Treatment results of 32 patients with pathologic fractures of cervical vertebrae bodies were analyzed. Vertebral destruction was due to tumour metastases (18 patients), nonspecific spondylitis (12 patients) and fibrocystic displasia (2 patients). Myelopathy with local and radicular pain syndrome was registered in all cases before the operation. All patients underwent the destroyed vertebral body replacement by the carbonic implant with collapanoplasty. Pain was relieved in all cases, full and partial myelopathy regression was registered in 27 and 5 patients, respectively. PMID:20336046
Kavalerski?, G M; Karanadze, A N; Gordeev, G G; Fazilov, Sh K; Nikuradze, V K
Functional deficits after whiplash injury can be analyzed with a quite novel radiologic method by examination of joint-blocks in C0/1 and C1/2. Thereto the movability of C0, C1 and C2 is determined with three spiral CT-scans of the patient's cervical spine. One series in neutral and one in maximal active lateral right and left rotation each. Previous methods were slice based and time consuming when manually evaluated. We propose a new approach to a computation of these angles in 3D. After a threshold segmentation of bone tissue, a rough 2D classification takes place for C0, C1 and C2 in each rotation series. The center of an axial rotation for each vertebra is gained from the approximation of its center of gravity. The rotation itself is estimated by a cross-correlation of the radial distance functions. From the previous rotation the results are taken to initialize a 3D matching algorithm based on the sum of squared differences in intensity. The optimal match of the vertebrae is computed by means of the multidimensional Powell minimization algorithm. The three translational and three rotational components build a six-dimensional search-space. The vertebrae detection and rotation computation is done fully automatic.
Compared with the traditional anterior and posterior operation,anterior transpedicular screw fixation (ATPS) has many advantages of hiomechanics, relative safety. Both problems of decompression and reconstruction can be resolved only through an anterior approach. A rather peculiar anatomic channel was used in ATPS, but no special tools was used in system supporting for anterior pedicle screw to place,so the indications of ATPS of lower cervical vertebrae is relatively narrow,it cannot replace of traditional anterior and posterior surgery. Problems of accurately inserting screws and the development of internal fixation device about ATPS is a hot spot of current research and a future direction. In recent years,many scholars have systematically studied the technique, and applied it in clinic gradually and achieved good effects. In order to improve the level of application,recent articles were analyzed retrospectively in this paper,and the studies of anatomy,biomechanical and clinical application of ATPS were reviewed. PMID:24490542
Li, Jie; Zhao, Lin-Jun; Xu, Rong-Ming; Zhang, Ming; Jiang, Wei-Yu; Qi, Feng
The gross anatomical features of human cervical vertebrae during the fetal-neonatal period were investigated in order to develop morphological standards for the individual ossification centres for use in forensic and anthropological osteology. It was found that the morphology of the cervical vertebral arches and the centra cannot be used for the determination of fetal age although the dens of the axis displays some developmental differences which may be useful for the determination of fetal maturity.
CASTELLANA, C.; KOSA, F.
Osteoradionecrosis (ORN) is one of the common late adverse effects that follow radiation therapy for head and neck cancers. ORN usually develops on the mandible and less frequently on the maxilla. We present three cases of ORN of the cervical vertebrae, which is rarely reported. Two patients suffered from secondary osteomyelitis after neoadjuvant chemotherapy followed by definitive concurrent chemoradiation therapy with a hyperfractionated and an accelerated hyperfractionated regimen, respectively. For these patients, the high intensity of treatment was considered the cause of ORN. The third patient underwent concurrent chemoradiation therapy for upper thoracic esophageal cancer and subsequently underwent endoscopic laser resection and radiation therapy for hypopharyngeal cancer. ORN developed in the area of reirradiation. In this case, an excessive radiation dose was considered the cause. ORN of cervical vertebrae, different from that of the mandible and maxilla, has a risk of radiculopathy and myelopathy. In the future, ORN of cervical vertebrae will increase because metachronous double cancers will increase and opportunities for reirradiation, in turn, will increase. To prevent this, it is necessary to optimize the treatment schedule for radiation therapy, including the total dose, fractionation, and concurrent chemotherapy, and to decrease the volume of cervical vertebrae within the irradiation field. PMID:20585930
Kosaka, Yasuhiro; Okuno, Yoshishige; Tagawa, Yumiko; Ueki, Nami; Itoh, Kyo; Shinohara, Shogo; Kikuchi, Masahiro
The cervical vertebral column bears or balances the weight of the head supported by the nuchal muscles that partly originate from the cervical vertebrae. The position of the head relative to the vertebral column, and consequently locomotion and posture behavior, could thus be associated with the form of the cervical vertebrae. In spite of this assumption and some empirical indications along these lines, primate vertebral morphologies have been reported to be very similar and not clearly related to locomotion. We therefore study the relationship between the morphology of the first cervical vertebra, the atlas, and the locomotion pattern within primates using a geometric morphometric approach. Our analysis is based on a total of 116 vertebrae of adult Homo sapiens, Gorilla gorilla, Pan troglodytes, Pongo pygmaeus, Hylobates lar, Macaca mulatta, Papio hamadryas, Ateles geoffroyi, and Alouatta palliata. On each atlas, 56 landmarks were digitized and superimposed by Procrustes registration. The resulting shape variables were analyzed by principal component analysis, multivariate regression, and partial least-squares analysis. We found that the nine primate species differ clearly in their atlas morphology and that allometric shape change is distinct between the nonhuman primates and Homo sapiens. We could further identify morphological features that relate to the species' locomotion pattern. Human atlas shape, however, cannot be predicted by an extrapolation of the nonhuman primate model. This implies that either the primate atlas is generalized enough to allow bipedal locomotion or else the human atlas morphology is a unique adaptation different from that in the more orthograde nonhuman primates. PMID:16955497
Manfreda, Evelyn; Mitteroecker, Philipp; Bookstein, Fred L; Schaefer, Katrin
. Earlier studies have shown that single-energy quantitative computed tomography (SEQCT) is a reliable method for bone mineral\\u000a density (BMD) measurements in thoracic and lumbar vertebrae. Moreover, SEQCT has proved to be a useful parameter in the selection\\u000a of appropriate implants in cervical spondylodesis. The aim of this study was to determine the accuracy of SEQCT in cervical\\u000a vertebrae BMD
P.-M. Zink; M. Samii; W. Luedemann; M. Bellinzona; M. Prokop
An important criterion of orthodontic diagnosis is the determination of the skeletal maturation stage. The cervical vertebral maturation (CVM) method is presented as an alternative to skeletal maturation determination. However, studies published to date concerning CVM have generally been cross-sectional. The aim of this investigation was to longitudinally evaluate growth and development with the CVM method. Lateral cephalometric radiographs of 41 girls, aged 9-16 years, collected between 1978 and 1984 were used to evaluate changes in C2, C3, and C4 dimensions. The mean values, standard deviations, maximum and minimum values of cervical vertebrae growth, and growth rate were calculated for every age and age interval. Cumulative growth increment was determined by summing annual mean values for each parameter. CVM stages were initially evaluated according to the method of Lamparski. The time differences between the following CVM stages were evaluated with a paired t-test. The total length increment was distinct for C2 but similar for C1, C3, and C4. Total length increments reached their maximum between CVM stages 2 and 3, except for C3. The total length increment of C3 reached its peak 1 year earlier. The height increments of the spinose processes of C2, C3, and C4 were similar. The results showed that height increments were greater than length increments, which was due to changes in the anatomical pattern. Vertical growth displayed a decreasing trend from the upper to the lower cervical vertebrae. Determination of skeletal maturation from dimensional measurements and anatomical changes of the cervical vertebrae will facilitate orthodontic evaluation by eliminating the need for hand-wrist films and, therefore, decrease the patient's exposure to radiation. PMID:21511819
Altan, Müge; Nebio?lu Dalci, Öykü; ?seri, Haluk
Radiologists are always looking for more reliable and robust methods to help them assess, describe and classify bone structures in x-ray images. Although, in the recent years, computer-assisted techniques have proven to be useful in this regard, they still face difficult challenges such as inter-subject variability in shape and a lack of contrast in the digitized images of radiographs. These challenges have focused the attention of the computer vision research community on techniques that employ deformable models. One such technique, i.e., Active Shape Models (ASM), has received significant attention due to its ability to capture the shape variability and to deal with the poor quality of the images in a straightforward manner. However, as is often the case with iterative optimization techniques, success of the ASM search step is highly dependent on the initial positioning of the mean shape on the target image. Within the specific framework of automatic, cervical vertebra segmentation, we have developed and tested an up-front preprocessing algorithm that estimates the orientation and position of the cervical vertebrae in x-ray images and leads to a more accurate, initial placement of the mean shape. The algorithm estimates the orientation of the spine by calculating parallel-beam line integrals of the x-ray images. The position of the spine is estimated by considering the density of edges perpendicular to the line integral that gives the estimate of the orientation. The output of the algorithm is a bounding box surrounding the cervical spine area. Morphometric points placed by expert radiologists on a set of 40, digitized radiographs were used to quantify the efficacy of the estimation. This test yielded acceptable results in estimating the orientation and the locating of the cervical spine.
Zamora, Gilberto; Sari-Sarraf, Hamed; Mitra, Sunanda; Long, L. Rodney
Growth differentiation factor 11 (GDF11) is one of the significant genes that control skeletal formation. Knockout of GDF11 function causes abnormal patterning of the anterior/posterior axial skeleton. The mRNA of GDF11 is initially translated to a precursor protein that undergoes a proteolytic cleavage to generate the C-terminal peptide or mature GDF11, and the N-terminal peptide named GDF11 propeptide. The propeptide can antagonize GDF11 activity in vitro. To investigate the effects of GDF11 propeptide on GDF11 function in vivo, we generated transgenic mice that over-express the propeptide cDNA in skeletal tissue. The transgenic mice showed formation of extra ribs on the seventh cervical vertebra (C7) as a result of transformation of the C7 vertebra into a thoracic vertebra. The GDF11 propeptide transgene mRNA was detected in tail tissue in embryos and was highly expressed in tail and calvaria bones after birth. A high frequency of C7 rib formation was noticed in the transgenic mouse line with a high level of transgene expression. The anterior boundaries of Hoxa-4 and Hoxa-5 mRNA in situ expressions showed cranial shifts from their normal prevertebra locations in transgenic embryos. These results demonstrated significant effects of GDF11 propeptide transgene on vertebral formation, which are likely occurring through depressing GDF11 function and altered locations of Hoxa-4 and Hoxa-5 expression. PMID:21049546
Li, Zicong; Kawasumi, Miyuri; Zhao, Baoping; Moisyadi, Stefan; Yang, Jinzeng
SUMMARY Growth differentiation factor 11 (GDF11) is one of the significant genes that control skeletal formation. Knockout of GDF11 function causes abnormal patterning of the anterior/posterior axial skeleton. The mRNA of GDF11 is initially translated to a precursor protein that undergoes a proteolytic cleavage to generate the C-terminal peptide or mature GDF11, and the N-terminal peptide named GDF11 propeptide. The propeptide can antagonize GDF11 activity in vitro. To investigate the effects of GDF11 propeptide on GDF11 function in vivo, we generated transgenic mice that over-express the propeptide cDNA in skeletal tissue. The transgenic mice showed formation of extra ribs on the seventh cervical vertebra (C7) as a result of transformation of the C7 vertebra into a thoracic vertebra. The GDF11 propeptide transgene mRNA was detected in tail tissue in embryos and was highly expressed in tail and calvaria bones after birth. A high frequency of C7 rib formation was noticed in the transgenic mouse line with a high level of transgene expression. The anterior boundaries of Hoxa-4 and Hoxa-5 mRNA in situ expressions showed cranial shifts from their normal prevertebra locations in transgenic embryos. These results demonstrated significant effects of GDF11 propeptide transgene on vertebral formation, which are likely occurring through depressing GDF11 function and altered locations of Hoxa-4 and Hoxa-5 expression.
LI, ZICONG; KAWASUMI, MIYURI; ZHAO, BAOPING; MOISYADI, STEFAN; YANG, JINZENG
Defects in cervical vertebrae in boric acid-exposed rat embryos are associated with anterior shifts of hox gene expression domains Nathalie Wery,1 Michael G. Narotsky,2 Nathalie Pacico,1 Robert J. Kavlock,2 Jacques J. Picard,1 AND Francoise Gofflot,1* 1Unit of Developme...
Zur Ursache fokaler Mehrspeicherungen in der Halswirbelsaeule bei skelettszintigraphischen Routineuntersuchungen. (Contribution on the causes of increased degrees of density in the cervical vertebrae during routine skeletal scintiscanning).
On the basis of the findings revealed by this study the scintigraphic image and site of degenerative changes in the in region of the cervical vertebrae (routine examinations in a total of 61 patients) were rated as typical enough to permit benign skeletal...
Background Owls possess an extraordinary neck and head mobility. To understand this mobility it is necessary to have an anatomical description of cervical vertebrae with an emphasis on those criteria that are relevant for head positioning. No functional description specific to owls is available. Methodology/Principal findings X-ray films and micro-CT scans were recorded from American barn owls (Tyto furcata pratincola) and used to obtain three-dimensional head movements and three-dimensional models of the 14 cervical vertebrae (C1?C14). The diameter of the vertebral canal, the zygapophyseal protrusion, the distance between joint centers, and the pitching angle were quantified. Whereas the first two variables are purely osteological characteristics of single vertebrae, the latter two take into account interactions between vertebrae. These variables change in characteristic ways from cranial to caudal. The vertebral canal is wide in the cranial and caudal neck regions, but narrow in the middle, where both the zygapophyseal protrusion and the distance between joint centers are large. Pitching angles are more negative in the cranial and caudal neck regions than in the middle region. Cluster analysis suggested a complex regionalization. Whereas the borders (C1 and C13/C14) formed stable clusters, the other cervical vertebrae were sorted into 4 or 5 additional clusters. The borders of the clusters were influenced by the variables analyzed. Conclusions/Significance A statistical analysis was used to evaluate the regionalization of the cervical spine in the barn owl. While earlier measurements have shown that there appear to be three regions of flexibility of the neck, our indicators suggest 3–7 regions. These many regions allow a high degree of flexibility, potentially facilitating the large head turns that barn owls are able to make. The cervical vertebral series of other species should also be investigated using statistical criteria to further characterize morphology and the potential movements associated with it.
Krings, Markus; Nyakatura, John A.; Fischer, Martin S.; Wagner, Hermann
A 53-year-old man with a 13-year history ofankylosing spondylitis presented to the emergency clinic of another hospital because of neck pain after a fall from a low stepladder. The patient was put at ease and discharged after physical examination and X-ray of the cervical spine revealed nothing out of the ordinary. Because his neck pain persisted, the patient contacted his rheumatologist. New cervical X-rays revealed fractures of the body and articular process of CVI and CVII. The patient was referred to our hospital for orthopaedic treatment. The fractures healed during 2.5 months' treatment with halotraction and a halovest. All patients with ankylosing spondylitis with neck pain after trauma have an unstable cervical fracture until proven otherwise. Cervical fractures should be excluded in all cases and other diagnostic tools (CT-scan or MRI) must be used whenever necessary. PMID:16136744
Graat, H C A; van Bommel, E; Pöll, R G
Introduction Spontaneous pathological fractures of the cervical spine due to tuberculosis are rare. But with escalating incidences of atypical presentations of tubercular disease, clinicians should exercise a high index of suspicion for early diagnosis of such cases. Case presentation We present a case of a 50-year-old Hindu man from northern India, who complained of pain and stiffness in his neck. His radiographs showed a fracture in his second cervical vertebral body. But further investigations raised the suspicion of an infective pathology, which was corroborated by magnetic resonance imaging and fine needle aspiration cytology. His symptoms improved and the fracture healed following antitubercular chemotherapy and immobilization. Conclusion In endemic regions like India, clinicians should be on the lookout for atypical presentations of tuberculosis. Any suspicious lesion should be evaluated with care for clinical, radiological and laboratory evidences of the infection. The affected spine should be protected and appropriate chemotherapy should be instituted at the earliest opportunity.
Monostotic fibrous dysplasia of the spine is a rare entity. Only 26 cases, of which 11 were located in the cervical spine,\\u000a are to be found in the literature. We report a 56-year-old male patient with cervicobrachialgia of half year’s duration. Radiographs\\u000a showed a diffuse destruction of the vertebral body and the spinous process of C4. A biopsy of the
D. Proschek; R. Orler; E. Stauffer; P. Heini
The assessment of age-at-death in non-adult skeletal remains is under constant review. However, in many past societies an individual's physical maturation may have been more important in social terms than their exact age, particularly during the period of adolescence. In a recent article (Shapland and Lewis: Am J Phys Anthropol 151 (2013) 302-310) highlighted a set of dental and skeletal indicators that may be useful in mapping the progress of the pubertal growth spurt. This article presents a further skeletal indicator of adolescent development commonly used by modern clinicians: cervical vertebrae maturation (CVM). This method is applied to a collection of 594 adolescents from the medieval cemetery of St. Mary Spital, London. Analysis reveals a potential delay in ages of attainment of the later CVM stages compared with modern adolescents, presumably reflecting negative environmental conditions for growth and development. The data gathered on CVM is compared to other skeletal indicators of pubertal maturity and long bone growth from this site to ascertain the usefulness of this method on archaeological collections. PMID:24318949
Shapland, Fiona; Lewis, Mary E
This was an in vitro and in vivo study to develop a novel artificial cervical vertebra and intervertebral complex (ACVC) joint in a goat model to provide a new method for treating degenerative disc disease in the cervical spine. The objectives of this study were to test the safety, validity, and effectiveness of ACVC by goat model and to provide preclinical data for a clinical trial in humans in future. We designed the ACVC based on the radiological and anatomical data on goat and human cervical spines, established an animal model by implanting the ACVC into goat cervical spines in vitro prior to in vivo implantation through the anterior approach, and evaluated clinical, radiological, biomechanical parameters after implantation. The X-ray radiological data revealed similarities between goat and human intervertebral angles at the levels of C2-3, C3-4, and C4-5, and between goat and human lordosis angles at the levels of C3-4 and C4-5. In the in vivo implantation, the goats successfully endured the entire experimental procedure and recovered well after the surgery. The radiological results showed that there was no dislocation of the ACVC and that the ACVC successfully restored the intervertebral disc height after the surgery. The biomechanical data showed that there was no significant difference in range of motion (ROM) or neural zone (NZ) between the control group and the ACVC group in flexion-extension and lateral bending before or after the fatigue test. The ROM and NZ of the ACVC group were greater than those of the control group for rotation. In conclusion, the goat provides an excellent animal model for the biomechanical study of the cervical spine. The ACVC is able to provide instant stability after surgery and to preserve normal motion in the cervical spine.
Qin, Jie; He, Xijing; Wang, Dong; Qi, Peng; Guo, Lei; Huang, Sihua; Cai, Xuan; Li, Haopeng; Wang, Rui
Background Extraneural and extracranial metastases of glioblastoma (GB) are very rarely reported in the literature. They occur in only 0.2% of all GB patients. Case presentation We present a 40 year old caucasian male with secondary GB and first diagnosis of an astrocytoma world health organisation (WHO) grade II through stereotactic biopsy in 2006. He presented a new hemiparesis and a progress of the known mass lesion in 2008. Subtotal tumor resection was performed and the histological examination verified a GB. After combined radio- and chemotherapy the adjuvant temozolomide therapy was not started because of non-compliance. In 2011 a second local relapse was resected and 4 month later the patient presented a fast progressing tetraparesis. Cervical CT and MRI scan showed a mass lesion infiltrating the fifth and sixth vertebra with infiltration of the spinal canal and large paravertebral tumor masses. Emergency surgery was performed. By additional screening further metastases were detected in the thoracal and lumbal spine and surprisingly also in the lung and pulmonary lymphnodes. Palliative radio- and chemotherapy of the pulmonal lesions was completed, further antitumor therapy was rejected. The patient died 10 months after diagnosis of the extraneural metastases. Conclusion Especially young “long-term-survivors” seem to have a higher risk of extraneural metastasis from a GB and appropriate staging should be performed in these cases.
Objective: The cervical anatomy has been shown to affect injury patterns in vehicle crashes. Characterizing the spine anatomy and changes associated with growth and gender is important when assessing occupant protection. In this study, selected cervical characteristics were quantified. Methods: Computed tomography (CT) scans of 750 patients were selected from the University of Michigan trauma database; 314 were children and 436 were adults. Four variables were obtained: the maximum spinal canal radius, vertebral body depth, facet angles, and retroversion angles. Results: The cervical spine measurements varied with age and gender. The body depth increased nonlinearly with age. The average vertebral body depth at C4 was 9.2 ± 0.38 mm in the 0-3 age group, 15.7 ± 0.29 mm in the 18-29 age group, and 17.2 ± 0.46 mm in the 60+ age group. Pediatric and adult males had larger vertebral body depth than females overall, irrespective of vertebral level (P <.001). Compared to females, the vertebral body depth was 8-9 percent greater in male children and 13-16 percent greater in adult males. The average radius varied with gender, with male children generally having a larger radius than females irrespective of vertebral level (P <.001). Overall, spinal canal radius was smallest in the 0-3 and 60+ age groups and largest in the 18-29 age group. The C4 radius was 5.91 ± 0.17, 6.28 ± 0.14, and 6.73 ± 0.17 mm respectively. The radius was larger in the 4-7 age group than in the 0-3 age group, irrespective of vertebral level (P <.0001). There were nonsignificant radius changes between the 4-7 and 8-11 age groups and the 8-11 and age 12-17 groups, suggesting that the size of the spinal cord reaches near maturation by the age of 7. Facet angles decreased with age in children and increased with age in adults. The average facet angles were largest in the 0-3 age group (P <.1, C2-C6). Adult facet angles were greater in the 60+ age group than in the 18-29 age group (P <.0001, C2-C6). Males had larger facet angles than females overall (P <.01 at C2, C5-C7). The retroversion angles were largest at C6 and C7. They increased with age in children and decreased in the adult population; they were larger (5-22%) in the 18-29 age group than in the 60+ age group (P <.0001, C2-C6). Conclusions: The results obtained in this study help explain variations in cervical anatomical changes associated with age and gender. The information is useful when assessing differences in injury patterns between different segments of the population. Anatomical measurements of the cervical spine should be considered for the development of models used to assess injury mechanisms for various occupant age groups. PMID:24625249
Parenteau, Chantal S; Wang, Nicholas C; Zhang, Peng; Caird, Michelle S; Wang, Stewart C
The dissertation compares the operation results with each of the two different graft materials by radiography. By means of lateral radiographic images of the nede vertebrae the following criteria were evaluated: 1. The height of the segment 2. The curving...
The strength of the vertebrae in the age group from 19 to 40 years underwent changes under the rate of loading 10 mm/min, on the average from 400 kg in the cervical region to 1300 kg in the lumbar one. In case of axial loading the sublimbic zone proved to...
S. A. Gozulov V. A. Korzhenyants V. G. Skrupnik Y. N. Sushkov
A 69-year-old lady presented with back pain for 5 days associated with spiking temperatures, lower limb weakness and urinary retention. Urgent MRI showed discitis at the disc between cervical vertebra seven (C7), thoracic vertebra one (T1) and lumbar vertebra three and four (L3-4), associated dural inflammation, stenosis of the cervical spinal canal and cervical cord oedema at the level of C3. No definite epidural abscess was seen. She was transferred to the spinal unit for observation. Following transfer she rapidly developed respiratory compromise and required emergency spinal decompression later that day.
Idris, Salah; Collum, Niall
Cervical spine instability in children is rare but not exceptional and may be due to many factors. Although it mostly occurs at the upper cervical spine, all vertebrae from the occiput to T1 may be involved. It may be acute or chronic, occurring secondary to trauma or due to congenital anomaly, skeletal or metabolic dystrophy or rheumatoid arthritis. It can be isolated or associated with other musculoskeletal or visceral anomalies. A thorough knowledge of embryology, anatomy, physiology and physiopathology of the cervical spine in children is essential to avoid pitfalls, recognize normal variants and identify children at risk of developing cervical spine instability and undertake the appropriate treatment.
El Hage, Samer; Rachkidi, Rami; Kharrat, Khalil; Dagher, Fernand; Kreichati, Gabi
Lumbosacral transitional vertebrae (LSTV) are a common finding in the general population. Their clinical significance is controversial with no consensus as to their relationship to low back pain or disc prolapse. However, on magnetic resonance imaging (MRI) they may be difficult to positively identify on sagittal sequences and can lead to confusion with respect to numbering of lumbar discs and vertebrae, with the consequent risk of surgical intervention at an inappropriate level. The imaging findings of LSTV on plain radiography and MRI are reviewed and their clinical significance discussed. PMID:15488846
Hughes, R J; Saifuddin, A
Lumbosacral transitional vertebrae (LSTV) are a common finding in the general population. Their clinical significance is controversial with no consensus as to their relationship to low back pain or disc prolapse. However, on magnetic resonance imaging (MRI) they may be difficult to positively identify on sagittal sequences and can lead to confusion with respect to numbering of lumbar discs and
R. J. Hughes; A. Saifuddin
The problem of vertebrae segmentation in digitized x-ray images is addressed with a hierarchical approach that combines three different methodologies. As a starting point, two customized active shape models are trained on data sets of cervical and lumbar images, respectively. Here, a methodology to include edge information in the gray-level modeling part of the active shape models is developed to increase the representativeness of the model and to improve the chances of finding vertebral boundaries. Active shape models' initialization shortcoming is then addressed by a customized implementation of the Generalized Hough Transform, which provides an estimate of the pose of the vertebrae within target images. Active shape models' shortcoming of lack of local deformation is addressed by a customized implementation of the technique of Deformable Models. In this implementation, an energy minimization approach is employed in which the external energy term is extracted from the training set of images and the internal energy terms control the shape of the template. Segmentation results on data sets of cervical and lumbar images show that the proposed hierarchical approach produces errors of less than 3mm in 75% of the cervical images and 6.4mm in 50% of the lumbar images.
Zamora, Gilberto; Sari-Sarraf, Hamed; Long, L. Rodney
The differential diagnosis of an osteoblastic vertebral lesion (ivory vertebra) includes metastatic prostate cancer, lung cancer, lymphoma, osteosarcoma and Paget's disease. We report a case of a man who was initially diagnosed with Paget's disease on vertebral biopsy. He failed to respond to conventional bisphosphate therapy. The review of the original biopsy specimen showed metastatic carcinoid tumor involving the bone marrow. The various features of carcinoid tumors metastasizing to the skeleton are briefly reviewed. PMID:11021770
Basaria, S; McCarthy, E F; Belzberg, A J; Ball, D W
This review constitutes the first of four reviews that systematically address contemporary knowledge about the mechanical behavior of the cervical vertebrae and the soft-tissues of the cervical spine, under normal conditions and under conditions that result in minor or major injuries. This first review considers the normal kinematics of the cervical spine, which predicates the appreciation of the biomechanics of
Nikolai Bogduk; Susan Mercer
Automatically detecting vertebral bodies in X-Ray images is a very complex task, especially because of the noise and the low contrast resulting in that kind of medical imagery modality. Therefore, the contributions in the literature are mainly interested in only 2 medical imagery modalities: Computed Tomography (CT) and Magnetic Resonance (MR). Few works are dedicated to the conventional X-Ray radiography and propose mostly semi-automatic methods. However, vertebra detection is a key step in many medical applications such as vertebra segmentation, vertebral morphometry, etc. In this work, we develop a fully automatic approach for the vertebra detection, based on a learning method. The idea is to detect a vertebra by its anterior corners without human intervention. To this end, the points of interest in the radiograph are firstly detected by an edge polygonal approximation. Then, a SIFT descriptor is used to train an SVM-model. Therefore, each point of interest can be classified in order to detect if it belongs to a vertebra or not. Our approach has been assessed by the detection of 250 cervical vertebræ on radiographs. The results show a very high precision with a corner detection rate of 90.4% and a vertebra detection rate from 81.6% to 86.5%.
Lecron, Fabian; Benjelloun, Mohammed; Mahmoudi, Saïd
A case of a Schmorl's node in the cervical vertebra causing neck pain is reported. An inflammatory focus was found on histological examination of Schmorl's node indicating a possible mechanism of pain production. Images
Lipson, S J; Fox, D A; Sosman, J L
A case of a Schmorl's node in the cervical vertebra causing neck pain is reported. An inflammatory focus was found on histological examination of Schmorl's node indicating a possible mechanism of pain production.
S J Lipson; D A Fox; J L Sosman
The identification of skeletal remains is one of the classic problems faced by forensic experts. Congenital and acquired malformations can prove to be an important tool for identification, provided antemortem records are available. A lumbosacral transitional vertebra is one such rare congenital anomaly that has clinical and medicolegal implications. We report a case of unilateral lumbosacral transitional vertebra, detected during
Kanchan T; Shetty M; Nagesh K R
A butterfly vertebra is a rare congenital anomaly that is usually asymptomatic. The authors, however, describe a novel case involving a butterfly vertebra overlapping with disc herniation that presented as radiculopathy. A butterfly vertebra is characterized by a symmetrical fusion defect resulting in a sagittal cleft vertebra. Only a few cases of butterfly vertebrae have been reported as incidental findings. This spinal anomaly may be associated with other congenital conditions such as Pfeiffer, Crouzon, Jarcho-Levin, and Alagille syndromes. Moreover, there is no previous report of a case associated with symptomatic disc herniation from the sagittal cleft. The authors excised the herniated disc fragment. They performed intraoperative discography after exposure of the corresponding intervertebral space via a conventional interlaminar approach. Histological examination of a tissue specimen showed scattered chondrocytes in the myxohyaline stroma, which indicated the nucleus pulposus. PMID:21819182
Cho, Hyung-Lea; Kim, Jin-Sung; Paeng, Sung Suk; Lee, Sang-Ho
We report staged treatment of severe combined spinal deformity in an 11-year-old patient with Ollier disease and abnormal cervical vertebra. Combined scoliosis with systemic pathology and abnormal vertebrae is a rare condition and features atypical deformity location and rapid progression rate and frequently involves the rib cage and pelvis, disturbing the function of chest organs and skeleton. Progressive deformity resulted in cachexia and acute respiratory failure. A halo-pelvic distraction device assembled of Ilizarov components was employed for a staged surgical treatment performed for lifesaving indications. After vital functions stabilized, the scoliosis curve of the cervical spine was corrected and fixed with a hybrid system of transpedicular supporting points, connecting rods, and connectors that provided staged distraction during growth. The treatment showed good functional and cosmetic result. PMID:24436859
Ryabykh, S ?; Gubin, A V; Prudnikova, Capital O Cyrillic G; Kobyzev, Capital A Cyrillic ?
We report a 20-year-old male patient who was admitted to our emergency clinic after a traffic accident and who suffered from neck pain. Radiographic examination of the cervical spine showed hypertrophy of the left lamina and hypertrophy and elongation of the left spinous process of the sixth cervical vertebra (C6). A computed tomography scan revealed the associated schisis of the spinous process at the same level. Magnetic resonance imaging scan demonstrated no abnormality of the neural elements. The patient underwent a surgical operation due to persistent neck pain and the local aesthetic abnormality. PMID:22258285
Kazanci, Burak; Tehli, Ozkan; Adilay, Utku; Guclu, Bulent
The identification of skeletal remains is one of the classic problems faced by forensic experts. Congenital and acquired malformations can prove to be an important tool for identification, provided antemortem records are available. A lumbosacral transitional vertebra is one such rare congenital anomaly that has clinical and medicolegal implications. We report a case of unilateral lumbosacral transitional vertebra, detected during medicolegal examination of skeletal remains that were recovered from a forested area in coastal Karnataka, India. The congenital anomaly of the transitional vertebra helped in the forensic identification of the deceased. PMID:19296021
Kanchan, T; Shetty, M; Nagesh, K R; Menezes, R G
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
Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal can result in spinal cord compression, ultimately resulting in cervical spondylosis myelopathy. This review article examines the current literature in relation to the cervical spondylosis and describes the three clinical syndromes of axial neck pain, cervical radiculopathy and cervical myelopathy
Kelly, John C.; Groarke, Patrick J.; Butler, Joseph S.; Poynton, Ashley R.; O'Byrne, John M.
OBJECTIVESTo test whether the position of lumbosacral dermatomes varies in the presence of transitional vertebrae.MATERIAL AND METHODSFifty consecutive male patients were tested for thoracolumbar and lumbosacral transitional vertebrae by radiography and for the position of the dermatome gap between the lumbar dermatomes Ll, L2, L3, and the sacral dermatomes S2 and S3. The dermatome gap was documented with the use
3D printer applications in the biomedical sciences and medical imaging are expanding and will have an increasing impact on the practice of medicine. Orthopedic and reconstructive surgery has been an obvious area for development of 3D printer applications as the segmentation of bony anatomy to generate printable models is relatively straightforward. There are important issues that should be addressed when using 3D printed models for applications that may affect patient care; in particular the dimensional accuracy of the printed parts needs to be high to avoid poor decisions being made prior to surgery or therapeutic procedures. In this work, the dimensional accuracy of 3D printed vertebral bodies derived from CT data for a cadaver spine is compared with direct measurements on the ex-vivo vertebra and with measurements made on the 3D rendered vertebra using commercial 3D image processing software. The vertebra was printed on a consumer grade 3D printer using an additive print process using PLA (polylactic acid) filament. Measurements were made for 15 different anatomic features of the vertebral body, including vertebral body height, endplate width and depth, pedicle height and width, and spinal canal width and depth, among others. It is shown that for the segmentation and printing process used, the results of measurements made on the 3D printed vertebral body are substantially the same as those produced by direct measurement on the vertebra and measurements made on the 3D rendered vertebra.
Ogden, Kent; Ordway, Nathaniel; Diallo, Dalanda; Tillapaugh-Fay, Gwen; Aslan, Can
During voluntary flexion\\/extension of the head-neck system, the cervical spine undergoes a stepwise motion from upper to lower regions with a specific pattern. The motion of each vertebra is composed of a translation and rotation with respect to lower vertebrae, which may be considered as an absolute rotation about an axis called instantaneous axis of rotation (IAR). The location of
A. MEGHDARI; A. H. BAHRAMI
An 18-month-old, intact male Akita presented with a 12-month history of progressive ataxia, hypermetria, and loss of conscious proprioception of the thoracic and pelvic limbs. Neurological examination and myelography localized a lesion at cervical vertebrae 1 and 2 consistent with an arachnoid cyst. Hemilaminectomy and cyst fenestration led to virtually full recovery. Images Figure 1.
Hashizume, C T
Odontoid fractures are common in the elderly following minor falls. Almost all of them have osteoarthritis of the cervical spine below the axis vertebra. As a result, there is increased stress on the spared upper cervical spine, resulting in a higher incidence of injuries. As movement in the upper cervical spine involves participation of five joints, degeneration in any one
Palaniappan Lakshmanan; Alwyn Jones; John Howes; Kathleen Lyons
This case study demonstrates the importance of involving an anthropologist in forensic situations with decomposed remains. Anthropological consultation was used in conjunction with the comparison of antemortem and postmortem radiographs to establish positive identification of unknown, decomposed remains. The remains had no traditional identifying features such as fingerprints or dental. Through anthropological analysis, it was determined the decedent was male, between 20 and 23 years at time of death and c. 5'2'' tall. This information allowed for a presumptive identification and a request for antemortem radiographs. The missing person was identified comparing the spinous processes of the cervical and thoracic vertebrae between ante- and postmortem radiographs. PMID:17018076
Mundorff, Amy Z; Vidoli, Giovanna; Melinek, Judy
Background Knowledge of the anatomical variation of the vertebral artery has clinical importance not only for the performance of interventional or surgical procedures itself but also to ensure their safety. We conducted a study of the anatomical variation by reviewing multi-detector computed tomography (MDCT) images of the cervical spine from 460 Korean patients. Methods 16-row MDCT data from 460 patients were used in this study. We observed 920 vertebral arteries. Examination points included level of entrance of the artery into the transverse foramen of the cervical vertebra, origin site of the vertebral artery, course of a vertebral artery with aberrant entrance. Result The vertebral artery in 2 (0.2%) cases in this study entered into the transverse foramen of the 7th cervical vertebra from the left. In 45 (4.9%) cases, the vertebral artery entered into the transverse foramen of the 5th cervical vertebra. Of these, the entrance was on the right in 15 (1.6%) and on the left in 30 (3.3%). We found 17 (1.8%) cases in which the artery entered into the transverse foramen of the 4th cervical vertebra, 10 (1.1%) on the right and 7 (0.7%) on the left side. As is commonly acknowledged, the 6th cervical vertebra was the most common site of entry; the vertebral artery entered the transverse foramen of the 6th cervical vertebra in the remaining 855 (93.0%) cases, on the right in 434 (47.2%) and on the left in 421 (45.8%). Conclusions In conclusion, the possibility of an atypical course of the vertebral artery in segments V1 and V2 should be evaluated with magnetic resonance imaging (MRI) or CT images before carrying out procedures involving the anterior cervical vertebrae.
Shin, Hye Young; Park, Ji Kang; Park, Sun Kyung; Jung, Gyu Seo
Posterior limbus vertebra (PLV) is the retropulsion of the vertebral ring apophysis resulting from disc herniation through posterior ring physis. Large PLV can cause spinal stenosis, and small PLV can be mistaken as intraspinal disc herniation. Although the clinical presentations were similar, the surgery was quite different. We had experienced preoperative misdiagnosed cases and the surgery could not be finished. Therefore we analyzed the imaging features of PLV in 34 patients in order to prompt appropriate preoperative diagnosis and surgical planning. PMID:23154012
Huang, Pei-Yu; Yeh, Lee-Ren; Tzeng, Wen-Sheng; Tsai, Meng-Yuan; Shih, Tiffany Ting-Fang; Pan, Huay-Ben; Chen, Clement Kuen-Huang
We are currently working toward developing computer-assisted methods for the indexing of a collection of 17,000 digitized x-ray images by biomedical content. These images were collected as part of a nationwide health survey and form a research resource for osteoarthitis and bone morphometry. This task requires the development of algorithms to robustly analyze the x-ray contents for key landmarks, to segment the vertebral bodies, to accurately measure geometric features of the individual vertebrae and inter-vertebral areas, and to classify the spine anatomy into normal or abnormal classes for conditions of interest, including anterior osteophytes and disc space narrowing. Subtasks of this work have been created and divided among collaborators. In this paper, we provide a technical description of the overall task, report on progress made by collaborators, and provide the most recent results of our own research into obtaining first-order location of the spine region of interest by automated methods. We are currently concentrating on images of the cervical spine, but will expand the work to include the lumbar spine as well. Development of successful image processing techniques for computer-assisted indexing of medical image collections is expected to have a significant impact within the medical research and patient care systems.
Long, L. Rodney; Thoma, George R.
Elongation of the anterior tubercle of a transverse process of a cervical vertebra is a congenital anomaly that should be considered in a patient demonstrating a bony mass projecting anterior to the vertebral body on a lateral radiograph of the cervical spine. Reported is a case of elongation of the tubercles of the transverse processes of both C5 and C6
Y. Applbaum; P. Gerard; D. Bryk
BACKGROUND: Klippel-Feil syndrome is defined as congenital fusion of two or more cervical vertebrae and is believed to result from faulty segmentation along the embryo's developing axis during weeks 3–8 of gestation. Persons with Klippel-Feil syndrome and cervical stenosis may be at increased risk for spinal cord injury after minor trauma as a result of hypermobility of the various cervical
Subramanian Vaidyanathan; Peter L Hughes; Bakul M Soni; Gurpreet Singh; Pradipkumar Sett
A case of cervical chondrosarcoma that recurred after incomplete excision is presented. The mass was removed in three stages and the involved vertebrae were fused. Excision of the huge mass with only minor complications was only possible by staging the procedure. Due to the location of the lesion, only marginal excision could be performed and the patient was given adjuvant
A. M. Alpaslan; R. E. Acaroglu; M. Kis
The height, width, and cross-sectional area of the vertebral canal and spinal cord along with the area ratio of spinal cord to vertebral canal in the cervical vertebra were evaluated in images obtained using computed tomography (CT). Measurements were taken at the cranial, middle, and caudal point of each cervical vertebra in eight clinically normal small breed dogs (two shih tzu, two miniature schnauzers, and four mixed breed), 10 beagles, and four German shepherds. CT myelography facilitated the delineation of the epidural space, subarachnoid space, and spinal cord except at the caudal portion of the 7th cervical vertebra. The spinal cord had a tendency to have a clear ventral border in the middle portion of the vertebral canal and lateral borders near both end plates. The height, width, and area of the vertebral canal and spinal cord in the cervical vertebra were increased as the size of dog increased. However, the ratio of the spinal cord area to vertebral canal area in the small dogs was higher than that of the larger dogs. Results of the present study could provide basic and quantitative information for CT evaluation of pathologic lesions in the cervical vertebra and spinal cord.
Seo, Eunjeong; Choi, Jihye; Choi, Mincheol
We have developed a region-based image processing method to enhance selective radiodense regions on digital radiographs. We employ a wavelet filtering technique to locate the radiodense regions-of-interest and then apply different degrees of enhancement procedure to them. The enhancement procedure is based on an unsharp masking technique controlled by a set of sigmoidal functions. The method was tested on computed chest radiographs to improve the visualization of the mediastinum and radiodense spine areas. The enhanced chest images showed improved visualization in the mediastinum area, and the visibility of vascular structures which were obscured by the diaphragm and mediastinum was improved. To demonstrate the method's potential in other medical image processing tasks, we applied it to cervical spine images. The processed cervical spine images also showed better visualization of the seventh cervical vertebrae and the first thoracic vertebrae in the high radiodense area caused by the superimposition of the patient's shoulder tissue over these regions of interest.
Lin, Jyh-Shyan; Steller Artz, Dorothy E.; Li, Huai; Legendre, Kevin; Freedman, Matthew T.; Mun, Seong K.
BACKGROUND/OBJECTIVES A short neck and low posterior hairline are characteristics of Noonan syndrome (NS) and are hallmarks of basilar invagination/impression. However, it is seldom that NS has been directly linked with this symptom. Thus, this study aimed to investigate basilar impression in NS subjects compared with control subjects and individuals exhibiting Turner Syndrome (TS). SUBJECTS/METHODS The degree of basilar impression and vertical positional differences of the third and fourth cervical vertebrae and hyoid bone in NS (n = 9, mean age: 12.1 years), TS (n = 9, mean age: 12.1 years), and control subjects (n = 9, mean age: 12.0 years) were investigated using lateral cephalometric radiographs. Differences between the three groups were compared using the Steel-Dwass test. Vertical positional differences in the anatomical structures within each group were compared using the Wilcoxon signed-rank test accompanied by a Bonferroni-Holm correction. RESULTS The distance by which the odontoid tip extended past McGregor's line in subjects with NS was significantly greater compared with TS and control subjects. The third and fourth cervical vertebrae were positioned significantly superiorly in subjects with NS compared with TS and control subjects and, in NS, were also significantly superior to the hyoid bone. There was no difference in the position of the hyoid bone itself between the groups. CONCLUSION/IMPLICATION These results suggest that basilar impression may be a frequently found symptom of NS. PMID:23660838
Miyamoto, Jun J; Yabunaka, Tomoe; Moriyama, Keiji
The proportion of trabecular bone in human cadaver vertebrae was assessed by anatomic dissection. Thirty-two whole thoracic and lumbar vertebrae were obtained from 10 normal human postmenopausal female cadavers, 14 from 4 normal adult human male cadavers of similar age, and 8 from one female osteoporotic cadaver. Each vertebra was opened by saw cuts and separated into four tissue types: (1) body trabecular bone and marrow; (2) body cortical bone; (3) vertebral arch trabecular bone and marrow; and (4) vertebral arch cortical bone. Calcium was determined in each tissue type for each vertebra by ashing and atomic absorption spectrophotometry. Trabeculae accounted for 24.4 +/- 4.5% of the total calcium in whole female vertebrae, and 18.8 +/- 4.4% in whole male vertebrae (p less than 0.001). The body averaged 41.8% trabecular bone in females and 33.5% in males. The arch averaged 9.7% trabecular bone in females and 4.9% in males. The proportion of trabecular bone in the whole vertebrae in the single osteoporotic spine was 28.5 +/- 3.2%, a value not significantly different from the trabecular fraction in normal females. These data indicate that whole human thoraco-lumbar vertebrae are composed of a substantially lower proportion of trabecular bone than is usually assumed, and they suggest that cortical and trabecular bone are eventually lost in equal proportion from the vertebrae during the development of spinal osteoporosis. These results are important for the interpretation of data from noninvasive bone measurement techniques that evaluate the spine, and they suggest that studies of this type are important for any site where noninvasive bone mass measurement is done. PMID:3455169
Nottestad, S Y; Baumel, J J; Kimmel, D B; Recker, R R; Heaney, R P
A "butterfly" vertebra is a rare congenital anomaly, presenting as a sagittal cleft in the vertebral body. In the literature it has been described as an isolated finding, but it can also be associated with various syndromes, such as Alagille, Jarcho-Levin, Crouzon and Pfeiffer syndrome. We present a case of a 35-year old man with chronic low back pain. The diagnosis of a butterfly vertebra of S1 with disc space narrowing of L5-S1 was made. Usually the abnormality occurs at the thoracolumbar spine and we are not aware of a description of a sacral butterfly vertebra. Although a butterfly vertebra is usually asymptomatic, it could lead to discal herniation or chronic back pain due to alteration in spinal biomechanics. PMID:22368979
Boulet, Cedric; Schiettecatte, Ann; De Mey, Johan; De Maeseneer, Michel
Percutaneous vertebroplasty is an efficient procedure to treat pain due to osteoporotic vertebral compression fractures. However,\\u000a refracture of cemented vertebrae occurs occasionally after vertebroplasty. It is unclear whether such fractures are procedure-related\\u000a or part of the natural course of osteoporosis. The effect of potentially important covariates on refracture risk in cemented\\u000a vertebrae has not been evaluated previously. We retrospectively analyzed
Wei-Che Lin; Yu-Chang Lee; Chen-Hsiang Lee; Yeh-Lin Kuo; Yu-Fan Cheng; Chun-Chung Lui; Tien-Tsai Cheng
The hibernoma is a rare benign tumor of soft tissue, derived from remnants of fetal brown adipose tissue. A cervical rib is a supernumerary or accessory rib derived from the 7th cervical vertebra. CLINCAL CASE: 2-year-old girl, previously healthy, referenced to Pediatrics consultation, for left supraclavicular mass. No history of infectious diseases or systemic symptoms. At exam presented mass in supraclavicular left region, 1.5 to 2 cm in diameter, hard, mobile, non-adherent to the deep planes. Laboratory tests exclude an infectious or lymphoproliferative disease. In cervical radiograph we observed bilateral cervical ribs. Cervical ultrasound revealed calcified nodule 0.8 cm, compatible with calcified adenopathy. Biopsy was performed and histology revealed a hibernoma, which was completely removed surgically. This case illustrates the association of two diagnoses, uncommon in children. These were made during the investigation of lymphadenopathies, a frequent reason for pediatrics consultation. PMID:24482907
Antunes, J; Santos, S; Andrade, N; Simões, F; Salgado, C
The present study aimed to describe the radiographic appearance of lumbosacral transitional vertebrae in the cat and compare prevalence of hip dysplasia and lumbosacral spondylosis with a population of cats without transitional vertebrae. Pelvic radiographs of cats were reviewed retrospectively, providing a population of 100 cats without transitional vertebrae and 14 examples of lumbosacral transitional vertebrae. All cats were assessed
Anna L. M. Newitt; Alexander J. German; Frances J. Barr
Cervical cancer is a disease in which cancer develops in the tissues of the cervix. The Cancer Genome Atlas is studying the two main types of cervical cancer. Squamous cell carcinoma develops in the thin, flat, squamous cells that line the vagina. Adenocarcinoma arises in the glandular cells in the vagina that secrete mucus. Risk factors for cervical cancer include smoking and human papillomavirus (HPV) infection. In the future, the HPV vaccine will lower the infection rate.
Previous description of cervical spine fractures in children have emphasized high mortality injuries to the upper cervical vertebra. Our experience suggests a much wider spectrum of injury. The medical records of all children with cervical spine fractures admitted to Children's Hospital between January 1, 1985 and December 31, 1989 were reviewed. The average age of the 50 patients was 11 years (range, 2.7 to 18.8 years) and 62% were boys. Motor vehicle-related accidents (54%), sports injuries (18%), and falls (12%) accounted for the majority of the fractures. Twenty-nine patients (58%) had an associated head injury. Fifty percent of the patients were transported from the accident scene and 44% were interhospital transfers. All patients receiving medical care prior to referral had appropriate cervical spine stabilization. On admission 30% of the patients were unresponsive. Thirty-one children were alert and verbal at the time of evaluation and 30 complained of neck pain and tenderness (97%). Twenty-five of the 31 patients (83%) had no demonstrable neurological deficit on initial physical examination. Lateral cervical spine radiographs were diagnostic in 49 children (98%). A relatively even distribution of fractures occurred at all levels of the cervical spine. The anatomic site of the injury did not correlate with age. Sixteen patients (32%) died. Of the 34 who survived, only 6 had a persistent neurological deficit. Children with cervical spine fractures have two distinct patterns of presentation: lethal or intact. The majority of children with cervical spine fractures presented with no complaints of neck pain and/or tenderness need a complete radiographic evaluation of their cervical spine. PMID:1919996
Dietrich, A M; Ginn-Pease, M E; Bartkowski, H M; King, D R
The normal sagittal alignment of the cervical spine is lordotic and is affected by the posture of the head and neck. The question of whether loss of cervical lordosis is the result of muscle spasm after injury or a normal variation, and the clinical significance of such changes in sagittal profile of the cervical spine has been an issue of several studies. The purpose of this paper is to study the incidence of normal cervical lordosis and its changes after neck injury compared to the healthy population. We studied the lateral radiographs of the cervical spine of 60 patients with neck injury compared to 100 patients without a neck injury. Lateral radiographs were obtained in the standing or sitting position, and the curvature of the cervical spine was measured using the angle formed between the inferior end plates of the C2 and C7 vertebrae. In the patients without neck injury, lordotic and straight cervical spine sagittal alignment was observed in 36.5% each, double curvature in 17%, and kyphotic in 10%. In the patients with neck injury, lordotic sagittal alignment was observed in 36%, straight in 34%, double curvature in 26% and kyphotic in 4%. No significant difference between the two groups regarding all types of sagittal alignment of the cervical spine was found (p > 0.100). The alterations in normal cervical lordosis in patients with neck injury must be considered coincidental. These alterations should not be associated with muscle spasm caused by neck pain. PMID:23412281
Beltsios, Michail; Savvidou, Olga; Mitsiokapa, Evanthia A; Mavrogenis, Andreas F; Kaspiris, Angelos; Efstathopoulos, Nikolaos; Papagelopoulos, Panayiotis J
Automatic extraction of vertebra regions from a spinal magnetic resonance (MR) image is normally required as the first step to an intelligent spinal MR image diagnosis system. In this work, we develop a fully automatic vertebra detection and segmentation system, which consists of three stages; namely, AdaBoost-based vertebra detection, detection refinement via robust curve fitting, and vertebra segmentation by an iterative normalized cut algorithm. In order to produce an efficient and effective vertebra detector, a statistical learning approach based on an improved AdaBoost algorithm is proposed. A robust estimation procedure is applied on the detected vertebra locations to fit a spine curve, thus refining the above vertebra detection results. This refinement process involves removing the false detections and recovering the miss-detected vertebrae. Finally, an iterative normalized-cut segmentation algorithm is proposed to segment the precise vertebra regions from the detected vertebra locations. In our implementation, the proposed AdaBoost-based detector is trained from 22 spinal MR volume images. The experimental results show that the proposed vertebra detection and segmentation system can achieve nearly 98% vertebra detection rate and 96% segmentation accuracy on a variety of testing spinal MR images. Our experiments also show the vertebra detection and segmentation accuracies by using the proposed algorithm are superior to those of the previous representative methods. The proposed vertebra detection and segmentation system is proved to be robust and accurate so that it can be used for advanced research and application on spinal MR images. PMID:19783497
Huang, Szu-Hao; Chu, Yi-Hong; Lai, Shang-Hong; Novak, Carol L
Klippel-Feil syndrome is an uncommon congenital anomaly that is characterized by abnormal fusion of the cervical vertebrae and occasionally accompanied by various anomalies of other bones and internal organs. We report the autopsy case of a 5-year-old girl with this syndrome ssociated with congenital cervical dislocation, with special reference to the pathological findings of the vertebral column and spinal cord. Principal anomalies of the cranio-spinal axis were as follows: partial defect of the clivus, scoliosis, hypoplasia of the whole cervical vertebrae, anterior dislocation of C7 with S-shaped deformity of the spinal canal, fusion of the spinous processes of the cervical and thoracic vertebrae, fusion of the vertebral bodies of C6 and C7 with collapse of C7, and spina bifida occulta of L5 and S1. In addition to these skeletal anomalies, subarachnoid vascular malformation in the medulla oblongata, a bronchogenic cyst in the posterior mediastinum, anomalous lobation of the lungs, and the mobile cecum were found at autopsy. The cervical cord showed an increase of the antero-posterior diameter, multifocal spongy changes of the white matter, and partial branching or duplication of the central canal. The brain showed features of anoxic encephalopathy. The partial defect of the clivus, C7 dislocation, and various lesions of the medulla oblongata and cervical cord were interpreted as integral components of, or lesions closely associated with, Klippel-Feil syndrome. PMID:22762890
Shintaku, Masayuki; Wada, Kyosuke; Koyama, Takashi; Kohno, Hiroaki; Sakamoto, Takeshi; Hida, Shinya
The number of cervical vertebrae in mammals is highly conserved at seven. We have shown that changes of this number are selected against due to a coupling with major congenital abnormalities (pleiotropic effects). Here we show that the incidence of abnormal cervical vertebral numbers in Late Pleistocene mammoths from the North Sea is high (33.3%) and approximately 10 times higher than that of extant elephants (3.6%). Abnormal numbers were due to the presence of large cervical ribs on the seventh vertebra, which we deduced from the presence of rib articulation facets on sixth (posterior side) and seventh (anterior side) cervical vertebrae. The incidence of abnormal cervical vertebral numbers in mammoths appears to be much higher than in other mammalian species, apart from exceptional sloths, manatees and dugongs and indicates a vulnerable condition. We argue that the increased incidence of cervical ribs in mammoths is probably caused by inbreeding and adverse conditions that impact early pregnancies in declining populations close to extinction in the Late Pleistocene.
Reumer, Jelle W.F.; ten Broek, Clara M.A.
The number of cervical vertebrae in mammals is highly conserved at seven. We have shown that changes of this number are selected against due to a coupling with major congenital abnormalities (pleiotropic effects). Here we show that the incidence of abnormal cervical vertebral numbers in Late Pleistocene mammoths from the North Sea is high (33.3%) and approximately 10 times higher than that of extant elephants (3.6%). Abnormal numbers were due to the presence of large cervical ribs on the seventh vertebra, which we deduced from the presence of rib articulation facets on sixth (posterior side) and seventh (anterior side) cervical vertebrae. The incidence of abnormal cervical vertebral numbers in mammoths appears to be much higher than in other mammalian species, apart from exceptional sloths, manatees and dugongs and indicates a vulnerable condition. We argue that the increased incidence of cervical ribs in mammoths is probably caused by inbreeding and adverse conditions that impact early pregnancies in declining populations close to extinction in the Late Pleistocene. PMID:24711969
Reumer, Jelle W F; Ten Broek, Clara M A; Galis, Frietson
A synchrotron radiation computed microtomography system allowing high resolution 3D imaging of bone samples has been developed at ESRF. The system uses a high resolution 2D detector based on a CCd camera coupled to a fluorescent screen through light optics. The spatial resolution of the device is particularly well adapted to the imaging of bone structure. In view of studying growth, vertebra samples of fetus with differential gestational ages were imaged. The first results show that fetus vertebra is quite different from adult bone both in terms of density and organization.
Peyrin, Francoise; Salome, Murielle; Denis, Frederic; Braillon, Pierre; Laval-Jeantet, Anne-Marie; Cloetens, Peter
An anatomically accurate, three-dimensional, nonlinear finite element model of the human cervical spine was developed using computed tomography images and cryomicrotome sections. The detailed model included the cortical bone, cancellous core, endplate, lamina, pedicle, transverse processes and spinous processes of the vertebrae; the annulus fibrosus and nucleus pulposus of the intervertebral discs; the uncovertebral joints; the articular cartilage, the synovial
Srirangam Kumaresan; Narayan Yoganandan; Frank A Pintar; Dennis J Maiman
An 11-year-old, spayed female giant schnauzer was presented for evaluation of chronic, progressive tetraparesis. Diagnostic imaging was consistent with intervertebral disk protrusion, and surgical decompression and stabilization were performed. Postoperatively the dog did not improve, and further imaging suggested an intramedullary mass at the level of the sixth cervical vertebra. The dog was euthanized 7 days after surgery, and a teratoma was found postmortem. PMID:17823480
Wong, Michael A; Mariani, Christopher L; Powe, Joshua R; Clemmons, Roger M
Cervical spine injuries such as subluxation and fracture dislocation have long been known to result in severe consequences, as well as the trauma management itself. The injury to the region has been identified as one of the major causes of death in Malaysian motorcyclists involved in road crashes, besides head and chest injuries (Pang, 1999). Despite this, cervical spine injury in motorcyclists is not a well-studied injury, unlike the whiplash injury in motorcar accidents. The present study is a retrospective study on the mechanisms of injury in cervical spine sustained by Malaysian motorcyclists, who were involved in road crash using an established mechanistic classification system. This will serve as an initial step to look at the cervical injuries pattern. The information obtained gives engineer ideas to facilitate design and safety features to reduce injuries. All cervical spine injured motorcyclists admitted to Hospital Kuala Lumpur between January 1, 2000 and December 31, 2001 were included in the present study. Based on the medical notes and radiological investigations (X-rays, CT and MRI scans), the mechanisms of injuries were formulated using the injury mechanics classification. The result shows that flexion of the cervical vertebrae is the most common vertebral kinematics in causing injury to motorcyclists. This indicates that the cervical vertebrae sustained a high-energy loading at flexion movement in road crash, and exceeded its tolerance level. The high frequency of injury at the C5 vertebra, C6 vertebra and C5-C6 intervertebral space are recorded. Classification based on the Abbreviated Injury Scale (AIS) is made to give a view on injury severity, 9.1% of the study samples have been classified as AIS code 1, 51.5% with AIS 2 and 21.2% with AIS 3. PMID:15559162
Ooi, S S; Wong, S V; Radin Umar, R S; Azhar, A A; Yeap, J S; Megat Ahmad, M M H
The aim of this study is to determine by plain radiography if there is a relationship between lumbosacral transitional vertebrae (LSTV) and low back pain (LBP) The correlation or relationship between LSTV and LBP has been highly controversial. Widely varying and contrasting findings have been reported by various investigators. While some studies have indicated the etiological significance of LSTV in
Eyo A. Olofin; C. Noronha; A. Okanlawon; M. U. Eyo
We studied 52 patients, each with a lumbosacral transitional vertebra. Using MRI we found that the lumbar discs immediately above the transitional vertebra were significantly more degenerative and those between the transitional vertebrae and the sacrum were significantly less degenerative compared with discs at other levels. We also performed an anatomical study using 70 cadavers. We found that the iliolumbar ligament at the level immediately above the transitional vertebra was thinner and weaker than it was in cadavers without a lumbosacral transitional vertebra. Instability of the vertebral segment above the transitional vertebra because of a weak iliolumbar ligament could lead to subsequent disc degeneration which may occur earlier than at other disc levels. Some stability between the transitional vertebra and the sacrum could be preserved by the formation of either an articulation or by bony union between the vertebra and the sacrum through its transverse process. This may protect the disc from further degeneration in the long term. PMID:15855373
Aihara, T; Takahashi, K; Ogasawara, A; Itadera, E; Ono, Y; Moriya, H
We are developing an automated method for the identification of the spinal cord and the vertebras on spinal MR images, which is an essential step for computerized analysis of bone marrow diseases. The spinal cord segment was first enhanced by a newly developed hierarchical multiscale tubular (HMT) filter that utilizes the complementary hyper- and hypo- intensities in the T1-weighted (T1W) and STIR MRI sequences. An Expectation-Maximization (EM) analysis method was then applied to the enhanced tubular structures to extract candidates of the spinal cord. The spinal cord was finally identified by a maximum-likelihood registration method by analysis of the features extracted from the candidate objects in the two MRI sequences. Using the identified spinal cord as a reference, the vertebras were localized based on the intervertebral disc locations extracted by another HMT filter applied to the T1W images. In this study, 5 and 30 MRI scans from 35 patients who were diagnosed with multiple myeloma disease were collected retrospectively with IRB approval as training and test set, respectively. The vertebras manually outlined by a radiologist were used as reference standard. A total of 422 vertebras were marked in the 30 test cases. For the 30 test cases, 100% (30/30) of the spinal cords were correctly segmented with 4 false positives (FPs) mistakenly identified on the back muscles in 4 scans. A sensitivity of 95.0% (401/422) was achieved for the identification of vertebras, and 5 FPs were marked in 4 scans with an average FP rate of 0.17 FPs/scan.
Zhou, Chuan; Chan, Heang-Ping; Dong, Qian; He, Bo; Wei, Jun; Hadjiiski, Lubomir M.; Couriel, Daniel
Hydatid disease (Echinococcosis) is a common parasitic infection caused by Echinococcus granulosus mainly in sheep-raising areas of the world. Liver, lungs and brain are the predominantly involved organs. However, 0.5-1% of the hydatid disease involves the spine and in 90% of the cases it is confined to the bone and the epidural space. Although intramedullary involvement is extremely rare, in this report, we present a 55-year-old female patient who was diagnosed with a cervical intramedullary hydatid cyst during magnetic resonance imaging of the cervical vertebrae. Accordingly, we imply that particularly in endemic areas, hydatid cyst disease should be kept in mind for the differential diagnosis of spinal mass lesions. PMID:23183479
Senol, M G; Güney, Mehmet; Tekeli, H; Kendirli, M T; Kendirli, Hakan; Tansel, Mustafa; Kaya, S; Turhan, V; Vedat, Turhan; Sonmez, G; Güner, Sonmez; Saracoglu, M
A case of 65-year-old farmer who presented with Brucella-related cervical spondylitis is described. Because of the advanced form of the infection resulted in neurological impairment, cervical vertebra corpectomy and debridement of the paravertebral granulomatous tissue deposits were performed followed by stabilization with anterior plating and bone grafting. In addition, double antimicrobial chemotherapy regimen was administered for 12 weeks. After one year, follow up evaluation demonstrated resolution of the infection. The authors recommend that brucellosis should be included in the differential diagnosis of cervical spondylitis, particularly in patients who reside in countries where the zoonosis is still endemic.
Hantzidis, Paraskevas; Kalabakos, Christos; Boursinos, Loukas; Dimitriou, Christos G
We report a case of spontaneous cervical spondylodiscitis caused by Salmonella typhi. A 52-year-old man presented in the neurosurgical service with complaints of pain in the cervical and scapular region. Cervical inflammatory disease was suggested by bone scintigraphy and magnetic resonance imaging. The diagnosis of Salmonella typhi spondylodiscitis was established by blood culture and culture of needle biopsy specimen taken from the C5 vertebra. The agglutinin titers for Salmonella were elevated. Intravenous ciprofloxacin therapy and external immobilization with a halo vest were instituted. A review of literature was performed evaluating the clinical, diagnostic and therapeutic aspects of this unusual pathology. PMID:12563403
Falavigna, Asdrubal; Ferraz, Fernando Antonio Patriani
A 4-year-old, 40-kg, male, entire Dalmatian was presented for evaluation of chronic neck pain and pelvic limb ataxia. Myelography revealed ventrodorsal (hourglass) extradural compression over the intervertebral space between the 5th and 6th cervical vertebra and ventral extradural compression between the 6th and 7th cervical vertebra. Cranial compression disappeared and caudal compression markedly diminished after performing cervical traction. MRI scan confirmed protrusion of intervertebral discs and spinal cord compression in previously mentioned intervertebral spaces. Surgical distraction-stabilization of both intervertebral spaces was performed using threaded pins and polymethylmethacrylate. The convalescence from surgery was uneventful and the dog was walking without any signs of paresis until 5 months after surgery when radiography revealed implants loosening. The dog recovered fully of the implant removal and remained asymptomatic for more than 30 months. PMID:23644293
Beranek, J; Tomek, A; Lorinson, D
Imaging the cervix for benign and malignant disease can be achieved using transvaginal ultrasound, computed tomography (CT), magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomography. The best established role of imaging is in cervical carcinoma where magnetic resonance imaging, CT and increasingly positron emission tomography-CT are the most frequently used imaging modalities. These have a role in staging, treatment selection, recurrent disease, and imaging complications of treatment. Histopathological diagnosis of cervical disorders cannot be made on the basis of imaging alone but certain imaging features may provide an indication as to the underlying diagnosis. We describe the imaging features of some malignant tumor subtypes in which a preoperative diagnosis may alter management. Benign lesions of the cervix are usually detected incidentally or during investigations for dysfunctional vaginal bleeding. We describe the imaging features of the commonly encountered benign cervical lesions. PMID:20974359
A retrospective study of 118 women with breast cancer metastatic to bone is presented. All had originally received post mastectomy adjuvant radiation therapy for Stage II (T2 N0, T2 N1, T1 N1) infiltrating duct carcinoma of breast. Sixty-two women (group A) received a parasternal portal and 56 women (group B) did not. There was significantly less metastatic involvement of the mid-dorsal vertebrae D5- 6-7-8, 13% in group A compared to 60% in group B. The mean time to diagnosis of metastatic disease was 33 months (group A) and 36 months (group B). The dose of radiation to the vertebrae through which the parasternal beam exited was estimated at between 1000-1600 rad over three to four weeks. This observation may have significant implications for the management of high risk operable breast cancer.
Hercbergs, A.; Werner, A.; Brenner, H.J.
A sea snake vertebra from the Middle Eocene (Kuma Horizon) of the vicinity of the town of Bakhchisarai (Crimea) is referred\\u000a to Palaeophis nessovi Averianov, 1997, which was previously recorded in the Middle and Upper Eocene of northern and western Kazakhstan. P. udovichenkoi Averianov, 1997 described from the Crimea based on the material from the Prolom locality (Bartonian-Priabonian?) is a
P. B. Snetkov; A. F. Bannikov
A previously unreported pattern of bone involvement in autosomal dominant osteopetrosis is described in three affected members\\u000a of a Vietnamese kindred. The hands, feet, distal bones, and skull were markedly osteosclerotic on radiologic examination.\\u000a The vertebrae displayed very minimal thickening of the endplates in two of the cases, and no visible involvement in the third.\\u000a The vertebral bone density (assessed
Christopher S. Kovacs; Robert G. W. Lambert; Guy J. Lavoie; Kerry Siminoski
Vertebral segmentation is a critical first step in any quantitative evaluation of vertebral pathology using CT images. This is especially challenging because bone marrow tissue has the same intensity profile as the muscle surrounding the bone. Thus simple methods such as thresholding or adaptive k-means fail to accurately segment vertebrae. While several other algorithms such as level sets may be used for segmentation any algorithm that is clinically deployable has to work in under a few seconds. To address these dual challenges we present here, a new algorithm based on the geodesic distance transform that is capable of segmenting the spinal vertebrae in under one second. To achieve this we extend the theory of the geodesic distance transforms proposed in1 to incorporate high level anatomical knowledge through adaptive weighting of image gradients. Such knowledge may be provided by the user directly or may be automatically generated by another algorithm. We incorporate information 'learnt' using a previously published machine learning algorithm2 to segment the L1 to L5 vertebrae. While we present a particular application here, the adaptive geodesic transform is a generic concept which can be applied to segmentation of other organs as well.
Gaonkar, Bilwaj; Shu, Liao; Hermosillo, Gerardo; Zhan, Yiqiang
Up to 20% of all patients with pectoral symptoms have an underlying orthopedic problem. The most common orthopedic conditions that may mimic chest pain radiating into the left arm include slipped disc, cervicothoracic tension syndrome, blockage of intervertebral or rib joints, and intercostal neuralgia. Less common causes of such pain are arthrosis of the shoulder, spondylocystitis, osteoporotic fractures or tumors of the bone. Management is oriented to the underlying cause, and treatment extends from physiotherapeutic measures (rest, heat treatment) via medication (non-steroidal anti-inflammatory drugs, myotonolytic agents) to operative interventions. PMID:12048845
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.
Exposure of pregnant CD-1 mice to methanol during the period of gastrulation results in exencephaly, cleft palate, and cervical vertebra malformations (Rogers and Mole, 1997, Teratology 55, 364). C57BL/6J mice are sensitive to the teratogenicity of ethanol; fetuses of this strai...
SUMMARY The relationship between the lumbosacral disc degeneration and lumbosacral transitional vertebrae, being accepted as one of the cause of low back pain, is controversial. In this study, disc heights were measured on plain radiographs and the presence of disc degeneration was evaluated with computed tomography in 38 patients with transitional vertebrae. L5-S1 disc height was found to be significantly
Özlem BAYSAL; Tamer BAYSAL; Zuhal ALTAY
Four patients aged 41 to 73 years, who had had rheumatoid arthritis for eight to 25 years, had signs and symptoms of cervical myelopathy and radiculopathy due to either atlantoaxial dislocation with herniation of the odontoid through the foramen magnum, or subluxation of the middle to lower cervical vertebrae. Spastic paraparesis or quadriparesis, severe nuchal immobility and pain, and flaccid paresis of the upper limbs necessitated anterior medullary decompression and posterior cervical fusion. Postmortem examination disclosed old ischemic necrosis, atrophy, and gliosis in the low medulla and cervical cord. Anterior and posterior gray horns and contiguous posterior and lateral funiculi bore the brunt of the damage. Ascending and descending wallerian degeneration and atrophy of the cervical nerve root were evident. In three cases, anterior spinal or radicular arteries demonstrated intimal fibrosis with moderate stenosis; two cases depicted chronic phlebitis or subarachnoid vessels. Previous reports have infrequently provided evidence of a vasculopathy. PMID:6687427
Manz, H J; Luessenhop, A J; Robertson, D M
The biomechanical and biochemical responses of lumbar vertebral bodies during a 12.5-day spaceflight (Cosmos 1887 biosatellite) were determined for rapidly growing rats (90-day-old, Czechoslovakian-Wistar). By use of age-matched vivarium controls (normal cage environment) and synchronous controls (simulated flight conditions), as well as a basal control group (killed before lift-off on the 1st day of flight), the combined influences of growth and space-flight could be examined. Centra of the sixth lumbar vertebrae (L6) were compressed to 50% strain at a fast strain rate while immersed in physiological buffer (37 degrees C). The body masses of vivarium and synchronous controls were significantly heavier than either the flight or basal controls. The flight group had an L6 vertebral body compressional stiffness that was 39% less than the vivarium controls, 47% less than the synchronous control, and 16% less than the basal controls. In addition, the average initial maximum load of the flight L6 was 22% less than vivarium controls and 18% less than the synchronous controls, whereas the linear compressional load of the flight group averaged 34% less than the vivarium and 25% less than the synchronous groups. The structural properties of the vertebrae from the 12.5-day-younger basal group closely resembled the flight vertebrae. Calcium, phosphorous, and hydroxyproline concentrations were not significantly different among the groups. Nevertheless, the lack of strength and stiffness development in spaceflight, coupled with a smaller proportion of mature hydroxypyridinoline cross-links, suggested that the 12.5 days of spaceflight slowed the maturation of trabecular bone in the vertebral bodies of rapidly growing rats. PMID:2360684
Zernicke, R F; Vailas, A C; Grindeland, R E; Kaplansky, A; Salem, G J; Martinez, D A
Congenital malformations such as lumbosacral transitional vertebrae and spina bifida occulta constitute unrare anomalies and could affect the symptomatology of low back pain. A transitional vertebra is characterized by elongation of one or both transverse processes, leading to the appearance ofa sacralized fifth lumbar vertebra or a lumbarized first sacral vertebra. Furthermore, sacral spina bifida occulta is a developmental anomaly that corresponds to the incomplete closure of the vertebral column. In the present case report, we describe a case of a dried sacrum presenting a partially sacralized fifth lumbar vertebra and total spina bifida, extended from first to fifth sacral vertebra. A pseudoarthrosis is formed on the left side and the specimen could be incorporated in Castellvi's type IIa. Moreover, the incidence, morphology, clinical and surgical significance of these spinal malformations are discussed. PMID:24592751
George, Paraskevas; Maria, Tzika; Panagiotis, Kitsoulis
The present study aimed to describe the radiographic appearance of lumbosacral transitional vertebrae in the cat and compare prevalence of hip dysplasia and lumbosacral spondylosis with a population of cats without transitional vertebrae. Pelvic radiographs of cats were reviewed retrospectively, providing a population of 100 cats without transitional vertebrae and 14 examples of lumbosacral transitional vertebrae. All cats were assessed for hip dysplasia and lumbosacral spondylosis; the lumbosacral transitional vertebrae identified were also assessed for asymmetry or rotation of sacro-iliac (SI) attachment. The transitional vertebrae demonstrated a wide variety of morphology; six cats had asymmetry or rotation of SI attachment in a dorsal plane; four of those six cats had lumbosacral spondylosis and two of these had hip dysplasia. No further examples of degenerative changes were identified in the remaining eight cats with lumbosacral transitional vertebrae. The frequency of lumbosacral spondylosis was higher in the population with lumbosacral transitional vertebrae, but this was not statistically significant. There was a marked trend towards lumbosacral spondylosis in cats with pelvic rotation or asymmetry. The frequency of hip dysplasia in cats with lumbosacral transitional vertebrae was very similar to those without. PMID:19539511
Newitt, Anna L M; German, Alexander J; Barr, Frances J
Summary A broad sample of extant turtles possesses a series of paired bones in the neck that are situated between the cervical vertebrae. These paired bones were originally proposed to be cervical rib remnants, but have more recently been interpreted as vestiges of intercentra. Here, we document, for the first time, the neck development of a pleurodire turtle, Emydura subglobosa, and identify blastematous structures, which partially recapitulate the ribs and intercentra of the plesiomorphic tetrapod condition. We identify blastematous “bridges” between intercentra and the corresponding ribs, which we homologize with the vestiges visible in extant turtles and with the remnant parapophyseal articulation processes of the intercentra of some stem taxa. Only the unpaired, median part of the intercentrum of the atlas is retained in adult turtles, but intercentra are recapitulated along the entire vertebral column during development; they are embedded in the cervical myosepta and serve as attachment sites for neck musculature. We also identify two rib rudiments in the occipital region, which may indicate that at least two vertebrae are integrated into the cranium of turtles in particular, and of amniotes in general.
Werneburg, Ingmar; Maier, Wolfgang; Joyce, Walter G.
To date, several studies were conducted to find which procedure is superior to the others for the treatment of cervical myelopathy. The goal of surgical treatment should be to decompress the nerves, restore the alignment of the vertebrae, and stabilize the spine. Consequently, the treatment of cervical degenerative disease can be divided into decompression of the nerves alone, fixation of the cervical spine alone, or a combination of both. Posterior approaches have historically been considered safe and direct methods for cervical multisegment stenosis and lordotic cervical alignment. On the other hand, anterior approaches are indicated to the patients with cervical compression with anterior factors, relatively short-segment stenosis, and kyphotic cervical alignment. Recently, posterior approach is widely applied to several cervical degenerative diseases due to the development of various instruments. Even if it were posterior approach or anterior approach, each would have its complication. There is no Class I or II evidence to suggest that laminoplasty is superior to other techniques for decompression. However, Class III evidence has shown equivalency in functional improvement between laminoplasty, anterior cervical fusion, and laminectomy with arthrodesis. Nowadays, each surgeon tends to choose each method by evaluating patients' clinical conditions.
Nishizawa, Kazuya; Mori, Kanji; Saruhashi, Yasuo; Matsusue, Yoshitaka
Cervical cancer, a potentially preventable disease, remains the second most common malignancy in women worldwide. Human papillomavirus (HPV) is the single most important etiological agent in cervical cancer, contributing to neoplastic progression through the action of viral oncoproteins, mainly E6 and E7. Cervical screening programs using Pap smear testing have dramatically improved cervical cancer incidence and reduced deaths, but cervical cancer still remains a global health burden. The biomarker discovery for accurate detection and diagnosis of cervical carcinoma and its malignant precursors (collectively referred to as high-grade cervical disease) represents one of the current challenges in clinical medicine and cytopathology.
Yim, Eun-Kyoung; Park, Jong-Sup
Using axial computed tomography (CT), we measured pedicle width, pedicle axis length, pedicle transverse angle, and distance between screw entry point and vertebrae midline in the cervical spines (C3-C7) of 40 patients. All measurements were greater in men than in women, and we noted significant sex differences at most levels of pedicle inner and outer widths (P < or = .05 or P < or = .01). Mean pedicle inner and outer widths for all levels and all patients ranged from 2.3 to 3.0 mm and from 5.0 to 6.0 mm, respectively. Mean distances between screw entry point and vertebrae midline ranged from 22.2 to 23.7 mm. Results of this study-along with axial CT measurements of individual pedicle diameter, pedicle transverse angle, and screw entry point-would be useful when considering and performing transpedicular screw fixation in the cervical spine. PMID:11198831
Rezcallah, A T; Xu, R; Ebraheim, N A; Jackson, T
INTRODUCTION: Lumbosacral transitional vertebra is an anatomical variation of the fifth lumbar vertebra in which an enlarged transverse process can form a joint or fusion with the sacrum or ilium. The association of that variant with low back pain and the change in the biomechanical properties of the lumbar spine is called Bertolotti's syndrome. CASE PRESENTATION: We report a case
Georgios Paraskevas; Alexandros Tzaveas; Georgios Koutras; Konstantinos Natsis
Fourth and fifth lumbar vertebrae were obtained at post mortem examinations of human subjects in the range 26 to 86 years and at the same time specimens were taken from the iliac crests for histological assessment of trabecular density (iliac crest score). After removal of pedicles and spinous processes the vertebrae were compressed in a testing machine to mechanical failure.
G. H. Bell; Olive Dunbar; J. S. Beck; A. Gibb
Three-dimensional finite element models of the thoracolumbar junction (T12-L2) and isolated L1 vertebra were developed to investigate the role of material properties and loading conditions on vertebral stresses and strains to predict fracture risk. The geometry of the vertebrae was obtained from CT images. The isolated vertebra model included an L1 vertebra loaded through polymethylmethacrylate (PMMA) plates located at the top and bottom of the vertebra, and the segment model included T12 to L2 vertebrae and seven ligaments, fibrous intervertebral discs and facet joints. Each model was examined with both homogeneous and spatially varying bone tissue properties. Stresses and strains were compared for uniform compression and for flexion. Including material heterogeneity remarkably reduced the stiffness of the isolated L1 vertebra, and increased the magnitudes of the minimum principal strains and stresses in the mid-transverse section. The stress and strain distributions further changed when physiological loading was applied to the L1 vertebra. In the segment models, including heterogeneous material properties increased the magnitude of the minimum principal strain by 158% in the centre of the mid-transverse section. Overall, the inclusion of heterogeneity and physiological loading increased magnitude of the strains up to 346% in flexion and 273% in compression.
Erdem, Ibrahim; Truumees, Eeric; van der Meulen, Marjolein C.H.
Transpedicular screw fixation has recently been shown to be successful in stabilizing the middle and lower cervical spine. Controversy exists, however, over its efficacy, due to the smaller size of cervical pedicles and the proximity of significant neurovascular structures to both lateral and medial cortical walls. To aid the spinal surgeon in the insertion of pedicle screws, a number of studies have been performed to quantify the gross dimensions and angulations of the cervical pedicle. Notwithstanding these quantitative studies, there has been a conspicuous absence of research reporting the qualitative characteristics of the cervical pedicle. The purpose of our study was to provide comparative graphical data that would systematically document the anatomic variability in cervical pedicle morphology. Such information should better elucidate the complexity of the pedicle as a three-dimensional structure and provide the spinal surgeon with a more complete understanding of cervical pedicle architecture. Twenty-six human cervical vertebrae (C3-C7) from six fresh-frozen spines were secured to a thin sectioning apparatus to produce three 0.7-mm-thick pedicle slices along its axis. Radiographs taken of these pedicle slices were scanned, digitized, and traced to facilitate visual comparison. The pedicle slices were found to exhibit substantial variability in composition and shape, not only between individual spines and vertebral levels, but also within the pedicle axis. However, the lateral cortex was consistently found to be thinner than the medial cortex in all samples. These physical findings must be noted by surgeons attempting transpedicular screw fixation in the cervical spine. PMID:10766079
Shin, E K; Panjabi, M M; Chen, N C; Wang, J L
Bracing is a widely used treatment of scoliosis, but there is still no consensus about its actual effect. Previous studies were based on global descriptors of the spine shape (Cobb angle, plane of maximal deformity, etc.). We present a new method to analyze braces effects at a finer scale and to find which vertebral levels are significantly affected by this treatment. The proposed method compares a group of patients treated with a brace and a control group. The 3D spine geometry of the patients from the two groups was digitized on two separate occasions: with and without brace (first group) or two times without brace (control group). The modifications of the vertebrae relative poses (combination of relative translation and rotation between consecutive vertebrae) were then extracted from 3D reconstructions. Centrality and dispersion measures of the relative poses modifications were computed using a method that take into account the non-linearity of the rotation matrix. Then, finally, multivariate hypothesis tests were used to compare the centrality and dispersion of the two groups. The method was applied to 28 untreated scoliotic patients and 41 patients treated with a Boston brace. Significant differences (p<0.01) between the centrality and dispersion measures of the relative poses modifications were respectively found from T1 to T6 and from T8 to L1. Those significant differences concords with the back flattening effect and the spatially limited correction found in other studies; however the proposed method offers a more specific evaluation of the localization of those effects. PMID:17108454
Boisvert, Jonathan; Cheriet, Farida; Pennec, Xavier; Ayache, Nicholas; Labelle, Hubert
Metal fixation has been advocated to achieve immediate local stabilization during anterior cervical fusion surgery. Screw loosening, screw backout, and breakage of screws or plates remain clinical complications that warrant concern. This study examined the biomechanical characteristics of a prototype anterior cervical plating system with unique screw and plate geometries in comparison to a fixation system currently used clinically. Compared with a standard screw design, a taper screw design resulted in increased ultimate strength and fatigue life. The addition of a locking pin hole in the tapered screw made the screw's fatigue life comparable to the standard design. Pullout strength was comparable in all screw designs. The prototype fixation system had higher strength in pure compression and compression with bending than the comparative system, while also demonstrating improved fatigue characteristics. The tensile bending stiffness of the prototype was double that of the comparative system and within the anatomical range of cervical vertebrae, the bending moment was greater. Torsional yield strength was greater than the reported breaking strength of cervical disc in situ for both systems. The unique designs of the screw and plate geometry resulted in an anterior cervical plate fixation system that is stronger with decreased risk of fatigue failure than a currently used system. Clinical evaluation in patients requiring immediate stabilization is warranted. PMID:8605415
Griffith, S L; Zogbi, S W; Guyer, R D; Shelokov, A P; Contiliano, J H; Geiger, J M
Cervicitis has been described by some as the female counterpart of urethritis in men. Over the years a number of clinical and microscopy-based definitions have been suggested in the literature. Clinical manifestations include mucopurulent discharge from the cervix, cervical friability (easy bleeding from the cervix with passage of a swab) and cervical ectopy. Microscopic definitions involving the use of Gram stain of cervical secretions have included either more than 10 white blood cells (WBCs) or more than 30 WBCs per high-power field. Combinations of these clinical and microscopic findings have been used in attempts to increase the accuracy of cervicitis diagnosis. When cervicitis was initially recognized as a clinical entity, several investigators reported the primary pathogens causing cervicitis as Neisseria gonorrhoeae and Chlamydia trachomatis. It is now well established that most cases of cervicitis are not caused by these two organisms. Most cases of cervicitis are of unknown etiology. PMID:24859465
Taylor, Stephanie N
Background contextOccurrence of transitional vertebrae at the lumbosacral junction, especially accessory lumbosacral articulations (partial sacralization of the L5 vertebrae), is not uncommon. These transitional states are frequently associated with low back pain situations requiring surgical intervention.
Niladri Kumar Mahato
Spondylo-megaepiphyseal-metaphyseal dysplasia (SMMD; OMIM 613330) is a dysostosis/dysplasia caused by recessive mutations in the homeobox-containing gene, NKX3-2 (formerly known as BAPX1). Because of the rarity of the condition, its diagnostic features and natural course are not well known. We describe clinical and radiographic findings in six patients (five of which with homozygous mutations in the NKX3-2 gene) and highlight the unusual and severe changes in the cervical spine and the neurologic complications. In individuals with SMMD, the trunk and the neck are short, while the limbs, fingers and toes are disproportionately long. Radiographs show a severe ossification delay of the vertebral bodies with sagittal and coronal clefts, missing ossification of the pubic bones, large round "balloon-like" epiphyses of the long bones, and presence of multiple pseudoepiphyses at all metacarpals and phalanges. Reduced or absent ossification of the cervical vertebrae leads to cervical instability with anterior or posterior kinking of the cervical spine (swan neck-like deformity, kyknodysostosis). As a result of the cervical spine instability or deformation, five of six patients in our series suffered cervical cord injury that manifested clinically as limb spasticity. Although the number of individuals observed is small, the high incidence of cervical spine deformation in SMMD is unique among skeletal dysplasias. Early diagnosis of SMMD by recognition of the radiographic pattern might prevent of the neurologic complications via prophylactic cervical spine stabilization. PMID:22791571
Simon, Marleen; Campos-Xavier, Ana Belinda; Mittaz-Crettol, Lauréane; Valadares, Eugenia Ribeiro; Carvalho, Daniel; Speck-Martins, Carlos Eduardo; Nampoothiri, Sheela; Alanay, Yasemin; Mihci, Ercan; van Bever, Yolande; Garcia-Segarra, Nuria; Cavalcanti, Denise; Mortier, Geert; Bonafé, Luisa; Superti-Furga, Andrea
Study Design All parameters were measured manually and with a computed tomography (CT) scanner. For the manual measurements, a Vernier scale instrument was used. Purpose This study evaluates quantitatively pedicles of middle and lower cervical spine (C3 to C7) and to evaluate the possibilities of using these structures as anchors in posterior cervical fusion. Overview of Literature Pedicle screws may be an alternative fixation technique for posterior cervical instrumentation. Methods Twenty-two bony sets of adult cervical spines were studied (110 vertebrae, 220 pedicles) from C3 down to C7. Results CT measurement of cervical pedicles appeared to be accurate and valuable for preoperative planning of cervical pedicle screw instrumentation. The study showed a high correlation between the values obtained by manual and CT measurements of pedicle dimensions. The technical challenge of insertion is the obvious theoretical drawback of the use of cervical pedicle screws. Many technical factors are important to consider, namely, the point of screw entry, the pedicle dimensions, the screw direction according to the pedicle angle and orientation, the screw diameter and length, and the method of screw introduction. Conclusions Transpedicular screw fixation of the cervical spine appears to be promising. Anatomic limitations should be clear to the surgeon. Further clinical and biomechanical studies are needed to settle this technique.
Background Cervical pedicle screw (CPS) insertion is a technically demanding procedure. The quantitative understanding of cervical pedicle morphology, especially the narrowest part of cervical pedicle or isthmus, would minimize the risk of catastrophic damage to surrounding neurovascular structures and improve surgical outcome. The aim of this study was to investigate morphology and quantify cortical thickness of the cervical isthmus by using Multi-detector Computerized Tomography (MD-CT) scan. Methods The cervical CT scans were performed in 74 patients (37 males and 37 females) with 1-mm slice thickness and then retro-reconstructed into sagittal and coronal planes to measure various cervical parameters as follows: outer pedicle width (OPW), inner pedicle width (IPW), outer pedicle height (OPH), inner pedicle height (IPH), pedicle cortical thickness, pedicle sagittal angle (PSA), and pedicle transverse angle (PTA). Results Total numbers of 740 pedicles were measured in this present study. The mean OPW and IPW significantly increased from C3 to C7 while the mean OPH and IPH of those showed non-significant difference between any measured levels. The medial-lateral cortical thickness was significantly smaller than the superior-inferior one. PTA in the upper cervical spine was significantly wider than the lower ones. The PSA changed from upward inclination at upper cervical spine to the downward inclination at lower cervical spine. Conclusions This study has demonstrated that cervical vertebra has relatively small and narrow inner pedicle canal with thick outer pedicle cortex and also shows a variable in pedicle width and inconsistent transverse angle. To enhance the safety of CPS insertion, the entry point and trajectories should be determined individually by using preoperative MD-CT scan and the inner pedicle width should be a key parameter to determine the screw dimensions.
Background: Cervical pedicle screw fixation is challenging due to the small osseous morphometrics and the close proximity of neurovascular elements. Computer navigation has been reported to improve the accuracy of pedicle screw placement. There are very few studies assessing its efficacy in the presence of deformity. Also cervical pedicle screw insertion in children has not been described before. We evaluated the safety and accuracy of Iso-C 3D-navigated pedicle screws in the deformed cervical spine. Materials and Methods: Thirty-three patients including 15 children formed the study group. One hundred and forty-five cervical pedicle screws were inserted using Iso-C 3D-based computer navigation in patients undergoing cervical spine stabilization for craniovertebral junction anomalies, cervico-thoracic deformities and cervical instabilities due to trauma, post-surgery and degenerative disorders. The accuracy and containment of screw placement was assessed from postoperative computerized tomography scans. Results: One hundred and thirty (89.7%) screws were well contained inside the pedicles. Nine (6.1%) Type A and six (4.2%) Type B pedicle breaches were observed. In 136 levels, the screws were inserted in the classical description of pedicle screw application and in nine deformed vertebra, the screws were inserted in a non-classical fashion, taking purchase of the best bone stock. None of them had a critical breach. No patient had any neurovascular complications. Conclusion: Iso-C navigation improves the safety and accuracy of pedicle screw insertion and is not only successful in achieving secure pedicle fixation but also in identifying the best available bone stock for three-column bone fixation in altered anatomy. The advantages conferred by cervical pedicle screws can be extended to the pediatric population also.
Rajasekaran, S.; Kanna, P. Rishi Mugesh; Shetty, T. Ajoy Prasad
... causes cervical cancer. To learn more about these tests and what happens during them, visit the Web sites listed at the end of this fact ... statement. To learn more, visit the Task Force Web site. USPSTF Recommendation Grades ... Happens During Screening Tests Screening for Cervical Cancer Get Tested for Cervical ...
The objective of the present study was to quantify ossification processes of the human pediatric cervical spine. Computed tomography images were obtained from a high resolution scanner according to clinical protocols. Bone window images were used to identify the presence of the primary synchondroses of the atlas, axis, and C3 vertebrae in 101 children. Principles of logistic regression were used to determine probability distributions as a function of subject age for each synchondrosis for each vertebra. The mean and 95% upper and 95% lower confidence intervals are given for each dataset delineating probability curves. Posterior ossifications preceded bilateral anterior closures of the synchondroses in all vertebrae. However, ossifications occurred at different ages. Logistic regression results for closures of different synchondrosis indicated p-values of <0.001 for the atlas, ranging from 0.002 to <0.001 for the axis, and 0.021 to 0.005 for the C3 vertebra. Fifty percent probability of three, two, and one synchondroses occurred at 2.53, 6.97, and 7.57 years of age for the atlas; 3.59, 4.74, and 5.7 years of age for the axis; and 1.28, 2.22, and 3.17 years of age for the third cervical vertebrae, respectively. Ossifications occurring at different ages indicate non-uniform maturations of bone growth/strength. They provide an anatomical rationale to reexamine dummies, scaling processes, and injury metrics for improved understanding of pediatric neck injuries. PMID:22105393
Yoganandan, Narayan; Pintar, Frank A; Lew, Sean M; Rao, Raj D; Rangarajan, Nagarajan
Purpose: Treatment results in patients with Ewing tumors of the vertebrae enrolled in the Cooperative Ewing's Sarcoma Study (CESS) 81, 86, and the European Intergroup Cooperative Ewing's Sarcoma Study (EICESS) 92 trials were analyzed with special emphasis on radiation-associated factors. Patients and Methods: A retrospective analysis was performed on 116 patients with primary tumors of the cervical, thoracic, or lumbar vertebrae treated between 1981 and 1999. Furthermore, a relapse analysis was done on those patients who underwent radiotherapy and subsequently had a local recurrence. Results: A total of 64.6% of the patients received definitive radiotherapy; 27.5% of patients had surgery and radiotherapy. Only 4 patients (3.4%) underwent definitive surgery. Twenty-seven patients presented with metastases at diagnosis. 22.4% of the total group developed a local relapse. Among the subgroup with definitive radiotherapy, local recurrence was seen in 17 of 75 patients (22.6%). Event-free survival and survival at 5 years were 47% and 58%, respectively. Of the 14 evaluable patients with a local relapse after radiotherapy, 13 were in-field. No correlation between radiation dose and local control could be found. Conclusion: Surgery with wide resection margins is rarely possible. The results after definitive radiotherapy in vertebral tumors are comparable to those of other tumor sites when definitive radiotherapy is given. Nearly all local relapses after radiotherapy are in-field.
Schuck, Andreas [Department of Radiotherapy, University Hospital of Muenster, Muenster (Germany)]. E-mail: firstname.lastname@example.org; Ahrens, Susanne [Department of Pediatric Oncology and Hematology, University Hospital of Muenster, Muenster (Germany); Schorlemer, Ines von [Department of Radiotherapy, University Hospital of Muenster, Muenster (Germany); Kuhlen, Michaela [Department of Pediatric Oncology and Hematology, University Hospital of Muenster, Muenster (Germany); Paulussen, Michael [Department of Pediatric Oncology and Hematology, University Hospital of Muenster, Muenster (Germany); Hunold, Andrea [Department of Pediatric Oncology and Hematology, University Hospital of Muenster, Muenster (Germany); Gosheger, Georg [Department of Orthopedics, University Hospital of Muenster, Muenster (Germany); Winkelmann, Winfried [Department of Orthopedics, University Hospital of Muenster, Muenster (Germany); Dunst, Juergen [Department of Radiotherapy, University Hospital of Halle, Halle (Germany); Willich, Normann [Department of Radiotherapy, University Hospital of Muenster, Muenster (Germany); Juergens, Heribert [Department of Pediatric Oncology and Hematology, University Hospital of Muenster, Muenster (Germany)
Purpose: To assess the prevalence and degree of lumbosacral transitional vertebrae (LSTV) in the Osteoarthritis Initiative (OAI) cohort, to assess whether LSTV correlates with low back pain (LBP) and buttock pain, and to assess the reproducibility of grading LSTV. Materials & Methods: Institutional review board approval was obtained, and informed consent documentation was approved for the study protocol. Standard standing pelvic radiographs that included the transverse processes of L5 were graded according to Castellvi classification of LSTV in 4636 participants (1992 men and 2804 women; aged 45–80 years) from the OAI cohort. These data were correlated with prevalence and severity of LBP and buttock pain. Results: Prevalence of LSTV was 18.1% (841 of 4636), with a higher rate in men than in women (28.1% vs 11.1%, respectively; P < .001). Of the 841 individuals with LSTV, 41.72% were type I (dysplastic enlarged transverse process), 41.4% were type II (pseudoarticulation), 11.5% were type III (fusion), and 5.2% were type IV (one transverse process fused and one with pseudoarticulation). Of the participants without LSTV, 53.9% reported LBP, while the prevalence of LBP for types I, II, III, and IV was 46%, 73%, 40%, and 66%, respectively (P < .05, ?2 test). Types II and IV had higher prevalence and severity of LBP and buttock pain (P < .001). Conclusion: LSTV types II and IV positively correlate with prevalence and severity of LBP and buttock pain. © RSNA, 2012
Alizai, Hamza; Virayavanich, Warapat; Liu, Felix; Hernandez, Alexandra; Lynch, John A.; Nevitt, Michael C.; McCulloch, Charles E.; Lane, Nancy E.; Link, Thomas M.
The gross osseous anatomy of the spine has been the subject of much study but the internal architecture and trabecular anatomy of thoracolumbar vertebrate has not previously been well described. This study is based on high resolution x-ray images of 56 isolated thoracolumbar vertebrae and thick sections obtained from them. A previously undescribed array of trabeculae was documented which originated from the medial corner of the base of the pedicles and extended in a radial array throughout the vertebral body. This trabecular array persisted even in severely osteoporotic specimens. The cortex of the vertebral canal thinned abruptly near the base of the pedicle creating what may be a stress concentration at this site. This corresponded to the site of origin of the trabecular array. The presence of this possible stress concentration, in proximity to the trabecular array, may provide an explanation for the trapezoidal shape of the bony fragments that are frequently retropulsed into the spinal canal in axial load type burst fractures, common in this area of the spine.
HEGGENESS, MICHAEL H.; DOHERTY, BRIAN J.
Myxoma is a neoplasm of mesenchymal origin composed of undifferentiated stellate cells in a myxoid stroma. This tumor can develop in a variety of locations. Myxomas that arise from skeletal muscles are called intramuscular myxomas. They usually occur in large skeletal muscles. Only ten cases of these benign tumors involving the neck muscles were reported in literature. Of them, only three were located at the paraspinal muscles. A 64-year-old woman presented with occipital and neck pain over 5 years noted an expansive painful lesion located at posterior cervical region with progressive volume increase in the last 12 months. Image exams revealed a large mass located in the left posterior region of the neck in contact with the C2, C3 and C4 laminae with no invasion of the vertebrae. Tumor total removal was performed through normal muscle margins and the vertebral periosteum was scraped. The tumor was encapsulated, lobulated with a gray-white appearance. The histological examination yielded the diagnosis of intramuscular myxoma. Follow-up at 1 year showed complete resolution of preoperative symptoms and no evidence of local recurrence. In conclusion, although rare, intramuscular myxoma should be included in differential diagnosis of cervical paraspinal tumors. We reported the fourth case of intramuscular myxoma in the paraspinal musculature of the neck. Despite its benign characteristics, local recurrence was reported after subtotal resection. Tumor total removal should be the goal of surgery. PMID:19301043
Falavigna, Asdrubal; Righesso, Orlando; Volquind, Daniel; Teles, Alisson Roberto
Background ContextSpines with sacralized fifth lumbar vertebrae are quite commonly encountered. Sacralizations represent a transitional state at lumbosacral junctions and are more susceptible to degenerative changes resulting from the altered load-bearing patterns at these regions.
Niladri Kumar Mahato
A ten-year-old male standard dachshund was presented with a history of neck pain and progressive gait disturbances. Following a neurological examination and diagnostic imaging, including CT, a neoplastic lesion involving the third and fourth cervical vertebrae was suspected. The lesion included an extradural mass on the right side of the spinal canal causing a local compression of the cervical cord. Surgery, using a modified dorsal laminectomy procedure, was performed in order to decompress the cervical spinal cord. Histopathological examination of the extradural mass indicated that the tumour was a chondroid chordoma. Following discharge, the quality of life for the dog was very good for a sustained period, but clinical signs recurred at 22 months. The dog was euthanased 25 months post-surgery. On post-mortem examination, a regrowth of neoplastic tissue was found to have infiltrated the bone and spinal cord at C3-C4. This is the first report to show that palliative surgery can offer successful long-lasting treatment of chondroid chordoma of the cervical spine in the dog. PMID:22017812
Stigen, Øyvind; Ottesen, Nina; Gamlem, Hans; Åkesson, Caroline P
The purpose of this paper is to compare the new functional intervertebral cervical disc prosthesis replacement and the classical interbody fusion operation, including the clinical effect and maintenance of the stability and segmental motion of cervical vertebrae. Twenty-four patients with single C5-6 intervertebral disk hernias were specifically selected and divided randomly into two groups: One group underwent artificial cervical disc replacement and the other group received interbody fusion. All patients were followed up and evaluated. The operation time for the single disc replacement was (130 +/- 50) minutes and interbody fusion was (105 +/- 53) minutes. Neurological or vascular complications were not observed during or after operation. There was no prosthesis subsidence or extrusion. The JOA score of the group with prosthesis replacement increased from an average of 8.6 to 15.8. The JOA score of the group with interbody fusion increased from an average of 9 to 16.2. The clinical effect and the ROM of the adjacent space of the two groups showed no statistical difference. The short follow-up time does not support the advantage of the cervical disc prosthesis. The clinical effect and the maintenance of the function of the motion of the intervertebral space are no better than the interbody fusion. At least 5 years of follow-up is needed to assess the long-term functionality of the prosthesis and the influence on adjacent levels. PMID:17180356
Peng-Fei, Sun; Yu-Hua, Jia
The objective of this study was to measure intradiscal pressure (IDP) changes in the lower cervical spine during a manual cervical distraction (MCD) procedure. Incisions were made anteriorly, and pressure transducers were inserted into each nucleus at lower cervical discs. Four skilled doctors of chiropractic (DCs) performed MCD procedure on nine specimens in prone position with contacts at C5 or at C6 vertebrae with the headpiece in different positions. IDP changes, traction forces, and manually applied posterior-to-anterior forces were analyzed using descriptive statistics. IDP decreases were observed during MCD procedure at all lower cervical levels C4-C5, C5-C6, and C6-C7. The mean IDP decreases were as high as 168.7 KPa. Mean traction forces were as high as 119.2 N. Posterior-to-anterior forces applied during manual traction were as high as 82.6 N. Intraclinician reliability for IDP decrease was high for all four DCs. While two DCs had high intraclinician reliability for applied traction force, the other two DCs demonstrated only moderate reliability. IDP decreases were greatest during moving flexion and traction. They were progressevely less pronouced with neutral traction, fixed flexion and traction, and generalized traction.
Gudavalli, M. R.; Potluri, T.; Carandang, G.; Havey, R. M.; Voronov, L. I.; Cox, J. M.; Rowell, R. M.; Kruse, R. A.; Joachim, G. C.; Patwardhan, A. G.; Henderson, C. N. R.; Goertz, C.
Abstract: Background: Anterior cervical discectomy and fusion (ACDF) is currently treatment of choice for managing medical therapy refractory cervical degenerative disc disease. Numerous studies have demonstrated the effectiveness of ACDF; patients generally experience rapid recoveries, and dramatic improvement in their pain and quality of life. However, as several studies reported symptomatic adjacent segment disease attributed to fusions’ altered kinematics, cervical disc arthroplasty emerged as a new motion-sparing alternative to fusion. Fusion at one level increases motion at adjacent levels along with increased intradiscal pressures. This phenomenon can result in symptomatic adjacent level degeneration, which can necessitate reoperation at these levels. The era of cervical arthroplasty began in Europe in the late 1990s. In recent years, artificial cervical disc arthroplasty (ACDA) has been increasingly used by spine surgeons for degenerative cervical disc disease. There have been several reports of safety, efficacy and indications of ACDA. Cervical arthroplasty offers several theoretical advantages over anterior cervical discectomy and fusion (ACDF) in the treatment of selected patients with medically refractory cervical radiculopathy. Preserving motion at the operated level, cervical TDR has the potential to decrease the occurrence of adjacent segment degeneration. There are a few studies on the efficacy and effectiveness of ACDA compared to cervical fusion. However, the true scenery of cervical arthroplasty yet to be identified. Objective: This study is intended to define patients' characteristics and outcomes of ACDA by a single surgeon in Iran. Methods: This retrospective study was performed in two general Hospitals in Tehran, Iran from 2005 To 2010. All patients were operated by one senior neurospine surgeon. One hundred fifty three patients were operated in this period. All patients signed the informed consent form prior to surgery. All patients presented with cervical discopathy who had myelopathy or radiculopathy and failed conservative management, undergoing cervical disc arthroplasty by ACDA were included, consecutively. Patients were followed for at least 2 years. Exclusion criteria was age greater than 60 years, non compliance with the study protocol, osteoporosis, infection, congenital or post traumatic deformity, malignancy metabolic bone disease, and narrow cervical canal (less than 12 mm). Heterotopic ossification and adjacent segment degenerative changes were assessed at 2 years follow up by means of neutral and dynamic xrays and CT/MRI if clinically indicated. Neck and upper extremity pain were assessed before the procedure and in the first post-operative visit and 3 months later by means of visual analogue scale. A standard approach was performed to the anterior cervical spine. Patients were positioned supine while holding neck in neutral position. A combination of sharp and blunt dissection was performed to expose longus coli musculature and anterior cervical vertebrae. Trachea and esophagus were retracted medially and carotid artery and jugular vein laterally. After a thorough discectomy, the intersomatic space is distracted in a parallel way by a vertebral distracter. Followed by Caspar distractor is applied to provide a working channel into posterior disc space. In this stage, any remnant disc materials as well as osteophytes are removed and foraminal decompression is done. Posterior longitudinal ligament (PLL) opening and removal, although discouraged by some, is done next. In order to define the size of the prosthesis, multiple trials are tested. It is important not to exceed the height of the healthy adjacent disc to avoid facet joint overdistraction. An specific insertor is applied to plant the prosthesis in disc space. Control X-rays are advised to check the precise positioning of the implant. Results: one hundred-fifty three patients including 87 females and 66 males were included. The mean age was 41 for females and 42 for males. Affected level was C5-C6 in 81 cases, C6-C7 in 72
Khadivi, Masoud; Rahimi Movaghar, Vafa; Abdollahzade, Sina
BackgroundDespite the high prevalence of lumbosacral transitional vertebrae (LSTV), little is known about the segmental innervation in this condition.MethodsThe authors performed a prospective comparative clinical evaluation and an intraoperative electromyographic (EMG) investigation on patients with six lumbar vertebral bodies (6LVB) and on patients with five lumbar vertebrae (5LVB). First, clinical pain distribution in 80 patients (46 patients with 6LVB, 34
Philipp Hinterdorfer; Babak Parsaei; Karl Stieglbauer; Michael Sonnberger; Johannes Fischer; Gabriele Wurm
Effects of Immunotherapy; Metastatic/Recurrent Cervical Cancer; Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Cervical Small Cell Carcinoma; Stage III Cervical Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer
Background: Lumbo-sacral transitional variations are common in the general population. Structural inadequacies of the terminal lumbar vertebral pars interarticularis (PI) and lamina have often been implicated as important factors for lumbo-sacral instability. Aims: Quantifying dimensions of PI and laminae in terminal lumbar vertebrae associated with lumbosacral transitions and compare them with their normal counterparts. Materials and Methods: Fourth lumbar vertebrae in spines involved with complete sacralization of the fifth lumbar (L5) vertebrae and L5 vertebrae associated with lumbosacral accessory articulation were measured for the height, width and thickness of the PI and the laminae on both sides and compared to normal vertebrae. Results: Dimensions in sacralization associated terminal vertebrae were smaller than the normal. The height of the PI and the widths of laminae were observed to be significantly smaller in terminal lumbar segment in sacralized specimen. Lumbo-sacral accessory articulations demonstrated smaller overall dimensions of several parameters. Lamiane in the last lumbar segment associated with lumbo-sacral transitions demonstrate smaller dimensions compared to the normal ones. Sacralization results in maximum diminution of these parameters. Conclusions: Smaller PI may predispose spondylolysis and spondylolisthesis at lumbo-sacral junctions associated with transitional variations, and warrant special attention to avoid iatrogenic injuries.
Mahato, Niladri Kumar
Lumbar vertebral fractures vary greatly in types and causes and usually result from severe trauma or pathological conditions such as osteoporosis. Lumbar wedge compression fractures are amongst the most common ones where the vertebra is severely compressed forming a wedge shape and causing pain and pressure on the nerve roots and the spine. Since vertebral segmentation is the first step in any automated diagnosis task, we present a fully automated method for robustly localizing and segmenting the vertebrae for preparation of vertebral fracture diagnosis. Our segmentation method consists of five main steps towards the CAD(Computer-Aided Diagnosis) system: 1) Localization of the intervertebral discs. 2) Localization of the vertebral skeleton. 3) Segmentation of the individual vertebra. 4) Detection of the vertebrae center line and 5) Detection of the vertebrae major boundary points. Our segmentation results are promising with an average error of 1.5mm (modified Hausdorff distance metric) on 50 clinical CT cases i.e. a total of 250 lumbar vertebrae. We also present promising preliminary results for automatic wedge compression fracture diagnosis on 15 cases, 7 of which have one or more vertebral compression fracture, and obtain an accuracy of 97.33%.
Ghosh, Subarna; Alomari, Raja's.; Chaudhary, Vipin; Dhillon, Gurmeet
Evaluation of bone mineral density (BMD) of the ancient peoples has received great interest by anthropologists. The aims of this study are to investigate the lumbar vertebrae of the Iasos people during the Byzantine period, in order to determine the prevalence of bone loss and to interpret dietary conditions of ancient Mediterranean populations. Lumbar vertebrae belonging to twenty eight skeletons of the 6th c AD were analyzed by radiographs and dual energy X-ray absorptiometry. The BMD values for each biologic sex and age group were compared. The correlation between the BMD and radiological features was also analyzed. The mean BMD was 0.940 g/cm2. BMD was decreased by aging in both sexes, but it was not significant. Osteopenia was found in 11 (39%) and osteoporosis in 4 (14.3%) out 28 vertebrae. The BMD was normal in 13 (46%) out of 28 vertebrae. Osteopenia was present in 7 (38%) of 18 male vertebrae and 4 (40%) of 10 female vertebrae. The spine score was high in the male group and there was a strong positive correlation between the BMD and spine score for both sexes. This study revealed that the BMD decreased by aging and that osteopenia was a problem in both sexes of the Iasos people during the 6th c AD. There was no correlation between the BMD and radiological features for age groups and biological sexes.
Kaya, Serdar; Solmaz, Ilker; Il?ca, A. Turan; Karaçal?o?lu, Özgür; Damla Y?lmaz, Nalan; Ba?o?lu, Ok?an; K?l?c, Selim; Izci, Yusuf
Cervical pedicle screw (CPS) fixation has recently been performed in patients in need of cervical reconstruction. We report the case of a 50-year-old man who was operated for traumatic cervical vertebra subluxation using CPS fixation, in whom laminectomy had been performed in the past. We performed CPS fixation using the pedicle axis view technique under fluoroscopy. The four pedicle screws were accurately inserted within the pedicles without perforating the bone cortex of the pedicles. A navigation system is useful for cervical spine surgery because it enables a surgeon to perform relatively safe and accurate surgery during transpedicular screw fixation. However, attachment of the stereotactic reference arc to the spinous process is impossible, and the application of a navigation system is limited in cases in which laminectomy has been performed in the past. We have been using the pedicle axis view technique under fluoroscopy and have found that if we take care of the entry point accurately, we can safely insert the pedicle screw in cases with fewer landmarks. PMID:23060373
Machino, Masaaki; Yukawa, Yasutsugu; Ito, Keigo; Nakashima, Hiroaki; Kanbara, Shunsuke; Morita, Daigo; Kato, Fumihiko
From Th1 to L7 midsagittal and interpedicular vertebral canal diameters were measured in macerated spines of 162 dogs to determine, whether the presence of lumbosacral transitional vertebrae or numerical vertebral variations are associated with dislocation of the maximal enlargement of the lumbar vertebral canal. Relative to dogs with a regular number of 27 presacral vertebrae (C7/Th13/L7), the maximal enlargement of the lumbar vertebral canal was more frequently ( P < 0.05) located at vertebra 24 in dogs with 26 presacral vertebrae (C7/Th13/L6), and more frequently at vertebra 25 in dogs with 28 presacral vertebrae (C7/Th13/L8). However, in dogs with 26 presacral vertebrae, maximal agreement in the spinal position of maximal lumbar vertebral canal diameters was achieved relative to dogs with 28 presacral vertebrae by adding one additional thoracic (Th6, 7, or 8) segment. Therefore, the present findings strongly suggest that relative to the regular (C7/Th13/L7) condition, decrease in the number of presacral vertebrae (C7/Th13/L6) is associated with incorporation of a midthoracic segment, whereas increase in the number of presacral vertebrae (C7/Th13/L8) is not related to the presence of an additional vertebral segment. When using Th1 as landmark, the difference in the position of the maximal enlargement of the lumbar vertebral canal between dogs with 26 and dogs with 28 presacral vertebrae in average was only one segment. It is known from previous reports that the maximal enlargement of the lumbar vertebral canal corresponds with the maximal enlargement of the lumbar spinal cord. When using S1 or the transitional vertebra as the landmark for determination of the appropriate site for subarachnoid cannulation, this site is expected to range within the same limits regardless of the vertebral formula. PMID:12021914
Breit, Sabine; Künzel, Wolfgang
Adjacent level vertebral fractures are common in patients with osteoporotic wedge fractures, but can theoretically be prevented with prophylactic vertebroplasty. Previous tests on prophylactic vertebroplasties have been performed under axial loading, while in vivo changes in spinal alignment likely cause off-axis loads. In this study we determined whether prophylactic vertebroplasty can also reduce the fracture risk under off-axis loads. In a previous study, we tested vertebral bodies that were loaded axially or 20° off-axis representing vertebrae in an unfractured spine or vertebrae adjacent to a wedge fracture, respectively. In the current study, vertebral failure load and stiffness of our previously tested vertebral bodies were compared to those of a new group of vertebral bodies that were filled with bone cement and then loaded 20° off-axis. These vertebral bodies represented adjacent-level vertebrae with prophylactic bone cement filling. Prophylactic augmentation resulted in failure loads that were comparable to those of the 0° group, and 32% greater than the failure loads of the 20° group. The stiffness of the prophylacticly augmented vertebrae was 21% lower than that of the 0° group, but 27% higher than that of the 20° group. We conclude that prophylactic augmentation can decrease the fracture risk in a malaligned, osteoporotic vertebra. Whether this is enough to actually prevent additional vertebral fractures in vivo remains subject of further study. PMID:24736018
Aquarius, René; Homminga, Jasper; Hosman, Allard Jan Frederik; Verdonschot, Nico; Tanck, Esther
This paper presents a method for localizing and labeling the lumbar vertebrae and intervertebral discs in mid-sagittal MR image slices. The approach is based on a Markov-chain-like graphical model of the ordered discs and vertebrae in the lumbar spine. The graphical model is formulated by combining local image features and semiglobal geometrical information. The local image features are extracted from the image by employing pyramidal histogram of oriented gradients (PHOG) and a novel descriptor that we call image projection descriptor (IPD). These features are trained with support vector machines (SVM) and each pixel in the target image is locally assigned a score. These local scores are combined with the semiglobal geometrical information like the distance ratio and angle between the neighboring structures under the Markov random field (MRF) framework. An exact localization of discs and vertebrae is inferred from the MRF by finding a maximum a posteriori solution efficiently using dynamic programming. As a result of the novel features introduced, our system can scale-invariantly localize discs and vertebra at the same time even in the existence of missing structures. The proposed system is tested and validated on a clinical lumbar spine MR image dataset containing 80 subjects of which 64 have disc- and vertebra-related diseases and abnormalities. The experiments show that our system is successful even in abnormal cases and our results are comparable to the state of the art. PMID:23559025
Oktay, Ayse Betul; Akgul, Yusuf Sinan
Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer
Osteophytes of the cervical spine are usually seen in elderly adults. When prominent, they have been blamed for dysphagia, cough, dysphonia and dyspnoea. This paper reports on an obstructive sleep apnoea (OSA) patient with cervical spinal osteophytes, one cause of airway obstruction. A 75-year-old male complained of pronounced snoring. The diagnosis was mild OSA, apnoea hypopnoea index was 9.4. Patient reported no restrictions in neck movements, experiences of neck pain or neck trauma. Previously, patient underwent a tonsillectomy due to discomfort in the pharyngeal region. A lateral cephalometric image was taken to observe airway before oral appliance therapy. The image revealed the presence of large osteophytes or sclerotic enthesopathy, lying on anterior surfaces from the fourth to seventh cervical vertebrae. A computed tomography (CT) image revealed the relationship of airway position to the spine. In the reconstructed three-dimensional (3D) image, the airway appeared displaced to the right of the craniomandiblar bone, with the hyoid bone similarly displaced in a manner to that of the airway. The spine also appeared displaced to the left side ofcraniomandiblar bone. Additionally, the 3D image revealed calcification of the stylohyoideum ligament and ligamentum nuchae. This present case highlights the necessity of CT examination for OSA patients. There were several ligament calcifications in the head and neck region. Cervical spine osteophytes, as a component of Forestier's or cervical spine disease, have been associated with dysphagia and dysphonia. It was reported that bilateral vocal cord paralysis was caused by osteophytes compressing the post-cricoid area of larynx. PMID:19702680
Ando, E; Ogawa, T; Shigeta, Y; Hirai, S; Ikawa, T; Ishikawa, C; Nejima, J
Introduction Lumbosacral transitional vertebra is an anatomical variation of the fifth lumbar vertebra in which an enlarged transverse process can form a joint or fusion with the sacrum or ilium. The association of that variant with low back pain and the change in the biomechanical properties of the lumbar spine is called Bertolotti’s syndrome. Case presentation We report a case of a 40-year-old male patient with chronic low back pain extending to the left buttock, just above the ipsilateral sacroiliac joint. Radiographic investigation revealed an anomalous enlargement of the left transverse process of the fifth lumbar vertebra forming a pseudarthrosis with the infrajacent ala of the sacrum. Conclusion In young patients with back pain the possibility of Bertolotti’s syndrome should always be taken in account.
Koutras, Georgios; Natsis, Konstantinos
The context of this work is related to the vertebra segmentation. The method we propose is based on the active shape model (ASM). An original approach taking advantage of the edge polygonal approximation was developed to locate the vertebra positions in a X-ray image. Despite the fact that segmentation results show good efficiency, the time is a key variable that has always to be optimized in a medical context. Therefore, we present how vertebra extraction can efficiently be performed in exploiting the full computing power of parallel (GPU) and heterogeneous (multi-CPU/multi-GPU) architectures. We propose a parallel hybrid implementation of the most intensive steps enabling to boost performance. Experimentations have been conducted using a set of high-resolution X-ray medical images, showing a global speedup ranging from 3 to 22, by comparison with the CPU implementation. Data transfer times between CPU and GPU memories were included in the execution times of our proposed implementation.
Lecron, Fabian; Mahmoudi, Sidi Ahmed; Benjelloun, Mohammed; Mahmoudi, Said; Manneback, Pierre
Cervical cancer (CC) is the third most common cancer in women worldwide; however, CC is a preventable disease, and much effort should be done to prevent it. Persistence of high-risk HPV infection is the strongest epidemiologic risk factor for CC, however it is not sufficient for development of the disease it cofactors should be present. In 2004; IARC listed cervical cancer among those causally related to smoking. Smoking interferes with incidence and prevalence of HPV infection and is associated with cervical intraepithelial neoplasia and invasive CC. Multiple factors seem to intervene on cervical carcinogenesis related with tobacco, especially by direct local carcinogenic effect and local immunosuppression. Smoking addition is also closely related with other confounding factors, like unfavorable psychosocial events, systemic immunity, contraception, and nutrition, which got difficult epidemiologic evaluation of smoking role on cervical carcinogenesis. Smoking habits should be taken in account in clinical practice and in research concerning CC.
Fonseca-Moutinho, Jose Alberto
Cervical median corpectomy as an alternative to laminoplasty and laminectomy has been suggested as an effective treatment for cervical spondylotic myelopathy (CSM) in cases of multisegmental spondylotic stenosis. We report on our experience with this procedure with particular reference to neurological outcome and complications. Median corpectomy was performed in 17 cases (3 female, 14 male; mean age 59 yrs, (41-80 yrs.) with cervical myelopathy (CM) and radiologically diagnosed multisegmental spondylotic stenosis and spinal cord compression seen on MRI. The degree of stenosis was determined by means of the modified Pavlov's index (ratio between spinal canal width at the level of the intervertebral disc and the diameter of the vertebral body itself). 3/17 patients suffered from acute, 4/17 from subacute and 10/17 from chronic CM. Single level corpectomy was performed in 9 cases, one and a half vertebrae were removed in 2 cases and dual level corpectomy was performed in the remaining 6 cases. All patients received an autologous bone graft and AO - anterior plate stabilization or were stabilized as described by Morscher. Postoperative follow - up was possible in 16/17 cases over a mean time of 13.5 months. Myelopathy was graded according to Nurick's scale. Postoperatively, 12% with chronic CM improved by two grades, 38% (2 pts, with acute, 3 with subacute and 1 with chronic CM) improved by one grade. The other patients remained stable, none showed worsening of their myelopathy. Paresis improved in 92%, sensory deficits in 69%, spasticity in 73%, pain in 60%, and vegetative disturbances in 100% of all patients presenting these preoperative symptoms respectively. One patient died due to esophageal perforation and subsequent lethal mediastinitis caused by screw loosening 4 months following surgery and after initial neurological improvement. 4 other patients experienced screw loosening, three with acataposis, one remained clinically asymptomatic with concomitant graft displacement in two of these. One patient had to be re-operated due to a hematoma at the iliac crest and 2 suffered from a pelvic fracture of the spina iliaca at the site of graft removal. With respect to the neurological improvement, especially to the motor function and spasticity, median corpectomy can be regarded as an effective procedure in selected cases with cervical myelopathy, even when treatment related complications are taken into consideration. PMID:8779271
Burger, R; Tonn, J C; Vince, G H; Hofmann, E; Reiners, K; Roosen, K
We analysed the distribution and expression of the small leucine-rich proteoglycans (SLRPs) decorin, biglycan and lumican in vertebral columns of Atlantic salmon Salmo salar L. with and without radiographically detectable deformities. Vertebral deformities are a reoccurring problem in salmon and other intensively farmed species, and an understanding of the components involved in the pathologic development of the vertebrae is important in order to find adequate solutions to this problem. Using immunohistology and light microscopy, we found that in non-deformed vertebrae biglycan, lumican and decorin were all expressed in osteoblasts at the vertebral growth zones and at the ossification front of the chondrocytic arches. Hence, the SLRPs are expressed in regions where intramembranous and endochondral ossification take place. In addition, mRNA expression of biglycan, decorin and lumican was demonstrated in a primary osteoblast culture established from Atlantic salmon, supporting the in vivo findings. Transcription of the SLRPs increased during differentiation of the osteoblasts in vitro and where lumican mRNA expression increased later in the differentiation compared with decorin and biglycan. Intriguingly, in vertebral fusions, biglycan, decorin and lumican protein expression was extended to trans-differentiating cells at the border between arch centra and osteoblast growth zones. In addition, mRNA expression of biglycan, decorin and lumican differed between non-deformed and fused vertebrae, as shown by quantitative PCR (qPCR). Western blotting revealed an additional band of biglycan in fused vertebrae which had a higher molecular weight than in non-deformed vertebrae. Fourier-transform infrared (FTIR) spectroscopy revealed more spectral focality in the endplates of vertebral fusions and significantly more non-reducible collagen crosslinks compared with non-deformed vertebrae, thus identifying differences in bone structure. PMID:24062553
Pedersen, Mona E; Ytteborg, Elisabeth; Kohler, Achim; Baeverfjord, Grete; Enersen, Grethe; Ruyter, Bente; Takle, Harald; Hannesson, Kirsten O
In this review a new interpretation of the origin of bony developmental malformations affecting the craniocervical junction and the cervical spine is presented based on recent advances in the understanding of embryonic development of the spine and its molecular genetic control. Radiographs, CT and MRI scans or CT myelograms of patients with Klippel-Feil syndrome were used for demonstration. Detailed clinical and radiological analysis of these patients was published earlier [David KM, Stevens JM, Thorogood P, Crockard HA. The dysmorphic cervical spine in Klippel-Feil syndrome: interpretations from developmental biology. Neurosurg Focus 1999;6(6):1.]. Homeotic transformation due to mutations or disturbed expression of Hox genes is a possible mechanism responsible for Cl assimilation. Notochordal defects and/or signalling problems, that result in reduced or impaired Pax-1 gene expression, may underlie vertebral fusions. This, together with asymmetrical distribution of paraxial mesoderm cells and a possible lack of communication across the embryonic mid-line, could cause the asymmetrical fusion patterns. The wide and flattened shape of the fused vertebral bodies, their resemblance to the embryonic cartilaginous vertebrae and the process of progressive bony fusion with age suggest that the fusions occur before or, at the latest, during chondrification of vertebrae. The authors suggest that the aforementioned mechanisms are likely to be, at least in part, responsible for the origin of the bony developmental malformations affecting the craniocervical junction and the cervical spine. PMID:12201233
Károly, Dávid; Kasó, Gábor; Thorogood, Peter V; Stevens, John M; Crockard, H Alan
The problem of cervical defects is a repeatedly discussed issue. Nowadays, thanks to the dental materials excessive development, the problem of cervical defects once again, has become the center of dentist' interest. The presented article summarizes the historical and current opinion views of cervical defects etiology, as well as their treatment opportunities. It's no more a secret, that successful treatment of cervical defects requires the elimination of the causing agent, without which the failure of any cervical restoration becomes unavoidable. PMID:17966190
In this paper, two patient-specific finite element (FE) models of both an L1 vertebra with a normal T-score and a mildly wedging, osteoporotic one were created and analysed under usual action. Utilising commercial software packages for image processing and FE analysis (FEA) along with in house computer codes for a posteriori assignment of material properties, in vivo high-resolution spiral computed tomography of the entire vertebrae and FEA were combined. Using the vertebra with a normal T-score as baseline it was found that the maximum value of the von Mises stress in the osteoporotic vertebra was 60% higher but still far below bone strength, while the maximum value of von Mises strain in the same vertebra was 148% higher than that of the vertebra with normal T-score. In the vertebra with normal T-score, 17% of its volume exhibited values of von Mises strain higher than the threshold of 4500 ?strains, referenced by Homminga et al. as a threshold of fracture risk, while in the osteoporotic one this percentage was raised up to 37%. The results suggested that the osteoporotic vertebra is susceptible to fracture due to raised strains and not stresses. PMID:19657799
Provatidis, C; Vossou, C; Koukoulis, I; Balanika, A; Baltas, C; Lyritis, G
Vertebra plana is a rare presentation of spinal lymphoma. When radiological picture of a patient of paraplegia presents vertebra plana, diagnosis becomes a challenge. In a developing country like India tuberculosis should also be a consideration. Even histology sometimes fails to conclude a diagnosis. Immunohistochemistry is of immense help in clinching a diagnosis.
Zahid, Mohd.; Ahamed, Sohail; Jain, Jitesh Kumar; Chabra, Ravish
Ventrodorsal radiographs of the pelvis (n=150) of Rottweilers, Golden Retrievers, and German Shepherd dogs and macerated spines (n=800) from a variety of breeds were assessed for morphological evidence of lumbosacral transitional vertebrae as well as for factors that might lead to radiographic misinterpretation of this condition. Those alterations closely resembling the radiographic appearance of transitional vertebrae were identified to be:
S Breit; I Knaus; W Künzel
Elasmosaurid plesiosaurians are renowned for their immensely long necks, and indeed, possessed the highest number of cervical vertebrae for any known vertebrate. Historically, the largest count has been attributed to the iconic Elasmosaurus platyurus from the Late Cretaceous of Kansas, but estimates for the total neck series in this taxon have varied between published reports. Accurately determining the number of vertebral centra vis-à-vis the maximum length of the neck in plesiosaurians has significant implications for phylogenetic character designations, as well as the inconsistent terminology applied to some osteological structures. With these issues in mind, we reassessed the holotype of E. platyurus as a model for standardizing the debated cervical-dorsal transition in plesiosaurians, and during this procedure, documented a “lost” cervical centrum. Our revision also advocates retention of the term “pectorals” to describe the usually three or more distinctive vertebrae close to the cranial margin of the forelimb girdle that bear a functional rib facet transected by the neurocentral suture, and thus conjointly formed by both the parapophysis on the centrum body and diapophysis from the neural arch (irrespective of rib length). This morphology is unambiguously distinguishable from standard cervicals, in which the functional rib facet is borne exclusively on the centrum, and dorsals in which the rib articulation is situated above the neurocentral suture and functionally borne only by the transverse process of the neural arch. Given these easily distinguishable definitions, the maximum number of neck vertebrae preserved in E. platyurus is 72; this is only three vertebrae shorter than the recently described Albertonectes, which together with E. platyurus constitute the “longest necked” animals ever to have lived.
Sachs, Sven; Kear, Benjamin P.; Everhart, Michael J.
Klippel-Feil syndrome is a rare condition characterized by the congenital fusion of two of the seventh cervical vertebrae. A 50-year-old woman presented with a 2-year history of neck pain and ataxia for 1 year. She had not urinary incontinence. She was referred to a neurosurgeon by a neurologist because of her progressive gait ataxia. Risk for brachial plexus injury because of compression or stretching by the clavicle accelerate with age. Therefore, the surgical approach of adults’ patients with Sprengel's deformity can intend suitable surgical conclusions.
Mirhosseini, Seyyed Ahmad; Mirhosseini, Seyyed Mohammad Mahdy; Bidaki, Reza; Boshrabadi, Ahmad Pourrashidi
A previously healthy 64-year-old man developed an Escherichia coli spinal epidural abscess (SEA) isolated to the cervical vertebrae posturinary tract infection 9 days previously. He subsequently underwent emergent surgical decompression followed by a prolonged course of intravenous antibiotics. He is symptom free at 1-year follow-up. SEA is an uncommon condition. Even with modern surgical techniques and antimicrobial agents, the mortality remains significant. Intravenous drug use, spinal procedures and medical conditions such as diabetes, Crohn's disease and chronic renal failure are all known risk factors for SEA and the majority of cases are associated with at least one of these risk factors. The case report highlights the importance of maintaining a high index of suspicion for this condition even in patients without established risk factors who present with red flag symptoms: back pain, fever and neurological deficit, as the consequences of a delayed diagnosis can be severe. PMID:24473426
O'Neill, Shane C; Baker, Joseph F; Ellanti, Prasad; Synnott, Keith
This paper is focused on investigation of mechanical properties of rat vertebrae during compressive loading in the longitudinal direction of rat's spine. High-resolution time-lapse micro-tomography was used as a tool to create models of the inner structure and deformed shape in pre-defined deformation steps. First, peripheral areas of vertebra specimen were embedded in polymethyl methacrylate to obtain proper boundary conditions of contact between specimen and loading plattens. Experimental loading device designed for application in X-ray setups was utilized to compress the vertebrae in several deformation steps. High-resolution micro-tomography scanning was carried out at each deformation step. Specimen was irradiated in tomography device equipped with microfocus X-ray tube with 5?m focal spot size and large area flat panel detector. Spatial resolution of reconstructed three-dimensional images was approximately 10?m. Digital volume correlation algorithm was utilized in order to assess displacements in the microstructure in every loading increment. Finite element model of vertebra was created from volumetric data reconstructed from tomography of the undeformed specimen. Simulated compressive test of the developed finite element model was performed in order to compare stiffness and displacements obtained by digital volume correlation and finite element simulation.
Fíla, T.; Kytý?, D.; Zlámal, P.; Kumpová, I.; Doktor, T.; Koudelka, P.; Jiroušek, O.
The present study aimed to discuss the method and effect of posterior internal fixation of thoracolumbar fractures strengthened by the vertical stress pedicle screw fixation of fractured vertebrae. Patients with single thoracolumbar fractures were examined retrospectively. Fourteen patients (group A) had been treated with vertical stress pedicle screw fixation of a fractured vertebra and sixteen patients (group B) received traditional double-plate fixation, as a control. All patients were diagnosed with fresh fractures with a complete unilateral or bilateral pedicle and no explosion of the inferior half of the vertebral body or inferior endplate. In group A, patients received conventional posterior distraction and lumbar lordosis restoration, as well as pedicle screws in the fractured vertebra in a vertical direction to relieve stress to achieve a local stress balance. All patients were followed up postoperatively for 4–18 months (average, 12.6 months). The vertical stress pedicle screw fixation assisted in the reduction of vertebrae fracture, which reduced the postoperative Cobb’s angle loss. There was a significant difference in the change of Cobb’s angle between the two groups one year after surgery (P<0.01). Conditional application of pedicle screws in a single thoracolumbar fracture enhances the stability of the internal fixation system and is conducive to the correction of kyphosis and maintenance of the corrective effects.
HUANG, WEIJIE; LUO, TAO
Background contextResearch on lumbosacral transitional vertebra (LSTV) has yielded important information on the structural alterations of the sacrum associated with LSTV. Nevertheless, very little data are available on the relationship of a given type of LSTV with either a typical pattern of sacral morphology or its gender distribution in the population.
Niladri Kumar Mahato
Despite the high prevalence of lumbosacral transitional vertebra (LSTV), little is known about the biomechanics of this condition. In addition, as previous studies have focused solely on symptomatic and elderly LSTV patients, the relationship between LSTV and congenital or developmental spinal stenosis remains uncertain. In the present study, the spinal canal diameters were measured in young subjects in whom degenerative
Hasan O?uz; Selami Akku?; Serdar Tarhan; Saim Açikgözo?lu; Memduh Kerman
The prevalence of lumbosacral transitional vertebrae (LTV) was determined by reviewing the pelvic radiographs of 4000 medium- and large-breed dogs of 144 breeds routinely screened for canine hip dysplasia. An LTV was seen in 138 (3.5%) dogs. The prevalence was higher in German Shepherd dogs and Greater Swiss Mountain dogs than in the other breeds, suggesting a genetic predisposition. There was no gender predisposition. The transverse processes of the LTV were divided into three types based on their morphological characteristics: lumbar type or type 1; intermediate type or type 2; and sacral type or type 3. In a symmetric LTV, both transverse processes are of the same type, while in an asymmetric LTV they are not. The frequency of occurrence of symmetric and asymmetric LTV was similar. In symmetric LTV, intermediate-type transverse processes predominated. Most of the asymmetric LTV had an intermediate-type transverse process combined with a lumbar or sacral type, respectively. Highly asymmetric LTV were often angled relative to the adjacent vertebrae. We hypothesize that an LTV is not the result of transformation of a lumbar into a sacral vertebra or vice versa, but rather is an autonomous intermediate type of vertebra. It occurs when the point of contact of the pelvis with the vertebral column is slightly cranial or caudal to its normal position. The resulting formative stimulus on the vertebral ossification centers, sagittally still separated, causes the various morphologies seen in LTV including the asymmetric variations. PMID:16429982
Damur-Djuric, Natascha; Steffen, Frank; Hässig, Michael; Morgan, Joe P; Flückiger, Mark A
STUDY DESIGN: A retrospective study was conducted on the preoperative neurologic symptoms of patients with lumbar herniated discs. OBJECTIVE: To evaluate the possibility that the muscle innervation pattern and the sensory dermatomes of lumbar nerve roots are altered when a lumbosacral transitional vertebra is present. SUMMARY OF BACKGROUND DATA: In 1962, McCulloch et al suggested with intraoperative recordings that the
Han Soo Chang; Hiroshi NAKAGAWA
A vertebral element assigned to an Apatosaurus cf. ajax from the Late Jurassic Morrison Formation is described. The specimen exhibits an unusual morphology where two vertebrae are nearly seamlessly fused together, including the haemal arch that spans them. This morphology is thought be the result of a developmental abnormality. CT scans of the specimen reveal a thin zone of dorsoventral thickening between the two neural arches consistent with cortical bone. Contrast in internal morphology differentiates the anterior and posterior vertebral bodies with the anterior expressing greater porosity, which increased accommodation for barite-rich calcite precipitation. No vacuities are observed to suggest the former presence of an intervertebral disk or intervertebral joints: the absence of an intervertebral disc or intervertebral joints is indicative of a condition known as block vertebra. Block vertebrae occur with the loss, or inhibition, of somitocoele mesenchyme early in embyogenesis (i.e., during resegmentation of the somites responsible for the formation of the affected vertebra). The derivatives of somitocoele mesenchyme include the intervertebral disc and joints. Although vertebral paleopathologies are not uncommon in the fossil record, this specimen is the first recognized congenital malformation within Sauropoda. Anat Rec, 297:1262-1269, 2014. © 2014 Wiley Periodicals, Inc. PMID:24532488
Lovelace, David M
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Mammalian cervical count has been fixed at seven for more than 200 million years. The rare exceptions to this evolutionary constraint have intrigued anatomists since the time of Cuvier, but the developmental processes that generate them are unknown. Here we evaluate competing hypotheses for the evolutionary origin of cervical variants in Bradypus and Choloepus, tree sloths that have broken the seven cervical vertebrae barrier independently and in opposite directions. Transitional and mediolaterally disjunct anatomy characterizes the cervicothoracic vertebral boundary in each genus, although polarities are reversed. The thoracolumbar, lumbosacral, and sacrocaudal boundaries are also disrupted, and are more extreme in individuals with more extreme cervical counts. Hypotheses of homologous, homeotic, meristic, or associational transformations of traditional vertebral column anatomy are not supported by these data. We identify global homeotic repatterning of abaxial relative to primaxial mesodermal derivatives as the origin of the anomalous cervical counts of tree sloths. This interpretation emphasizes the strong resistance of the "rule of seven" to evolutionary change, as morphological stasis has been maintained primaxially coincident with the generation of a functionally longer (Bradypus) or shorter (Choloepus) neck. PMID:19196334
Buchholtz, Emily A; Stepien, Courtney C
The articular facets of the cervical spine have been well addressed; however, little information is available on the relationship of the superior facets of the cervical spine to traumatic dislocation in the literature. Morphometric analyses of the superior facets of 30 dried cervical spines from C3 to C7 were performed to determine any morphological differences. The angle of the superior facet with respect to the transverse plane was also measured on computed tomography (CT) scans of 30 patients having neck injury without fracture/dislocation. The vertical and surface lengths of the superior facet were significantly lower (P?0.01) at C6–C7 levels than at C3–5 levels. The anteroposterior diameter of the superior facet was smaller (P?0.05) at C6 and C7 levels compared to C3–5 levels. Although the superior facet joint surface is in a more coronal orientation in lower cervical vertebrae, the inclination of the superior facet is more horizontal relative to the transverse plane when measured in vivo. A combination of lower height, smaller anteroposterior diameter of the superior facet, and a more horizontally oriented superior facet at C6 and C7 levels in vivo may explain the predilection of translation relative to one another in the lower cervical spine.
Ebraheim, Nabil A.; Patil, Vishwas; Haman, Steve P.; Yeasting, Richard A.
Neurofibromatosis type 1 (NF1) is a common autosomal dominant genetic disorder caused by mutation of the NF1 tumor suppressor gene. Spinal deformities are common skeletal manifestations in patients with NF1. To date, the mechanism of vertebral abnormalities remains unclear because of the lack of appropriate animal models for the skeletal manifestations of NF1. In the present study, we report a novel murine NF1 model, Nf1flox/?;Col2.3Cre+ mice. These mice display short vertebral segments. In addition, a significant reduction in cortical and trabecular bone mass of the vertebrae was observed in Nf1flox/?;Col2.3Cre+ mice as measured by dual-energy X-ray absorptiometry (DEXA) and peripheral quantitative computed tomography (pQCT). Peak stress and peak load were also significantly reduced in Nf1flox/?;Col2.3Cre+ mice as compared to controls. Furthermore, the lumbar vertebrae showed enlargement of the inter-vertebral canal, a characteristic feature of lumbar vertebrae in NF1 patients. Finally, histologic analysis demonstrated increased numbers of osteoclasts and decreased numbers of osteoblasts in the vertebrae of Nf1flox/?;Col2.3Cre+ mice in comparison to controls. In summary, Nf1flox/?;Col2.3Cre+ mice demonstrate multiple structural and functional abnormalities in the lumbar vertebrae which recapitulate the dystrophic vertebral changes in NF1 patients. This novel murine model provides a platform to understand the cellular and molecular mechanisms underlying the pathogenesis of spinal deficits in NF1 patients.
Zhang, Wei; Rhodes, Steven D.; Zhao, Liming; He, Yongzheng; Zhang, Yingze; Shen, Yong; Yang, Dalong; Wu, Xiaohua; Li, Xiaohong; Yang, Xianlin; Park, Su-Jung; Chen, Shi; Turner, Charles; Yang, Feng-Chun
Osteoporotic spinal fractures are a significant global public health issue affecting more than 200 million people. Local degradation of the mechanical properties of bone and changes in global spine curvature increase fracture risk. However, a gap in knowledge exists relating material properties of trabecular bone in different regions of the spine. The purpose of our project was to measure the intrinsic mechanical properties of the anterior and posterior regions of human vertebral bodies in the thoracic and lumbar spine. Nanoindentation was used to evaluate Young's modulus (E) and hardness (H) of anterior and posterior trabecular bone regions from each vertebra (T7, T8 and L4). One-way ANOVA and the Turkey-Kramer test were used to analyze significance between vertebrae and t-test was used to test for significance within vertebrae. There was no difference in (E) and (H) within vertebrae. Young's modulus in the anterior regions of T7 (19.8±1.3) and T8 (19.6±1.4) were statistically greater than that in L4 (17.6±0.5). There was no difference between the posterior regions of all the vertebrae. There was a statistical significant difference in hardness between the anterior regions of T7 and T8 compared to L4, while the posterior regions demonstrated no difference. The results presented in this study, for the first time, reveal the differences in bone properties between the kyphotic thoracic spine and lordotic lumbar spine regions. This information will be helpful in understanding vertebral body remodeling and adaption in different regions of the spine which may be associated with spinal curvature and loading conditions. PMID:23182219
Giambini, Hugo; Wang, Hua-Jun; Zhao, Chunfeng; Chen, Qingshan; Nassr, Ahmad; An, Kai-Nan
We retrospectively reviewed the clinical characteristics and the surgical results of seven patients treated with L5 vertebrectomy. The pathologies, clinical characteristics, preoperative and postoperative radiological findings, surgical techniques, and instrumentation for seven patients operated on between 1998 and 2009 are presented in this article. Biopsies were performed on all patients except those involving trauma. Patients were followed up at three-month intervals in the first year, at 6-month intervals in the second year, and on a regular basis afterward. One patient had a traumatic L5 burst fracture; the other six had tumoral pathologies in the L5 vertebrae. One tumoral lesion was a chordoma, another was a hemangioma, and the remaining four were metastatic lesions. Radiotherapy and chemotherapy were performed for the metastatic tumor patients during the postoperative period. Patients with renal cancer and chordoma survived for 3 years; patients with lung cancer and bladder cancer survived for 1 year; and patients with breast cancer survived for 16 months. The lumbosacral region presents significant stabilization problems because of the presence of sacral slope. In our opinion, if the lesion involves only the L5 vertebra, anterior cage-filled bone cement or bone graft should be performed, as dictated by the pathology and posterior transpedicular instrumentation. If the lesion involves the L4 vertebra or the sacrum and the L5 vertebra, the instrumentation can be extended to cover other segments with sacral attachments. The present cases involved only L5 vertebra and treatment with short-segment stabilization covering the anterior and posterior columns.
Kaner, Tuncay; Oktenoglu, Tunc; Sasani, Mehdi; Ozer, Ali Fahir
The ability of a vertebra to carry load after an initial deformation and the determinants of this postfracture load-bearing capacity are critical but poorly understood. This study aimed to determine the mechanical behavior of vertebrae after simulated mild fracture and to identify the determinants of this postfracture behavior. Twenty-one human L(3) vertebrae were analyzed for bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) and for microarchitecture by micro-computed tomography (µCT). Mechanical testing was performed in two phases: initial compression of vertebra to 25% deformity, followed, after 30?minutes of relaxation, by a similar test to failure to determine postfracture behavior. We assessed (1) initial and postfracture mechanical parameters, (2) changes in mechanical parameters, (3) postfracture elastic behavior by recovery of vertebral height after relaxation, and (4) postfracture plastic behavior by residual strength and stiffness. Postfracture failure load and stiffness were 11%?±?19% and 53%?±?18% lower than initial values (p?=?.021 and p?.0001, respectively), with 29% to 69% of the variation in the postfracture mechanical behavior explained by the initial values. Both initial and postfracture mechanical behaviors were significantly correlated with bone mass and microarchitecture. Vertebral deformation recovery averaged 31%?±?7% and was associated with trabecular and cortical thickness (r?=?0.47 and r?=?0.64; p?=?.03 and p?=?.002, respectively). Residual strength and stiffness were independent of bone mass and initial mechanical behavior but were related to trabecular and cortical microarchitecture (|r|?=?0.50 to 0.58; p?=?.02 to .006). In summary, we found marked variation in the postfracture load-bearing capacity following simulated mild vertebral fractures. Bone microarchitecture, but not bone mass, was associated with postfracture mechanical behavior of vertebrae. PMID:20928886
Wegrzyn, Julien; Roux, Jean-Paul; Arlot, Monique E; Boutroy, Stéphanie; Vilayphiou, Nicolas; Guyen, Olivier; Delmas, Pierre D; Chapurlat, Roland; Bouxsein, Mary L
Extrapulmonary manifestation of tuberculosis (Tb), a medieval disease, occurs in every part of the body with varying degree of frequency but commonly in the pleural and lymph nodes. When it occurs in bones thoracolumbar vertebrae is the usual site of involvement. Other bones are less involved hence seldomly reported. This is true for other organs and parts of the body including larynx, pharynx nose and the middle ear. More importantly, isolated extrapulmonary tuberculosis without pulmonary involvement is uncommon. The case of a 65 year old Nigerian trader who presented with headache, chronic ear ache with otorrhoea, persistent neck pain and found to be diabetic on further evaluation is presented. She was hitherto managed as a case of otitis external malignans without any improvement but rather her clinical condition worsened with evidence of cervical vertebra destruction and multiple cranial nerve palsies without pulmonary tuberculosis. Prompt and effective response to anti tuberculosis drugs informed the diagnosis of tuberculosis of the cervical vertebra and tuberculous otitis media with multiple cranial nerve palsies. This case underscores the value of high index of suspicion, thorough and complete clinical evaluation in any patient with chronic symptoms and signs unresponsive to conventional treatment. PMID:15508343
Aderibigbe, A; Ologe, F E
Anterior cervical discectomy and arthrodesis has come to represent standard of care for patients with persistent radicular and/or myelopathic symptoms that have failed to improve with conservative treatments. One potential complication of the procedure is the accelerated degeneration of the vertebrae and the intervertebral discs adjacent to the level fused and the effects of fusion on those levels. The concern that fusion may be a contributing factor to accelerated adjacent segment degeneration led to increased interest in cervical disc replacement after anterior decompressive surgery. Several studies analyzing the short-term outcomes of the disc replacement procedure have been published since then, and the pros and cons of both procedures continue to remain a topic of debate among the scientific community. The analysis of published literature and our own experience has convinced us that the overall longer-term clinical outcomes after anterior cervical discectomy and fusion (ACDF) and total disc replacement (TDR) in the general patient population are not significantly different in terms of symptomatic improvement, neurological improvement, and restoration to better quality of life. Age of the patients and number of affected levels may impact the outcomes and hence determine the choice of optimum procedure. To definitely compare the incidence of adjacent segment disease after these procedures, multi-institutional studies with predetermined and unanimously agreed upon clinical and radiological criteria should be undertaken and the results analyzed in an unbiased fashion. Until that time, it is reasonable to assume that ACDF as well as cervical TDR are both safe and effective procedures that may have outcome benefits in specific patient subgroups based upon demographics and clinical/radiological parameters at the time of surgery.
Jawahar, Ajay; Nunley, Pierce
Larsen syndrome is a rare genetic disorder of the connective tissue that is characterized by multiple joint dislocations, distinctive deformities of the hands and feet, characteristic facial features, kyphoscoliosis, and segmentation anomalies of the vertebrae. Diverse treatment options, including conservative observation and surgical correction, have been reported for patients who present with cervical spine pathophysiology. Differences in surgical approaches, timing of the correction, and pre- or postoperative bracing have been reported. According to the authors, the present case is the first report of a pediatric patient with Larsen syndrome in whom an asymptomatic cervical instability was treated before neurological deterioration with synchronous anterior decompression and fixation, posterior fusion and fixation, and halo placement. A review of the literature on similar patients reveals the variety of practices associated with a diagnosis of Larsen syndrome. PMID:18377309
Madera, Marci; Crawford, Alvin; Mangano, Francesco T
Anatomical measurements of the cervical pedicle in a large series of human cervical vertebrae from 48 individuals were obtained to reduce the incidence and severity of complications caused by transpedicular screw placement. The greatest pedicle length was at C-3 and the greatest pedicle width was at C-6. Pedicle width and lateral mass thickness gradually increased from C-3 to C-6. Pedicle height and interpedicular distance increased from C-3 to C-5, and decreased slightly at C-6. The lateral mass-pedicle length was greatest at C-4. The present study found right-left differences for the pedicle-spinous process distance at C-6 (p < 0.05). Pedicle width and height were smaller than those reported in earlier studies, especially at C-3 and C-4, whereas the increasing pedicle widths at C-5 and C-6 were appropriate for pedicle screw fixation. PMID:17384491
Kayalioglu, Gulgun; Erturk, Mete; Varol, Tuncay; Cezayirli, Enis
From a comparative study of 222 human and 261 nonhuman primates complete cervical spines, two bony variants associated to the course of the vertebral artery are proposed as unique to genus Homo within primates. First, the opening of the foramen transversarium at C2, a trait present at low frequency in humans (3 to 5.6%). Second, the presence of a bipartite foramen transversarium in the cervical segment C3-C6, a trait that can be observed fully formed in human fetal skeletons, with a clear frequency pattern along the cervical spine (C3>C4>C5>C6
Rios, Luis; Muñoz, Alexandra; Cardoso, Hugo; Pastor, Francisco
Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor. PMID:24761204
Joshi, Vijay P; Zanwar, Atul; Karande, Anuradha; Agrawal, Amit
Ten fresh human cadavers were intubated while recording cervical motion using a cinefluoroscopic technique. Segmental cervical motion from the occiput through C5 was measured in both the intact spine and following the creation of a Type II odontoid fractu...
V. C. Traynelis
The instant center of rotation (ICR) has been proposed as an alternative to range of motion (ROM) for evaluating the quality, rather than the quantity, of cervical spine movement. The purpose of the present study was to assess the sensitivity, reliability and accuracy of cervical spine ICR path calculations obtained during dynamic in vivo movement. The reliability and sensitivity of in vivo cervical spine ICR calculations were assessed by evaluating the effects of movement direction (flexion versus extension), rotation step size, filter frequency, and motion tracking error. The accuracy of the ICR path calculations was assessed through a simulation experiment that replicated in vivo movement of cervical vertebrae. The in vivo assessment included 20 asymptomatic subjects who performed continuous head flexion-extension movements while biplane radiographs were collected at 30 frames/s. In vivo motion of C2 through C7 cervical vertebrae was tracked with sub-millimeter accuracy using a volumetric model-based tracking technique. The finite helical axis method was used to determine ICRs between each pair of adjacent vertebra. The in vivo results indicate ICR path is not different during the flexion movement and the extension movement. In vivo, the path of the ICR can reliably be characterized within 0.5 mm in the SI and 1.0 mm in the AP direction. The inter-subject variability in ICR location averaged ±1.2 mm in the SI direction and ±2.2 mm in the AP direction. The computational experiment estimated the in vivo accuracy in ICR location was between 1.1 mm and 3.1 mm.
Cervical disk injuries are defined as a cervical injury associated with neurological deficits, radicular symptoms, or radiological evidence of disk degeneration, but not with a fracture or a dislocation of the cervical spine. Thirty cases covering the period from July 1982 to June 1984 were analyzed, and the following findings are presented. Fifty percent of the injuries were sustained in
K. Kumano; T. Umeyama
The association between the occurrence of a lumbosacral transitional vertebra (LTV) and the cauda equina syndrome (CES) in dogs was investigated. In 4000 control dogs without signs of CES, 3.5% had an LTV, while in 92 dogs with CES, 16.3% had an LTV. The lesion causing CES always occurred between the last true lumbar vertebra and the LTV. Dogs with an LTV were eight times more likely to develop CES than dogs without an LTV. German Shepherd dogs were eight times more likely to develop CES compared with other breeds. Male dogs were twice as likely to develop CES than females. Dogs with an LTV develop CES 1-2 years earlier than dogs without an LTV. PMID:16429983
Flückiger, Mark A; Damur-Djuric, Natascha; Hässig, Michael; Morgan, Joe P; Steffen, Frank
Lumbar spondylolysis, a well known cause of low back pain, usually affects the pars interarticularis of a lower lumbar vertebra and rarely involves the articular processes. We report a rare case of bilateral spondylolysis of inferior articular processes of L4 vertebra that caused spinal canal stenosis with a significant segmental instability at L4/5 and scoliosis. A 31-year-old male who had suffered from low back pain since he was a teenager presented with numbness of the right lower leg and scoliosis. Plain X-rays revealed bilateral spondylolysis of inferior articular processes of L4, anterolisthesis of the L4 vertebral body, and right lateral wedging of the L4/5 disc with compensatory scoliosis in the cephalad portion of the spine. MR images revealed spinal canal stenosis at the L4/5 disc level. Posterior lumbar interbody fusion of the L4/5 was performed, and his symptoms were relieved. PMID:22111522
Koakutsu, Tomoaki; Morozumi, Naoki; Hoshikawa, Takeshi; Ogawa, Shinji; Ishii, Yushin; Itoi, Eiji
Paracentesis is a common operation for pain clinics and spinal anesthetics administration and requires empirical training and flexible skills to cope with the various cases of individual patients. We propose a method of measuring and visualizing three-dimensional vertebra shapes for assisting anesthesiologists, by an ultrasound imaging technique that is prevalent in many hospitals and has no harmful risks to the human body. The proposed system enables anesthesiologists to investigate vertebra shapes by freehand probing. Three-dimensional reconstruction and graphical rendering can be performed by monitoring the motion of the ultrasound probe and registering the scanned echography into the identical three-dimensional space. Considering the echography imaging features, volume rendering of hard tissue surfaces is achieved and interactive measurement is possible. This paper describes the practicability of the proposed method based on experimental measurement of both phantom and real lumbar vertebre and sacra.
Kohyama, Kazuhiro; Yasumuro, Yoshihiro; Imura, Masataka; Manabe, Yoshitsugu; Oshiro, Osamu; Moroi, Keishichiro; Chihara, Kunihiro
The purpose of the present study was to analyze and predict the changes in acceleration tolerance of human vertebra as a result of bone loss caused by long-term space flight. A human L3-L4 vertebra FEM model was constructed, in which the cancellous bone was separated, and surrounding ligaments were also taken into account. The simulation results demonstrated that bone loss has more of an effect on the acceleration tolerance in x-direction. The results serve to aid in the creation of new acceleration tolerance standards, ensuring astronauts return home safely after long-term space flight. This study shows that more attention should be focused on the bone degradation of crew members and to create new protective designs for space capsules in the future.
Ma, Honglei; Zhang, Feng; Zhu, Yu; Xiao, Yanhua; Wazir, Abrar
Biomechanical studies have shown hooks to be superior to pedicle screws in pull-out, especially in osteoporosis. This study evaluates the possible increase in stiffness of pedicle screws provided by laminar hooks while applying non-destructive forces to a vertebrectomy model assembled with Compact Cotrel Dubousset (CCD) instrumentation. Synthetic vertebrae were employed in a three-level vertebrectomy model. CCD screw-based three-level constructs with
J. Y. Margulies; R. S. Casar; S. A. Caruso; M. G. Neuwirth; T. R. Haher
The purpose of this prospective study was to determine the overall incidence and distribution of lumbo-sacral degenerative changes (i.e. disc protrusion or extrusion, facet degeneration, disc degeneration, nerve root canal stenosis and spinal stenosis) in patients with and without a lumbo-sacral transitional vertebra (LSTV). The study population consisted of 350 sequential patients with low back pain and\\/or sciatica, referred for
S. Vergauwen; P. M. Parizel; L. van Breusegem; J. W. Van Goethem; Y. Nackaerts; L. Van den Hauwe; A. M. De Schepper
Transaxial computed tomographic (CT) sections represent a new approach to vertebral morphometry, allowing certain measurements to be made in vivo for the first time. The cross-sectional morphology of the bodies and pedicles of L3, L4, and L5 was studied in a series of 213 vertebrae. This revealed that the pedicles of L5 arise more laterally from the body of L5
Jan J. P. van Schaik; Henk Verbiest; F. D. J. van Schaik
A 10-year-old cocker spaniel bitch presented with severe lumbosacral pain and acute onset left pelvic limb lameness. A diagnosis of asymmetric lumbosacral transitional vertebra with disc protrusion at L6-L7 was made by computed tomography. The cauda equina and left L6 nerve root were surgically decompressed with a dorsal laminectomy and lateral foraminotomy, which led to rapid resolution of the clinical signs.
Archer, Rebecca; Sissener, Thomas; Connery, Neil; Spotswood, Tim
This is a report of a young girl with congenital kyphosis at the thoracolumbar spine in association with myelomeningocele.\\u000a Kyphectomy and posterior stabilisation extending from the eighth thoracic to the fourth lumbar vertebra was done. Apophyseolysis\\u000a occurred as an early postoperative complication at the level of the L4-L5 disc. This failure mode was treated by extending\\u000a the fusion to the
H. Böhm; Hesham ElSaghir
The purpose of our study was to demonstrate the clinical and radiographic findings in patients with dysphagia and ventral osteophytes of the cervical spine due to degeneration or as a typical feature of diffuse idiopathic skeletal hyperostosis (DISH, Forestier Disease). Since 2003 we encountered 20 patients with such changes in the cervical spine causing an impairment of deglutition. A total of 12 patients had one solitary pair of osteophytes of neighboring vertebrae, 4 patients revealed two pairs and 4 patients had triple pairs of osteophytes. Thirty-two osteophytes were observed totally. A total of 14 of these arose from the right, 15 from the left side and 3 from the middle of the anterior face of the vertebra. Ten patients suffered from DISH, while ten patients revealed osteophytes as a part of a degenerative disorder of the cervical spine. The osteophytes had an average length of 19 mm maximum anterior posterior range. Most of the osteophytes (16) were found in the segments C5/6 and C6/7. Osteophytes of vertebrae C3/4/5 occurred in six cases. Only in one case C2/3 was affected. Functional endoscopic evaluation of swallowing (FEES) revealed an aspiration of thin liquids in seven patients with osteophytes arising from the anterior face of the vertebra C3/4/5 restricting the motility of the epiglottis, which seemed not to close the aditus laryngis. Retention of solids in the piriform sinus on the side obstructed by an osteophyte (C4/5) could also be repeatedly evidenced through FEES. In one case, a strong impairment of the voice because of an immobility of the right vocal cord due to mechanical obstruction by an osteophyte was the indication for surgical removal of the structure. Thus, the dysphagia of this patient was reduced and his voice turned to normal. The development of symptoms in patients with ventral osteophytes was very much related to the location of the structures. Moreover, the clinical symptoms were to some extent dependent on the size of the osteophytes, although there was no direct correlation between size of the structure and severity of the patient's complaint. PMID:18587593
Seidler, T O; Pèrez Alvarez, J C; Wonneberger, K; Hacki, T
Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc arthroplasty devices have come onto the market and completed Food and Drug Administration Investigational Device Exemption trials. Though some of the early results demonstrate equivalency of arthroplasty to fusion, compelling evidence of benefits in terms of symptomatic adjacent segment degeneration are lacking. In addition, non-industry-sponsored studies indicate that these devices are equivalent to fusion in terms of adjacent segment degeneration. Longer-term studies will eventually provide the definitive answer.
Basho, Rahul; Hood, Kenneth A.
Ankylosing Spondylitis is a disease of the vertebra where abnormal bone structures (syndesmophytes) grow at intervertebral disk spaces. Because this growth is so slow as to be undetectable on plain radiographs taken over years, it is necessary to resort to computerized techniques to complement qualitative human judgment with precise quantitative measures on 3-D CT images. Very fine segmentation of the vertebral body is required to capture the small structures caused by the pathology. We propose a segmentation algorithm based on a cascade of three level set stages and requiring no training or prior knowledge. First, the noise inside the vertebral body that often blocks the proper evolution of level set surfaces is attenuated by a sigmoid function whose parameters are determined automatically. The 1st level set (geodesic active contour) is designed to roughly segment the interior of the vertebra despite often highly inhomogeneous and even discontinuous boundaries. The result is used as an initial contour for the 2nd level set (Laplacian level set) that closely captures the inner boundary of the cortical bone. The last level set (reversed Laplacian level set) segments the outer boundary of the cortical bone and also corrects small flaws of the previous stage. We carried out extensive tests on 30 vertebrae (5 from each of 6 patients). Two medical experts scored the results at intervertebral disk spaces focusing on end plates and syndesmophytes. Only two minor segmentation errors at vertebral end plates were reported and two syndesmophytes were considered slightly under-segmented.
Tan, Sovira; Yao, Jianhua; Ward, Michael M.; Yao, Lawrence; Summers, Ronald M.
Background The axial skeleton is one of the defining evolutionary landmarks of vertebrates. How this structure develops and how it has evolved in the different vertebrate lineages is, however, a matter of debate. Vertebrae and vertebral structures are derived from the embryonic somites, although the mechanisms of development are different between lineages. Discussion Using the anecdotal description of a teratological newt (Triturus dobrogicus) with an unusual malformation in its axial skeleton, we review, compare, and discuss the development of vertebral structures and, in particular, the development of centra from somitic cellular domains in different vertebrate groups. Vertebrae development through re-segmentation of the somitic sclerotomal cells is considered the general mechanism among vertebrates, which has been generalized from studies in amniotic model organisms. The prevalence of this mechanism among anamniotes is, however, controversial. We propose alternative developmental mechanisms for vertebrae formation that should be experimentally tested. Summary Research in model organisms, especially amniotes, is laying the foundations for a thorough understanding of the mechanisms of development of the axial skeleton in vertebrates, foundations that should expand the extent of future comparative studies. Although immersed in the ‘-omics’ era, we emphasize the need for an integrative and organismal approach in evolutionary developmental biology for a better understanding of the causal role of development in the evolution of morphological diversity in nature.
Transaxial computed tomographic (CT) sections represent a new approach to vertebral morphometry, allowing certain measurements to be made in vivo for the first time. The cross-sectional morphology of the bodies and pedicles of L3, L4, and L5 was studied in a series of 213 vertebrae. This revealed that the pedicles of L5 arise more laterally from the body of L5 than from L3. Further, the lateral surfaces of the L5 body are inclined obliquely, unlike those of L3. L4 is transitional in form between L3 and L5, more closely resembling the former. This morphology explains the fact, hitherto unnoticed, that the lateral outlines of the pedicles and the lateral borders of the body of L5 are not normally imaged on plain anteroposterior radiographs. It is evident that pathologic changes of the lateral borders of the body of L5 may be invisible also. In cases of transitional vertebrae in the lumbosacral region the presence or absence of the lateral outlines of the pedicles and of the lateral borders of the vertebral body may be of help in identifying the vertebrae on conventional projections.
van Schaik, J.J.P.; Verbiest, H.; van Schaik, F.D.J.
The objective of this study was to determine the level of the aortic bifurcation in relation to the lumbar spine by MRI and the effect of lumbosacral anomalies on the aortic bifurcation. A prospective study of 441 patients was performed. Sagittal MR images of the entire spine were obtained along with the standard protocol for imaging of the lumbar spine. The vertebrae were counted caudally from C2 instead of cranially from the presumed L5 vertebra. The aortic bifurcation in relation to the lumbar vertebrae was determined. The aorta bifurcated at the L4 vertebral body in 67% of cases. In patients with sacralization of L5 the aortic bifurcation was at the L3 vertebral body in 59%. In those patients with lumbarization of S1 the aorta bifurcated at the level of the L4 vertebral body in 40% and at the L4/5 disc space in 33%. There was no demographic variation of the aortic bifurcation in relation to age or sex. The aorta bifurcated at L4 in two-thirds of cases and was variably located in the remaining third. The stability of this as a landmark is disturbed by the significant high incidence of lumbosacral transitional segments. PMID:12497222
Chithriki, M; Jaibaji, M; Steele, R D
This paper looks at Jordanian women's attitudes towards cervical screening and cervical cancer. The sample consisted of 600 women attending gynaecology clinics at King Hussein Medical Centre, Amman, Jordan. Seventy-five per cent of women had never had a smear before; however, the majority agreed that it is important; 34.5% of women did not know the significance of a positive cervical smear; 77% of women were not aware of causes of cervical cancer. Finally, when asked who would they like to take their cervical smear test, a clear preference was stated for a female doctor or a female nurse. These findings provide a useful background for developing strategies to increase the uptake of cervical smears among Jordanian women. It also emphasises the need to educate and promote awareness of women to risk factors for cervical cancer and to the need for screening programmes. PMID:12521469
Maaita, M; Barakat, M
Leiomyosarcoma is a rare malignant tumor derived from smooth muscle cells, which commonly metastasizes to the lungs, liver, kidney, brain and skin. The current study presents the case of a 42-year-old male who presented with progressive neck pain and numbness of the left arm. Spinal computed tomography and magnetic resonance imaging revealed osteolytic lesions of numerous vertebrae (C2, C3, C4, C5, C6, C7, T1 and T2). With regard to the C6 vertebra, total destruction of the vertebral body resulted in vertebral collapse and subsequent spinal cord compression. The patient underwent an anterior C6 corpectomy, reconstruction with a mesh cage filled with polymethyl methacrylate (PMMA) and open PMMA infusion to C5 and C7. The surgical procedure significantly alleviated the symptoms and obtained a reliable reconstruction. The clinical follow-up examination at 13 months was uneventful with the exception of mild numbness of the left hand since the surgery. To the best of our knowledge, this is the first case of leiomyosarcoma recurrence presenting in the cervical spine, and the present study provides insight into the use of a surgical technique that has rarely been used in the cervical spine.
SUN, ZHENZHONG; WANG, HENG; YANG, HUILIN; JIANG, WEIMIN
Ventrodorsal radiographs of the pelvis (n=150) of Rottweilers, Golden Retrievers, and German Shepherd dogs and macerated spines (n=800) from a variety of breeds were assessed for morphological evidence of lumbosacral transitional vertebrae as well as for factors that might lead to radiographic misinterpretation of this condition. Those alterations closely resembling the radiographic appearance of transitional vertebrae were identified to be: (1) calcification of the dorsal and ventral sacroiliac ligaments (=pseudolumbarisation), which might be interpreted as a costal process at S1 (or the corresponding vertebra in cases of numerical vertebral variations); and (2) osteophyte formation at the lumbosacral junction simulating separation of the cranial articular processes from the assembly of the sacral wing as seen in transitional vertebrae. PMID:12618068
Breit, S; Knaus, I; Künzel, W
The aim of the study was to evaluate the relationship between personality, stress and cervical dysplasia. Twenty women with cervical dysplasia were compared to a control group of 23 healthy women. An evaluation of their personality was made by the 16 PF questionnaire; stressing events were investigated with the Paykel scale; hormonal repercussions were studied by using serum and urinary cortisol titers. Significant differences were found in intellectual capability and fancifulness, as well as in cortisol levels. Considering the significant issues that have emerged, we feel that this research is worthy of further investigation and that new evaluation parameters are necessary. PMID:9641233
De Punzio, C; Salvestroni, C; Guazzelli, G; Papa, M C; Freschi, G; Ferdeghini, M; Masoni, S
. From Th1 to L7 midsagittal and interpedicular vertebral canal diameters were measured in macerated spines of 162 dogs to determine, whether the presence of lumbosacral transitional vertebrae or numerical vertebral variations are associated with dislocation of the maximal enlargement of the lumbar vertebral canal. Relative to dogs with a regular number of 27 presacral vertebrae (C7\\/Th13\\/L7), the maximal enlargement
Sabine Breit; Wolfgang Künzel
Summary To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment\\u000a pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with\\u000a thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment\\u000a pedicle screw fixation and were randomly divided into two groups. Fractures
Jinguo Wang; Hua Wu; Xiaolin Ding; Yutian Liu
This study aimed to compare the variation of cancellous bones at four skeletal sites: lumbar vertebra, femoral neck, mandibular angle and rib in ovariectomized sheep. Sixteen adult sheep were randomly divided into two groups: eight sheep were ovariectomized served as experimental group; the other eight untreated sheep were served as control group. Bone mineral density was assessed by dual-energy X-ray absorptiometry on lumbar vertebrae at baseline and twelve months after ovariectomy. After 12 months, lumbar vertebrae L3 and L4, femoral necks, mandibular angles and the fourth ribs were harvested for micro-CT scanning, histological analysis and biomechanical test. The results showed that bone mineral density of lumbar vertebra decreased significantly in twelfth month (p<0.05). The results of micro-CT showed that the bone volume/total volume decreased by 45.6%, 36.1% 21.3% and 18.7% in lumbar vertebrae, femoral necks, mandibular angles and ribs in experimental group (p<0.05) respectively. The trabecular number showed the same downtrend (p<0.05). Histological analysis showed trabecular area/tissue area decreased by 32.1%, 23.2% and 20.7% in lumbar vertebrae, femoral necks and mandibular angles respectively (p<0.05), but no significant difference in ribs. Specimens elastic modulus from lumbar vertebra, femoral neck and mandibular angle were 952±76MPa (628±70MPa), 961±173MPa (610±72MPa) and 595±60MPa (444±31MPa) in control group (experimental group) respectively. These datum indicated that the sensibility of cancellous bones to oestrogen deficiency in ovariectomized sheep was site-specific on a pattern as follows: lumbar vertebra, femoral neck, mandibular angle and rib. PMID:24769217
Zhang, Yongqiang; Li, Yongfeng; Gao, Qi; Shao, Bo; Xiao, Jianrui; Zhou, Hong; Niu, Qiang; Shen, Mingming; Liu, Baolin; Hu, Kaijin; Kong, Liang
Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer
Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Recurrent Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer
Since the cervical cerclage was introduced to clinical practice 50 years ago, the efficacy of the operation has not been established by evidence-based standards for many indications. Serious flaws in the methods employed to study the safety and efficacy of cerclage have led to confusion and misuse of the operation, although some investigators maintain that current standards make randomized clinical
James H Harger
Disc-associated cervical spondylomyelopathy (DA-CSM) is the most common cause of cervical spondylomyelopathy in dogs. In this condition, progressive caudal cervical spinal cord compression is typically caused by protrusion of one or more intervertebral discs. This disc-associated compression is sometimes seen in combination with mild vertebral abnormalities and dorsal compression resulting from ligamentum flavum hypertrophy. The intervertebral disc space between the sixth (C6) and seventh (C7) cervical vertebrae is most commonly affected. Although several large breed dogs can be affected, the adult to older dobermann is overrepresented. Clinical signs vary from cervical hyperaesthesia to tetraplegia. Dogs can present with a chronic progressive or an acute onset of clinical signs. Many aspects of this multifactorial neurological syndrome are not completely understood and are the subject of controversy and debate. Although several factors have been proposed, the underlying pathology and aetiology remain unknown. Recently, new insights have been gained in the pathogenesis, diagnosis and treatment of this challenging neurological syndrome. This review outlines current controversies and new developments concerning the pathogenesis and diagnosis of DA-CSM. PMID:23180710
De Decker, S; da Costa, R C; Volk, H A; Van Ham, L M L
A three-dimensional finite element (FE) model for the multi-level lower cervical spinal segment C3-C6 has been developed using computed tomography (CT) data, and applied to study of the effects of the fusion and the artificial disc prosthesis on the biomechanical behavior of the lower cervical spine. The NURBS computer adided dedsig (CAD) data used in this study for modeling the vertebrae facilitate adding surface patch layouts for seamless attachment of the soft tissues, such as intervertebral discs onto the vertebrae. A FE model was completed by generating mesh out of this geometry. Its accuracy was validated by comparing with previously published experimental and numerical results for the flexion-extension, axial rotation, and lateral bending moments. An implantation of an elastomer-type disc prosthesis or fused graft between C4-C5 vertebrae was considered in the FE model by modifying the intact disc. It is shown that the fusion reduced the mobility at its level by about 50-70% for the considered loading cases. It is numerically demonstrated that an elastomer with Young's modulus of 5.9 MPa for the artificial disc prosthesis well restores the biomechanical behavior of the intact spine. PMID:16278091
Ha, Sung Kyu
Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer
Besides skin tumors, osteosarcomas were induced at high frequency in the lumbar vertebrae of ICR mice by repeated local external irradiation of the back with /sup 90/Sr-/sup 90/Y beta-rays when irradiation was repeated three times a week until tumors appeared. The optimum dose range for osteosarcoma induction was 250-350 cGy per exposure at the surface of the back, or 125-175 cGy at the depth of the center of the bone. With the same irradiation schedule, the optimal dose of radiation for induction of osteosarcomas was much lower than that for induction of skin tumors.
Ootsuyama, A.; Tanooka, H.
Objective The purpose of this study is to report the chiropractic management of a patient with low back pain and Castellvi type II lumbosacral transitional vertebrae (LSTV). Clinical Features A patient with previously undiagnosed LSTV presented with moderate low back pain. Interventions and Outcome Manual therapy, soft tissue therapy, and exercise/stretching were included in the initial treatment plan. Following a short course of treatment, the presenting symptoms resolved; however, they returned after 3 symptom-free months. At that time, radiographs were ordered and the LSTV were identified. Following another course of chiropractic care, the patient's symptoms resolved. Conclusions Chiropractic management resulted in resolution of symptoms for this patient with LSTV.
Muir, Jeffrey M.
Cervical spondylosis is caused by degenerative disc disease and usually produces intermittent neck pain in middle-aged and elderly patients. This pain usually responds to activity modification, neck immobilization, isometric exercises, and medication. Neurologic symptoms occur infrequently, usually in patients with congenital spinal stenosis. For these patients, magnetic resonance imaging is the preferred initial diagnostic study. Because involvement of neurologic structures on imaging studies may be asymptomatic, consultation with a neurologist is advised to rule out other neurologic diseases. In most cases of spondylotic radiculopathy, the results of conservative treatment are so favorable that surgical intervention is not considered unless pain persists or unless there is progressive neurologic deficit. If indicated, a surgical procedure may be done through the anterior or posterior cervical spine; results are gratifying, with long-term improvement in 70% to 80% of patients. Cervical spondylotic myelopathy is the most serious and disabling condition of this disease. Because many patients have nonprogressive minor impairment, neck immobilization is a reasonable treatment in patients presenting with minor neurologic findings or in whom an operation is contraindicated. This simple remedy will result in improvement in 30% to 50% of patients. Surgical intervention is indicated for patients presenting with severe or progressive neurologic deficits. Anterior cervical approaches are generally preferred, although there are still indications for laminectomy. Surgical results are modest, with good initial results expected in about 70% of patients. Functional outcome noticeably declines with long-term follow-up, which raises the question of whether, and how much, surgical treatment affects the natural course of the disease. Prospective randomized studies are needed to answer these questions. Images Figure 1. Figure 2. Figure 3.
McCormack, B M; Weinstein, P R
Opinion statement Early cervical cancer includes a broad range of disease, from clinically undetectable microinvasive cancer to large, bulky\\u000a tumors that replace the entire cervix. Further subgrouping of this category is therefore necessary to define the optimal treatment\\u000a approach for individual cases. The International Federation of Gynecology and Obstetrics (FIGO) staging system stratifies\\u000a stage I tumors into two broad categories, stage
Karen H. Lu; Thomas W. Burke
Involvement of the cervical spine is common in rheumatoid arthritis. Clinical presentation can be variable, and symptoms may be due to neck pain or compressive myeloradiculopathy. We discuss the pathology, grading systems, clinical presentation, indications for surgery and surgical management of cervical myelopathy related to rheumatoid arthritis in this paper. We describe our surgical technique and results. We recommend early consultation for surgical management when involvement of the cervical spine is suspected in rheumatoid arthritis. Even patients with advanced cervical myelopathy should be discussed for surgical treatment, since in our experience improvement in function after surgery is common.
Mukerji, N.; Todd, N. V.
Purpose To compare MRI, CT, clinical exam and histopathological analysis for predicting lymph node involvement in women with cervical carcinoma, verified by lymphadenectomy. Methods A 25-center ACRIN/GOG study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT prior to attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist, and retrospectively by 4 independent offsite radiologists, all blinded to surgical, histopathological and other imaging findings. Likelihood of parametrial and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in 3 axes. Association with histologic lymph node involvement, scored as absent, pelvic only and common iliac or paraaortic, was evaluated using Cochran-Mantel Haenszel statistics, univariate and multivariate logistic regression, generalized estimating equations, accuracy statistics and ROC analysis. Results Lymphatic metastases were found in 34% of women; 13% had common iliac nodal metastases, and 9% had paraortic nodal metastases. Based on the retrospective multi-observer re-reads, average AUC for predicting histologic lymph node involvement between MRI and CT for tumor size were higher for MRI versus CT, although formal statistic comparisons could not be conducted. Multivariate analysis showed improved model fit incorporating predictors from MRI, but not CT, over and above the initial clinical and biopsy predictors, although the increase in discriminatory ability was not statistically significant. Conclusion MRI findings may help predict the presence of histologic lymph node involvement in women with early invasive cervical carcinoma, thus providing important prognostic information.
Mitchell, Donald G; Snyder, Bradley; Coakley, Fergus; Reinhold, Caroline; Thomas, Gillian; Amendola, Marco A.; Schwartz, Lawrence H; Woodward, Paula; Pannu, Harpreet; Atri, Mostafa; Hricak, Hedvig
For assessing mechanical properties of osteoporotic bone, biomechanical testing combined with in silico modeling plays a key role. The present study focuses on microscopic mechanical bone properties in a rat model of postmenopausal osteoporosis. Female Sprague-Dawley rats were (1) euthanized without prior interventions, (2) sham-operated, and (3) subjected to ovariectomy combined with a multi-deficiencies diet. Rat vertebrae (corpora vertebrae) were imaged by micro-CT, their stiffness was determined by compression tests, and load-induced stress states as well as property changes due to the treatment were analyzed by finite-element modeling. By comparing vertebra stiffness measurements with finite-element calculations of stiffness, an overall microscopic Young's modulus of the bone was determined. Macroscopic vertebra stiffness as well as the microscopic modulus diminish with progression of osteoporosis by about 70 %. After strong initial changes of bone morphology, further decrease in macroscopic stiffness is largely due to decreasing microscopic Young's modulus. The micromechanical stress calculations reveal particularly loaded vertebra regions prone to failure. Osteoporosis-induced changes of the microscopic Young's modulus alter the fracture behavior of bone, may influence bone remodeling, and should be considered in the design of implant materials. PMID:24518991
Müller, Robert; Kampschulte, Marian; Khassawna, Thaqif El; Schlewitz, Gudrun; Hürter, Britta; Böcker, Wolfgang; Bobeth, Manfred; Langheinrich, Alexander C; Heiss, Christian; Deutsch, Andreas; Cuniberti, Gianaurelio
A modified form of the Cloward technique for anterior cervical fusion in human beings was used in the application of different grafts for evaluation of their effectiveness in stabilizing equine cervical vertebrae. Results of bovine xenograft implants in 8 horses were compared with results of stainless steel baskets (SSB) packed with cancellous autogenous bone in 8 horses. Graft material was incorporated in all cases. Evidence of graft rejection was not present. Both forms of implants decreased the mobility of the intervertebral space in which they were implanted. A fibrous connective tissue union was prevalent after xenograft implantation. Osseous union was prevalent after implantation of the SSB. Reduction in range of motion was greatest at those sites with the SSB. PMID:6367560
DeBowes, R M; Grant, B D; Bagby, G W; Gallina, A M; Sande, R D; Ratzlaff, M H
Micro-finite element (?FE) modeling has shown promise in evaluating the structural integrity of trabecular bone. Histologic microcrack analyses have been compared to ?FE models of trabecular bone cores to demonstrate the potential of this technique. To date this has not been achieved in whole bone structures, and comparisons of histologic microcrack and ?FE results have been limited due to challenges in alignment of 2D sections with 3D data sets. The goal of this study was to ascertain if image registration can facilitate determination of a relationship between stresses and strains generated from ?FE models of whole vertebrae and histologically identified microdamage. ?FE models of three whole vertebrae, stained sequentially with calcein and fuchsin, were generated with accurate integration of element sets representing the histologic sections based on volumetric image registration. Displacement boundary conditions were applied to the ?FE models based on registration of loaded and unloaded ?CT images. Histologically labeled damaged regions were found to have significantly higher von Mises stresses and principle strains in the ?FE models, as compared to undamaged regions. This work provides a new robust method for generating and histologically validating ?FE models of whole bones that can represent trabecular damage resulting from complex physiologic loading. PMID:23737260
Herblum, Ryan; Beek, Maarten; Whyne, Cari M
Snakes are a very speciose group of squamates that adapted to various habitats and ecological niches. Their ecological diversity is of particular interest and functional demands associated with their various styles of locomotion are expected to result in anatomical specializations. In order to explore the potential adaptation of snakes to their environment we here analyze variation in vertebral structure at the microanatomical level in species with different locomotor adaptations. Vertebrae, being a major element of the snake body, are expected to display adaptations to the physical constraints associated with the different locomotor modes and environments. Our results revealed a rather homogenous vertebral microanatomy in contrast to what has been observed for other squamates and amniotes more generally. We here suggest that the near-absence of microanatomical specializations in snake vertebrae might be correlated to their rather homogeneous overall morphology and reduced range of morphological diversity, as compared to lizards. Thus, snakes appear to retain a generalist inner morphology that allows them to move efficiently in different environments. Only a few ecologically highly specialized taxa appear to display some microanatomical specializations that remain to be studied in greater detail.
Houssaye, Alexandra; Boistel, Renaud; Böhme, Wolfgang; Herrel, Anthony
Objectives: Few studies have described morphological deviations in obstructive sleep apnoea (OSA) patients on two-dimensional (2D) lateral cephalograms, and the reliability of 2D radiographs has been discussed. The objective is to describe the morphology of the cervical vertebral column on cone beam CT (CBCT) in adult patients with OSA and to compare 2D lateral cephalograms with three-dimensional (3D) CBCT images. Methods: For all 57 OSA patients, the cervical vertebral column morphology was evaluated on lateral cephalograms and CBCT images and compared according to fusion anomalies and posterior arch deficiency. Results: The CBCT assessment showed that 21.1% had fusion anomalies of the cervical column, i.e. fusion between two cervical vertebrae (10.5%), block fusions (8.8%) or occipitalization (1.8%). Posterior arch deficiency occurred in 14% as partial cleft of C1 and in 3.5% in combination with block fusions. The agreement between the occurrence of morphological deviations in the cervical vertebral column between lateral cephalograms and CBCT images showed good agreement (??=?0.64). Conclusions: Prevalence and pattern in the cervical column morphology have now been confirmed on CBCT. The occurrence of morphological deviations in the cervical vertebral column showed good agreement between lateral cephalograms and CBCT images. This indicates that 2D lateral cephalograms (already available after indication in connection with, e.g. treatment planning) are sufficient for identifying morphological deviations in the cervical vertebral column. For a more accurate diagnosis and location of the deviations, CBCT is required. New 3D methods will suggest a need for new detailed characterization and division of deviations in cervical vertebral column morphology.
Sonnesen, L; Jensen, KE; Petersson, AR; Petri, N; Berg, S; Svanholt, P
Background: Various lateral mass screw fixation methods have been described in the literature with various levels of safety in relation to the anterior neurovascular structures. This study was designed to radiologically determine the minimum lateral angulations of the screw to avoid penetration of the vertebral artery canalusing three of the most common techniques: Roy-Camille, An, and Magerl. Materials and Methods: Sixty normal cervical CT scans were reviewed. A minimum lateral angulation of a 3.5 mm lateral mass screw which was required to avoid penetration of the vertebral artery canal at each level of vertebra were measured. Results: The mean lateral angulations of the lateral mass screws (with 95% confidence interval) to avoid vertebral artery canal penetration, in relation to the starting point at the midpoint (Roy-Camille), 1 mm medial (An), and 2 mm medial (Magerl) to the midpoint of lateral mass were 6.8° (range, 6.3–7.4°), 10.3° (range, 9.8–10.8°), and 14.1° (range, 13.6–14.6°) at C3 vertebrae; 6.8° (range, 6.2–7.5°), 10.7° (range, 10.0–11.5°), and 14.1° (range, 13.4–14.8°) at C4 vertebrae; 6.6° (range, 6.0–7.2°), 10.1° (range, 9.3–10.8°), and 13.5° (range, 12.8–14.3°) at C5 vertebrae and 7.6° (range, 6.9–8.3°), 10.9° (range, 10.3–11.6°), and 14.3° (range, 13.7–15.0°) at C6 vertebrae. The recommended lateral angulations for Roy-Camille, Magerl, and An are 10°, 25°,and 30°, respectively. Statistically, there is a higher risk of vertebral foramen violation with the Roy-Camille technique at C3, C4 and C6 levels, P < 0.05. Conclusions: Magerl and An techniques have a wide margin of safety. Caution should be practised with Roy-Camille's technique at C3, C4, and C6 levels to avoid vertebral vessels injury in Asian population.
Sureisen, Mariapan; Saw, Lim Beng; Wei Chan, Chris Yin; Singh, Deepak Ajit; Kwan, Mun-Keong
Localization of target vertebrae is an essential step in minimally invasive spine surgery, with conventional methods relying on "level counting" - i.e., manual counting of vertebrae under fluoroscopy starting from readily identifiable anatomy (e.g., the sacrum). The approach requires an undesirable level of radiation, time, and is prone to counting errors due to the similar appearance of vertebrae in projection images; wrong-level surgery occurs in 1 of every ~3000 cases. This paper proposes a method to automatically localize target vertebrae in x-ray projections using 3D-2D registration between preoperative CT (in which vertebrae are preoperatively labeled) and intraoperative fluoroscopy. The registration uses an intensity-based approach with a gradient-based similarity metric and the CMA-ES algorithm for optimization. Digitally reconstructed radiographs (DRRs) and a robust similarity metric are computed on GPU to accelerate the process. Evaluation in clinical CT data included 5,000 PA and LAT projections randomly perturbed to simulate human variability in setup of mobile intraoperative C-arm. The method demonstrated 100% success for PA view (projection error: 0.42mm) and 99.8% success for LAT view (projection error: 0.37mm). Initial implementation on GPU provided automatic target localization within about 3 sec, with further improvement underway via multi-GPU. The ability to automatically label vertebrae in fluoroscopy promises to streamline surgical workflow, improve patient safety, and reduce wrong-site surgeries, especially in large patients for whom manual methods are time consuming and error prone.
Otake, Y.; Schafer, S.; Stayman, J. W.; Zbijewski, W.; Kleinszig, G.; Graumann, R.; Khanna, A. J.; Siewerdsen, J. H.
Objective The purpose of this study is to elucidate the anatomic relationships between the uncinate process and surrounding neurovascular structures to prevent possible complications in anterior cervical surgery. Methods Twenty-eight formalin-fixed cervical spines were removed from adult cadavers and were studied. The authors investigated the morphometric relationships between the uncinate process, vertebral artery and adjacent nerve roots. Results The height of the uncinate process was 5.6-7.5 mm and the width was 5.8-8.0 mm. The angle between the posterior tip of the uncinate process and vertebral artery was 32.2-42.4°. The distance from the upper tip of the uncinate process to the vertebral body immediately above was 2.1-3.3 mm, and this distance was narrowest at the fifth cervical vertebrae. The distance from the posterior tip of the uncinate process to the nerve root was 1.3-2.0 mm. The distance from the uncinate process to the vertebral artery was measured at three different points of the uncinate process : upper-posterior tip, lateral wall and the most antero-medial point of the uncinate process, and the distances were 3.6-6.1 mm, 1.7-2.8 mm, and 4.2-5.7 mm, respectively. The distance from the uncinate process tip to the vertebral artery and the angle between the uncinate process tip and vertebral artery were significantly different between the right and left side. Conclusion These data provide guidelines for anterior cervical surgery, and will aid in reducing neurovascular injury during anterior cervical surgery, especially in anterior microforaminotomy.
Kim, Sung-Ho; Lee, Jae Hack; Kim, Ji Hoon; Chun, Kwon Soo; Doh, Jae Won
Morphometric investigations comparing normal and affected animals increase our understanding of spinal diseases in dogs. The aim of this study was to generate morphometric data for osseous-associated cervical spondylomyelopathy (CSM) in Great Danes (GDs). Magnetic resonance imaging (MRI) morphometric features of the cervical vertebral column of GDs with and without clinical signs of CSM were characterized and compared. Thirty client-owned GDs were prospectively enrolled, including 15 clinically normal and 15 CSM-affected GDs. All dogs underwent MRI of the cervical to thoracic vertebral column (C2-C3 through T1-T2). Areas of the cranial and caudal articular processes, and the height, width and areas of the vertebral canal and spinal cord were determined. Middle foraminal heights were measured. Intervertebral disc width was measured before and after traction. Intraobserver and interobserver agreement were calculated. CSM-affected GDs had larger areas of the caudal articular processes from C2-C3 through T1-T2. In CSM-affected GDs, the vertebral canal and spinal cord areas were significantly smaller at C5-C6 and C6-C7, the vertebral canal width was significantly narrower at C6-C7 and C7-T1, and the spinal cord width was significantly narrower at C5-C6 and C6-C7. Middle foraminal height was smaller in CSM-affected GDs from C3-C4 through C7-T1. Neutral intervertebral disc widths were smaller in CSM-affected GDs. It was concluded that the cervical vertebral canal dimensions are significantly different between normal and CSM-affected GDs. Absolute vertebral canal stenosis and severe foraminal stenosis involving the cervical vertebrae distinguish CSM-affected from clinically normal GDs. These findings are relevant to the pathogenesis of osseous-associated CSM and should be taken into consideration when performing imaging studies and planning surgery. PMID:24888675
Martin-Vaquero, P; da Costa, R C; Lima, C G D
Invasive cervical resorption is a relatively uncommon form of external root resorption. It is characterized by invasion of cervical region of the root by fibrovascular tissue derived from the periodontal ligament. This case presents an invasive cervical resorption occurring in maxillary lateral incisor, following damage in cervical cementum from avulsion and intracoronal bleaching procedure. Flap reflection, debridement and restoration with glass ionomer cement were performed in an attempt to repair the defect. But after 2 mon, more resorption extended apically. Considering root stability and recurrence potential, we decided to extract the tooth. Invasive cervical resorption in advanced stages may present great challenges for clinicians. Therefore, prevention and early detection must be stressed when dealing with patients presenting history of potential predisposing factors.
Kim, Yookyung; Lee, Chan-Young; Kim, Euiseong
Cervical intradural disc herniation (IDH) is a rare condition with very few case reports in the literature. We report a 64-year-old man who presented with sudden onset neck pain and rapidly progressing weakness in the left upper and lower limb. There was no history of trauma. MRI of the cervical spine showed a C6-C7 disc prolapse, for which he underwent a C6-C7 discectomy and fusion with bone graft through an anterior cervical approach. To our knowledge, all patients with a cervical IDH reported in the literature have a traumatic etiology. To the best of our knowledge, we report the first patient with a spontaneous cervical IDH. PMID:24210799
Warade, Abhijit G; Misra, Basant K
Aging is the major risk factor that contributes to the onset of cervical spondylosis. Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss along the ventral margin of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. The altered posture of the cervical spine will progress into kyphosis and continue if the load balance and lordosis is not restored. The content of this paper will address the physiological and biomechanical pathways leading to cervical spondylosis and the biomechanical principles related to the surgical correction and treatment of kyphotic progression.
Ferrara, Lisa A.
An anatomically accurate, three-dimensional, nonlinear finite element model of the human cervical spine was developed using computed tomography images and cryomicrotome sections. The detailed model included the cortical bone, cancellous core, endplate, lamina, pedicle, transverse processes and spinous processes of the vertebrae; the annulus fibrosus and nucleus pulposus of the intervertebral discs; the uncovertebral joints; the articular cartilage, the synovial fluid and synovial membrane of the facet joints; and the anterior and posterior longitudinal ligaments, interspinous ligaments, capsular ligaments and ligamentum flavum. The finite element model was validated with experimental results: force-displacement and localized strain responses of the vertebral body and lateral masses under pure compression, and varying eccentric anterior-compression and posterior-compression loading modes. This experimentally validated finite element model was used to study the biomechanics of the cervical spine intervertebral disc by quantifying the internal axial and shear forces resisted by the ventral, middle, and dorsal regions of the disc under the above axial and eccentric loading modes. Results indicated that higher axial forces (compared to shear forces) were transmitted through different regions of the disc under all loading modes. While the ventral region of the disc resisted higher variations in axial force, the dorsal region transmitted higher shear forces under all loading modes. These findings may offer an insight to better understand the biomechanical role of the human cervical spine intervertebral disc. PMID:10717549
Kumaresan, S; Yoganandan, N; Pintar, F A; Maiman, D J
Heparanase is an endoglycosidase that specifically cleaves heparan sulfate side chains of heparan sulfate proteoglycans, the major proteoglycans in the extracellular matrix and cell surfaces. Traditionally, heparanase activity was implicated in cellular invasion associated with angiogenesis, inflammation, and cancer metastasis. More recently, heparanase up-regulation was documented in an increasing number of primary human tumors. Iotan this study, we sought to investigate the expression of heparanase messenger RNA (mRNA) in normal cervical tissue and intraepithelial cervical lesion and its clinicopathologic importance in invasive cervical cancer. Gene expression of heparanase was assessed by quantitative real-time reverse transcriptase polymerase chain reaction in 28 normal cervical, 26 intraepithelial neoplastic, and 48 cervical cancer tissue samples. Heparanase mRNA expression was different between the 3 groups and lower in normal cervical specimens in relationship with intraepithelial cervical lesions and invasive cervical cancer tissue samples (P = 0.048). Gradually increasing expression of heparanase was evident as the cells progressed from low-grade to high-grade squamous intraepithelial lesions (P = 0.002). In invasive cervical cancer cases, there was a direct correlation between heparanase expression and tumor size (P = 0.002). In cases treated with radical hysterectomy and pelvic lymphadenectomy, the heparanase mRNA expression was significantly higher in tumors exhibiting lymph vascular space invasion (P = 0.044) and in cases with big tumor size (P = 0.005). In our study, we did not find any significant correlation between disease-free and overall survival rates and expression of heparanase (P = 0.396 and P = 0.712, respectively). The results of this study suggest that the gene expression of heparanase in cervical cancer enhances growth, invasion, and angiogenesis of the tumor and may have therapeutic applications. PMID:19955948
Varchalama, Eugene; Rodolakis, Alexander; Strati, Areti; Papageorgiou, Theocharis; Valavanis, Christos; Vorgias, George; Lianidou, Evi; Antsaklis, Aristidis
Despite the high prevalence of lumbosacral transitional vertebra (LSTV), little is known about the biomechanics of this condition. In addition, as previous studies have focused solely on symptomatic and elderly LSTV patients, the relationship between LSTV and congenital or developmental spinal stenosis remains uncertain. In the present study, the spinal canal diameters were measured in young subjects in whom degenerative changes have not yet become significant. Seventeen young adults with LSTV and 24 normal controls were included in this study. The spinal canal sagittal diameter, interpedicular distance, interfacet distance and lateral recess diameter were measured using CT scans. There was no significant difference in the measured values between the two groups. In conclusion, the results indicate that there is no relationship between LSTV and a congenitally narrower canal. PMID:11956916
O?uz, Hasan; Akku?, Selami; Tarhan, Serdar; Açikgözo?lu, Saim; Kerman, Memduh
This article brings the biomechanical analysis of sport--Nordic walking--for patients with osteoporotic fractured vertebrae and shows that it is suitable for them. Based on the biomechanical model of skeletal load we have developed a method of walking movement for patients, different from the method of walking movement for healthy people. And so came into being the "first sport" for patients with osteoporotic fractures. They can go for regular walks in easy terrains outdoors with friends and family, and so be liberated from social isolation. It requires only one-off financial costs of buying the poles and special footwear (Tab. 7, Fig. 3, Ref. 14). Full Text (Free, PDF) www.bmj.sk. PMID:18814434
Scanning electron microscopic studies of replicas of the first and second thoracic vertebrae of mice aged 25-60 days allow us to differentiate areas of bone deposition and resorption, the sites of areas of calcified cartilage and the attachments of ligaments. The main site of resorption throughout the period is beneath the neural arch, with other local areas of resorption occurring around the developing vertebral processes. The spinous process increases in size over the period, especially in T2. Results obtained in this way correlate well with an earlier morphometric study of the same bones. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11
O'Higgins, P; Johnson, D R; Paxton, S K
Medical records of 41 dogs, including 15 small breed dogs (<15 kg) and 26 large breed dogs (>15 kg), with cervical intervertebral disc disease (IVDD) that underwent a hemilaminectomy were reviewed. Dogs were diagnosed using myelography, computed tomography/myelography, or MRI, and dogs were classified as having either Hansen Type I disc extrusion or Hansen Type II disc protrusion located ventrally, ventrolaterally, or laterally within the cervical spinal canal. The most common clinical presentation was ambulatory tetraparesis and/or lameness (44%). The most affected sites for cervical IVDD were between the sixth and seventh cervical vertebrae (C6-C7; 78% of Hansen Type II discs) and C2-C3 (86% of Hansen Type I discs). Treatment was effective in 88% of dogs. Five large breed dogs (12%) did not improve. In dogs with a Hansen Type I disc extrusion, clinical signs improved in 96% of the cases. In dogs with a Hansen Type II disc protrusion, an excellent and good outcome was seen in 47% and 32% of cases, respectively. Outcome was significantly better for small breed dogs and dogs with Hansen Type I disc disease compared with large breed dogs and dogs with Hansen Type II disc disease. PMID:21852506
Schmied, Oliver; Golini, Lorenzo; Steffen, Frank
Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Recurrent Cervical Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer
Vertebral cement augmentation can restore the stiffness and strength of a fractured vertebra and relieve chronic pain. Previous finite element analysis, biomechanical tests and clinical studies have indirectly associated new adjacent vertebral fractures following augmentation to altered loading. The aim of this repeated measures in situ biomechanical study was to determine the changes in the adjacent and augmented endplate deformation following cement augmentation of human cadaveric functional spine units (FSU) using micro-computed tomography (micro-CT). The surrounding soft tissue and posterior elements of 22 cadaveric human FSU were removed. FSU were assigned to two groups, control (n = 8) (loaded on day 1 and day 2) and augmented (n = 14) (loaded on day 1, augmented 20% cement fill, and loaded on day 2). The augmented group was further subdivided into a prophylactic augmentation group (n = 9), and vertebrae which spontaneously fractured during loading on day 1 (n = 5). The FSU were axially loaded (200, 1,000, 1,500–2,000 N) within a custom made radiolucent, saline filled loading device. At each loading step, FSUs were scanned using the micro-CT. Endplate heights were determined using custom software. No significant increase in endplate deformation following cement augmentation was noted for the adjacent endplate (P > 0.05). The deformation of the augmented endplate was significantly reduced following cement augmentation for both the prophylactic and fracture group (P < 0.05, P < 0.01, respectively). Endplate deformation of the controls showed no statistically significant differences between loading on day 1 and day 2. A linear relationship was noted between the applied compressive load and endplate deflection (R2 = 0.58). Evidence of significant endplate deformation differences between unaugmented and augmented FSU, while evident for the augmented endplate, was not present for the adjacent endplate. This non-invasive micro-CT method may also be useful to investigate endplate failure, and parameters that predict vertebral failure.
Boyd, S. K.; Heini, P. F.; Ferguson, S. J.
Subsidence of various constructs into the vertebral body is a well-known complication in anterior fusion. Information on bone structure is needed, as a basis for improving these procedures. There are, however, no data available on the distribution of mineral density within vertebral endplates. In this study the regional distribution of mineralization within the cervical endplates with respect to endplate orientation (inferior and superior endplate) and level distribution (C3–C7) was examined by means of computed tomographic osteoabsorptiometry (CT-OAM). The distribution of mineralization in 80 cervical endplates of 8 spinal columns (4 male, 4 female, age range 38–62 years) in vertebrae C3–C7 was investigated by CT osteoabsorptiometry (CT-OAM). The subchondral mineralization distribution revealed considerable topographic differences within each endplate, whereby the areas of greatest density were found in the peripheral marginal zones with maxima in the posterolateral surface, whereas mineralization density was much lower in the central areas. The superior endplates showed an additional posteromedial maximum, whereas the inferior endplates showed an additional anterior mineralization maximum. Comparison of the distribution patters of inferior and superior endplates at different levels from C3 to C7 reveals a uniform increase of mineralization in the anterior portions from cranial to caudal. The mineralization distribution showed characteristic reproducible patterns. The maximal values occurred in the posterolateral parts, and can thus be considered a morphological substrate of high long-term loading. This can serve as a basis for improved prosthesis design and the anchorage point for various fusion techniques.
Weisser, Stefan; Linsenmeier, Ulrich
Discussion of screening for cervical cancer and it precursors, management of abnormal cervical cancer screening test, and evidence-based management of women with cervical intraepithelial neoplasia. PMID:24785416
Boisen, Michelle; Diedrich, Justin T; Lonky, Neal M; Guido, Richard
In sediments of the Aguja Formation (Late Cretaceous: Campanian) at La Salada in northern part of the state of Coahuila, Mexico, numerous fossils of vertebrates have been discovered including Hadrosauridae. One hadrosaur vertebra provides evidence of predation probably by a giant alligator Deinosuchus riograndensis.
Héctor E. RIVERA-SYLVA; Eberhard FREY; José Rubén GUZMÁN-GUTIÉRREZ
Twelve pediatric patients were studied with MRI. All had various disk problems including Scheuermann's disease, Schmorl's\\u000a nodes and limbus vertebrae. All patients shared loss of disk height, altered disk hydration and variable herniation of nuclear\\u000a material.
Leonard E. Swischuk; Susan D. John; Sandra Allbery
We present a case of extreme cervical elongation with a cervix of 12 cm after an unusual operation in which the uterine corpus was directly fixed to the promontory, and which became symptomatic after 8 years. The possible pathophysiology of cervical elongation is discussed. Diagnosing a case of severe cervical elongation can be important in the pre-operative evaluation. It can alter the operative plan to a uterus-sparing technique or it can alert the surgeon to a difficult entry in the abdominal cavity during vaginal hysterectomy. PMID:23052629
Vierhout, Mark E; Fütterer, Jurgen J
Teratomas are unusual tumors derived from all 3 germs cells layers: endoderm, mesoderm, and ectoderm, with varying proportions. The cervical area is exceptionally affected. We report 4 cases of cervical teratoma. The clinically and radiologically suggested diagnosis was confirmed by histology. We describe herein the main clinical, radiological, and histological aspects and outcomes of this disease. Despite its most often benign histologic nature, cervical teratoma may threaten newborn infants' life due to airway compression. A multidisciplinary approach to the disease starting at delivery is required to improve the prognosis. PMID:24011439
Ksia, A; Mosbahi, S; Zrig, A; Achour, Z; Khadhar, M-K; Chioukh, F; Sahnoun, L; Krichene, I; Mekki, M; Belghith, M; Stambouli, L; Golli, M; Zakhama, A; Monastiri, K; Nouri, A
The authors conducted a study to identify radiological patterns of Klippel-Feil syndrome (KFS), and they present a new interpretation of the origin of these patterns based on recent advances in understanding of embryonic development of the spine and its molecular genetic control. The authors studied radiographs and computerized tomography (CT) scans as well as magnetic resonance images or CT myelograms obtained in 30 patients with KFS who were referred for treatment between 1982 and 1996; the patients had complained of various neuroorthopedic complications. Homeotic transformation due to mutations or disturbed expression of Hox genes is a possible mechanism responsible for C-1 assimilation, which was found to have occurred in 19 cases (63%). Notochordal defects and/or signaling problems, which result in reduced or impaired Pax-1 gene expression, may underlie vertebral fusions. This, together with asymmetrical distribution of paraxial mesoderm cells and a possible lack of communication across the embryonic midline, could cause asymmetrical fusion patterns, which were present in 17 cases (57%). The wide and flattened shape of the fused vertebral bodies and their resemblance to the embryonic cartilaginous vertebrae as well as the process of progressive bone fusion with age suggest that the fusions occur before or, at the latest, during chondrification of vertebrae. The authors suggest that the aforementioned mechanisms are likely to be, at least in part, responsible for the observed patterns in KFS that affect the craniovertebral junction and the cervical spine. PMID:16972746
David, K M; Thorogood, P V; Stevens, J M; Crockard, H A
Surgical tactics were analyzed in 1350 patients with cervical spine injuries treated during 1972-2009 years. In 80% of cases injuries were caused by car accidents. 855 patients were admitted in acute or early period of trauma. In other cases old injuries were observed. Vertebral neurological syndromes were revealed in most cases and were absent only in 80 patients. All patients were operated using anterior access. Authors consider that reposition of dislocated vertebras can be carried out in acute and early periods of trauma. Unsuccessful reposition, fractures or fracture-dislocations with spinal stenosis served as indications for transcorporal spinal decompression. This operation is considered to be a method of choice for late periods of trauma. Stabilization of spinal column was achieved using carbonic implant (950 patients), bone auto-transplant (400) combined with utilized auto-bone (960) or biocomposite material "KollapAn" (390 patients). Good results were achieved in 1150 patients, satisfactory - in 190, poor - in 10 patients. Long term results with catamnesis more than 25 years were traced in 120 patients. Results were not revalued. PMID:21350403
Protsenko, A I; Nikuradze, V K; Mekhtikhanov, D S
Posterior neck deformity with an unsightly crater-like defect may result after cervicothoracic laminectomies. The authors present a new technique, spinous process reconstruction, to address this problem. A 64-year-old man presented with progressive quadriparesis secondary to cervical spondylotic myelopathy. Previously he had undergone multiple neck surgeries including cervicothoracic decompressive laminectomy. Postoperatively, he developed severe craniocervical spinal deformity and a large painful concave surgical defect in the neck. The authors performed craniocervical decompression and craniocervicothoracic instrumented stabilization. At the same time, cervicothoracic spinous process reconstruction was performed using titanium mesh to address the defect. Cervicothoracic decompressive laminectomy results in varying degrees of neck defect with resulting unsightly and an often painful surgical wound defect despite an appropriate multilayer closure. The presented spinous process reconstruction is a simple technique to address this problem with good clinical outcome. PMID:24206034
Panchal, Ripul R; Duong, Huy T; Shahlaie, Kiarash; Kim, Kee D
This report is composed of two patients with anteriorly located cervical intradural arachnoid cyst and review of 24 cases in Englishlanguage literature. Both of our patients were in the first two decades of life with neck pain and motor weakness. With suspicious diagnosis of anterior arachnoid cyst surgery was carried out in both cases, though laminectomy in one and laminoplasty in the other. The cyst wall was widely fenestrated with subsequent subtotal excision of the cyst. Both cases had good long-term outcome. The review disclosed male predominance. 73% of the patients were diagnosed within the first two decades of life. Neck pain and motor weakness were the dominant signs and symptoms of this pathology. Magnetic resonance imaging showing a cerebrospinal fluid (CSF) containing cyst was the best mode of diagnosis. Wide cyst fenestration with waying CSF into subarachnoid cyst was the most appropriate and applied surgery with optimal outcome.
Cervical cancer is a disease that affects women worldwide. In some countries it is the leading cause of death among women. Although the incidence of cervical cancer has decreased with the advent of the Papanicolaou smear, it remains a problem in adult women. Cervical dysplasia most often affects women in their 20s; carcinoma in situ affects women 30 to 39 years of age; and invasive carcinoma affects women older than 40 years. These age groups fall into the final three of Erickson's eight stages of ego development. However, taking a developmental approach in planning nursing interventions for women with cervical cancer has its drawbacks. Much of developmental theory research has been conducted on nonrepresentative samples, with women being underrepresented. A template for exploring patient problems from a life stage (developmental) perspective has been developed within the context of three different nursing diagnoses (sexual dysfunction, spiritual distress, and alteration in family processes). PMID:8892133
Klemm, P R; Guarnieri, C
An elderly woman had an expanding cervical mass that entrapped and compressed the adjacent cranial nerves, blood vessels, and muscles. The mass was dense on radiographs, extended from the skull base to low neck in the prevertebral and parapharyngeal tissues, and showed mixed intensity on MR. A previous direct carotid arteriogram with thorium dioxide as the contrast agent suggested the histologically proved diagnosis of a cervical thorium dioxide granuloma ("thorotrastoma"). PMID:7502983
Nguyen, B T; Yousem, D M; Hayden, R E; Montone, K T
\\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 .\\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
Human pappilomavirus (HPV) has been recognized as the most common sexually transmitted disease in the world and over 100 different HPV types have been identified. Persistent HPV infection has been closely linked to the development of invasive cervical cancer. Although surgical and ablative therapies have been the mainstay of treatment, vaccination against the main oncogenic type of HPV is a reasonable preventive strategy for HPV-induced cervical cancer. PMID:24633405
Divine, Laura M; Huh, Warner K
... for cervical cancer? What should you ask your doctor about cervical cancer? It is important for you ... and Staging Treating Cervical Cancer Talking With Your Doctor After Treatment What`s New in Cervical Cancer Research? ...
Reports of tiger attacks in the United States are rare. This article presents a case of a young woman who was violently attacked by a Siberian tiger and sustained penetrating trauma to the neck, cervical spine, and bilateral lower extremities. This article presents both diagnostic and therapeutic management of patients who may present with similar injuries. Animal bites from large animals are prone to infection in 10% to 20% of cases. Most infections are polymicrobial, with Pasteurella multicida being the most common isolate. Animal bites also mandate consideration of tetanus and rabies prophylaxis. The decision to administer postexposure rabies prophylaxis is dependent on the type of animal involved, whether the exposure was provoked, the local epidemiology of rabies, and the availability of the animal for observation or testing. Assessment of patients with cervical spine injury requires knowledge of possible associated injuries. Evaluation involves assessment of plain radiographs and computed tomography for evaluation of the cervical spine for bony injury. Furthermore, computed angiography is advantageous to noninvasively evaluate carotid or vertebral artery injury at the same setting in patients with deep cervical puncture wounds. Surgical treatment of unstable cervical spine fractures with lateral mass screw and rod fixation has been reported in the literature to have superior biomechanical properties compared to anterior and posterior instrumentation and fusion. In recent clinical studies, the use of lateral mass screws for traumatic injury of the cervical spine has been associated with excellent maintenance of alignment and minimal complications. PMID:19226051
Anderson, Meredith; Utter, Philip; Szatkowski, Jan; Patrick, Todd; Duncan, William; Turner, Norman; Dekutoski, Mark
The purpose of this study was to determine the effect of head-neck position on cervical facet stretch during low speed rear end impact. Twelve tests were conducted on four Post Mortem Human Subjects (PMHS) in a generic bucket seat environment. Three head positions, namely Normal (neutral), Zero Clearance between the head and head restraint, and Body Forward positions were tested. A high-speed x-ray system was used to record the motion of cervical vertebrae during these tests. Results demonstrate that: a) The maximum mean facet stretch at head restraint contact occurs at MS4 and MS5 for the Body Forward condition, b) The lower neck flexion moment, prior to head contact, shows a non-linear relationship with facet stretch, and c) "Differential rebound" during rear end impact increases facet stretch. PMID:17230273
Sundararajan, Srini; Prasad, Priya; Demetropoulos, Constantine K; Tashman, Scott; Begeman, Paul C; Yang, King H; King, Albert I
Cervical cancer is the second most common malignancy in women worldwide. If diagnosed in the premalignant stage, cure is invariably assured. Although the Papanicolaou (Pap) smear has significantly reduced the incidence of cervical cancer where implemented, the test is only moderately sensitive, highly subjective and skilled-labor intensive. Newer optical screening tests (cervicography, direct visual inspection and speculoscopy), including fluorescent and reflective spectroscopy, are fraught with certain weaknesses. Yet, the integration of optical probes for the detection and discrimination of cervical neoplasia with automated image analysis methods may provide an effective screening tool for early detection of cervical cancer, particularly in resource poor nations. Investigative studies are needed to validate the potential for automated classification and recognition algorithms. By applying image analysis techniques for registration, segmentation, pattern recognition, and classification, cervical neoplasia may be reliably discriminated from normal epithelium. The National Cancer Institute (NCI), in cooperation with the National Library of Medicine (NLM), has embarked on a program to begin this and other similar investigative studies.
Ferris, Daron G.
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
The analysis of current cervical collars (Aspen and Miami J collars) and cervical thoracic orthoses (CTOs) (Aspen 2-post and Aspen 4-post CTOs) in reducing cervical interverte- bral and gross range of motion in flexion and extension was per- formed using 20 normal volunteer subjects. The gross sagittal motion of the head was measured relative to the horizon with the use
Thomas M. Gavin; Gerard Carandang; Robert Havey; Patrick Flanagan; Alexander Ghanayem; Avinash G. Patwardhan
The sheep spine is widely used as a model for preclinical research in human medicine to test new spinal implants and surgical procedures. Therefore, precise morphometric data are needed. The present study aimed to provide computed tomographic (CT) morphometry of sheep thoracolumbar spine. Five adult normal Merino sheep were included in this study. Sheep were anaesthetised and positioned in sternal recumbency. Subsequently, transverse and sagittal images were obtained using a multi-detector-row helical CT scanner. Measurements of the vertebral bodies, pedicles, intervertebral disc and transverse processes were performed with dedicated software. Vertebral bodies and the spinal canal were wider than they were deep, most obviously in the lumbar vertebrae. The intervertebral discs were as much as 57.4% thicker in the lumbar than in the thoracic spine. The pedicles were higher and longer than they were wide over the entire thoracolumbar spine. In conclusion, the generated data can serve as a CT reference for the ovine thoracolumbar spine and may be helpful in using sheep spine as a model for human spinal research.
Berner, Dagmar; Julke, Henriette; Hohaus, Christian; Brehm, Walter; Gerlach, Kerstin
The aim of our study was to examine the locational distribution of paraspinal structures on MRI and to determine any predictable parameters that may be used for the identification of transitional vertebra (TV). We enrolled 534 patients who underwent MRI of their lumbosacral spine. The locations of the paraspinal structures, such as aortic bifurcation (AB), IVC confluence (IC), right renal artery (RRA), celiac trunk (CT), SMA root (SR), and iliolumbar ligament (ILL), were determined using "cross link" in PACS. We also assessed the morphology of the TV. The MRI showed that the most common site of the paraspinal structures in the normal group was AB at the lower L4, IC at the L4-5 disc space, RRA at the L1-2 disc space, CT at the T12-L1 disc space, SR at the upper L1, and ILL at the L5. The frequency of TV was 23.8% (lumbarization, 9.9%; sacralization, 13.9%). The paraspinal structures of the S1 lumbarization were positioned more toward the caudal location, whereas the paraspinal structures of the L5 sacralization were positioned more toward the cephalic location (P < 0.01). In conclusion, AB, IC, RRA, CT, SR, and ILL are useful landmarks for predicting the presence of TV on MRI. TV is possible when these paraspinal structures are in positions outside of the frequent locations. PMID:17879307
Lee, Chang Hee; Park, Cheol Min; Kim, Kyeong Ah; Hong, Suk Joo; Seol, Hae Young; Kim, Baek Hyun; Kim, Jung Hyuk
Peculiarities of the relief of the mineralization front have been investigated on the periostal surface of the human vertebral body in several zones. The material has been obtained from male persons at the age of 20-84 years and studied by means of the light and scanning electron microscopy. The size of lateral surfaces of the vertebral body does not differ essentially from the relief of the periostal surfaces of other bones. In people of middle age certain changes in structure of the mineralized cartilage plate in the area adjoining the nucleus pulposus and the fibrous ring of the intervertebral disc are demonstrated. In persons of elderly and old age a definite decrease in thickness of the cortical layer of the vertebra is noted. At the same time, the plate of the mineralized cartilage adjoining the cortical layer grows thicker and collagene fibers in the spinal column ligaments undergo mineralization. Sometimes, microfractures of the cortical plate of the vertebral body and Schmorl noduli are revealed. PMID:4084072
Doktorov, A A; Denisov-Nikol'ski?, Iu I
Elderly patients who have osteoporosis and a cancer history with backache and vertebral fractures are diagnostic challenges. We present a case of an 87-year-old man who complained of severe low-back pain with radiation to the lower limbs and weakness of the lower limbs. The patient had had a fall on a bus 1 month before admission. The patient also had a history of colon cancer and had received a colostomy 9 years before. In this admission, lumbar spine radiographs showed compressive fractures of vertebral bodies at L1 and L3. Magnetic resonance imaging (MRI) showed hyperemic change of the L3 marrow with osteonecrosis (fluid sign). The ventral thecal sac was slightly compressed due to retropulsion of L3. The L1 marrow was normal. Bone densitometry of the calcaneous revealed osteoporosis. The patient was then treated by vertebroplasty and bilateral foraminotomy of L3 after a diagnosis of acute compressive fracture. On histology, there was a metastatic adenocarcinoma arranged in glands and nests in the bone and paraspinal soft tissue. On retrospective viewing, an axial gadolinium-enhanced MRI revealed paraspinal extension of soft tissue at L3, which is highly suggestive of metastasis in a vertebra. PMID:15859020
Ho, Chun-Sheng; Choi, Wai-Man; Chen, Chia-yuen; Chen, Wei-Yu; Chan, Wing P
Micro-tomographic imaging with a spatial resolution on the micrometer scale offers owes a high potential to perform certain types of measurements that were not feasible with other techniques or conventional laboratory methods. The synchrotron X-ray source gives substantial advantages because of its high brilliance and continuous X-ray spectrum. Based on this, visualized the microstructure of rat bone and lumber vertebra was visualized using 20, 25 and 30 keV synchrotron X-rays. We utilized the data which was acquired at different energies for multi-model imaging and to estimate the Ca/P ratio. Up to now there has been no research carried out using these images for the estimation of the calcium content, with synchrotron X-rays. The results are based on the analysis of images and gray values obtained at different energies. We introduce this new method in order to measure the calcium content by means of high resolution synchrotron micro-CT.
Rao, Donepudi V.; Cesareo, Roberto; Brunetti, Antonio; Akatsuka, Takao; Yuasa, Tetsyua; Takeda, Tohoru; Tromba, Giuliana; Gigante, Giovanni E.
Micro-tomographic imaging with a spatial resolution on the micrometer scale offers owes a high potential to perform certain types of measurements that were not feasible with other techniques or conventional laboratory methods. The synchrotron X-ray source gives substantial advantages because of its high brilliance and continuous X-ray spectrum. Based on this, visualized the microstructure of rat bone and lumber vertebra was visualized using 20, 25 and 30 keV synchrotron X-rays. We utilized the data which was acquired at different energies for multi-model imaging and to estimate the Ca/P ratio. Up to now there has been no research carried out using these images for the estimation of the calcium content, with synchrotron X-rays. The results are based on the analysis of images and gray values obtained at different energies. We introduce this new method in order to measure the calcium content by means of high resolution synchrotron micro-CT.
Rao, Donepudi V. [Department of Physics, Sir. C.R.R. (A) College, Eluru-534007., W.G. Dt., A.P. (India); Cesareo, Roberto; Brunetti, Antonio [Istituto di Matematica e Fisica, Universita di Sassari, Via Vienna 2, 07100 Sassari (Italy); Akatsuka, Takao; Yuasa, Tetsyua [Department of Bio-System Engineering, Faculty of Engineering, Yamagata University, 4-3-16 Jonan, Yonezawa 992-8510 (Japan); Takeda, Tohoru [Institute of Clinical Medicine, University of Tsukuba, Tsukuba (Japan); Tromba, Giuliana [SYRMEP, Elettra, Trieste (Italy); Gigante, Giovanni E. [SDepartimento di Fisica, Universita di Roma ''La Sapienza'' 00185, Roma (Italy)
The cancellous structure of vertebrae has been studied to investigate the direction of trabeculae and thus the lines of stress. The trabecular bone of the pedicle, connecting the body to the lamina, differed in different regions of the vertebral column. At C2 level, it was found that trabeculae are involved in transfer of th column. At C2 level, it was found that trabeculae are involved in transfer of the compressive forces from the superior articular surface to the inferior articular process and body. Throughout the thoracic region, trabeculae in the pedicle were inclined anteriorly towards the body, indicating that compressive forces in the thoracic spine are transferred from the neural arch to the body. In the lower lumbar region, trabeculae run from the body towards the neural arch. Trabeculae in the thoracic transverse processes extend from the costal facet to the lamina, suggesting that weight brought by the ribs to the costotransverse articulations is transmitted to laminae through transverse processes. PMID:3228210
Pal, G P; Cosio, L; Routal, R V
Cervical spondylosis is a common degenerative condition that is a significant cause of morbidity. This review discusses the pathophysiology and natural history of cervical spondylotic myelopathy and focuses on the current literature evaluating the clinical management of these patients.
Hsu, Wesley; Dorsi, Michael J.; Witham, Timothy F.
Cervical cancer is theoretically completely preventable by effective screening using cervical cytology methods (the Pap test). The process of preparing and interpreting Pap tests remains one of the last high-volume manual processes in the clinical laborat...
D. C. Wilbur
The aim of this study was to search for neuropathological changes in postmortem brain tissue of individuals with cervical dystonia (CD). Multiple regions of formalin-preserved brains were collected from patients with CD and controls and examined with an extensive battery of histopathological stains in a two-stage study design. In stage one, 4 CD brains underwent a broad screening neuropathological examination. In stage two, these 4 CD brains were combined with 2 additional CD brains, and the subjective findings were quantified and compared to 16 age-matched controls. The initial subjective neuropathological assessment revealed only two regions with relatively consistent changes. The substantia nigra had frequent ubiquitin-positive intranuclear inclusions known as Marinesco bodies. Additionally, the cerebellum showed patchy loss of Purkinje cells, areas of focal gliosis and torpedo bodies. Other brain regions showed minor or inconsistent changes. In the second stage of the analysis, quantitative studies failed to reveal significant differences in the numbers of Marinesco bodies in CD versus controls, but confirmed a significantly lower Purkinje cell density in CD. Molecular investigations revealed 4 of the CD cases and 2 controls to harbor sequence variants in non-coding regions of THAP1, and these cases had lower Purkinje cell densities regardless of whether they had CD. The findings suggest that subtle neuropathological changes such as lower Purkinje cell density may be found in primary CD when relevant brain regions are investigated with appropriate methods. PMID:23195594
Prudente, C N; Pardo, C A; Xiao, J; Hanfelt, J; Hess, E J; Ledoux, M S; Jinnah, H A
Dual-energy CT allows for a better material differentiation than conventional CT. For the purpose of osteoporosis diagnosis, a detection of regions with lowered bone mineral density (BMD) is of high clinical interest. Based on an existing biophysical model of the trabecular bone in vertebrae a new method for directly highlighting those low density regions in the image data has been developed. For this, we combine image data acquired at 80 kV and 140 kV with information about the BMD range in different vertebrae and derive a method for computing a color enhanced image which clearly indicates low density regions. An evaluation of our method which compares it with a quantitative method for BMD assessment shows a very good correspondence between both methods. The strength of our method lies in its simplicity and speed.
Wesarg, Stefan; Erdt, Marius; Kafchitsas, Konstantinos; Khan, M. Fawad
Quantitative measurement of vertebral rotation is important in surgical planning, analysis of surgical results, and monitoring of the progression of spinal deformities. However, many established and newly developed techniques for measuring axial vertebral rotation do not exploit three-dimensional (3D) information, which may result in virtual axial rotation because of the sagittal and coronal rotation of vertebrae. We propose a novel automatic approach to the measurement of the location and rotation of vertebrae in 3D without prior volume reformation, identification of appropriate cross-sections or aid by statistical models. The vertebra under investigation is encompassed by a mask in the form of an elliptical cylinder in 3D, defined by its center of rotation and the rotation angles. We exploit the natural symmetry of the vertebral body, vertebral column and vertebral canal by dividing the vertebral mask by its mid-axial, mid-sagittal and mid-coronal plane, so that the obtained volume pairs contain symmetrical parts of the observed anatomy. Mirror volume pairs are then simultaneously registered to each other by robust rigid auto-registration, using the weighted sum of absolute differences between the intensities of the corresponding volume pairs as the similarity measure. The method was evaluated on 50 lumbar vertebrae from normal and scoliotic computed tomography (CT) spinal scans, showing relatively large capture ranges and distinctive maxima at the correct locations and rotation angles. The proposed method may aid the measurement of the dimensions of vertebral pedicles, foraminae and canal, and may be a valuable tool for clinical evaluation of the spinal deformities in 3D.
Vrtovec, Tomaž; Likar, Boštjan; Pernuš, Franjo
: Biomechanical and quantitative computed tomography (QCT) analyses showed beneficial effects of parathyroid hormone (PTH (1–34))\\u000a on lumbar vertebrae from ovariectomized monkeys, even after withdrawal of treatment for 6 months. Adult cynomolgus monkeys\\u000a were randomized, ovariectomized (except for sham ovariectomy controls), and treated subcutaneously with vehicle (OVX) or 5\\u000a ?g\\/kg per day PTH (1–34) (PTH5) for 18 months. An additional
M. Sato; M. Westmore; J. Clendenon; S. Smith; B. Hannum; G. Q. Zeng; R. Brommage; C. H. Turner
Cervical screening has been one of the most successful public health prevention programmes. For 50 years, cytology formed the basis for screening, and detected cervical intraepithelial lesions (CIN) were treated surgically to prevent progression to cancer. In a high-risk country as Denmark, screening decreased the incidence of cervical cancer from 34 to 11 per 100 000, age-standardized rate (World Standard Population). Screening is, however, also expensive; Denmark (population: 5.6 million) undertakes close to half a million tests per year, and has 6-8 CIN-treated women for each prevented cancer case. The discovery of human papillomavirus (HPV) as the cause of cervical cancer dramatically changed perspectives for disease control. Screening with HPV testing was launched around 1990, and preventive HPV vaccination was licensed in 2006. Long-term randomized controlled trials (RCT) demonstrated that HPV testing provides better protection against cervical cancer than cytology, but it requires extra repeated testing. HPV vaccination RCTs, furthermore, have proved that HPV vaccination protects against vaccine-type high-grade CIN in women vaccinated prior to sexual activity, but less so in women vaccinated later. The challenge now is therefore to find an algorithm for screening of a heterogeneous population including non-vaccinated women; women vaccinated prior to start of sexual activity; and women vaccinated later. PMID:25046198
Lynge, Elsebeth; Rygaard, Carsten; Baillet, Miguel Vazquez-Prada; Dugué, Pierre-Antoine; Sander, Bente Braad; Bonde, Jesper; Rebolj, Matejka
Far-out foraminal stenosis with radiculopathy caused by bony spur formation secondary to anomalous articulation between the transverse process and the sacral ala is rarely reported. We report two cases of unilateral far-out foraminal entrapment of the L5 spinal nerve below a transitional vertebra, with a review of the literature. The objective of this work was to describe the management of a rare far-out foraminal stenosis below a transitional vertebra and to evaluate the surgical and conservative procedures and results. In a previous article, decompression was performed through an anterior approach. However, we report no difficulty with decompression using a posterior approach for one patient. The diagnosis was confirmed with computed tomography, magnetic resonance imaging, and selective radiculography. First, selective nerve root blocks were performed in two cases for the purpose of nonoperative treatment. After failure of conservative treatment with selective nerve root block, one patient underwent posterior decompression by resection of the bony spur using a posterior approach. One patient obtained good relief of radicular pain with only selective nerve root block. The other patient obtained good relief of radicular pain after posterior decompression was performed. Posterior decompression through the posterior approach is an easy, safe, and useful treatment for radicular pain caused by an L5 nerve far-out foraminal stenosis below a transitional vertebra when conservative treatments have failed to obtain good relief of radicular pain. PMID:15260100
Ichihara, Kazuhiko; Taguchi, Toshihiko; Hashida, Tadaaki; Ochi, Yasuhiro; Murakami, Tetsuro; Kawai, Shinya
Three cases of hereditary lateral cervical fistulas are reported. The patients had lateral cervical fistulas bilaterally and different types of auricular malformations. The mothers of the patients also had lateral cervical fistulas. Moreover, one mother had bilateral microtias and the other mothers bilateral preauricular fistulas. The literature is reviewed and discussed. PMID:3377420
Takato, T; Fukuda, O
The association of cervical spinal cord injury and swallowing disorders is clinically well recognized. This study was performed to determine the clinical significance and the outcome of deglutition disorders observed in the initial treatment of cervical spinal cord injury in our tertiary care spinal cord injury unit. All patients with cervical spinal cord injury admitted to our facility for initial
Rainer Abel; Silke Ruf; Bernhard Spahn
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
This paper reports a study of 57 patients with cervical spondylosis who underwent nerve conduction velocity (NCV), cervical somatosensory evoked potentials (CSEP), and concentric needle electromyography (EMG) as an aid to diagnosis. The results were analyzed in two groups. In Group I, there were 24 patients with radiological changes of cervical spondylosis in the absence of clear neurological signs. Nine patients in this group had abnormal electrophysiological recordings. In Group II, there were 33 patients with clinical signs, and 22 had abnormal electrophysiological recordings. The CSEP was abnormal in 12 of 14 patients who had evidence of nerve root filling defects on myelography. It is concluded that NCV, CSEP, and concentric needle electromyography are useful tests in distinguishing between root lesions and peripheral entrapment neuropathy. Although the methods available are not sufficiently precise to localize the level involved, they can be used as a screen prior to myelography or enhanced computed tomography (CT) scanning if surgery is proposed. PMID:2562447
Khan, M R; McInnes, A; Hughes, S P
Background: Hypertrophic pachymeningitis is a unique clinical entity characterized by fibrosis and thickening of dura mater resulting in neurological dysfunction. It could be idiopathic or due to variety of inflammatory and infectious conditions. Tuberculous hypertrophic pachymeningitis involving cranio cervical region is rarely reported. Case Description: A 50-year-old female presented with history of progressive quadriparesis and stiffness of neck for 2 years, dysphagia to liquid for past 3 months. Her condition rapidly deteriorated when another physician prescribed her corticosteroid. Physical examination revealed high cervical compressive myelo-radiculopathy with lower cranial nerve palsy and neck rigidity. Series of serum analysis, cerebrospinal fluid (CSF) study and contrast magnetic resonance imaging (MRI) clinched the diagnosis. She improved on antitubercular treatment. Conclusion: In case of multilevel cervical compressive myelo-radiculopathy with lower cranial involvement, possibility of hypertrophic pachymeningitis should be kept in mind. Before diagnosing it as idiopathic, infectious causes should be excluded otherwise prescription of corticosteroid will flare up the disease process.
Senapati, Satya Bhusan; Mishra, Sudhansu Sekhar; Das, Srikanta; Parida, Deepak Kumar; Satapathy, Mani Charan
The therapeutic effect of fluoride alone or fluoride followed by calcium and vitamin D administration on the osteoporosis\\u000a induced by immobilization of the rat tail vertebrae was investigated. Tail immobilization was carried out by musclectomy and\\u000a tendectomy. After 60 days of immobilization, the vertebrae were examined for bone mass, breaking strength, ash percentage\\u000a and Ca, P and F content. NaF
D. Rosen; I. Gedalia; J. Anaise; A. Simkin; M. Arcan
IntroductionPull-out of the cranial end-vertebra screw following a correction of a scoliosis with the VDS implant is a common complication, especially in the thoracic region. It requires an extension of the fusion length or at least reduces the outcome of the correction.Materials and methodsWe therefore looked for a new approach to solve the problem of end-vertebra screw pull-out. It was
C. Klöckner; A. Rohlmann; G. Bergmann
Cytologic evaluation of cervical smears has been carried out in 3,374 women who used different modes of contraception (Lippes loop, copper T200, copper T220, copper devices containing higher copper content than the copper T200, CuT380 Ag, levonorgestrel IUD, injections of noresthisterone oenanthate, and subdermal implants of levonorgestrel) under the Contraceptive Testing Programme of Indian Council of Medical Research for periods ranging from 6 months to 15 yr. While no case of severe dysplasia or malignancy was noticed with any type of contraceptive, 113 dysplastic smears (99 mild and 14 moderate) were encountered on follow-up, giving an incidence of 3.3%, which was statistically insignificant compared with the pretreatment incidence of 1.4% (47 of 3,374). The highest incidence of dysplasia was seen with devices containing a high copper content (9.2%), followed by CuT200 (6.1%) and levonorgestrel implants (4.2%), and was lowest with Lippes loop (1.8%), injection of noresthisterone oenanthate (1.7%), and CuT380 Ag (1.5%), but statistics higher than the pretreatment incidence of 1.4% were seen only with CuT200 and devices containing high copper content. Retrogression of dysplasia was seen in 85 of the 94 posttreatment dysplasia cases and in all 47 pretreatment dysplasia cases, whereas in the remaining nine posttreatment cases of dysplasia the lesion persisted for 6-12 mo, necessitating discontinuation of contraception. The accumulated follow-up data indicate that the CuT380 Ag device is a promising IUD for the future in view of its low incidence of dysplasia determined during its use up to 5 yr. However, more prolonged follow-up in larger numbers of subjects is required to confirm its innocuousness on long-term retention. PMID:1935511
Misra, J S; Engineer, A D; Das, K; Tandon, P
The aim of this study was to assess effective doses of a lateral cephalogram radiograph with and without thyroid shield and compare the differences with the radiation dose of a hand-wrist radiograph. Thermoluminescent dosimeters were placed at 19 different sites in the head and neck of a tissue-equivalent human skull (RANDO phantom). Analogue lateral cephalograms with and without thyroid shield (67 kV, 250 mA, 10 mAs) and hand-wrist radiographs (40 kV, 250 mA, 10 mAs) were obtained. The effective doses were calculated using the 2007 International Commission on Radiological Protection recommendations. The effective dose for conventional lateral cephalogram without a thyroid shield was 5.03 microsieverts (µSv). By applying a thyroid shield to the RANDO phantom, a remarkable dose reduction of 1.73 µSv could be achieved. The effective dose of a conventional hand-wrist radiograph was calculated to be 0.16 µSv. Adding the effective dose of the hand-wrist radiograph to the effective dose of the lateral cephalogram with thyroid shield resulted in a cumulative effective dose of 3.46 µSv. Without thyroid shield, the effective dose of a lateral cephalogram was approximately 1.5-fold increased than the cumulative effective dose of a hand-wrist radiograph and a lateral cephalogram with thyroid shield. Thyroid is an organ that is very sensitive to radiation exposure. Its shielding will significantly reduce the effective dose. An additional hand-wrist radiograph, involving no vulnerable tissues, however, causes very little radiation risk. In accordance with the ALARA (As Low As Reasonably Achievable) principle, if an evaluation of skeletal age is indicated, an additional hand-wrist radiograph seems much more justifiable than removing the thyroid shield. PMID:22828078
Patcas, Raphael; Signorelli, Luca; Peltomäki, Timo; Schätzle, Marc
We will discuss a potential role of percutaneous vertebroplasty (PVP) in the management of patients with severe fibrous dysplasia of the spine with multiple cervical lesions and C2–C3 pathologic fractures that may not be a good surgical candidate. Polyostotic fibrous dysplasia involvement of the cervical spine is rare. Review of literature indicates only few reported cases of surgical management with one case of mortality indicating increased risks associated with surgical intervention. While PVP is commonly used for the treatment of osteoporotic thoracolumbar vertebral compression fractures, its role in vertebral stabilization for fibrous dysplasia has not been reported. A 35-year-old man with McCune–Albright syndrome and severe polyostotic fibrous dysplasia of C2 and C3 vertebrae presented with severe neck pain, radiculopathy, quadriparesis and myelopathy. The lesion had pathologic fractures, and there was an os odontoideum with cervical cord atrophy at the C1 level. After discussing need for aggressive surgical management and potential complications, we offered PVP due to surgical risks involved. PVP was performed with a posterolateral transpedicular approach without complication. The patient had remarkable improvement in clinical relief of neck pain and improvement of myelopathic symptoms at 1-year follow-up. We present a case that illustrates a potential use of PVP in the management of a patient with symptomatic spinal fibrous dysplasia with associated pathologic fractures who was poor surgical candidate.
Dang, David; Christoforidis, Greg; Chiocca, E. Antonio; Gabriel, Joshue
External cervical resorption (ECR) is the loss of dental hard tissue as a result of odontoclastic action; it usually begins on the cervical region of the root surface of the teeth. The etiology, predisposing factors, diagnosis, and management of ECR are reviewed. Effective management and appropriate treatment can only be carried out if the true nature and exact location of the ECR lesion are known. The role of cone beam computed tomography as a diagnostic adjunct for the management of ECR is also reviewed. PMID:19410071
Patel, Shanon; Kanagasingam, Shalini; Pitt Ford, Thomas
With the help of a biomechanical neck model, several normal postures of an F-16 pilot were analysed. Measurements of accelerations and head positions were obtained during four flights, including simulated air combat. With the help of a model, muscle forces and joint reaction forces in the neck were estimated. Although at the present stage of research results of calculations must be interpreted carefully, conclusions can be drawn with respect to sitting posture, head position and helmet devices. The backward inclined back rest of the F-16 chair decrease the lordosis of the cervical spine, resulting in reduced calculated forces in the lower cervical spine. In high load situations, calculated maximal forces are of the same order of magnitude as failure loads of vertebrae and estimations of maximum muscle forces. The calculated neck load is increased substantially by the helmet and helmet-mounted devices. This load can be reduced by lightening the helmet or shifting the centre of mass of the helmet backwards. PMID:8408084
Hoek van Dijke, G A; Snijders, C J; Roosch, E R; Burgers, P I
The author reports the case of a 36 year old man with cervical cord injury in whom autonomic dysreflexia developed into intracerebral hemorrhage during inpatient rehabilitation. This patient showed complete quadriplegia (motor below C6 and sensory below C7) due to fracture of the 6th cervical vertebra. An indwelling urethral catheter had been inserted into the bladder for 3 months, diminishing bladder expansiveness. Bladder capacity decreased to 200 ml and the patient frequently experienced headaches whenever his bladder was full.To obtain smoother urine flow, a supra-pubic cystostomy was performed. The headaches were temporarily cured, but soon relapsed with extreme increases in blood pressure, representing typical symptoms of autonomic dysreflexia. However, no potential triggers were identified or removed, and lack of blood pressure management led to left putaminal hemorrhage. Despite operative treatment, the right upper extremity showed progressive increases in muscle tonus and finally formed a frozen shoulder with elbow flexion contracture. Two factors contributed to this serious complication: first, autonomic dysreflexia triggered by minor malfunction and/or irritation from the cystostomy catheter; and second, the medical staff lacked sufficient experience in and knowledge about the management of autonomic dysreflexia.It is of the utmost importance for medical staff engaging in rehabilitation of spinal patients to share information regarding triggers of autonomic dysreflexia and to be thorough in ensuring proper medical management. PMID:23774659
Congenital dermal sinus represents a dysraphic state of the central nervous system. It can show up throughout a defect of the midline, of both the skull and the spine. Usually, the malformation presents a fistulous tract, connecting the skin with the underlying tissues (hypoderm, paraspinal muscles, vertebrae and, in some cases, also the dura mater and spinal cord). The incidence of the malformation is quite low, 1:2,500 births; the cervical and dorsal locations represent the less common region. The malformation can remain undetected at the clinical examination because of the scarce cutaneous stigmata. Usually, it is revealed by repeated episodes of meningeal infection, due to the free communication between the inner dural space and the nervous structure and the external space, allowed by the open cutaneous tract. The case of a cervical dermal sinus tract, observed and successfully treated in a 10-months-old female child prompted us to this study and to review of the cases reported in the literature. PMID:2087230
Ceddia, A; Di Rocco, C; Pastorelli, G
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
Eighty-eight patients over age 40 with traumatic cervical spinal cord injuries were clinically and radiographically evaluated, and comparison was made with 35 spinal cord injury patients under age 36. While most older patients sustained obvious bony and\\/or ligamentous damage commensurate with their neurologic findings, 25 (28%) of the 88 patients had no demonstrable bony abnormalities and 17 (20%) of the
Victor S. Regenboge; Lee F. Roger; Kwang S. Kim
Eighty-eight patients over age 40 with traumatic cervical spinal cord injuries were clinically and radiographically evaluated, and comparison was made with 35 spinal cord injury patients under age 36. While most older patients sustained obvious bony and/or ligamentous damage commensurate with their neurologic findings, 25 (28%) of the 88 patients had no demonstrable bony abnormalities and 17 (20%) of the 88 patients had only minimal evidence of bony injury. Of particular interest are the patients with severe cord injuries, yet no bony abnormalities, who seem to form a distinct subgroup of the cervical spinal cord injury patient on the basis of radiographic and clinical features. Of these 25 patients, 24 (96%) had severe cervical spondylosis. Fourteen (56%) of the 25 patients were injured in falls, five (36%) of these 14 being of a seemingly trivial nature. Of the 42 patients with minimal or no demonstrable bony abnormalities, 33 (79%) were evaluated with plain tomography and no occult fractures or other significant pathology was demonstrated. Pantopaque myelography in 27 (64%) of the 42 cases revealed no extruded disk or other surgical lesion in any patient. In large measure, these injuries can be attributed to cervical spondylosis, which narrows the canal and makes the cord more susceptible to compression by the bulging ligamenta flava during hyperextension. PMID:3484576
Regenbogen, V S; Rogers, L F; Atlas, S W; Kim, K S
Cervical whiplash, usually the result of impact injuries at high speed, is a typically 20th-century problem. This article describes the biomechanical stresses that result in whiplash and outlines the treatment programs that can be expected to help the patient through the four stages of recovery to achieve functional rehabilitation.
Spine fractures are the most frequent complication of osteoporosis, a disease characterized by low bone mass and structural deterioration of bone tissue. In case of the spine, the trabecular network plays the main role in load carrying and distribution. A correct description of mechanical properties of this bone structure helps to differentiate between strong and weak bones and can be useful for fracture prediction and treatment monitoring. By means of the finite element method (FEM), applied to ?CT images, we modelled biomechanical processes in probes during loading and correlated the estimated failure load with the maximum compressive strength (MCS), obtained in real biomechanical tests. We studied a sample of 151 specimens taken from the trabecular part of human vertebrae in vitro, visualised using ?CT imaging at an isotropic resolution of 26?m and tested by uniaxial compression. Besides the standard way of estimating failure load, which takes into account only strong micro-fractures, we also included small micro-fractures, what improved the correlation with MCS (Pearson's correlation coefficient r=0.78 vs. r=0.58). This correlation coefficient was larger than that for both the standard morphometric parameters (r=0.73 for bone volume fraction) and for texture measures defined by the local (an-) isotropic scaling indices method (r=0.55) and Minkowski Functionals (r=0.61). However, the performance of the FEM was different for subsamples selected according to the MCS value. The correlation increased for strong specimens (r=0.88), slightly decreased for weak specimens (r=0.68) and markedly dropped for specimens with medium MCS, e.g. between 60 Sidorenko, Irina N.; Bauer, Jan; Monetti, Roberto; Müller, Dirk; Rummeny, Ernst J.; Eckstein, Felix; Matsuura, Maiko; Lochmüller, Eva-Maria; Zysset, Philippe K.; Räth, Christoph W. 2009-02-01
Sidorenko, Irina N.; Bauer, Jan; Monetti, Roberto; Müller, Dirk; Rummeny, Ernst J.; Eckstein, Felix; Matsuura, Maiko; Lochmüller, Eva-Maria; Zysset, Philippe K.; Räth, Christoph W.
Age-related degenerative changes within the vertebral column are a significant cause of morbidity with considerable socio-economic impact worldwide. An improved understanding of these changes through the development of experimental models may lead to improvements in existing clinical treatment options. The zebrafish is a well-established model for the study of skeletogenesis with significant potential in gerontological research. With advancing age, zebrafish frequently develop gross deformities of their vertebral column, previously ascribed to reduced trunk muscle tone. In this study, we assess degenerative changes specifically within the bone and cartilage of the vertebral column of zebrafish at 1, 2 and 3-years of age. We show increased frequency and severity of spinal deformities/curvatures with age. Underlying the most severe phenotypes are partial or complete vertebral dislocations and focal thickening of the vertebral bone at the joint margins. MicroCT examination demonstrates small defects, fractures and morphological evidence suggestive of bone erosion and remodeling (i.e. osteophytes) within the vertebrae during aging, but no significant change in bone density. Light and electron microscopic examination reveal striking age-related changes in cell morphology, suggestive of chondroptosis, and tissue remodelling of the vertebral cartilage, particularly within the pericellular micro-environment. Glycosaminoglycan analysis of the vertebral column by HPLC demonstrates a consistent, age-related increase in the yield of total chondroitin sulfate disaccharide, but no change in sulfation pattern, supported by immunohistochemical analysis. Immunohistochemistry strongly identifies all three chondroitin/dermatan sulphate isoforms (C-0-S, C-4-S/DS and C-6-S) within the vertebral cartilage, particularly within the pericellular micro-environment. In contrast, keratan sulfate immunolocalises specifically with the notochordal tissue of the intervertebral disc, and its labelling diminishes with age. In summary, these observations raise the prospect that zebrafish, in addition to modelling skeletal development, may have utility in modelling age-related degenerative changes that affect the skeleton during senescence.
Hayes, Anthony J.; Reynolds, Scott; Nowell, Mari A.; Meakin, Lee B.; Habicher, Judith; Ledin, Johan; Bashford, Andrew; Caterson, Bruce; Hammond, Chrissy L.
Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors’ clinic and treated by PCN. The patients’ gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 ± 10.2 years). The levels of involvement were 21 cases at C3–4, 30 cases at C4–5, 40 cases at C5–6, and 35 cases at C6–7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) ?11° or horizontal displacement (HD) ?3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no significant difference in stability either preoperatively or postoperatively (P > 0.05). Our findings confirm that PCN for the treatment of cervical disc herniation results in a good outcome without any tampering of the stability of the cervical spine. Hence, PCN as a procedure is safe, minimally invasive, less traumatic, requiring less time with an excellent clinical outcome. PCN should be performed for those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery.
Li, Jian; Zhang, Zai-Heng
Postoperative spinal wound dehiscence is a significant complication following the posterior midline approach. It is postulated that this approach disrupts the vasculature supplying the paraspinal muscles and overlying skin. Although the spinal vasculature has been investigated previously, the smaller arterioles have not been described in the context of the posterior midline approach. Eight cadaveric neck and posterior torso specimens were dissected after injection with a radio-opaque lead oxide mixture and subsequent radiographs taken were analyzed. The deep cervical, vertebral, superficial cervical, and occipital arteries consistently supplied the cervical paraspinal muscles. The latter two arteries also vascularized the overlying skin. The deep cervical arteries were found to be located lateral to the C3 to C6 vertebrae, vulnerable to damage with the posterior approach. In the thoracic region, the superior and posterior intercostal arteries consistently supplied the spinal muscles. In all specimens, two small anastomotic vessels posterior to the laminae were found connecting the intercostal artery perforators. Both the arterial perforators and their anastomotic channels were situated in the surgical field and susceptible to damage with the posterior approach. It is likely that the disruption in spinal vasculature contributes to the multifactorial problem of wound dehiscence with the posterior midline approach. PMID:22887027
Yue, Brian Yin Ting; le Roux, Cara Michelle; Corlett, Russell; De La Harpe, David; Richardson, Martin; Ashton, Mark
The increase of age-related diseases such as musculoskeletal and neurological dysfunction will require increased use of rehabilitation therapy. The effectiveness of this treatment depends of the skill of the therapist and the functionality inherent in the therapeutic device used. Here, a new EMG biofeedback controlled therapeutic traction machine was developed to relieve neck pain or cervical compression syndrome. Through EMG
M. Y. Lee; M. K. Wong; F. T. Tang; W. H. Chang; Y. L. Chen
Summary: An elderly woman had an expanding cervical mass that entrapped and compressed the adjacent cranial nerves, blood vessels, and muscles. The mass was dense on radio- graphs, extended from the skull base to low neck in the prever- tebral and parapharyngeal tissues, and showed mixed intensity on MR. A previous direct carotid arteriogram with thorium diox- ide as the
Binh T. Nguyen; David M. Yousem; Richard E. Hayden; Kathleen T. Montone
An improved and detailed 3-D FE model of human cervical spine was created using digitized geometric measurement. The model was validated with the in-vivo studies of Moroney , Panjabi  and Fuller . Clinical instability of the spine for two cases involving flexion and compression loading (simulating injuries in motorcycle vaulting, football and diving accidents) were analyzed. The instability was
Abraham Tchako; Ali M. Sadegh
... problems include: pain that interferes with daily activities neck pain that extends (radiates) to the shoulder or arm ... done while the patient is deep asleep and pain-free (general anesthesia). For the neck (cervical spine), an incision may be made either ...
... of the cervix. This stage is also called carcinoma in situ (CIS) which is part of cervical intraepithelial neoplasia ... Stage IVB (any T, any N, M1): The cancer has spread to distant organs beyond the pelvic area, such as the lungs or liver. Last Medical Review: 04/11/2013 ...
The development of robotic technology has facilitated the application of minimally invasive techniques for the treatment and evaluation of patients with early, advanced, and recurrent cervical cancer. The application of robotic technology for selected patients with cervical cancer and the data available in the literature are addressed in the present review paper. The robotic radical hysterectomy technique developed at the Mayo Clinic Arizona is presented with data comparing 27 patients who underwent the robotic procedure with 2 matched groups of patients treated by laparoscopic (N = 31), and laparotomic radical hysterectomy (N = 35). A few other studies confirmed the feasibility and safety of robotic radical hysterectomy and comparisons to either to the laparoscopic or open approach were discussed. Based on data from the literature, minimally invasive techniques including laparoscopy and robotics are preferable to laparotomy for patients requiring radical hysterectomy, with some advantages noted for robotics over laparoscopy. A prospective randomised trial is currently being perfomred under the auspices of the American Association of Gyneoclogic Laparoscopists comparing minimally invasive radical hysterectomy (laparoscopy or robotics) with laparotomy. For early cervical cancer radical parametrectomy and fertility preserving trachelectomy have been performed using robotic technology and been shown to be feasible, safe, and easier to perform when compared to the laparoscopic approach. Similar benefits have been noted in the treatment of advanced and recurrent cervical cancer where complex procedures such as extraperitoneal paraortic lymphadenectomy and pelvic exenteration have been required. Conclusion: Robotic technology better facilitates the surgical approach as compared to laparoscopy for technically challenging operations performed to treat primary, early or advanced, and recurrent cervical cancer. Although patient advantages are similar or slightly improved with robotics, there are multiple advantages for surgeons.
Zanagnolo, Vanna L.
The development of robotic technology has facilitated the application of minimally invasive techniques for the treatment and evaluation of patients with early, advanced, and recurrent cervical cancer. The application of robotic technology for selected patients with cervical cancer and the data available in the literature are addressed in the present review paper. The robotic radical hysterectomy technique developed at the Mayo Clinic Arizona is presented with data comparing 27 patients who underwent the robotic procedure with 2 matched groups of patients treated by laparoscopic (N = 31), and laparotomic radical hysterectomy (N = 35). A few other studies confirmed the feasibility and safety of robotic radical hysterectomy and comparisons to either to the laparoscopic or open approach were discussed. Based on data from the literature, minimally invasive techniques including laparoscopy and robotics are preferable to laparotomy for patients requiring radical hysterectomy, with some advantages noted for robotics over laparoscopy. A prospective randomised trial is currently being performed under the auspices of the American Association of Gyneoclogic Laparoscopists comparing minimally invasive radical hysterectomy (laparoscopy or robotics) with laparotomy. For early cervical cancer radical parametrectomy and fertility preserving trachelectomy have been performed using robotic technology and been shown to be feasible, safe, and easier to perform when compared to the laparoscopic approach. Similar benefits have been noted in the treatment of advanced and recurrent cervical cancer where complex procedures such as extraperitoneal paraortic lymphadenectomy and pelvic exenteration have been required. Conclusion: Robotic technology better facilitates the surgical approach as compared to laparoscopy for technically challenging operations performed to treat primary, early or advanced, and recurrent cervical cancer. Although patient advantages are similar or slightly improved with robotics, there are multiple advantages for surgeons. PMID:19108008
Magrina, Javier F; Zanagnolo, Vanna L
The notochord plays an important role in the differentiation of the paraxial mesoderm and the neural tube. We have analyzed the role of the notochord in somite differentiation and subsequent formation of the vertebral column using a mouse mutant, Danforth's short-tail (Sd). In this mutant, the skeletal phenotype is most probably a result of degeneration and subsequent loss of the notochord. The Sd gene is known to interact with undulated (un), a sclerotome mutant. Double mutants between Sd and un alleles show an increase in the severity of the defects, mainly in the ventral parts of the vertebrae. We also show that part of the Sd phenotype is strikingly similar to that of the un alleles. As un is known to be caused by a mutation in the Pax-1 gene, we analyzed Pax-1 expression in Sd embryos. In Sd embryos, Pax-1 expression is reduced, providing a potential molecular basis for the genetic interaction observed. A complete loss of Pax-1 expression in morphologically intact mesenchyme was found in the lower thoracic-lumbar region, which is phenotypically very similar to the corresponding region in a Pax-1 null mutant, Undulated short-tail. The sclerotome developmental abnormalities in Sd coincide closely, both in time and space, with notochordal changes, as determined by whole-mount T antibody staining. These findings indicate that an intact notochord is necessary for normal Pax-1 expression in sclerotome cells, which is in turn required for the formation of the ventral parts of the vertebrae. The observed correlation among structural changes of the notochord, Pax-1 expression levels and skeletal phenotypes, suggests that Pax-1 might be an intrinsic mediator of notochordal signals during the dorsoventral specification of vertebrae. PMID:8187635
Koseki, H; Wallin, J; Wilting, J; Mizutani, Y; Kispert, A; Ebensperger, C; Herrmann, B G; Christ, B; Balling, R
Cervical cancer screening has become more complex with the addition of HPV testing to pap testing. This chapter covers evidence based national recommendations for managing abnormal cervical cancer screening tests. PMID:24785417
Invasive cervical resorption is an insidious and often aggressively destructive form of external root resorption which may occur as a late complication following dental trauma particularly where it involves damage to cementum and supporting tissues. While this resorption may be evident clinically as a pink coronal discolouration, later with cavitation of the enamel, often there are no obvious external signs and the condition is only detected radiographically. It is characterised by the invasion of the cervical region of the root by fibrovascular tissue which progressively resorbs dentine, enamel and cementum. The dental pulp remains protected by an intact layer of dentine and predentine until late in the process. Ectopic calcifications can be observed in advanced lesions both within the invading fibrous tissue and deposited directly onto the resorbed dentine surface. The aetiology of invasive cervical resorption is unknown but trauma has been documented as a potential predisposing factor. A recent study by the author of 222 patients with a total of 257 teeth which displayed varying degrees of invasive cervical resorption showed that trauma alone was a potential predisposing sole factor in 14% of patients and 15.1% of teeth. Trauma in combination with bleaching, orthodontics or delayed eruption was found in an additional 11.2% of patients or 10.6% of teeth and of these a combination of trauma and bleaching occurred in a relatively high proportion of 7.7% of patients or 7.4% of teeth. This study also revealed that of other potential predisposing factors orthodontics was the most common sole factor constituting 21.2% of patients and 24.1% of teeth examined. Successful treatment of invasive cervical resorption is dependent on the extent of the resorptive process. Teeth with invasive cervical resorption have been divided into four classes. Whilst several treatment modalities are possible, a clinical evaluation of the treatment of this condition by the topical application of a 90% aqueous solution of trichloracetic acid, curettage, endodontic therapy where necessary and restoration with a glass ionomer cement has been evaluated on 94 patients with a total of 101 teeth with a minimum follow-up period of three years. Results indicate a satisfactory treatment outcome can be anticipated in Class 1, 2 and 3 cases. In Class 4 resorption no treatment or alternative therapy is recommended. Diagnosis of lesions at an early stage of development is highly desirable and therefore the patients who have a potential for the development of this condition by virtue of a history such as trauma should be monitored radiographically at intervals throughout life. PMID:11411085
Heithersay, G S
Prospective, randomized studies conducted over the past 10 years have changed the management of patients with advanced cervical cancer. The reviewed studies evaluated the use of surgery, irradiation, and chemotherapy in patients with various stages of cervical carcinoma in the absence and presence of high-risk factors for recurrence. A study by the Radiation Therapy Oncology Group (RTOG) compared pelvic with pelvic plus prophylactic para-aortic irradiation in patients with stages IB (> 4 cm), IIA, and IIB cervical cancer. The 10-year survival advantage was 11% for patients treated with prophylactic para-aortic irradiation. A follow-up study compared pelvic plus prophylactic para-aortic irradiation and brachytherapy with pelvic irradiation, brachytherapy, and chemotherapy with cisplatin and 5-FU in patients with IB-to IVA-stage cervical cancer. Overall and disease-free survivals were significantly improved in patients receiving chemotherapy. In patients with a prevalence of stage IIB and III, the Gynecologic Oncology Group (GOG) demonstrated that treatment with hydroxyurea alone was inferior to cisplatin or cisplatin, 5-FU, and hydroxy-urea in patients treated concurrently with pelvic irradiation and brachytherapy, and the GOG adopted irradiation and weekly cisplatin as standard therapy. Further GOG studies suggest that irradiation and weekly cisplatin chemotherapy without hysterectomy is the optimal treatment for patients with stage IB cervical cancer. High-risk factors for recurrence include tumor size, depth of tumor invasion, lymphovascular space involvement, and lymph node involvement. Prospective, randomized studies conducted by the GOG evaluated the effectiveness of various treatments in patients with high-risk factors. In one study that did not use chemotherapy, the recurrence-free interval was about 10% better for stage IB patients receiving postoperative irradiation after radical hysterectomy and pelvic lymphadenectomy compared with those who received no further therapy. Patients with Stages IB and IIA disease who, following radical hysterectomy and lymph node dissection, are identified as having positive pelvic lymph nodes and positive parametrial involvement, are at higher risk for recurrence and death than the high-risk group described above. An intergroup study conducted by the GOG, RTOG, and Southwest Oncology Group compared postoperative pelvic irradiation alone with postoperative pelvic irradiation plus concurrent chemotherapy in this group of patients. Overall and progression-free survivals were superior for patients receiving chemotherapy, and their greatest survival occurred in patients who received 3 or 4 chemotherapy cycles compared with 1 or 2 cycles or no chemotherapy. These findings are summarized with respect to their implications fortreatment of patients with advanced cervical cancer. PMID:11504285
Grigsby, P W
Cervical cancer remains a great problem for woman health, as it is the second deadly cancer of females worldwide. The infection of human papilloma virus (HPV) is the major risk factor for this cancer, although several other factors are also associated. Oxidative stress or antioxidant deficiency has been frequently identified to be associated with cervical cancer. Defects in the antioxidant enzyme systems are reported to play important role behind this antioxidant deficiency, which is responsible for the production of reactive oxygen species and ultimately, DNA damage in cervical cells. In response, cells become more vulnerable to HPV infection for cervical cancer development. Recently, antioxidant therapies or dietary supplementation of antioxidants have gained considerable interests in the cervical cancer treatment. In this study, we have reviewed the association of defective antioxidant systems and cervical cancer development. The recent advances in both of the basic and clinical research focusing on possible antioxidant therapy have also been discussed. PMID:23616011
Jiang, Bin; Xiao, Songshu; Khan, Md Asaduzzaman; Xue, Min
Background: Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question. Methods: This study reviews the current research regarding cervical athroplasty, and emphasizes both the pros and cons of arthroplasty as compared with ACDF. Results: Early clinical outcomes show that cervical arthroplasty is as effective as the standard ACDF. However, this new technology is also associated with an expanding list of novel complications. Conclusion: Although there is no definitive evidence that cervical disc replacement reduces the incidence of adjacent segment degeneration, it does show other advantages; for example, faster return to work, and reduced need for postoperative bracing.
Moatz, Bradley; Tortolani, P. Justin
The effects of a moderate-intensity static magnetic field (SMF) on osteoporosis of the lumbar vertebrae were studied in ovariectomized rats. A small disc magnet (maximum magnetic flux density 180?mT) was implanted to the right side of spinous process of the third lumbar vertebra. Female rats in the growth stage (10 weeks old) were randomly divided into 4 groups: (i) ovariectomized and implanted with a disc magnet (SMF); (ii) ovariectomized and implanted with a nonmagnetized disc (sham); (iii) ovariectomized alone (OVX) and (vi) intact, nonoperated cage control (CTL). The blood serum 17-?-estradiol (E2) concentrations were measured by radioimmunoassay, and the bone mineral density (BMD) values of the femurs and the lumbar vertebrae were assessed by dual energy X-ray absorptiometry. The E2 concentrations were statistically significantly lower for all three operated groups than those of the CTL group at the 6th week. Although there was no statistical significant difference in the E2 concentrations between the SMF-exposed and sham-exposed groups, the BMD values of the lumbar vertebrae proximal to the SMF-exposed area statistically significantly increased in the SMF-exposed group than in the sham-exposed group. These results suggest that the SMF increased the BMD values of osteoporotic lumbar vertebrae in the ovariectomized rats.
Xu, Shenzhi; Okano, Hideyuki; Tomita, Naohide; Ikada, Yoshito
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.
Background. Children with neurofibromatosis type 1 (NF1) are at increased risk of developing plexiform neurofibroma throughout the body,\\u000a including the cervical soft tissues. However, the incidence of cervical soft tissue tumors and the value of screening MR for\\u000a children with NF1 are not known. Purpose. The purposes of this study were to determine the incidence and clinical significance of cervical
Charles J. Chung; K. B. Armfield; Suresh K. Mukherji; Lynn A. Fordham; W. L. Krause
This paper presents a biomechanical analysis of the cervical C5–C6 functional spine unit before and after the anterior cervical discectomy and fusion. The aim of this work is to study the influence of the medical procedure and its instrumentation on range of motion and stress distribution. First, a three-dimensional finite element model of the lower cervical spine is obtained from
P. C. Fernandes; P. R. Fernandes; J. O. Folgado; J. Levy Melancia
Study Design. Randomized controlled study. Objective. To compare the rates of adverse events associated with disc arthroplasty versus those of anterior cervical discectomy and arthrodesis with allograft and plate. Summary of Background Data. Cervical disc arthro- plasty as a substitute for fusion has been developed to maintain motion and, theoretically, prevent adjacent seg- ment degeneration. Currently, cervical arthroplasty de- vices
Paul A. Anderson; Rick C. Sasso; K. Daniel Riew
OBJECTIVE: Our purpose was to investigate the hypothesis that cervical competence is a continuum that is related to cervical length and is reflected by pregnancy history.STUDY DESIGN: A cross-sectional study was performed of cervical length measured by transvaginal ultrasonography in women with prior preterm delivery at ? 26 weeks, 27 to 32 weeks, and 33 to 35 weeks compared with
Jay D. Iams; Francee F. Johnson; Jiri Sonck; Larry Sachs; Cathy Gebauer; Philip Samuels
We report the case of a 22-year-old Marine who presented to the emergency department, after a martial arts exercise, with transient weakness and numbness in all extremities. Computed tomography cervical spine radiographs revealed os odontoideum. Lateral flexion-extension radiographs identified atlanto-axillary instability. This abnormality is rare and can be career ending for military members who do not undergo surgical fusion. PMID:22224150
Robson, Kristie A
We report the case of a 22-year-old Marine who presented to the emergency department, after a martial arts exercise, with transient weakness and numbness in all extremities. Computed tomography cervical spine radiographs revealed os odontoideum. Lateral flexion–extension radiographs identified atlanto-axillary instability. This abnormality is rare and can be career ending for military members who do not undergo surgical fusion.
Robson, Kristie A
. ?To determine changes in cervical muscle strength after laminoplasty and to evaluate the relation between muscle strength\\u000a and neck pain, we measured maximum isometric muscle strength using a handheld dynamometer. We also investigated neck pain\\u000a before surgery and every month after surgery in 21 subjects who had undergone French-door laminoplasty. Muscle strength decreased\\u000a particularly 1 month after surgery, the extensor
Sueo Nakama; Kikuko Nitanai; Yoichi Oohashi; Teruaki Endo; Yuichi Hoshino
Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women.
Facchini, Chiara; Rapacchia, Giuseppina; Montanari, Giulia; Casadio, Paolo; Pilu, Gianluigi; Seracchioli, Renato
During the progression of epithelial cancer, cells usually lose epithelial characteristic features and gain a mesenchymal phenotype. Cervical cancer is a common female malignancy worldwide. Despite the generally good prognosis for early-stage cervical cancer patients, many patients still die as a result of metastasis and recurrence. Epithelial-mesenchymal transition (EMT) has been implicated in the metastasis of primary tumors and provides molecular mechanisms for cervical cancer metastasis. Here we provide an up-to-date overview regarding the program of EMT in cervical cancer. In the stepwise progression of cervical cancer, human papilloma viral proteins contribute to the cell transformation and the conversion of typical epithelial cells to the epithelial carcinoma cells with hybrid epithelial and mesenchymal characteristics. Molecules related to the EMT program of cervical cancer cells are summarized in this review paper. Several soluble factors acting on their cognate receptors stimulate the mesenchymal transition of cervical epithelial cells. Ion transport system as well as cytoskeletal modulators also stimulate the progression of EMT program in cervical carcinoma cells. Transcriptional factors such as Snail, Twist1, Twist2, and six1 homeoproteins are involved in the complicated regulation and cervical cancer metastasis. Among the various signalings associated with EMT program, Snail is a central transcription factor which governs EMT program. In contrast to tumor promoters, several tumor suppressors such as SFRP1/2 and LMX-1A have been reported to suppress tumorigenesis as well as metastatic spread through inhibiting the EMT program.
Lee, Mei-Yi; Shen, Meng-Ru
Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women. PMID:24696772
Facchini, Chiara; Rapacchia, Giuseppina; Montanari, Giulia; Casadio, Paolo; Pilu, Gianluigi; Seracchioli, Renato
During the progression of epithelial cancer, cells usually lose epithelial characteristic features and gain a mesenchymal phenotype. Cervical cancer is a common female malignancy worldwide. Despite the generally good prognosis for early-stage cervical cancer patients, many patients still die as a result of metastasis and recurrence. Epithelial-mesenchymal transition (EMT) has been implicated in the metastasis of primary tumors and provides molecular mechanisms for cervical cancer metastasis. Here we provide an up-to-date overview regarding the program of EMT in cervical cancer. In the stepwise progression of cervical cancer, human papilloma viral proteins contribute to the cell transformation and the conversion of typical epithelial cells to the epithelial carcinoma cells with hybrid epithelial and mesenchymal characteristics. Molecules related to the EMT program of cervical cancer cells are summarized in this review paper. Several soluble factors acting on their cognate receptors stimulate the mesenchymal transition of cervical epithelial cells. Ion transport system as well as cytoskeletal modulators also stimulate the progression of EMT program in cervical carcinoma cells. Transcriptional factors such as Snail, Twist1, Twist2, and six1 homeoproteins are involved in the complicated regulation and cervical cancer metastasis. Among the various signalings associated with EMT program, Snail is a central transcription factor which governs EMT program. In contrast to tumor promoters, several tumor suppressors such as SFRP1/2 and LMX-1A have been reported to suppress tumorigenesis as well as metastatic spread through inhibiting the EMT program. PMID:22347518
Lee, Mei-Yi; Shen, Meng-Ru
Epidemiological and laboratory-based studies have identified infection with one of 15 high-risk human papillomavirus (HPV) types as a necessary but not sufficient cause of cervical cancer. The prevalence of genital HPV infections is high in young women, but most of the infections regress without interventions. Host genetic variations in genes involved in immune response pathways may be related to HPV clearance, and HPV E6/E7 oncoproteins interacting or downstream genes, both coding and non-coding, may contribute to the outcome of high risk HPV infection and cervical cancer. Of specific interest for this review has been the selection of genetic variants in genes involved in the above-referred pathways with a summary of their applications in association studies. Because the supportive and opposing data have been reported in different populations, well-designed international collaborative studies need to be conducted to define the consistency of the associations, paving the way to better define the patients at high risk of developing cervical cancer.
Chen, Xiaojun; Jiang, Jie; Shen, Hongbing; Hu, Zhibin
It has been seen an increase of the cervical cancer and of intraepithelial cancer in the last years. The most important risk factors for cervical cancer are sexual conduct, early of sexual relationships, number of partners, cigarettes, oral anticonceptive, pregnancy, immunosuppression, sexually transmitted illness. And an important role of the Human Papilloma Virus. The HPV has been classified in 3 groups; low risk, the most frequents are 11 and 6, middle risk, tipe 31, 33 and 35, and high risk, 16 and 18, that have frequent association with cervical cancer and with high grade intraepithelial lesions. The cervicovaginal citology is still the most accurate diagnosis method to detect SIL or CIN and invasive cancer in early stages, it is discussed the periodicity and group of women to whom the method must point. There are different options depending if it is a SIL of low or high grade or and cancer. With the possibility of doing follow up or treatment, such as. LLETZ, Laser, Criotraphy, cone and interferon for the preneoplastic lesions. The achievement of a vaccine for HPV could have a significant impact on these pathology. PMID:16972742
Irico, G; Escobar, H; Marinelli, B
Purpose Illustrative cases are presented to demonstrate the surgical management of complex instability of the cervical spine.Methods Six patients with different underlying pathologies are presented along with their clinical and radiologic findings, surgical procedures, complications, and outcomes.Results Five patients underwent anteroposterior (AP) decompression and stabilization, of which two required secondary posterior stabilization because of dislocation or subsidence of the anterior osteosynthesis. In another case, a patient with a two-level corpectomy, a stable situation was achieved with an anterior approach only. The outcomes, measured according to Odom's criteria, were excellent in one patient, good in three patients, and fair in two patients.Conclusions In cases of complex cervical instability, combined AP decompression and stabilization minimizes the risk of anterior plate failure or dislocation of the vertebral body prosthesis. However, there may be increased risk of adjacent-level degeneration. Therefore, a combined procedure should be considered in selected patients. Not all patients with cervical instability require circumferential surgery. In two-level corpectomy cases, the decision between the less invasive anterior-only approach and the more stable combined approach can be difficult. However, in patients with proof of poor bone quality or with metabolic disorders, a more stable combined approach should be considered. PMID:23765918
König, Stefan Alexander; Ranguis, Sebastian; Spetzger, Uwe
INCREASING THE CERVICAL LORDOSIS WITH CHIROPRACTIC BIOPHYSICS SEATED COMBINED EXTENSION-COMPRESSION AND TRANSVERSE LOAD CERVICAL TRACTION WITH CERVICAL MANIPULATION: NONRANDOMIZED CLINICAL CONTROL TRIAL
Background: Cervical lordosis has been shown to be an important outcome of care; however, few conservative methods of rehabilitating sagittal cervical alignment have been reported. Objective: To study whether a seated, retracted, extended, and compressed position would cause tension in the anterior cervical ligament, anterior disk, and muscle structures, and thereby restore cervical lordosis or increase the curvature in patients
Deed E. Harrison; Donald D. Harrison; Joeseph J. Betz; Tadeusz J. Janik; Burt Holland; Christopher J. Colloca; Jason W. Haas
The morphological parameters, bone area, marrow area, bone-to-bone+marrow ratio, periosteal-to-total bone surface ratio, and surface-to-volume ratio, were studied in the fourth and fifth lumbar vertebrae of male and female rats (Heiligenberg strain) between birth and the end of lifespan. With increasing age, the bone area and marrow area increased for all ages, whereas the bone-to-bone + marrow ratio, periosteal-to-total bone surface ratio, and surface-to volume ratio decreased during the first 150 days. Afterwards, the bone-to-bone + marrow ratio decreased, whereas the periosteal-to-total bone surface ratio and surface-to-volume ratio were nearly constant. Modelling data were measured by use of the vital labeling technique with calcein. From the stained bone area the bone formation and the bone resorption rates were calculated. The bone formation rate, about 8300%/year, was highest after birth and decreases continuously with increasing age to 14%/year. The bone resorption rate, about 1100%/year, was highest after birth and decreased continuously with increasing age to 9%/year, whereas for all ages the bone formation rate was higher than the bone resorption rate, which led to an increase in bone area. The values obtained for the lumbar vertebra are compared with literature data and with the corresponding data for the distal femur obtained under identical conditions. PMID:7873287
Intraosseous schwannomas or neurilemomas are rare benign neoplasms that account for less than 0.2% of primary bone tumours. Very rarely they have been observed in lumbar vertebrae. We report a neurilemoma involving the lower thoracic spine and present the clinical, radiological and histological findings with surgical management and 5-year follow-up. An 18-year-old-male presented with back pain and deteriorating locomotor function. Neurological examination revealed wasting of both calves and weakness in plantar flexion and dorsiflexion bilaterally. X-rays showed a D12 vertebral body abnormality with cystic changes and collapse of the body and pedicle. MRI showed a tumor occupying the D12 vertebrae with perivertibral protrusion compressing the thecal sac. Surgical decompression, excision and stabilisation with an extendable cage, bone graft and anterior rod system were achieved through a thoracolumbar approach. Histology results confirmed an intraosseous schwannoma with no remnants of an originating nerve. These tumors are rare but can be successfully treated with surgical excision and maintenance of spinal stability with recovery of neurological and functional change. Recurrence is uncommon.
Younis, Fizan; Smith, Roger B.
Physiological and anatomical ranges of movements at lumbar and lumbo-sacral motion segments are influenced by passive (bones and ligaments) and active (muscles) elements. The movements are visualized in terms of intrinsically unopposed (Neutral Zones) or opposed (Transitional Zones) movement zones. These two zones constitute the absolute ranges of motion for different regions of the spine. Though values of these ranges for flexion, extension, lateral bending and axial rotation at different spinal segments may demonstrate similarities across matched population, these parameters are most likely to show different values in lumbar spines affected with lumbo-sacral transitional vertebrae (LSTV). LSTV is a common variation of the lumbo-sacral junction and present well documented structural changes at the lower spine and L5/S1 vertebrae. This study attempts to (i) delineate and hypothesize relationships between changes in active and passive elements, (ii) understand the possibilities of restriction or augmentation in the values of these 'zones', and (iii) to predict overall LSTV induced physiological lumbar motion changes, in association with these variations. PMID:23159743
Mahato, Niladri Kumar
The aim of this biomechanical study was to investigate the role of the dorsal vertebral cortex in transpedicular screw fixation. Moss transpedicular screws were introduced into both pedicles of each vertebra in 25 human cadaver vertebrae. The dorsal vertebral cortex and subcortical bone corresponding to the entrance site of the screw were removed on one side and preserved on the other. Biomechanical testing showed that the mean peak pull-out strength for the inserted screws, following removal of the dorsal cortex, was 956.16 N. If the dorsal cortex was preserved, the mean peak pullout strength was 1295.64 N. The mean increase was 339.48 N (26.13%; p = 0.033). The bone mineral density correlated positively with peak pull-out strength. Preservation of the dorsal vertebral cortex at the site of insertion of the screw offers a significant increase in peak pull-out strength. This may result from engagement by the final screw threads in the denser bone of the dorsal cortex and the underlying subcortical area. Every effort should be made to preserve the dorsal vertebral cortex during insertion of transpedicular screws. PMID:16645123
Karataglis, D; Kapetanos, G; Lontos, A; Christodoulou, A; Christoforides, J; Pournaras, J
The fluorescence spectra from rat bones of different age groups (8, 56 and 78 weeks) and lumber vertebra were measured with 8, 10 and 12 keV synchrotron X-rays. We have utilized the new hard X-ray micro-spectroscopy beamline facility, X27A, available at NSLS with a primary beam spot size of the order of ˜10 ?m. With this spatial resolution and high flux throughput, X-ray fluorescent intensities for Ca and other trace elements were measured using a liquid-nitrogen-cooled 13-element energy-dispersive high-purity germanium detector. Regarding the lumber vertebra, we acquired the fluorescence spectra from the left, right and middle portions and calcium accumulation was evaluated and compared with the other samples. We have identified the major trace elements of Ca, Ni, Fe and Zn and minor trace elements of Ti, Cr and Mn in the sample. The percentage of scattered radiation and trace element contributions from these samples were highlighted at different energies.
Rao, Donepudi V.; Swapna, Medasani; Cesareo, Roberto; Brunetti, Antonio; Akatsuka, Tako; Yuasa, Tetsuya; Takeda, Tohoru; Tromba, Giuliana; Gigante, Giovanni E.
Low bone mineral density (BMD) is a strong risk factor for vertebral fracture risk in osteoporosis. However, many fractures occur in people with moderately decreased or normal BMD. Our aim was to assess the contributions of trabecular microarchitecture and its heterogeneity to the mechanical behavior of human lumbar vertebrae. Twenty-one human L3 vertebrae were analyzed for BMD by dual-energy X-ray absorptiometry (DXA) and microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) and then tested in axial compression. Microarchitecture heterogeneity was assessed using two vertically oriented virtual biopsies—one anterior (Ant) and one posterior (Post)—each divided into three zones (superior, middle, and inferior) and using the whole vertebral trabecular volume for the intraindividual distribution of trabecular separation (Tb.Sp*SD). Heterogeneity parameters were defined as (1) ratios of anterior to posterior microarchitectural parameters and (2) the coefficient of variation of microarchitectural parameters from the superior, middle, and inferior zones. BMD alone explained up to 44% of the variability in vertebral mechanical behavior, bone volume fraction (BV/TV) up to 53%, and trabecular architecture up to 66%. Importantly, bone mass (BMD or BV/TV) in combination with microarchitecture and its heterogeneity improved the prediction of vertebral mechanical behavior, together explaining up to 86% of the variability in vertebral failure load. In conclusion, our data indicate that regional variation of microarchitecture assessment expressed by heterogeneity parameters may enhance prediction of vertebral fracture risk. © 2010 American Society for Bone and Mineral Research.
Wegrzyn, Julien; Roux, Jean-Paul; Arlot, Monique E; Boutroy, Stephanie; Vilayphiou, Nicolas; Guyen, Olivier; Delmas, Pierre D; Chapurlat, Roland; Bouxsein, Mary L
Idiopathic scoliosis involves complex spinal intrinsic deformations such as the wedging of vertebral bodies (VB) and intervertebral disks (ID), and it is obvious that the clinical evaluation obtained by the spinal projections on the two-dimensional (2D) radiographic planes do not give a full and accurate interpretation of scoliotic deformities. This paper presents a method that allows reconstruction in 3D of the vertebral body endplates and measurement of the 3D wedging angles. This approach was also used to verify whether 2D radiographic measurements could lead to a biased evaluation of scoliotic spine wedging. The 3D reconstruction of VB contours was done using calibrated biplanar X-rays and an iterative projection computer procedure that fits 3D oriented ellipses of adequate diameters onto the 3D endplate contours. "3D wedging angles" of the VB and ID (representing the maximum angle between adjacent vertebrae) as well as their angular locations with respect to the vertebral frontal planes were computed by finding the positions of the shortest and longest distances between consecutive endplates along their contour. This method was extensively validated using several approaches: (1) by comparing the 3D reconstructed endplates of a cadaveric functional unit (T8-T9) with precise 3D measurements obtained using a coordinate measuring machine for 11 different combinations of vertebral angular positions; (2) by a sensitivity study on 400 different vertebral segments mathematically generated, with errors randomly introduced on the digitized points (standard deviations of 0.5, 1, 2, and 3 mm); (3) by comparing the clinical wedging measurements (on postero-anterior and lateral radiographs) at the thoracic apical level of 34 scoliotic patients (15 degrees < Cobb < 45 degrees) to the computed values. Mean errors for the 11 vertebral positions were 0.5 +/- 0.4 mm for VB thickness, less than 2.2 degrees for endplate orientation, and about 11 degrees (3 mm) for the location of the maximum 3D wedging angle along the endplate contour. The errors below 2 mm (introduced on the digitized points) slightly affected the 3D wedging angle (< 2 degrees) and its location (< 4 degrees) for the ID. As for the clinical evaluation, average angular errors were less than 0.4 degrees in the radiographic frontal and lateral planes. The mean 3D wedged angles were about 4.9 degrees +/- 1.9 degrees for the VB and 6.0 degrees +/- 1.7 degrees for the ID. Linear relations were found between the 2D and the 3D angles, but the 3D angles were located on diagonal planes statistically different than the radiographic ones (between 100 degrees and 221 degrees). There was no statistical relation between the 2D radiographic angles and the locations of the 3D intervertebral wedging angles. These results clearly indicate that VB and ID endplates are wedged in 3D, and that measurements on plain radiographs allow incomplete evaluation of spinal wedging. Clinicians should be aware of these limitations while using wedging measurements from plain radiographs for diagnosis and/or research on scoliotic deformities. PMID:9548361
Aubin, C E; Dansereau, J; Petit, Y; Parent, F; de Guise, J A; Labelle, H
Anemia; Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Drug/Agent Toxicity by Tissue/Organ; Radiation Toxicity; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer
Articulating cervical disk implants have been proposed as an alternative to disk fusion in the treatment of cervical disk disease. To examine the mechanical effect of articulating cervical disk implants (ACDI) versus simulated cervical disk fusion, a mechanical test device was constructed and cadaveric tests were carried out. While results show little effect on the pressures above and below the treatment level, the percent hysteretic behavior of the specimens trended to be higher for the ACDI, indicating that these implants retain more of the natural energy absorption capability of the cervical spine. PMID:16813439
Davies, M A; Bryant, S C; Larsen, S P; Murrey, D B; Nussman, D S; Laxer, E B; Darden, B V
The number of vertebrae in pigs varies and is associated with meat productivity. Wild boars, which are ancestors of domestic pigs, have 19 vertebrae. In comparison, European commercial breeds have 21–23 vertebrae, probably owing to selective breeding for enlargement of body size. We previously identified two quantitative trait loci (QTL) for the number of vertebrae on Sus scrofa chromosomes (SSC) 1 and 7. These QTL explained an increase of more than two vertebrae. Here, we performed a map-based study to define the QTL region on SSC1. By using three F2 experimental families, we performed interval mapping and recombination analyses and defined the QTL within a 1.9-cM interval. Then we analyzed the linkage disequilibrium of microsatellite markers in this interval and found that 10 adjacent markers in a 300-kb region were almost fixed in European commercial breeds. Genetic variation of the markers was observed in Asian local breeds or wild boars. This region encoded an orphan nuclear receptor, germ cell nuclear factor (NR6A1, formerly known as GCNF), which contained an amino acid substitution (Pro192Leu) coincident with the QTL. This substitution altered the binding activity of NR6A1 to its corepressors, nuclear receptor-associated protein 80 (RAP80) and nuclear receptor corepressor 1 (NCOR1). In addition, somites of mouse embryos demonstrated expression of NR6A1 protein. Together, these results suggest that NR6A1 is a strong candidate for one of the QTL that influence number of vertebrae in pigs.
Mikawa, Satoshi; Morozumi, Takeya; Shimanuki, Shin-Ichi; Hayashi, Takeshi; Uenishi, Hirohide; Domukai, Michiko; Okumura, Naohiko; Awata, Takashi
Introduction Mucopolysaccharidosis I (MPS I) is a lysosomal storage disorder characterized by deficient ?-L-iduronidase activity leading to accumulation of poorly degraded dermatan and heparan sulfate glycosaminoglycans (GAGs). MPS I is associated with significant cervical spine disease, including vertebral dysplasia, odontoid hypoplasia, and accelerated disc degeneration, leading to spinal cord compression and kypho-scoliosis. The objective of this study was to establish the nature and rate of progression of cervical vertebral bone disease in MPS I using a canine model. Methods C2 vertebrae were obtained post-mortem from normal and MPS I dogs at 3, 6 and 12 months-of-age. Morphometric parameters and mineral density for the vertebral trabecular bone and odontoid process were determined using micro-computed tomography. Vertebrae were then processed for paraffin histology, and cartilage area in both the vertebral epiphyses and odontoid process were quantified. Results Vertebral bodies of MPS I dogs had lower trabecular bone volume/total volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) and bone mineral density (BMD) than normals at all ages. For MPS I dogs, BV/TV, Tb.Th and BMD plateaued after 6 months-of-age. The odontoid process appeared morphologically abnormal for MPS I dogs at 6 and 12 months-of-age, although BV/TV and TMD were not significantly different from normals. MPS I dogs had significantly more cartilage in the vertebral epiphyses at both 3 and 6 months-of-age. At 12 months-of-age, epiphyseal growth plates in normal dogs were absent, but in MPS I dogs they persisted. Conclusions In this study we report reduced trabecular bone content and mineralization, and delayed cartilage to bone conversion in MPS I dogs from 3 months-of-age, which may increase vertebral fracture risk and contribute to progressive deformity. The abnormalities of the odontoid process we describe likely contribute to increased incidence of atlanto-axial subluxation observed clinically. Therapeutic strategies that enhance bone formation may decrease incidence of spine disease in MPS I patients.
Chiaro, Joseph A; Baron, Matthew D; del Alcazar, Chelsea; O'Donnell, Patricia; Shore, Eileen M; Elliott, Dawn M; Ponder, Katherine P; Haskins, Mark E; Smith, Lachlan J
Cervical cancer is a major cause of mortality and premature death among women in their most productive years in low- and medium-resourced countries in Asia, Africa and Latin America, despite the fact that it is an eminently preventable cancer. While cytology screening programmes have resulted in a substantial reduction of cervical cancer mortality in developed countries, they have been shown
Rengaswamy Sankaranarayanan; Somanathan Thara; Pulikottil Okkuru Esmy; Partha Basu
Purpose: To report on an extremely rare tumour located in the cervical spine, its treatment and result. Review of the literature. Patient: Case report of a 38-year-old woman with an intraosseous schwannoma of the cervical spine. Results: After local curettage no evidence for local recurrence at long-term follow-up.
Veth, Rene P. H.; Pruszczynski, Maciej; Lemmens, J. Albert M.; van Laarhoven, Erik W.
Ten fresh human cadavers were intubated while recording cervical motion using a cinefluoroscopic technique. Segmental cervical motion from the occiput through C5 was measured in both the intact spine and following the creation of a C4-5 posterior-ligament...
V. C. Traynelis
Sixteen fresh human cadavers were intubated while recording cervical motion using a cine fluoroscopic technique. Segmental cervical motion from the occiput through C5 was measured in both the intact spine and following the creation of a C4-5 posterior lig...
V. C. Traynelis
Dysphagia is one of the complications of anterior cervical surgery. Although common, few articles were published on this subject. Its incidence and duration varies depending on the author. We show a prospective study, analyzing the incidence, duration and quality of the dysphagia after anterior cervical surgery. PMID:15273851
Falavigna, Asdrubal; Righesso Neto, Orlando; Ferraz, Fernando Antonio Patriani; Martinato, Geraldo; Riegel, Rafael Ernesto
This study attempted to use cervical spine magnetic resonance imaging (MRI) to detect cord injury in 12 dead children with head injury from child abuse. Eighty percent of children autopsied had small cervical spine hemorrhages; MRI did not identify them and did not identify cord injury in any child studied, indicating that MRI scans are probably…
Feldman, Kenneth W.; And Others
This papers reports on methodologies and outcome of a study aiming at developing robust tool to evaluate and classify histology images of cervical cancer. Using the histology images acquired from the pathology laboratories in an Indonesian hospital, this study aims to classify cervical biopsy images based on four well known discriminatory features a) the ratio of nuclei to cytoplasm b)
Rahmadwati; G. Naghdy; M. Ross; C. Todd; E. Norachmawati
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...
The purpose of the present paper was to investigate the significance of DEK protein expression in uterine cervical lesions and its relationship with HPV infection status. DEK protein expression was studied in 253 cervical lesions, including 30 non-neoplastic cervix with or without squamous metaplasia, 64 cervical intra-epithelial neoplasias (CIN; CIN-1, n = 28; CIN-2, n = 17; CIN-3, n = 19), 102 squamous cell carcinomas (SCC), 51 adenocarcinomas, and six adenosquamous cell carcinomas (adenoSCC) on immunohistochemistry. For comparison, HPV-positive and -negative cervical cancer cell lines were also included. The HPV screening was performed using TaKaRa polymerase chain reaction. On immunohistochemistry DEK was found to be negative in all 30 non-neoplastic cervical epithelia, but it was positive in 96.1% of SCC (98/102), 92.2% of adenocarcinomas (47/51), 100% of adenoSCC (6/6), 85.7% of CIN-1 (24/28), 94.1% of CIN-2 (16/17), and 89.5% of CIN-3 (17/19). There was no significant difference between HPV-positive and -negative cervical lesions. Also, strongly positive staining was observed in all aforementioned cervical cancer cell lines regardless of HPV infection, according to immunocytochemistry. In summary, DEK plays an important role in the carcinogenesis of cervical cancers, and can be helpful for early diagnosis, and is a potential therapeutic target. PMID:18477217
Wu, Qunying; Li, Zhuhu; Lin, Hai; Han, Longzhe; Liu, Shuangping; Lin, Zhenhua
Objective: This study was undertaken to investigate prognostic factors in patients with recurrent cervical carcinoma who had undergone a primary radical hysterectomy and pelvic lymphadenectomy. Study Design: A retrospective analysis of 177 patients with recurrent cervical carcinoma after radical hysterectomy and pelvic lymphadenectomy for stage IB to II disease at a single institution was performed to evaluate clinicopathologic parameters, time
Chin-Jung Wang; Chyong-Huey Lai; Huei-Jean Huang; Ji-Hong Hong; Hung-Hsueh Chou; Kuan-Gen Huang; Jen-Daw Lin
As recently as the 1940s, cervical cancer was a major cause of death among women of childbearing age in the U.S. but widespread introduction of the Pap test in the 1950s helped reduce cervical cancer incidence and mortality in this country by more than 70 percent.
Pediatric cervical epidural hematoma is an uncommon diagnosis and very few cases have been reported so far. The condition is difficult to diagnose and requires immediate surgical intervention to obtain the best possible neurological outcome. Most of the cases are of a spontaneous origin. We report a case of traumatic cervical epidural hematoma, which was managed surgically, resulting in complete neurological recovery.
Gupta, Vishnu; Kundra, Sandeep; Chaudhary, AK; Kaushal, RK
... of getting cervical cancer, followed by Hispanic, white, American Indian/Alaska Native, and Asian/Pacific Islander women. Cervical ... from race categories (white, black, Asian/Pacific Islander, American Indian/Alaska Native). Death Rates by Race/Ethnicity From ...
The surgical treatment of cervical spondylosis and resulting cervical radiculopathy or myelopathy has evolved over the past century. Surgical options for dorsal decompression of the cervical spine includes the traditional laminectomy and laminoplasty, first described in Asia in the 1970's. More recently the dorsal approch has been explored in terms of minimally invasive options including foraminotomies for nerve root descompression. Ventral decompression and fusion techniques are also described in the article, including traditional anterior cervical discectomy and fusion, strut grafting and cervical disc arthroplasty. Overall, the outcome from surgery is determined by choosing the correct surgery for the correct patient and pathology and this is what we hope to explain in this brief review.
Moran, C.; Bolger, C.
Neck afferents not only assist the coordination of eye, head, and body, but they also affect spatial orientation and control of posture. This implies that stimulation of, or lesions in, these structures can produce cervical vertigo. In fact, unilateral local anesthesia of the upper dorsal cervical roots induces ataxia and nystagmus in animals, and ataxia without nystagmus in humans. If cervical vertigo exists outside these experimental conditions, it is obviously characterized by ataxia and unsteadiness of gait, and not by a clear rotational or linear vertigo. Neurological, vestibular, and psychosomatic disorders must first be excluded before the dizziness and unsteadiness in cervical pain syndromes can be attributed to a cervical origin. To date, however, the syndrome remains only a theoretical possibility awaiting a reliable clinical test to demonstrate its independent existence. PMID:9390801
This is a case study presented by the University of Pittsburgh Department of Pathology, which describes a 78-year-old male who presented with a 6 month history of cervical adenopathy. Visitors are given patient history, microscopic description, differential diagnosis, and immunohistochemistry, including images, and are given the opportunity to diagnose the patient. A "Final Diagnosis" section provides a discussion of the findings as well as references. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in hematopathology.
Craig, Fiona; Krishnamurti, Uma
Recurrent Cervical Cancer; Recurrent Vaginal Cancer; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Vaginal Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Stage IVB Cervical Cancer; Stage IVB Vaginal Cancer; Therapy-related Toxicity
The overall aim of this study is to compare the effectiveness of cervical lateral mass plate (CLMP) fixation to that of cervical lateral mass rod (CLMR) fixation and transpedicular fixation in providing stability to the cervical spine. Twenty-one cervical spines will be tested intact and with instrumentation in varying degrees of instability including posterior instability, anterior\\/posterior instability, corpectomy, and reconstructed
R. P. Morris; B. Svagr; R. M. Patterson; J. Yang; A. J. Muffoletto; J. W. Simmons
Object: The authors evaluated cervical spine radiographs to determine sagittal alignment in patients who underwent one- or two-level arthroplasty with the Bryan cervical artificial disc prosthesis. Methods: The curvature of the surgically treated spinal segments and the overall curvature of the cervical spine were evaluated in 13 patients who underwent 16 cervical arthroplasty device placements. Preoperative and postoperative lateral radiographs
J. Patrick Johnson; Carl Lauryssen; Helen O. Cambron; Robert Pashman; John J. Regan; Neel Anand; Robert Bray
A 29-year-old man presented with a rare case of far-out foraminal stenosis with radiculopathy caused by osteophyte formation secondary to an anomalous articulation between the transverse process and the sacral ala. Diagnosis of unilateral far-out foraminal entrapment of the L5 spinal nerve below a transitional vertebra (TV) depended on selective radiculography and nerve root block. Computed tomography after selective radiculography clearly demonstrated foraminal entrapment of the L5 nerve root via the osteophytes. The patient underwent posterior decompression by resection of the osteophytes using an operating microscope and experienced good relief of radicular pain. This case illustrates the effectiveness and some refinements of posterior decompression for radicular pain caused by far-out foraminal stenosis below a TV and compression of the L5 spinal nerve. PMID:21358163
Miyoshi, Yasuyuki; Yasuhara, Takao; Date, Isao
Recent Food and Drug Administration (FDA) approval of a Roche cobas human papillomavirus (HPV) test application as a first line primary cervical screening tool in women 25 and older introduces a new era of complex cervical screening choices. Perhaps the most surprising findings in Roche's supporting ATHENA trial data were the unexpectedly low verification bias-adjusted CIN3+ sensitivities documented by the FDA for both the proposed cobas HPV testing algorithm (58.26%) and Pap testing algorithm (42.63%). These unexpectedly low sensitivity estimates suggest intuitively that there is still considerable room for improvement in cervical screening, and available data from large systems point to routine cytology and HPV co-testing as offering the greatest protection against development of cervical cancer. Observational studies of large populations screened over time remain essential to document actual protection from development of cervical cancer with any new cervical screening options, as natural history studies and available data from large systems indicate that most CIN2/3 cases detected in short term clinical trials would not progress to invasive cervical cancer. Interpretation of ATHENA trial data and its application to routine clinical practice is further limited by published studies which document that a significant proportion of CIN2/3 biopsy diagnoses in the ATHENA trial could not be confirmed as accurate when evaluated with p16 immunohistochemistry and that cytology laboratory performance in the trial was notably suboptimal.
Austin, R. Marshall; Zhao, Chengquan
The objective of the study was to introduce a new parameter describing bone strength with greater precision than the widely used antero-posterior DXA (dual-energy X-ray absorptiometry), which measures areal bone mineral density (aBMD). The adjusted areal bone mineral density (AaBMD) defined as the ratio between aBMD and h a/h p (h a and h p: anterior and posterior vertebral body heights measured on the lateral view, respectively) is proposed: AaBMD = aBMD/(h a/h p). The utility of AaBMD in prediction of bone strength was assessed by in vitro measurements of cadaver L3 vertebrae. The AaBMD of 31 vertebrae was correlated with the ultimate stress (P max) and load (F max) values obtained in mechanical tests. The correlations were compared to those obtained for aBMD and for volumetric bone mineral density (vBMD) measured by computed tomography. The correlation of AaBMD to F max adjusted for donor's age was significantly higher than for aBMD and vBMD (r = 0.740, 0.658, and 0.609, respectively, p < 0.05). The differences between partial correlation coefficients for P max to AaBMD, aBMD and vBMD relationships were smaller (r = 0.764, 0.720, and 0.732, respectively, p < 0.05), but also showed the superiority of AaBMD. Combining antero-posterior DXA aBMD and the lateral h a/h p ratio, measured, for example, by the Vertebral Fracture Assessment software of the new generation of DXA devices, seems to accurately predict the mechanical vertebral parameters related to bone strength. It is assumed that the proposed AaBMD parameter may be more predictive for fracture risk assessment, which requires further studies. PMID:24854155
Tato?, Grzegorz; Rokita, Eugeniusz; Korkosz, Mariusz; Wróbel, Andrzej
Cervical spinal cord injury is a rare but serious complication after general anesthesia. The risk factors include traumatic cervical injury, cervical spine instability, and difficult airway management. It has also occurred in the absence of cervical instability. Here we report a patient who had a history of intermittent neck pain without numbness. Preoperative radiologic examinations showed degenerative changes in the cervical spine. She developed progressive tingling and numbness in her limbs after thyroidectomy under general anesthesia. Magnetic resonance imaging showed a cervical disc protruding into the canal at C5-C6, which was considered to be induced by surgical positioning. She recovered after anterior cervical decompression and internal fixation surgery. PMID:23828450
Yao, Wenlong; Qiu, Jin; Zhou, Zhiqiang; Zhang, Lin; Zhang, Chuanhan
Ovariectomized cynomolgus monkeys have previously been investigated as a nonhuman primate model of postmenopausal osteoporosis (Jerome et al., Bone Miner 9:527–540; 1994). In the present study, Fourier transform infrared microspectroscopy (FTIRM) was used to verify that differences in bone mineral quality and quantity in the vertebrae of mature intact (INT) and ovariectomized (ovx) monkeys were analogous to those seen in
S. J Gadeleta; A. L Boskey; E Paschalis; C Carlson; F Menschik; T Baldini; M Peterson; C. M Rimnac
Background This study describes reference data for L3 vertebra and its 3 ossification centers at varying gestational ages. Material/Methods Using CT, digital-image analysis and statistics, the growth of L3 vertebra and its 3 ossification centers in 55 spontaneously aborted human fetuses aged 17–30 weeks was examined. Results Neither sex nor right-left significant differences were found. The height and transverse and sagittal diameters of the L3 vertebral body increased logarithmically. Its cross-sectional area followed linearly, whereas its volume increased parabolically. The transverse and sagittal diameters of the ossification center of the L3 vertebral body varied logarithmically, but its cross-sectional area and volume grew linearly. The ossification center-to-vertebral body volume ratio gradually declined with age. The neural ossification centers increased logarithmically in length and width, and proportionately in cross-sectional area and volume. Conclusions With no sex differences, the growth dynamics of the L3 vertebral body follow logarithmically in height, sagittal and transverse diameters, linearly (in cross-sectional area), and parabolically (in volume). The growth dynamics of the 3 ossification centers of the L3 vertebra follow logarithmically in transverse and sagittal diameters, and linearly (in cross-sectional area and volume). The age-specific reference intervals of the L3 vertebra and its 3 ossification centers present the normative values of clinical importance in the diagnosis of congenital spinal defects.
Szpinda, Michal; Baumgart, Mariusz; Szpinda, Anna; WoYniak, Alina; Mila-Kierzenkowska, Celestyna
Invasive cervical resorption is a relatively uncommon form of external root resorption exhibiting no external signs. The resorptive condition is often detected by routine radiographic examination. The clinical features vary from a small defect at the gingival margin to a pink coronal discoloration of the tooth crown resulting in ultimate cavitation of the overlying enamel which is painless unless pulpal or periodontal infection supervenes. Radiographic features of lesions vary from well-delineated to irregularly bordered mottled radiolucencies, and these can be confused with dental caries. A characteristic radiopaque line generally separates the image of the lesion from that of the root canal, because the pulp remains protected by a thin layer of predentin until late in the process. Histopathologically, the lesions contain fibrovascular tissue with resorbing clastic cells adjacent to the dentin surface. More advanced lesions display fibro-osseous characteristics with deposition of ectopic bonelike calcifications both within the resorbing tissue and directly on the dentin surface. How to cite this article: Kandalgaonkar SD, Gharat LA, Tupsakhare SD, Gabhane MH. Invasive Cervical Resorption: A Review. J Int Oral Health 2013;5(6):124-30 . PMID:24453457
Kandalgaonkar, Shilpa D; Gharat, Leena A; Tupsakhare, Suyog D; Gabhane, Mahesh H
Human papillomavirus (HPV), particularly type 16, has been associated with more than 99% of cervical cancers. There are two HPV oncogenic proteins, E6 and E7, which play a major role in the induction and maintenance of cellular transformation. Thus, immunotherapy targeting these proteins may be employed for the control of HPV-associated cervical lesions. Although the commercially available preventive HPV vaccines are highly efficient in preventing new HPV infection, they do not have therapeutic effects against established HPV infection or HPV-associated lesions. Since T cell-mediated immunity is important for treating established HPV infections and HPV-associated lesions, therapeutic HPV vaccine should aim at generating potent E6 and E7-specific T cell-mediated immune responses. DNA vaccines have now developed into a promising approach for antigen-specific T cell-mediated immunotherapy to combat infection and cancer. Because dendritic cells are the most potent professional antigen-presenting cells, and are highly effective in priming antigen-specific T cells, several DNA vaccines have employed innovative strategies to modify the properties of dendritic cells (DCs) for the enhancement of the DNA vaccine potency. These studies have revealed impressive pre-clinical data that has led to several ongoing HPV DNA vaccine clinical trials.
Huang, Chien-Fu; Monie, Archana; Weng, Wei-Hung; Wu, TC
A cervical cytology biobank (CCB) is an extension of current cytopathology laboratory practice consisting in the systematic storage of Pap smears or liquid-based cytology samples from women participating in cervical cancer screening with the explicit purpose to facilitate future scientific research and quality audit of preventive services. A CCB should use an internationally agreed uniform cytology terminology, be integrated in a national or regional screening registry, and be linked to other registries (histology, cancer, vaccination). Legal and ethical principles concerning personal integrity and data safety must be respected strictly. Biobank-based studies require approval of ethical review boards. A CCB is an almost inexhaustible resource for fundamental and applied biological research. In particular, it can contribute to answering questions on the natural history of HPV infection and HPV-induced lesions and cancers, screening effectiveness, exploration of new biomarkers, and surveillance of the short- and long-term effects of the introduction of HPV vaccination. To understand the limitations of CCB, more studies are needed on the quality of samples in relation to sample type, storage procedures, and duration of storage. PMID:20872354
Arbyn, Marc; Van Veen, Evert-Ben; Andersson, Kristin; Bogers, Johannes; Boulet, Gaëlle; Bergeron, Christine; von Knebel-Doeberitz, Magnus; Dillner, Joakim
This study had three aims: to determine the prevalence of the risk-factors for contracting HPV (the Human Papillomavirus) and developing cervical cancer among young women; to establish if there are any links between the presence of these risk-factors, attendance for cervical screening and abnormal cervical screening results; and to ascertain the key barriers to the prevention of cervical cancer. The
We evaluate the use of oxygen isotope values of biogenic apatite for tracking freshwater to marine migration in modern and fossil Pacific sockeye salmon. Oxygen isotope analyses of otoliths, vertebrae, and teeth of three anadromous modern sockeye salmon from Alaska establish a basis for the interpretation of fossil vertebrae and tooth apatite from Pleistocene sockeye salmon of the Skokomish River Valley, Washington. High resolution ?18O profiles in salmon otoliths provide, at a monthly resolution, a detailed record of individual history including continental rearing, migration to sea, seasonal variation in sea surface temperatures during marine life, and spawning migration before capture. Pacific salmon teeth are constantly renewed with the last set of teeth forming under the influence of freshwater. Therefore, they do not allow inference concerning sea-run versus landlocked life history in fossil salmon. Salmon vertebrae are also ambiguous indicators of life history regarding fresh versus marine water because centra are minimally ossified in the freshwater stages of life and the outermost layer of vertebral bone might be resorbed to provide nutrients during the non-feeding phase of the spawning migration. Therefore, ?18O values of accretionary growth rings in sea-run salmon vertebrae are dominated by the marine signal only if they are not diagenetically altered in freshwater deposits. In Pleistocene sockeye reported here, neither the teeth nor vertebral apatite present clear marine ?18O values due to the combined effects of tooth replacement and diagenetic alteration of bone and dentine. ?18O(PO 4) values of fossil vertebrae are intermediate between ?18O(PO 4) values of enamel and basal tooth dentin. Assuming a similar rate of isotope exchange of vertebrae and dentine with freshwater during diagenesis, these results are interpreted to reflect formation of the teeth under the influence of freshwater, and formation of the vertebrae under the influence of oceanic water. Our approach demonstrates that when appropriate knowledge of tissue formation is available, isotopic differences between altered and unaltered tissue holds promise of distinguishing between marine and freshwater origin of the tissues.
Zazzo, A.; Smith, G. R.; Patterson, W. P.; Dufour, E.
Positron Emission Tomography Using Fluoromisonidazole F 18 and Fludeoxyglucose F 18 to Find Oxygen in Tumor Cells of Patients Undergoing Treatment for Newly Diagnosed Stage IB, Stage II, Stage III, or Stage IV Cervical Cancer
Cervical Adenocarcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer
SUMMARY Background Dysphagia, is a significant sign of many different lesions in upper digestive system especially in proximal esophagus. Tumors, gastroesophageal reflux, achalasia and extrinsic compressions are the most common causes that may lead to dysphagia in geriatric population. Cervical osteophyte induced dysphagia, is one of the uncommon reasons of dysphagia, therefore other causes of dysphagia must be excluded to establish the exact diagnosis. Eagle syndrome is one of the considerable reason which may lead to misdiagnosis in patients with cervical osteophytes. In this case report, we represent four patients who had dysphagia due to anteriorly located cervical osteophytes and evaluate the patients with special reference to Eagle syndrome. Material and methods After a detailed anamnesis and ENT examination, cervical plain radiographs in four projections and Towne radiographs were obtained for every patient. After that, magnetic resonance imaging (MRI) of cervical spine and barium swallowing studies were performed to evaluate the presence of esophageal compression. Results Eagle syndrome was excluded due to absence of other symptoms and physical signs, eventhough unilateral or bilateral elongation of styloid processes was found in all of the patients. Conclusion Cervical osteophytes induced dysphagia is a rare clinical entity, diagnosis should be done by a careful examination, intensive radiologic evaluation. Moreover, all the other causes like Eagle syndrome should be excluded during the diagnosis of cervical osteophyte induced dysphagia.
Unlu, Zeliha; Orguc, Sebnem; Eskiizmir, Gorkem; Aslan, Asim; Bayindir, Petek
Persistent infection with high-risk types of human papillomavirus(HPV) is known to cause cervical cancer; however, additional genetic and epigenetic alterations are required for progression from precancerous disease to invasive cancer. DNA methylation is an early and frequent molecular alteration in cervical carcinogenesis. In this review, we summarize DNA methylation within the HPV genome and human genome and identify its clinical implications. Methylation of the HPV long control region (LCR) and L1 gene is common during cervical carcinogenesis and increases with the severity of the cervical neoplasm. The L1 gene of HPV16 and HPV18 is consistently hypermethylated in invasive cervical cancers and can potentially be used as a clinical marker of cancer progression. Moreover, promoters of tumor suppressor genes (TSGs) involved in many cellular pathways are methylated in cervical precursors and invasive cancers. Some are associated with squamous cell carcinomas, and others are associated with adenocarcinomas. Identification of methylated TSGs in Pap smear could be an adjuvant test in cervical cancer screening for triage of women with high-risk HPV, atypical squamous cells of undetermined significance, or low grade squamous intraepithelial lesion (LSIL). However, consistent panels must be validated for this approach to be translated to the clinic. Furthermore, reversion of methylated TSGs using demethylating drugs may be an alternative anticancer treatment, but demethylating drugs without toxic carcinogenic and mutagenic properties must be identified and validated. PMID:22943599
Abstract The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation.
Haneline, Michael T.; Rosner, Anthony L.
Congenital cervical kyphosis is a rare clinical condition. The purpose of this study was to review the surgical management and outcomes of 12 consecutive cases of congenital cervical kyphosis management by the same surgical team. The authors retrospectively analyzed the records of 12 patients (5 men and 7 women) with an average age of 18.4 years (range, 15-31 years) who underwent surgery for congenital cervical kyphosis at the authors' institution between 2001 and 2005. All patients had congenital cervical kyphosis; those with secondary kyphosis deformity due to causes such as infection, tumors, and surgery were excluded. The indications for surgery were signs of spinal cord compression with progression of clinical symptoms such as decreased muscle strength and paresthesia. All patients had radiographic evidence of cervical kyphosis. Six patients underwent anterior decompression, autogenous bone grafting, and instrumentation, and the other 6 patients underwent combined anterior-posterior surgery. All surgeries were performed successfully with no complications. Bone graft fusion occurred in 11 patients. In 1 patient who underwent anterior surgery, the bone graft was partly absorbed, and pseudarthrosis was noted at 3 years postoperatively. Mean Japan Orthopaedic Association cervical myelopathy score and mean Cobb angle were significantly improved at 1 week and 1 year postoperatively compared with preoperative values. Anterior and combined anterior-posterior surgical approaches are useful for the correction of congenital cervical kyphosis. Bone graft fusion is also critical for maintaining the surgical correction. Choice of surgical methods depends on the patient's clinical condition. PMID:22955408
He, Zhimin; Liu, Yang; Xue, Feng; Xiao, Haijun; Yuan, Wen; Chen, Deyu
Cervical cancer is the 11th leading cause of death from cancer for females in Japan. In 2005, there were 2486 deaths from cervical cancer, accounting for 1.8% of the total number of cancer deaths in Japan. Cervical cancer screening using conventional cytology has been conducted worldwide. The guideline for cervical cancer screening was developed based on the established method. The efficacies of conventional and liquid-based cytology, human papillomavirus testing alone and two combination methods were evaluated. On the basis of the balance of the benefits and harms, recommendations for population-based and opportunistic screening were formulated. Five methods of cervical cancer screening were evaluated. On the basis of the analytic framework involving key questions, 3450 articles published from January 1985 to October 2007 were selected using MEDLINE and other methods. After the systematic literature review, 66 articles were confirmed. The results of 33 studies were consistent, and the evidence was sufficient to evaluate the effect of conventional cytology screening. The accuracy of liquid-based cytology was almost equal to that of conventional cytology. Although human papillomavirus testing and combination methods showed high sensitivity, no study has evaluated the reduction in mortality from cervical cancer. Except for the possibility of overdiagnosis, no serious adverse effects of cervical cancer screening were found. Cervical cancer screening using conventional and liquid-based cytology is recommended for population-based and opportunistic screening due to sufficient evidence. Cervical cancer screening using either human papillomavirus testing alone or two combination methods is not recommended for population-based screening due to insufficient evidence. PMID:20436034
Hamashima, Chisato; Aoki, Daisuke; Miyagi, Etsuko; Saito, Eiko; Nakayama, Tomio; Sagawa, Motoyasu; Saito, Hiroshi; Sobue, Tomotaka
The "prong deflector" tool improves accuracy and ease of access to the cervical disk spaces for use in cervical diskography. The tool allows control, deflection, and stabilization of vital neck structures (carotid artery, thyroid cartilages and pharynx) while allowing fluoroscopic visualization during needle insertion without direct operator radiation exposure. Use of the prong deflector resulted in marked reduction of fluoroscopy per cervical level studied because of more rapid access to disk space. PMID:15891152
Bartynski, Walter S; Grahovac, Stephen Z; Rothfus, William E
Summary ?Diseases and conditions which cause instability of the cranio-cervical junction and the adjacent upper cervical spine are\\u000a relatively common and potentially life-threatening. Direct internal occipito-cervical fusion (OCF) is a modern means of surgical\\u000a treatment in such cases, and has some advantages over simple immobilization of the affected segments. The present study was\\u000a designed to evaluate surgical handling, results, and complications
V. Heidecke; N. G. Rainov; W. Burkert
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
Corpectomy is widely used to treat cervical spondylotic myelopathy (CSM). However, when this technique alone is performed at 1 or 2 levels for a multisegmental involvement (3 or more vertebrae), the incidence of post-operative complications is high. The optimal treatment for multisegmental CSM is still debatable. The aim of this study was to assess clinical and radiological outcomes for patients with multisegmental CSM who underwent combined anterior and posterior (AP) surgical approaches. Forty adults (17 women and 23 men; age range, 41-76 y) treated at our center between 2004 and 2007 were reviewed retrospectively. Their neurological function was assessed at different times using the Nurick classification (Grades 0 [root symptoms only] to 5 [wheelchair- or bed-bound]). Patients' satisfaction with the surgery was evaluated using Odom's criteria (poor, fair, good, or excellent). Pre-operatively, 20% of patients were assessed as Nurick Grade 0, 60% as Grade 1, and 20% as Grade 2. At the 1-year follow-up, only 10% of patients were assessed as Grade 1. At 1 year after surgery, 85% of patients rated their satisfaction with the operation as "excellent" and 15% rated it as "good". These outcomes suggest that, when surgery is indicated and patients with multisegmental CSM are carefully selected, the combined AP approach yields symptom relief comparable to that of corpectomy alone and a lower incidence of post-operative complications. PMID:19153044
Konya, Deniz; Ozgen, Serdar; Gercek, Arzu; Pamir, M Necmettin
OBJECTIVE. The purpose of this study was to determine whether each grade in a new system suggested by Park et al. (Park system) to assess cervical neural foraminal stenosis validly correlates with the associated clinical findings and to evaluate the interobserver agreement in grading between two MRI readers. MATERIALS AND METHODS. We evaluated 166 patients (98 men and 68 women; mean age, 46 years) at our institution who underwent oblique sagittal MRI of the cervical spine. Using the new Park grading system, two radiologists evaluated the MRI findings for the presence and grade of cervical neural foraminal stenosis at the most narrow point. A neurosurgeon assessed the associated clinical manifestations. A positive neurologic manifestation of the cervical neural foraminal stenosis was defined as more than one positive neurologic clinical manifestation combined with more than one positive neurologic sign. Interobserver agreements between the two radiologists were analyzed using kappa statistics. Correlation coefficients (R) to assess the relationship between the grade and neurologic manifestations were calculated with nonparametric correlation analysis (Spearman correlation). The relationship between the assigned grade and the clinical manifestations was analyzed several ways: vertebrae level (C4-5, C5-6, or C6-7) and by age group (< 46 years and ? 46 years). RESULTS. Among patients who were evaluated by each reader to be grade 0, only 19 (17%) and 20 patients (18%) showed positive neurologic manifestations, respectively, with most patients showing negative neurologic manifestations. Among the patients who were grade 2 and 3, one reader found all patients and the second reader found all but one patient (100% and 93%, respectively) to have positive neurologic manifestations. According to the correlation coefficients, each Park grade was moderately correlated with the associated neurologic manifestations, such that higher grades were associated with more severe clinical manifestations. If we consider grade 2 or 3 MRI findings positive for identifying positive neurologic manifestations, the sensitivities and specificities were 39.7% and 99.0% (reader 1) and 39.7% and 99.0% (reader 2), respectively. CONCLUSION. The Park system, based on oblique sagittal MRI sections, provides a reliable and reproducible assessment of the severity of cervical neural foraminal stenosis. According to the Park system, grades 2 and 3 are associated with positive neurologic manifestations, and the Park system successfully predicts positive neurologic manifestations at these grades. PMID:25055278
Park, Hee Jin; Kim, Sam Soo; Han, Chul Hee; Lee, So Yeon; Chung, Eun Chul; Kim, Mi Sung; Kwon, Heon Ju
This project explores the combination of computerized automated primary screening of cervical cytology specimens in remote sites with interpretation of device-selected images transmitted via the Internet. The project is in 3 phases: 1) hardware/software a...
B. A. Crothers D. C. Wilbur J. A. Gelfand J. H. Eichhorn M. S. Ro
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The clinical and laboratory findings in six patients with congenital narrowing of the cervical spinal canal and neurological symptoms are described. A variable age of onset and an entirely male occurrence were found. Signs and symptoms of spinal cord dysfunction predominated in all but one patient. Symptoms were produced in five patients by increased physical activity alone. Congenital narrowing of the cervical spinal canal may result in cord compression without a history of injury and occasionally without evidence of significant bony degenerative changes. The clinical features may be distinguishable from those found in cervical spondylosis without congenital narrowing. Intermittent claudication of the cervical spinal cord appears to be an important feature of this syndrome. Surgery improved four out of five people.
Kessler, J T
Posterior cervical node enlargement is characteristic of clinical toxoplasmosis in adults. Lymph node biopsies from 37 patients, who were tested for toxoplasmosis by serologic and isolation studies, were examined. A characteristic pattern of sinus histiocytosis was seen in 17 of 18 posterior cervical nodes and in only 1 of 4 lymph nodes from other sites from patients with toxoplasmosis. The characteristic pattern was not seen in posterior cervical nodes or in lymph nodes from other sites from patients with other diseases. Lymphoma obscured the characteristic changes of toxoplasmosis in the posterior cervical nodes and other nodes of 5 patients with these coexisting diseases. Organisms were seen in tissue sections in only 2 instances. T gondii was isolated from mice in 14 of 17 attempts using nodes from patients with toxoplasmosis, but from none of 8 attempts using nodes from patients with other diseases. ImagesFig 3Fig 4Fig 1Fig 2
Gray, George F.; Kimball, Anne C.; Kean, B. H.
ObjectiveCervical ectopic pregnancy is a rare complication that can have severe consequences if an early diagnosis is not made. This diagnosis should always be considered in vaginal bleeding in the first trimester of pregnancy.
A. Rubio; F. Jiménez; M. Herrero; S. Alcalá; C. Sabadell; I. Bruna; M. L. Cano
To minimize risk of spinal cord injury, airway management providers must understand the anatomic and functional relationship between the airway, cervical column, and spinal cord. Patients with known or suspected cervical spine injury may require emergent intubation for airway protection and ventilatory support or elective intubation for surgery with or without rigid neck stabilization (i.e., halo). To provide safe and efficient care in these patients, practitioners must identify high-risk patients, be comfortable with available methods of airway adjuncts, and know how airway maneuvers, neck stabilization, and positioning affect the cervical spine. This review discusses the risks and benefits of various airway management strategies as well as specific concerns that affect patients with known or suspected cervical spine injury.
Austin, Naola; Krishnamoorthy, Vijay; Dagal, Arman
An 8-month-old male infant had presented with a history of a fall from the crib a fortnight ago. He had developed progressive weakness of both lower limbs. On examination, the infant had spastic paraplegia. Magnetic resonance (MR) imaging of the cervical spine showed an epidural hematoma extending from the fourth cervical (C4) to the first dorsal (D1) vertebral level with cord compression. The patient had no bleeding disorder on investigation. He underwent cervical laminoplasty at C6 and C7 levels. The epidural hematoma was evacuated. The cervical cord started pulsating immediately. Postoperatively, the patient's paraplegia improved dramatically in 48 hours. According to the author's literature search, only seven cases of post-traumatic epidural hematoma have been reported in pediatric patients, and our patient is the youngest. The present case report discusses the etiopathology, presentation, and management of this rare case.
Rangarajan, Vithal; Mavani, Sandip B; Nadkarni, Trimurti D; Goel, Atul H
Estrogen and its receptors are implicated in the promotion and prevention of various cancers. While the uterine cervix is highly responsive to estrogen, the role of estrogen in cervical cancer, which is strongly associated with human papillomavirus (HPV) infections, is poorly understood. Recent studies in HPV transgenic mouse models provide evidence that estrogen and its nuclear receptor promote cervical cancer in combination with HPV oncogenes. While epidemiological studies further support this hypothesis, there is little experimental data assessing the hormonal responsiveness of human cervical cancers. If these cancers are dependent upon estrogen, then drugs targeting estrogen and its receptors may be effective in treating and/or preventing cervical cancer, the second leading cause of death by cancer amongst women worldwide.
Chung, Sang-Hyuk; Franceschi, Silvia; Lambert, Paul F.
Cervical cancer is the tenth most common cancer in women in developed countries that have national screening programs, while it is in the second line in underdeveloped countries. According to Ministry of Health registry data, cervical cancer is the eighth most common cancer among female cancers in Turkey. Today, the most effective screening for cervical cancer is to obtain smears from the cervix. Therefore, periodic screening programs are of great importance in identifying preinvasive lesions to prevent their progression to invasive cancer. Today, with the use of human papilloma virus (HPV) vaccine, screening programs have brought new insights into the prevention of cervical cancer. Management of preinvasive lesions has to be known by each obstetrics and gynecology specialist. Redundant procedures and treatments can be avoided by directing patients correctly at this step. Cancer phobia should not be created. Ablative or destructive treatments should not be done without histological diagnosis; hysterectomy, which has an equal risk of recurrence, should not be recommended.
Kose, Faruk M.; Naki, Murat M.
Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Chemotherapeutic Agent Toxicity; Cognitive/Functional Effects; Psychosocial Effects of Cancer and Its Treatment; Radiation Toxicity; Sexuality and Reproductive Issues; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer
American football is a high-energy contact sport that places players at risk for cervical spine injuries with potential neurological deficits. Advances in tackling and blocking techniques, rules of the game and medical care of the athlete have been made throughout the past few decades to minimize the risk of cervical injury and improve the management of injuries that do occur. Nonetheless, cervical spine injuries remain a serious concern in the game of American football. Injuries have a wide spectrum of severity. The relatively common 'stinger' is a neuropraxia of a cervical nerve root(s) or brachial plexus and represents a reversible peripheral nerve injury. Less common and more serious an injury, cervical cord neuropraxia is the clinical manifestation of neuropraxia of the cervical spinal cord due to hyperextension, hyperflexion or axial loading. Recent data on American football suggest that approximately 0.2 per 100,000 participants at the high school level and 2 per 100,000 participants at the collegiate level are diagnosed with cervical cord neuropraxia. Characterized by temporary pain, paraesthesias and/or motor weakness in more than one extremity, there is a rapid and complete resolution of symptoms and a normal physical examination within 10 minutes to 48 hours after the initial injury. Stenosis of the spinal canal, whether congenital or acquired, is thought to predispose the athlete to cervical cord neuropraxia. Although quite rare, catastrophic neurological injury is a devastating entity referring to permanent neurological injury or death. The mechanism is most often a forced hyperflexion injury, as occurs when 'spear tackling'. The mean incidence of catastrophic neurological injury over the past 30 years has been approximately 0.5 per 100,000 participants at high school level and 1.5 per 100,000 at the collegiate level. This incidence has decreased significantly when compared with the incidence in the early 1970s. This decrease in the incidence of catastrophic injury is felt to be the result of changes in the rules in the mid-1970s that prohibited the use of the head as the initial contact point when blocking and tackling. Evaluation of patients with suspected cervical spine injury includes a complete neurological examination while on the field or the sidelines. Immobilization on a hard board may also be necessary. The decision to obtain radiographs can be made on the basis of the history and physical examination. Treatment depends on severity of diagnosed injury and can range from an individualized cervical spine rehabilitation programme for a 'stinger' to cervical spine decompression and fusion for more serious bony or ligamentous injury. Still under constant debate is the decision to return to play for the athlete. PMID:19691361
Rihn, Jeffrey A; Anderson, David T; Lamb, Kathleen; Deluca, Peter F; Bata, Ahmed; Marchetto, Paul A; Neves, Nuno; Vaccaro, Alexander R
The introduction of concurrent chemotherapy and radiotherapy for the definitive treatment of cervical cancer constituted a\\u000a major advance in the management of cervical cancer, resulting in a significant improvement in local control, progression-free\\u000a survival, and overall survival. Since the publication of the results of seminal trials demonstrating the benefits of platinum-based\\u000a chemotherapy, investigations of new cytotoxic and targeting agents have
Ann H. Klopp; Patricia J. Eifel
1 Development of Development of Consensus Educational Materials Consensus Educational Materials on HPV & Cervical Cancer for Europe on HPV & Cervical Cancer for Europe Philip Davies Philip Davies European Cervical Cancer Association European Cervical
Significant relationships exist between areal bone mineral density (BMD) derived from dual energy X-ray absorptiometry (DXA) and bone strength. However, the predictive validity of BMD for osteoporotic vertebral fractures remains suboptimal. The diagnostic sensitivity of DXA in the lumbar spine may be improved by assessing BMD from lateral-projection scans, as these might better approximate the objective of measuring the trabecular-rich bone in the vertebral body, compared to the commonly-used posterior-anterior (PA) projections. Nowadays, X-ray micro-computed tomography (?CT) allows non-destructive three-dimensional structural characterization of entire bone segments at high resolution. In this study, human lumbar cadaver spines were examined ex situ by DXA in lateral and PA projections, as well as by ?CT, with the aims (1) to investigate the ability of bone quantity measurements obtained by DXA in the lateral projection and in the PA projection, to predict variations in bone quantity measurements obtained by ?CT, and (2) to assess their respective capabilities to predict whole vertebral body strength, determined experimentally. Human cadaver spines were scanned by DXA in PA projections and lateral projections. Bone mineral content (BMC) and BMD for L2 and L3 vertebrae were determined. The L2 and L3 vertebrae were then dissected and entirely scanned by ?CT. Total bone volume (BV(tot)=cortical+trabecular), trabecular bone volume (BV), and trabecular bone volume fraction (BV/TV) were calculated over the entire vertebrae. The vertebral bodies were then mechanically tested to failure in compression, to determine ultimate load. The variables BV(tot), BV, and BV/TV measured by ?CT were better predicted by BMC and BMD measured by lateral-projection DXA, with higher R(2) values and smaller standard errors of the estimate (R(2)=0.65-0.90, SEE=11%-18%), compared to PA-projection DXA (R(2)=0.33-0.53, SEE=22%-34%). The best predictors of ultimate load were BV(tot) and BV assessed by ?CT (R(2)=0.88 and R(2)=0.81, respectively), and BMC and BMD from lateral-projection DXA (R(2)=0.82 and R(2)=0.70, respectively). Conversely, BMC and BMD from PA-projection DXA were lower predictors of ultimate load (R(2)=0.49 and R(2)=0.37, respectively). This ex vivo study highlights greater capabilities of lateral-projection DXA to predict variations in vertebral body bone quantity as measured by ?CT, and to predict vertebral strength as assessed experimentally, compared to PA-projection DXA. This provides basis for further exploring the clinical application of lateral-projection DXA analysis. PMID:22430313
Perilli, Egon; Briggs, Andrew M; Kantor, Susan; Codrington, John; Wark, John D; Parkinson, Ian H; Fazzalari, Nicola L
Cervical Cancer is the second most common cancer among women worldwide and the leading cause of cancer mortality of women in developing countries. If detected early and treated adequately, cervical cancer can be virtually prevented. Cervical precursor lesions and invasive cancer exhibit certain morphologic features that can be identified during a visual inspection exam. Digital imaging technologies allow us to assist the physician with a Computer-Aided Diagnosis (CAD) system. In colposcopy, epithelium that turns white after application of acetic acid is called acetowhite epithelium. Acetowhite epithelium is one of the major diagnostic features observed in detecting cancer and pre-cancerous regions. Automatic extraction of acetowhite regions from cervical images has been a challenging task due to specular reflection, various illumination conditions, and most importantly, large intra-patient variation. This paper presents a multi-step acetowhite region detection system to analyze the acetowhite lesions in cervical images automatically. First, the system calibrates the color of the cervical images to be independent of screening devices. Second, the anatomy of the uterine cervix is analyzed in terms of cervix region, external os region, columnar region, and squamous region. Third, the squamous region is further analyzed and subregions based on three levels of acetowhite are identified. The extracted acetowhite regions are accompanied by color scores to indicate the different levels of acetowhite. The system has been evaluated by 40 human subjects' data and demonstrates high correlation with experts' annotations.
Li, Wenjing; Gu, Jia; Ferris, Daron; Poirson, Allen
INTRODUCTION: Cervical vertigo is a controversial entity. While it was overemphasised in the past, it is overlooked nowadays, and it seems to combine elements of myth and reality. The purpose of this article is to review the most important aspects of this entity from a historical, pathophysiological, clinical, and therapeutic point of view. We also identify the main alternative diagnoses that led to it being recognised erroneously, and classify and organise the literature in order to review earlier articles which first described the disease. DEVELOPMENT: Some entities previously defined as cervical vertigo have survived the test of time and may be found in the literature today. This is true of rotational vertebral artery syndrome, post-traumatic cervical vertigo, and cervicogenic proprioceptive vertigo. Others, such as cervical sympathetic syndrome (Barré-Lieou syndrome), have been discredited. We present a clinical variant known as subclinical vertebrobasilar insufficiency in a context of cervical osteoarticular changes. CONCLUSIONS: Cervical vertigo has been a controversial entity for many years. Completing a clinical-pathophysiological assessment to explain the symptoms in a particular case proves to be the most reasonable bedside strategy, regardless of the name assigned to the disease in the end. At present, no complementary studies have demonstrated that the variant known as cervicogenic proprioceptive vertigo is an independent entity, and measuring its true impact is difficult. Once potentially severe causes of the symptoms have been ruled out, the most appropriate strategy seems to be use of manipulative and vestibular physical therapy. PMID:22981375
Yacovino, D A
Cancer of the cervix is the second most common life-threatening cancer among women worldwide, with incidence rates ranging from 4.8 per 100,000 women per year in the Middle East to 44.3 per 100,000 in East Africa. Epidemiologic and clinical data demonstrate that human papillomaviruses (HPV), especially HPV-16 and HPV-18, play at least a major if not a necessary role in the etiology of cervical cancer. However, many investigators acknowledge that HPV is not sufficient to induce cervical cancer and that a multifactorial etiology is likely. HPV can be found in a growing proportion of patients with cervical cancer, approaching 100%, but is not yet found in every patient with disease. Other factors, such as herpes simplex virus type 2 infections, cigarette smoking, vaginal douching, nutrition, and use of oral contraceptives, have been proposed as contributing factors. In the first half of the 20th century, Peyton Rous and colleagues demonstrated the joint action of tars and Shope papillomavirus to consistently induce squamous cell carcinomas in rabbits. Using the Rous model as a prototype, one might hypothesize that some cases of cervical cancer arise from an interaction between oncogenic viruses and cervical tar exposures. Cervical tar exposures include cigarette smoking, use of tar-based vaginal douches, and long years of inhaling smoke from wood- and coal-burning stoves in poorly ventilated kitchens.
Haverkos, Harry W.
For many years it has been thought that a significant proportion of cervical cancer could be attributed to sexually transmitted agents, such as sperm, smegma, Treponema pallidum, Gonococcus and herpes simplexvirus type 2. Recent advances of molecular biology, however, have revealed that human papillomavirus (HPV) might be the most causative virus of the disease. Since HPV type 16 DNA was found in a patient with cervical cancer in 1983, many HPV types have been cloned from cervical cancers, also from premalignant lesions (intraepithelial neoplasias). In Japan, we have found 6 new types of HPV (HPV 58, 59, 61, 62, 64, 67) in the female genital tract so far. Especially, HPV 58, which was cloned from a patient with cervical squamous cell carcinoma and was already fully sequenced, is thought to be an important agent for the development of cervical cancer as well as HPV 16. Now we are investigating extensively to clarify the real relationship between genital HPV infection and cervical cancer. PMID:1327090
Background We estimated the number of women undergoing cervical cancer screening annually in Italy, the rates of cervical abnormalities detected, and the costs of screening and management of abnormalities. Methods The annual number of screened women was estimated from National Health Interview data. Data from the Italian Group for Cervical Cancer Screening were used to estimate the number of positive, negative and unsatisfactory Pap smears. The incidence of CIN (cervical intra-epithelial neoplasia) was estimated from the Emilia Romagna Cancer Registry. Patterns of follow-up and treatment costs were estimated using a typical disease management approach based on national guidelines and data from the Italian Group for Cervical Cancer Screening. Treatment unit costs were obtained from Italian National Health Service and Hospital Information System of the Lazio Region. Results An estimated 6.4 million women aged 25–69 years undergo screening annually in Italy (1.2 million and 5.2 million through organized and opportunistic screening programs, respectively). Approximately 2.4% of tests have positive findings. There are approximately 21,000 cases of CIN1 and 7,000–17,000 cases of CIN2/3. Estimated costs to the healthcare service amount to €158.5 million for screening and €22.9 million for the management of cervical abnormalities. Conclusion Although some cervical abnormalities might have been underestimated, the total annual cost of cervical cancer prevention in Italy is approximately €181.5 million, of which 87% is attributable to screening.
Rossi, Paolo Giorgi; Ricciardi, Alessandro; Cohet, Catherine; Palazzo, Fabio; Furnari, Giacomo; Valle, Sabrina; Largeron, Nathalie; Federici, Antonio
Study Design: A case series of consecutive patients with cervical radiculopathy. Background: A multitude of physical therapy interventions have been proposed to be effective in the management of cervical radiculopathy. However, outcome studies using consistent treatment approaches on a well-defined sample of patients are lacking. The purpose of this case series is to describe the outcomes of a consecutive series
Joshua A. Cleland; Julie M. Whitman; Julie M. Fritz; Jessica A. Palmer
Study Design. A retrospective review of all patients surgically treated with a two-level anterior cervical disc- ectomy and fusion with and without anterior plate fixa- tion by a single surgeon. Objectives. To compare the clinical and radiographic success of two-level discectomy and the effect of anterior cervical plate fixation. Summary of Background Data. Prior studies of multi- segment fusions have
Jeffrey C. Wang; Paul W. McDonough; Kevin K. Endow; Rick B. Delamarter
Worldwide, cervical cancer is the third most common cancer in women, and the first or second most common in developing countries. Cervical cancer remains in Colombia the first cause of cancer mortality and the second cause of cancer incidence among women, despite the existence of screening programs during the last 3 decades. Bucaramanga, Manizales and Cali reported rates around 20 per 100,000and Pasto 27 per 100,000. The Cali cancer registry has reported a progressive decrease in the age standardized incidence and mortality rates of cervical cancer over the past 40 years. Reasons for the decline in incidence and mortality of cervical cancer are multiple and probably include: improvement in socio-economic conditions, decrease in parity rates and some effect of screening programs. Human papilloma Virus is the main cause of cervical cancer, HPV natural history studies have now revealed that HPVs are the commonest of the sexually transmitted infections in most populations. Most HPV exposures result in spontaneous clearance without clinical manifestations and only a small fraction of the infected persons, known as chronic or persistent carriers, will retain the virus and progress to precancerous and cancer. HPV 16 and 18 account for 70% of cervical cancer and the 8 most common types. (HPV 16, 18, 45, 33, 31, 52, 58 and 35) account for about 90% of cervical cancer. Case-control studies also allowed the identification of the following cofactors that acting together with HPV increase the risk of progression from HPV persistent infection to cervical cancer: tobacco, high parity, long term use of oral contraceptives and past infections with herpes simplex type 2 and Chlamydia trachomatis. The demonstration that infection with certain types of human papillomavirus (HPV) is not only the main cause but also a necessary cause of cervical cancer has led to great advances in the prevention of this disease on two fronts: (i) Primary prevention by the use of prophylactic HPV vaccines; and (ii) secondary prevention by increasing the accuracy of cervical cancer screening.
Current cervical cancer screening programs are changing due to the development of tests that detect the presence of human papillomavirus (HPV), the cause of cervical cancer. These tests are more sensitive than cytology-based methods for detecting cervical precancer and a negative test offers long-term assurance that cervical cancer will not develop and therefore longer screening intervals can be achieved. In screening programs, HPV-based tests have been approved to triage women with equivocal cytology results and as a primary testing method in conjunction with cytology. HPV-based tests also have a role in determining risk of recurrence after treatment for cervical precancer as well as in surveillance for vaccine-related changes in HPV genotype prevalence.
Luhn, Patricia; Wentzensen, Nicolas
The direct and secondary changes following diode laser irradiation of intervertebral discs were studied in rabbits. A quartz fiber was inserted into the discs, and laser irradiation was applied. Subsequently, the lumbar vertebrae were extracted en bloc, and subjected to sagittal magnetic resonance (MR) imaging and histologic examination immediately after irradiation, and 3, 12, and 24 weeks after irradiation. MR images showed low signal intensity of the intervertebral discs on T2-weighted images 3 weeks after irradiation, which remained unchanged to 24 weeks. Although the signal intensity of the adjacent vertebral bodies remained unchanged on T1-weighted images, the intensity was high on T2-weighted images 3 weeks after irradiation, but had reverted to normal or was low 12 to 24 weeks after irradiation. On histologic examination, the inner layer of the annulus fibrosus was seen to protrude into the void created by vaporization of the nucleus pulposus 3 weeks after irradiation. Multinuclear chondrocytes were observed, as if the disc was being reconstructed. Fibrous tissue in the epiphysis and metaphysis was observed soon after irradiation but decreased over time and was replaced by normal bone marrow.
Naga, Kumi; Nakai, Sadaaki; Maehara, Kazuyuki; Nishimoto, Seiji
Human papillomavirus (HPV) infection is the commonest sexually transmitted infection, which is associated with various clinical conditions, ranging from asymptomatic infection to malignant disease of the cervix. The aim of this study was to evaluate the prevalence and genotypic distribution of HPV in women with cervical erosion and to compare the results with those in women with a clinically normal cervix. A further aim was to establish the association between HPV infection and cervical cytology results in women with and without cervical erosion. Cervical samples were collected by liquid-based method and consecutively evaluated for the presence of HPV DNA and for cervical cytology. HPV DNA was tested by a nested polymerase chain reaction (PCR) and typed by reverse dot blot genotyping. Cytological classification was made according to Bethesda 2001 criteria. The overall HPV prevalence was 16.9%; HPV DNA was positive in 20.2% of women with cervical erosion and 12.8% in women with normal cervix (P < 0.05). Multiple infections were found in 34.1% of the HPV-positive women. Commonest types were HPV 18 (32.9%), HPV 16 (29.5%), HPV 54 (20.5%), and HPV 6 (17%). Cervical cytology results were abnormal for 5.2% of women with cervical erosion and for 1.3% with clinically normal cervix (P < 0.05). This study detected a high prevalence of HPV infection in women with cervical erosion compared to women with a normal cervix. This data may contribute to the HPV epidemiology in the southeastern Turkey. It is recommended that women with cervical erosion should be given priority in HPV screening programs. PMID:21915876
Bayram, Aysen; Erk?l?ç, Suna; Balat, Özcan; Ek?i, Fahriye; U?ur, Mete Gürol; Öztürk, Ebru; Kaya, Gülsüm
Noninvasive radiologic methods to detect paraaortic lymph node metastases are reliable when combined with FNA of enlarged lymph nodes. However, the sensitivity is low, and undetected microscopic metastases leads to treatment failure. These patients with paraaortic lymph node metastasis are not treated with extended-field radiation, and they all die within 3 years. The CT scanning is probably the best diagnostic method to evaluate cervical cancer, because it can assess the primary tumor, the urinary tract, gastrointestinal tract, liver parenchyma, and retroperitoneum. It also permits the guidance of FNA and the arrangement of radiation ports. Surgical staging provides the direct assessment of the peritoneal cavity and the retroperitoneal spaces. Metastatic tumor, including enlarged lymph nodes, can be resected, but this is of dubious benefit. The operative morbidity is acceptable, with fewer intestinal complications when the extraperitoneal approach is used, and long-term morbidity is minimal when appropriate paraaortic radiation doses are employed (less than 5,000 cGy). Surgical staging has provided data on the frequency of paraaortic lymph node metastasis by stage of cervical cancer, and thus, treatment strategies can be better developed. Extended-field radiation results in 5-year survival rates of 20-25% in patients with microscopic paraaortic lymph node metastasis, patients who would not survive without the treatment. However, surgical staging has produced only a modest boost in survival rates, because of the high rate of pelvic and systemic failure. When extended-field radiation is used prophylactically or in patients with probable lymph node metastasis seen on radiographic studies, survival rates are similar to patients irradiated after surgical staging finds paraaortic lymph node disease. As our ability to predict, and detect nonsurgically, positive paraaortic node disease improves, extended radiation (or other adjuvant therapy) could be used more frequently without operation in patients who are at high risk for metastatic disease. In a study by Haie et al, prophylactic paraaortic radiation was given to patients at high risk for paraaortic metastasis. In patients with a high probability of local disease control, paraaortic radiation significantly reduced the incidence of paraaortic and distant metastases. Patients with known paraaortic lymph node metastases frequently have occult systemic metastases. In these same patients, pelvic failure is also common. Thus, until effective systemic therapies emerge, a marked improvement in survival is unlikely in patients who have paraaortic lymph node metastasis.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2289352
Heaps, J M; Berek, J S
Because of the theoretic benefits of autologous vein we undertook an investigation to evaluate cervical veins (facial, external jugular) as patch material after carotid endarterectomy. A device that stimulated both circumferential fixation by sutures and radial tension exerted on in vivo patches was constructed to measure burst strength of tissue. Mean bursting pressure for groin saphenous vein (n = 10) was 94.5 +/- 15.1 pounds per square inch (psi), 75.5 +/- 8.9 psi for ankle saphenous vein (n = 10), 83.3 +/- 14.5 psi for everted (double layer) cervical vein (n = 5) and 10 +/- 3.3 psi for single layer cervical vein (n = 5). No significant differences between saphenous vein at any level and everted (double layer) cervical vein, but all were significantly different from single layer cervical vein (p less than 0.05). From June 1987 through November 1989, 19 patients underwent 21 carotid endarterectomies complemented with adjunctive everted cervical vein patch angioplasty. Indications for surgery were asymptomatic stenosis (53%), transient ischemic attack (29%), and cerebrovascular accident with recovery (18%). All patients were studied after surgery with duplex scanning. Asymptomatic recurrent stenosis was observed in one patient. Transient hypoglossal nerve dysfunction occurred in one other patient. One postoperative death occurred as a result of massive aspiration. These results indicate that everted cervical vein is comparable to the saphenous vein in resistance to bursting and can yield similar results as patch material after carotid endarterectomy. Accordingly, saphenous vein can be spared and lower extremity incisions avoided.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2231962
Yu, A; Dardik, H; Wolodiger, F; Raccuia, J; Kapadia, I; Sussman, B; Kahn, M; Pecoraro, J P; Ibrahim, I M
Unstable pelvic ring fractures cause high rates of morbidity and mortality. Percutaneous iliosacral screws provide a safe pelvic fixation obviating large surgical exposures. The presence of transitional vertebrae may present difficulties in numbering and fluoroscopic identification of lumbar discs and vertebrae. We performed percutaneous iliolumbar screw fixation for an unstable pelvic fracture due to a traffic accident in a 20-year-old male patient with transitional lumbar vertebrae. No neurologic or vascular complications were seen and the patient returned to his preinjury work and was pain-free in the second postoperative year. In order to determine the anatomic relationship of the iliolumbar screw with the major neurovascular structures, a cadaveric study was performed on the corpse of an adult man. Following dissection, it was observed that the iliolumbar screw inserted from the lateral wall of the iliac wing passed through the iliopsoas muscle and advanced to the L(5) vertebral corpus posterior to the fourth and fifth lumbar roots and with a reasonably distant course from the common iliac veins and arteries. PMID:19881327
Ayvaz, Mehmet; Yilmaz, Güney; Akpinar, Erhan; Acaro?lu, Rifat Emre
... factors for cervical cancer? What are the key statistics about cervical cancer? The American Cancer Society's estimates ... Symptoms of Cancer Treatments & Side Effects Cancer Facts & Statistics News About Cancer Expert Voices Blog Programs & Services ...
...Identification. An expandable cervical dilator is an instrument with two handles and two opposing blades used manually to dilate (stretch open) the cervical os. (b) Classification. Class III (premarket approval). (c) Date PMA or...
•Toe metastasis is a rare pattern of cervical cancer spread.•Enlarged erythematous toe is an important sign suggesting bone metastasis.•Toe metastasis represents a grave prognostic indicator of cervical cancer. PMID:24567886
Ciccone, Marcia A; Conturie, Charlotte L; Lee, Cassie M; Matsuo, Koji
A study to comprehensively assess biomarkers of risk for progressive cervical neoplasia, and thus develop a new set of biomarkers that can distinguish those at highest risk of cervical cancer from those with benign infection
Explains HPV Infection; cervical cancer screening tests including Pap test, HPV test, and Pap/HPV cotesting; new cervical cancer screening guidelines; possible Pap test results and Pap/HPV cotest results; follow-up testing; treatment; and HPV vaccination.
... Related MedlinePlus Pages African American Health Cervical Cancer Seniors' Health MONDAY, May 12, 2014 (HealthDay News) -- A new ... Health News on: African American Health Cervical Cancer Seniors' Health Recent Health News Page last updated on 13 ...
Background The female lower genital tract is a gateway for pathogens entering the host through the mucous membrane. One of the prevalent human viruses is Torque teno virus (TTV). The major reported routes of TTV transmission are fecal-oral and parenteral. Furthermore, other modes of transmission, e.g. sexual contact, are suggested. To investigate the sexual route of TTV transmission, cervical smears of healthy women and those with cervical lesions were screened for the presence of TTV DNA. Methods TTV DNA was studied in cervical smears of 95 patients with cervical lesions and 55 healthy women. Paired serum samples were available from 55 and 42 women, respectively. All healthy women had normal cytology while 44 patients had histologically confirmed low-grade lesion (LGL) and 51 high-grade lesion (HGL). TTV DNA was detected with primers specific for the non-coding region. In 40 paired cervical smears and serum samples, the phylogenetic group of TTV isolates was determined. The presence of HPV DNA in cervical smears was detected by means of PCR with MY09/11 primers. Results The prevalence of TTV DNA in cervical smears of healthy women was 52.7% and was comparable with that in paired serum samples (50%). Symptomatic women had significantly higher prevalence of TTV DNA in cervical smears (74.7%) than healthy controls. The TTV DNA prevalence in patient serum samples was 51%. The phylogenetic groups of TTV serum isolates were concordant with those of TTV from cervical smears of the same subjects. In cervical smears, a wider variety of TTV isolates was found. The viral loads in cervical smears were 10 to 1000 times as high as in sera. The HPV-positive study subjects had significantly higher TTV DNA prevalence than HPV negatives. The prevalence of TTV was not associated with disease severity. Conclusion High prevalence of TTV in cervical smears suggests that sexual transmission is another mode of expansion of TTV infection among the population. The higher viral load in cervical smears than in the respective serum samples might indicate active TTV replication in the female genital tract. Nevertheless, cooperation between TTV and HPV needs to be further investigated.
Objective. We aim to investigate methods and use of cervical ripening in women without and with a prior cesarean delivery in The Netherlands. Methods. In 2010, we conducted a postal survey in all Dutch hospitals with a labor ward. One gynecologist per hospital was addressed and was asked to respond on behalf of the staff. The questionnaire contained 31 questions concerning cervical ripening and induction of labor. We compared this survey to a similar Dutch survey conducted in 2006. Results. Response rate was 78% (70/92 hospitals). In women without a prior cesarean and in need of cervical ripening, all hospitals (100%) applied prostaglandins (either E1 or E2). In women with a prior cesarean, 21.4% of the hospitals performed an elective cesarean section if delivery was indicated (26.0% in 2006). In case of cervical ripening, 72.7% used mechanical methods (49.1% in 2006), 20.0% used prostaglandins (40.4% in 2006), 3.6% used a combination of prostaglandins and mechanical methods, and 3.6% used membrane-sweeping or oxytocin. Conclusions. In 2010, in The Netherlands, prostaglandins and Foley catheters were the preferred methods for cervical ripening in women without and with a prior cesarean, respectively. Use of mechanical methods in women with a prior cesarean has increased rapidly between 2006 and 2010, corresponding with decreasing use of prostaglandins and elective repeat cesarean sections.
Huisman, Claartje M. A.; Jozwiak, Marta; de Leeuw, Jan Willem; Mol, Ben Willem; Bloemenkamp, Kitty W. M.
Reconstruction of the highly unstable, anteriorly decompressed cervical spine poses biomechanical challenges to current stabilization strategies, including circumferential instrumented fusion, to prevent failure. To avoid secondary posterior surgery, particularly in the elderly population, while increasing primary construct rigidity of anterior-only reconstructions, the authors introduced the concept of anterior transpedicular screw (ATPS) fixation and plating. We demonstrated its morphological feasibility, its superior biomechanical pull-out characteristics compared with vertebral body screws and the accuracy of inserting ATPS using a manual fluoroscopically assisted technique. Although accuracy was high, showing non-critical breaches in the axial and sagittal plane in 78 and 96%, further research was indicated refining technique and increasing accuracy. In light of first clinical case series, the authors analyzed the impact of using an electronic conductivity device (ECD, PediGuard) on the accuracy of ATPS insertion. As there exist only experiences in thoracolumbar surgery the versatility of the ECD was also assessed for posterior cervical pedicle screw fixation (pCPS). 30 ATPS and 30 pCPS were inserted alternately into the C3–T1 vertebra of five fresh-frozen specimen. Fluoroscopic assistance was only used for the entry point selection, pedicle tract preparation was done using the ECD. Preoperative CT scans were assessed for sclerosis at the pedicle entrance or core, and vertebrae with dense pedicles were excluded. Pre- and postoperative reconstructed CT scans were analyzed for pedicle screw positions according to a previously established grading system. Statistical analysis revealed an astonishingly high accuracy for the ATPS group with no critical screw position (0%) in axial or sagittal plane. In the pCPS group, 88.9% of screws inserted showed non-critical screw position, while 11.1% showed critical pedicle perforations. The usage of an ECD for posterior and anterior pedicle screw tract preparation with the exclusion of dense cortical pedicles was shown to be a successful and clinically sound concept with high-accuracy rates for ATPS and pCPS. In concert with fluoroscopic guidance and pedicle axis views, application of an ECD and exclusion of dense cortical pedicles might increase comfort and safety with the clinical use of pCPS. In addition, we presented a reasonable laboratory setting for the clinical introduction of an ATPS-plate system.
Hitzl, Wolfgang; Acosta, Frank; Tauber, Mark; Zenner, Juliane; Resch, Herbert; Yukawa, Yasutsugu; Meier, Oliver; Schmidt, Rene; Mayer, Michael
Cervical Adenocarcinoma; Cervical Adenosquamous Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Vaginal Cancer; Stage IIIA Cervical Cancer; Stage IIIB Cervical Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Vaginal Adenocarcinoma; Vaginal Squamous Cell Carcinoma
...884.4270 Vibratory cervical dilators. (a) Identification. A vibratory cervical dilator is a device designed to dilate the cervical os by stretching it with a power-driven vibrating probe head. The device is used to gain access to the...