prevalence. Magnetic resonance imaging (MRI) is useful in identifying the causes of neck pain. However, MRI shows not only pathological lesions but also physiological changes at the same time, and there are few Korean data. The authors have attempted to analyze the prevalence of disc degeneration in highly selective asymptomatic Korean subjects using MRI. Methods We performed 3 T MRI sagittal scans from C2 to T1 on 102 asymptomatic subjects (50 men and 52 women) who visited our hospital between the ages of 14 and 82 years (mean age 46.3 years). All images were read independently by three observers (two neurosurgeons and one neuroradiologist) who were not given any information about the subjects. We classified grading for cervical disc herniation (HN), annular fissure (AF), and nucleus degeneration (ND), using disc degeneration classification. Results The prevalence of HN, AF, and ND were 81.0%, 85.9%, and 95.4%, respectively. High prevalence of HN, AF, and ND was shown compared to previous literature. Conclusion In asymptomatic Korean subjects, the abnormal findings of 3 T MRI showed a high prevalence in HN, AF, and ND. Several factors might play important roles in these results, such as population-specific characters, MRI field strength, and disc degeneration grading system.

Lee, Tae Hoon; Lim, Soo Mee

2013-01-01

278

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

PubMed Central

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 Points While 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.

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

2013-01-01

279

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

2013-09-01

280

Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging.  

PubMed

Evidence on magnetic resonance (MR) images of disk degeneration and herniation, as well as of cord and root impingement, may be regarded either as normal, age-related changes or as causative of symptoms. Individuals referred for MR examinations of the larynx without symptoms referable to the cervical spine were studied retrospectively (35 patients) or prospectively (65 patients) over a 2-year period. With a solenoid surface coil, 5-mm-thick sections were acquired in sagittal, axial, and coronal planes with T1-weighted spin-echo pulsing sequences. Disk protrusion (herniation/bulge) was seen in five of 25 (20%) patients aged 45-54 and 24 of 42 (57%) patients older than 64 years of age. Posterolateral protrusions were seen in only nine of 100 patients and occurred with greatest frequency in patients over 64 years of age. In no patient was obliteration of the intraforaminal fat seen. Spinal cord impingement was observed in nine of 58 (16%) patients under 64 years of age, and in 11 of 42 (26%) patients over 64 years of age. Cord compression was observed in seven of 100 patients and occurred solely secondary to disk protrusion in all cases. The percentage of cord area reduction never exceeded 16% and averaged approximately 7%. PMID:3588931

Teresi, L M; Lufkin, R B; Reicher, M A; Moffit, B J; Vinuela, F V; Wilson, G M; Bentson, J R; Hanafee, W N

1987-07-01

281

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

282

Scalene Myofascial Pain Syndrome Mimicking Cervical Disc Prolapse: A Report of Two Cases  

PubMed Central

Scalene myofascial pain syndrome is a regional pain syndrome wherein pain originates over the neck area and radiates down to the arm. This condition may present as primary or secondary to underlying cervical pathology. Although scalene myofascial pain syndrome is a well known medical entity, it is often misdiagnosed as being some other neck pain associated with radiculopathy, such as cervical disc prolapse, cervical spinal stenosis and thoracic outlet syndrome. Because scalene myofascial pain syndrome mimics cervical radiculopathy, this condition often leads to mismanagement, which can, in turn, result in persistent pain and suffering. In the worst-case scenarios, patients may be subjected to unjustifiable surgical intervention. Because the clinical findings in scalene myofascial pain syndrome are “pathognomonic”, clinicians should be aware of ways to recognize this disorder and be able to differentiate it from other conditions that present with neck pain and rediculopathy. We present two cases of unilateral scalene myofascial pain syndrome that significantly impaired the patients’ functioning and quality of life. This case report serves to create awareness about the existence of the syndrome and to highlight the potential morbidity due to clinical misdiagnosis.

Abd Jalil, Nizar; Awang, Mohammad Saufi; Omar, Mahamarowi

2010-01-01

283

[Wrist pain].  

PubMed

Acute or chronic wrist pain is a relatively frequent complaint that may involve all age groups. The pain may be of osseous, articular, periarticular, neurologic, vascular origin, or be referred from the cervical spine, shoulder or elbow. The diagnosis should be oriented by a precise history and clinical examination. More specialised exams will be required according to clinical findings. Psychosocial and environmental influences need to be taken into consideration. PMID:17233497

Sadowski, M; Della Santa, D

2006-12-20

284

Changes in muscle activity determine progression of clinical symptoms in patients with chronic spine-related muscle pain. A complex clinical and neurophysiological approach.  

PubMed

Spine-related muscle pain can affect muscle strength and motor unit activity. This study was undertaken to investigate whether surface electromyographic (sEMG) recordings performed during relaxation and maximal contraction reveal differences in the activity of muscles with or without trigger points (TRPs). We also analyzed the possible coexistence of characteristic spontaneous activity in needle electromyographic (eEMG) recordings with the presence of TRPs. Thirty patients with non-specific cervical and back pain were evaluated using clinical, neuroimaging and electroneurographic examinations. Muscle pain was measured using a visual analog scale (VAS), and strength using Lovett's scale; trigger points were detected by palpation. EMG was used to examine motor unit activity. Trigger points were found mainly in the trapezius muscles in thirteen patients. Their presence was accompanied by increased pain intensity, decreased muscle strength, increased resting sEMG amplitude, and decreased sEMG amplitude during muscle contraction. eEMG revealed characteristic asynchronous discharges in TRPs. The results of EMG examinations point to a complexity of muscle pain that depends on progression of the myofascial syndrome. PMID:22152435

Wytrazek, Marcin; Huber, Juliusz; Lisinski, Przemyslaw

285

Massage Therapy for Cervical Degenerative Disc Disease: Alleviating a Pain in the Neck?  

PubMed Central

Background: A 66-year-old female client with cervical degenerative disc disease at lateral left facet joint C6/C7 was experiencing symptoms of chronic neck pain accompanied by limited cervical range of motion, as well as radicular left shoulder and arm pain. The objective of this case report was to describe the effect of therapeutic massage on the client’s symptoms and impairments of cervical DDD. Methods: Therapeutic massage interventions included soft-tissue manipulation using petrissage and neuromuscular techniques, fascial work, facilitated stretching, joint play, hydrotherapy, education on self-stretching, and positive guidance about condition management. Assessment included pain-free cervical ROM and a subjective verbal pain scale. Results: After several treatment sessions, client’s symptoms had decreased and cervical ROM had improved moderately. There was also a decrease in reported pain and an increase in functional daily activities. Client showed a greater understanding of the physiologic barriers which degenerative changes may present. Conclusions: This client responded favorably to massage therapy as a treatment intervention for cervical DDD symptoms.

Avery, Rhonda-Marie

2012-01-01

286

Validity of surface markers placement on the cervical spine for craniocervical posture assessment.  

PubMed

The objective of this study was to evaluate the ability of a physical therapist to place surface markers on the skin over spinous process of C2, C4, C6, and C7 by evaluating the markers positioning using radiographs. A total of 39 healthy female subjects participated. From 39 subjects, 22 had 2 radiographs taken and 17 had 1 radiograph taken. This study presents the results from the 22 subjects and from all 39 subjects together. The markers used were visible on the radiographs. The surface markers placement was tested by using percentage agreement. The criteria used were based on the direction of palpation. Only the markers placed that presented the center of the markers tip aligned to the tip of the spinous process was considered an acceptable placement. Only one level of agreement was considered. A misplaced marker was measured by its relation with the vertebra above or below. From the 22 subjects, the total percentage of agreement was 87.5%. Of the 12.5% error, 1.7% (3) occurred attempting to find C2; 4.5% (8) for C4; 3.4% (6) for C6; and 2.8% (5) for C7. From the total of 39 subjects, the total percentage of agreement was 87.8%. Of the 12.2% error 1.3% (2) occurred attempting to find C2; 2.6% (4) for C4; 3.2% (5) for C6; and 5.2% (8) for C7. Based on the results from this study, clinicians and researchers should take into account possible errors on surface markers placement on the cervical spine when measuring craniocervical posture using photographs. PMID:23158022

Gadotti, I C; Magee, D

2012-11-15

287

Novel Subtype of Congenital Generalized Lipodystrophy Associated With Muscular Weakness and Cervical Spine Instability  

PubMed Central

Congenital generalized lipodystrophy (CGL) is a rare auto-somal recessive disorder characterized by extreme paucity of adipose tissue from birth, and early onset of metabolic complications related to insulin resistance. Mutations in three genes, 1-acylglycerol 3-phosphate-O-acyltransferase 2 (AGPAT2), Berardinelli Seip Congenital Lipodystrophy 2 (BSCL2), and Caveolin-1 (CAV1) are associated with the three subtypes of this disorder, CGL1, CGL2 and CGL3, respectively. We report two siblings of Hispanic origin who displayed characteristic features of CGL such as generalized loss of subcutaneous fat from birth, acanthosis nigricans, acromegaloid habitus, umbilical prominence, hepatosplenomegaly, hypoleptinemia, dyslipidemia, and insulin resistance. However, no disease causing variants were detected in the DNA sequence of AGPAT2, BSCL2 or CAV1 genes. Further, whole body magnetic resonance imaging (MRI) in the two siblings revealed marked loss of subcutaneous, intraabdominal and intrathoracic fat like in other patients with CGL, but preservation of bone marrow fat which is invariably lost in all patients with CGL1 and CGL2, but not in the patient reported with CGL3. They also had generalized muscle weakness during infancy and early childhood associated with a nearly fivefold increase in serum creatine kinase (CK) levels, but with normal muscle biopsy and electrophysiologic studies. Both patients were also found to have atlantoaxial dislocation requiring surgical intervention. Thus, this pedigree represents a novel subtype of CGL characterized by generalized loss of body fat but with preservation of bone marrow fat, congenital muscular weakness and cervical spine instability. The genetic basis of this novel subtype remains to be determined.

Simha, Vinaya; Agarwal, Anil K.; Aronin, Patricia A.; Iannaccone, Susan T.; Garg, Abhimanyu

2009-01-01

288

In vivo 3D kinematics of the cervical spine segments during pre-manipulative positioning at the C4/C5 level.  

PubMed

Segmental range of motion (ROM) during high-velocity manipulative spinal treatment is generally considered an important factor for the risk of adverse side effects, especially in the cervical spine region. Among the many techniques reported, the so-called multiple-component technique (MCT) is increasingly recommended. Such a technique is assumed to induce a relatively low three-dimensional (3D) segmental ROM compared with other techniques. The aims of our study are to quantify the 3D segmental ROM and to determine the pattern of motion between cervical vertebrae during the pre-manipulative position at the C4-C5 level. Ten healthy volunteers participated in this study. Two CT scans were conducted: one in a neutral position and the other in the pre-manipulative positioning. The manipulation using MCT was carried out by a skilled practitioner. During positioning, the head was rotated to the left and bent laterally to the right, and the upper cervical spine was rotated to the left and bent laterally to the right. In contrast, the lower cervical spine underwent right rotation and was bent laterally to the right. Segmental ROM was lower than the values obtained during active physiological rotation (P < 0.05). This study provides new insight into the 3D kinematics of the cervical spine during manipulation. An unexpected mechanism of counter-rotation was identified at the lower cervical levels and could represent a valuable and convenient way for precisely focussing on the level for manipulation. PMID:23347773

Salem, Walid; Klein, Paul

2013-01-21

289

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

290

[Chronic functional dislocation of the cervical spine with radiculo-spinal effects. Discectomy by anterior route and fusion without graft].  

PubMed

X ray dynamic study of cerevical spine movements in 12 patients with neurological impairment has shown an abnormal mobility between two vertebrae in the anterior or posterior direction. This abnormal mobility which has been called functional dislocation, is situated usually over major discarthrosic lesions rather than under. This dislocation, which appears during voluntary and automatic movements of the head and neck has been qualified chronic. A discectomie through an anterior surgical approach and a bony fusion of vertebral bodies without any graft at the dislocation site lead to 10 good results. 2 failures have been imputed to the fact that there was a 10 years evolution of a tetraplegia before operation. The pathogenesis of chronic functional dislocation of the cervical spine is discussed with regard to compression and stretching of the spinal cord, roots and arteries of both. Traumatism of vertebral arteries during dislocation remain under discussion. PMID:1013573

Pertuiset, B; Lyon-Caen, O

1976-12-01

291

Biomechanical analysis of expansion screws and cortical screws used for ventral plate fixation on the cervical spine  

PubMed Central

Compared to bicortical screws, the surgical risk of injuring intraspinal structures can be minimized with the use of monocortical screws. However, this reduction should not be achieved at the expense of the stability of the fixation. With monocortical stabilization, the expansion screws have the potential of absorbing high loads. Therefore, they are expected to be a suitable alternative to bicortical screws for revision surgeries and in osteoporotic bone. The purpose of this in vitro study was to investigate the stiffness of the two screw-plate systems used for ventral stabilization of the cervical spine, by focusing on the suitability of expansion screws as tools for revision treatments. The study was conducted in ten functional units of human cervical spines. The device sample stiffness was determined for four conditions using a turning moment of 2.25 N m each around one of the three principle axes. The conditions were native, destabilized, primarily stabilized with one of the screw-plate systems, followed by secondary stabilization using the expansion screw implant. The stabilized samples achieved a comparable, in most cases higher stiffness than the native samples. The samples undergoing secondary stabilization using expansion screws tend to display greater stiffness for all three axes compared to the primarily stabilized samples. The achieved tightening moment of the screws was higher than the one achieved with primary fixation. Both plates revealed similar primary stability. Revision surgeries with secondary instrumentation achieve a high stiffness of the screwed up segments. Monocortical expansion screws combined with a trapezoidal plate allow ventral stabilization of the cervical spine that is comparable to the plate fixation using bicortical screws.

Ullrich, Bernhard; Huber, Gerd; Morlock, Michael M.

2009-01-01

292

Effects of advanced age on the morphometry and degenerative state of the cervical spine in a rat model.  

PubMed

Aging causes changes in the geometry of the human cervical spine that may influence the tissue response to applied loads. Rat models are often used to study spinal cord injuries (SCI) and have the potential to enhance our understanding of the effect of age on SCI. The goal of this study was to characterize the morphometry and degenerative state of the cervical spine in Fisher 344 rats, and to determine the influence of age on these variables. Fifteen rats were split into three age groups: young adult (3 months of age), aged (12-18 months) and geriatric (30 months). Following tissue harvest we used a ?CT scanner to image the cervical and upper thoracic spine from each specimen. Analysis software was used to measure variables including canal pinch diameter (the most rostral point on the dorsal aspect of a vertebral body to the most caudal aspect of the lamina on the immediately rostral vertebra), vertebral canal depth, width, and area, vertebral body height, depth, width, and area, and intervertebral disc thickness. Orthopaedic surgeons used midsagittal images to rate the degenerative state of the intervertebral discs. For all measures except disc thickness there was a significant increase (mean (SD) = 15.0 (9.7)%) for the aged compared to young specimens (P < 0.05). There were significant differences between the aged and geriatric specimens for only vertebral body depth (P = 0.016) and area (P = 0.020). Intervertebral disc degeneration was significantly greater on the ventral aspect of the spinal column (P < 0.001), with a trend toward increased degeneration in the geriatric specimens (P = 0.069). The results suggest that age-related morphometric differences may need to be accounted for in experimental aging models of SCI in rats. PMID:21714115

Laing, Andrew C; Cox, Riley; Tetzlaff, Wolfram; Oxland, Thomas

2011-06-28

293

Biomechanical analysis of expansion screws and cortical screws used for ventral plate fixation on the cervical spine.  

PubMed

Compared to bicortical screws, the surgical risk of injuring intraspinal structures can be minimized with the use of monocortical screws. However, this reduction should not be achieved at the expense of the stability of the fixation. With monocortical stabilization, the expansion screws have the potential of absorbing high loads. Therefore, they are expected to be a suitable alternative to bicortical screws for revision surgeries and in osteoporotic bone. The purpose of this in vitro study was to investigate the stiffness of the two screw-plate systems used for ventral stabilization of the cervical spine, by focusing on the suitability of expansion screws as tools for revision treatments. The study was conducted in ten functional units of human cervical spines. The device sample stiffness was determined for four conditions using a turning moment of 2.25 N m each around one of the three principle axes. The conditions were native, destabilized, primarily stabilized with one of the screw-plate systems, followed by secondary stabilization using the expansion screw implant. The stabilized samples achieved a comparable, in most cases higher stiffness than the native samples. The samples undergoing secondary stabilization using expansion screws tend to display greater stiffness for all three axes compared to the primarily stabilized samples. The achieved tightening moment of the screws was higher than the one achieved with primary fixation. Both plates revealed similar primary stability. Revision surgeries with secondary instrumentation achieve a high stiffness of the screwed up segments. Monocortical expansion screws combined with a trapezoidal plate allow ventral stabilization of the cervical spine that is comparable to the plate fixation using bicortical screws. PMID:19588171

Röhl, Klaus; Ullrich, Bernhard; Huber, Gerd; Morlock, Michael M

2009-07-09

294

Reconstruction of the cervical spine with two osteocutaneous fibular flap after radiotherapy and resection of osteoclastoma : a case report.  

PubMed

Transfer of a vascularised free fibular bone for reconstruction of the cervical spine has been described previously.(1-4) However, this is the first report of a reconstruction with both an osteocutaneous fibular flap for anterior stabilisation and a double-islanded osteocutaneous fibular flap for posterior stability. We present a case of an osteoclastoma in C2 initially treated with radiotherapy 1.8 Gy × 30. Two months after radiotherapy, the patient developed severe osteoradionecrosis and luxation of C2 causing neurological impairment. The patient was treated with cervical traction for 10 days. Resection of C2 was performed through a posterior approach and a secondary transoral approach. The spine was stabilised from a posterior approach using allografts and a titanium plate and rod construct (Vertex) from the occipital squama to C5 and from an anterior approach with allograft filled cage from C1 to C3. Two months later, rupture of the pharyngeal wall was noted with exposure of the anterior cage. A few days later, the posterior scar ruptured. The anterior cage was removed and the pharyngeal wall was sutured. Revision of the posterior wound was performed, leaving the implants in place. To secure stability of the spine, the patient was treated with a HALO. Once again, the pharyngeal wall ruptured. Reconstruction of the posterior pharyngeal wall and the anterior column of the spine was performed with an osteocutaneous fibular flap from the skull base to C3. Five months later, a computed tomography (CT) scan showed insufficient bony fusion of both anterior and posterior bone grafts, and the posterior wound had not healed. A second osteocutaneous fibular flap was placed bilaterally from the occipital squama to the posterior elements of Th1, closing the wound defect. Apart from the occipital squama, fusion was seen at all sites after 14 months, and the HALO was removed. PMID:22398439

Kaltoft, Britta; Kruse, Anders; Jensen, Lisa Toft; Elberg, Jens Jørgen

2012-03-06

295

[Instability and misdiagnosed or neglected dislocations of the upper cervical spine in children. Apropos of 20 cases].  

PubMed

Neglected instabilities or luxations of the upper cervical spine in children are rare if one discards conditions such as chondrodysplasia, Down Syndrome or others, were the spine is known to be at high risk of instability. We have studied twenty cases of neglected luxations and the delay in diagnosis is explained either by the asymptomatic character of some of these lesions, or by the difficulty in diagnosis. At the occipito-atlantal level we have reviewed: an instability in translation which required an occipito-axial fusion; two compensatory counter occipito-atlantal luxation of an atlanto-axial rotatory fixation. The diagnosis was best made with computed tomography scan and the treatment was not much different from the isolated atlanto-axial rotatory luxation. An instability in flexion extension, which was merely followed at regular intervals. At the atlanto-axial level 9 cases of sagittal instabilities in kyphosis and translation with a distance between atlas and axis of more than 5 mm were observed. These instabilities were most often associated with a malformation of the cranio-cervical junction; their treatment was usually surgical by means of an atlanto-axial or occipito-axial arthrodesis depending on the case. 9 other cases of atlanto-axial rotatory luxations were either isolated (7 cases) or associated with a counter occipito-atlantal rotatory subluxation (2 cases). Their diagnosis was made on routine X-rays, but the complete or incomplete aspect of the luxation, as well as its fixed aspect, was best appreciated with dynamic CT scan. Their treatment was always started with collar neck or halo traction in order to obtain, reduction of the dislocation, or at least the disparition of the torticollis and the head straight up on shoulders. The stability of the spine was achieved with a minerva cast jacket, halo cast or spine fusion depending on the case. PMID:1289981

Arlet, V; Rigault, P; Padovani, J P; Finidori, G; Touzet, P; Janklevicz, P

1992-01-01

296

Osteoradionecrosis of the cervical spine presenting with quadriplegia in a patient previously treated with radiotherapy for laryngeal cancer: a case report  

PubMed Central

Introduction Osteoradionecrosis of the mandible and temporal bones has been extensively reported in literature, but cases of avascular necrosis of the cervical spine following radiotherapy to the larynx appear to be extremely rare. A review of the English language literature has shown only one other case where radiotherapy treatment of a laryngeal carcinoma has resulted in osteoradionecrosis of the cervical spine. Case presentation We present the case of a 65 year old male patient who suffered from osteoradionecrosis of the cervical spine 20 years after radiotherapy treatment for a T1aN0M0 laryngeal carcinoma resulting in quadriplegia. Conclusions Radiotherapy carries a long-term risk of complications, including osteoradionecrosis which may present 20 years later with significant implications.

2009-01-01

297

Surgical Experience of Neglected Lower Cervical Spine Fracture in Patient with Ankylosing Spondylitis  

PubMed Central

The management of lower cervical fractures in patients with ankylosing spondylitis (AS) differs from normal cervical fractures. Patients with AS are highly susceptible to extensive neurologic injuries and spinal deformities after cervical fractures from even minor traumatic forces. These injuries are uniquely complex, require careful imaging assessment, and aggressive surgical management to optimize spinal stability and functional outcomes.

Kim, Sung-Min; Kim, Ki-Tack; Seo, Eun-Min

2010-01-01

298

A Comparative Roentgenographic Analysis of the Lumbar Spine in Male Army Recruits with and without Lower Back Pain  

Microsoft Academic Search

AIM: To determine whether there is an association between lumbar spine radiographic findings and reported current and\\/or past lower back pain (LBP).MATERIALS AND METHODS: Four hundred and sixty-four age-matched (mean age 18 years±2 months) consecutive male army recruits were examined. Half of them had a history of episodes of LBP. An orthopaedic evaluation (including radiographs of the lumbar spine) is

E. L Steinberg; E Luger; R Arbel; A Menachem; S Dekel

2003-01-01

299

Melanotic schwannoma of the cervical spine progressing with pulmonary metastasis: case report.  

PubMed

Melanotic schwannoma (MS) is an unusual variant of nerve sheath neoplasm. Only 10% of these tumors will undergo malignant degeneration, with exceedingly rare reported metastasis. We present a 32-year-old woman with a 6-month history of cervical pain and left arm progressive weakness. Neurological examination showed a left upper limb radicular pain, with pyramidal syndrome at C5 level. The magnetic resonance imaging (MRI) study highlighted an intradural extramedullary heterogeneous mass along the spinal cord at the C4-C5 level, slightly hyperintense with T1 and hypointense with T2-weighted sequences, invading the left neural foramen. The patient underwent C3-C5 laminectomy with total resection of a black tumor. In the postoperative period, a patent deficit of shoulder abduction ensued related to the nervous section. Microscopically, compactly fascicles of spindle-shaped cells with pleomorphic and hypercromatic nuclei, dark brown intracellular pigments, as well as some mitotic figures were seen. Immunohistochemical stains for S-100, Human Melanoma Black-45 (HMB-45), and vimentin were positive, with Ki-67 Labelling Index (LI) of 15% compatible with MS. Six months after radiotherapy she presents local recurrence and lung metastatic dissemination of the MS. She underwent left pulmonary segmentectomy, followed by chemotherapy and radiosurgery. The patient developed a febrile neutropenia and worsening of general status, and died after 3 months due to respiratory complications. MS are rare tumors with potential for local recurrence and distal metastasis. Complete surgical resection remains as the treatment of choice, once the uncommon cases with malignant progression shows low response to chemo and radiotherapy. PMID:24077273

Faria, Mário Henrique Girão; Dória-Netto, Ricardo Henrique; Osugue, Gustavo Jun; Queiroz, Luciano de Souza; Chaddad-Neto, Feres Eduardo

2013-09-27

300

The Immediate Effects of Thoracic Spine and Rib Manipulation on Subjects with Primary Complaints of Shoulder Pain  

PubMed Central

Shoulder pain is a common orthopedic condition seen by physical therapists, with many potential contributing factors and proposed treatments. Although manual physical therapy interventions for the cervicothoracic spine and ribs have been investigated for this patient population, the specific effects of these treatments have not been reported. The purpose of this investigational study is to report the immediate effects of thoracic spine and rib manipulation in patients with primary complaints of shoulder pain. Using a test-retest design, 21 subjects with shoulder pain were treated during a single treatment session with high-velocity thrust manipulation to the thoracic spine or upper ribs. Post-treatment effects demonstrated a 51% (32mm) reduction in shoulder pain, a corresponding increase in shoulder range of motion (30°-38°), and a mean patient-perceived global rating of change of 4.2 (median 5). These immediate post-treatment results suggest that thoracic and rib manipulative therapy is associated with improved shoulder pain and motion in patients with shoulder pain, and further these interventions support the concept of a regional interdependence between the thoracic spine, upper ribs, and shoulder.

Strunce, Joseph B.; Walker, Michael J.; Boyles, Robert E.; Young, Brian A.

2009-01-01

301

Favorable outcome after radical resection and subsequent local irradiation of malignant peripheral nerve sheath tumor in the cervical spine.  

PubMed

A 25-year-old man presented with malignant transformation to malignant peripheral nerve sheath tumor (MPNST) in the cervical spine associated with neurofibromatosis type 1. He presented with a 3-week history of rapidly increasing weakness and numbness in all four extremities. Magnetic resonance (MR) imaging of the cervical spine demonstrated a dumbbell-shaped tumor, which compressed the spinal cord at the C2-3 level. The tumor was excised, mainly within the spinal canal to decompress the spinal cord. The histological diagnosis was benign neurofibroma. Three months after surgery, he rapidly developed progressive tetraparesis and MR imaging revealed marked regrowth of an extradural mass into the spinal canal. At reoperation, the regrown mass in the spinal canal was totally excised. The histological diagnosis revealed MPNST. He underwent radiation therapy, with a total dose of 32 Gy, for approximately 3 weeks after the second surgery, but MR imaging showed tumor regrowth within the spinal canal, and his condition deteriorated. The decision was made to remove the tumor radically, including the involved facet and extradural lesion. Posterior fusion using a pedicle screw was performed one month later. He manifested no additional neurological deficits. He has been free of relapse for 46 months. Radical resection remains the most effective treatment for MPNST, although complete removal with a clear tumor margin is often impossible in practice. PMID:23006884

Sasamori, Toru; Hida, Kazutoshi; Yano, Shunsuke; Aoyama, Takeshi; Asano, Takeshi; Kubota, Kanako; Ito, Manabu; Abumi, Kuniyoshi; Iwasaki, Yoshinobu; Saito, Hisatoshi; Houkin, Kiyohiro

2012-01-01

302

Short-Term Effects of Pulsed Radiofrequency on Chronic Refractory Cervical Radicular Pain  

PubMed Central

Objective To evaluate the short-term effectiveness of pulsed radiofrequency on the dorsal root ganglion (DRG) in patients with chronic refractory cervical radicular pain. Method Fifteen patients (13 males, 2 females; mean age, 55.9 years) with chronic radicular pain due to cervical disc herniation or foraminal stenosis refractory to active rehabilitative management, including transforaminal cervical epidural steroid injection and exercise, were selected. All patients received pulsed radiofrequency on the symptomatic cervical dorsal root ganglion and were carefully evaluated for neurologic deficits and side effects. The clinical outcomes were measured using a visual analogue scale (VAS) and a neck disability index (NDI) before treatment, one and three months after treatment. Successful pain relief was defined as a 50% or greater reduction in the VAS score as compared with the pre-treatment score. After three months, we categorized the patients' satisfaction. Results The average VAS for radicular pain was reduced significantly from 5.3 at pretreatment to 2.5 at 3 months post-treatment (p<0.05). Eleven of 15 patients (77.3%) after cervical pulsed RF stimulation reported pain relief of 50% or more at the 3 month follow-up. The average NDI was significantly reduced from 44.0% at pretreatment to 35.8% 3 months post-treatment (p<0.05). At 3 months post-treatment, eleven of fifteen patients (73.3%) were satisfied with their status. No adverse effects were observed. Conclusion The results demonstrate that the application of pulsed radiofrequency on DRG might be an effective short-term intervention for chronic refractory cervical radicular pain. Further studies, including a randomized controlled trial with long-term follow-up, are now needed.

Choi, Gyu-Sik; Cho, Yun-Woo; Lee, Dong-Kyu

2011-01-01

303

Spine radiographs in patients with low-back pain. An epidemiological study in men.  

PubMed

A cohort of 321 men between the ages of eighteen and fifty-five was randomly selected from a group of 1221 men who had been surveyed by a questionnaire. They then had radiographs made of the lumbar spine. Of the 292 subjects fulfilling the criteria for inclusion in the study, ninety-six (32.9 per cent) had never had low-back pain, 134 (45.9 per cent) had had or were having moderate low-back pain, and sixty-two (21.2 per cent) had had or were having severe low-back pain. In the three groups there was a similar frequency of transitional vertebrae, Schmorl's nodes, the disc vacuum sign, narrowing of the disc space between the third and fourth lumbar and the fifth lumbar and first sacral vertebrae, and claw spurs. When there were traction spurs or disc-space narrowing, or both, between the fourth and fifth lumbar vertebrae, an increased incidence of severe low-back pain was evident. There also was a significant association of these two radiographic findings with symptoms (pain, weakness, and numbness) in the lower limbs. The measured lumbar lordosis, the length of the transverse process of the fourth lumbar vertebra, and the relationship between the fourth and fifth lumbar vertebral bodies with reference to the intercristal line had no association with the low-back pain. Increased lumbar lordosis had a significant association with decreased disc-space height and wedging deformity of the disc between the fourth and fifth lumbar vertebrae.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6237110

Frymoyer, J W; Newberg, A; Pope, M H; Wilder, D G; Clements, J; MacPherson, B

1984-09-01

304

Clinical reasoning: a 51-year-old man with cervical pain and progressively deteriorating gait.  

PubMed

A 51-year-old Caucasian man presented with cervical pain, right hand weakness, and progressively deteriorating gait. Onset of symptoms occurred 1 month before admission with cervical pain that worsened during neck flexion. A few days later he noticed reduced dexterity and numbness of his right hand. During the following 3 weeks, his gait became increasingly unstable. Additionally, he reported erectile dysfunction and urinary hesitancy. No previous trauma was recalled. His medical and family history was unremarkable except for hypertension that was treated with angiotensin-converting enzyme inhibitors. PMID:23713091

Rallis, Dimitrios; Tsirigotis, Panagiotis; Arvaniti, Chryssa; Sgouros, Spiros; Foukas, Periclis G; Oikonomopoulos, Nikolaos; Andronas, Nikolaos; Panayiotides, Ioannis G; Kouloulias, Vasilios; Papageorgiou, Sotirios; Voumvourakis, Konstantinos; Stamboulis, Eleftherios

2013-05-28

305

Fatal outcome after brain stem infarction related to bilateral vertebral artery occlusion - case report of a detrimental complication of cervical spine trauma  

PubMed Central

Background Vertebral artery injury (VAI) after blunt cervical trauma occurs more frequently than historically believed. The symptoms due to vertebral artery (VA) occlusion usually manifest within the first 24 hours after trauma. Misdiagnosed VAI or delay in diagnosis has been reported to cause acute deterioration of previously conscious and neurologically intact patients. Case presentation A 67 year-old male was involved in a motor vehicle crash (MVC) sustaining multiple injuries. Initial evaluation by the emergency medical response team revealed that he was alert, oriented, and neurologically intact. He was transferred to the local hospital where cervical spine computed tomography (CT) revealed several abnormalities. Distraction and subluxation was present at C5-C6 and a comminuted fracture of the left lateral mass of C6 with violation of the transverse foramen was noted. Unavailability of a spine specialist prompted the patient's transfer to an area medical center equipped with spine care capabilities. After arrival, the patient became unresponsive and neurological deficits were noted. His continued deterioration prompted yet another transfer to our Level 1 regional trauma center. A repeat cervical spine CT at our institution revealed significantly worsened subluxation at C5-C6. CT angiogram also revealed complete occlusion of bilateral VA. The following day, a repeat CT of the head revealed brain stem infarction due to bilateral VA occlusion. Shortly following, the patient was diagnosed with brain death and care was withdrawn. Conclusion Brain stem infarction secondary to bilateral VA occlusion following cervical spine trauma resulted in fatal outcome. Prompt imaging evaluation is necessary to assess for VAI in cervical trauma cases with facet joint subluxation/dislocation or transverse foramen fracture so that treatment is not delayed. Additionally, multiple transportation events are risk factors for worsening when unstable cervical injuries are present. Close attention to proper immobilization and neck position depending on the mechanism of injury is mandatory.

2011-01-01

306

A review of prognostic factors for surgical outcome of ossification of the posterior longitudinal ligament of cervical spine  

PubMed Central

For patients with ossification of the posterior longitudinal ligament (OPLL) who have neurological-symptoms, surgery is necessary but not always effective. Various clinical factors influence the surgical outcome. The studies identifying these factors have been inconclusive and conflicting. It is essential for surgeons to understand the significance of the factors and choose the optimal therapeutic strategy for OPLL. The objective of this review is to determine the clinical factors predictive of the surgical outcome of cervical OPLL. The authors conducted a review of literature published in the English language. They examined studies in which the correlation between clinical factors and outcome were statistically evaluated. The results showed that the traverse area of the spinal cord, the spinal cord-evoked potentials (SCEPs), the increase of the range of motion in the cervical spine (ROM), diabetes, history of trauma, the onset of ossification of the ligament flavum (OLF) in the thoracic spine, snake-eye appearance (SEA) and incomplete decompression may be predictive factors. Age at surgery seems to be closely related to the outcome of posterior surgical procedure. Whether the neurological score, OPLL type, pre-operative duration of symptoms, focal intra-medullar high signal intensity in T2-weighted (IMHSI) and progression of OPLL or kyphosis and expansion of the spinal canal predict the surgical outcome remains unclear. The use of uniform neurological score and proper statistic analysis should facilitate comparison of data from different studies. It is important to analyze the effect of each factor on groups with different surgical procedures as well as patients with different compressive pathology. Research on the etiology and pathology of cervical myelopathy due to OPLL should be helpful in precisely understanding these clinical factors and predicting surgical outcome.

Li, Hai; Jiang, Lei-Sheng

2008-01-01

307

Fusion of the occiput to the upper cervical spine. A review of 37 cases.  

PubMed

This is the first report of a large series of patients undergoing preoperative traction to reduce spinomedullary compression from cranial settling. In all cases, an attempt was made to reduce the malalignment with Gardner-Wells or halo traction before posterior fusion. One patient required an anterior retropharyngeal decompression of the odontoid performed as a one-stage procedure at the time of the posterior operation, and two required subsequent anterior transoral-transpharyngeal resection of the odontoid. From 1974 to 1989, 37 patients underwent posterior occipital cervical arthrodesis. All cases presented with neurologic deficit, and most had signs of brain stem compression, such as L'hermitte's sign or Ondine's curse. The most common cause of basilar impression was rheumatoid arthritis, neoplastic destruction, previously failed C1-C2 fusion, or Down's syndrome. Mean postoperative follow-up was 2 years and 10 months; the patients with less than 2 years' follow-up were followed until successful fusion. Eight of 9 patients with L'hermitte's sign or Ondine's curse and 10 of 12 patients with intractable occipital pain were relieved of their symptoms after reduction and triple-wire stabilization-fusion. Eighteen of 25 patients with long tract signs improved after surgery. Interestingly, 14 (93.3%) of 15 patients with myelopathy improved when successful preoperative reduction of their deformity occurred, whereas only 4 (40%) of 10 patients with fixed basilar impression improved (chi 2 = 8.57, P = .014). Symptoms such as Ondine's curse, L'hermitte's sign, intractable occipital headache, and myelopathy are usually relieved by skeletal traction and posterior fusion without need of an additional transmucosal anterior procedure.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1801259

McAfee, P C; Cassidy, J R; Davis, R F; North, R B; Ducker, T B

1991-10-01

308

Autograft versus interbody fusion cage without plate fixation in the cervical spine: a randomized clinical study using radiostereometry  

PubMed Central

A primary object with a fusion cage is avoidance of graft collapse with subsequent subsidence and malalignment of the cervical spine that is observed after bone grafting alone. No randomized studies exist that demonstrate the difference between these two methods in terms of graft subsidence and angulation of the fused segment. The size of the study population was calculated to be 24 patients to reach a significant difference at the 95% CI level. Patients with one-level cervical radiculopathy scheduled for surgery were randomized to anterior discectomy and fusion (ACDF) with autograft or to fusion cage, both without plate fixation. Tantalum markers were inserted in the two adjacent vertebrae at the end of surgery. Radiostereometry was performed immediately postoperatively and at regular intervals for 2 years. Questionnaires were used to evaluate the clinical outcome and an unbiased observer graded the outcome after 2 years. No significant differences were found between the two methods after 2 years in regard of narrowing of the disc space (mean 1.7 and 1.4 mm, respectively) or deformation of the fused segment into flexion (mean 7.7° and 4.6°, respectively). Patients in the cage group had a significantly better clinical outcome. The findings of subsidence and flexion deformation of the fused segment after 2 years seem to be of no clinical importance after one-level cervical disc surgery. However, in multi-level surgery using the same methods, an additive effect of the deformations of the fused segments may affect the clinical outcome.

Zoega, Bjorn; Rosen, Hans

2007-01-01

309

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

Microsoft Academic Search

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

Amy Crothers; Bruce Walker; Simon D French

2008-01-01

310

Undiagnosed osteoid osteoma of the spine presenting as painful scoliosis from adolescence to adulthood: a case report  

PubMed Central

Presented here is a case of a young woman, with an undiagnosed osteoid osteoma of the spine, which presented with painful scoliosis in adolescence and was treated by bracing until her accession to adulthood. A more thorough investigation, years after the initial one, revealed the tumor. Surgical excision and stabilization offered the long-awaited cure. Misdiagnosis resulted in intractable pain for years, deformity, the discomfort of brace therapy, and the frustration of a prolonged yet ineffective treatment.

Sapkas, George; Efstathopoulos, Nicolas E; Papadakis, Michael

2009-01-01

311

Effect of surgical cricothyrotomy on the unstable cervical spine in a cadaver model of intubation 1 1 Original Contributions is coordinated by John A. Marx, MD, of Carolinas Medical Center, Charlotte, North Carolina  

Microsoft Academic Search

Cricothyrotomy is indicated for patients who require an immediate airway and in whom orotracheal or nasotracheal intubation is unsuccessful or contraindicated. Cricothyrotomy is considered safe with cervical spine (c-spine) injury; however, the amount of c-spine movement that occurs during the procedure has not been determined. In this experimental study, an established cadaver model of c-spine injury was used to quantify

Michael C Gerling; Daniel P Davis; Robert S Hamilton; Gabrielle F Morris; Gary M Vilke; Steven R Garfin; Stephen R Hayden

2001-01-01

312

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

313

Can an evidence-based guideline reduce unnecessary imaging of road trauma patients with cervical spine injury in the emergency department?  

PubMed

The aim of this study was to determine if an unvalidated imaging guideline can reduce the use of imaging in patients with cervical spine trauma. A non-randomized clinical trial using historical controls was conducted in the emergency department from October 2001 to September 2002. Following an education programme, which introduced the imaging guideline to clinicians, the use of guideline and imaging were measured. The guideline was also converted to decision-support software for use in the emergency department. Three hundred and fifty-three patients satisfied inclusion criteria during the study period and these were compared with 403 historical control subjects. No significant difference was found between the two groups for age, sex or fracture prevalence. A significant increase was observed during the study period in the proportion of patients who were managed without the use of any cervical spine imaging (21.25 vs 31.2%; P=0.03; 95% confidence interval, 3-13). There were no delayed diagnoses of cervical spine injury among those not imaged. It is feasible to disseminate and implement an evidence-based imaging guideline for patients with cervical spine trauma. The use of a computerized decision-support system can facilitate this and is associated with a safe reduction in the proportion of patients imaged. PMID:17107528

Goergen, S K; Fong, C; Dalziel, K; Fennessy, G

2006-12-01

314

Posterior stabilization of the cervical spine with hooks and screws. A clinical evaluation of 26 patients with traumatic, degenerative or metastatic lesions, using a new implant system  

Microsoft Academic Search

We operated on 26 patients with cervical spine disorders (13 with traumatic lesions, 3 with spinal stenosis and myelopathy, 1 with osteomyelitis and 9 with metastasis) with posterior stabilization. A new implant system (Cervi-Fix) based on rods, enabling a choice of either screw or laminar hook fixation in a free combination, was used. The system was evaluated for ease of

Christer Hildingsson; Håkan Jonsson

2001-01-01

315

Spine biomechanics  

Microsoft Academic Search

Current trends in spine research are reviewed in order to suggest future opportunities for biomechanics. Recent studies show that psychosocial factors influence back pain behaviour but are not important causes of pain itself. Severe back pain most often arises from intervertebral discs, apophyseal joints and sacroiliac joints, and physical disruption of these structures is strongly but variably linked to pain.

Michael A. Adams; Patricia Dolan

2005-01-01

316

Long-term randomised comparison between a carbon fibre cage and the Cloward procedure in the cervical spine  

PubMed Central

A prospective randomised study. To compare the long-term outcome of anterior cervical decompression and fusion (ACDF) with a cervical intervertebral fusion cage (CIFC) and the Cloward procedure (CP). We have previously shown that the 2 year outcome of ACDF with the CIFC is the same as for the CP. The fusion rate in CIFC group was, however, only 55%, compared to 85% in CP group. The long-term outcome of CIFC is poorly documented. Ninety-five patients with at least 6 months duration of neck pain and radicular arm pain were randomly allocated for ACDF with the CIFC or the CP. Radiographs were obtained at 2 years. Questionnaires about pain, disability (Neck Disability Index, NDI), distress, quality of life and global outcome were obtained from 83 patients (87%) (43 CIFC, 40 CP) at a mean follow-up time of 6 years (range 56–94 months). There were no significant differences in any outcome variable between the two treatments. For both CP and CIFC the pain intensity improved (P<0.0001) whereas the NDI was unchanged at long-term follow-up compared to preoperatively. In the CIFC group patients with a healed fusion had significantly less mean pain (24 mm) and NDI (26%) than patients with pseudarthrosis (42 and 41, respectively). Furthermore, the mean pain and NDI reported by CIFC patients with a healed fusion was significantly less than in healed CP patients (37 and 38, respectively). The long-term outcome is the same for the CIFC and the CP, with similar improvements of pain but with considerable remaining functional disability. However, in the subgroup of patients with healed CIFC the outcome was clearly better than for the non-healed CIFC group, and also clearly better than for the healed CP group. Thus, if the healing problem associated with the CIFC can be solved the results indicate that a better outcome can be expected with the cage than with the CP.

Vavruch, Ludek; Hedlund, Rune

2006-01-01

317

Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: A pilot randomized clinical trial  

Microsoft Academic Search

Background: To date, no substantiated studies have been performed to investigate the efficacy of spinal manipulative therapy on thoracic spinal syndromes. Objective: To investigate the effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain. Study Design: A single-blind, randomized, comparative, controlled pilot study. Setting: Technikon Natal Chiropractic Clinic in Durban, South Africa. Participants: Thirty subjects selected

Linda Schiller

2001-01-01

318

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

319

Cervical spondylosis  

MedlinePLUS

... on the cartilage and bones of the neck (cervical vertebrae). It is a common cause of chronic neck ... spondylosis is caused by chronic wear on the cervical spine. This includes the disks or cushions between the ...

320

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

321

Hollow bone cement filled with impacted cancellous bone as a substitute for bone grafts in cervical spine fusion.  

PubMed

Autogenous iliac crest bone is the gold standard for graft material in cervical spinal fusion, but a high incidence of donor site morbidity has been reported. Therefore, to achieve a better fusion rate and decrease the rate of donor site morbidity, we used a novel method whereby hollow bone cement filled with impacted cancellous bone is used as a substitute for bone graft in cervical interbody fusion. From 2003 to 2004, 21 patients with cervical spinal disorders who were treated using this method were included in this study. Fourteen patients underwent single-level grafts and seven underwent two-level grafts. Evaluation included a monthly clinical and X-ray examination for the first 3 months, and then follow-up every 3 months thereafter. Multiple-slice computed tomography (CT) scan with reconstruction to evaluate the viability of the bone graft was performed when evidence of bone fusion was found on X-ray. The mean age of the patients was 59 years (range 27-79). The mean follow-up period was 19 months (13-24 months). Evidence of impacted cancellous bone bridging the adjacent vertebral body was observed in all patients at the 6-month follow-up based on X-rays and reconstructive CT scans. No severe donor site morbidity occurred. One patient experienced hardware failure due to screw fracture, but a reconstructive CT scan revealed well-bridged cancellous bone between the vertebral bodies. Hollow bone cement filled with impacted cancellous bone could be an alternative material for cervical spine interbody fusion. Using this method, we found not only satisfactory growth of cancellous bone in the holes of the bone cement, but also low morbidity in the donor site. However, for this method, the long-term stability, potential complications, and the necessity of instrumentation all require further investigation. PMID:17161288

Pan, Hung-Chuan; Wang, Yeou-Chih; Lee, Cheng-Hung; Yang, Dar-Yu

2007-02-01

322

Extensive cervical laminoplasty for patients with long segment OPLL in the cervical spine: an alternative to the anterior approach  

Microsoft Academic Search

We investigated treatment of long segment cervical OPLL by posterior decompression using a laminoplasty technique. Our aim was to both decompress the spinal cord and also to preserve neck motion. There were 38 patients treated by this posterior approach. Twenty-eight patients underwent C1–C7 expanding laminoplasty, 4 patients underwent C1–T1 expanding laminoplasty, and 6 patients C2–C7 expanding laminoplasty. The transverse width

2000-01-01

323

Comparison of the use of McCoy and TruView EVO2 laryngoscopes in patients with cervical spine immobilization  

PubMed Central

Context: The cervical spine has to be stabilized in patients with suspected cervical spine injury during laryngoscopy and intubation by manual in-line axial stabilization. This has the propensity to increase the difficulty of intubation. An attempt has been made to compare TruView EVO2 and McCoy with cervical spine immobilization, which will aid the clinician in choosing an appropriate device for securing the airway with an endotracheal tube (ETT) in the clinical scenario of trauma. Aims: To compare the effectiveness of TruView EVO2 and McCoy laryngoscopes when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization. Settings and design: K. M. C. Hospital, Mangalore, This was a randomized control clinical trial. Methods: Sixty adult patients of either sex of ASA physical status 1 and 2 who were scheduled to undergo general anesthesia with endotracheal intubation were studied. Comparison of intubation difficulty score (IDS), hemodynamic response, Cormack and Lehane grade, duration of the tracheal intubation and rate of successful placement of the ETT in the trachea between TruView EVO2 and McCoy laryngoscopes was performed. Results: The results demonstrated that TruView has a statistically significant less IDS of 0.33 compared with an IDS of 1.2 for McCoy. TruView also had a better Cormack and Lehane glottic view (CL 1 of 77% versus 40%) and less hemodynamic response. Conclusions: The TruView blade is a useful option for tracheal intubation in patients with suspected cervical spine injury.

Joseph, Jiju; Sequeira, Trevor; Upadya, Madhusudan

2012-01-01

324

Advanced imaging of the cervical spine and spinal cord in 22q11.2 deletion syndrome: age-matched, double-cohort, controlled study  

PubMed Central

Purpose The 22q11.2 deletion syndrome is a common genetic syndrome with a wide spectrum of abnormalities. We have previously described multiple anomalies of the upper cervical spine in this disorder. The objective of this study was to use advanced imaging to further define the morphology of the cervical spine and spinal cord in the 22q11.2 deletion syndrome, with a comparison to age-matched controls. Methods A total of 32 patients with a 22q11.2 deletion underwent advanced imaging (computed tomography/magnetic resonance imaging; CT/MRI) of the cervical spine. In 27 patients, space available for the cord (SAC); the sagittal diameter of the vertebral body, spinal canal, cerebrospinal fluid (CSF), and spinal cord; and the cross sectional area of the spinal canal, CSF, and spinal cord were measured at each cervical level and compared to 29 age-matched controls. Statistical analysis was performed and potential implications were hypothesized. Results In 22q11.2 patients, advanced imaging identified 40 pathologies not evident on plain radiographs with potential mechanical and/or neurological implications. These patients also had significantly smaller values (P ? 0.05) of the following parameters at one or more cervical levels, relative to age-matched controls: width of the vertebral body, spinal canal, CSF, and spinal cord; area of the spinal canal, CSF, and spinal cord. Neurologic symptoms were observed in 4/32 patients, with one patient requiring surgical intervention. Conclusions Advanced imaging of the cervical spine can detect findings not evident on plain radiographs in the 22q11.2 deletion syndrome. CT and/or MRI may be indicated when there is a high index of suspicion for clinical instability or neurologic compromise in order to rule out dynamic encroachment or impending neurologic sequelae. Spinal canal and spinal cord dimensions are reduced in these patients relative to controls with currently unknown clinical significance.

Ricchetti, Eric T.; Hosalkar, Harish S.; Gholve, Purushottam A.; Cameron, Danielle B.

2008-01-01

325

Surgical management of the subaxial cervical spine (C3-T1) in rheumatoid arthritis  

Microsoft Academic Search

Dans le cadre des altérations squelettiques de l'arthrite rhumatoïde (RA), le rachis cervical inférieur peut être affecté de manière caractéristique par une subluxation, une insuffisance disco-ligamentaire et une résorption osseuse. Ces altérations peuvent provoquer des douleurs sévères ainsi qu'un déficit neurologique important, et nécessiter une intervention chirurgicale. Sur 122 patients porteurs d'une arthrite rhumatoïde et opérés du rachis cervical, 23

D. Grob; J. Dvo?ák; J. A. Antinnes

1993-01-01

326

Range of global motion of the cervical spine: intraindividual reliability and the influence of measurement device  

Microsoft Academic Search

Range of motion tests are often employed in the quantification of musculoskeletal impairment and in the assessment of the\\u000a efficacy of therapeutic interventions. The aim of the present study was to compare the absolute values for, and the day-to-day\\u000a reliability of, measures of cervical spinal mobility made with two computerised motion analysis devices. The ranges of cervical\\u000a flexion, extension, lateral

A. F. Mannion; G. N. Klein; J. Dvorak; C. Lanz

2000-01-01

327

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

Microsoft Academic Search

In the future, there will be an increased number of cervical revision surgeries, including 4- and more-levels. But, there\\u000a is a paucity of literature concerning the geometrical and clinical outcome in these challenging reconstructions. To contribute\\u000a to current knowledge, we want to share our experience with 4- and 5-level anterior cervical fusions in 26 cases in sight of\\u000a a critical

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

2007-01-01

328

Finite Element Analysis of Cervical Spine Plate Using Double Cage Fusion  

Microsoft Academic Search

Abstract-Objective: To analyze the biomechanical influences on cervical vertebra after the removal of nucleus going with the cervical disc degradation, and to inspect the immediate stability and bone fusion rate with artificial double Cage fusion setting into intervertebral disc.Methods: to establish precisely with CAE method four finite element models as followed: C3-6 normal height disc model, C4-5 height decreased disc

Bingzhi Chen; Wei Zhao; Yuedong Wang; Suming Xie

2010-01-01

329

Imaging evaluation of adult spinal injuries: emphasis on multidetector CT in cervical spine trauma.  

PubMed

As computed tomography (CT) technology has evolved, multidetector CT has become an integral part of the initial assessment of many injured patients, and the spine is easily included in the total body screening performed in patients with severe blunt polytrauma. Despite all the advantages of multidetector CT, clearing the spine in which injury is suspected continues to be a daily challenge in clinical practice. The purpose of this review is to present the evidence and the controversies surrounding the practice of imaging in patients suspected of having spine injury. The discussion is centered on the increasing reliance on multidetector CT in the work-up of these patients but also considers the important contributions of clinical trials to select patient for appropriate imaging on the basis of risk and probability of injury. Available protocols, injury classification systems, and issues awaiting future research are addressed. PMID:22623691

Munera, Felipe; Rivas, Luis A; Nunez, Diego B; Quencer, Robert M

2012-06-01

330

Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial  

Microsoft Academic Search

To evaluate immediate effects of two different modes of acupuncture on motion-related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure. Thirty-six patients with chronic neck pain and limited cervical spine mobility participated in a prospective, randomized, double-blind, sham-controlled crossover trial. Every patient was treated once with needle acupuncture at distant points, dry needling

Dominik Irnich; Nicolas Behrens; Jochen M Gleditsch; Wolfram Stör; Martin A Schreiber; Peter Schöps; Andrew J Vickers; Antje Beyer

2002-01-01

331

Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: A double blind sham controlled randomized clinical trial  

Microsoft Academic Search

Cervical radicular pain affects approximately 1 on 1000 adults per year. Although many treatment modalities are described in the literature, the available evidence for efficacy is not sufficient to allow definitive conclusions on the optimal therapy to be made. The effect of pulsed radiofrequency treatment for this type of patients was evaluated in a prospective audit that showed satisfactory pain

Jan Van Zundert; Jacob Patijn; Alfons Kessels; Inge Lamé; Hans van Suijlekom; Maarten van Kleef

2007-01-01

332

High-Level Cervical Spinal Cord Stimulation Used to Treat Intractable Pain Arising from Transverse Myelitis Caused by Schistosomiasis  

PubMed Central

The efficacy of spinal cord stimulation (SCS) for treatment of various chronic painful conditions is well established. Very few reports have documented the use of SCS for treatment of chronic pain after spinal cord injury. We present a case showing a good outcome after such treatment, and suggest that high cervical stimulation may be efficacious. A 53-year-old male underwent SCS on the C1-3 level for treatment of intractable neuropathic pain below the T3 level, and in the upper extremities, arising from spinal cord injury resulting from transverse myelitis caused by schistosomiasis. High cervical SCS significantly improved the pain in the upper extremities and at the T3-T10 dermatome level. The patient continues to report excellent pain relief 9 months later. The present case suggests that high cervical stimulation may improve chronic pain in the upper extremities and the T3-T10 dermatome level arising from spinal cord injury.

Kim, Jin Kyung; Hong, Seok Ho

2010-01-01

333

Posttraumatic pseudomenigocoele of cervical spine in a patient with skeletal fluorosis. Case report.  

PubMed

A case of fluorotic cervical compressive myelopathy precipitated by trauma is reported. The delayed neurological deterioration was due to a posttraumatic pseudomenincocele, the prompt treatment of which resulted in recovery. Posttraumatic pseudomeningocele is very rate; and certainly so in fluorosis, and thus has not been reported in the literature to date. PMID:7997344

Prasad, V S; Reddy, D R

1994-09-01

334

Nomal Range of Motion of the Cervical Spine: An Initial Goniometric Study  

Microsoft Academic Search

I1 to 97 years. Measurements were taken by jive physical therapists with 7 to 30 years of clinical and teaching exppenence. Among male and female subjects of the same age, females had a greater AROM than did males for all AROMs except neck flexion. Among both males and females, each of the six cervical AROMs de- creased signijicantly with age.

James W Youdas; Tom R Garrett; Vera J Suman; Connle L Bogard; James R Carey

1992-01-01

335

Incidence of Vertebral Artery Thrombosis in Cervical Spine Trauma: Correlation with Severity of Spinal Cord Injury  

Microsoft Academic Search

BACKGROUND AND PURPOSE: The incidence of blunt traumatic vertebral artery dissec- tion\\/thrombosis varies widely in published trauma series and is associated with spinal trauma. The purpose of this study was to determine the frequency of traumatic vertebral artery thrombosis (VAT) in cervically injured patients by using routine MR angiography (MRA) and MR imaging and identify associations with the severity of

Philip J. Torina; Adam E. Flanders; John A. Carrino; Anthony S. Burns; David P. Friedman; James S. Harrop; Alexander R. Vacarro

2005-01-01

336

Withdrawal rates as a consequence of disclosure of risk associated with manipulation of the cervical spine  

PubMed Central

Background The risk associated with cervical manipulation is controversial. Research in this area is widely variable but as yet the risk is not easily quantifiable. This presents a problem when informing the patient of risks when seeking consent and information may be withheld due to the fear of patient withdrawal from care. As yet, there is a lack of research into the frequency of risk disclosure and consequent withdrawal from manipulative treatment as a result. This study seeks to investigate the reality of this and to obtain insight into the attitudes of chiropractors towards informed consent and disclosure. Methods Questionnaires were posted to 200 UK chiropractors randomly selected from the register of the General Chiropractic Council. Results A response rate of 46% (n = 92) was achieved. Thirty-three per cent (n = 30) respondents were female and the mean number of years in practice was 10. Eighty-eight per cent considered explanation of the risks associated with any recommended treatment important when obtaining informed consent. However, only 45% indicated they always discuss this with patients in need of cervical manipulation. When asked whether they believed discussing the possibility of a serious adverse reaction to cervical manipulation could increase patient anxiety to the extent there was a strong possibility the patient would refuse treatment, 46% said they believed this could happen. Nonetheless, 80% said they believed they had a moral/ethical obligation to disclose risk associated with cervical manipulation despite these concerns. The estimated number of withdrawals throughout respondents' time in practice was estimated at 1 patient withdrawal for every 2 years in practice. Conclusion The withdrawal rate from cervical manipulation as a direct consequence of the disclosure of associated serious risks appears unfounded. However, notwithstanding legal obligations, reluctance to disclose risk due to fear of increasing patient anxiety still remains, despite acknowledgement of moral and ethical responsibility.

2010-01-01

337

Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain  

Microsoft Academic Search

The objective of this study was to compare onset of deep and superficial cervical flexor muscle activity during rapid, unilateral arm movements between ten patients with chronic neck pain and 12 control subjects. Deep cervical flexor (DCF) electromyographic activity (EMG) was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx.

D. Falla; G. Jull; P. W. Hodges

2004-01-01

338

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

339

Headache in patients with neck-shoulder-arm pain of cervical radicular origin.  

PubMed

In a series of 81 patients with chronic cervicobrachialgia, 54 (67%) reported that they also suffered from recurrent headache. Forty-four (81%) of these patients were classified as having cervical headache, 5 as having migraine, 2 with tension-type headache, and 3 patients were not classifiable according to the diagnostic system of the International Headache Society (IHS). Patients with headache presented significantly higher tenderness scores and pain intensity in the neck-shoulder-arm region than patients without headaches. Twenty-three (52%) of the 44 patients with cervical headache reported that their headache had improved after treatments directed towards their cervicobrachialgia. The IHS classification system of cervical headache is discussed. PMID:15613217

Persson, L C; Carlsson, J Y

1999-03-01

340

Neurologic Disorders due to Disease of the Spine  

Microsoft Academic Search

Summary Back pain (usually cervical or lumbar) is a common complaint, and most often is self-limited or responds to conservative measures. Acute disk herniation and degenerative disease of the spine (spondylosis) are common but only occasionally involve neural structures (nerve roots and spinal cord). Most often affected patients are best treated conservatively. Surgery is indicated only when neural impingement threatens

Stephen E. Nadeau

341

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

Microsoft Academic Search

Introduction  To review the safety and efficacy of gadolinium in spine pain management procedures in patients at high risk for a contrast\\u000a reaction and who are not suitable candidates for the use of standard non-ionic contrast.\\u000a \\u000a \\u000a \\u000a Methods  We reviewed records over a 61-month period of all image-guided spinal pain management procedures where patients had allergies\\u000a making them unsuitable candidates for standard non-ionic

Yair Safriel; Roberto Ang; Muhammed Ali

2008-01-01

342

CT-guided epidural\\/perineural injections in painful disorders of the lumbar spine: Short and extended-term results  

Microsoft Academic Search

Purpose: Evaluation of short- and extended-term results of repeated epidural\\/perineural injections (EDT\\/PRT) of corticoids in painful\\u000a afflictions of the lumbar spine.\\u000a \\u000a \\u000a Methods: Thirty-two patients who had persistent radicular or low back pain for more than 6 weeks were treated with CT-guided injection\\u000a therapy. By EDT\\/PRT, 40 mg of triamcinolonacetonid was injected either periradicularly or by a direct intraspinal epidural\\u000a method

Gebhard Schmid; Sylvia Vetter; Dieter Göttmann; Ernst-Peter Strecker

1999-01-01

343

Kinematics of human cadaver cervical spine during low-speed rear-end impacts  

Microsoft Academic Search

The purposes of this study are to measure the relative linear and angular displacements of each pair of adjacent cervical vertebrae and to compute the deformation of the facet joint capsule during low posterior-anterior (+Gx) acceleration without significant hyperextension of the head. A HYGE type mini-sled has been successfully developed to conduct whole body cadaver tests with a high-speed x-ray

Bing Deng

1999-01-01

344

A Retrospective Study of Cervical Spine Injuries in American Rugby, 1970 to 1994  

Microsoft Academic Search

We undertook a retrospective study to document and analyze the occurrence of cervical spinal injuries in rugby in the United States from 1970 to 1994. We studied 59 cases (average, 2.36 per year). Thirty jun ior-level players (50.8%) (college or high school), 28 (47.5%) men's club players, and 1 (1.7%) woman player were injured. Fifty-seven injuries (97%) oc curred during

Merrick J. Wetzler; Toks Akpata; Todd Albert; Timothy E. Foster; Andrew S. Levy

1996-01-01

345

Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients  

Microsoft Academic Search

There has been little investigation into whether or not differences exist in the nature of physical impairment associated with neck pain of whiplash and insidious origin. This study examined the neck flexor synergy during performance of the cranio-cervical flexion test, a test targeting the action of the deep neck flexors.Seventy-five volunteer subjects participated in this study and were equally divided

G Jull; E Kristjansson; P Dall’Alba

2004-01-01

346

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

347

Long-term follow-up after interbody fusion of the cervical spine.  

PubMed

The aim of this work was to add to the body of data on the frequency and severity of degenerative radiographic findings at adjacent levels after anterior cervical interbody fusion and on their clinical impact and to contribute to the insights about their pathogenesis. One hundred eighty patients who were treated by anterior cervical interbody fusion and who had a follow-up of >60 months were clinically and radiologically examined by independent investigators. For all patients, the long-term Odom score was compared with the score as obtained 6 weeks after surgery. For myelopathic cases, both the late Nurick and the Odom score were compared with the initial postoperative situation. For the adjacent disc levels, a radiologic "degeneration score" was defined and assessed both initially and at long-term follow-up. At late follow-up after anterior cervical interbody fusion, additional radiologic degeneration at the adjacent disc levels was found in 92% of the cases, often reflecting a clinical deterioration. The severity of this additional degeneration correlated with the time interval since surgery. The similarity of progression to degeneration between younger trauma patients and older nontrauma patients suggests that both the biomechanical impact of the interbody fusion and the natural progression of pre-existing degenerative disease act as triggering factors for adjacent level degeneration. PMID:15260088

Goffin, Jan; Geusens, Eric; Vantomme, Nicolaas; Quintens, Els; Waerzeggers, Yannic; Depreitere, Bart; Van Calenbergh, Frank; van Loon, Johan

2004-04-01

348

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

349

Impact on image quality when a variety of x-ray source detector distances are considered for the arthritic cervical spine  

NASA Astrophysics Data System (ADS)

The unavoidable distance between the cervical spine and the image receptor presents measurable levels of geometric unsharpness, which hinders arthritic scoring. The current work explores the impact on the visualisation of important arthritic indicators by increasing the distance between the X-ray source and image detector (SID) from the commonly employed 150cm. Lateral cervical spine images were acquired of an osteoarthritic human cadaver using a DR imaging system. All exposures were taken at 65kVp using automatic exposure control and various SID distances from 150 to 210cm. Four experienced clinicians assessed the images by means of visual grading analysis, using objective criteria based on normal anatomic features and arthritic indicators. A statistically significant improvement in image quality was observed with images acquired at 210cm compared with those acquired at 150cm and 180cm (p<0.05), with values of 56.0 (SE=1.105), 50.85 (SE=1.415) and 65.35 (SE=0.737) respectively. All images with a SID of 210cm scored higher for visually sharp reproduction of the spinous processes, facet joints, intervertebral disc spaces and trabecular bone pattern compared with both 180cm and 150cm. Results indicate that total image quality and visualisation of specific anatomical features is improved in cervical spine radiographs when traditionally employed SID distances are increased.

Joyce, Maria; Brennan, Patrick C.; Rainford, Louise A.; Last, Jason; Ryan, John T.

2008-04-01

350

A case of symptomatic cervical perineural (Tarlov) cyst: clinical manifestation and management  

Microsoft Academic Search

Perineural (Tarlov) cysts are most often found in the sacral region and are rare in the cervical spine. Although they are\\u000a usually asymptomatic, a small number of those at the lumbosacral level have been known to produce localized or radicular pain.\\u000a Few reports are available on symptomatic perineural cysts in the cervical spine and it has not been discussed how

Keewon Kim; Se Woong Chun; Sun G. Chung

351

Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders  

PubMed Central

Purpose: To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders. Methods: During one ski season (1998–99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified. On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event. Physicians documented the site and severity of injury, investigations, and disposition of each patient. Concurrently, counts were made at the entry to the ski area of the number of skiers and snowboarders wearing helmets. Results: Seventy children were evaluated at the clinic following ski/snowboard related head, neck, and face injuries. Fourteen did not require investigation or treatment. Of the remaining 56, 17 (30%) were wearing helmets and 39 (70%) were not. No serious neck injury occurred in either group. Using helmet-use data from the hill, among those under 13 years of age, failure to wear a helmet increased the risk of head, neck, or face injury (relative risk (RR) 2.24, 95% confidence interval (CI) 1.23 to 4.12). When corrected for activity, RR was 1.77 and 95% CI 0.98 to 3.19. There was no significant difference in the odds ratio for collisions. The two groups may have been different in terms of various relevant characteristics not evaluated. No separate analysis of catastrophic injuries was possible. Conclusion: This study suggests that, in skiers and snowboarders under 13 years of age, helmet use does not increase the incidence of cervical spine injury and does reduce the incidence of head injury requiring investigation and/or treatment.

Macnab, A; Smith, T; Gagnon, F; Macnab, M

2002-01-01

352

Chronic cervical dysfunction: correlation of myoelectric findings with clinical progress.  

PubMed

In this pilot study, four patients with motion impairment and chronic cervical pain after cervical spine injury received osteopathic manipulative treatment for spinal dysfunction for periods in excess of 3 months. Records were compared for changes in the patient's subjective complaints, in the physician's findings, and in the standardized measurement of electrical activity of the cervical spine musculature. All three measures demonstrated parallel improvement in the health status of these patients. Attention to functional aspects of a neuromusculoskeletal problem appears to provide reliable indicators for directing treatment of somatic dysfunction and registering both subjective and objective change. PMID:2768007

Beal, M C; Vorro, J; Johnston, W L

1989-07-01

353

[The effect of isometric exercises for cervical spine on blood pressure].  

PubMed

Isometric exercises are common modality in the treatment of cervical syndrome. They are based on maximal voluntary contraction for 5-10 seconds. Isometric exercises can significantly rise blood presure. The purpose of the study was to asses the effect of isometric exercises submaximal intesity (60% maximal voluntary contraction) redarding blood pressure. The reults showed that even isometric exercises lower intesity statistically singnificabt rise systolic and diastolic blood pressure immediately after exercises. The blood pressure values reach normal values after 30 minutes. PMID:17939241

Curkovi?, B; Puksec, M; Peri?, P; Babi?-Nagli?, D

1998-01-01

354

[Wide esophageal wall rupture as iatrogenic complication of anterior cervical spine surgery].  

PubMed

The case of 19-year old men with iatrogenic esophageal wall perforation is presented. The patient underwent anterior cervical stabilization using plate and screw for fracture of the C4 and C5 vertebra followed by an abscess of prevertebral space with discharging pus and food from the wound. The general condition was poor. Symptoms included: pneumonia, pleuritis with effusion, septicemia with mediastinitis, fever up to 40 and quadriplegia on neurological examination. During surgical procedure the implant loose but was still fixed into the esophagus causing a large defect in the posterior wall of the hypopharynx and cervical part of esophagus was found. The patient undergone three step surgery with wide drainage of prevertebral abscess, removing of osteosynthetic plate removal and formation of pedicle flap with sterno-cleido-mastoideus muscule. The finnal fourth procedure with using of pediculed infrahyoid flap gave an excellent result. During 160 days hospitalization the pus culture showed growth of the 11 bacterials species (like Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis) and 2 species of fungus. He was treated 13 types of antybiotics. This special case we present because of live threatening complication (mediastinitis) and complicated clinical course as well as because of unique technique of the defect closure, i.e. the infrahyoid flap occurred to be successful. PMID:16521458

Wierzbicka, Ma?gorzata; Pabiszczak, Maciej; Smuszkiewicz, Piotr; Szyfter, Witold

2005-01-01

355

Magnetic resonance imaging of the cervical spine: technical and clinical observations  

SciTech Connect

Seventy-two patients were examined to determine the clinical potential for magnetic resonance imaging (MRI) of the spine. MRI using different pulse sequences was compared with plain radiography, high-resolution computed tomography, and myelography. There were 35 normal patients; pathologic conditions studied included canal stenosis, herniated disk, metastatic tumor, neurofibroma, trauma, Chiari malformation, syringomyelia, arteriovenous malformation, and rheumatoid arthritis. MRI provided sharply defined anatomic delineation and tissue characterization. It was diagnostic in syringomyelia and Chiari malformation and was useful in the evaluation of trauma and spinal canal block from any cause. MRI was sensitive to degenerative disk disease and infection. The spin-echo technique, with three pulse sequence variations, seems very promising. A short echo time (TE) produces the best signal-to-noise ratio and spatial resolution. Lengthening the TE enhances differentiation of various tissues by their signal intensity, whil the combined increase of TE and recovery time (TR) produces selective enhancement of the cerebrospinal fluid signal intensity.

Modic, M.T.; Weinstein, M.A.; Pavlicek, W.; Boumphrey, F.; Starnes, D.; Duchesneau, P.M.

1983-12-01

356

Percutaneous cervical cordotomy for the control of pain in patients with pleural mesothelioma  

PubMed Central

BACKGROUND—Severe chest pain is common in mesothelioma. Percutaneous cervical cordotomy, which interrupts the spinothalamic tract at the C1/C2 level causing contralateral loss of pain sensation, is particularly appropriate in mesothelioma as the tumour is unilateral and systemic analgesia may be ineffective and is limited by harmful side effects.?METHOD—A retrospective review was performed to determine the effectiveness and complication rate of this procedure.?RESULTS—Fifty two patients were using opioids prior to cordotomy. The median daily dose of morphine before and after cordotomy was 100 mg (range 0-1000 mg) and 20 mg (range 0-520 mg), respectively (p<0.001). Forty three patients (83%) had a reduction in pain such that their dose of opioid could be at least halved. Twenty patients (38%) were able to stop completely. Recurrence of pain requiring an increase in opioid medication was recorded in 18patients at a median time of nine weeks (range 0.7-26 weeks). Four patients developed mild weakness, two had troublesome dysaesthesia. The median time from cordotomy to death was 13 weeks (range 0.3-52 weeks). Six early deaths within two weeks of cordotomy occurred early in the series and reflect postoperative chest infection and poor selection as the patients were in the terminal stages of mesothelioma.?CONCLUSIONS—Percutaneous cervical cordotomy is successful in treating pain from mesothelioma. There was a low complication rate in this series. Referral to a unit experienced in cordotomy is recommended as soon as pain from chest wall invasion is suspected.??

Jackson, M; Pounder, D; Price, C; Matthews, A; Neville, E

1999-01-01

357

Total disc replacement in the cervical spine: a systematic review evaluating long-term safety.  

PubMed

Study design:?Systematic review.Clinical questions:?What are the rates and causes of subsequent surgeries? What is the long-term complication rates following cervical artificial disc replacement (C-ADR)? How do these rates change over time?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 comparative and non-comparative studies reporting long-term (? 48 months) complications of C-ADR. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus.Results:?Two RCTs reporting outcomes following C-ADR (Bryan disc, Prestige disc) versus anterior cervical discectomy and fusion (ACDF) at follow-ups of 4 to 5 years were found; five case series reporting outcomes following C-ADR at follow-ups of 4 to 8 years were identified. Secondary surgery rates were similar or slightly lower following C-ADR compared with fusion at 4 to 5 years postoperatively. In one small subset of an RCT, rates of adjacent disc heterotopic ossification were lower in C-ADR patients than in those treated with fusion. Rates of other adverse events were similar between treatment groups.Conclusions:?There is low evidence on the long-term safety outcomes following C-ADR. Additional comparative studies with follow-up of at least 4 years are needed to fully understand the long-term safety outcomes of C-ADR compared with fusion. PMID:23236309

Anderson, Paul A; Hashimoto, Robin

2012-02-01

358

[Biomechanical evaluation of immediate stability of biodegradable multi-amino acid copolymer/tri-calcium phosphate composite interbody Cages in a goat cervical spine model].  

PubMed

A new kind of Interbody Cage made of multi-amino acid copolymer/tri-calcium phosphate (MAACP/TCP) composite was designed, and the purpose of this study was to evaluate immediate stability of MAACP/TCP Cage in a goat cervical spine model (C3-4). After the motion segment C3-4 was tested intact, 27 goat cervical spines were divided into three groups randomly. There were four groups group A. MAACP/TCP Cage group (n = 9), group B2 titanium Cage group (n = 9), group C2 autologous tricortical iliac crest bone group (n = 9) and group D: intact group (n = 27). Different Cage groups were implanted after complete discectomy (C3-4) was performed. Then they were tested in flexion, extension, axial rotation, and lateral bending with a nondestructive stiffness method. The range of motion (ROM) and relative stiffness were calculated and compared between groups. In comparison to the intact motion segment, MAACP/TCP Cage showed a significantly (P < 0.05) lower ROM and a significantly (P < 0.05) higher relative stiffness in flexion and lateral bending. In comparison to the tricortical iliac crest bone graft, MAACP/TCP Cage showed a significantly (P < 0.05) lower ROM and a significantly (P < 0.05) higher relative stiffness in extension, flexion and lateral bending. There was no significant (P > 0.05) difference in the ROM and relative stiffness between MAACP/TCP Cage and titanium Cage in extension, flexion and lateral bending. In comparison to titanium Cage, MAACP/TCP Cage showed a significantly (P < 0.05) higher ROM and a significantly (P < 0.05) lower relative stiffness in rotation. Conclusion: MAACP/TCP Cage can provide enough immediate stability for cervical interbody fusion in a goat cervical spine model. PMID:21485185

Zhou, Chunguang; Song, Yueming; Tu, Chongqi; Duan, Hong; Pei, Fuxing; Yan, Yonggang; Li, Hong

2011-02-01

359

Fluoroscopic cervical epidural injections in chronic axial or disc-related neck pain without disc herniation, facet joint pain, or radiculitis  

PubMed Central

Background While chronic neck pain is a common problem in the adult population, with a typical 12-month prevalence of 30%–50%, there is a lack of consensus regarding its causes and treatment. Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain. Methods A randomized, double-blind, active, controlled trial was conducted to evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of chronic neck pain with or without upper extremity pain in patients without disc herniation, radiculitis, or facet joint pain. Results One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of two treatment groups, ie, injection of local anesthetic only (group 1) or local anesthetic mixed with nonparticulate betamethasone (group 2). The primary outcome of significant pain relief and improvement in functional status (?50%) was demonstrated in 72% of group 1 and 68% of group 2. The overall average number of procedures per year was 3.6 in both groups with an average total relief per year of 37–39 weeks in the successful group over a period of 52 weeks. Conclusion Cervical interlaminar epidural injections of local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic or axial pain.

Manchikanti, Laxmaiah; Cash, Kimberly A; Pampati, Vidyasagar; Malla, Yogesh

2012-01-01

360

Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review comparing long-term follow-up results from two FDA trials  

PubMed Central

Study design:?Systematic review. Clinical question:?Does single-level unconstrained, semiconstrained, or fully constrained cervical artificial disc replacement (C-ADR) improve health outcomes compared with single-level anterior cervical discectomy and fusion (ACDF) in the long-term? 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 US Food and Drug Administration (FDA) studies reporting long-term (? 48 months) follow-up results of C-ADR compared with ACDF. Non-FDA trials and FDA trials reporting outcomes at short-term or mid-term follow-up periods were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results:?Two FDA trials reporting outcomes following C-ADR (Bryan disc, Prestige disc) versus ACDF at follow-up periods of 48 months and 60 months were found (follow-up rates are 68.7% [318/463] and 50.1% [271/541], respectively). Patients in the C-ADR group showed a higher rate of overall success, greater improvements in Neck Disability Index, neck and arm pain scores, and SF-36 PhysicalComponent Scores at long-term follow-up compared with those in the ACDF group. The rate of adjacent segment disease was less in the C-ADR group versus the ACDF group at 60 months (2.9% vs 4.9%). Normal segmental motion was maintained in the C-ADR group. Furthermore, rates of revision and supplemental fixation surgical procedures were lower in the arthroplasty group. Conclusions:?C-ADR is a viable treatment option for cervical herniated disc/spondylosis with radiculopathy resulting in improved clinical outcomes, maintenance of normal segmental motion, and low rates of subsequent surgical procedures at 4 to 5 years follow-up. More studies with long-term follow-up are warranted.

Mummaneni, Praveen V.; Amin, Beejal Y.; Wu, Jau-Ching; Brodt, Erika D.; Dettori, Joseph R.; Sasso, Rick C.

2012-01-01

361

Objective Sonographic Measures for Characterizing Myofascial Trigger Points Associated With Cervical Pain  

PubMed Central

Objectives The purpose of this study was to determine whether the physical properties and vascular environment of active myofascial trigger points associated with acute spontaneous cervical pain, asymptomatic latent trigger points, and palpably normal muscle differ in terms of the trigger point area, pulsatility index, and resistivity index, as measured by sonoelastography and Doppler imaging. Methods Sonoelastography was performed with an external 92-Hz vibration in the upper trapezius muscles in patients with acute cervical pain and at least 1 palpable trigger point (n = 44). The area of reduced vibration amplitude was measured as an estimate of the size of the stiff myofascial trigger points. Patients also underwent triplex Doppler imaging of the same region to analyze blood flow waveforms and calculate the pulsatility index of blood flow in vessels at or near the trigger points. Results On sonoelastography, active sites (spontaneously painful with palpable myofascial trigger points) had larger trigger points (mean ± SD, 0.57 ± 0.20 cm2) compared to latent sites (palpable trigger points painful on palpation; 0.36 ± 0.16 cm2) and palpably normal sites (0.17 ± 0.22 cm2; P < .01). Analysis of receiver operating characteristic curves showed that area measurements could robustly distinguish between active, latent, and normal sites (areas under the curve, 0.9 for active versus latent, 0.8 for active versus normal, and 0.8 for latent versus normal, respectively). Doppler spectral waveform data showed that vessels near active sites had a significantly higher pulsatility index (median, 8.3) compared to normal sites (median, 3.0; P < .05). Conclusions The results presented in this study show that myofascial trigger points may be classified by area using sonoelastography. Furthermore, monitoring the trigger point area and pulsatility index may be useful in evaluating the natural history of myofascial pain syndrome.

Ballyns, Jeffrey J.; Shah, Jay P.; Hammond, Jennifer; Gebreab, Tadesse; Gerber, Lynn H.; Sikdar, Siddhartha

2012-01-01

362

[Personal experience with surgical treatment of degenerative diseases of the cervical spine using an anterior approach].  

PubMed

In 1995 to 1999 the authors operated on account of cervical spondylosis, using an anterior approach and methylmethacryl filling of the intervertebral space 57 patients. The mean period of hospitalization was 6.2 days (4-9 days). The clinical condition was evaluated 1, 3, 6, and 12 months after surgery. In 55 patients also X-ray pictures were evaluated. One year after surgery in a group of 14 patients with radiculipathy complete restoration of the condition occurred in 13 patients, improvement was recorded in one patient. In a group of 4 patients with myelopathy the condition did not change in two patients and in two deterioration was recorded. In a group of 39 patients with radiculo- and myelopathy improvement of the condition was recorded in 30 and the condition was unaltered in 9 patients. X-ray examination revealed bridging of the intervertebral space in 11 patients, mobility in the operated segment in 8 and a slight shift of the graft in three instances. The submitted results are comparable with those of other authors. PMID:11367609

Levkus, P; Výrostko, J; Kat'uch, M; Kollová, A; Ménová, K; Kotusová, B

2001-03-01

363

Compressive strength of autologous and allogenous bone grafts for thoracolumbar and cervical spine fusion.  

PubMed

The selection of the bone graft type for stabilization of spinal fusion depends on availability, the clinical situation, and the desired mechanical stability. The authors determined the potential immediate postoperative compressive strength of various types of bone grafts under axial compression on a material testing machine. The fibular strut graft (5,070 +/- 3,250 N, mean +/- standard deviation [SD]) was significantly stronger (P less than 0.05) than the anterior (1,150 +/- 487 N) and posterior (667 +/- 311 N) iliac crest grafts, and the rib grafts (452 +/- 192 N). Hydroxyapatite grafts with a pore size of 200 mu were significantly stronger (P less than 0.05) than those with a pore size of 500 mu (1,420 +/- 480 N versus 338 +/- 78 N). Ethylenoxide sterilization had no significant effect on the immediate compressive strength. Bicortical and tricortical Bailey-Badgley and Cloward bone grafts also were compared. Results showed that all cervical graft types may be sufficiently strong to support sizable loads. PMID:2263975

Wittenberg, R H; Moeller, J; Shea, M; White, A A; Hayes, W C

1990-10-01

364

Probable cervical midline epidural septum complicating the treatment of a patient with upper extremity sympathetically maintained pain.  

PubMed

We present a woman who developed left arm sympathetically maintained pain (SMP, or "shoulder-hand syndrome") as a result of brachial plexus injury. After confirmatory diagnosis with both stellate local anesthetic block and intravenous phentolamine infusion, the patient had a cervical epidural catheter placed and a local anesthetic infusion started. After numerous unilateral blocks were obtained, a cervical epidurogram demonstrated a probable cervical midline epidural septum. Catheter placement was adjusted, and a successful chemical sympathectomy was performed for 6 days. This resulted in significant relief of the patient's shoulder pain as well as almost complete resolution of the patient's left arm SMP symptoms. This case represents, to our knowledge, the first documentation of the use of phentolamine for the diagnosis of SMP secondary to pathology at a site proximal to that of symptomatology, as well as the first documentation of presumptive cervical midline epidural septum. PMID:7516959

Valley, M A; Sheplock, G J; Rogers, J N

1994-04-01

365

Lumbar spine MRI in the elite-level female gymnast with low back pain  

Microsoft Academic Search

Objective  Previous studies have shown increased degenerative disk changes and spine injuries in the competitive female gymnast. However,\\u000a it has also been shown that many of these findings are found in asymptomatic athletic people of the same age. Previous magnetic\\u000a resonance imaging (MRI) studies evaluating the gymnastic spine have not made a distinction between symptomatic and asymptomatic\\u000a athletes. Our hypothesis is

D. Lee Bennett; Lawrence Nassar; Mark C. DeLano

2006-01-01

366

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

367

Maximum principal strain correlates with spinal cord tissue damage in contusion and dislocation injuries in the rat cervical spine.  

PubMed

The heterogeneity of the primary mechanical mechanism of spinal cord injury (SCI) is not currently used to tailor treatment strategies because the effects of these distinct patterns of acute mechanical damage on long-term neuropathology have not been fully investigated. A computational model of SCI enables the dynamic analysis of mechanical forces and deformations within the spinal cord tissue that would otherwise not be visible from histological tissue sections. We created a dynamic, three-dimensional finite element (FE) model of the rat cervical spine and simulated contusion and dislocation SCI mechanisms. We investigated the relationship between maximum principal strain and tissue damage, and compared primary injury patterns between mechanisms. The model incorporated the spinal cord white and gray matter, the dura mater, cerebrospinal fluid, spinal ligaments, intervertebral discs, a rigid indenter and vertebrae, and failure criteria for ligaments and vertebral endplates. High-speed (? 1 m/sec) contusion and dislocation injuries were simulated between vertebral levels C3 and C6 to match previous animal experiments, and average peak maximum principal strains were calculated for several regions at the injury epicenter and at 1-mm intervals from +5 mm rostral to -5 mm caudal to the lesion. Average peak principal strains were compared to tissue damage measured previously in the same regions via axonal permeability to 10-kD fluorescein-dextran. Linear regression of tissue damage against peak maximum principal strain for pooled data within all white matter regions yielded similar and significant (p<0.0001) correlations for both contusion (R(2)=0.86) and dislocation (R(2)=0.52). The model enhances our understanding of the differences in injury patterns between SCI mechanisms, and provides further evidence for the link between principal strain and tissue damage. PMID:22320127

Russell, Colin M; Choo, Anthony M; Tetzlaff, Wolfram; Chung, Tae-Eun; Oxland, Thomas R

2012-04-18

368

Percutaneous pulsed radiofrequency treatment of the cervical dorsal root ganglion in the treatment of chronic cervical pain syndromes: a clinical audit.  

PubMed

Cervicogenic headache and cervicobrachialgia are frequent diagnoses of chronic cervical pain. After failure of conservative treatment, an interventional approach may be indicated in the absence of any indication for causal surgical treatment. The pulsed radiofrequency (PRF) technique exposes the nerve to a high-frequency electric field while the temperature of the electrode tip does not exceed 42°C. This method is thought to be nondestructive and almost free of neurologic side effects and complications. Our extended pilot study was performed to confirm the perceived efficacy of PRF for short- and long-term relief of chronic cervical pain. We carried out a clinical audit of the first 18 patients treated with PRF at the cervical dorsal root ganglion. An independent evaluator reviewed the medical records. Patients with good clinical results at 8 weeks were evaluated for long-term effect (> 6 months), based on a 7-point Likert scale. Thirteen patients (72%) showed short-term clinical success (? 50% pain relief). Mean follow-up was 19.4 months (SD 8.9 months), maximum 2.5 years. The duration of satisfactory pain relief (6 or 7 on the Likert scale) varied between 2 and over 30 months, with a mean duration of 9.2 months (SD 11.2 months). Kaplan-Meier analysis illustrated that 50% of patients experienced success 3 months after treatment. We could not identify predictive variables for clinical outcome. None of the patients reported post-treatment neuritis or other adverse events. To our knowledge, this is the first documented series of chronic cervical pain syndromes treated with PRF. Satisfactory pain relief of at least 50% was achieved in 13 of 18 (72%) patients at 8 weeks. More than one year after treatment, six patients (33%) continue to rate treatment outcome as good or very good. No side effects were reported.?j. PMID:22150908

Van Zundert, J; Lamé, I E; de Louw, A; Jansen, J; Kessels, F; Patijn, J; van Kleef, M

2003-01-01

369

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, while their centre reflects the movements' symmetry. Using Generalizability Theory, the index of dependability for the area and anterior-posterior centre position was found to be ?0.90, but was slightly lower for the medio-lateral centre 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

2012-12-27

370

Botulinum toxin type A combined with cervical spine manual therapy for masseteric hypertrophy in a patient with Alzheimer-type dementia: a case report  

PubMed Central

Objective The purpose of this case study is to present the findings of combining botulinum toxin type A (BoNT-A) and cervical spine manual therapy to address masseter muscle spasticity in a patient with Alzheimer-type dementia. Case Report A 78-year-old woman with bilateral spasticity of the masseteric regions for 2 years was referred for physiotherapy. She had trismus and bruxism, and could neither close nor open her mouth normally; thus, she was unable to be fed orally in a normal manner. Intervention and Outcome The patient underwent combined treatment with BoNT-A and cervical spine manual therapy. A medical physician (neurologist) performed the BoNT-A injections into 2 points at the center of the lower third of the masseter muscle. A physical therapist performed manual therapy interventions targeted at the cervical spine. Manual therapy started the day after the BoNT-A injection and continued for 5 sessions per week for a total period of 2 weeks. Clinical outcomes were measured including spasticity (Modified Ashworth Scale), functionality (Barthel Index), and jaw opening. Outcomes were conducted at baseline, 2 weeks after treatment, and at 2-month follow-up session after finishing the treatment. The patient improved in all of the outcomes at the end of treatment, and these results were maintained during the follow-up. After treatment, the patient was able to feed with minimal caregiver dependency because oral feeding was possible. Conclusion The patient in this study responded positively to a combination of BoNT-A and manual therapy, resulting in decreased masseter muscles spasticity and improved trismus and bruxism.

Villafane, Jorge H.; Fernandez-de-las-Penas, Cesar; Pillastrini, Paolo

2012-01-01

371

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations.  

PubMed

Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns and investigate the effect on post-operative outcome with the help of fluoroscopically guided spine infiltrations in patients from an ongoing prospective study with ProDisc II. Patients who reported unsatisfactory results at any of the FU-examinations received fluoroscopically guided spine infiltrations as part of a semi-invasive diagnostic and conservative treatment program. Pain sources were identified in patients with reproducible (> or =2x) significant (50-75%) or highly significant (75-100%) pain relief. Results were correlated with outcome parameters visual analogue scale (VAS), Oswestry disability index (ODI) and the subjective patient satisfaction rate. From a total of 175 operated patients with a mean follow-up (FU) of 29.3 months (range 12.2-74.9 months), n = 342 infiltrations were performed in n = 58 patients (33.1%) overall. Facet joint pain, predominantly at the index level (86.4%), was identified in n = 22 patients (12.6%). The sacroiliac joint was a similarly frequent cause of post-operative pain (n = 21, 12.0%). Pain from both structures influenced all outcome parameters negatively (P < 0.05). Patients with an early onset of pain (< or =6 months) were 2-5x higher at risk of developing persisting complaints and unsatisfactory outcome at later FU-stages in comparison to the entire study cohort (P < 0.05). The level of TDR significantly influenced post-operative outcome. Best results were achieved for the TDRs above the lumbosacral junction at L4/5 (incidence of posterior joint pain 14.8%). Inferior outcome and a significantly higher incidence of posterior joint pain were observed for TDR at L5/S1 (21.6%) and bisegmental TDR at L4/5/S1 (33.3%), respectively. Lumbar facet and/or ISJ-pain are a frequent and currently underestimated source of post-operative pain and the most common reasons for unsatisfactory results following TDR. Further failure-analysis studies are required and adequate salvage treatment options need to be established with respect to the underlying pathology of post-operative pain. The question as to whether or not TDR will reduce the incidence of posterior joint pain, which has been previously attributed to lumbar fusion procedures, remains unanswered. Additional studies will have to investigate whether TDR compromises the index-segment in an attempt to avoid adjacent segment degeneration. PMID:17972116

Siepe, Christoph J; Korge, Andreas; Grochulla, Frank; Mehren, Christoph; Mayer, H Michael

2007-10-31

372

Face validity of VIS-Ed: a visualization program for teaching medical students and residents the biomechanics of cervical spine trauma.  

PubMed

This RCT study aimed to investigate if VIS-Ed (Visualization through Imaging and Simulation - Education) had the potential to improve medical student education and specialist training in clinical diagnosis and treatment of trauma patients. The participants' general opinion was reported as high in both groups (lecture vs. virtual patient (VP)). Face validity of the VIS-Ed for cervical spine trauma was demonstrated and the VP group reported higher stimulation and engagement compared to the lecture group. No significant difference in the knowledge test between both groups could be observed, confirming our null hypothesis that VIS-Ed was on par with a lecture. PMID:23400137

Courteille, Olivier; Ho, Johnson; Fahlstedt, Madelen; Fors, Uno; Felländer-Tsai, Li; Hedman, Leif; Möller, Hans

2013-01-01

373

Pillow use: the behavior of cervical stiffness, headache and scapular/arm pain  

PubMed Central

Background: Pillows are intended to support the head and neck in a neutral position to minimize biomechanical stresses on cervical structures whilst sleeping. Biomechanical stresses are associated with waking cervical symptoms. This paper adds to the scant body of research investigating whether different pillow types produce different types and frequencies of waking symptoms in asymptomatic subjects. Methods: A random-allocation block-design blinded field trial was conducted in a large South Australian regional town. Subjects were side-sleepers using one pillow only, and not receiving treatment for cervicothoracic problems. Waking cervical stiffness, headache and scapular/arm pain were recorded daily. Five experimental pillows (polyester, foam regular, foam contour, feather, and latex) were each trialed for a week. Subjects’ ‘own’ pillow was the control (a baseline week, and a washout week between each experimental pillow trial week). Subjects reported waking symptoms related to known factors (other than the pillow), and subjects could ‘drop out’ of any trial pillow week. Results: Disturbed sleep unrelated to the pillow was common. Waking symptoms occurring at least once in the baseline week were reported by approximately 20% of the subjects on their ‘own’ pillow. The feather trial pillow performed least well, producing the highest frequency of waking symptoms, while the latex pillow performed best. The greatest number of ‘drop outs’ occurred on the feather pillow. The foam contour pillow performed no better than the foam regular pillow. Conclusion: ‘Own’ pillows did not guarantee symptom-free waking, and thus were a questionable control. The trial pillows had different waking symptom profiles. Latex pillows can be recommended over any other type for control of waking headache and scapular/arm pain.

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

2010-01-01

374

Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement.  

PubMed

Interbody fusion cages are small hollow implants that are inserted into the intervertebral space to restore physiological disc height and to allow bony fusion. They sometimes cause clinical complications due to instability, subsidence or dislocation. These are basic biomechanical parameters, which influence strongly the quality of a fusion device; however, only few data about these parameters are available. Therefore, the purpose of the present study was to investigate the primary stabilizing effect of four different cervical fusion devices in in vitro flexibility tests. Twenty-four human cervical spine segments were used in this study. After anterior discectomy, fusion was performed either with a WING cage (Medinorm AG, Germany), a BAK/C cage (Sulzer SpineTech, USA), an AcroMed cervical I/F cage (DePuy AcroMed International, UK) or bone cement (Sulzer, Switzerland). All specimens were tested in a spine tester in the intact condition and after implantation of one of the four devices. Alternating sequences of pure lateral bending, flexion-extension and axial rotation moments (+/- 2.5 Nm) were applied continuously and the motions in each segment were measured simultaneously. In general, all tested implants had a stabilizing effect. This was most obvious in lateral bending, where the range of motion was between 0.29 (AcroMed cage) and 0.62 (BAK/C cage) with respect to the intact specimen (= 1.00). In lateral bending, flexion and axial rotation, the AcroMed cervical I/F cages had the highest stabilizing effect, followed by bone cement, WING cages and BAK/C cages. In extension, specimens fused with bone cement were most stable. With respect to the primary stabilizing effect, cages, especially the AcroMed I/F cage but also the WING cage and to a minor extent the BAK/C cage, seem to be a good alternative to bone cement in cervical interbody fusion. Other characteristics, such as the effect of implant design on subsidence tendency and the promotion of bone ingrowth, have to be determined in further studies. PMID:11057535

Wilke, H J; Kettler, A; Claes, L

2000-10-01

375

Cervical angina.  

PubMed

Cervical angina, resembling true angina pectoris, but resulting from cervical spondylosis and nerve root compression, is also known as pseudoangina. This report describes 164 patients treated over a 22-year period. Patients included 103 men and 61 women, with ages ranging from 45 to 68 years and averaging 54 years of age. The duration of symptoms prior to definitive diagnosis averaged ten months and ranged from ten to 18 months. Most patients had consulted at least two cardiologists prior to diagnosis. The results of stress testing were abnormal in ten patients, but none underwent angiography. Symptoms common to all patients, in varying severity, included neck pain and stiffness, occipital headache, arm pain with sensory symptoms. Neurologic deficit was found in only three instances. The majority of patients responded satisfactorily to a standard nonsurgical regimen, employed for at least three months, involving the use of a hard collar, intermittent traction, isometric exercise, and a combination of anti-inflammatory and muscle relaxant medications. In cases where disability persisted, myelography was usually employed and when confirming nerve root compression, anterior disc excision and spine fusion were performed. Such treatment was required in only 38 cases and resulted in complete relief of complaints in all but five instances in which fusion failure required re-operation with ultimate success. Fusion usually was completed in three months, during which time the patient was required to wear a hard collar. PMID:2296405

Jacobs, B

1990-01-01

376

Directional preference following epidural steroid injection in three patients with acute cervical radiculopathy.  

PubMed

Cervical radiculopathy is typically characterized by neurologic symptoms that are traced to disturbances of discrete spinal nerve root(s) due to inflammatory or mechanical etiologies. Here we present three patients diagnosed with cervical radiculopathy, whose directional preference only surfaced after either a cervical transforaminal or intralaminar nerve root epidural steroid injection. This retrospective observational case series describes three men who presented with cervical radiculopathy with 7-9/10 neck pain, neck disability index (NDI) ranging between 44% and 90%, and an irreducible derangement upon McKenzie mechanical diagnosis and therapy (MMDT) evaluation. These patients demonstrated weaknesses, sensory changes, and/or decreased reflexes in the C5, C6, or C7 distributions. They each underwent a cervical transforaminal or intralaminar epidural injections at one or two levels, which uncovered their directional preference and facilitated further conservative treatment. These three patients experienced drastic improvements with each postinjection physical therapy session. They demonstrated decreased pain scores, centralization of pain, and a decreasing NDI trends throughout their treatments. They were all discharged with stable 0-3/10 pain severity after four physical therapy sessions and NDI scores of 0%. These cases suggest an interplay between inflammatory and mechanical contributors to spine-mediated pain and the treatment challenge this presents. Dissecting the components of spine pain can be challenging; however, delivery of skilled multidisciplinary care in an algorithmic fashion may be beneficial and provide the future framework for the management of cervical radiculopathy and other spine-related conditions. PMID:23113937

Desai, Mehul J; Padmanabhan, Girish; Simbasivan, Ajai; Kamanga-Sollo, Gladys G; Dharmappa, Ajay

2012-10-31

377

Mechanisms involved in extraterritorial facial pain following cervical spinal nerve injury in rats  

PubMed Central

Background The aim of this study is to clarify the neural mechanisms underlying orofacial pain abnormalities after cervical spinal nerve injury. Nocifensive behavior, phosphorylated extracellular signal-regulated kinase (pERK) expression and astroglial cell activation in the trigeminal spinal subnucleus caudalis (Vc) and upper cervical spinal dorsal horn (C1-C2) neurons were analyzed in rats with upper cervical spinal nerve transection (CNX). Results The head withdrawal threshold to mechanical stimulation of the lateral facial skin and head withdrawal latency to heating of the lateral facial skin were significantly lower and shorter respectively in CNX rats compared to Sham rats. These nocifensive effects were apparent within 1 day after CNX and lasted for more than 21 days. The numbers of pERK-like immunoreactive (LI) cells in superficial laminae of Vc and C1-C2 were significantly larger in CNX rats compared to Sham rats following noxious and non-noxious mechanical or thermal stimulation of the lateral facial skin at day 7 after CNX. Two peaks of pERK-LI cells were observed in Vc and C1-C2 following mechanical and heat stimulation of the lateral face. The number of pERK-LI cells in C1-C2 was intensity-dependent and increased when the mechanical and heat stimulations of the face were increased. The decrements of head withdrawal latency to heat and head withdrawal threshold to mechanical stimulation were reversed during intrathecal (i.t.) administration of MAPK/ERK kinase 1/2 inhibitor PD98059. The area of activated astroglial cells was significantly higher in CNX rats (at day 7 after CNX). The heat and mechanical nocifensive behaviors were significantly depressed and the number of pERK-LI cells in Vc and C1-C2 following noxious and non-noxious mechanical stimulation of the face was also significantly decreased following i.t. administration of the astroglial inhibitor fluoroacetate. Conclusions The present findings have demonstrated that mechanical allodynia and thermal hyperalgesia occur in the lateral facial skin after CNX and also suggest that ERK phosphorylation of Vc and C1-C2 neurons and astroglial cell activation are involved in orofacial extraterritorial pain following cervical nerve injury.

2011-01-01

378

CT-Guided Epidural\\/Perineural Injections in Painful Disorders of the Lumbar Spine:Short and Extended-Term Results  

Microsoft Academic Search

Purpose: Evaluation of short- and extended-term results of repeated epidural\\/perineural injections (EDT\\/PRT) of corticoids in painful afflictions of the lumbar spine. Methods: Thirty-two patients who had persistent radicular or low back pain for more than 6 weeks were treated with CT-guided injection therapy. By EDT\\/PRT, 40 mg of triamcinolonacetonid was injected either periradicularly or by a direct intraspinal epidural method

Gebhard Schmid; Sylvia Vetter; Dieter Goettmann; Ernst-Peter Strecker

1999-01-01

379

Posterior Cervical Bone Screws  

Center for Biologics Evaluation and Research (CBER)

Text Version... Smith MD et al, Spine 1993: 18, 1984. Page 3. POSTERIOR CERVICAL BONE SCREWS ... Page 4. POSTERIOR CERVICAL BONE SCREWS ... More results from www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials

380

Effectiveness of acupuncture intervention for neck pain caused by cervical spondylosis: study protocol for a randomized controlled trial  

PubMed Central

Background Neck pain caused by cervical spondylosis has become a common health problem worldwide among >40-year-old adults. Acupuncture intervention is one of the most popular treatment measures for this disorder. However, evidence for its efficacy in relieving neck pain and recovering neck physiological function has not been established in randomized, placebo-controlled trials. The primary aim of this trial is to assess the efficacy and safety of active acupuncture compared with sham acupuncture intervention for neck pain caused by cervical spondylosis. Methods/Design We will conduct a randomized, double-blind, parallel-group, placebo-controlled trial comparing active acupuncture with placebo (sham acupuncture). A total of 456 patients with neck pain caused by cervical spondylosis who meet the eligibility criteria from outpatient clinics of the Second People’s Hospital of Fujian Province and the Affiliated Rehabilitation Hospital, Fujian University of Traditional Chinese Medicine will be recruited and randomized into an active acupuncture or sham acupuncture group. The participants will undergo treatment sessions with either active or sham acupuncture intervention five times a week for 2 weeks. Evaluation by blinded assessors at baseline and at intervention for 1 and 2 weeks will include demographic characteristics, validated questionnaires (Northwick Park Neck Pain Questionnaire (NPQ) scale, Short-Form 36 (SF-36) scale, and McGill pain scale), examination of neck physiological function, and adverse events. All included patients will be followed up and investigated for relapse of neck pain at 4, 8, and 12 weeks after intervention. Discussion This paper describes the rationale and design of a randomized double-blind, placebo-controlled trial that aims to determine the efficacy and safety of acupuncture intervention for neck pain caused by cervical spondylosis. The primary outcomes are changes in the NPQ score and neck physiological function. Secondary outcome measures include quality of life, adverse events, and relapse of neck pain. If successful, this project will provide evidence of the efficacy and safety of acupuncture for neck pain caused by cervical spondylosis. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-12002206. Registration date: 11 May 2012.

2013-01-01

381

PAIN, TRUNK MUSCLE STRENGTH, SPINE MOBILITY AND DISABILITY FOLLOWING LUMBAR DISC SURGERY  

Microsoft Academic Search

Objective: To study associations between pain, trunk muscle strength, flexibility and disability in patients with lumbar disc herniation 2 months after surgery. Design: Clinical cross-sectional survey. Participants: 172 operated lumbar disc herniation patients. Methods: Back and leg pain on Visual Analogue Scale, Oswestry Disability Index and Brief Depression Scale were applied to assess the subjectively perceived outcome. Isometric and dynamic

Arja Häkkinen; Jari Ylinen; Hannu Kautiainen; Olavi Airaksinen; Arto Herno; Ulla Tarvainen; Ilkka Kiviranta

2003-01-01

382

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

383

[Cervicogenic headache caused by lower cervical spondylosis].  

PubMed

We report a rare case of severe facial pain and headache due to cervical spondylosis successfully treated by surgical intervention. A 48-year-old woman had been suffering from severe left side facial pain and headache since she was 44 years old. Analgesics were not effective. At 48 years of age, a magnetic resonance imaging of the cervical spine revealed a degenerated disk at the C5/6 level with encroachment on the foramina and the cord. Anesthetic blockade to the C5/6 facet joint was effective, but was temporary. After the anterior decompression and stabilization using a titanium cage, the pain disappeared completely and has not recurred through 1 year of follow up. This report indicates that lower cervical root compression may cause cervicogenic headache, which can be treated effectively by surgical intervention. PMID:19432099

Kawabori, Masahito; Hida, Kazutoshi; Yano, Shunsuke; Iwasaki, Yoshinobu

2009-05-01

384

Cervical spine injuries associated with lateral mass and facet joint fractures: New classification and surgical treatment with pedicle screw fixation  

Microsoft Academic Search

To clarify the injury pattern, initial spinal instability, degree of discoligamentous injuries in cervical lateral mass and facet joint fractures, we retrospectively analyzed radiological parameters and introduced a new classification for these injuries. Surgical treatment was performed with cervical pedicle screw fixation (CPS), and overall neurological and radiological outcome was evaluated with a minimum follow-up period of 2 years. Lateral mass

Yoshihisa Kotani; Kuniyoshi Abumi; Manabu Ito; Akio Minami

2005-01-01

385

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

386

Dysphagia and hypervitaminosis A: Cervical hyperostosis  

Microsoft Academic Search

Vertebral hyperostosis typically predominates at the thoracic spine and causes only minor symptoms. Involvement of the cervical spine may cause dysphagia due to pressure on the esophagus. We report three cases of dysphagia revealing cervical hyperostosis.

Daniel Wendling; Chafika Hafsaoui; Jean-Marie Laurain; Michel Runge; Nadine Magy-Bertrand; Clément Prati

2009-01-01

387

Treatment of Neck Pain  

PubMed Central

Study Design Best evidence synthesis. Objective To identify, critically appraise, and synthesize literature from 1980 through 2006 on surgical interventions for neck pain alone or with radicular pain in the absence of serious pathologic disease. Summary of Background Data There have been no comprehensive systematic literature or evidence-based reviews published on this topic. Methods We systematically searched Medline for literature published from 1980 to 2006 on percutaneous and open surgical interventions for neck pain. Publications on the topic were also solicited from experts in the field. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our Best Evidence Synthesis. Results Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term out comes are improved with the surgical treatment of cervical radiculopathy compared to non operative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%–20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients. Conclusion Surgical treatment and limited injection procedures for cervical radicular symptoms may be reasonably considered in patients with severe impairments. Percutaneous and open surgical treatment for neck pain alone, without radicular symptoms or clear serious pathology, seems to lack scientific support.

Hurwitz, Eric L.; Cheng, Ivan; Carroll, Linda J.; Nordin, Margareta; Guzman, Jaime; Peloso, Paul; Holm, Lena W.; Cothe, Pierre; Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Cassidy, J. David; Haldeman, Scott

2008-01-01

388

Back pain and disability after Harrington rod fusion to the lumbar spine for scoliosis.  

PubMed

Back pain questionnaires were completed by a study group of 103 idiopathic scoliosis patients fused with Harrington rods from L3 or lower and a control group of 29 patients fused to L2 or above. Minimum time to follow-up examination was 2 years. The study group had a higher rate of secondary surgeries for complications or late disc disease below the fusion, a higher back pain score, more difficulties with normal daily activities, needed more regular pain medications, and had more episodes of back pain. Patients older than 30 years at surgery had more of these problems if fused to L3 or more caudally. The amount of remaining lumbar lordosis correlated significantly with the difficulty of normal daily activities. PMID:1387979

Paonessa, K J; Engler, G L

1992-08-01

389

Structural changes in the cervical facet capsular ligament: potential contributions to pain following subfailure loading.  

PubMed

While studies have demonstrated the cervical facet capsule is at risk for tensile injury during whiplash, the relationship between joint loading, changes in the capsule's structure, and pain is not yet fully characterized. Complementary approaches were employed to investigate the capsule's structure-function relationship in the context of painful joint loading. Isolated C6/C7 facet joints (n=8) underwent tensile mechanical loading, and measures of structural modification were compared for two distraction magnitudes: 300 m (PV) and 700 m (SV). In a matched in vivo study, C6/C7 facet joints (n=4) were harvested after the same SV distraction and the tissue was sectioned to analyze collagen fiber organization using polarized light microscopy. Laxity following SV distraction (7.30+/-3.01%) was significantly greater (p<0.001) than that produced following PV distraction (0.99+/-0.44%). Also, SV distractions produced significantly higher maximum principal strain (p<0.001) in the capsule and resulted in significantly greater decreases in stiffness (p=0.002) when compared to PV distraction. After SV distraction in vivo, mean angular deviation of the fiber direction (16.8+/-2.6 degrees) was significantly increased (p=0.004) relative to naive samples in the lateral region of the capsule, indicating collagen fiber disorganization. These findings demonstrate that certain subfailure loading conditions are associated with altered joint mechanics and collagen fiber disorganization and imply ligament damage. Damage in the capsule has the potential to both directly modulate nerve fiber signaling and produce sustained physiologic modifications that may initiate persistent pain. PMID:18278597

Quinn, Kyle P; Lee, Kathryn E; Ahaghotu, Chukwunyere C; Winkelstein, Beth A

2007-10-01

390

Health care burden of cervical spine fractures in the United States: analysis of a nationwide database over a 10-year period.  

PubMed

OBJECT The objective of this work was to search a national health care database of patients diagnosed with cervical spine fractures in the US to analyze discharge, demographic, and hospital charge trends over a 10-year period. METHODS Clinical data were derived from the Nationwide Inpatient Sample (NIS) for the years 1997 through 2006. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with cervical spine fractures with and without spinal cord injury (SCI) were identified using the appropriate ICD-9-CM codes. The volume of discharges, length of stay (LOS), hospital charges, total national charges, discharge pattern, age, and sex were analyzed. National estimates were calculated using the HCUPnet tool. RESULTS Approximately 200,000 hospitalizations were identified. In the non-SCI group, there was a 74% increase in hospitalizations and charges between 1997 and 2006, but LOS changed minimally. There was no appreciable change in the rate of in-hospital mortality (< 3%), but discharges home with home health care and to skilled rehabilitation or nursing facilities increased slightly. In the SCI group, hospitalizations and charges increased by 29 and 38%, respectively. There were no significant changes in LOS or discharge status in this group. Spinal cord injury was associated with increases in LOS, charges, and adverse outcomes compared with fractures without SCI. Total national charges associated with both groups combined exceeded $1.3 billion US in 2006. CONCLUSIONS During the studied period, increases in hospitalizations and charges were observed in both the SCI and non-SCI groups. The percentage increase was higher in the non-SCI group. Although SCI was associated with higher adverse outcomes, there were no significant improvements in immediate discharge status in either group during the 10 years analyzed. PMID:20594019

Baaj, Ali A; Uribe, Juan S; Nichols, Tann A; Theodore, Nicholas; Crawford, Neil R; Sonntag, Volker K H; Vale, Fernando L

2010-07-01

391

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

392

Effects of three different conservative treatments on pain, disability, quality of life, and mood in patients with cervical spondylosis  

Microsoft Academic Search

This aim of this study was to determine the effect of different conservative treatment methods on pain intensity, disability,\\u000a quality of life, and mood in patients with cervical spondylosis during a 6-month period. The patients were randomized into\\u000a three groups. The 1st group (n = 20) was treated with active and passive physiotherapy methods, the 2nd group (n = 20) with active treatment methods,

Emine Aslan Telci; Ayse Karaduman

393

Therapeutic Exercise for Athletes With Nonspecific Neck Pain  

PubMed Central

Context: Benign neck pain is common in athletes and is usually the result of minor sprains, strains, or contusions. Athletes with neck pain may have deficits in cervical and/or upper thoracic mobility, muscle recruitment, strength and endurance, repositioning acuity, postural stability, and oculomotor control. Evidence Acquisition: A Medline search was performed via PubMed to locate articles of any publication date through December 2011 using the search terms cervical pain, neck pain, athlete, athletic, therapeutic exercise, and rehabilitation. Reference lists of retrieved articles were searched for additional relevant references. Results: Therapeutic exercise has promise as an intervention for individuals with neck pain, although reports on isolated athletic populations are lacking. To date, recommendations for specific therapeutic exercises have been derived largely from anecdotal or uncontrolled level IV or V evidence. Conclusion: Clinicians should consider deficits, functional limitations, irritability level, and the sport’s cervical spine stress profile when selecting exercises for athletes with neck pain.

2012-01-01

394

Effective management of spinal pain in one hundred seventy-seven patients evaluated for manipulation under anesthesia  

Microsoft Academic Search

Objective: To demonstrate that manipulation under anesthesia (MUA), a conservative treatment modality, is both safe and efficacious in the treatment of both acute and chronic spinal pain disorders in appropriately selected patients. MUA can be safely used to treat pain arising from the cranial, cervical, thoracic, and lumbar spine, as well as the sacroiliac and pelvic region. Setting: An ambulatory

Daniel T. West; Robert S. Mathews; Matthew R. Miller; George M. Kent

1999-01-01

395

Low Back Pain: Considerations of When to Refer Patients for Interventional Spine Procedures  

Microsoft Academic Search

\\u000a Although this textbook will not specifically address the details of lumbosacral region spinal injection procedures, the important\\u000a issue of when to refer a patient for a possible lumbosacral spinal injection will be discussed. This is an important topic\\u000a to physicians involved with musculoskeletal medicine given the frequency with which patients report low back pain and the\\u000a morbidity associated with it.

Eric L. Altschuler; Brian F. White; Todd P. Stitik; Jong H. Kim

396

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

397

Metric and morphological study of the upper cervical spine from the Sima de los Huesos site (Sierra de Atapuerca, Burgos, Spain).  

PubMed

In this article, the upper cervical spine remains recovered from the Sima de los Huesos (SH) middle Pleistocene site in the Sierra de Atapuerca (Burgos, Spain) are described and analyzed. To date, this site has yielded more than 5000 human fossils belonging to a minimum of 28 individuals of the species Homo heidelbergensis. At least eleven individuals are represented by the upper cervical (C1 and C2) specimens: six adults and five subadults, one of which could represent an adolescent individual. The most complete adult vertebrae (three atlases and three axes) are described, measured, and compared with other fossil hominins and modern humans. These six specimens are associated with one another and represent three individuals. In addition, one of these sets of cervical vertebrae is associated with Cranium 5 (Individual XXI) from the site. The metric analysis demonstrates that the Sima de los Huesos atlases and axes are metrically more similar to Neandertals than to our modern human comparative sample. The SH atlases share with Neandertals a sagittally elongated canal. The most remarkable feature of the SH (and Neandertal) axes is that they are craniocaudally low and mediolaterally wide compared to our modern male sample. Morphologically, the SH sample shares with Neandertals a higher frequency of caudally projected anterior atlas arch, which could reflect greater development of the longus colli muscle. In other features, such as the frequency of weakly developed tubercles for the attachment of the transverse ligament of the atlas, the Sima de los Huesos fossils show intermediate frequencies between our modern comparative samples and the Neandertals, which could represent the primitive condition. Our results are consistent with the previous phylogenetic interpretation of H. heidelbergensis as an exclusively European species, ancestral only to H. neanderthalensis. PMID:17467038

Gómez-Olivencia, Asier; Carretero, José Miguel; Arsuaga, Juan Luis; Rodríguez-García, Laura; García-González, Rebeca; Martínez, Ignacio

2007-04-30

398

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

2011-03-23

399

Congenital Defect of the Posterior Arch of Cervical Spine : Report of Three Cases and Review of the Current Literature  

PubMed Central

Abnormalities of the posterior arch, including congenitally absent cervical pedicle and cervical spondylolysis, are rare entities that are usually found incidentally on neck radiographs. It is important to recognize these characteristic radiological features because their radiographic appearance may cause them to be confused with more serious entities such as fractures, locked facets, and tumor-induced bony erosions. Also, it is important to distinguish these abnormalities from similar pathologies to prevent the use of inappropriate treatment. We report the relevant clinical and radiological findings seen in three cases of posterior arch defect after trauma with review of pertinent literature.

Song, Kyo-Chang; Cho, Kyoung-Suok

2010-01-01

400

Leprotic cervical spondylodiscitis.  

PubMed

Leprosy is a chronic infectious disease caused by the Mycobacterium leprae that leads to leprotic neuropathy involving the peripheral nerve and several characteristic skin lesions. Skeletal involvement can occur in peripheral joints, such as the wrist and the ankle. However, there is no report of an axial leprotic lesion involving the spine or paraspinal soft tissue. The authors report the first case of a leprotic cervical lesion involving the axial skeletal system. A 48-year-old male presented with neck pain and severe pain in the right suprascapular area and left arm. Preoperative MRI of the cervical spine revealed signal changes in the prevertebral soft tissue at the level of the C3, 4, 5 vertebral bodies. There were a lower signal intensity on T1-weighted image and high signal intensity on T2WI of the bone marrow at the level of the C5 and C6 vertebral bodies, and a C5/6 segmental ossification of the posterior longitudinal ligament. There were herniated cervical disc on the left C5/6 with C6 root and the right side of C6/7 with a C7 root compression. He was previously diagnosed with leprosy when he was 14 years old and received treatment intermittently over the course of 7 years. But patient did not disclose his past history. Surgical intervention was conducted using an anterior cervical approach. An incision was made in the anterior longitudinal ligament at C5/6, and a pinkish gray friable gelatinous material was observed on the C5/6 disc and on the anterior lower one-third surface of the C5 vertebral body. Specimens were obtained and subjected to pathological