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Sample records for cervical spine pain

  1. Cervical spine pain in the competitive athlete.

    PubMed

    Krabak, Brian J; Kanarek, Samantha L

    2011-08-01

    Cervical pain is a common complaint in both the well-conditioned athlete and the weekend warrior. Some injuries are mild in nature, responding to conservative treatment, including rest, medication, physical therapy, and time. However, more serious injuries, especially those involving the cervical spine, can have devastating consequences. Having a comprehensive understanding of the evaluation and management of cervical pain and cervical spine emergencies is crucial for physicians providing coverage for organized athletic events or for those who serve as team physicians. This article reviews the common causes of cervical spine pain in the competitive athlete.

  2. PAIN CHARACTERISTICS OF TEMPOROMANDIBULAR DISORDER – A PILOT STUDY IN PATIENTS WITH CERVICAL SPINE DYSFUNCTION

    PubMed Central

    Pedroni, Cristiane Rodrigues; de Oliveira, Anamaria Siriani; Bérzin, Fausto

    2006-01-01

    Objective: The purpose of the present pilot study was to describe pain complaints of TMD patients and cervical spine dysfunction. Methods: Fourteen women with myogenous TMD, cervical motion limitation and rotation of at least one of the three first cervical vertebrae evidenced by radiographic examination participated in this study. The multidimensional pain evaluation was accomplished by a Brazilian version of the McGill Pain Questionnaire. Results: The results showed that the most painful body site mentioned was cervical spine, followed by scapular region and temporomandibular joint. More than half of the volunteers reported temporal pain pattern as rhythmic, periodic and, or still, intermittent. The majority of the patients classified the pain intensity assessed at the moment of the evaluation as mild to discomforting. Absolute agreement was not observed among volunteers regarding word dimensions used to describe their pain, although a great number of patients chose the descriptor related to tension as the better expression to describe their painful complaint. Conclusion: Pain characteristics of TMD patients with cervical spine dysfunction showed cervical spine as a common painful region reported and words related to affective and emotional dimensions of pain perception can be used by these patients to qualify their pain complain. PMID:19089063

  3. Cervical Spine pain as a presenting complaint in metastatic pancreatic cancer: a case report.

    PubMed

    Rosenberg, Emily; Buchtel, Lindsey

    2016-01-01

    A 48 year-old female presented to her primary care physician with a two-month history of neck pain with negative cervical spine x-rays. During that office visit, the patient was noted to be tachycardic with EKG revealing ST depressions, which led to hospital admission. Acute coronary syndrome was ruled out, however, persistent neck pain warranted inpatient MRI of the cervical spine, which revealed a cervical spine lesion. Extensive investigation and biopsy ultimately confirmed stage IV pancreatic adenocarcinoma with metastases to the bone, liver, and likely lung. In the literature, the findings of a primary metastatic site being bone is rare with only a few case reports showing vertebral or sternal metastasis as the first clinical manifestation of pancreatic cancer. The uniqueness of this case lies in the only presenting complaint being cervical spine pain in the setting of extensive metastases to the liver, bone, and likely lung.

  4. [Combined surgical and physical treatment in traumatic painful syndromes of the cervical spine].

    PubMed

    Stachowski, B; Kaczmarek, J; Nosek, A; Kocur, L

    1976-01-01

    Clinical observations suggest the need for changing therapeutic management to a more active one in cases of cervical spine injury with damage to the spinal cord and nerve roots or brachial plexus. In 248 patients with these injuries treated initially conservatively the incidence of cervicobrachial pain was analysed. Neuralgic pains were present in 31.5% of cases, causalgic pains in 2.4% and sympathalgic pains in 2%. Conservative treatment conducted in these patients (89 cases) during many months after trauma had no effect on return of mobility. Long-term application of physioterapy prevented only temporarily the development of trophic changes and only partially relieved pains. Only surgical decompression of the spinal cord or spinal nerves with stabilization of damaged vertebrae caused disappearance of painful syndromes and improvement in the motor activity of the extremities. These observations show that early surgical intervention for decompression of the spinal cord, roots or brachial plexus should be advocated in these cases.

  5. The biomechanical and functional relationship between temporomandibular dysfunction and cervical spine pain.

    PubMed

    Walczyńska-Dragon, Karolina; Baron, Stefan

    2011-01-01

    The aim of this study was to investigate the influence of TMD on spinal pain and to check whether TMD therapy helps to cure spinal pain. The total number of 44 evaluated patients underwent physical examination of masticatory motor system, including an evaluation of TMJ function with a Zebris JMA device and an analysis of the cervical spine motion using a Zebris MCS device. Patients from the treated (tested) group, who were diagnosed with TMD, were treated with an occlusal splint. Subsequent examinations were planned 3 weeks and 3 months after the treatment. The results show that there is a close correlation between TMD and spinal pain. The results of the tests performed 3 months after the beginning of occlusal splint therapy show a significant improvement in TMJ function as well as a reduction in spinal pain, as general motor parameters of spinal movements improved.

  6. Fractures of the cervical spine

    PubMed Central

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

    2013-01-01

    OBJECTIVES: The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative. PMID:24270959

  7. Palliative Surgery in Treating Painful Metastases of the Upper Cervical Spine

    PubMed Central

    Wu, Xinghuo; Ye, Zhewei; Pu, Feifei; Chen, Songfeng; Wang, Baichuan; Zhang, Zhicai; Yang, Cao; Yang, Shuhua; Shao, Zengwu

    2016-01-01

    Abstract Increased incidence of upper cervical metastases and higher life expectancy resulted in higher operative rates in patients. The purpose of this study was to explore the methods and the clinical outcomes of palliative surgery for cervical spinal metastases. A systematic review of a 15-case series of upper cervical metastases treated with palliative surgery was performed. All cases underwent palliative surgery, including anterior tumor resection and internal fixation in 3 cases, posterior tumor resection and internal fixation in 10 cases, and combined anterior and posterior tumor resection and internal fixation in 2 cases. Patients were followed-up clinically and radiologically after the operation, and visual analog scale (VAS) and activities of daily living scores were calculated. In addition, a literature review was performed and patients with upper cervical spine metastases were analyzed. The mean follow-up period was 12.5 months (range, 3–26 months) in this consecutive case series. The pain was substantially relieved in 93.3% (14/15) of the patients after the operation. The VAS and Japanese Orthopedic Association scores showed improved clinical outcomes, from 7.86 ± 1.72 and 11.13 ± 2.19 preoperatively to 2.13 ± 1.40 and 14.26 ± 3.03 postoperatively, respectively. The mean survival time was 9.5 months (range, 5–26 months). Dural tear occurred in 1 patient. Wound infections, instrumentation failure, and postoperative death were not observed. Among our cases and other cases reported in the literature, 72% of the patients were treated with simple anterior or posterior operation, and only 12% of the patients (3/25) underwent complex combined anterior and posterior operation. Metastatic upper cervical spine disease is not a rare occurrence. Balancing the perspective of patients on palliative surgery concerning the clinical benefits of operation versus its operative risks can assist the decision for surgery. PMID:27149472

  8. The degenerative cervical spine.

    PubMed

    Llopis, E; Belloch, E; León, J P; Higueras, V; Piquer, J

    2016-04-01

    Imaging techniques provide excellent anatomical images of the cervical spine. The choice to use one technique or another will depend on the clinical scenario and on the treatment options. Plain-film X-rays continue to be fundamental, because they make it possible to evaluate the alignment and bone changes; they are also useful for follow-up after treatment. The better contrast resolution provided by magnetic resonance imaging makes it possible to evaluate the soft tissues, including the intervertebral discs, ligaments, bone marrow, and spinal cord. The role of computed tomography in the study of degenerative disease has changed in recent years owing to its great spatial resolution and its capacity to depict osseous components. In this article, we will review the anatomy and biomechanical characteristics of the cervical spine, and then we provide a more detailed discussion of the degenerative diseases that can affect the cervical spine and their clinical management. PMID:26878769

  9. The degenerative cervical spine.

    PubMed

    Llopis, E; Belloch, E; León, J P; Higueras, V; Piquer, J

    2016-04-01

    Imaging techniques provide excellent anatomical images of the cervical spine. The choice to use one technique or another will depend on the clinical scenario and on the treatment options. Plain-film X-rays continue to be fundamental, because they make it possible to evaluate the alignment and bone changes; they are also useful for follow-up after treatment. The better contrast resolution provided by magnetic resonance imaging makes it possible to evaluate the soft tissues, including the intervertebral discs, ligaments, bone marrow, and spinal cord. The role of computed tomography in the study of degenerative disease has changed in recent years owing to its great spatial resolution and its capacity to depict osseous components. In this article, we will review the anatomy and biomechanical characteristics of the cervical spine, and then we provide a more detailed discussion of the degenerative diseases that can affect the cervical spine and their clinical management.

  10. Cervical spine trauma

    PubMed Central

    Torretti, Joel A; Sengupta, Dilip K

    2007-01-01

    Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteo-ligamentous instability with spinal cord injury. The emergent evaluation of patients at risk relies on standardized clinical and radiographic protocols to identify injuries; elucidate associated pathology; classify injuries; and predict instability, treatment and outcomes. The unique anatomy of each region of the cervical spine demands a review of each segment individually. This article examines both upper cervical spine injuries, as well as subaxial spine trauma. The purpose of this article is to provide a review of the broad topic of cervical spine trauma with reference to the classic literature, as well as to summarize all recently available literature on each topic. Identification of References for Inclusion: A Pubmed and Ovid search was performed for each topic in the review to identify recently published articles relevant to the review. In addition prior reviews and classic references were evaluated individually for inclusion of classic papers, classifications and previously unidentified references. PMID:21139776

  11. [Injury of upper cervical spine].

    PubMed

    Ryba, Luděk; Cienciala, Jan; Chaloupka, Richard; Repko, Martin; Vyskočil, Robert

    2016-01-01

    Injuries of the upper cervical spine represent 1/3 of all cervical spine injuries and approximately 40 % result by the death. Every level of the cervical spine can be injured - fractures of condyles of the occipital bone (CO), atlantooccipital dislocation (AOD), fractures of the Atlas (C1), atlantoaxial dislocation (AAD) and fractures of the axis (C2). Most of cases in younger patients are caused by high-energy trauma, while by elderly people, because of the osteoporosis, is needed much less energy and even simple falls can cause the injury of the cervical spine. That´s why the etiology of injuries can be different. In younger patients are caused mainly by car accidents, motorcycle and bicycle accidents and pedestrian crashes by car and in elderly populations are the main reason falls. The mechanism of the injury is axial force, hyperflexion, hyperextension, latero-flexion, rotation and combination of all. The basic diagnostic examination is X ray in AP, lateral and transoral projection. But in the most of cases is CT examination necessary and in the suspicion of the ligamentous injury and neurological deterioration must be MRI examination added. Every injury of the upper cervical spine has its own classification. Clinical symptoms can vary from the neck pain, restricted range of motion, antalgic position of the head, injury of the cranial nerves and different neurologic symptoms from the irritation of nerves to quadriplegia. A large percentage of deaths is at the time of the injury. Therapy is divided to conservative treatment, which is indicated in bone injuries with minimal dislocation. In more severe cases, with the dislocation and ligamentous injury, when is high chance of the instability, is indicated the surgical treatment. We can use anterior or posterior approach, make the osteosynthesis, stabilisation and fusion of the spine. Complex fractures and combination of different types of injuries are often present in this part of the spine. Correct and early

  12. [First guidelines of Croatian interest group in diagnosing and treating pain conditions of cervical and thoracic spine using minimally invasive procedures].

    PubMed

    Houra, Karlo; Ledić, Darko; Kvesić, Dražen; Perović, Darko; Radoš, Ivan; Kapural, Leonardo

    2014-01-01

    Pain syndromes originating from cervical and thoracic spine remain to be a major public health problem. Medical expenses in general and surgical procedures associated with overall care for the neck and thoracic pain are high and growing. Furthermore, these two chronic pain conditions are also leading causes for missed workdays. Chronic pain syndromes originating from cervical spine are most commonly caused by degenerative changes of the facet joints. Cervi- cobrachial syndrome is most commonly caused by herniated discs. Diagnostic controlled blocks, performed in order to identify, the source of pain, often predetermine patient for further therapeutic minimally invasive interventions. If the chronic pain syndromes of the cervical and thoracic spine are caused by degenerative facet joints, patient can be offered neuroablative procedures using radiofrequency. In patients suffering from chronic cervical and thoracic pain caused by painful intervertebral disc minimally invasive intradiscal decompression procedures can be performed. In cases where the neck pain and radicular pain are caused by the central and foraminal spinal stenosis patients are advised epidural steroid injections. The purpose of above advised procedures, using steroids, local anesthetics and RF current, is to relieve patients' pain, allow optimal physical therapy, and improved functional capacity, consequently providing a better quality of life.

  13. The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders

    PubMed Central

    Bernhoff, Gabriella; Landén Ludvigsson, Maria; Peterson, Gunnel; Bertilson, Bo Christer; Elf, Madeleine; Peolsson, Anneli

    2016-01-01

    Objective The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement. Design This cross-sectional study included data collected in a randomized controlled study. Patients: Two hundred and sixteen patients with chronic (≥6 months) whiplash-associated disorders, grade 2 or 3, were included in this study. Methods The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings. Results Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa =0.11, 95% CI: −0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa =0.64, 95% CI: 0.53 to 0.76). Conclusion: The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries. PMID:27358576

  14. Altered spinal kinematics and muscle recruitment pattern of the cervical and thoracic spine in people with chronic neck pain during functional task.

    PubMed

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

    2014-02-01

    Knowledge on the spinal kinematics and muscle activation of the cervical and thoracic spine during functional task would add to our understanding of the performance and interplay of these spinal regions during dynamic condition. The purpose of this study was to examine the influence of chronic neck pain on the three-dimensional kinematics and muscle recruitment pattern of the cervical and thoracic spine during an overhead reaching task involving a light weight transfer by the upper limb. Synchronized measurements of the three-dimensional spinal kinematics and electromyographic activities of cervical and thoracic spine were acquired in thirty individuals with chronic neck pain and thirty age- and gender-matched asymptomatic controls. Neck pain group showed a significantly decreased cervical velocity and acceleration while performing the task. They also displayed with a predominantly prolonged coactivation of cervical and thoracic muscles throughout the task cycle. The current findings highlighted the importance to examine differential kinematic variables of the spine which are associated with changes in the muscle recruitment in people with chronic neck pain. The results also provide an insight to the appropriate clinical intervention to promote the recovery of the functional disability commonly reported in patients with neck pain disorders.

  15. [Cervical spine instability in the surgical patient].

    PubMed

    Barbeito, A; Guerri-Guttenberg, R A

    2014-03-01

    Many congenital and acquired diseases, including trauma, may result in cervical spine instability. Given that airway management is closely related to the movement of the cervical spine, it is important that the anesthesiologist has detailed knowledge of the anatomy, the mechanisms of cervical spine instability, and of the effects that the different airway maneuvers have on the cervical spine. We first review the normal anatomy and biomechanics of the cervical spine in the context of airway management and the concept of cervical spine instability. In the second part, we review the protocols for the management of cervical spine instability in trauma victims and some of the airway management options for these patients.

  16. Osteotomies in the Cervical Spine

    PubMed Central

    Nemani, Venu M.; Derman, Peter B.

    2016-01-01

    Rigid cervical deformities are difficult problems to treat. The goals of surgical treatment include deformity correction, achieving a rigid fusion, and performing a thorough neural decompression. In stiff and ankylosed cervical spines, osteotomies are required to restore sagittal and coronal balance. In this chapter, we describe the clinical and radiographic workup for patients with cervical deformities, and delineate the various factors that must be considered when planning surgical treatment. We also describe in detail the various types of cervical osteotomies, along with their surgical technique, advantages, and potential complications. PMID:26949476

  17. Vertebroplasty for Spine Fracture Pain

    MedlinePlus

    MENU Return to Web version Vertebroplasty for Spine Fracture Pain Vertebroplasty for Spine Fracture Pain More than 40 million people in the United States have osteoporosis (a decrease in the amount ...

  18. Cervical Spine Injuries in the Athlete.

    PubMed

    Schroeder, Gregory D; Vaccaro, Alexander R

    2016-09-01

    Cervical spine injuries are extremely common and range from relatively minor injuries, such as cervical muscle strains, to severe, life-threatening cervical fractures with spinal cord injuries. Although cervical spine injuries are most common in athletes who participate in contact and collision sports, such as American football and rugby, they also have been reported in athletes who participate in noncontact sports, such as baseball, gymnastics, and diving. Cervical spine injuries in athletes are not necessarily the result of substantial spine trauma; some athletes have chronic conditions, such as congenital stenosis, that increase their risk for a serious cervical spine injury after even minor trauma. Therefore, physicians who cover athletic events must have a thorough knowledge of cervical spine injures and the most appropriate ways in which they should be managed. Although cervical spine injuries can be career-ending injuries, athletes often are able to return to play after appropriate treatment if the potential for substantial re-injury is minimized.

  19. Cervical spine in Treacher Collins syndrome.

    PubMed

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

    2012-05-01

    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.

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

    PubMed

    Grgić, Vjekoslav

    2010-01-01

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

  1. Cervical Spine MRI in Abused Infants.

    ERIC Educational Resources Information Center

    Feldman, Kenneth W.; And Others

    1997-01-01

    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…

  2. Non-rigid registration of cervical spine MRI volumes.

    PubMed

    Aktar, Mst Nargis; Alam, Md Jahangir; Pickering, Mark; Webb, Alexandra; Perriman, Diana

    2015-08-01

    Whiplash is the colloquial term for neck injuries caused by sudden extension of the cervical spine. Patients with chronic whiplash associated disorder (WAD) can experience neck pain for many years after the original injury. Researchers have found some evidence to suggest that chronic whiplash is related to the amount of intra-muscular fat in the cervical spine muscles. Hence, an important step towards developing a treatment for chronic WAD is a technique to accurately and efficiently measure the amount of intra-muscular fat in the muscles of the cervical spine. Our proposed technique for making this measurement is to automatically segment the cervical spine muscles using a fused volume created from multi-modal MRI volumes of the cervical spine. Multiple modes are required to enhance the boundaries between the different muscles to assist the following automatic segmentation process. However, before these multiple modes can be fused it is first necessary to accurately register these volumes. Hence, in this paper, we have proposed a new non-rigid multi-modal registration algorithm using the sum of conditional variance (SCV) with partial volume interpolation (PVI) similarity measure and Gauss-Newton (GN) optimization for the accurate registration of multi-modal cervical spine MRI volumes. The performance of the proposed approach is compared with the existing SCV based registration algorithm and the sum of the conditional squared deviation from the mode (SCSDM) method. The experimental results demonstrate that the proposed approach provides superior performance than the best existing approaches. PMID:26736677

  3. Advances in the understanding of cervical spine deformity.

    PubMed

    Sharan, Alok D; Krystal, Jonathan D; Singla, Amit; Nassr, Ahmad; Kang, James D; Riew, K Daniel

    2015-01-01

    Cervical spine deformities pose substantial challenges for spine surgeons. The anatomy and biomechanics of the cervical spine play an important role in the decision-making process regarding treatment. The etiology of cervical deformities can be congenital, developmental, iatrogenic, degenerative, or inflammatory. Dropped head syndrome has been recently described but is poorly understood. Patients have variable presentations ranging from neck pain to an inability to maintain head position and neural compromise. Radiographic angles are important to monitor the deformity and plan the surgical correction. Treatment is focused on relieving pain, preventing and improving neurologic compromise, and improving overall spinal alignment and balance. The surgical approach and the level of fusion should be individualized on a case-by-case basis. The surgeon can greatly improve a patient's quality of life by understanding the nature of the patient's deformity and fully considering all treatment options. PMID:25745925

  4. Cervical Spine Injuries in the Athlete.

    PubMed

    Schroeder, Gregory D; Vaccaro, Alexander R

    2016-09-01

    Cervical spine injuries are extremely common and range from relatively minor injuries, such as cervical muscle strains, to severe, life-threatening cervical fractures with spinal cord injuries. Although cervical spine injuries are most common in athletes who participate in contact and collision sports, such as American football and rugby, they also have been reported in athletes who participate in noncontact sports, such as baseball, gymnastics, and diving. Cervical spine injuries in athletes are not necessarily the result of substantial spine trauma; some athletes have chronic conditions, such as congenital stenosis, that increase their risk for a serious cervical spine injury after even minor trauma. Therefore, physicians who cover athletic events must have a thorough knowledge of cervical spine injures and the most appropriate ways in which they should be managed. Although cervical spine injuries can be career-ending injuries, athletes often are able to return to play after appropriate treatment if the potential for substantial re-injury is minimized. PMID:27479833

  5. Traumatic cervical spine fractures in the adult.

    PubMed

    Copley, Phillip; Tilliridou, Vicky; Jamjoom, Aimun

    2016-09-01

    This article reviews fractures of the cervical spine, highlighting the pertinent goals of initial management, the indications for different imaging modalities and the different fracture patterns. Basic principles of management of these different fracture patterns are outlined. PMID:27640656

  6. Magnetic resonance imaging atlas of the cervical spine musculature.

    PubMed

    Au, John; Perriman, Diana M; Pickering, Mark R; Buirski, Graham; Smith, Paul N; Webb, Alexandra L

    2016-07-01

    The anatomy of the cervical spine musculature visible on magnetic resonance (MR) images is poorly described in the literature. However, the correct identification of individual muscles is clinically important because certain conditions of the cervical spine, for example whiplash associated disorders, idiopathic neck pain, cervical nerve root avulsion and cervical spondylotic myelopathy, are associated with different morphological changes in specific muscles visible on MR images. Knowledge of the precise structure of different cervical spine muscles is crucial when comparisons with the contralateral side or with normal are required for accurate description of imaging pathology, management and assessment of treatment efficacy. However, learning the intricate arrangement of 27 muscles is challenging. A multi-level cross-sectional depiction combined with three-dimensional reconstructions could facilitate the understanding of this anatomically complex area. This paper presents a comprehensive series of labeled axial MR images from one individual and serves as a reference atlas of the cervical spine musculature to guide clinicians, researchers, and anatomists in the accurate identification of these muscles on MR imaging. Clin. Anat. 29:643-659, 2016. © 2016 Wiley Periodicals, Inc. PMID:27106787

  7. Airway management in cervical spine injury

    PubMed Central

    Austin, Naola; Krishnamoorthy, Vijay; Dagal, Arman

    2014-01-01

    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. PMID:24741498

  8. Fractures of the articular processes of the cervical spine

    SciTech Connect

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

    1982-08-01

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

  9. Cervical spine injuries in rugby players.

    PubMed

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

    1984-03-15

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

  10. Cervical spine immobilization in the elderly population

    PubMed Central

    Phan, Kevin; Mobbs, Ralph J.; Wilson, David; Ball, Jonathon

    2016-01-01

    Background Immobilization of the cervical spine is a cornerstone of spinal injury management. In the context of suspected cervical spine injury, patients are immobilized in a ‘neutral position’ based on the head and trunk resting on a flat surface. It is hypothesized that the increased thoracic kyphosis and loss of cervical lordosis seen in elderly patients may require alternative cervical immobilization, compared with the ‘neutral position’. Methods To investigate this, an audit of pan-scan CT performed on consecutive major trauma patients aged over 65 years was carried out over a 6-month period. Utilizing the pan-CT’s localizing scout film, a novel measurement, the ‘chin-brow horizontal’ angle was independently measured by a senior spine surgeon (RJM) and a neurosurgeon (PJR) with the gantry used as a horizontal zero- degree reference. The benefit of the ‘chin-brow horizontal’ angle in the trauma setting is it can be assessed from the bedside whilst the patient is immobilized against a flat surface. Results During the 6-month study period, 58 patients were identified (30 male, 28 female), with an average age of 77.6 years (minimum 65, maximum 97). Results showed that ‘chin-brow horizontal’ angles varied widely, between +15.8 degrees in flexion to −30.5 degrees in extension (mean −12.4 degrees in extension, standard deviation 9.31 degrees. The interobserver correlation was 0.997 (95% CI: 0.995–0.998). Conclusions These findings suggest that, due to degenerative changes commonly seen in elderly patients, the routine use of the ‘neutral position’ adopted for cervical spine immobilization may not be appropriate in this population. We suggest that consideration be taken in cervical spine immobilization, with patients assessed on an individual basis including the fracture morphology, to minimize the risk of fracture displacement and worsened neurological deficit.

  11. Reconstitution of lost cervical spine function: management strategies

    PubMed Central

    Ernst, Arne; Niedeggen, Andreas

    2005-01-01

    The cervical spine (CS) is the most vulnerable part of the whole spine because it has least protection. This is due to its high mobility (few bone, but largely muscle and joint support) which is associated with a high injury risk. The anatomical characteristics are based on evolutionary biological reasons, i.e. humans had to be able to freely controlling the surrounding space with their eyes and to have permanent postural control by an upright position of the head. The cervical spine, its joint and the surrounding muscles are highly interconnected (e.g. direct neuronal projections into the brain stem, connections to the TMJ, Head's zones with projections to the skin surface). Moreover, the spinal pain memory store can lead to a variets of multi-facette clinical pictures. In addition to reversible disorders of the cervical spine, posttraumatic disorders play a major role. The therapy options available include physiotherapy, drug therapy and surgical measures. However, a multidisciplinary approach is most favourable. PMID:22073068

  12. Fatal Cervical Spine Injury From Diving Accident.

    PubMed

    Voland, Christelle; Vilarino, Raquel; Grabherr, Silke; Lobrinus, Johannes Alexander; Palmiere, Cristian

    2015-09-01

    Spinal cord injuries result after diving into shallow water, often after incautious jumps head first into water of unknown depth during recreational or sport activities. Mortality is generally due to upper cervical trauma. The authors present a case of a diving-related death in a young woman who underwent medicolegal investigations. The measured water depth at the supposed dive site was 1.40 m. Postmortem radiology and autopsy revealed fractures of the body and the posterior arch of the fifth cervical vertebra, a fracture of the right transverse process of the sixth cervical vertebra and hemorrhages involving the cervical paraspinal muscles. Neuropathology showed a posterior epidural hematoma involving the whole cervical region and a symmetric laceration of the spinal cord located at the fourth and fifth cervical vertebra level, surrounded by multiple petechial hemorrhages. Toxicology revealed the presence of ethanol in both blood and urine samples. The death was attributed to cervical spine fracture (C5-C6), spinal cord contusion, and subsequent drowning. This case highlights the usefulness of postmortem radiology, examination of the deep structures of the neck, toxicology, neuropathology, and a detailed research of signs of drowning to formulate appropriate hypotheses pertaining to the cause and mechanism of death.

  13. Pharyngocutaneous fistula after anterior cervical spine surgery

    PubMed Central

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

    2009-01-01

    Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19 year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closure and esophageal exclusion with a Jpeg tube. The patient was eventually successfully treated with a three-stage procedure consisting of firstly a posterior approach to reinforce the posterior stabilization of the cervical spine that was felt to be inadequate, secondly an anterior approach with removal of all the anterior instrumentation followed by iliac crest bone graft and thirdly a superior based sternocleidomastoid flap that was interposed between the esophagus and the anterior cervical spine. The patient's fistula healed successfully. However, yet asymptomatic, the anterior iliac crest bone graft resorbed almost completely at 16 months follow up. In light of this complication, we discuss the surgical options for the treatment of pharyngocutaneous fistulae and the closure of this fistula using a superiorly based sternocleidomastoid muscle flap. PMID:19330360

  14. [Accident analytics for structural traumas of the cervical spine].

    PubMed

    Hartwig, E; Elbel, M; Schultheiss, M; Kettler, A; Kinzl, L; Kramer, M

    2004-12-01

    The differentiation between degenerative syndromes of the cervical spine and post-traumatic symptoms requires accident analysis. Experiments with human subjects yield data only in the low-energy range, and there are still no accident analyses of structural traumas of the cervical spine. From 1 January 2000 to 30 April 2002, 15 patients with structural injuries to the cervical spine due to car accidents were treated in the Department of Trauma Surgery of the University of Ulm. In 11 of these cases, the DEKRA Ulm completed an appraisal of the accident process.With lateral impacts, structural injuries to the cervical spine can occur even at speeds of only ca 10 km/h. Injuries to the alar ligaments are produced by frontal collisions with substantial differences in speed. Data from accident analysis of structural injuries to the cervical spine must be taken into consideration in causality examinations of distortions of the cervical spine.

  15. Cervical spine trauma in children and adults: perioperative considerations.

    PubMed

    Vanderhave, Kelly L; Chiravuri, Srinivas; Caird, Michelle S; Farley, Frances A; Graziano, Gregory P; Hensinger, Robert N; Patel, Rakesh D

    2011-06-01

    A wide spectrum of cervical spine injuries, including stable and unstable injuries with and without neurologic compromise, account for a large percentage of emergency department visits. Effective treatment of the polytrauma patient with cervical spine injury requires knowledge of cervical spine anatomy and the pathophysiology of spinal cord injury, as well as techniques for cervical spine stabilization, intraoperative positioning, and airway management. The orthopaedic surgeon must oversee patient care and coordinate treatment with emergency department physicians and anesthesia services in both the acute and subacute settings. Children are particularly susceptible to substantial destabilizing cervical injuries and must be treated with a high degree of caution. The surgeon must understand the unique anatomic and biomechanical properties associated with the pediatric cervical spine as well as injury patterns and stabilization techniques specific to this patient population.

  16. Percutaneous anterolateral balloon kyphoplasty for metastatic lytic lesions of the cervical spine.

    PubMed

    Lykomitros, Vasilis; Anagnostidis, Kleovoulos S; Alzeer, Ziad; Kapetanos, George A

    2010-11-01

    The purpose of our report is to describe a new application of kyphoplasty, the percutaneous anterolateral balloon kyphoplasty that we performed in two cases of metastatic osteolytic lesions in cervical spine. The first patient, aged 48 years, with primary malignancy in lungs had two metastatic lesions in C2 and C6 vertebrae. Patient's complaints were about pain and restriction of movements (due to the pain) in the cervical spine. The second patient, aged 70 years, with primary malignancy in stomach, had multiple metastatic lesions in thoracolumbar spine and C3, C4 and C5 vertebrae without neurological symptoms. The main symptoms were from cervical spine with severe pain even in bed rest and systematic use of opiate-base analgesic. The preoperative status was evaluated with X-rays, CT scan, MRI scan and with Karnofsky score and visual analogue pain (VAS) scale. Both patients underwent percutaneous anterolateral balloon kyphoplasty via the anterolateral approach in cervical spine under general anaesthesia. No clinical complications occurred during or after the procedure. Both patients experienced pain relief immediately after balloon kyphoplasty and during the following days. The stiffness also resolved rapidly and cervical collars were removed. VAS score significantly improved from 85 and 95 preoperatively to 30 in both patients. Karnofsky score showed also improvement from 40 and 30 preoperatively to 80 and 70, respectively, at the final follow-up (7 months after the procedure). Fluoroscopy-guided percutaneous anterolateral balloon kyphoplasty proved to be safe and effective minimally invasive procedure for metastatic osteolytic lesions of the cervical spine, reducing pain and avoiding vertebral collapse. Experience and attention are necessary in order to avoid complications.

  17. EVALUATION OF THE CERVICAL SPINE AMONG PATIENTS WITH RHEUMATOID ARTHRITIS

    PubMed Central

    Passos Cardoso, André Luiz; Da Silva, Nilzio Antonio; Daher, Sérgio; De Moraes, Frederico Barra; Do Carmo, Humberto Franco

    2015-01-01

    Objective: To evaluate the prevalence of cervical spine abnormalities among patients with rheumatoid arthritis and correlate the imaging findings with the clinical state. Methods: A cross-sectional study on 35 patients was carried out at the School of Medicine of the Federal University of Goiás (UFG) in 2004. The following were evaluated: age, use of medications and the clinical picture of pain and neurological characteristics. The erythrocyte sedimentation rate (ESR) and rheumatoid factor were tested, and radiographs of the cervical spine were produced in anteroposterior, lateral and dynamic views. To evaluate the influence of the variables on the emergence of instabilities, univariate and multivariate logistic regression tests were used (p < 0.05). Results: Among the 35 patients evaluated, 13 (37.1%) presented a stable cervical spine. Out of the 22 patients with instability, six presented more than one type. Atlantoaxial instability was found in 15 patients, with a mean anterior atlantodental distance of 3.40 mm in the neutral lateral radiographic view and 6.54 mm in the lateral view with flexion. Basilar invagination was found in five patients and subaxial subluxation in seven patients. Two thirds of the asymptomatic patients had instabilities. Bicipital hyperreflexia presented statistically significant correlations with atlantoaxial instability (p = 0.024) and subaxial instability (p = 0.01). Age at diagnosis correlated with subaxial instability (p = 0.02). Conclusions: The prevalence of cervical instability was 62.9 % (22/35). The most frequent instabilities were: atlantoaxial subluxation (42.9 %), subaxial subluxation (20%) and basilar invagination (14.3%). The correlation between instabilities and clinical signs and symptoms was poor. The patients with subaxial subluxation presented disease onset at a younger age. Dynamic radiography was important for diagnosing atlantoaxial subluxation. PMID:27022536

  18. Misdiagnosing Absent Pedicle of Cervical Spine in the Acute Trauma Setting.

    PubMed

    Abduljabbar, Fahad H; Rossel, Felipe; Nooh, Anas; Jarzem, Peter

    2015-09-28

    Congenital absence of cervical spine pedicle can be easily misdiagnosed as facet dislocation on plain radiographs especially in the acute trauma setting. Additional imaging, including computed tomography (CT)-scan with careful interpretation is required in order to not misdiagnose cervical posterior arch malformation with subsequent inappropriate management. A 39-year-old patient presented to the emergency unit of our university hospital after being trampled by a cow over her back and head followed by loss of consciousness, retrograde amnesia and neck pain. Her initial cervical CT-scan showed possible C5-C6 dislocation, then, it became clear that her problem was a misdiagnosed congenital cervical abnormality. Patient was treated symptomatically without consequences. The congenital absence of a cervical pedicle is a very unusual condition that is easily misdiagnosed. Diagnosis can be accurately confirmed with a CT-scan of the cervical spine. Symptomatic conservative treatment will result in resolution of the symptoms. PMID:26605026

  19. Dysphagia associated with cervical spine and postural disorders.

    PubMed

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

    2013-12-01

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

  20. Micromechanics of Minor Cervical Spine Injuries

    NASA Astrophysics Data System (ADS)

    Niederer, Peter F.; Schmitt, Kai-Uwe; Muser, Markus H.; Walz, Felix H.

    Minor soft tissue injuries of the cervical spine are of increasing significance in public health. They may in particular be associated with long-term impairment. Such injuries are observed primarily in rear-end automobile collisions at low impact speeds and are attributed to a “whiplash”-type event. The question with respect to injury mechanisms of the cervical spine in cases of impacts of a low severity have raised controversial views in the past. Among proposed injury mechanisms, interactions between fluid and solid structures have been postulated: Viscous shear stresses or pressure gradients which arise in the deforming anatomical structures may have an adverse influence, e. g., on cellular membranes. In this communication, mathematical modeling approaches are presented which allow for a quantification of fluid/solid interactions under typical loading conditions of interest here. It is found, that the shear stresses caused by fluids and acting on accelerated surfaces of fluid-filled bodies depend largely on the size of the fluid space under consideration. Accelerations exhibit a stronger influence than their duration. It cannot be excluded that critical levels are reached even in a low speed impact scenario.

  1. Biomechanical response of the human cervical spine.

    PubMed

    Duma, Stefan M; Kemper, Andrew R; Porta, David J

    2008-01-01

    The purpose of this study was to characterize the biomechanical response of human cervical spine segments in dynamic axial compression. This was accomplished by performing dynamic axial compression tests on human cervical spine segments, C4-T1 and C6-T1, dissected from fresh frozen human male cadavers. The proximal and distal vertebral bodies were fixed to a load cell with a custom aluminum pot and subjected to dynamic compressive loading rates using a servo-hydraulic Material Testing System at a rate of 50 mm/s. The average force and moment at time of structural failure were found to be 3022 +/- 45 N and 46.1 +/-8.1 Nm, respectively, for C4-T1 segments and 6117 +/- 6639 N and 69.5 +/-6.8 Nm, respectively for C6-T1segments. The most severe injury as a result of this testing was compression fractures of the vertebral body. In addition, injuries to the intervertebral discs were only observed in specimens that sustained severe vertebral body fractures. This is consistent with the findings of previous researchers who have reported that intervertebral disc failures do not occur due to single acute loading events without associated severe boney fractures. PMID:19141905

  2. Traumatic extradural hematoma of the cervical spine.

    PubMed

    Garza-Mercado, R

    1989-03-01

    An example of a traumatic extradural hematoma of the cervical spine that occurred in a 32-year-old man who suffered from chronic ankylosing spondylitis is reported. Progressive sensory and motor deficit ensued some 3 hours after the patient fell from a standing position. The patient landed on his back, striking his head on the floor. After being helped up, he was able to walk unassisted to a nearby chair, where he sat down until his left lower extremity--and shortly afterwards, the right one--became numb and weak. On admission, the patient was found to have tetraparesis that was more pronounced in the lower extremities and associated with incomplete sensation to pinprick at level T7-T10. He also had painless distention of the urinary bladder. After a few hours, the weakness in his limbs increased and his sensory level rose to C5 bilaterally. A horizontal diastatic fracture across the vertebral body of C7 was discovered on plain x-ray films of the spine, and an extradural hematoma extending dorsally from C5 to T1 was revealed by emergency magnetic resonance imaging. After an emergency decompressive cervical laminectomy and removal of the clot, the patient rapidly regained complete neurological function, except with regard to both the urinary bladder and the rectum, which remained abnormal for almost 7 weeks after the operation.

  3. Accountable disease management of spine pain.

    PubMed

    Smith, Matthew J

    2011-09-01

    The health care landscape has changed with new legislation addressing the unsustainable rise in costs in the US system. Low-value service lines caring for expensive chronic conditions have been targeted for reform; for better or worse, the treatment of spine pain has been recognized as a representative example. Examining the Patient Protection and Affordable Care Act and existing pilot studies can offer a preview of how chronic care of spine pain will be sustained. Accountable care in an organization capable of collecting, analyzing, and reporting clinical data and operational compliance is forthcoming. Interdisciplinary spine pain centers integrating surgical and medical management, behavioral medicine, physical reconditioning, and societal reintegration represent the model of high-value care for patients with chronic spine pain.

  4. Chronic pain and the thoracic spine

    PubMed Central

    Louw, Adriaan; Schmidt, Stephen G.

    2015-01-01

    In recent years there has been an increased interest in pain neuroscience in physical therapy.1,2 Emerging pain neuroscience research has challenged prevailing models used to understand and treat pain, including the Cartesian model of pain and the pain gate.2–4 Focus has shifted to the brain's processing of a pain experience, the pain neuromatrix and more recently, cortical reorganisation of body maps.2,3,5,6 In turn, these emerging theories have catapulted new treatments, such as therapeutic neuroscience education (TNE)7–10 and graded motor imagery (GMI),11,12 to the forefront of treating people suffering from persistent spinal pain. In line with their increased use, both of these approaches have exponentially gathered increasing evidence to support their use.4,10 For example, various randomised controlled trials and systematic reviews have shown that teaching patients more about the biology and physiology of their pain experience leads to positive changes in pain, pain catastrophization, function, physical movement and healthcare utilisation.7–10 Graded motor imagery, in turn, has shown increasing evidence to help pain and disability in complex pain states such as complex regional pain syndrome (CRPS).11,12 Most research using TNE and GMI has focussed on chronic low back pain (CLBP) and CRPS and none of these advanced pain treatments have been trialled on the thoracic spine. This lack of research and writings in regards to the thoracic spine is not unique to pain science, but also in manual therapy. There are, however, very unique pain neuroscience issues that skilled manual therapists may find clinically meaningful when treating a patient struggling with persistent thoracic pain. Utilising the latest understanding of pain neuroscience, three key clinical chronic thoracic issues will be discussed – hypersensitisation of intercostal nerves, posterior primary rami nerves mimicking Cloward areas and mechanical and sensitisation issues of the spinal dura in

  5. Anterior Cervical Spine Surgery for Degenerative Disease: A Review

    PubMed Central

    SUGAWARA, Taku

    Anterior cervical spine surgery is an established surgical intervention for cervical degenerative disease and high success rate with excellent long-term outcomes have been reported. However, indications of surgical procedures for certain conditions are still controversial and severe complications to cause neurological dysfunction or deaths may occur. This review is focused mainly on five widely performed procedures by anterior approach for cervical degenerative disease; anterior cervical discectomy, anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical foraminotomy, and arthroplasty. Indications, procedures, outcomes, and complications of these surgeries are discussed. PMID:26119899

  6. Multiple subluxations and comminuted fracture of the cervical spine in a sheep.

    PubMed

    Lin, C-C; Chen, K-S; Lin, Y-L; Chan, J P-W

    2015-01-01

    A 5-month-old, 13.5 kg, female Corriedale sheep was referred to the Veterinary Medicine Teaching Hospital, with a history of traumatic injury of the cervical spine followed by non-ambulatoric tetraparesis that occurred 2 weeks before being admitted to the hospital. At admission, malalignment of the cervical spine with the cranial part of the neck deviating to the right was noted. Neurological examinations identified the absence of postural reactions in both forelimbs, mildly decreased spinal reflexes, and normal reaction to pain perception tests. Radiography revealed malalignment of the cervical vertebrae with subluxations at C1-C2 and C2-C3, and a comminuted fracture of the caudal aspect of C2. The sheep was euthanized due to a presumed poor prognosis. Necropsy and histopathological findings confirmed injuries of the cervical spine from C1 to C3, which were consistent with the clinical finding of tetraparesis in this case. This paper presents a rare case of multiple subluxations of the cervical spine caused by blunt force trauma in a young sheep. These results highlight the importance of an astute clinical diagnosis for such an acute cervical spine trauma and the need for prompt surgical correction for similar cases in the future. PMID:25626484

  7. Multiple subluxations and comminuted fracture of the cervical spine in a sheep.

    PubMed

    Lin, C-C; Chen, K-S; Lin, Y-L; Chan, J P-W

    2015-01-01

    A 5-month-old, 13.5 kg, female Corriedale sheep was referred to the Veterinary Medicine Teaching Hospital, with a history of traumatic injury of the cervical spine followed by non-ambulatoric tetraparesis that occurred 2 weeks before being admitted to the hospital. At admission, malalignment of the cervical spine with the cranial part of the neck deviating to the right was noted. Neurological examinations identified the absence of postural reactions in both forelimbs, mildly decreased spinal reflexes, and normal reaction to pain perception tests. Radiography revealed malalignment of the cervical vertebrae with subluxations at C1-C2 and C2-C3, and a comminuted fracture of the caudal aspect of C2. The sheep was euthanized due to a presumed poor prognosis. Necropsy and histopathological findings confirmed injuries of the cervical spine from C1 to C3, which were consistent with the clinical finding of tetraparesis in this case. This paper presents a rare case of multiple subluxations of the cervical spine caused by blunt force trauma in a young sheep. These results highlight the importance of an astute clinical diagnosis for such an acute cervical spine trauma and the need for prompt surgical correction for similar cases in the future.

  8. The 100 Most Influential Articles in Cervical Spine Surgery.

    PubMed

    Skovrlj, Branko; Steinberger, Jeremy; Guzman, Javier Z; Overley, Samuel C; Qureshi, Sheeraz A; Caridi, John M; Cho, Samuel K

    2016-02-01

    Study Design Literature review. Objective To identify and analyze the top 100 cited articles in cervical spine surgery. Methods The Thomson Reuters Web of Knowledge was searched for citations of all articles relevant to cervical spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each article. Results The most cited article was the classic from 1991 by Vernon and Mior that described the Neck Disability Index. The second most cited was Smith's 1958 article describing the anterior cervical diskectomy and fusion procedure. The third most cited article was Hilibrand's 1999 publication evaluating the incidence, prevalence, and radiographic progression of symptomatic adjacent segment disease following anterior cervical arthrodesis. The majority of the articles originated in the United States (65), and most were published in Spine (39). Most articles were published in the 1990s (34), and the three most common topics were cervical fusion (17), surgical complications (9), and biomechanics (9), respectively. Author Abumi had four articles in the top 100 list, and authors Goffin, Panjabi, and Hadley had three each. The Department of Orthopaedic Surgery at Hokkaido University in Sapporo, Japan, had five articles in the top 100 list. Conclusion This report identifies the top 100 articles in cervical spine surgery and acknowledges those individuals who have contributed the most to the advancement of the study of the cervical spine and the body of knowledge used to guide evidence-based clinical decision making in cervical spine surgery today.

  9. The Burden of Clostridium difficile after Cervical Spine Surgery.

    PubMed

    Guzman, Javier Z; Skovrlj, Branko; Rothenberg, Edward S; Lu, Young; McAnany, Steven; Cho, Samuel K; Hecht, Andrew C; Qureshi, Sheeraz A

    2016-06-01

    Study Design Retrospective database analysis. Objective The purpose of this study is to investigate incidence, comorbidities, and impact on health care resources of Clostridium difficile infection after cervical spine surgery. Methods A total of 1,602,130 cervical spine surgeries from the Nationwide Inpatient Sample database from 2002 to 2011 were included. Patients were included for study based on International Classification of Diseases Ninth Revision, Clinical Modification procedural codes for cervical spine surgery for degenerative spine diagnoses. Baseline patient characteristics were determined. Multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality. Results Incidence of C. difficile infection in postoperative cervical spine surgery hospitalizations is 0.08%, significantly increased since 2002 (p < 0.0001). The odds of postoperative C. difficile infection were significantly increased in patients with comorbidities such as congestive heart failure, renal failure, and perivascular disease. Circumferential cervical fusion (odds ratio [OR] = 2.93, p < 0.0001) increased the likelihood of developing C. difficile infection after degenerative cervical spine surgery. C. difficile infection after cervical spine surgery results in extended length of stay (p < 0.0001) and increased hospital costs (p < 0.0001). Mortality rate in patients who develop C. difficile after cervical spine surgery is nearly 8% versus 0.19% otherwise (p < 0.0001). Moreover, multivariate analysis revealed C. difficile to be a significant predictor of inpatient mortality (OR = 3.99, p < 0.0001). Conclusions C. difficile increases the risk of in-hospital mortality and costs approximately $6,830,695 per year to manage in patients undergoing elective cervical spine surgery. Patients with comorbidities such as renal failure or congestive heart failure have increased probability of developing infection

  10. The Burden of Clostridium difficile after Cervical Spine Surgery.

    PubMed

    Guzman, Javier Z; Skovrlj, Branko; Rothenberg, Edward S; Lu, Young; McAnany, Steven; Cho, Samuel K; Hecht, Andrew C; Qureshi, Sheeraz A

    2016-06-01

    Study Design Retrospective database analysis. Objective The purpose of this study is to investigate incidence, comorbidities, and impact on health care resources of Clostridium difficile infection after cervical spine surgery. Methods A total of 1,602,130 cervical spine surgeries from the Nationwide Inpatient Sample database from 2002 to 2011 were included. Patients were included for study based on International Classification of Diseases Ninth Revision, Clinical Modification procedural codes for cervical spine surgery for degenerative spine diagnoses. Baseline patient characteristics were determined. Multivariable analyses assessed factors associated with increased incidence of C. difficile and risk of mortality. Results Incidence of C. difficile infection in postoperative cervical spine surgery hospitalizations is 0.08%, significantly increased since 2002 (p < 0.0001). The odds of postoperative C. difficile infection were significantly increased in patients with comorbidities such as congestive heart failure, renal failure, and perivascular disease. Circumferential cervical fusion (odds ratio [OR] = 2.93, p < 0.0001) increased the likelihood of developing C. difficile infection after degenerative cervical spine surgery. C. difficile infection after cervical spine surgery results in extended length of stay (p < 0.0001) and increased hospital costs (p < 0.0001). Mortality rate in patients who develop C. difficile after cervical spine surgery is nearly 8% versus 0.19% otherwise (p < 0.0001). Moreover, multivariate analysis revealed C. difficile to be a significant predictor of inpatient mortality (OR = 3.99, p < 0.0001). Conclusions C. difficile increases the risk of in-hospital mortality and costs approximately $6,830,695 per year to manage in patients undergoing elective cervical spine surgery. Patients with comorbidities such as renal failure or congestive heart failure have increased probability of developing infection

  11. Complications of Anterior and Posterior Cervical Spine Surgery

    PubMed Central

    Cheung, Jason Pui Yin

    2016-01-01

    Cervical spine surgery performed for the correct indications yields good results. However, surgeons need to be mindful of the many possible pitfalls. Complications may occur starting from the anaesthestic procedure and patient positioning to dura exposure and instrumentation. This review examines specific complications related to anterior and posterior cervical spine surgery, discusses their causes and considers methods to prevent or treat them. In general, avoiding complications is best achieved with meticulous preoperative analysis of the pathology, good patient selection for a specific procedure and careful execution of the surgery. Cervical spine surgery is usually effective in treating most pathologies and only a reasonable complication rate exists. PMID:27114784

  12. Cervical spine surgery in professional athletes: a systematic review.

    PubMed

    Joaquim, Andrei F; Hsu, Wellington K; Patel, Alpesh A

    2016-04-01

    Cervical surgery is one of the most common surgical spinal procedures performed around the world. The authors performed a systematic review of the literature reporting the outcomes of cervical spine surgery in high-level athletes in order to better understand the nuances of cervical spine pathology in this population. A search of the MEDLINE database using the search terms "cervical spine" AND "surgery" AND "athletes" yielded 54 abstracts. After exclusion of publications that did not meet the criteria for inclusion, a total of 8 papers reporting the outcome of cervical spine surgery in professional or elite athletes treated for symptoms secondary to cervical spine pathology (focusing in degenerative conditions) remained for analysis. Five of these involved the management of cervical disc herniation, 3 were specifically about traumatic neurapraxia. The majority of the patients included in this review were American football players. Anterior cervical discectomy and fusion (ACDF) was commonly performed in high-level athletes for the treatment of cervical disc herniation. Most of the studies suggested that return to play is safe for athletes who are asymptomatic after ACDF for cervical radiculopathy due to disc herniation. Surgical treatment may provide a higher rate of return to play for these athletes than nonsurgical treatment. Return to play after cervical spinal cord contusion may be possible in asymptomatic patients. Cervical cord signal changes on MRI may not be an absolute contraindication for return to play in neurologically intact patients, according to some authors. Cervical contusions secondary to cervical stenosis may be associated with a worse outcome and a higher recurrence rate than those those secondary to disc herniation. The evidence is low (Level IV) and individualized treatment must be recommended.

  13. Cervical spine surgery in professional athletes: a systematic review.

    PubMed

    Joaquim, Andrei F; Hsu, Wellington K; Patel, Alpesh A

    2016-04-01

    Cervical surgery is one of the most common surgical spinal procedures performed around the world. The authors performed a systematic review of the literature reporting the outcomes of cervical spine surgery in high-level athletes in order to better understand the nuances of cervical spine pathology in this population. A search of the MEDLINE database using the search terms "cervical spine" AND "surgery" AND "athletes" yielded 54 abstracts. After exclusion of publications that did not meet the criteria for inclusion, a total of 8 papers reporting the outcome of cervical spine surgery in professional or elite athletes treated for symptoms secondary to cervical spine pathology (focusing in degenerative conditions) remained for analysis. Five of these involved the management of cervical disc herniation, 3 were specifically about traumatic neurapraxia. The majority of the patients included in this review were American football players. Anterior cervical discectomy and fusion (ACDF) was commonly performed in high-level athletes for the treatment of cervical disc herniation. Most of the studies suggested that return to play is safe for athletes who are asymptomatic after ACDF for cervical radiculopathy due to disc herniation. Surgical treatment may provide a higher rate of return to play for these athletes than nonsurgical treatment. Return to play after cervical spinal cord contusion may be possible in asymptomatic patients. Cervical cord signal changes on MRI may not be an absolute contraindication for return to play in neurologically intact patients, according to some authors. Cervical contusions secondary to cervical stenosis may be associated with a worse outcome and a higher recurrence rate than those those secondary to disc herniation. The evidence is low (Level IV) and individualized treatment must be recommended. PMID:27032913

  14. CERVICAL SPINE SIGNS AND SYMPTOMS: PERPETUATING RATHER THAN PREDISPOSING FACTORS FOR TEMPOROMANDIBULAR DISORDERS IN WOMEN

    PubMed Central

    Bevilaqua-Grossi, Débora; Chaves, Thaís Cristina; de Oliveira, Anamaria Siriani

    2007-01-01

    Aim: The purpose of this study was to assess in a sample of female community cases the relationship between the increase of percentage of cervical signs and symptoms and the severity of temporomandibular disorders (TMD) and vice-versa. Material and Methods: One hundred women (aged 18-26 years) clinically diagnosed with TMD signs and symptoms and cervical spine disorders were randomly selected from a sample of college students. Results: 43% of the volunteers demonstrated the same severity for TMD and cervical spine disorders (CSD). The increase in TMD signs and symptoms was accompanied by increase in CSD severity, except for pain during palpation of posterior temporal muscle, more frequently observed in the severe CSD group. However, increase in pain during cervical extension, sounds during cervical lateral flexion, and tenderness to palpation of upper fibers of trapezius and suboccipital muscles were observed in association with the progression of TMD severity. Conclusion: The increase in cervical symptomatology seems to accompany TMD severity; nonetheless, the inverse was not verified. Such results suggest that cervical spine signs and symptoms could be better recognized as perpetuating rather than predisposing factors for TMD. PMID:19089141

  15. Comparison of Cervical Spine Anatomy in Calves, Pigs and Humans

    PubMed Central

    Sheng, Sun-Ren; Xu, Hua-Zi; Wang, Yong-Li; Zhu, Qing-An; Mao, Fang-Min; Lin, Yan; Wang, Xiang-Yang

    2016-01-01

    Background Context Animals are commonly used to model the human spine for in vitro and in vivo experiments. Many studies have investigated similarities and differences between animals and humans in the lumbar and thoracic vertebrae. However, a quantitative anatomic comparison of calf, pig, and human cervical spines has not been reported. Purpose To compare fundamental structural similarities and differences in vertebral bodies from the cervical spines of commonly used experimental animal models and humans. Study Design Anatomical morphometric analysis was performed on cervical vertebra specimens harvested from humans and two common large animals (i.e., calves and pigs). Methods Multiple morphometric parameters were directly measured from cervical spine specimens of twelve pigs, twelve calves and twelve human adult cadavers. The following anatomical parameters were measured: vertebral body width (VBW), vertebral body depth (VBD), vertebral body height (VBH), spinal canal width (SCW), spinal canal depth (SCD), pedicle width (PW), pedicle depth (PD), pedicle inclination (PI), dens width (DW), dens depth (DD), total vertebral width (TVW), and total vertebral depth (TVD). Results The atlantoaxial (C1–2) joint in pigs is similar to that in humans and could serve as a human substitute. The pig cervical spine is highly similar to the human cervical spine, except for two large transverse processes in the anterior regions ofC4–C6. The width and depth of the calf odontoid process were larger than those in humans. VBW and VBD of calf cervical vertebrae were larger than those in humans, but the spinal canal was smaller. Calf C7 was relatively similar to human C7, thus, it may be a good substitute. Conclusion Pig cervical vertebrae were more suitable human substitutions than calf cervical vertebrae, especially with respect to C1, C2, and C7. The biomechanical properties of nerve vascular anatomy and various segment functions in pig and calf cervical vertebrae must be

  16. Detection of degenerative change in lateral projection cervical spine x-ray images

    NASA Astrophysics Data System (ADS)

    Jebri, Beyrem; Phillips, Michael; Knapp, Karen; Appelboam, Andy; Reuben, Adam; Slabaugh, Greg

    2015-03-01

    Degenerative changes to the cervical spine can be accompanied by neck pain, which can result from narrowing of the intervertebral disc space and growth of osteophytes. In a lateral x-ray image of the cervical spine, degenerative changes are characterized by vertebral bodies that have indistinct boundaries and limited spacing between vertebrae. In this paper, we present a machine learning approach to detect and localize degenerative changes in lateral x-ray images of the cervical spine. Starting from a user-supplied set of points in the center of each vertebral body, we fit a central spline, from which a region of interest is extracted and image features are computed. A Random Forest classifier labels regions as degenerative change or normal. Leave-one-out cross-validation studies performed on a dataset of 103 patients demonstrates performance of above 95% accuracy.

  17. Cervical spine injuries in the pediatric and adolescent athlete.

    PubMed

    Herman, Martin J

    2006-01-01

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

  18. Avoiding and Managing Intraoperative Complications During Cervical Spine Surgery.

    PubMed

    Bible, Jesse; Rihn, Jeffrey A; Lim, Moe R; Brodke, Darrel S; Lee, Joon Y

    2016-01-01

    The incidence of intraoperative complications during cervical spine surgery is low; however, if they do occur, intraoperative complications have the potential to cause considerable morbidity and mortality. Spine surgeons should be familiar with methods to minimize intraoperative complications. If they do occur, surgeons must be prepared to immediately treat each potential complication to reduce any associated morbidity. PMID:27049196

  19. Avoiding and Managing Intraoperative Complications During Cervical Spine Surgery.

    PubMed

    Bible, Jesse E; Rihn, Jeffrey A; Lim, Moe R; Brodke, Darrel S; Lee, Joon Y

    2015-12-01

    The incidence of intraoperative complications in cervical spine surgery is low. However, when they do occur, such complications have the potential for causing considerable morbidity and mortality. Spine surgeons should be familiar with methods of minimizing such complications. Furthermore, if they do occur, surgeons must be prepared to immediately treat each potential complication to reduce any associated morbidity. PMID:26519429

  20. Improving visual estimates of cervical spine range of motion.

    PubMed

    Hirsch, Brandon P; Webb, Matthew L; Bohl, Daniel D; Fu, Michael; Buerba, Rafael A; Gruskay, Jordan A; Grauer, Jonathan N

    2014-11-01

    Cervical spine range of motion (ROM) is a common measure of cervical conditions, surgical outcomes, and functional impairment. Although ROM is routinely assessed by visual estimation in clinical practice, visual estimates have been shown to be unreliable and inaccurate. Reliable goniometers can be used for assessments, but the associated costs and logistics generally limit their clinical acceptance. To investigate whether training can improve visual estimates of cervical spine ROM, we asked attending surgeons, residents, and medical students at our institution to visually estimate the cervical spine ROM of healthy subjects before and after a training session. This training session included review of normal cervical spine ROM in 3 planes and demonstration of partial and full motion in 3 planes by multiple subjects. Estimates before, immediately after, and 1 month after this training session were compared to assess reliability and accuracy. Immediately after training, errors decreased by 11.9° (flexion-extension), 3.8° (lateral bending), and 2.9° (axial rotation). These improvements were statistically significant. One month after training, visual estimates remained improved, by 9.5°, 1.6°, and 3.1°, respectively, but were statistically significant only in flexion-extension. Although the accuracy of visual estimates can be improved, clinicians should be aware of the limitations of visual estimates of cervical spine ROM. Our study results support scrutiny of visual assessment of ROM as a criterion for diagnosing permanent impairment or disability. PMID:25379754

  1. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma

    PubMed Central

    Tannoury, Chadi; Degiacomo, Anthony

    2015-01-01

    Study Design. This case illustrates complications to a vertebral artery injury (VAI) resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5–C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI. PMID:26640731

  2. Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study

    PubMed Central

    2014-01-01

    Background To describe MRI and clinical findings in patients with juvenile idiopathic arthritis with cervical spine involvement at onset and follow-up under therapy. Methods 13 patients with signs of cervical spine involvement in juvenile idiopathic arthritis with a median disease duration of 1.7 years were included in the study. Clinical records and MR images were retrospectively analyzed according to symptoms and findings concerning the cervical spine. Results At the onset of cervical spine involvement all patients showed limited range of motion, whereas only 5 of them complained of pain. In MR images joint hyperintensity, contrast enhancement, malalignment, ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction were found at 28, 32, 15, 2, 2 and 3 sites in 12 (93%), 13 (100%), 8 (62%), 2 (15%), 2 and 3 (20%) patients respectively. 3 of the 5 patients with pain (60%) showed ankylosis, erosions or narrowing of the spinal canal at cranio-cervical junction on MRI. At follow-up - after a median disease duration of cervical spine arthritis of 2.1 years and a variable duration of treatment with methotrexate (all patients) and biological agents (12 patients) - joint hyperintensity, enhancement and malalignment decreased to 15, 19 and 6 sites in 10 (77%), 11 (85%) and 3 (20%) patients respectively whereas ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction increased to 7, 6 and 4 sites in 3 (20%), 4 (31%) and 4 patients respectively. Pain was no longer reported, but 9 of 13 (69%) patients still had a limited range of motion with 6 of them (46%) showing skeletal changes on MRI. Conclusions This first MRI based follow-up study shows that cervical spine arthritis can follow a severe disease course in juvenile arthritis. While malalignments and inflammation sites decreased osseous changes with erosions, ankylosis, and narrowing of the spinal canal increased under treatment despite only minor subjective complaints

  3. Outpatient surgery in the cervical spine: is it safe?

    PubMed

    Lee, Michael J; Kalfas, Iain; Holmer, Haley; Skelly, Andrea

    2014-10-01

    Study Design Systematic review. Study Rationale As the length of stay after cervical spine surgery has decreased substantially, the feasibility and safety of outpatient cervical spine surgery come into question. Although minimal length of stay is a targeted metric for quality and costs for medical centers, the safety of outpatient cervical spine surgery has not been clearly defined. Objective The objective of this article is to evaluate the safety of inpatient versus outpatient surgery in the cervical spine for adult patients with symptomatic or asymptomatic degenerative disc disease. Methods A systematic review of the literature was undertaken for articles published through February 19, 2014. Electronic databases and the bibliographies of key articles were searched to identify comparative studies evaluating the safety of inpatient versus outpatient surgery in the cervical spine. Spinal cord stimulation, spinal injections, and diagnostic procedures were excluded. Two independent reviewers assessed the strength of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, and disagreements were resolved by consensus. Results Five studies that met the inclusion criteria were identified. One study reported low risk of hematoma (0% of outpatients and 1.6% of inpatients). Two studies reported on mortality and both reported no deaths in either group following surgery. Dysphagia risks ranged from 0 to 10% of outpatients and 1.6 to 5% of inpatients, and infection risks ranged from 0 to 1% of outpatients and 2 to 2.8% of inpatients. One study reported that no (0) outpatients were readmitted to the hospital due to a complication, compared with four inpatients (7%). The overall strength of evidence was insufficient for all safety outcomes examined. Conclusion Though the studies in our systematic review did not suggest an increased risk of complication with outpatient cervical spine surgery, the strength of evidence to

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

    PubMed Central

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

    1985-01-01

    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 PMID:4083942

  5. The 100 Most Influential Articles in Cervical Spine Surgery

    PubMed Central

    Skovrlj, Branko; Steinberger, Jeremy; Guzman, Javier Z.; Overley, Samuel C.; Qureshi, Sheeraz A.; Caridi, John M.; Cho, Samuel K.

    2015-01-01

    Study Design Literature review. Objective To identify and analyze the top 100 cited articles in cervical spine surgery. Methods The Thomson Reuters Web of Knowledge was searched for citations of all articles relevant to cervical spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each article. Results The most cited article was the classic from 1991 by Vernon and Mior that described the Neck Disability Index. The second most cited was Smith's 1958 article describing the anterior cervical diskectomy and fusion procedure. The third most cited article was Hilibrand's 1999 publication evaluating the incidence, prevalence, and radiographic progression of symptomatic adjacent segment disease following anterior cervical arthrodesis. The majority of the articles originated in the United States (65), and most were published in Spine (39). Most articles were published in the 1990s (34), and the three most common topics were cervical fusion (17), surgical complications (9), and biomechanics (9), respectively. Author Abumi had four articles in the top 100 list, and authors Goffin, Panjabi, and Hadley had three each. The Department of Orthopaedic Surgery at Hokkaido University in Sapporo, Japan, had five articles in the top 100 list. Conclusion This report identifies the top 100 articles in cervical spine surgery and acknowledges those individuals who have contributed the most to the advancement of the study of the cervical spine and the body of knowledge used to guide evidence-based clinical decision making in cervical spine surgery today. PMID:26835204

  6. Case Series of an Intraoral Balancing Appliance Therapy on Subjective Symptom Severity and Cervical Spine Alignment

    PubMed Central

    Lee, Young Jun; Lee, Joo Kang; Jung, Soo Chang; Lee, Hwang-woo; Yin, Chang Shik; Lee, Young Jin

    2013-01-01

    Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA) on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ) therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ clinic. Main Measures. Any immediate change in the curvature of cervical spine and the degree of atlantoaxial rotation was investigated in the images of simple X-ray and computed tomography of cervical spine with or without OA. Changes of subjective symptom severity were also analyzed for the holistic OA therapy cases. Results. A total of 59 cases were reviewed. Alignment of upper cervical spine rotation showed an immediate improvement (P < 0.001). Changes of subjective symptom severity also showed significant improvement (P < 0.05). Conclusion. These cases revealed rudimentary clinical evidence that holistic OA therapy may be related to an alleviated symptom severity and an improved cervical spinal alignment. These results show that further researches may warrant for the holistic TMJ therapy. PMID:23935655

  7. Utility of flexion-extension radiography for the detection of ligamentous cervical spine injury and its current role in the clearance of the cervical spine.

    PubMed

    Oh, Jason Jaeseong; Asha, Stephen Edward

    2016-04-01

    Detecting the presence of injuries to the cervical spine is an important component of the initial assessment of patients sustaining blunt trauma. A small proportion of cervical spine injuries consists of ligamentous disruption. Accurate detection of ligamentous injury is essential as it may result in sequelae including radiculopathy, quadriplegia and death. Flexion-extension (FE) radiography has traditionally been utilised for the detection of ligamentous injury in patients who have been cleared of bony injury. There are controversies surrounding the use of FE for alert patients with neck pain. There are studies that call into question the diagnostic accuracy of FE, the high proportion of inadequate FE images due to muscle spasm and the adverse effects of prolonged cervical collar immobilisation while awaiting FE. Other literature indicates that FE provides no additional diagnostic information following a multi-detector helical computed tomography. This review evaluates the literature on the utility of FE for the detection of ligamentous injury and explores alternate strategies for clearing the cervical spine of ligamentous injury.

  8. Cervical Spine Involvement in Mild Traumatic Brain Injury: A Review.

    PubMed

    Morin, Michael; Langevin, Pierre; Fait, Philippe

    2016-01-01

    Background. There is a lack of scientific evidence in the literature on the involvement of the cervical spine in mTBI; however, its involvement is clinically accepted. Objective. This paper reviews evidence for the involvement of the cervical spine in mTBI symptoms, the mechanisms of injury, and the efficacy of therapy for cervical spine with concussion-related symptoms. Methods. A keyword search was conducted on PubMed, ICL, SportDiscus, PEDro, CINAHL, and Cochrane Library databases for articles published since 1990. The reference lists of articles meeting the criteria (original data articles, literature reviews, and clinical guidelines) were also searched in the same databases. Results. 4,854 records were screened and 43 articles were retained. Those articles were used to describe different subjects such as mTBI's signs and symptoms, mechanisms of injury, and treatments of the cervical spine. Conclusions. The hypothesis of cervical spine involvement in post-mTBI symptoms and in PCS (postconcussion syndrome) is supported by increasing evidence and is widely accepted clinically. For the management and treatment of mTBIs, few articles were available in the literature, and relevant studies showed interesting results about manual therapy and exercises as efficient tools for health care practitioners. PMID:27529079

  9. Neurological deterioration during intubation in cervical spine disorders

    PubMed Central

    Durga, Padmaja; Sahu, Barada Prasad

    2014-01-01

    Anaesthesiologists are often involved in the management of patients with cervical spine disorders. Airway management is often implicated in the deterioration of spinal cord function. Most evidence on neurological deterioration resulting from intubation is from case reports which suggest only association, but not causation. Most anaesthesiologists and surgeons probably believe that the risk of spinal cord injury (SCI) during intubation is largely due to mechanical compression produced by movement of the cervical spine. But it is questionable that the small and brief deformations produced during intubation can produce SCI. Difficult intubation, more frequently encountered in patients with cervical spine disorders, is likely to produce greater movement of spine. Several alternative intubation techniques are shown to improve ease and success, and reduce cervical spine movement but their role in limiting SCI is not studied. The current opinion is that most neurological injuries during anaesthesia are the result of prolonged deformation, impaired perfusion of the cord, or both. To prevent further neurological injury to the spinal cord and preserve spinal cord function, minimizing movement during intubation and positioning for surgery are essential. The features that diagnose laryngoscopy induced SCI are myelopathy present on recovery, short period of unconsciousness, autonomic disturbances following laryngoscopy, cranio-cervical junction disease or gross instability below C3. It is difficult to accept or refute the claim that neurological deterioration was induced by intubation. Hence, a record of adequate care at laryngoscopy and also perioperative period are important in the event of later medico-legal proceedings. PMID:25624530

  10. Cervical Spine Involvement in Mild Traumatic Brain Injury: A Review

    PubMed Central

    Morin, Michael; Langevin, Pierre

    2016-01-01

    Background. There is a lack of scientific evidence in the literature on the involvement of the cervical spine in mTBI; however, its involvement is clinically accepted. Objective. This paper reviews evidence for the involvement of the cervical spine in mTBI symptoms, the mechanisms of injury, and the efficacy of therapy for cervical spine with concussion-related symptoms. Methods. A keyword search was conducted on PubMed, ICL, SportDiscus, PEDro, CINAHL, and Cochrane Library databases for articles published since 1990. The reference lists of articles meeting the criteria (original data articles, literature reviews, and clinical guidelines) were also searched in the same databases. Results. 4,854 records were screened and 43 articles were retained. Those articles were used to describe different subjects such as mTBI's signs and symptoms, mechanisms of injury, and treatments of the cervical spine. Conclusions. The hypothesis of cervical spine involvement in post-mTBI symptoms and in PCS (postconcussion syndrome) is supported by increasing evidence and is widely accepted clinically. For the management and treatment of mTBIs, few articles were available in the literature, and relevant studies showed interesting results about manual therapy and exercises as efficient tools for health care practitioners. PMID:27529079

  11. Sensitivity of plain radiography for pediatric cervical spine injury.

    PubMed

    Cui, Li W; Probst, Marc A; Hoffman, Jerome R; Mower, William R

    2016-10-01

    Pediatric patients with suspected cervical spine injuries (CSI) often receive a computed tomography (CT) scan as an initial diagnostic imaging test. While sensitive, CT of the cervical spine carries significant radiation and risk of lethal malignant transformation later in life. Plain radiographs carry significantly less radiation and could serve as the preferred screening tool, provided they have a high functional sensitivity in detecting pediatric patients with CSI. We hypothesize that plain cervical spine radiographs can reliably detect pediatric patients with CSI and seek to quantify the functional sensitivity of plain radiography as compared to CT. We analyzed data from the NEXUS cervical spine study to assess the sensitivity of plain radiographs in the evaluation of CSI. We identified all pediatric patients who underwent plain radiographic imaging, and all pediatric patients found to have CSI. We then determined the sensitivity of plain radiographs in detecting pediatric patients with CSI. We identified 44 pediatric patients with CSI in the dataset with age ranging from 2 to 18 years old. Thirty-two of the 44 pediatric patients received cervical spine plain films as a part of their workup. Plain films were able to identify all 32 pediatric patients with CSI to yield a sensitivity of 100 % in detecting injury victims (95 % confidence interval 89.1-100.0 %). Plain radiography was highly sensitive for the identification of CSI in our cohort of pediatric patients and is useful as a screening tool in the evaluation of pediatric CSI. PMID:27321014

  12. Catastrophic Cervical Spine Injuries in Contact Sports

    PubMed Central

    Hutton, Michael James; McGuire, Robert A.; Dunn, Robert; Williams, Richard; Robertson, Peter; Twaddle, Bruce; Kiely, Patrick; Clarke, Andrew; Mazda, Keyvan; Davies, Paul; Pagarigan, Krystle T.; Dettori, Joseph R.

    2016-01-01

    Study Design Systematic review. Objectives To determine the incidence of catastrophic cervical spine injuries (CCSIs) among elite athletes participating in contact team sports and whether the incidence varies depending on the use of protective gear or by player position. Methods Electronic databases and reference lists of key articles published from January 1, 2000, to January 29, 2016, were searched. Results Fourteen studies were included that reported CCSI in rugby (n = 10), American football (n = 3), and Irish hurling (n = 1). Among Rugby Union players, incidence of CCSI was 4.1 per 100,000 player-hours. Among National Football League players, the CCSI rate was 0.6 per 100,000 player-exposures. At the collegiate level, the CCSI rate ranged from 1.1 to 4.7 per 100,000 player-years. Mixed populations of elite and recreational rugby players in four studies report a CCSI rate of 1.4 to 7.2 per 100,000 player-years. In this same population, the scrum accounted for 30 to 51% of total reported CCSIs in Rugby Union versus 0 to 4% in Rugby League. The tackle accounted for 29 to 39% of injuries in Rugby Union and 78 to 100% of injuries in Rugby League. Making a tackle was responsible for 29 to 80% of injuries in American football. Conclusion CCSIs are infrequent among elite athletes. There is insufficient evidence to determine the effect of protective gear (e.g., helmets, padding) on CCSI incidence. Scrum and tackle in rugby and tackling in American football account for the majority of CCSIs in each respective sport. PMID:27781193

  13. Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability

    PubMed Central

    Steilen, Danielle; Hauser, Ross; Woldin, Barbara; Sawyer, Sarah

    2014-01-01

    The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of

  14. 78 FR 65451 - Agency Information Collection (Neck (Cervical Spine) Conditions Disability Benefits Questionnaire...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-31

    ... AFFAIRS Agency Information Collection (Neck (Cervical Spine) Conditions Disability Benefits Questionnaire...) Conditions Disability Benefits Questionnaire)'' in any correspondence. FOR FURTHER INFORMATION CONTACT...- ] NEW (Neck (Cervical Spine) Conditions Disability Benefits Questionnaire).'' SUPPLEMENTARY...

  15. Posterior Fixation Techniques in the Subaxial Cervical Spine

    PubMed Central

    Ghori, Ahmer; Makanji, Heeren; Cha, Thomas

    2015-01-01

    This article reviews the historical context, indications, techniques, and complications of four posterior fixation techniques to stabilize the subaxial cervical spine. Specifically, posterior wiring, laminar screw fixation, lateral mass fixation, and pedicle screw fixation are among the common methods of operative fixation of the subaxial cervical spine. While wiring and laminar screw fixation are now rarely used, both lateral mass and pedicle screw fixation are technically challenging and present the risk of significant complications if performed incorrectly. With a sound understanding of anatomy and rigorous preoperative evaluation of bony structures, both lateral mass and pedicle screw fixation provide a safe and reliable method for subaxial cervical spine fixation. PMID:26594602

  16. Risk Factors for Vertebral Artery Injuries in Cervical Spine Trauma

    PubMed Central

    Dabke, Harshad V.

    2014-01-01

    Blunt cerebrovascular injuries (i.e. involvement of carotid and vertebral arteries) are increasingly being recognized in setting of cervical spine trauma/fractures and are associated with high incidence of stroke/morbidity and mortality. The incidence of vertebral artery injuries (VAI) is more common than previously thought and regular screening is seldom performed. However there exists no screening criteria and conflicting reports exists between spine and trauma literature. Many clinicians do not routinely screen/evaluate patients presenting with cervical spine trauma for potential VAI. This article provides a brief summary of existing evidence regarding the incidence of VAI in the background of cervical trauma/fractures. The type and fracture pattern that is associated with a high risk of VAI warranting mandatory screening/further work-up is discussed. A brief overview of diagnostic modalities and their respective sensitivity/specificity along with available treatment options is also summarized. PMID:25317310

  17. Lateral Mass Fixation in the Subaxial Cervical Spine.

    PubMed

    Kurd, Mark F; Millhouse, Paul W; Schroeder, Gregory D; Kepler, Christopher K; Vaccaro, Alexander R

    2015-08-01

    The use of lateral mass screws and rods in the subaxial spine has become the standard method of fixation for posterior cervical spine fusions. Multiple techniques have been described for the placement of lateral mass screws, including the Magerl, the Anderson, and the An techniques. While these techniques are all slightly different, the overall goal is to obtain solid bony fixation while avoiding the neurovascular structures. The use of lateral mass screws has been shown to be a safe and effective technique for achieving a posterior cervical fusion.

  18. Assessment of spine pain presence in children and young persons studying in ballet schools.

    PubMed

    Wójcik, Małgorzata; Siatkowski, Idzi

    2015-04-01

    [Purpose] Spine disorders affect various sections of the spine and have a variety of causes. Most pain occurs in the lumbo-sacral and cervical regions. Dance is associated with exercise. High levels of physical activity predispose to back pain occurrence. [Subjects and Methods] The subjects were 237 ballet learners; 80 children (primary school level), mean age 11.24±0.77, mean of years of training ballet 2.14±0.74; 93 students (junior high school level), mean age 14.01±0.84, mean of years of learning ballet 4.64±1.24; 64 students (high school) mean age 17.01±0.77, mean of years of learning ballet 7.47±1.54. Numeric rating scale was used to determine spine pain. [Results] Feelings of pain were analyzed on the basis of "now" and "before" between levels education by using point statistics and statistical tests to compare groups. "Now" exhibited weaker back pain feelings than "before" at all the education levels. There were statistically significant differences in pain feeling for "before" (at any time of learning) and "now" (the day of survey). [Conclusion] All patients reported pain "before" and "now" in cervical, thoracic and lumbar spine. At all levels of education there were statistically significant differences in feelings of pain between "before" and "now". PMID:25995566

  19. Assessment of spine pain presence in children and young persons studying in ballet schools

    PubMed Central

    Wójcik, Małgorzata; Siatkowski, Idzi

    2015-01-01

    [Purpose] Spine disorders affect various sections of the spine and have a variety of causes. Most pain occurs in the lumbo-sacral and cervical regions. Dance is associated with exercise. High levels of physical activity predispose to back pain occurrence. [Subjects and Methods] The subjects were 237 ballet learners; 80 children (primary school level), mean age 11.24±0.77, mean of years of training ballet 2.14±0.74; 93 students (junior high school level), mean age 14.01±0.84, mean of years of learning ballet 4.64±1.24; 64 students (high school) mean age 17.01±0.77, mean of years of learning ballet 7.47±1.54. Numeric rating scale was used to determine spine pain. [Results] Feelings of pain were analyzed on the basis of “now” and “before” between levels education by using point statistics and statistical tests to compare groups. “Now” exhibited weaker back pain feelings than “before” at all the education levels. There were statistically significant differences in pain feeling for “before” (at any time of learning) and “now” (the day of survey). [Conclusion] All patients reported pain “before” and “now” in cervical, thoracic and lumbar spine. At all levels of education there were statistically significant differences in feelings of pain between “before” and “now”. PMID:25995566

  20. [Cervical spine instability: point of view of the anesthesiologist].

    PubMed

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

    2014-01-01

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

  1. [Cervical spine instability: point of view of the anesthesiologist].

    PubMed

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

    2014-01-01

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

  2. Maladaptive dendritic spine remodeling contributes to diabetic neuropathic pain.

    PubMed

    Tan, Andrew M; Samad, Omar A; Fischer, Tanya Z; Zhao, Peng; Persson, Anna-Karin; Waxman, Stephen G

    2012-05-16

    Diabetic neuropathic pain imposes a huge burden on individuals and society, and represents a major public health problem. Despite aggressive efforts, diabetic neuropathic pain is generally refractory to available clinical treatments. A structure-function link between maladaptive dendritic spine plasticity and pain has been demonstrated previously in CNS and PNS injury models of neuropathic pain. Here, we reasoned that if dendritic spine remodeling contributes to diabetic neuropathic pain, then (1) the presence of malformed spines should coincide with the development of pain, and (2) disrupting maladaptive spine structure should reduce chronic pain. To determine whether dendritic spine remodeling contributes to neuropathic pain in streptozotocin (STZ)-induced diabetic rats, we analyzed dendritic spine morphology and electrophysiological and behavioral signs of neuropathic pain. Our results show changes in dendritic spine shape, distribution, and shape on wide-dynamic-range (WDR) neurons within lamina IV-V of the dorsal horn in diabetes. These diabetes-induced changes were accompanied by WDR neuron hyperexcitability and decreased pain thresholds at 4 weeks. Treatment with NSC23766 (N(6)-[2-[[4-(diethylamino)-1-methylbutyl]amino]-6-methyl-4-pyrimidinyl]-2-methyl-4,6-quinolinediamine trihydrochloride), a Rac1-specific inhibitor known to interfere with spine plasticity, decreased the presence of malformed spines in diabetes, attenuated neuronal hyperresponsiveness to peripheral stimuli, reduced spontaneous firing activity from WDR neurons, and improved nociceptive mechanical pain thresholds. At 1 week after STZ injection, animals with hyperglycemia with no evidence of pain had few or no changes in spine morphology. These results demonstrate that diabetes-induced maladaptive dendritic spine remodeling has a mechanistic role in neuropathic pain. Molecular pathways that control spine morphogenesis and plasticity may be promising future targets for treatment.

  3. Cervical spine manifestations in patients with inflammatory arthritides.

    PubMed

    Cha, Thomas D; An, Howard S

    2013-07-01

    The cervical spine can frequently become involved in patients with rheumatologic disorders, as a result of either the rheumatologic disease itself or age-associated degenerative processes that can also occur in the rest of the population. Awareness of the increased risk of cervical spine manifestations in patients with rheumatologic disorders enables early recognition and initiation of the appropriate treatment regimen. For example, patients with rheumatoid arthritis (RA) often have spinal instability which, if left untreated, can lead to neurological deficits. Biologic agents are effective in slowing the progression of the skeletal abnormality as well as for treating the RA, and this approach is often sufficient. However, early surgical intervention is recommended for patients with RA who develop neurologic deficits, as conservative approaches have limited effectiveness in this group. Spinal stability should be the primary surgical objective. For patients with ankylosing spondylitis, cervical spine surgery might be required either for fracture repair or to correct severe kyphosis. Understanding each condition's specific cervical spine manifestation and its natural history can help to clarify the appropriate indications for and timing of surgery to maximize patients' outcomes and limit complications. PMID:23528639

  4. Dimensional coordinate measurements: application in characterizing cervical spine motion

    NASA Astrophysics Data System (ADS)

    Zheng, Weilong; Li, Linan; Wang, Shibin; Wang, Zhiyong; Shi, Nianke; Xue, Yuan

    2014-06-01

    Cervical spine as a complicated part in the human body, the form of its movement is diverse. The movements of the segments of vertebrae are three-dimensional, and it is reflected in the changes of the angle between two joint and the displacement in different directions. Under normal conditions, cervical can flex, extend, lateral flex and rotate. For there is no relative motion between measuring marks fixed on one segment of cervical vertebra, the cervical vertebrae with three marked points can be seen as a body. Body's motion in space can be decomposed into translational movement and rotational movement around a base point .This study concerns the calculation of dimensional coordinate of the marked points pasted to the human body's cervical spine by an optical method. Afterward, these measures will allow the calculation of motion parameters for every spine segment. For this study, we choose a three-dimensional measurement method based on binocular stereo vision. The object with marked points is placed in front of the CCD camera. Through each shot, we will get there two parallax images taken from different cameras. According to the principle of binocular vision we can be realized three-dimensional measurements. Cameras are erected parallelly. This paper describes the layout of experimental system and a mathematical model to get the coordinates.

  5. Magnetic Resonance Imaging of the Cervical, Thoracic, and Lumbar Spine in Children: Spinal Incidental Findings in Pediatric Patients

    PubMed Central

    Ramadorai, Uma E.; Hire, Justin M.; DeVine, John G.

    2014-01-01

    Study Design Retrospective case series. Objective To determine the rate of spinal incidental findings on magnetic resonance imaging (MRI) of the cervical, thoracic, and lumbar spine in the pediatric population. Methods We reviewed MRI imaging of the neuraxial spine in patients less than 18 years of age and documented abnormal spinal findings. We then reviewed the charts of these patients to determine the reason for ordering the study. Those who presented with pain were considered symptomatic. Those who had no presenting complaint were considered asymptomatic. The data were analyzed to break down the rate of spinal incidental findings in the cervical, thoracic, and lumbar spine, respectively. Results Thirty-one of the 99 MRIs had positive findings, with the most common being disk protrusion (51.6%). Spinal incidental findings were most common in the lumbar spine (9.4%) versus the cervical spine (8%) or thoracic spine (4.7%). In this group, Schmorl nodes and disk protrusion were the two most common findings (37.5% each). Other spinal incidental findings included a vertebral hemangioma and a Tarlov cyst. In the thoracic spine, the only spinal incidental finding was a central disk protrusion without spinal cord or nerve root compression. Conclusion MRI is a useful modality in the pediatric patient with scoliosis or complaints of pain, but the provider should remain cognizant of the potential for spinal incidental findings. PMID:25396102

  6. Magnetic resonance imaging of the cervical, thoracic, and lumbar spine in children: spinal incidental findings in pediatric patients.

    PubMed

    Ramadorai, Uma E; Hire, Justin M; DeVine, John G

    2014-12-01

    Study Design Retrospective case series. Objective To determine the rate of spinal incidental findings on magnetic resonance imaging (MRI) of the cervical, thoracic, and lumbar spine in the pediatric population. Methods We reviewed MRI imaging of the neuraxial spine in patients less than 18 years of age and documented abnormal spinal findings. We then reviewed the charts of these patients to determine the reason for ordering the study. Those who presented with pain were considered symptomatic. Those who had no presenting complaint were considered asymptomatic. The data were analyzed to break down the rate of spinal incidental findings in the cervical, thoracic, and lumbar spine, respectively. Results Thirty-one of the 99 MRIs had positive findings, with the most common being disk protrusion (51.6%). Spinal incidental findings were most common in the lumbar spine (9.4%) versus the cervical spine (8%) or thoracic spine (4.7%). In this group, Schmorl nodes and disk protrusion were the two most common findings (37.5% each). Other spinal incidental findings included a vertebral hemangioma and a Tarlov cyst. In the thoracic spine, the only spinal incidental finding was a central disk protrusion without spinal cord or nerve root compression. Conclusion MRI is a useful modality in the pediatric patient with scoliosis or complaints of pain, but the provider should remain cognizant of the potential for spinal incidental findings. PMID:25396102

  7. The Relationship between Neck Pain and Cervical Alignment in Young Female Nursing Staff

    PubMed Central

    Kim, Jang-Hun; Kim, Joo Han; Kim, Jong-Hyun; Kwon, Taek-Hyun; Park, Yoon-Kwan

    2015-01-01

    Objective Degenerative changes in the cervical spine are commonly accompanied by cervical kyphosis which can cause neck pain. This study examined the relationship between neck pain and cervical alignment. Methods A total of 323 female nursing staff from our hospital were enrolled. Sagittal radiographs of the cervical spine, Body Mass Index (BMI), Visual Analogue Scale (VAS) measures of neck and arm pain, Neck Disability Index (NDI) and the Short Form (36) Health Survey (SF-36 scores) were obtained and reviewed retrospectively. Global lordosis (GL) of the cervical spine was measured on radiograph images. Correlations between GL and questionnaire scores were investigated using the following three methods : 1) correlation between GL and questionnaire scores among the entire sample; 2) subgroup analysis of patients with "kyphosis (KYP) : GL scores<0" vs. those with "lordosis (LOR) : GL scores>0" on questionnaire measures; and 3) subgroup analysis of patients with pain vs. those without pain, on GL and questionnaire measures. Results There was no significant correlation between GL and any questionnaire measure. There was a significant difference between the mean GLs of the KYP and LOR groups, but there were no group differences in BMI, age or any questionnaire measures. There was no difference between the pain (n=92) and pain-free (n=231) groups in age, BMI or GL, but there were differences in neck, and arm pain, and physical function and NDI scores. Conclusions Our data suggest that kyphotic deformity was not associated with neck pain. PMID:26539266

  8. Bootstrap prediction bands for cervical spine intervertebral kinematics during in vivo three-dimensional head movements.

    PubMed

    Anderst, William J

    2015-05-01

    There is substantial inter-subject variability in intervertebral range of motion (ROM) in the cervical spine. This makes it difficult to define "normal" ROM, and to assess the effects of age, injury, and surgical procedures on spine kinematics. The objective of this study was to define normal intervertebral kinematics in the cervical spine during dynamic functional loading. Twenty-nine participants performed dynamic flexion\\extension, axial rotation, and lateral bending while biplane radiographs were collected at 30 images/s. Vertebral motion was tracked with sub-millimeter accuracy using a validated volumetric model-based tracking process that matched subject-specific CT-based bone models to the radiographs. Gaussian point-by-point and bootstrap techniques were used to determine 90% prediction bands for the intervertebral kinematic curves at 1% intervals of each movement cycle. Cross validation was performed to estimate the true achieved coverage for each method. For a targeted coverage of 90%, the estimated true coverage using bootstrap prediction bands averaged 86±5%, while the estimated true coverage using Gaussian point-by-point intervals averaged 56±10% over all movements and all motion segments. Bootstrap prediction bands are recommended as the standard for evaluating full ROM cervical spine kinematic curves. The data presented here can be used to identify abnormal motion in patients presenting with neck pain, to drive computational models, and to assess the biofidelity of in vitro loading paradigms.

  9. Pathological burst fracture in the cervical spine with negative red flags: a case report

    PubMed Central

    Cox, Jocelyn; DeGraauw, Chris; Klein, Erik

    2016-01-01

    Objective: To report on a case of a pathological burst fracture in the cervical spine where typical core red flag tests failed to identify a significant lesion, and to remind chiropractors to be vigilant in the recognition of subtle signs and symptoms of disease processes. Clinical Features: A 61-year-old man presented to a chiropractic clinic with neck pain that began earlier that morning. After a physical exam that was relatively unremarkable, imaging identified a burst fracture in the cervical spine. Intervention & Outcomes: The patient was sent by ambulance to the hospital where he was diagnosed with multiple myeloma. No medical intervention was performed on the fracture. Summary: The patient’s initial physical examination was largely unremarkable, with an absence of clinical red flags. The screening tools were non-diagnostic. Pain with traction and the sudden onset of symptoms prompted further investigation with plain film imaging of the cervical spine. This identified a pathological burst fracture in the C4 vertebrae. PMID:27069270

  10. Dry needling for the management of thoracic spine pain

    PubMed Central

    Fernández-de-las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-01-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars. PMID:26309385

  11. Dry needling for the management of thoracic spine pain.

    PubMed

    Fernández-de-Las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-07-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars. PMID:26309385

  12. Dry needling for the management of thoracic spine pain.

    PubMed

    Fernández-de-Las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-07-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars.

  13. [Reflex dystrophy following so-called whiplash injury of the cervical spine].

    PubMed

    Bühring, M

    1984-01-01

    In bad cases of whiplash injury of the cervical spine the post-accidental course is complicated by pain, vegetative dysfunctional syndromes and by psychic and psychiatric disorders over many years. There is no satisfactory concept to understand the pathophysiology of these processes. The paper deals with the possibility of a reflex dystrophy. Sympathetic reflex dystrophy syndromes are seen principally in patients with joint, tendon or vascular lesions. In case of whiplash injury, it would concern the cervical spine itself as well as visceral organs including the central nervous system. For the CNS the lymphostatic encephalopathy is a well defined entity. Above all, a reflex dystrophy develops on the basis of a special personality structure. In case of psychic and psychiatric complaints after whiplash injury patients with a so called Sudeck-personality should not be suspected to aggravate; in contrast, especially in these patients complications by reflex dystrophy are credible. Consequences for the assessment and for rehabilitation are discussed. PMID:6475217

  14. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

    PubMed Central

    Garcia, Jodan D.; Arnold, Stephen; Tetley, Kylie; Voight, Kiel; Frank, Rachael Anne

    2016-01-01

    Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH); however, there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text. Ultimately, 10 studies met the inclusion criteria: (1) randomized controlled trial (RCT) or open RCT; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison; (2) subjects must have had a diagnosis of CEH; (3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control; and (4) the study included headache pain and frequency as outcome measurements. Seven of the 10 studies had statistically significant findings that subjects who received mobilization or manipulation interventions experienced improved outcomes or reported fewer symptoms than control subjects. These results suggest that mobilization or manipulation of the cervical spine may be beneficial for individuals who suffer from CEH, although heterogeneity of the studies makes it difficult to generalize the findings. PMID:27047446

  15. The Neandertal vertebral column 1: the cervical spine.

    PubMed

    Gómez-Olivencia, Asier; Been, Ella; Arsuaga, Juan Luis; Stock, Jay T

    2013-06-01

    This paper provides a metric analysis of the Neandertal cervical spine in relation to modern human variation. All seven cervical vertebrae have been analysed. Metric data from eight Neandertal individuals are compared with a large sample of modern humans. The significance of morphometric differences is tested using both z-scores and two-tailed Wilcoxon signed rank tests. The results identify significant metric and morphological differences between Neandertals and modern humans in all seven cervical vertebrae. Neandertal vertebrae are mediolaterally wider and dorsoventrally longer than modern humans, due in part to longer and more horizontally oriented spinous processes. This suggests that Neandertal cervical morphology was more stable in both mid-sagittal and coronal planes. It is hypothesized that the differences in cranial size and shape in the Neandertal and modern human lineages from their Middle Pleistocene ancestors could account for some of the differences in the neck anatomy between these species. PMID:23541382

  16. Visuo-proprioceptive interactions in degenerative cervical spine diseases requiring surgery.

    PubMed

    Freppel, S; Bisdorff, A; Colnat-Coulbois, S; Ceyte, H; Cian, C; Gauchard, G; Auque, J; Perrin, P

    2013-01-01

    Cervical proprioception plays a key role in postural control, but its specific contribution is controversial. Postural impairment was shown in whiplash injuries without demonstrating the sole involvement of the cervical spine. The consequences of degenerative cervical spine diseases are underreported in posture-related scientific literature in spite of their high prevalence. No report has focused on the two different mechanisms underlying cervicobrachial pain: herniated discs and spondylosis. This study aimed to evaluate postural control of two groups of patients with degenerative cervical spine diseases with or without optokinetic stimulation before and after surgical treatment. Seventeen patients with radiculopathy were recruited and divided into two groups according to the spondylotic or discal origin of the nerve compression. All patients and a control population of 31 healthy individuals underwent a static posturographic test with 12 recordings; the first four recordings with the head in 0° position: eyes closed, eyes open without optokinetic stimulation, with clockwise and counter clockwise optokinetic stimulations. These four sensorial situations were repeated with the head rotated 30° to the left and to the right. Patients repeated these 12 recordings 6weeks postoperatively. None of the patients reported vertigo or balance disorders before or after surgery. Prior to surgery, in the eyes closed condition, the herniated disc group was more stable than the spondylosis group. After surgery, the contribution of visual input to postural control in a dynamic visual environment was reduced in both cervical spine diseases whereas in a stable visual environment visual contribution was reduced only in the spondylosis group. The relative importance of visual and proprioceptive inputs to postural control varies according to the type of pathology and surgery tends to reduce visual contribution mostly in the spondylosis group.

  17. Current Trends in the Use of Patient-Reported Outcome Instruments in Degenerative Cervical Spine Surgery

    PubMed Central

    Ueda, Haruki; Cutler, Holt S.; Guzman, Javier Z.; Cho, Samuel K.

    2015-01-01

    Study Design Bibliometric analysis. Objective To determine trends, frequency, and distribution of patient-reported outcome instruments (PROIs) in degenerative cervical spine surgery literature over the past decade. Methods A search was conducted via PubMed from 2004 to 2013 on five journals (The Journal of Bone and Joint Surgery, The Bone and Joint Journal, The Spine Journal, European Spine Journal, and Spine), which were chosen based on their impact factors and authors' consensus. All abstracts were screened and articles addressing degenerative cervical spine surgery using PROIs were included. Articles were then analyzed for publication date, study design, journal, level of evidence, and PROI trends. Prevalence of PROIs and level of evidence of included articles were analyzed. Results From 19,736 articles published, 241 articles fulfilled our study criteria. Overall, 53 distinct PROIs appeared. The top seven most frequently used PROIs were: Japanese Orthopaedic Association score (104 studies), visual analog scale for pain (100), Neck Disability Index (72), Short Form-36 (38), Nurick score (25), Odom criteria (21), and Oswestry Disability Index (15). Only 11 PROIs were used in 5 or more articles. Thirty-three of the PROIs were appeared in only 1 article. Among the included articles, 16% were of level 1 evidence and 32% were of level 4 evidence. Conclusion Numerous PROIs are currently used in degenerative cervical spine surgery. A consensus on which instruments to use for a given diagnosis or procedure is lacking and may be necessary for better communication and comparison, as well as for the accumulation and analysis of vast clinical data across multiple studies. PMID:27099815

  18. Vertebroplasty and kyphoplasty for cervical spine metastases: a systematic review and meta-analysis

    PubMed Central

    De la Garza-Ramos, Rafael; Benvenutti-Regato, Mario

    2016-01-01

    Background Vertebroplasty (VP) and kyphoplasty (KP) are two minimally invasive techniques used to relieve pain and restore stability in metastatic spinal disease. However, most of these procedures are performed in the thoracolumbar spine, and there is limited data on outcomes after VP/KP for cervical metastases. The purpose of this article is to evaluate the safety and efficacy of VP and KP for treating pain in patients with cervical spine metastases. Methods A systematic review of the literature was conducted using the PubMed and Medline databases. Only studies that reported five or more patients treated with VP/KP in the cervical spine were included. Levels of evidence and grades of recommendation were established based on the Oxford Centre for Evidence-Based Medicine guidelines. Data was pooled to perform a meta-analysis for pain relief and complication rates. Results Six studies (all level 4 studies) met the inclusion criteria, representing 120 patients undergoing VP/KP at 135 vertebrae; the most common addressed level was C2 in 83 cases. The average volume of injected cement was 2.5 ± 0.5 milliliters at each vertebra. There were 22 asymptomatic cement leaks (16%; 95% CI, 9.8% - 22.2%) most commonly occurring in the paraspinal soft tissue. There were 5 complications (4%; 95% CI, 0.5% - 7.5%): 3 cases of mild odynophagia, 1 case of occipital neuralgia secondary to leak, and 1 case of stroke secondary to cement embolism. Pain relief was achieved in 89% of cases (range: 80 - 100%). The calculated average pain score decreased significantly from 7.6 ± 0.9 before surgery to 1.9 ± 0.8 at last evaluation (p=0.006). Conclusion Although the calculated complication rate after VP/KP in the cervical spine is low (4%) and the reported pain relief rate is approximately 89%, there is lack of high-quality evidence supporting this. Future randomized controlled trials are needed. PMID:26913227

  19. [Cervical spine osteochondroma presenting with torticollis and hemiparesis].

    PubMed

    Castro-Castro, Julián; Rodiño-Padín, Jon; Touceda-Bravo, Alberto; Castro-Bouzas, Daniel; Pinzón-Millán, Alfonso

    2014-01-01

    Osteochondromas are slow-growing benign bone tumors that are located frequently in the long bones. Approximately 1-4% of them occur in the spine. Solitary spinal osteochondromas may produce a wide variety of symptoms depending on their location and relationship to associated structures. We report a case of a 74-year old woman who was admitted to our hospital with complaints of progressive left hemibody weakness and cervicalgia. Neurological examination disclosed mild left-sided hemiparesis and left torticollis. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansive lesion affecting the left C3-C4 facet joint. The patient underwent a posterior C3 and C4 hemilaminectomy, complete excision of the lesion and instrumented posterior cervical fixation. Histological examination confirmed the diagnosis of osteochondroma. After surgery her symptoms improved progressively with no neurological sequels. PMID:24139102

  20. Head and cervical spine postures in complete denture wearers.

    PubMed

    Salonen, M A; Raustia, A M; Huggare, J

    1993-01-01

    Signs and symptoms in the stomatognathic system and head and cervical spine postures were evaluated in 10 edentulous patients prior to renewal of their dentures, as well as immediately and six months after insertion of new dentures. Natural head posture was recorded using the fluid-level method and measured from the roentgen cephalograms. It was shown that the variables duration of edentulousness and free-way space displayed positive correlations with the dysfunction symptoms. In addition, the patients who needed oral rehabilitation the most, who received the greatest reduction in their free-way space, were seen to have raised their heads more than average. There was also an inverse correlation between the reduction of clinical dysfunction index score and cervical spine postures.

  1. [Cervical spine osteochondroma presenting with torticollis and hemiparesis].

    PubMed

    Castro-Castro, Julián; Rodiño-Padín, Jon; Touceda-Bravo, Alberto; Castro-Bouzas, Daniel; Pinzón-Millán, Alfonso

    2014-01-01

    Osteochondromas are slow-growing benign bone tumors that are located frequently in the long bones. Approximately 1-4% of them occur in the spine. Solitary spinal osteochondromas may produce a wide variety of symptoms depending on their location and relationship to associated structures. We report a case of a 74-year old woman who was admitted to our hospital with complaints of progressive left hemibody weakness and cervicalgia. Neurological examination disclosed mild left-sided hemiparesis and left torticollis. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansive lesion affecting the left C3-C4 facet joint. The patient underwent a posterior C3 and C4 hemilaminectomy, complete excision of the lesion and instrumented posterior cervical fixation. Histological examination confirmed the diagnosis of osteochondroma. After surgery her symptoms improved progressively with no neurological sequels.

  2. Head and cervical spine posture in behaving rats: implications for modeling human conditions involving the head and cervical spine.

    PubMed

    Griffin, C; Choong, W Y; Teh, W; Buxton, A J; Bolton, P S

    2015-02-01

    The aim of this study was to define the temporal and spatial (postural) characteristics of the head and cervical vertebral column (spine) of behaving rats in order to better understand their suitability as a model to study human conditions involving the head and neck. Time spent in each of four behavioral postures was determined from video tape recordings of rats (n = 10) in the absence and presence of an intruder rat. Plain film radiographic examination of a subset of these rats (n = 5) in each of these postures allowed measurement of head and cervical vertebral column positions adopted by the rats. When single they were quadruped or crouched most (∼80%) of the time and bipedal either supported or free standing for only ∼10% of the time. The introduction of an intruder significantly (P < 0.0001) reduced the proportion of time rats spent quadruped (median, from 71% to 47%) and bipedal free standing (median, from 2.9% to 0.4%). The cervical spine was orientated (median, 25-75 percentile) near vertical (18.8°, 4.2°-30.9°) when quadruped, crouched (15.4°, 7.6°-69.3°) and bipedal supported (10.5°, 4.8°-22.6°) but tended to be less vertical oriented when bipedal free standing (25.9°, 7.7°-39.3°). The range of head positions relative to the cervical spine was largest when crouched (73.4°) and smallest when erect free standing (17.7°). This study indicates that, like humans, rats have near vertical orientated cervical vertebral columns but, in contrast to humans, they displace their head in space by movements at both the cervico-thoracic junction and the cranio-cervical regions.

  3. Occurrence of cervical spine injuries during the rugby scrum.

    PubMed

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

    1998-01-01

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

  4. [Biomechanics of whiplash injuries of the cervical spine].

    PubMed

    Schmidt, G

    1989-07-01

    1. The whiplash injury of the cervical spine is a typical, but not very often observed injury of occupants of automotive vehicles involved in moderate collisions. 2. There still exist great uncertainties in the elaboration of expertises concerning the minor whiplash injury, so that the great part of the disturbances cannot be objectivated under a clinical point of view. And on the other hand, serious whiplash injuries often are superposed or veiled by secondary injuries. 3. Thus, the aim of the present paper was to point out injury mechanisms, to give a rough scaling of the whiplash severity under biomechanical aspects and finally to set these injury mechanisms in correlation to the following criteria of accident: a) vehicle velocity change (energy equivalent speed--EES); b) deformation of vehicles on the impact-exposed structure; c) loading of occupants by acceleration or deceleration. 4. The tolerance limit of the cervical spine generally decreases to a lower limit, if the cervical spine is changed in a pathological way, e.g. by preexisting diseases. 5. It is evident and important, that the difficult work of giving an expert's opinion on this field must be performed in an interdisciplinary collaboration of engineers for collision-analysis and physicians experienced in accident-traumatology. PMID:2669311

  5. Dysphagia Secondary to Anterior Osteophytes of the Cervical Spine.

    PubMed

    Egerter, Alexander C; Kim, Eric S; Lee, Darrin J; Liu, Jonathan J; Cadena, Gilbert; Panchal, Ripul R; Kim, Kee D

    2015-10-01

    Study Design Retrospective case series. Objective Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier disease involves hyperostosis of the spinal column. Hyperostosis involving the anterior margin of the cervical vertebrae can cause dysphonia, dyspnea, and/or dysphagia. However, the natural history pertaining to the risk factors remain unknown. We present the surgical management of two cases of dysphagia secondary to cervical hyperostosis and discuss the etiology and management of DISH based on the literature review. Methods This is a retrospective review of two patients with DISH and anterior cervical osteophytes. We reviewed the preoperative and postoperative images and clinical history. Results Two patients underwent anterior cervical osteophytectomies due to severe dysphagia. At more than a year follow-up, both patients noted improvement in swallowing as well as their associated pain. Conclusion The surgical removal of cervical osteophytes can be highly successful in treating dysphagia if refractory to prolonged conservative therapy. PMID:26430607

  6. Perioperative use of botulinum toxin for movement disorder-induced cervical spine disease.

    PubMed

    Adler, C H; Zimmerman, R S; Lyons, M K; Simeone, F; Brin, M F

    1996-01-01

    Patients with cervical dystonia or tics of the nuchal muscles can develop serious cervical spine disease. We report a series of four patients who received botulinum toxin injections to control their movement disorders prior to their required surgery. One patient with cervical tic-induced radiculomyelopathy required botulinum toxin injection postoperatively to facilitate stabilization of the cervical fusion. Two patients with torticollis-induced cervical radiculomyelopathy, and one patient with dystonia-induced C5 fracture, had botulinum toxin injected preoperatively to facilitate postoperative recovery. Botulinum toxin appears to be a useful adjunct in the treatment of cervical movement disorders prior to or following surgery for associated cervical spine disease.

  7. The transoral approach to the cervical spine.

    PubMed

    Morgan, S; Murphy, G

    1992-10-01

    The transoral surgical approach is useful for operating on structures at the base of the brain and the upper cervical spinal cord. For example, this route has been used for resecting spinal tumors and clipping vertebrobasilar aneurysms. In the past, this surgical approach was not advocated due to concerns about exposure and infection. However, the availability of the microscope, computed tomography, computed myelotomography, magnetic resonance imaging and intraoperative radiography as well as more effective techniques have improved the diagnosis of pathology of the craniovertebral junction and surgical performance. An understanding of the operative procedures involved with this approach assists the neuro-science nurse in preoperative teaching and anticipating potential postoperative complications. PMID:1402151

  8. Cervical spine abnormalities in institutionalized adults with Down's syndrome.

    PubMed

    MacLachlan, R A; Fidler, K E; Yeh, H; Hodgetts, P G; Pharand, G; Chau, M

    1993-06-01

    The prevalence of increased anterior atlanto-odontoid distance (AAOD), a risk factor for spinal cord compression, and degenerative disease of the cervical spine (DDCS) in a population of institutionalized adults with Down's syndrome (DS) was determined and compared with age- and sex-matched 'normals' presenting to a hospital emergency department. Radiographs of the cervical spines of 99 adults with DS and 198 'normals' were compared using a standardized rating scale. The prevalence of an AAOD of 3 mm or greater, the threshold of risk from the literature, was 8% for DS cases and 2% for controls (P < 0.01). The mean AAOD for DS cases was 2.0 +/- 1 mm and for controls 1.5 +/- 0.5 mm (P < 0.01). There was a negative correlation between AAOD and age of DS cases. The prevalence of any degree of DDCS among the DS cases was 64%, the controls 39% (P < 0.001); for moderate or severe DDCS the prevalence among DS cases was 45%, controls 12% (P < 0.001). The prevalence of DDCS increased with age in both groups, but the severity of DDCS was significantly increased with age in both groups, but the severity of DDCS was significantly greater for DS individuals in all age groups. The levels of the cervical spine affected ranged from C2 to C6; the most commonly affected level was C5-C6. While DS adults are at increased theoretical risk for spinal cord compression due to increased AAOD, its clinical significance would appear to be small and to decline with age.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. A Mathematical Model of the Cervical Spine Movement

    NASA Astrophysics Data System (ADS)

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

    2011-09-01

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

  10. Sensorimotor function of the cervical spine in healthy volunteers

    PubMed Central

    Artz, Neil J.; Adams, Michael A.; Dolan, Patricia

    2015-01-01

    Background Sensorimotor mechanisms are important for controlling head motion. However, relatively little is known about sensorimotor function in the cervical spine. This study investigated how age, gender and variations in the test conditions affect measures of position sense, movement sense and reflex activation in cervical muscles. Methods Forty healthy volunteers (19M/21F, aged 19–59 years) participated. Position sense was assessed by determining repositioning errors in upright and flexed neck postures during tests performed in 25%, 50% and 75% cervical flexion. Movement sense was assessed by detecting thresholds to passive flexion and extension at velocities between 1 and 25°s− 1. Reflexes were assessed by determining the latency and amplitude of reflex activation in trapezius and sternocleidomastoid muscles. Reliability was evaluated from intraclass correlation coefficients. Findings Mean repositioning errors ranged from 1.5° to 2.6°, were greater in flexed than upright postures (P = 0.006) and in people aged over 25 years (P = 0.05). Time to detect head motion decreased with increasing velocity (P < 0.001) and was lower during flexion than extension movements (P = 0.002). Reflexes demonstrated shorter latency (P < 0.001) and greater amplitude (P = 0.009) in trapezius compared to sternocleidomastoid, and became slower and weaker with age. None of the measures were influenced by gender. Reliability was good for movement sense measures, but was influenced by the test conditions when assessing position sense. Interpretation Increased repositioning errors and slower reflexes in older subjects suggest that sensorimotor function in the cervical spine becomes impaired with age. In position sense tests, reliability was influenced by the test conditions with mid-range flexion movements, performed in standing, providing the most reliable measurements. PMID:25686675

  11. Anatomical and functional perspectives of the cervical spine: Part III: the “unstable” cervical spine

    PubMed Central

    McGregor, Marion

    1990-01-01

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

  12. Assessment of neck pain and cervical mobility among female computer workers at Hail University.

    PubMed

    Mohammad, Walaa S; Hamza, Hayat H; ElSais, Walaa M

    2015-01-01

    The aims of this study were to investigate the prevalence of neck pain among computer workers at Hail University, Saudi Arabia and to compare the cervical range of motion (ROM) of female computer workers suffering from neck pain to the cervical ROM of healthy female computer workers. One hundred and seventy-six female volunteers between 20 and 46 years of age were investigated. Fifty-six of these volunteers were staff members, 22 were administrators and 98 were students. The Cervical Range of Motion (CROM) instrument was used to measure the ROM of the cervical spine. A questionnaire was used to assess participants for the presence of neck pain. The data were analyzed using the Statistical Package for Social Sciences (SPSS) software, and the level of significant was set at p < .05 for all statistical tests. There was a high prevalence of neck pain (75%) among computer workers at Hail University, particularly among students. There were significant differences in cervical lateral flexion, rotation to the right side and protraction range between the pain and pain-free groups. Our results demonstrated that cervical ROM measurements, particularly cervical lateral flexion, rotation and protraction, could be useful for predicting changes in head and neck posture after long-term computer work.

  13. Cervical Spondylotic Myelopathy due to the Ochronotic Arthropathy of the Cervical Spine

    PubMed Central

    Li, Nan; Yuan, Qiang; He, Da

    2016-01-01

    Ochronosis is a musculoskeletal manifestation of alkaptonuria, a rare hereditary metabolic disorder occurs due to the absence of homogentisic acid oxidase and leading to various systemic abnormalities related to deposition of homogentisic acid pigmentation (ochronotic pigmentation). The present case reports the clinical features, radiographic findings, treatments and results of a cervical spondylotic myelopathy woman patient due to the ochronotic arthropathy of the cervical spine. The patient aged 62 years was presented with gait disturbance and hand clumsiness. Physical examination, X-rays, computed tomography and lab results of the urine sample confirmed the presence of ochronosis with the involvement of the cervical spine. The patient underwent a modified cervical laminoplasty due to multi-segment spinal cord compression. The postoperative follow-up showed a good functional outcome with patient satisfaction. The present study concludes the conditions and important diagnostic and surgical aspects of a patient. It is necessary to identify the condition clinically and if cord compression is observed, appropriate surgical interventions needs to be instituted. PMID:26885289

  14. Incidence of cervical spine injury in patients with gunshot wounds to the head.

    PubMed

    Kennedy, F R; Gonzalez, P; Beitler, A; Sterling-Scott, R; Fleming, A W

    1994-06-01

    Cervical spine immobilization is standard during the early stages of prehospital and hospital care of patients with blunt head injury. However, the need for cervical spine immobilization in patients with gunshot wounds to the head has not been addressed. To determine the incidence and types of cervical spine injury in this group, we retrospectively examined the records of 308 consecutive patients who had computed tomographic (CT) scans of the head to evaluate brain injury after gunshot wounds. Of the 266 patients with data adequate for review, 157 (59%) had a complete lateral x-ray film of the cervical spine. Of these 157, 105 had wounds limited to the calvaria, and none had cervical spine injury. Of 52 patients with complete lateral x-ray films and wounds not limited to the calvaria, 5 (10%) had cervical spine or spinal cord injury. Of the 192 patients who had CT-proven intracranial injury, 86 (45%) required immediate intubation before x-ray films were obtained, and 67 (35%) died. We conclude that cervical spine immobilization may not be required during endotracheal intubation of brain-injured gunshot victims with wounds limited to the calvaria.

  15. Rugby union injuries to the cervical spine and spinal cord.

    PubMed

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

    2002-01-01

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

  16. Idiopathic scoliosis: the tethered spine II: post-surgical pain.

    PubMed

    Whyte Ferguson, Lucy

    2014-10-01

    The treatment of severe chronic pain in young people following surgery for the correction of curvatures of idiopathic scoliosis (IS) is presented through two case histories. Effective treatment involved release of myofascial trigger points (TrPs) known to refer pain into the spine, and treatment of related fascia and joint dysfunction. The TrPs found to be contributing to spinal area pain were located in muscles at some distance from the spine rather than in the paraspinal muscles. Referred pain from these TrPs apparently accounted for pain throughout the base of the neck and thoracolumbar spine. Exploratory surgery was considered for one patient to address pain following rod placement but the second surgery became unnecessary when the pain was controlled with treatment of the myofascial pain and joint dysfunction. The other individual had both scoliosis and hyperkyphosis, had undergone primary scoliosis surgery, and subsequently underwent a second surgery to remove hardware in an attempt to address her persistent pain following the initial surgery (and because of dislodged screws). The second surgery did not, however, reduce her pain. In both cases these individuals, with severe chronic pain following scoliosis corrective surgery, experienced a marked decrease of pain after myofascial treatment. As will be discussed below, despite the fact that a significant minority of individuals who have scoliosis corrective surgery are thought to require a second surgery, and despite the fact that pain is the most common reason leading to such revision surgery, myofascial pain syndrome (MPS) had apparently not previously been considered as a possible factor in their pain.

  17. Idiopathic scoliosis: the tethered spine II: post-surgical pain.

    PubMed

    Whyte Ferguson, Lucy

    2014-10-01

    The treatment of severe chronic pain in young people following surgery for the correction of curvatures of idiopathic scoliosis (IS) is presented through two case histories. Effective treatment involved release of myofascial trigger points (TrPs) known to refer pain into the spine, and treatment of related fascia and joint dysfunction. The TrPs found to be contributing to spinal area pain were located in muscles at some distance from the spine rather than in the paraspinal muscles. Referred pain from these TrPs apparently accounted for pain throughout the base of the neck and thoracolumbar spine. Exploratory surgery was considered for one patient to address pain following rod placement but the second surgery became unnecessary when the pain was controlled with treatment of the myofascial pain and joint dysfunction. The other individual had both scoliosis and hyperkyphosis, had undergone primary scoliosis surgery, and subsequently underwent a second surgery to remove hardware in an attempt to address her persistent pain following the initial surgery (and because of dislodged screws). The second surgery did not, however, reduce her pain. In both cases these individuals, with severe chronic pain following scoliosis corrective surgery, experienced a marked decrease of pain after myofascial treatment. As will be discussed below, despite the fact that a significant minority of individuals who have scoliosis corrective surgery are thought to require a second surgery, and despite the fact that pain is the most common reason leading to such revision surgery, myofascial pain syndrome (MPS) had apparently not previously been considered as a possible factor in their pain. PMID:25440198

  18. The cervical spine in patients with psoriatic arthritis: a clinical, radiological and immunogenetic study.

    PubMed Central

    Salvarani, C; Macchioni, P; Cremonesi, T; Mantovani, W; Battistel, B; Rossi, F; Capozzoli, N; Baricchi, R; Portioli, I

    1992-01-01

    The radiological changes of the cervical spine were evaluated in 57 patients with psoriatic arthritis and were correlated with clinical, radiological, and immunogenetic features of the disease. Forty patients (70%) showed radiological evidence of the cervical spine being affected by the disease. Two patterns of cervical spine abnormalities were noted. Fifteen patients (26%) had erosive and/or subluxing cervical rheumatoid like lesions; 25 patients (44%) had a more frequently reported pattern similar to ankylosing spondylitis. Although subaxial subluxations were the most frequently observed cervical abnormalities (53%) in the inflammatory subgroup, none of the patients studied had cord compression. Ankylosing cervical spine disease was the only form of axial involvement in nine (36%) of 25 patients with the ankylosing form of psoriatic arthritis. All of these patients had peripheral disease and were B27 negative. Predictors of cervical spine disease patterns were considered using clinical, demographic, and radiological features and HLA antigens. The results of a multivariate analysis showed that the best predictors of inflammatory cervical spine disease are the presence of HLA-B39 and HLA-DR4 antigens, radiocarpal erosions, and the absence of the HLA-DR5 antigen. PMID:1540041

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

    PubMed Central

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

    2009-01-01

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

  20. Maintenance of graft compression in the adult cervical spine.

    PubMed

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

    2006-08-01

    It is generally advised that the graft inserted in adult cervical spine should be pre-loaded with a compressive force or that the screws are inserted in a divergent orientation, in order to maximise compression and the chance of graft incorporation (Truumees et al. in Spine 28:1097-1102, 2003). However, there is little evidence that a compressive force is maintained once the force applicator has been removed, or that the divergent screws enhance compression. This study compared the maintenance of applied pre-load force, across cervical spine graft, between standard anterior plating technique with pre-load and divergent screws and a novel plate technique, which allows its application prior to removal of the force applicator. Six intact adult cadaveric human cervical spines were exposed by standard surgical technique. A Casper type distracter was inserted across the disc space of interest, the disc was removed. In 14 experiments, following the disc removal, an autologous iliac crest bone graft was inserted under distraction, together with a strain gauge pressure transducer. A resting output from the transducer was recorded. The voltage output has a linear relationship with compressive force. A standardised compressive force was applied across the graft through the "Casper type" distracter/compressor (7.5 kg, torque). The pre-load compressive force was measured using a torque drill. Then two different procedures were used in order to compare the final applied strain on the bone graft. In eight experiments (procedure 1), the "Casper type" distracter/compressor was removed and a standard anterior cervical plate with four divergent screws was inserted. In six experiments (procedure 2), a novel plate design was inserted prior to removal of the distracter/compressor, which is not possible with the standard plate design. A final compressive force across the graft was measured. For the standard plate construct (procedure 1), the applied compression force is significantly

  1. Chiropractic management of postoperative spine pain: a report of 3 cases

    PubMed Central

    Coulis, Christopher M.; Lisi, Anthony J.

    2013-01-01

    Objective The purpose of this case series is to describe chiropractic care including spinal manipulation for 3 patients with postsurgical spine pain. Clinical features Three patients with postsurgical spine pain (1 cervical fusion, 1 lumbar discectomy, and 1 lumbar laminectomy) presented for chiropractic treatment at a major US medical center. Treatment included spinal manipulation and/or flexion-distraction mobilization based on patient response to joint loading strategies. Intervention and outcomes Two patients were treated with high-velocity, low-amplitude spinal manipulation; and 1 patient was treated with flexion-distraction mobilization. Treatment frequency and duration were 4 treatments over 4 weeks for case 1, 17 treatments over 7 years for case 2, and 5 treatments over 5 weeks for case 3. Subjective improvement was noted using numeric pain scores and functional changes; and upon completion, the patients reported being “satisfied” with their overall outcome. One episode of transient benign soreness was noted by 1 patient. No additional adverse events or effects were noted. Conclusion In these 3 cases, patients with postsurgical spine pain responded positively to chiropractic care. Spinal manipulation/mobilization was tolerated without significant adverse effects. PMID:24396317

  2. Effects of Lateral Mass Screw Rod Fixation to the Stability of Cervical Spine after Laminectomy

    NASA Astrophysics Data System (ADS)

    Rosli, Ruwaida; Kashani, Jamal; Kadir, Mohammed Rafiq Abdul

    There are many cases of injury in the cervical spine due to degenerative disorder, trauma or instability. This condition may produce pressure on the spinal cord or on the nerve coming from the spine. The aim of this study was, to analyze the stabilization of the cervical spine after undergoing laminectomy via computational simulation. For that purpose, a three-dimensional finite element (FE) model for the multilevel cervical spine segment (C1-C7) was developed using computed tomography (CT) data. There are various decompression techniques that can be applied to overcome the injury. Usually, decompression procedures will create an unstable spine. Therefore, in these situations, the spine is often surgically restabilized by using fusion and instrumentation. In this study, a lateral mass screw-rod fixation was created to stabilize the cervical spine after laminectomy. Material properties of the titanium alloy were assigned on the implants. The requirements moments and boundary conditions were applied on simulated implanted bone. Result showed that the bone without implant has a higher flexion and extension angle in comparison to the bone with implant under applied 1Nm moment. The bone without implant has maximum stress distribution at the vertebrae and ligaments. However, the bone with implant has maximum stress distribution at the screws and rods. Overall, the lateral mass screw-rod fixation provides stability to the cervical spine after undergoing laminectomy.

  3. Endonasal access to the upper cervical spine, part one: radiographic morphometric analysis.

    PubMed

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

    2013-06-01

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

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

    PubMed Central

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

    2013-01-01

    Objectives To determine the anatomical relationships that may influence endonasal access to the upper cervical spine. Setting We retrospectively analyzed computed tomography of 100 patients at a single institution. Participants Participants included adults with imaging of the hard palate, clivus, and cervical spine without evidence of fracture, severe spondylosis, or previous instrumentation. Main Outcome Measures Morphometric analyses of hard palate length and both distance and angle between the hard palate and odontoid process were based on radiographic measurements. Descriptive zones were assigned to cervical spine levels, and endoscopic visualization was simulated with projected lines at 0, 30, and 45 degrees from the hard palate to the cervical spine. Results We found an inverse relationship between hard palate length and the lowest zone of the cervical spine potentially visualized by nasal endoscopy. The distance between the posterior tip of the hard palate and the odontoid tip, and the angle formed between the two, directly influenced the lowest possible cervical exposure. Conclusions Radiographic relationships between hard palate length, distance to the odontoid, and the angle formed between the two predict the limits of endonasal access to the cervical spine. These results are supported by cadaveric data in Part Two of this study. PMID:24436909

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

    PubMed Central

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

    2007-01-01

    A prospective study of 246 patients who received multimodal intraoperative monitoring during cervical spine surgery between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during cervical spine surgery. It is appreciated that complication rate of cervical spine surgery is low, however, there is a significant risk of neurological injury. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information and/or alert regarding any neurological changes during the operation to the surgeon. Intraoperative somatosensory spinal and cerebral evoked potentials combined with continuous EMG and motor-evoked potentials of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. A total of 246 consecutive patients with cervical pathologies, majority spinal stenosis due to degenerative changes of cervical spine were monitored by means of MIOM during the surgical procedure. About 232 patients presented true negative while 2 patients false negative responses. About ten patients presented true positive responses where neurological deficit after the operation was predicted and two patients presented false positive findings. The sensitivity of MIOM applied during cervical spine procedure (anterior and/or posterior) was 83.3% and specificity of 99.2%. MIOM is an effective method of monitoring the spinal cord functional integrity during cervical spine surgery and can help to reduce the risk of neurological deficit by alerting the surgeon when monitoring changes are observed. PMID:17610090

  6. Discal cysts of the cervical spine in two dogs

    PubMed Central

    Kang, Byung-Jae; Jung, Yechan; Park, Sangjun

    2015-01-01

    Discal cysts, which lie directly over intervertebral discs, are rare. Two old dogs with tetraparesis were referred to our facility. In both animals, magnetic resonance imaging revealed intraspinal extradural cystic mass lesions that were dorsal to degenerative intervertebral discs at the C3-C4 level. These lesions had low signal intensity on T1-weighted images, and high signal intensity on T2-weighted images. A ventral slot approach was used to perform surgical decompression, after which the symptoms improved remarkably. Discal cysts should be included in the differential diagnosis of dogs with cervical pain and tetraparesis. One effective treatment for discal cysts is surgical intervention. PMID:26040615

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

    PubMed

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

    2012-08-15

    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

  8. 78 FR 36306 - Proposed Information Collection (Neck (Cervical Spine) Conditions Disability Benefits...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ... Questionnaire) Activity: Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans... (Cervical Spine) Conditions Disability Benefits Questionnaire)'' in any correspondence. During the comment... Disability Benefits Questionnaire) Disability Benefits Questionnaire, VA Form 21-0960M-13. OMB Control...

  9. Cervical spine injury in children: a case report and literature review.

    PubMed

    Nebhani, Tahir; Bakkali, Hicham; Belyamani, Lahcen

    2015-01-01

    Traumatic injuries of the cervical spine are less common in children than in adults. But may be associated with significant disability and mortality. Pediatric victims of blunt trauma have mechanisms of injury, developmental and anatomic characteristics different than the adults. The purpose of this observation is to highlight the differences between the adult and pediatric cervical spine. We report below the case of spinal cord cut occurs to a very young girl after a motor vehicle accident. PMID:26161184

  10. Impact of morphine use in reducing the need for CT scan in patients with cervical spine trauma: a double blinded randomized clinical trial

    PubMed Central

    Sharifi, Mohammad Davood; Doloo, Hamid Zamani Moghadam; Hashemian, Amir Masoud; Tourghabe, Javad Tootian; Kakhki, Behrang Rezvani; Teimoori, Sasan Johari; Chokan, Niaz Mohammad Jafari; Noroozi, Hamid Reza

    2016-01-01

    Background Cervical spine trauma occurs mostly among young males due to falls and car accidents. The CT scan technology is replacing radiography in many medical clinics as it is very capable in detecting subtle cervical spine injuries. However, the use of CT scan for routine screening in patients with cervical spine trauma remains controversial due to its radiation risks and relatively high cost. Objective The focus of this research was on using morphine in patients with cervical spine trauma. The objective was to determine the ability of morphine to reduce the number of patients in need of CT scans. Methods This double-blinded randomized clinical trial study was conducted from April 2014 to March 2015 in Hasheminejad Hospital in Mashhad, Iran. We enrolled 67 patients with cervical spine trauma and normal radiography in the study. They were divided randomly into two groups (groups A and B), where group A received intravenous morphine, and group B received a placebo. We measured the pain scores in both groups before giving the medication and 10 minutes afterwards using a visual analog scale (VAS). Results As a result of receiving morphine, the patients in group A had significantly lower pain than group B (p-value < 0.001). The average pain score in group A was reduced by 43% versus 23% in group B. However, the most pain reduction was in those in group A with a normal CT scan. The pain score of these patients dropped by 52%. Conclusions The findings of this study suggest that patients with a normal radiography may be discharged with a cervical collar without a need for a CT scan if morphine reduces their pain. This is because the pain in these patients stem from the muscles and non-bony structures in the cervical spine area. Clinical trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2013100214872N1 Funding The authors received no financial support for the research or for the publication

  11. Airway Preparation Techniques for the Cervical Spine-Injured Football Player

    PubMed Central

    Ray, Richard; Luchies, Carl; Bazuin, Doug; Farrell, Robert N.

    1995-01-01

    Athletic health care professionals have been concerned about how to optimize the emergency care the cervical spine-injured football player receives on the field. Much of the discussion has centered on how to best expose and prepare the airway for rescue breathing in the quickest and safest manner possible. This study compared the time required and the extraneous motion induced at the cervical spine during three traditional and one new airway exposure and preparation technique. Twelve subjects wearing football helmets and shoulder pads were exposed to multiple trials of airway exposure via face mask repositioning using a manual screwdriver, power screwdriver, and the Trainer's Angel cutting device. Subjects also underwent airway preparation using the pocket mask insertion technique. Cervical spine motion was measured in two dimensions using an optoelectronic motion analysis system. Time and qualitative assessment were obtained through videotape analysis. Significant differences were found between the techniques with respect to time and cervical spine motion. The pocket mask allowed quicker activation of rescue breathing than the other three traditional techniques. There was no significant difference in the amount of extraneous motion induced at the cervical spine between the pocket mask, manual screwdriver, and power screwdriver techniques. The Trainer's Angel induced significantly more motion than the other three techniques in each of the four motions measured. Changes in traditional protocols used to treat cervical spine-injured football players on the field are recommended based on these data. ImagesFig 1.Fig 2. PMID:16558339

  12. Cervical spine geometry in the automotive seated posture: variations with age, stature, and gender.

    PubMed

    Desantis Klinich, Kathleen; Ebert, Sheila M; Van Ee, Chris A; Flannagan, Carol A C; Prasad, Monica; Reed, Matthew P; Schneider, Lawrence W

    2004-11-01

    In the mid 1970s, UMTRI investigated the biomechanical properties of the head and neck using 180 "normal" adult subjects selected to fill eighteen subject groups based on age (young, mid-aged, older), gender, and stature (short, medium, and tall by gender). Lateral-view radiographs of the subjects' cervical spines and heads were taken with the subjects seated in a simulated automotive neutral posture, as well as with their necks in full-voluntary flexion and full-voluntary extension. Although the cervical spine and lower head geometry were previously measured manually and documented, new technologies have enabled computer digitization of the scanned x-ray images and a more comprehensive and detailed analysis of the variation in cervical spine and lower head geometry with subject age, stature, and gender. After scanning the radiographic images, 108 skeletal landmarks on the cervical vertebrae and 10 head landmarks were digitized. The resulting database of cervical spine and head geometry was used to study cervical spine curvature, vertebral dimensions, and head/neck orientation as functions of age, gender, and stature. The data were used to characterize neutral posture cervical spine curvatures using two methods: a curvature index and Bézier spline functions. Lateral-view vertebral dimensions were also calculated for each subject, and a cascading series of equations was developed to estimate vertebral size and shape for a selected age, stature, and gender. The orientation of the cervical spine was defined using a neck chord angle, where the neck chord was varied to use different anatomical landmarks and estimates of joint centers for the top and bottom of the neck chord. Results from the study have been incorporated into a MS-Access based software package that allows researchers and modelers to generate cervical spine geometries for occupants of a specified age, gender, and stature. The program allows selection of individual occupants from the database that meet

  13. Effective Spine Triage: Patterns of Pain

    PubMed Central

    Hall, Hamilton

    2014-01-01

    Background The most common cause of recurring lost time from work, low back pain is a huge burden on society. Medical training dictates that we must establish a cause for pain before we can treat it and then base our treatment on a recognized and agreed-upon pathology. But in the overwhelming majority of low back pain cases, the issue is nothing more than a minor mechanical malfunction, the inevitable consequence of normal wear and tear. The severity of the pain does not reflect the benign nature of the underlying problem and its limited extent makes a definitive diagnosis impossible. One important component of the solution is improved spinal triage. Using patterns or syndromes in the initial assessment of low back pain is gaining renewed interest and clinical acceptance. Methods Identifying a patient's pain pattern is achieved primarily through an assessment of the patient's history. The patient interview begins with a series of questions to determine the specific syndrome. A subsequent physical examination supports or refutes the findings in history. Combining information from the history with the findings of the physical examination, the clinician has the ability to rule out a number of potentially grim diagnoses. Results More than 90% of back pain patients have benign mechanical problems and their pain can be classified into 4 distinct patterns: 2 back-dominant patterns and 2 leg-dominant patterns. Conclusion A clinical perspective capable of recognizing a defined syndrome at first contact will lead to a better outcome. Most patients with low back pain can be treated successfully with simple, pattern-specific, noninvasive primary management. Patients without a pattern and those who do not respond as anticipated require further investigation and specialized care. PMID:24688339

  14. Oropharyngeal Dysphagia after Anterior Cervical Spine Surgery: A Review

    PubMed Central

    Anderson, Karen K.; Arnold, Paul M.

    2013-01-01

    Study Design Review. Objective Postoperative oropharyngeal dysphagia is one of the most common complications following anterior cervical spine surgery (ACSS). We review and summarize recent literature in order to provide a general overview of clinical signs and symptoms, assessment, incidence and natural history, pathophysiology, risk factors, treatment, prevention, and topics for future research. Methods A search of English literature regarding dysphagia following anterior cervical spine surgery was conducted using PubMed and Google Scholar. The search was focused on articles published since the last review on this topic was published in 2005. Results Patients who develop dysphagia after ACSS show significant alterations in swallowing biomechanics. Patient history, physical examination, X-ray, direct or indirect laryngoscopy, and videoradiographic swallow evaluation are considered the primary modalities for evaluating oropharyngeal dysphagia. There is no universally accepted objective instrument for assessing dysphagia after ACSS, but the most widely used instrument is the Bazaz Dysphagia Score. Because dysphagia is a subjective sensation, patient-reported instruments appear to be more clinically relevant and more effective in identifying dysfunction. The causes of oropharyngeal dysphagia after ACSS are multifactorial, involving neuronal, muscular, and mucosal structures. The condition is usually transient, most often beginning in the immediate postoperative period but sometimes beginning more than 1 month after surgery. The incidence of dysphagia within one week after ACSS varies from 1 to 79% in the literature. This wide variance can be attributed to variations in surgical techniques, extent of surgery, and size of the implant used, as well as variations in definitions and measurements of dysphagia, time intervals of postoperative evaluations, and relatively small sample sizes used in published studies. The factors most commonly associated with an

  15. A review of functional outcome measures for cervical spine disorders: literature review

    PubMed Central

    Bussières, André

    1994-01-01

    The purpose of this paper is to assess the reliability, validity and usefulness of three outcome measures: cervical ranges of motion, sagittal neck muscle strength and presence or absence of the flexion relaxation phenomenon (FRP) in the neck. The literature search included the Index Medicus and computerized database of MEDLINE for relevant material. Articles were selected if they contained primary data on neck range of motion, sagittal muscle strength and FRP. The results of 59 articles and 2 textbooks were analyzed. Normative values of cervical ROM have been reported in healthy subjects ranging in age from 18 to 74 years. The extent of degrees of motion lost per year did not differ between male or female subjects, but females started with higher degrees of active range of motion, which they maintained throughout life. Instrumented methods of recording muscle strength have included strain gauge dynamometers and modified sphygmomanometers. Parameters such as gender, age and stature were also observed to have important effects on muscle strength. The ratio of extension to flexion maximum isometric peak force has been estimated to range between 1.40-1.70 in normal subjects. Therefore, the extensor muscles of the neck are approximately 40% stronger then the neck flexor muscles. Evidence suggested that neck pain sufferers have weaker neck flexors than normal subjects. The FRP refers to the absence of myoelectrical activity in extensor muscles upon full forward flexion and has been documented in the cervical spine of asymptomatic subjects. In conclusion, inclinometric methods used for measurements of cervical range of motion were found to be safe, effective and reliable. The Cervical Range of Motion Device appeared to be well suited for clinical practice. The ratio of cervical extension-flexion maximum isometric voluntary contraction has been determined in asymptomatic subjects. The presence of the FRP in the neck has also been observed in normals. Future study is

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

    SciTech Connect

    Safriel, Yair Ang, Roberto; Ali, Muhammed

    2008-03-15

    Introduction. To review the safety and efficacy of gadolinium in spine pain management procedures in patients at high risk for a contrast reaction and who are not suitable candidates for the use of standard non-ionic contrast. Methods. We reviewed records over a 61-month period of all image-guided spinal pain management procedures where patients had allergies making them unsuitable candidates for standard non-ionic contrast and where gadolinium was used to confirm needle tip placement prior to injection of medication. Results. Three hundred and four outpatients underwent 527 procedures. A spinal needle was used in all but 41 procedures. Gadolinium was visualized using portable C-arm fluoroscopy in vivo allowing for confirmation of needle tip location. The gadolinium dose ranged from 0.2 to 10 ml per level. The highest dose received by one patient was 15.83 ml intradiscally during a three-level discogram. Three hundred and one patients were discharged without complication or known delayed complications. One patient had documented intrathecal injection but without sequelae and 2 patients who underwent cervical procedures experienced seizures requiring admission to the intensive care unit. Both the latter patients were discharged without any further complications. Conclusion. Based on our experience we recommend using gadolinium judiciously for needle tip confirmation. We feel more confident using gadolinium in the lumbar spine and in cervical nerve blocks. Gadolinium should probably not be used as an injectate volume expander. The indications for gadolinium use in cervical needle-guided spine procedures are less clear and use of a blunt-tipped needle should be considered.

  17. Variation in emergency department use of cervical spine radiography for alert, stable trauma patients

    PubMed Central

    Stiell, I G; Wells, G A; Vandemheen, K; Laupacis, A; Brison, R; Eisenhauer, M A; Greenberg, G H; MacPhail, I; McKnight, R D; Reardon, M; Verbeek, R; Worthington, J; Lesiuk, H

    1997-01-01

    OBJECTIVE: To, assess the emergency department use of cervical spine radiography for alert, stable adult trauma patients in terms of utilization, yield for injury and variation in practices among hospitals and physicians. DESIGN: Retrospective survey of health records. SETTING: Emergency departments of 6 teaching and 2 community hospitals in Ontario and British Columbia. PATIENTS: Consecutive alert, stable adult trauma patients seen with potential cervical spine injury between July 1, 1994, and June 30, 1995. MAIN OUTCOME MEASURES: Total number of eligible patients, referral for cervical spine radiography (overall, by hospital and by physician), presence of cervical spine injury, patient characteristics and hospitals associated with use of radiography. RESULTS: Of 6855 eligible patients, cervical spine radiography was ordered for 3979 (58.0%). Only 60 (0.9%) patients were found to have an acute cervical spine injury (fracture, dislocation or ligamentous instability); 98.5% of the radiographic films were negative for any significant abnormality. The demographic and clinical characteristics of the patients were similar across the 8 hospitals, and no cervical spine injuries were missed. Significant variation was found among the 8 hospitals in the rate of ordering radiography (p < 0.0001), from a low of 37.0% to a high of 72.5%. After possible differences in case severity and patient characteristics at each hospital were controlled for, logistic regression analysis revealed that 6 of the hospitals were significantly associated with the use of radiography. At 7 hospitals, there was significant variation in the rate of ordering radiography among the attending emergency physicians (p < 0.05), from a low of 15.6% to a high of 91.5%. CONCLUSIONS: Despite considerable variation among institutions and individual physicians in the ordering of cervical spine radiography for alert, stable trauma patients with similar characteristics, no cervical spine injuries were missed. The

  18. A 73-Year-Old Male with Cervical Spine Osteomyelitis Presenting as Urosepsis

    PubMed Central

    Kakarlapudi, H.; Speirs, S.; Lal, A.P.; Alaie, D.; Petrillo, R.; Ashraf, M.B.; Kolanuvada, B.; Bhargava, M.

    2015-01-01

    Vertebral osteomyelitis is a serious debilitating infection if not detected early. Involvement of cervical vertebrae is usually seen in the presence of specific risk factors. Urinary tract infection commonly spreads to the lumbar vertebrae. This is a case presentation of an elderly male who, in the absence of specific risk factors for cervical osteomyelitis, presented with symptoms of urinary tract infection and was found to have cervical spine osteomyelitis. PMID:26715867

  19. Mandible, maxilla and cervical spine--a functional unit?

    PubMed

    Kubein-Meesenburg, D; Thieme, K M; Weber, S; Fanghanel, J; Dumont, C; Spassov, A; Hahn, W; Ihlow, D; Nagerl, H

    2008-11-01

    The motion patterns of mandibular points were recorded in vivo in closed, free movements of the mandible parallel to the sagittal-vertical plane. The points ran along loops which were valued by their area and length. All points whose loops included the same area under regarding the sense of circulation formed a straight line. Lines belonging to different areas were parallel. When the absolute areas of the oops were plotted for particular points a hollow depression with two minima resulted. The point that showed the lowest minimum in the depression corresponded to the position of the neuromuscular mandibular axis of rotation. The points running along equal loop lengths formed elliptical lines with a minimum below the condyle. The lines of constant loop area and loop length were overlaid with lateral radiographs, to match the patterns of motion with anatomical structures. The mandibular axis of rotation lay mostly cranial anterior of the condyle whereas the point with the shortest path lay mainly below this axis point, inside the bony structures. The row of teeth in the maxilla was found to be located below the line of minimal loop lengths. The cervical spine was arranged along the depression of the minimal absolute areas. PMID:19075327

  20. Laminar screw fixation in the subaxial cervical spine: A report on three cases

    PubMed Central

    Tanabe, Hironori; Aota, Yoichi; Saito, Tomoyuki

    2016-01-01

    Although laminar screw fixation is often used at the C2 and C7 levels, only few previous case reports have presented the use of laminar screws at the C3-C6 levels. Here, we report a novel fixation method involving the use of practical laminar screws in the subaxial spine. We used laminar screws in the subaxial cervical spine in two cases to prevent vertebral artery injury and in one case to minimize exposure of the lamina. This laminar screw technique was successful in all three cases with adequate spinal rigidity, which was achieved without complications. The use of laminar screws in the subaxial cervical spine is a useful option for posterior fusion of the cervical spine. PMID:27795952

  1. National trends in outpatient surgical treatment of degenerative cervical spine disease.

    PubMed

    Baird, Evan O; Egorova, Natalia N; McAnany, Steven J; Qureshi, Sheeraz A; Hecht, Andrew C; Cho, Samuel K

    2014-08-01

    Study Design Retrospective population-based observational study. Objective To assess the growth of cervical spine surgery performed in an outpatient setting. Methods A retrospective study was conducted using the United States Healthcare Cost and Utilization Project's State Inpatient and Ambulatory Surgery Databases for California, New York, Florida, and Maryland from 2005 to 2009. Current Procedural Terminology, fourth revision (CPT-4) and International Classification of Diseases, ninth revision Clinical Modification (ICD-9-CM) codes were used to identify operations for degenerative cervical spine diseases in adults (age > 20 years). Disposition and complication rates were examined. Results There was an increase in cervical spine surgeries performed in an ambulatory setting during the study period. Anterior cervical diskectomy and fusion accounted for 68% of outpatient procedures; posterior decompression made up 21%. Younger patients predominantly underwent anterior fusion procedures, and patients in the eighth and ninth decades of life had more posterior decompressions. Charlson comorbidity index and complication rates were substantially lower for ambulatory cases when compared with inpatients. The majority (>99%) of patients were discharged home following ambulatory surgery. Conclusions Recently, the number of cervical spine surgeries has increased in general, and more of these procedures are being performed in an ambulatory setting. The majority (>99%) of patients are discharged home but the nature of analyzing administrative data limits accurate assessment of postoperative complications and thus patient safety. This increase in outpatient cervical spine surgery necessitates further discussion of its safety.

  2. Severe Scapular Pain Following Unintentional Cervical Epidural Air Injection.

    PubMed

    Henthorn, Randall W; Murray, Kerra

    2016-03-01

    This a unique case of severe scapular pain following unintentional epidural space air injection during epidural steroid injection.A 70-year-old woman presented for a fluoroscopically guided C7-T1 interlaminar epidural steroid injection. Three injection attempts were made using the loss of resistance with air technique. On the first attempt the epidural space was entered, but contrast injection showed that the needle was intravenous. On the second attempt an equivocal loss of resistance with air was perceived and 5 mL of air was lost from the syringe. The needle was withdrawn and redirected, and upon the third needle passage the contrast injection showed appropriate epidural space filling up to the C4-5 level. Injection of betamethasone mixed in lidocaine was initially uneventful.However, 20 minutes post-injection the patient experienced sudden sharp and continuous pain along the medial edge of the scapula. After failing to respond to multiple intravascular analgesics, the patient was transferred to the emergency room. Her pain subsided completely following an intravenous diazepam injection. Cervical spine computerized tomography showed obvious air in the posterior epidural space from C4-5 to C6-7 as well as outside the spinal canal from (C4-T2). Having recovered fully, she was discharged the following morning. In reviewing the procedure, the equivocal loss of resistance on the second passage was actually a true loss of resistance to epidural space and air was unintentionally injected. Surprisingly, severe scapular pain resulted in a delayed manner after the steroid solution was injected. The authors theorize that unintentional prefilling of the epidural space with air prior to the injection of the subsequent steroid mixture added sufficient pressure to the epidural space to cause right-sided C4 nerve root stretching/entrapment and ensuing radicular pain to the right scapular border. The subsequent intravenous diazepam provided cervical muscle relaxation and

  3. Operative stabilization of the remaining mobile segment in ankylosed cervical spine in systemic onset - juvenile idiopathic arthritis: A case report

    PubMed Central

    Suhodolčan, Lovro; Mihelak, Marko; Brecelj, Janez; Vengust, Rok

    2016-01-01

    We describe a case of a 19-year-old young man with oligoarthritis type of juvenile idiopathic arthritis, who presented with several month duration of lower neck pain and progressive muscular weakness of all four limbs. X-rays of the cervical spine demonstrated spontaneous apophyseal joint fusion from the occipital condyle to C6 and from C7 to Th2 with marked instability between C6 and C7. Surgical intervention began with anterolateral approach to the cervical spine performing decompression, insertion of cage and anterior vertebral plate and screws, followed by posterior approach and fixation. Care was taken to restore sagittal balance. The condition was successfully operatively managed with multisegmental, both column fixation and fusion, resulting in pain cessation and resolution of myelopathy. Postoperatively, minor swallowing difficulties were noted, which ceased after three days. Patient was able to move around in a wheelchair on the sixth postoperative day. Stiff neck collar was advised for three months postoperatively with neck pain slowly decreasing in the course of first postoperative month. On the follow-up visit six months after the surgery patient exhibited no signs of spastic tetraparesis, X-rays of the cervical spine revealed solid bony fusion at single mobile segment C6-C7. He was able to gaze horizontally while sitting in a wheelchair. Signs of myelopathy with stiff neck and single movable segment raised concerns about intubation, but were successfully managed using awake fiber-optic intubation. Avoidance of tracheostomy enabled us to perform an anterolateral approach without increasing the risk of wound infection. Regarding surgical procedure, the same principles are obeyed as in management of fracture in ankylosing spondylitis or Mb. Forestrier. PMID:27458558

  4. Operative stabilization of the remaining mobile segment in ankylosed cervical spine in systemic onset - juvenile idiopathic arthritis: A case report.

    PubMed

    Suhodolčan, Lovro; Mihelak, Marko; Brecelj, Janez; Vengust, Rok

    2016-07-18

    We describe a case of a 19-year-old young man with oligoarthritis type of juvenile idiopathic arthritis, who presented with several month duration of lower neck pain and progressive muscular weakness of all four limbs. X-rays of the cervical spine demonstrated spontaneous apophyseal joint fusion from the occipital condyle to C6 and from C7 to Th2 with marked instability between C6 and C7. Surgical intervention began with anterolateral approach to the cervical spine performing decompression, insertion of cage and anterior vertebral plate and screws, followed by posterior approach and fixation. Care was taken to restore sagittal balance. The condition was successfully operatively managed with multisegmental, both column fixation and fusion, resulting in pain cessation and resolution of myelopathy. Postoperatively, minor swallowing difficulties were noted, which ceased after three days. Patient was able to move around in a wheelchair on the sixth postoperative day. Stiff neck collar was advised for three months postoperatively with neck pain slowly decreasing in the course of first postoperative month. On the follow-up visit six months after the surgery patient exhibited no signs of spastic tetraparesis, X-rays of the cervical spine revealed solid bony fusion at single mobile segment C6-C7. He was able to gaze horizontally while sitting in a wheelchair. Signs of myelopathy with stiff neck and single movable segment raised concerns about intubation, but were successfully managed using awake fiber-optic intubation. Avoidance of tracheostomy enabled us to perform an anterolateral approach without increasing the risk of wound infection. Regarding surgical procedure, the same principles are obeyed as in management of fracture in ankylosing spondylitis or Mb. Forestrier. PMID:27458558

  5. Motion analysis study on sensitivity of finite element model of the cervical spine to geometry.

    PubMed

    Zafarparandeh, Iman; Erbulut, Deniz U; Ozer, Ali F

    2016-07-01

    Numerous finite element models of the cervical spine have been proposed, with exact geometry or with symmetric approximation in the geometry. However, few researches have investigated the sensitivity of predicted motion responses to the geometry of the cervical spine. The goal of this study was to evaluate the effect of symmetric assumption on the predicted motion by finite element model of the cervical spine. We developed two finite element models of the cervical spine C2-C7. One model was based on the exact geometry of the cervical spine (asymmetric model), whereas the other was symmetric (symmetric model) about the mid-sagittal plane. The predicted range of motion of both models-main and coupled motions-was compared with published experimental data for all motion planes under a full range of loads. The maximum differences between the asymmetric model and symmetric model predictions for the principal motion were 31%, 78%, and 126% for flexion-extension, right-left lateral bending, and right-left axial rotation, respectively. For flexion-extension and lateral bending, the minimum difference was 0%, whereas it was 2% for axial rotation. The maximum coupled motions predicted by the symmetric model were 1.5° axial rotation and 3.6° lateral bending, under applied lateral bending and axial rotation, respectively. Those coupled motions predicted by the asymmetric model were 1.6° axial rotation and 4° lateral bending, under applied lateral bending and axial rotation, respectively. In general, the predicted motion response of the cervical spine by the symmetric model was in the acceptable range and nonlinearity of the moment-rotation curve for the cervical spine was properly predicted.

  6. On the creation of a segmentation library for digitized cervical and lumbar spine radiographs.

    PubMed

    Gururajan, Arunkumar; Kamalakannan, Sridharan; Sari-Sarraf, Hamed; Shahriar, Muneem; Long, Rodney; Antani, Sameer

    2011-06-01

    In this paper, we address the issue of computer-assisted indexing in one specific case, i.e., for the 17,000 digitized images of the spine acquired during the National Health and Nutrition Examination Survey (NHANES). The crucial step in this process is to accurately segment the cervical and lumbar spine in the radiographic images. To that end, we have implemented a unique segmentation system that consists of a suite of spine-customized automatic and semi-automatic statistical shape segmentation algorithms. Using the aforementioned system, we have developed experiments to optimally generate a library of spine segmentations, which currently include 2000 cervical and 2000 lumbar spines. This work is expected to contribute toward the creation of a biomedical Content-Based Image Retrieval system that will allow retrieval of vertebral shapes by using query by image example or query by shape example.

  7. Minimally invasive posterior cervical microforaminotomy in the lower cervical spine and C-T junction assisted by O-arm-based navigation.

    PubMed

    Del Curto, David; Kim, Jin-Sung; Lee, Sang-Ho

    2013-01-01

    Navigated posterior cervical microforaminotomy (PCM) is a promising minimally invasive technique for treating radiculopathy caused by lateral disc herniations and foraminal stenosis. Between December 2009 and October 2010, 14 patients with unilateral foraminal disc herniations or foraminal stenosis at the C6-7 or C7-T1 level underwent PCM assisted by O-arm navigation using the METRx tubular retractor. The main symptoms were radicular arm pain with no significant neck pain. Successful relief of radicular pain was achieved in all 14 patients. Two of the patients were lost during follow-up, and three had to undergo further decompression due to remnant foraminal stenosis being discovered on intraoperative O-arm images. There were no cases of instability or recurrence, and the only complication observed was a dural tear in one patient, which was adequately treated with fibrin glue and bed rest. The duration of symptoms was 4.5 months on average. The mean operation time was 136 minutes, with the additional time required for the image guided surgery assisted by O-arm-based navigation being approximately 28 minutes on average. There were no other complications during the surgical procedure or in the immediate postoperative period. Posterior cervical microforaminotomy assisted by O-arm-based navigation is a safe, effective and minimally invasive procedure for the treatment of lateral disc herniations and foraminal stenosis of the lower cervical spine and C-T junction, offering the possibility of an accurate decompression with a reduced risk of segmental instability.

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

    PubMed

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

    2012-03-01

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

  9. In-vivo Kinematics of the Cervical Spine in Frontal Sled Tests

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2004-07-01

    The objective of this study was to compare onset of deep and superficial cervical flexor muscle activity during rapid, unilateral arm movements between ten patients with chronic neck pain and 12 control subjects. Deep cervical flexor (DCF) electromyographic activity (EMG) was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the sternocleidomastoid (SCM) and anterior scalene (AS) muscles. While standing, subjects flexed and extended the right arm in response to a visual stimulus. For the control group, activation of DCF, SCM and AS muscles occurred less than 50 ms after the onset of deltoid activity, which is consistent with feedforward control of the neck during arm flexion and extension. When subjects with a history of neck pain flexed the arm, the onsets of DCF and contralateral SCM and AS muscles were significantly delayed ( p<0.05). It is concluded that the delay in neck muscle activity associated with movement of the arm in patients with neck pain indicates a significant deficit in the automatic feedforward control of the cervical spine. As the deep cervical muscles are fundamentally important for support of the cervical lordosis and the cervical joints, change in the feedforward response may leave the cervical spine vulnerable to reactive forces from arm movement.

  11. Length of the cervical spine as a factor in the etiology of cleft palate.

    PubMed

    Smahĕl, Z; Skvarilová, B

    1993-05-01

    The length of the cervical spine in a series of 206 adult males with cleft lip and/or palate and 50 normal controls was measured. The patients were divided into five subgroups according to the type and extent of the cleft. The shortening of the spine was most marked in bilateral cleft lip and palate patients (complete), less marked in unilateral cleft lip and palate patients, and was slight in isolated cleft palate patients. Complete isolated cleft palate and cleft lip was not associated with a shortening of the spine. A shortening of the cervical spine in less extensive types of isolated cleft palate was suggestive of the participation of the spine in their development, while in cleft lip and palate a simultaneous exposure to a teratogenic agent or any other developmental error during early stages of embryogenesis could explain the concomitant occurrence of spine anomalies. Patients with cleft lip and palate associated with a short spine also had a shorter mandibular ramus, which could be suggestive of simultaneous damage to both structures during morphogenesis. This relationship was not demonstrated in isolated cleft palate that developed in later stages of embryogenesis. In these cases a short spine itself could not have impaired the growth potential of the mandible, yet it could have mechanically induced the development of cleft palate. These observations are in agreement with the present state of knowledge on the development of orofacial clefts as shown in experimental animals.

  12. Range of motion and cervical myofascial pain.

    PubMed

    Wilke, J; Niederer, D; Fleckenstein, J; Vogt, L; Banzer, W

    2016-01-01

    Several studies investigating myofascial pain syndrome include assessments of range of motion (ROM) as a diagnostic criterion. However, the value of ROM in this context has not yet been evaluated in controlled clinical studies. We aimed to examine whether patients with myofascial pain syndrome display alterations of ROM when compared to healthy subjects. Twenty-two individuals (13 females, 9 males; aged 33.4 ± 13.9 yrs) afflicted with active myofascial trigger points in the upper trapezius muscle as well as 22 age and sex matched healthy controls were included. All subjects underwent an examination of maximal active cervical ROM in flexion/extension assessed by means of a 3D ultrasonic movement analysis system (30 Hz; Zebris CMS 70). In the patients group, pressure pain threshold (PPT) of the trigger points was determined using a pressure algometer. Maximum range of motion in the sagittal plane did not differ between individuals with MTrP (125.9 ± 23.2°, 95% CI: 116.2-135.6°) and asymptomatic subjects (128.2 ± 20.4°, 95% CI: 119.7-136.7°; p > .05). In patients, PPT (1.7 ± .6, 95% CI: 1.5-1.9) was not correlated with cervical mobility (r = -.13; p > .05). Based on these pilot data, range of motion in flexion/extension is not a valid criterion for the detection of myofascial trigger points. Additional research incorporating movement amplitudes in other anatomical planes and additional afflicted muscles should be conducted in order to further delineate the relative impact of MTrP on range of motion.

  13. Anatomic Study of Anterior Transdiscal Axial Screw Fixation for Subaxial Cervical Spine Injuries

    PubMed Central

    Ji, Wei; Zheng, Minghui; Qu, Dongbin; Zou, Lin; Chen, Yongquan; Chen, Jianting; Zhu, Qingan

    2016-01-01

    Abstract Anterior transdiscal axial screw (ATAS) fixation is an alternative or supplement to the plate and screw constructs for the upper cervical spine injury. However, no existing literatures clarified the anatomic feasibility of this technique for subaxial cervical spine. Therefore, the objective of this study was to evaluate the anatomical feasibility and to establish guidelines for the use of the ATAS fixation for the subaxial cervical spine injury. Fifty normal cervical spines had radiographs to determine the proposed screw trajectory (the screw length and insertion angle) and the interbody graft-related parameters (the disc height and depth, and the distance between anterior vertebral margin and the screw) for all levels of the subaxial cervical spine. Following screw insertion in 8 preserved human cadaver specimens, surgical simulation and dissection verified the feasibility and safety of the ATAS fixation. Radiographic measurements showed the mean axial screw length and cephalic incline angle of all levels were 41.2 mm and 25.2°, respectively. The suitable depth of the interbody graft was >11.7 mm (the distance between anterior vertebral margin and the screw), but <17.1 mm (disc depth). Except the axial screw length, increase in all the measurements was seen with level up to C5–C6 segment. Simulated procedure in the preserved specimens demonstrated that ATAS fixation could be successfully performed at C2–C3, C3–C4, C4–C5, and C5–C6 levels, but impossible at C6–C7 due to the obstacle of the sternum. All screws were placed accurately. None of the screws penetrated into the spinal canal and caused fractures determined by dissecting the specimens. The anterior transdiscal axial screw fixation, as an alternative or supplementary instrumentation for subaxial cervical spine injuries, is feasible and safe with meticulous surgical planning. PMID:27495016

  14. A systematic review of the use of expandable cages in the cervical spine.

    PubMed

    Elder, Benjamin D; Lo, Sheng-Fu; Kosztowski, Thomas A; Goodwin, C Rory; Lina, Ioan A; Locke, John E; Witham, Timothy F

    2016-01-01

    Expandable vertebral body replacement cages (VBRs) have been widely used for reconstruction of the thoracolumbar spine following corpectomy. However, their use in the cervical spine is less common, and currently, no expandable cages on the market are cleared or approved by the US Food and Drug Administration for use in the cervical spine. The objective of this study was to perform a systematic review on the use of expandable cages in the treatment of cervical spine pathology with a focus on fusion rates, deformity correction, complications, and indications. A comprehensive Medline search was performed, and 24 applicable articles were identified and included in this review. The advantages of expandable cages include greater ease of implantation with less risk of damage to the end plate, less intraoperative manipulation of the device, and potentially greater control over lordosis. They may be particularly advantageous in cases with poor bone quality, such as patients with osteoporosis or metastatic tumors that have been radiated. However, there is a potential risk of overdistraction, which is increased in the cervical spine, their minimum height limits their use in cases with collapsed vertebra, and the amount of hardware in the expansion mechanism may limit the surface area available for fusion. The use of expandable VBRs are a valuable tool in the armamentarium for reconstruction of the anterior column of the cervical spine with an acceptable safety profile. Although expandable cervical cages are clearly beneficial in certain clinical situations, widespread use following all corpectomies is not justified due to their significantly greater cost compared to structural bone grafts or non-expandable VBRs, which can be utilized to achieve similar clinical outcomes. PMID:26212700

  15. Tertiary Syphilis in the Cervical Spine: A Case Report and Review of the Literature

    PubMed Central

    Salem, K. M. I.; Majeed, H.; Bommireddy, R.; Klezl, Z.

    2012-01-01

    As the prevalence of syphilis rises, an increase in tertiary syphilis with spinal involvement is predicted. We report what we believe to be the first case of compressive cervical spine syphilitic gummata, with central cord compression signs. We also review the relevant literature to date. The diagnosis of syphilis in the spine relies on the physician to be aware of it as part of the differential diagnosis. Treponemal laboratory tests are an important aid in establishing a diagnosis. PMID:24436850

  16. A Female Ligamentous Cervical Spine Finite Element Model Validated for Physiological Loads.

    PubMed

    Östh, Jonas; Brolin, Karin; Svensson, Mats Y; Linder, Astrid

    2016-06-01

    Mathematical cervical spine models allow for studying of impact loading that can cause whiplash associated disorders (WAD). However, existing models only cover the male anthropometry, despite the female population being at a higher risk of sustaining WAD in automotive rear-end impacts. The aim of this study is to develop and validate a ligamentous cervical spine intended for biomechanical research on the effect of automotive impacts. A female model has the potential to aid the design of better protection systems as well as improve understanding of injury mechanisms causing WAD. A finite element (FE) mesh was created from surface data of the cervical vertebrae of a 26-year old female (stature 167 cm, weight 59 kg). Soft tissues were generated from the skeletal geometry and anatomical literature descriptions. Ligaments were modeled with nonlinear elastic orthotropic membrane elements, intervertebral disks as composites of nonlinear elastic bulk elements, and orthotropic anulus fibrosus fiber layers, while cortical and trabecular bones were modeled as isotropic plastic-elastic. The model has geometrical features representative of the female cervical spine-the largest average difference compared with published anthropometric female data was the vertebral body depth being 3.4% shorter for the model. The majority the cervical segments compare well with respect to biomechanical data at physiological loads, with the best match for flexion-extension loads and less biofidelity for axial rotation. An average female FE ligamentous cervical spine model was developed and validated with respect to physiological loading. In flexion-extension simulations with the developed female model and an existing average male cervical spine model, a greater range of motion (ROM) was found in the female model. PMID:26974520

  17. The role of the cervical spine in post-concussion syndrome.

    PubMed

    Marshall, Cameron M; Vernon, Howard; Leddy, John J; Baldwin, Bradley A

    2015-07-01

    While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion occurring in ∼ 10-15% of concussed patients. This paper reviews the existing literature surrounding the numerous proposed theories of PCS and introduces another potential, and very treatable, cause of this chronic condition; cervical spine dysfunction due to concomitant whiplash-type injury. We also discuss a short case-series of five patients with diagnosed PCS having very favorable outcomes following various treatment and rehabilitative techniques aimed at restoring cervical spine function. PMID:26138797

  18. The role of the cervical spine in post-concussion syndrome.

    PubMed

    Marshall, Cameron M; Vernon, Howard; Leddy, John J; Baldwin, Bradley A

    2015-07-01

    While much is known regarding the pathophysiology surrounding concussion injuries in the acute phase, there is little evidence to support many of the theorized etiologies to post-concussion syndrome (PCS); the chronic phase of concussion occurring in ∼ 10-15% of concussed patients. This paper reviews the existing literature surrounding the numerous proposed theories of PCS and introduces another potential, and very treatable, cause of this chronic condition; cervical spine dysfunction due to concomitant whiplash-type injury. We also discuss a short case-series of five patients with diagnosed PCS having very favorable outcomes following various treatment and rehabilitative techniques aimed at restoring cervical spine function.

  19. A prospective study of the radiological changes in the cervical spine in early rheumatoid disease.

    PubMed Central

    Winfield, J; Cooke, D; Brook, A S; Corbett, M

    1981-01-01

    The cervical spine radiographs of 100 patients with early rheumatoid disease were studied annually, on a prospective basis, for a mean follow-up period of 7 years 2 months. Atlantoaxial subluxation developed in 12 patients. The subluxation was more frequent in females, more severe in patients with progressive, seropositive, erosive rheumatoid disease, and more marked in patients treated with oral corticosteroids. Subaxial subluxation, affecting upper cervical disc levels, occurred in a further 20 patients. Three patients developed vertical subluxation. The mobility of the cervical spine affects the degree of subluxation achieved, and when assessing serial films for subluxation it may be necessary to measure the cervical spine flexion before deciding whether subluxation has progressed or not. Over 80% of the patients with subluxation developed the first evidence of subluxation within 2 years of disease onset. Subluxation in the cervical spine is not, therefore, a late complication of rheumatoid disease. During the follow-up period none of the patients developed neurological signs. PMID:7224682

  20. Back pain in space and post-flight spine injury: Mechanisms and countermeasure development

    NASA Astrophysics Data System (ADS)

    Sayson, Jojo V.; Lotz, Jeffrey; Parazynski, Scott; Hargens, Alan R.

    2013-05-01

    During spaceflight many astronauts experience moderate to severe lumbar pain and deconditioning of paraspinal muscles. There is also a significant incidence of herniated nucleus pulposus (HNP) in astronauts post-flight being most prevalent in cervical discs. Relief of in-flight lumbar back pain is facilitated by assuming a knee-to-chest position. The pathogenesis of lumbar back pain during spaceflight is most likely discogenic and somatic referred (from the sinuvertebral nerves) due to supra-physiologic swelling of the lumbar intervertebral discs (IVDs) due to removal of gravitational compressive loads in microgravity. The knee-to-chest position may reduce lumbar back pain by redistributing stresses through compressive loading to the IVDs, possibly reducing disc volume by fluid outflow across IVD endplates. IVD stress redistribution may reduce Type IV mechanoreceptor nerve impulse propagation in the annulus fibrosus and vertebral endplate resulting in centrally mediated pain inhibition during spinal flexion. Countermeasures for lumbar back pain may include in-flight use of: (1) an axial compression harness to prevent excessive IVD expansion and spinal column elongation; (2) the use of an adjustable pulley exercise developed to prevent atrophy of spine muscle stabilisers; and (3) other exercises that provide Earth-like annular stress with low-load repetitive active spine rotation movements. The overall objective of these countermeasures is to promote IVD health and to prevent degenerative changes that may lead to HNPs post-flight. In response to "NASA's Critical Path Roadmap Risks and Questions" regarding disc injury and higher incidence of HNPs after space flight (Integrated Research Plan Gap-B4), future studies will incorporate pre- and post-flight imaging of International Space Station long-duration crew members to investigate mechanisms of lumbar back pain as well as degeneration and damage to spinal structures. Quantitative results on morphological, biochemical

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

    PubMed

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

    2014-01-01

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

  2. Direct injury to the cervical spine of a child by a lap-shoulder belt resulting in quadriplegia: case report.

    PubMed

    Lynch, J M; Meza, M P; Pollack, I F; Adelson, P D

    1996-10-01

    Most pediatric cervical spine injuries from seat-belt restraints result from hyperflexion of the neck without direct injury to the spine from the restraining device. We report what we believe to be the first case of direct injury to the cervical spine by the shoulder component of a lap-shoulder seat belt. This resulted in quadriplegia. The mechanism of injury and recommendations to obviate such injuries are discussed.

  3. Chronic lumbar spine and radicular pain: pathophysiology and treatment.

    PubMed

    Wheeler, Anthony H; Murrey, Daniel B

    2002-04-01

    The lumbar spine forms the foundation and infrastructure of an organic skyscraper equipped with the physiologic capacity to act as a crane for lifting and a crankshaft for walking. Subjected to aging like other "human machinery," the lumbar spine adapts to the wear and tear of gravity and biomechanical loading through structural and neurochemical changes. Many of the changes are maladaptive, resulting in pain, physical and functional disability, and altered neurophysiologic circuitry. Some compensatory reactions are constructive, but others cause more interference with the organism's capacity to cope. A conceptional understanding of the multifaceted structural, biomechanical, biochemical, medical, and psychosocial influences that compose this mix elucidates the complexity of applying effective treatments. PMID:11872180

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

    PubMed Central

    Ogungbo, Biodun

    2011-01-01

    Background: We present a review of the results of the current surgical management of acute cervical spine injuries in the Federal Capital Territory, Abuja, Nigeria. This is the first detailed retrospective study on the surgical management of patients with cervical spine injuries from Nigeria. Methods: The medical reports of patients with traumatic cervical spine and spinal cord injuries undergoing surgery from 1 August 2009 till 30 August 2010 were reviewed. Management and early results of outcome were ascertained and detailed consecutively in a prospective Microsoft Office Access® database (Microsoft Group of Companies). Frankel grading was used for pre- and immediate post-operative evaluation (within 48 hours). The Barthel index (BI) was used to classify patients as dependent or independent at follow-up. Results: Twenty consecutive patients presented with acute cervical spine and spinal cord injuries since August 2009. Twenty anterior cervical spine decompression and fixation with an iliac graft and an anterior cervical plate (ACDF) were performed in 18 patients. All operations were performed with general anaesthesia using standard techniques but without a microscope or a high speed drill. Of the 18 patients who were operated, 4 patients died within a short period following surgical intervention. Seven patients have made a full recovery and seven remain fully dependent. Only two of the dependent quadriplegic patients have become reintegrated back into the society. Conclusion: The management of spinal cord injuries in Abuja is evolving. The operations were performed adequately with much limited complement of equipment. Poor intensive care therapy is a major challenge and improvements in this area of care will likely lead to better patient outcomes. PMID:22140641

  5. Functional anatomy of the spine.

    PubMed

    Bogduk, Nikolai

    2016-01-01

    Among other important features of the functional anatomy of the spine, described in this chapter, is the remarkable difference between the design and function of the cervical spine and that of the lumbar spine. In the cervical spine, the atlas serves to transmit the load of the head to the typical cervical vertebrae. The axis adapts the suboccipital region to the typical cervical spine. In cervical intervertebrtal discs the anulus fibrosus is not circumferential but is crescentic, and serves as an interosseous ligament in the saddle joint between vertebral bodies. Cervical vertebrae rotate and translate in the sagittal plane, and rotate in the manner of an inverted cone, across an oblique coronal plane. The cervical zygapophysial joints are the most common source of chronic neck pain. By contrast, lumbar discs are well designed to sustain compression loads, but rely on posterior elements to limit axial rotation. Internal disc disruption is the most common basis for chronic low-back pain. Spinal muscles are arranged systematically in prevertebral and postvertebral groups. The intrinsic elements of the spine are innervated by the dorsal rami of the spinal nerves, and by the sinuvertebral nerves. Little modern research has been conducted into the structure of the thoracic spine, or the causes of thoracic spinal pain.

  6. Controlled Laboratory Comparison Study of Motion With Football Equipment in a Destabilized Cervical Spine

    PubMed Central

    Prasarn, Mark L.; Horodyski, MaryBeth; DiPaola, Matthew J.; DiPaola, Christian P.; Del Rossi, Gianluca; Conrad, Bryan P.; Rechtine, Glenn R.

    2015-01-01

    Background Numerous studies have shown that there are better alternatives to log rolling patients with unstable spinal injuries, although this method is still commonly used for placing patients onto a spine board. No previous studies have examined transfer maneuvers involving an injured football player with equipment in place onto a spine board. Purpose To test 3 different transfer maneuvers of an injured football player onto a spine board to determine which method most effectively minimizes spinal motion in an injured cervical spine model. Study Design Controlled laboratory study. Methods Five whole, lightly embalmed cadavers were fitted with shoulder pads and helmets and tested both before and after global instability was surgically created at C5-C6. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment during transfer. Spine-boarding techniques evaluated were the log roll, the lift and slide, and the 8-person lift. Results The 8-person lift technique resulted in the least amount of angular and linear motion for all planes tested as compared with the lift-and-slide and log-roll techniques. This reached statistical significance for lateral bending (P = .031) and medial-lateral translation (P = .030) when compared with the log-roll maneuver. The lift-and-slide technique was significantly more effective at reducing motion than the log roll for axial rotation (P = .029) and lateral bending (P = .006). Conclusion The log roll resulted in the most motion at an unstable cervical injury as compared with the other 2 spine-boarding techniques examined. The 8-person lift and lift-and-slide techniques may both be more effective than the log roll at reducing unwanted cervical spine motion when spine boarding an injured football player. Reduction of such motion is critical in the prevention of iatrogenic injury. PMID:26535397

  7. Pseudarthrosis of the Cervical Spine: Risk Factors, Diagnosis and Management

    PubMed Central

    Leven, Dante

    2016-01-01

    Cervical myelopathy and radiculopathy are common pathologies that often improve with spinal decompression and fusion. Postoperative complications include pseudarthrosis, which can be challenging to diagnose and manage. We reviewed the literature with regard to risk factors, diagnosis, controversies, and management of cervical pseudarthrosis. PMID:27559462

  8. The use of botulinum toxin in the treatment of the consequences of bruxism on cervical spine musculature.

    PubMed

    Finiels, P J; Batifol, D

    2014-03-01

    Hypertonia and hyperactivity of masticatory muscles are involved in pain and contractions of the cervical spine musculature, but their pathophysiology remains nonetheless unknown and its treatment far to be codified. In this study, 8 patients, showing disabling posterior neck muscle contractures linked with bruxism were prospectively treated and followed for an average 15 months period, after having received Injections of botulinum toxin A essentially in masticatory muscles. Injections were made every 3 months, varying from 10 to 100 U Botox* by muscles, without administrating more than 300 U Botox* in the same patient. The angle of cervical lordosis were calculated on lateral sitting radiographs in neutral position, good results being considered to be achieved in the case of a 2 point diminution of VAS score as well as at least a 5° positive gain in the curve. 7 patients out of 8 showed a real improvement in their symptoms after an average of 3 injections, showing a decrease of 4.5 points on the VAS score and an average increment of 15° in cervical lordosis. Although the follow-up period of patients was relatively short and the sample quite small, the general impression, confirmed by the patients' experience, seems to suggest a potential place for the use of botulinum toxin amongst the array of treatments which can be offered in certain selected cases which associate bruxism and posterior cervical contractions.

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

    PubMed

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

    2011-01-01

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

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

    SciTech Connect

    Theocharopoulos, Nicholas; Chatzakis, Georgios; Damilakis, John

    2009-10-15

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

  11. Do inertial sensors represent a viable method to reliably measure cervical spine range of motion?

    PubMed

    Theobald, Peter S; Jones, Michael D; Williams, Jonathan M

    2012-02-01

    A rise in neck pain cases has initiated an exponential interest in the assessment and treatment of cervical spine range of motion (CROM). Experimental limitations, however, have been reported as therapists strive to collect continuous, dynamic data to aid prognosis. This technical report seeks to explore the viability of using inertial sensors to reliably assess CROM. In recognition of the need for secure skin-sensor attachment, four combinations of sensor pairings were established and investigated based upon four clinically identifiable surface landmarks. Twelve participants were recruited and asked to perform three specific movement cycles in each plane (i.e. flexion-extension; rotation; lateral bending). The reliability of the peak CROM, and the movement pattern, recorded in each of the three movement cycles was statistically analysed using the intra-class correlation coefficient (ICC) and coefficient of multiple correlations (CMC). It was determined that the most reliable positions of the orientation sensors, with one adhered to the forehead and the other representing T4, enables data to be recorded with a reliability that is comparable to other CROM measuring techniques. Subsequently, it is concluded that inertial sensors represent a viable method to assess CROM. PMID:21784696

  12. Helmet use and cervical spine injury: a review of motorcycle, moped, and bicycle accidents at a level 1 trauma center.

    PubMed

    Hooten, Kristopher G; Murad, Gregory J A

    2014-08-01

    Helmet use in two-wheeled vehicle accidents is widely reported to decrease the rates of death and traumatic brain injury. Previous reports suggest that there exists a trade off with helmet use consisting of an increased risk of cervical spine injuries. Recently, a review of a national trauma database demonstrated the opposite, with reduction in cervical spinal cord injuries in motorcycle crashes (MCC). In 2000, the State of Florida repealed its mandatory helmet law to make helmet use optional for individuals older than 21 with $10,000 of health insurance coverage. To better ascertain the risks of cervical spine injury with non-helmet use in all two-wheeled vehicles, we analyzed the University of Florida level one trauma center experience. We reviewed the Traumatic injury database over a five-year period (January 1, 2005, to July 1, 2010) for all patients involved in two-wheeled vehicle accidents. Patients were stratified according to vehicle type (motorcycle, scooter, and bicycle), helmet use, and the presence or absence of a cervical spine injury. Outcomes were compared for injury severity, cervical spine injury, cervical spinal cord injury, and presence of cervical spine injuries requiring surgery. Population means were compared using paired t-test. A total of 1331 patients were identified: 995 involved in motorcycle accidents, 87 involved in low-powered scooter accidents, and 249 involved in bicycle accidents. Helmet use was variable between each group. One hundred thirty-five total cervical spine injuries were identified. No evidence was found to suggest an increased risk of cervical spine injury or increased severity of cervical spine injury with helmet use. This fact, in combination with our previous findings, suggest that the law's age and insurance exemption should be revoked and a universal helmet law be reinstated in the state of Florida. PMID:24661125

  13. Manipulative practice in the cervical spine: a survey of IFOMPT member countries

    PubMed Central

    Carlesso, Lisa; Rivett, Darren

    2011-01-01

    The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) aims to achieve worldwide promotion of excellence and unity in clinical and academic standards for manual and musculoskeletal physical therapists. To this end, IFOMPT has sponsored several conference panel sessions and a survey of Member Organizations (MOs) and Registered Interest Groups (RIGs) regarding current cervical spine manipulation and pre-manipulative screening practice in each country. The purpose of this study was to determine common elements of cervical spine manipulative practice and pre-manipulative screening between countries. In late 2007, a questionnaire investigating recommended pre-manipulative screening protocol/guideline use, informed consent regarding risks, screening procedures, and treatment/manipulation technique was sent to all twenty MOs and five RIGs. The response rate was 88%. The main findings of the survey included: 77% of respondent organizations use pre-manipulative guidelines, with Australian guidelines the most frequently adopted internationally (36%); recommendations concerning the provision of information about the possibility of serious adverse events is not standard practice in all countries (50%); positional tests for vertebrobasilar insufficiency are used by all respondent organizations; craniovertebral ligament testing is sometimes taught as a pre-manipulative screening tool (36%); the use of upper cervical spine manipulation has declined in some countries (41%); and of the respondent organizations that continue to teach upper cervical manipulation, most (70%) minimize the rotation component. The findings of this research will inform an IFOMPT international standard for screening the cervical region prior to orthopaedic manual therapy intervention. The development of an IFOMPT endorsed document will be of assistance to manual therapy clinicians worldwide in safely managing disorders of the cervical spine. PMID:22547915

  14. A preliminary study comparing the use of cervical/upper thoracic mobilization and manipulation for individuals with mechanical neck pain

    PubMed Central

    Griswold, David; Learman, Ken; O'Halloran, Bryan; Cleland, Josh

    2015-01-01

    Objectives: Neck pain is routinely managed using manual therapy (MT) to the cervical and thoracic spines. While both mobilizations and manipulations to these areas have been shown to reduce neck pain, increase cervical range of motion, and reduce disability, the most effective option remains elusive. The purpose of this preliminary trial was to compare the pragmatic use of cervical and thoracic mobilizations vs. manipulation for mechanical neck pain. Methods: This trial included 20 patients with mechanical neck pain. Each patient was randomized to receive either mobilization or manipulation to both the cervical and thoracic spines during their plan of care. Within-group analyses were made with Wilcoxon signed-rank tests and between-group analyses were made with Mann–Whitney U. Results: There were no between-group differences for any of the dependent variables including cervical active range of motion (CAROM) (P = 0.18), deep cervical flexion (DCF) endurance (P = 0.06), numerical pain rating scale (NPRS) (P = 0.26), the neck disability index (NDI, P = 0.33), patient-specific functional scale (PSFS, P = 0.20), or the global rating of change (GROC) scale (P = 0.94). Within-group results were significant for all outcome variables (P<0.001) from initial evaluation to discharge for both groups. Discussion: These findings were consistent with other trials previously conducted that applied the MT techniques in a pragmatic fashion, but varied from previous trials where the treatment was standardized. A larger experimental study is necessary to further examine the differences between mobilization and manipulation for neck pain. PMID:26109828

  15. Percutaneous techniques for cervical pain of discal origin.

    PubMed

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

    2011-04-01

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

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

    PubMed Central

    Lafond, Danik; Champagne, Annick; Cadieux, Rosalie; Descarreaux, Martin

    2008-01-01

    Background Neck problems are often recurring or chronic. After pain, unsteadiness and balance problems are among the most frequent symptoms reported by chronic neck pain (CNP) patients. Altered sensorimotor control of the cervical spine and sensorimotor integration problems affecting postural control have been observed in CNP patients. Very few data are available regarding the post-intervention effects of rehabilitation programs on postural control in CNP. Case presentation This is a case study of a traumatic CNP patient (a 45-year old female) with postural unsteadiness who participated in an 8-week rehabilitation program combining therapeutic exercises with spinal manipulative therapy. Pre-intervention data revealed that the postural control system was challenged when postural control sensory inputs were altered, particularly during the head-extended-backward condition. Post-intervention centre of pressure measurements indicated a drastic reduction in postural sway during trials with changes in neck orientation. Conclusion This case report indicates that an 8-week rehabilitation program combining therapeutic exercises with spinal manipulative therapy may have had an effect on improvement of postural control in a trauma CNP patient with unsteadiness. These results warrant further studies to investigate the relationships between pain amelioration, sensorimotor control of the cervical spine, muscle fitness and postural steadiness. PMID:19014706

  17. Extensive cervical spine and foregut anomaly in ‘serpentine syndrome’

    PubMed Central

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

    2013-01-01

    INTRODUCTION We report an extremely rare and challenging combination of congenital anomalies. Only five similar cases have been described in the English language medical literature to date. PRESENTATION OF CASE A male infant was born at 30+5 weeks gestation by emergency caesarian section. Cervical spine rachischisis, shortened oesophagus, intrathoracic stomach, atretic duodenum and absent spleen were noted, in addition to respiratory insufficiency. Gastrointestinal re-anastomosis, particularly oesophageal lengthening, was not feasible at the initial thoracotomy. Surgical stabilization of the cervical spine was unlikely to be successful until two years of age. Asplenia predisposed the infant to sepsis from encapsulated organisms, and recurrent respiratory infections occurred. DISCUSSION A close relationship exists between the upper gastrointestinal tract and cervical spine during embryonic development. An embryonic aberration at this level could account for all the deformities present in this infant. Tethering of the embryonic cervical oesophagus to the somites in the first trimester, preventing foregut elongation, and producing ischaemia at the coeliac axis, is suggested as the aetiology. CONCLUSION This case presented a challenge to the multi-disciplinary team involved in his management and prompted extensive consultation with international experts. After considerable counseling of the parents, care was directed towards palliation. PMID:23567544

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

    PubMed Central

    Smith, Danny; Hoogenboom, Barb

    2011-01-01

    Since the inception of the term Sports Medicine Athletic Trainers, Sports Physical Therapists, Paramedics, and Emergency Room Physicians have faced a number of challenges when it comes to providing care to an equipment laden athlete suspected of having a cervical spine or serious head injury. The same equipment that is designed to protect the player may significantly impede the medical team when it comes to diagnosing and treating cervical spine and head injuries. Incorrectly removing the helmet and shoulder pads from a football player with a cervical spine injury, may lead to unwanted motion of the cervical spine during removal. It is the purpose of this article to review the current concepts relating to equipment removal and to introduce a novel system for quick and easy removal of football shoulder pads called the Riddell™RipKord system. PMID:21712941

  19. The riddell ripkord system for shoulder pad removal in a cervical spine injured athlete: a paradigm shift.

    PubMed

    Kordecki, Michael; Smith, Danny; Hoogenboom, Barb

    2011-06-01

    Since the inception of the term Sports Medicine Athletic Trainers, Sports Physical Therapists, Paramedics, and Emergency Room Physicians have faced a number of challenges when it comes to providing care to an equipment laden athlete suspected of having a cervical spine or serious head injury. The same equipment that is designed to protect the player may significantly impede the medical team when it comes to diagnosing and treating cervical spine and head injuries. Incorrectly removing the helmet and shoulder pads from a football player with a cervical spine injury, may lead to unwanted motion of the cervical spine during removal. It is the purpose of this article to review the current concepts relating to equipment removal and to introduce a novel system for quick and easy removal of football shoulder pads called the Riddell™RipKord system.

  20. Rac1-regulated dendritic spine remodeling contributes to neuropathic pain after peripheral nerve injury.

    PubMed

    Tan, Andrew M; Chang, Yu-Wen; Zhao, Peng; Hains, Bryan C; Waxman, Stephen G

    2011-12-01

    Although prior studies have implicated maladaptive remodeling of dendritic spines on wide-dynamic range dorsal horn neurons as a contributor to pain after spinal cord injury, there have been no studies on dendritic spines after peripheral nerve injury. To determine whether dendritic spine remodeling contributes to neuronal hyperexcitability and neuropathic pain after peripheral nerve injury, we analyzed dendritic spine morphology and functional influence in lamina IV-V dorsal horn neurons after sham, chronic constriction injury (CCI) of the sciatic nerve, and CCI treatment with NSC23766, a selective inhibitor of Rac1, which has been implicated in dendritic spine development. 10 days after CCI, spine density increased with mature, mushroom-shaped spines preferentially distributed along dendritic branch regions closer to the cell body. Because spine morphology is strongly correlated with synaptic function and transmission, we recorded the response of single units to innocuous and noxious peripheral stimuli and performed behavioral assays for tactile allodynia and thermal hyperalgesia. Wide dynamic range dorsal horn neurons of CCI animals exhibited hyperexcitable responses to a range of stimuli. They also showed reduced nociceptive thresholds in the ipsilateral hind paw. 3-day treatment with NSC23766 significantly reduced post-CCI spine dimensions and densities, and attenuated injury-induced hyperexcitability. Drug treatment reduced behavioral measures of tactile allodynia, but not for thermal hyperalgesia. Together, our results demonstrate that peripheral nerve injury induces Rac1-regulated remodeling of dendritic spines on dorsal horn neurons, and suggest that this spine remodeling contributes to neuropathic pain.

  1. Effects of the height of shoe heels on muscle activation of cervical and lumbar spine in healthy women

    PubMed Central

    Park, Kisu; Kim, Young; Chung, Yijung; Hwang, Sujin

    2016-01-01

    [Purpose] The purpose of this study was to investigate the effects of different height of high heels on muscle activation of the paraspinalis cervicis and erector spinae in healthy young women. [Subjects and Methods] Thirteen healthy women were recruited in this study. To examine the effects of different heights of heels on muscle activation, the paraspinalis cervicis (cervical spine) and erector spinae (lumbar spine) were measured at the time of heel strike and toe off during gait on three different conditions (barefoot, 4 cm high heels, and 10 cm high heels). There are no previous trials or reports that have evaluated this approach in patients with chronic neck pain. [Results] A significant increase in muscle activation of the paraspinalis cervicis and erector spinae at heel strike and toe off (except that of the paraspinalis cervicis at toe off in healthy subjects) was observed in the under 10 cm high heel condition as, compared to that with barefoot condition, in all the subjects. [Conclusion] The height of the high heels affects to the activation demand of the paraspinalis cervicis and erector spinae in patients with neck pain. PMID:27134392

  2. [Controversies about instrumented surgery and pain relief in degenerative lumbar spine pain. Results of scientific evidence].

    PubMed

    Robaina-Padrón, F J

    2007-10-01

    Investigation and development of new techniques for intrumented surgery of the spine is not free of conflicts of interest. The influence of financial forces in the development of new technologies an its immediately application to spine surgery, shows the relationship between the published results and the industry support. Even authors who have defend eagerly fusion techniques, it have been demonstrated that them are very much involved in the revision of new articles to be published and in the approval process of new spinal technologies. When we analyze the published results of spine surgery, we must bear in mind what have been call in the "American Stock and Exchange" as "the bubble of spine surgery". The scientific literature doesn't show clear evidence in the cost-benefit studies of most instrumented surgical interventions of the spine compare with the conservative treatments. It has not been yet demonstrated that fusion surgery and disc replacement are better options than the conservative treatment. It's necessary to point out that at present "there are relationships between the industry and back pain, and there is also an industry of the back pain". Nonetheless, the "market of the spine surgery" is growing up because patients are demanding solutions for their back problems. The tide of scientific evidence seams to go against the spinal fusions in the degenerative disc disease, discogenic pain and inespecific back pain. After decades of advances in this field, the results of spinal fusions are mediocre. New epidemiological studies show that "spinal fusion must be accepted as a non proved or experimental method for the treatment of back pain". The surgical literature on spinal fusion published in the last 20 years following the Cochrane's method establish that: 1- this is at least incomplete, not reliable and careless; 2- the instrumentation seems to slightly increase the fusion rate; 3- the instrumentation doesn't improve the clinical results in general, lacking

  3. Infantile tumoral calcinosis of the cervical spine presenting as torticollis.

    PubMed

    Ashraf, Ali; Diehn, Felix E; Luetmer, Patrick H; Lane, John I; Fritchie, Karen; Larson, A Noelle

    2016-01-01

    The computed tomography (CT) and MRI findings of infantile tumoral calcinosis and the utility of image-guided biopsy are demonstrated. A 5-month old presented with torticollis and a calcified cervical spinal mass. The radiologic appearance suggested a malignant neoplasm, prompting CT-guided biopsy, which diagnosed tumoral calcinosis. We hope to increase awareness of this entity and describe image-guided biopsy as a way to avoid morbidity associated with open biopsy.

  4. Identification of a relationship between cervical spine function and rotational movement control.

    PubMed

    Hage, R; Ancenay, E

    2009-11-01

    The cervical spine's stabilising function is generated by three interacting systems: an active system (the muscles), a passive system (capsules, intervertebral disks and ligaments) and a neutral system (the nervous system). Functional impairment induced by alteration of one or several systems can disturb movement control. Thus, a decrease in the quality of movement control could be directly linked to the cervical spine's state of impairment. The aim of the present study was to assess the relationship between cervical spine status (measured using a validated questionnaire) and the control of low-amplitude neck movements. Our starting hypothesis was that the more precise the movement, the faster it would be. We devised a test in which a sequence of rotational movements of the neck (to the left and to the right, alternately) was timed while monitoring the targeting of a laser beam (fixed to the right side of a pair of spectacles) on photodetectors placed directly in front of the subject and 30 degrees to the left and to the right of the body line. The test was performed using a system called the "Didren laser". Fifty-six subjects (of varying ages and both genders, classified as "disabled" or "healthy" according to the Neck Disability Index [NDI] questionnaire score) performed the test. Our results showed that: the score differed from one individual to another but was reproducible for a given subject; the score was age- and gender-independent; the highest scores (i.e. the slowest rotations) were generally produced by individuals classified as "disabled" in terms of the NDI questionnaire score. Our results led us to conclude that there is a relationship between functional disorders of the cervical spine and low-amplitude rotational movement control, although we were unable to define the exact nature of this relationship. PMID:19783494

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

    PubMed Central

    2014-01-01

    Introduction Interactions between the cervical spine and the stomatognathic system have been discussed in literature. The present study was conducted to investigate whether, and to what extent, orthodontically induced mandibular advancement produces changes in cervical spine posture. Furthermore, possible appliance-specific effects should be distinguished. Material and methods The cephalograms of 64 patients with skeletal class II were analysed before and after mandibular advancement. Linear and angular cephalometric parameters were identified to define the position of the atlanto-occipital and atlantoaxial joints. The total example was divided into two subgroups (comprising 32 individuals each) according to the employed appliance: activator versus bite-jump appliance (BJA). Student's t-test and analysis of covariance were used for statistical analysis. Results Overall, a significant straightening of the cervical spine was observed during the treatment. This conclusion is based on changes of Chamberlain (p = 0.0055), CVT (p = 0.0003), OPT (p < 0.0001), Redlund-Johnell/Petersson (p < 0.0001), McGregor-mC2 (p = 0.0333) and AT-FH (p = 0.0445). Improvements in occipitoatlantal dislocation were also observed in the total sample. Appliance-specific changes were found in the activator subgroup for a number of linear parameters (Chamberlain, McGregor, CVT, OPT, Redlund-Johnell/Petersson). In contrast, only two linear parameters (OPT and Powers ratio) revealed statistically significant changes in the BJA subgroup. Conclusions During skeletal class II treatment the position of upper cervical spine changes. In the activator subgroup the observed effects were more pronounced than those in the BJA subgroup. Further studies including a control group comprised with non-treated class II patients are needed to assess whether these effects may be caused directly by the appliances irrespective of growth. PMID:24661951

  6. A Study to Analyses Pattern and Treatment of Upper Cervical Spine Injuries Experience From Developing World

    PubMed Central

    Kamal, Younis; Khan, Hayat Ahmad; Gani, Naseemul; Gupta, Anil; Singh, Dara; Gul, Snobar

    2015-01-01

    Background: The literature regarding the different patterns of upper cervical spine injuries, their appropriate management, and management development of such injuries is scarce in the world. Objectives: The current study aimed to present the experience regarding the high velocity trauma of upper cervical spine injuries. Patients and Methods: Thirty patients (22 males, 8 females) with upper cervical spine injuries were treated and followed-up for an average of 24 months. The corresponding data were analyzed with respect to various types of injuries and different treatment modalities used to treat such patients keeping the basic healthcare facilities in view. Results: The clinical as well as radiological outcomes of the treatment of such injuries were mostly achievable with minimum facilities in India, with only few complications. Conclusions: Managing such patients needs a proper transport facility, proper care during transport, appropriate evaluation in the hospital and prompt conservative or operative treatment. Treatment is usually safe and effective by well trained professionals with good clinical and radiological outcomes. PMID:26543839

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

    PubMed

    Scher, A T

    1998-01-01

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

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

    SciTech Connect

    Ahn, Peter H. Ahn, Andrew I.; Lee, C. Joe; Shen Jin; Miller, Ekeni; Lukaj, Alex; Milan, Elissa; Yaparpalvi, Ravindra; Kalnicki, Shalom; Garg, Madhur K.

    2009-02-01

    Purpose: With 54{sup o} of freedom from the skull to mandible to C7, ensuring adequate immobilization for head-and-neck radiotherapy (RT) is complex. We quantify variations in skull, mandible, and cervical spine movement between RT sessions. Methods and Materials: Twenty-three sequential head-and-neck RT patients underwent serial computed tomography. Patients underwent planned rescanning at 11, 22, and 33 fractions for a total of 93 scans. Coordinates of multiple bony elements of the skull, mandible, and cervical spine were used to calculate rotational and translational changes of bony anatomy compared with the original planning scan. Results: Mean translational and rotational variations on rescanning were negligible, but showed a wide range. Changes in scoliosis and lordosis of the cervical spine between fractions showed similar variability. There was no correlation between positional variation and fraction number and no strong correlation with weight loss or skin separation. Semi-independent rotational and translation movement of the skull in relation to the lower cervical spine was shown. Positioning variability measured by means of vector displacement was largest in the mandible and lower cervical spine. Conclusions: Although only small overall variations in position between head-and-neck RT sessions exist on average, there is significant random variation in patient positioning of the skull, mandible, and cervical spine elements. Such variation is accentuated in the mandible and lower cervical spine. These random semirigid variations in positioning of the skull and spine point to a need for improved immobilization and/or confirmation of patient positioning in RT of the head and neck.

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

    PubMed

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

    2009-01-01

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

  10. Connective tissue, Ehlers-Danlos syndrome(s), and head and cervical pain.

    PubMed

    Castori, Marco; Morlino, Silvia; Ghibellini, Giulia; Celletti, Claudia; Camerota, Filippo; Grammatico, Paola

    2015-03-01

    Ehlers-Danlos syndrome (EDS) is an umbrella term for a growing group of hereditary disorders of the connective tissue mainly manifesting with generalized joint hypermobility, skin hyperextensibility, and vascular and internal organ fragility. In contrast with other well known heritable connective tissue disorders with severe cardiovascular involvement (e.g., Marfan syndrome), most EDS patients share a nearly normal life span, but are severely limited by disabling features, such as pain, fatigue and headache. In this work, pertinent literature is reviewed with focus on prevalence, features and possible pathogenic mechanisms of headache in EDSs. Gathered data are fragmented and generally have a low level of evidence. Headache is reported in no less than 1/3 of the patients. Migraine results the most common type in the hypermobility type of EDS. Other possibly related headache disorders include tension-type headache, new daily persistent headache, headache attributed to spontaneous cerebrospinal fluid leakage, headache secondary to Chiari malformation, cervicogenic headache and neck-tongue syndrome, whose association still lacks of reliable prevalence studies. The underlying pathogenesis seems complex and variably associated with cardiovascular dysautonomia, cervical spine and temporomandibular joint instability/dysfunction, meningeal fragility, poor sleep quality, pain-killer drugs overuse and central sensitization. Particular attention is posed on a presumed subclinical cervical spine dysfunction. Standard treatment is always symptomatic and usually unsuccessful. Assessment and management procedures are discussed in order to put some basis for ameliorating the actual patients' needs and nurturing future research. PMID:25655119

  11. Effect of pillow height on the biomechanics of the head-neck complex: investigation of the cranio-cervical pressure and cervical spine alignment

    PubMed Central

    Yang, Hui; Zhou, Yan; Lin, Jin

    2016-01-01

    Background While appropriate pillow height is crucial to maintaining the quality of sleep and overall health, there are no universal, evidence-based guidelines for pillow design or selection. We aimed to evaluate the effect of pillow height on cranio-cervical pressure and cervical spine alignment. Methods Ten healthy subjects (five males) aged 26 ± 3.6 years were recruited. The average height, weight, and neck length were 167 ± 9.3 cm, 59.6 ± 11.9 kg, and 12.9 ± 1.2 cm respectively. The subjects lay on pillows of four different heights (H0, 110 mm; H1, 130 mm; H2, 150 mm; and H3, 170 mm). The cranio-cervical pressure distribution over the pillow was recorded; the peak and average pressures for each pillow height were compared by one-way ANOVA with repeated measures. Cervical spine alignment was studied using a finite element model constructed based on data from the Visible Human Project. The coordinate of the center of each cervical vertebra were predicted for each pillow height. Three spine alignment parameters (cervical angle, lordosis distance and kyphosis distance) were identified. Results The average cranial pressure at pillow height H3 was approximately 30% higher than that at H0, and significantly different from those at H1 and H2 (p < 0.05). The average cervical pressure at pillow height H0 was 65% lower than that at H3, and significantly different from those at H1 and H2 (p < 0.05). The peak cervical pressures at pillow heights H2 and H3 were significantly different from that at H0 (p < 0.05). With respect to cervical spine alignment, raising pillow height from H0 to H3 caused an increase of 66.4% and 25.1% in cervical angle and lordosis distance, respectively, and a reduction of 43.4% in kyphosis distance. Discussion Pillow height elevation significantly increased the average and peak pressures of the cranial and cervical regions, and increased the extension and lordosis of the cervical spine. The cranio-cervical pressures and cervical spine alignment

  12. Effect of pillow height on the biomechanics of the head-neck complex: investigation of the cranio-cervical pressure and cervical spine alignment

    PubMed Central

    Yang, Hui; Zhou, Yan; Lin, Jin

    2016-01-01

    Background While appropriate pillow height is crucial to maintaining the quality of sleep and overall health, there are no universal, evidence-based guidelines for pillow design or selection. We aimed to evaluate the effect of pillow height on cranio-cervical pressure and cervical spine alignment. Methods Ten healthy subjects (five males) aged 26 ± 3.6 years were recruited. The average height, weight, and neck length were 167 ± 9.3 cm, 59.6 ± 11.9 kg, and 12.9 ± 1.2 cm respectively. The subjects lay on pillows of four different heights (H0, 110 mm; H1, 130 mm; H2, 150 mm; and H3, 170 mm). The cranio-cervical pressure distribution over the pillow was recorded; the peak and average pressures for each pillow height were compared by one-way ANOVA with repeated measures. Cervical spine alignment was studied using a finite element model constructed based on data from the Visible Human Project. The coordinate of the center of each cervical vertebra were predicted for each pillow height. Three spine alignment parameters (cervical angle, lordosis distance and kyphosis distance) were identified. Results The average cranial pressure at pillow height H3 was approximately 30% higher than that at H0, and significantly different from those at H1 and H2 (p < 0.05). The average cervical pressure at pillow height H0 was 65% lower than that at H3, and significantly different from those at H1 and H2 (p < 0.05). The peak cervical pressures at pillow heights H2 and H3 were significantly different from that at H0 (p < 0.05). With respect to cervical spine alignment, raising pillow height from H0 to H3 caused an increase of 66.4% and 25.1% in cervical angle and lordosis distance, respectively, and a reduction of 43.4% in kyphosis distance. Discussion Pillow height elevation significantly increased the average and peak pressures of the cranial and cervical regions, and increased the extension and lordosis of the cervical spine. The cranio-cervical pressures and cervical spine alignment

  13. Minimally invasive central corpectomy for ossified posterior longitudinal ligament in the cervical spine.

    PubMed

    Hirano, Yoshitaka; Mizuno, Junichi; Nakagawa, Hiroshi; Itoh, Yasunobu; Kubota, Keiichi; Watanabe, Sadayoshi; Matsuoka, Hidenori; Numazawa, Shinichi; Tomii, Masato; Watanabe, Kazuo

    2011-01-01

    Minimally invasive central corpectomy (MICC) for cervical segmental ossified posterior longitudinal ligament (OPLL) is described. The procedure of MICC includes upper- or lower-half central corpectomy of the involved cervical spine, transdiscal decompression of the adjacent disc level, dissection and partial removal of the OPLL, removal of the OPLL behind the vertebral body via these windows, and fusion with cylindrical titanium cages. Anterior plate fixation is not necessary. From January 2008 to December 2009 we surgically treated three patients with cervical OPLL by MICC. All three patients showed remarkable improvement of their symptoms within a few days after the operation. No neurological or radiological complication was observed during that period. MICC is beneficial in avoiding complete corpectomy and long fusion, usage of an anterior plate, and usage of a large external orthosis. MICC also reduces the risk of postoperative esophageal perforation due to a screw backing out of the plate. PMID:20888772

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

    PubMed

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

    2014-05-01

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

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

    PubMed

    Savva, Christos; Giakas, Giannis

    2013-10-01

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

  16. MRI evaluation of spontaneous intervertebral disc degeneration in the alpaca cervical spine.

    PubMed

    Stolworthy, Dean K; Bowden, Anton E; Roeder, Beverly L; Robinson, Todd F; Holland, Jacob G; Christensen, S Loyd; Beatty, Amanda M; Bridgewater, Laura C; Eggett, Dennis L; Wendel, John D; Stieger-Vanegas, Susanne M; Taylor, Meredith D

    2015-12-01

    Animal models have historically provided an appropriate benchmark for understanding human pathology, treatment, and healing, but few animals are known to naturally develop intervertebral disc degeneration. The study of degenerative disc disease and its treatment would greatly benefit from a more comprehensive, and comparable animal model. Alpacas have recently been presented as a potential large animal model of intervertebral disc degeneration due to similarities in spinal posture, disc size, biomechanical flexibility, and natural disc pathology. This research further investigated alpacas by determining the prevalence of intervertebral disc degeneration among an aging alpaca population. Twenty healthy female alpacas comprised two age subgroups (5 young: 2-6 years; and 15 older: 10+ years) and were rated according to the Pfirrmann-grade for degeneration of the cervical intervertebral discs. Incidence rates of degeneration showed strong correlations with age and spinal level: younger alpacas were nearly immune to developing disc degeneration, and in older animals, disc degeneration had an increased incidence rate and severity at lower cervical levels. Advanced disc degeneration was present in at least one of the cervical intervertebral discs of 47% of the older alpacas, and it was most common at the two lowest cervical intervertebral discs. The prevalence of intervertebral disc degeneration encourages further investigation and application of the lower cervical spine of alpacas and similar camelids as a large animal model of intervertebral disc degeneration.

  17. Segmentation and feature extraction of cervical spine x-ray images

    NASA Astrophysics Data System (ADS)

    Long, L. Rodney; Thoma, George R.

    1999-05-01

    As part of an R&D project in mixed text/image database design, the National Library of Medicine has archived a collection of 17,000 digitized x-ray images of the cervical and lumbar spine which were collected as part of the second National Health and Nutrition Examination Survey (NHANES II). To make this image data available and usable to a wide audience, we are investigating techniques for indexing the image content by automated or semi-automated means. Indexing of the images by features of interest to researchers in spine disease and structure requires effective segmentation of the vertebral anatomy. This paper describes work in progress toward this segmentation of the cervical spine images into anatomical components of interest, including anatomical landmarks for vertebral location, and segmentation and identification of individual vertebrae. Our work includes developing a reliable method for automatically fixing an anatomy-based coordinate system in the images, and work to adaptively threshold the images, using methods previously applied by researchers in cardioangiography. We describe the motivation for our work and present our current results in both areas.

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

    SciTech Connect

    Chiang, Andrew; Zeng, Liang; Zhang, Liying; Lochray, Fiona; Korol, Renee; Loblaw, Andrew; Chow, Edward; Sahgal, Arjun

    2013-07-15

    Purpose: To determine the incidence of pain flare after spine stereotactic body radiation therapy (SBRT) in steroid-naïve patients and identify predictive factors. Methods and Materials: Forty-one patients were treated with spine SBRT between February 2010 and April 2012. All patients had their pain assessed at baseline, during, and for 10 days after SBRT using the Brief Pain Inventory. All pain medications were recorded daily and narcotics converted to an oral morphine equivalent dose. Pain flare was defined as a 2-point increase in worst pain score as compared with baseline with no decrease in analgesic intake, a 25% increase in analgesic intake as compared with baseline with no decrease in worst pain score, or if corticosteroids were initiated at any point during or after SBRT because of pain. Results: The median age and Karnofsky performance status were 57.5 years (range, 27-80 years) and 80 (range, 50-100), respectively. Eighteen patients were treated with 20-24 Gy in a single fraction, whereas 23 patients were treated with 24-35 Gy in 2-5 fractions. Pain flare was observed in 68.3% of patients (28 of 41), most commonly on day 1 after SBRT (29%, 8 of 28). Multivariate analysis identified a higher Karnofsky performance status (P=.02) and cervical (P=.049) or lumbar (P=.02) locations as significant predictors of pain flare. In those rescued with dexamethasone, a significant decrease in pain scores over time was subsequently observed (P<.0001). Conclusions: Pain flare is a common adverse event after spine SBRT and occurs most commonly the day after treatment completion. Patients should be appropriately consented for this adverse event.

  19. Coexistence of neurofibroma and meningioma at exactly the same level of the cervical spine.

    PubMed

    Chen, Kai-Yuan; Wu, Jau-Ching; Lin, Shih-Cheih; Huang, Wen-Cheng; Cheng, Henrich

    2014-11-01

    We report a case of the coexistence of different spinal tumors at the same level of the cervical spine, without neurofibromatosis (NF), which was successfully treated with surgery. A 72-year-old female presented with right upper-limb clumsiness and weakness. Magnetic resonance imaging revealed an intradural, extramedullary tumor mass at the right C3-4 level with extradural extension into the intervertebral foramen. The extradural tumor was removed, and the pathology showed neurofibroma. After incision of the dura, the intradural tumor was removed, and was identified as meningioma in the pathological report. The patient did not meet the criteria of NF. Coexistence of neurofibroma and meningioma at exactly the same level of the spine without NF is extremely rare. Exploration of the intradural space may be necessary after resection of an extradural tumor if the surgical finding does not correlate well with the preoperative images.

  20. Pain Relief in Cervical Dystonia with Botulinum Toxin Treatment

    PubMed Central

    Camargo, Carlos Henrique Ferreira; Cattai, Lígia; Teive, Hélio Afonso Ghizoni

    2015-01-01

    Dystonia is a neurological disorder characterized by intermittent or sustained muscle contractions that cause abnormal, usually repetitive, movements and postures. Dystonic movements can be tremulous and twisting and often follow a pattern. They are frequently associated with overflow muscle activation and may be triggered or worsened by voluntary action. Most voluntary muscles can be affected and, in the case of the neck muscles, the condition is referred to as cervical dystonia (CD), the most common form of dystonia. The high incidence of pain distinguishes CD from other focal dystonias and contributes significantly to patient disability and low quality of life. Different degrees of pain in the cervical region are reported by more than 60% of patients, and pain intensity is directly related to disease severity. Botulinum toxin (BoNT) is currently considered the treatment of choice for CD and can lead to an improvement in pain and dystonic symptoms in up to 90% of patients. The results for BoNT/A and BoNT/B are similar. The complex relationship between pain and dystonia has resulted in a large number of studies and more comprehensive assessments of dystonic patients. When planning the application of BoNT, pain should be a key factor in the choice of muscles and doses. In conclusion, BoNT is highly effective in controlling pain, and its analgesic effect is sustained for a long time in most CD patients. PMID:26110508

  1. Three-dimensional intervertebral kinematics in the healthy young adult cervical spine during dynamic functional loading.

    PubMed

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

    2015-05-01

    The objective of this study was to determine the intervertebral kinematics of the young, healthy cervical spine during dynamic, three-dimensional, functional loading. Intervertebral motion was characterized by the range of motion (ROM) and the helical axis of motion (HAM). Biplane radiographs of the cervical spine were collected at 30 images/s as 29 participants (20-35 yr) performed dynamic flexion\\extension, axial rotation, and lateral bending. Vertebral motion (C1-T1 in flexion\\extension, C3-T1 in lateral bending and axial rotation) was tracked with sub-millimeter accuracy using a validated volumetric model-based tracking process that matched subject-specific CT-based bone models to the radiographs. Flexion\\extension ROM was smallest at the C2-C3 motion segment (12.7±2.6°) and largest at the C5-C6 motion segment (19.7±3.7°). During head lateral bending and axial rotation, the intervertebral bending ROM was greater than the rotation ROM at every motion segment. The HAM demonstrated differences among motion segments and among movements. During flexion\\extension, the helical axis of motion was directed nearly perpendicular to the sagittal plane for the C2-C3 through C7-T1 motion segments. During lateral bending, the angle between the HAM and the transverse plane progressively increased from the C6-C7 motion segment (approximately ±22°) to the C3-C4 motion segment (approximately ±40°). During axial rotation, the angle between the transverse plane and the HAM was approximately ±42° at the C3-C4 through C5-C6 motion segments, and approximately ±32° at the C6-C7 motion segment. This study provides valuable reference data for evaluating the effects of age, degeneration, and surgical procedures on cervical spine kinematics during three-dimensional dynamic functional loading.

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

    SciTech Connect

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

    1989-08-01

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

  3. Radiographic characteristics of the hand and cervical spine in fibrodysplasia ossificans progressiva.

    PubMed

    Mishima, Kenichi; Kitoh, Hiroshi; Haga, Nobuhiko; Nakashima, Yasuharu; Kamizono, Junji; Katagiri, Takenobu; Susami, Takafumi; Matsushita, Masaki; Ishiguro, Naoki

    2014-05-01

    Fibrodysplasia ossificans progressiva (FOP) is a disabling heritable disorder of connective tissue characterized by progressive heterotopic ossification in various extraskeletal sites. Early correct diagnosis of FOP is important to prevent additional iatrogenic harm or trauma. Congenital malformation of the great toes is a well-known diagnostic clue, but some patients show normal-appearing great toes. The thumb shortening and cervical spine abnormalities are other skeletal features often observed in FOP. This study aimed to address the quantitative assessment of these features in a cohort of patients with FOP, which potentially helps early diagnosis of FOP. Radiographs of the hand and cervical spine were retrospectively analyzed from a total of 18 FOP patients (9 males and 9 females) with an average age of 13.9 years (range 0.7-39.3 years). The elevated ratio of the second metacarpal bone to the distal phalanx of the thumb (> +1SD) was a consistent finding irrespective of the patient's age and gender. Infant FOP patients, in addition, exhibited an extremely high ratio of the second metacarpal bone to the first metacarpal bone (> +3SD). The height/depth ratio of the C5 vertebra increased in patients over 4 years of age (> +2SD). Additionally, the ratio of (height+depth) of the C5 spinous process to the C5 vertebral depth was markedly elevated in young patients (> +2SD). We quantitatively demonstrated the hand and cervical spine characteristics of FOP. These findings, which can be seen from early infancy, could be useful for early diagnosis of FOP even in patients without great toe abnormalities.

  4. [Pharyngo-esophageal risk of surgery of the cervical spine using an anterior approach].

    PubMed

    Crampette, L; Mondain, M; Guerrier, B; Fuentes, J M; Segnarbieux, F

    1989-01-01

    The authors report six cases of pharyngo-oesophageal damage associated with fractures of the cervical spine treated by osteo-synthesis via the anterior route. These complications, not previously described, may have life threatening (especially mediastinitis) and functional consequences. They discuss the relative responsibility of: the initial trauma, which should be better defined by an initial endoscopic assessment. the surgical approach, the principles of which and its dangers and preventive aspects are discussed, early or late fixation failure justifying careful surveillance of the osteosynthesis material and in certain cases its systematic removal.

  5. Giant cell tumor of the upper cervical spine: transmandibular-translingual access. Clinical case.

    PubMed

    Cappuccio, M; Bandiera, S; Gasbarrini, A; De Iure, F; Barbanti Bròdano, G; Scimeca, G B; Presutti, L; Cocchi, R; Boriani, S

    2004-01-01

    The authors describe the clinical case of a patient aged 18 years affected with giant cell tumor (GCT) at C3 who came to the surgical unit of Orthopaedics and Traumatology at the Ospedale Maggiore in Bologna after being treated by surgery elsewhere. Particular attention is paid to surgical access by means of median transmandibuloglossotomy used in order to obtain a sufficiently wide surgical field that can adequately expose the vertebral segment affected by neoplastic disease. In particular, possible complications that may be observed postsurgery can be compared to other surgical approaches to the upper cervical spine and above all that there are no permanent clinical sequelae.

  6. Effect of loading rate on the compressive mechanics of the immature baboon cervical spine.

    PubMed

    Elias, Paul Z; Nuckley, David J; Ching, Randal P

    2006-02-01

    Thirty-four cervical spine segments were harvested from 12 juvenile male baboons and compressed to failure at displacement rates of 5, 50, 500, or 5000 mm/s. Compressive stiffness, failure load, and failure displacement were measured for comparison across loading rate groups. Stiffness showed a significant concomitant increase with loading rate, increasing by 62% between rates of 5 and 5000 mm/s. Failure load also demonstrated an increasing relationship with loading rate, while displacement at failure showed no rate dependence. These data may help in the development of improved pediatric automotive safety standards and more biofidelic physical and computational models.

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

    PubMed Central

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

    2012-01-01

    Cervical spine immobilization is an essential component of the ATLS® system. Inadequate training in the management of trauma calls and failure of early recognition can have disastrous consequences. Pre-hospital personnel are routinely involved more in the assessment and stabilization of patients in comparison to other health care professionals. This case study and review highlights the importance of early recognition, assessment and correct stabilization of cervical spine injuries both in the field and during the initial assessment in hospital. Inadequate assessment, immobilization and lack of standard guidelines on the management of suspected cervical spine trauma can result in secondary injury. Regular assessment and training of pre-hospital and medical personnel is essential to the proper management of these potentially devastating injuries. PMID:23248726

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

    PubMed Central

    Gotlib, Allan C.; Thiel, Haymo

    1985-01-01

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

  9. Neglected dislocation in sub-axial cervical spine: Case series and a suggested treatment protocol

    PubMed Central

    Srivastava, Sudhir Kumar; Aggarwal, Rishi Anil; Bhosale, Sunil Krishna; Nemade, Pradip Sharad

    2016-01-01

    Context: Approaches suggested for treatment of neglected dislocations in the subaxial cervical spine (SACS) include only anterior approach (a), only posterior approach (b), posterior-anterior approach, posterior-anterior-posterior approach, and anterior-posterior-anterior-posterior approach. No protocol is suggested in literature to guide surgeons treating neglected dislocations. Aim: To describe a protocol for the treatment of neglected dislocation in the SACS. Settings and Designs: Retrospective case series and review of literature. Materials and Methods: Six consecutive patients of neglected dislocation (presenting to us more than 3 weeks following trauma) of the SACS were operated as per the protocol suggested in this paper. A retrospective review of the occupational therapy reports, patient records, and radiographs was performed. Only cases with time lapse of more than 3 weeks between the time of injury and initial management have been included in the review. Results: Closed reduction (CR) was achieved in three patients following cervical traction and these were managed by anterior cervical discectomy and fusion (ACDF). Open reduction via posterior approach and soft tissue release was required to achieve reduction in two patients. Following reduction posterior instrumented fusion was done in them. One patient with preoperative neurological deficit needed a facetectomy to achieve reduction. Following short-segment fixation, ACDF was also performed in this patient. None of the patients deteriorated neurologically following surgery. Fusion was achieved in all patients. Conclusions: Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release. A treatment

  10. Probabilistic design analysis of the influence of material property on the human cervical spine.

    PubMed

    Ng, Hong Wan; Teo, Ee Chon

    2004-04-01

    Studies reported previously in the literature have described the importance of material variation on the cervical responses and have examined some effects by varying the material properties, but there is no systematic approach using statistical methods to understand the influence of material variation on a cervical spine model under a full range of loading conditions, especially under compression and anterior and posterior shear. A probabilistic design system based on Monte Carlo simulation methods using Latin hypercube sampling techniques is used to analyze the material sensitivity of a C4-C6 cervical spine model involving 13 uncertain input parameters on the biomechanical responses and disc annulus stresses under compression, anterior shear, posterior shear, flexion, extension, lateral bending, and axial rotation. The loading types and range of values were as follows: compression, 0-1 mm; anterior shear, 0-2 mm; posterior shear, 0-3.5 mm; flexion, extension, lateral bending, and axial rotation. 0-1.8 Nm with 73.6-N preload. For each case, the load-deflection and key stress values at various spinal components were captured after each load step. The model was also validated under the same conditions. The minimum and maximum predicted responses were within the range of the experimental data. Ignoring compression loading, the combined effects on the biomechanical responses of the cervical ligaments under the remaining loads are enormous. Their total impacts are almost equal to or slightly less than the influence of disc annulus. Results show that the fiber mechanical properties did not have a significant effect on the compressive stiffness. This study reveals important features that help us identify the critical input parameters and enable us to reduce the development time of a patient-specific biomechanical model. PMID:15260096

  11. Degenerative Cervical Myelopathy: A Spectrum of Related Disorders Affecting the Aging Spine.

    PubMed

    Tetreault, Lindsay; Goldstein, Christina L; Arnold, Paul; Harrop, James; Hilibrand, Alan; Nouri, Aria; Fehlings, Michael G

    2015-10-01

    Cervical spinal cord dysfunction can result from either traumatic or nontraumatic causes, including tumors, infections, and degenerative changes. In this article, we review the range of degenerative spinal disorders resulting in progressive cervical spinal cord compression and propose the adoption of a new term, degenerative cervical myelopathy (DCM). DCM comprises both osteoarthritic changes to the spine, including spondylosis, disk herniation, and facet arthropathy (collectively referred to as cervical spondylotic myelopathy), and ligamentous aberrations such as ossification of the posterior longitudinal ligament and hypertrophy of the ligamentum flavum. This review summarizes current knowledge of the pathophysiology of DCM and describes the cascade of events that occur after compression of the spinal cord, including ischemia, destruction of the blood-spinal cord barrier, demyelination, and neuronal apoptosis. Important features of the diagnosis of DCM are discussed in detail, and relevant clinical and imaging findings are highlighted. Furthermore, this review outlines valuable assessment tools for evaluating functional status and quality of life in these patients and summarizes the advantages and disadvantages of each. Other topics of this review include epidemiology, the prevalence of degenerative changes in the asymptomatic population, the natural history and rates of progression, risk factors of diagnosis (clinical, imaging and genetic), and management strategies. PMID:26378358

  12. Degenerative Cervical Myelopathy: A Spectrum of Related Disorders Affecting the Aging Spine.

    PubMed

    Tetreault, Lindsay; Goldstein, Christina L; Arnold, Paul; Harrop, James; Hilibrand, Alan; Nouri, Aria; Fehlings, Michael G

    2015-10-01

    Cervical spinal cord dysfunction can result from either traumatic or nontraumatic causes, including tumors, infections, and degenerative changes. In this article, we review the range of degenerative spinal disorders resulting in progressive cervical spinal cord compression and propose the adoption of a new term, degenerative cervical myelopathy (DCM). DCM comprises both osteoarthritic changes to the spine, including spondylosis, disk herniation, and facet arthropathy (collectively referred to as cervical spondylotic myelopathy), and ligamentous aberrations such as ossification of the posterior longitudinal ligament and hypertrophy of the ligamentum flavum. This review summarizes current knowledge of the pathophysiology of DCM and describes the cascade of events that occur after compression of the spinal cord, including ischemia, destruction of the blood-spinal cord barrier, demyelination, and neuronal apoptosis. Important features of the diagnosis of DCM are discussed in detail, and relevant clinical and imaging findings are highlighted. Furthermore, this review outlines valuable assessment tools for evaluating functional status and quality of life in these patients and summarizes the advantages and disadvantages of each. Other topics of this review include epidemiology, the prevalence of degenerative changes in the asymptomatic population, the natural history and rates of progression, risk factors of diagnosis (clinical, imaging and genetic), and management strategies.

  13. Epidemiology and Risk Factors of Cervical Spine Injury during Heating Season in the Patients with Cervical Trauma: A Cross-Sectional Study

    PubMed Central

    Yang, Sidong; Ding, Wenyuan; Yang, Dalong; Gu, Tixin; Zhang, Feng; Zhang, Di; Sun, Yapeng; Ma, Lei; Song, Yanli

    2013-01-01

    Purpose The purpose of this study was to describe the epidemiology of cervical spine injury in the patients with cervical trauma and analyze its associated risk factors during the special heating season in North China. Methods This cross-sectional study investigated predictors for cervical spine injury in cervical trauma patients using retrospectively collected data of Hebei Provincial Orthopaedic Hospital from 11/2011 to 02/2012, and 11/2012 to 02/2013. Binary logistic regression analysis was used to determine risk factors for cervical fractures/dislocations or cord injury. Results A total of 106 patients were admitted into this study. Of all, 34 patients (32.1%) were treated from 11/2011 to 02/2012 and 72 patients (67.9%) from 11/2012 to 02/2013. The mean age was 41.9±13.3 years old; 85 patients (80.2%) were male and 82 (77.4%) from rural areas. Eighty patients (75.5%) were caused by fall including 45 (42.5%) by severe fall (>2 m). Sixty-five patients (61.3%) of all suffered injuries to other body regions and 32 (30.2%) got head injury. Thirty-one patients (29.2%) sustained cervical cord injury with cervical fractures/dislocations. Twenty-six (83.9%) of cervical cord injury patients were from rural areas and 24 (77.4%) of those resulted from fall including 15 (48.4%) from severe fall (>2 m). Logistic regression displayed that age (OR, 1.47; 95% CI, 1.05–2.07), head injury (OR, 5.63; 95% CI, 2.23–14.26), were risk factors for cervical cord injury and snowing (OR, 8.25; 95% CI, 2.26–30.15) was a risk factor for cervical spine injury due to severe fall (>2 m). Conclusions The elder male patients and patients with head trauma are high-risk population for cervical cord injury. As a seasonal factor, snowing during heating season is of note a risk factor for cervical spine injury resulting from severe fall (>2 m) in the patients with cervical trauma in North China. PMID:24223795

  14. Surgical management of multilevel cervical spinal stenosis and spinal cord injury complicated by cervical spine fracture

    PubMed Central

    2014-01-01

    Background There are few reports regarding surgical management of multilevel cervical spinal stenosis with spinal cord injury. Our purpose is to evaluate the safety and feasibility of open-door expansive laminoplasty in combination with transpedicular screw fixation for the treatment of multilevel cervical spinal stenosis and spinal cord injury in the trauma population. Methods This was a retrospective study of 21 patients who had multilevel cervical spinal stenosis and spinal cord injury with unstable fracture. An open-door expansive posterior laminoplasty combined with transpedicular screw fixation was performed under persistent intraoperative skull traction. Outcome measures included postoperative improvement in Japanese Orthopedic Association (JOA) score and incidence of complications. Results The average operation time was 190 min, with an average blood loss of 437 ml. A total of 120 transpedicular screws were implanted into the cervical vertebrae between vertebral C3 and C7, including 20 into C3, 34 into C4, 36 into C5, 20 into C6, and 10 into C7. The mean preoperative JOA score was 3.67 ± 0.53. The patients were followed for an average of 17.5 months, and the average JOA score improved to 8.17 ± 1.59, significantly higher than the preoperative score (t = 1.798, P < 0.05), with an average improvement of 44.7 ± 11.7%. Postoperative complications in four patients included cerebrospinal fluid leakage, delayed wound healing, pulmonary infection, and urinary system infection. All four patients were responsive to antibiotic treatment; one died from respiratory failure 3 months postoperatively. Conclusions The open-door expansive laminoplasty combined with posterior transpedicular screw fixation is feasible for treating multilevel cervical spinal stenosis and spinal cord injury complicated by unstable fracture. Its advantages include minimum surgical trauma, less intraoperative blood loss, and satisfactory stable supportive effect for

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

    NASA Astrophysics Data System (ADS)

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

    2005-04-01

    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.

  16. Three-dimensional analysis of the cervical spine kinematics: effect of age and gender in healthy subjects.

    PubMed

    Lansade, Céline; Laporte, Sébastien; Thoreux, Patricia; Rousseau, Marc-Antoine; Skalli, Wafa; Lavaste, François

    2009-12-15

    STUDY DESIGN.: A three-dimensional (3D) analysis of the cervical spine kinematics in vivo about a large asymptomatic database in order to evaluate the impact of age and gender on the neck's performances. OBJECTIVE.: To investigate the effect of age and gender on kinematical parameters of the cervical spine, specifically quantitative parameters concerning coupled movements and proprioception, using the infra-red POLARIS measurement system. SUMMARY OF BACKGROUND DATA.: Cervical spine kinematics has been investigated in vivo by numerous authors using various devices. However, few is known about the influence of gender and age on the 3D cervical biomechanics, specifically regarding coupled movements and proprioceptive abilities. METHODS.: A total of 140 asymptomatic volunteers (70 men and 70 women) aged 20 to 93 years old were enrolled. The noninvasive infrared system Polaris was used to quantify the 3D range of motion (ROM) of cervical spine and to evaluate proprioceptive abilities. For validating the protocol in terms of reproducibility, 12 volunteers were tested 3 times by 2 independent operators. RESULTS.: The standard error of measurement for the maximal ROM in the 3 space planes was 5%. Gender had no significant influence on the 3D cervical ROM, except for the "70-79 years old" group. Age had a significant influence on all main movements showing 0.55 degrees to 0.79 degrees magnitude decrease per decade. Age and gender had no significant influence on coupled movements. "Head-to-Target" proprioception was significantly affected by the age only in the horizontal plane. CONCLUSION.: A data base for cervical ROM, pattern of motion, and proprioceptive capability was established in population of 140 healthy subjects of various age and gender. Significant age-related decrease in ROM and proprioceptive abilities were observed in this study. Coupled movements did not vary with gender or age; however, their role in the cervical performance increased with age since main

  17. A Clinical Model for the Diagnosis and Management of Patients with Cervical Spine Syndromes

    PubMed Central

    Murphy, Donald R.

    2004-01-01

    Background: Disorders of the cervical spine are common and often disabling. The etiology of these disorders is often multifactorial and a comprehensive approach to both diagnosis and management is essential to successful resolution. Objective: This article provides an overview of a clinical model of the diagnosis and management of patients with disorders related to the cervical spine. This model is based in part on the scientific literature, clinical experience, and communication with other practitioners over the course of the past 20 years. Discussion: The clinical model presented here involves taking a systematic approach to diagnosis, and management. The diagnostic process is one that asks three essential questions. The answers to these questions then guides the management process, allowing the physician to apply specific methods that address the many factors that can be involved in each individual patient. This clinical model allows the physician to individualize the management strategy while utilizing principles that can be applied to all patients. At times, the management strategy must be multidisciplinary, and cooperation with other physicians and therapists is often necessary for effective patient care. This model is currently being used by the author in practice, as well as forming the basis upon which further research can be conducted to refine or, if necessary, abandon any of its aspects, as the evidence dictates. It is the purpose of this paper to present this clinical model and the clinical and scientific evidence, or lack thereof, of its components. PMID:17987214

  18. [Cervical myofascial pain syndrome. Narrative review of physiotherapeutic treatment].

    PubMed

    Capó-Juan, M A

    2015-01-01

    Pain is a complex and multifactorial phenomenon that depends on the interaction of biopsychosocial factors. Between 15-25% of adults suffer from chronic pain at some point in their lives. Cervical chronic pain is considered a public health problem affecting 9.6% men and 21.9% women, according to the latest National Health Survey 2011-12. A high percentage of medical consultations due to muscle pain turn out to be myofascial pain syndrome (MPS). Its existence implies the presence of myofascial trigger points which can be latent or active throughout the whole population. The aim of this review is to update knowledge in the various therapies applied by the physiotherapist in the treatment of this syndrome at cervical level. From the review it appears that some of the most used techniques that may be useful in the short or medium term are: ischemic compression and/or trigger point pressure release and dry needling. Furthermore, various combinations of treatment modalities are used to treat this syndrome, taking other aspects into account, such as education. PMID:25963463

  19. [Cervical myofascial pain syndrome. Narrative review of physiotherapeutic treatment].

    PubMed

    Capó-Juan, M A

    2015-01-01

    Pain is a complex and multifactorial phenomenon that depends on the interaction of biopsychosocial factors. Between 15-25% of adults suffer from chronic pain at some point in their lives. Cervical chronic pain is considered a public health problem affecting 9.6% men and 21.9% women, according to the latest National Health Survey 2011-12. A high percentage of medical consultations due to muscle pain turn out to be myofascial pain syndrome (MPS). Its existence implies the presence of myofascial trigger points which can be latent or active throughout the whole population. The aim of this review is to update knowledge in the various therapies applied by the physiotherapist in the treatment of this syndrome at cervical level. From the review it appears that some of the most used techniques that may be useful in the short or medium term are: ischemic compression and/or trigger point pressure release and dry needling. Furthermore, various combinations of treatment modalities are used to treat this syndrome, taking other aspects into account, such as education.

  20. Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine

    PubMed Central

    Rajan, Vinod V; Kamath, Vijay; Shetty, Ajoy Prasad; Rajasekaran, S

    2010-01-01

    Background: Pedicle screw instrumentation of the deformed cervical and thoracic spine is challenging to even the most experienced surgeon and associated with increased incidence of screw misplacement. Iso-C3D based navigation has been reported to improve the accuracy of pedicle screw placement, however, there are very few studies assessing its efficacy in the presence of deformity. We conducted a study to evaluate the accuracy of Iso-C3D based navigation in pedicle screw fixation in the deformed cervical and thoracic spine. Materials and Methods: We inserted 98 cervical pedicle screws (18 patients) and 242 thoracic pedicle screws (17 patients) using Iso-C3D based navigation for deformities of spine due to scoliosis, ankylosing spondylitis, post traumatic and degenerative disorders. Two independent observers determined and graded the accuracy of screw placement from postoperative computed tomography (CT) scans. Results: Postoperative CT scans of the cervical spine showed 90.8% perfectly placed screws with 7 (7%) grade I pedicle breaches, 2 (2%) grade II pedicle breaches and one anterior cortex penetration (< 2mm). Five lateral pedicle breaches violated the vertebral artery foramen and three medial pedicle breaches penetrated the spinal canal; however, no patient had any neurovascular complications. In the thoracic spine there were 92.2% perfectly placed screws with only six (2%) grade II pedicle breaches, eight (3%) grade I pedicle breaches and five screws (2%) penetrating the anterior or lateral cortex. No neuro-vascular complications were encountered. Conclusion: Iso-C3D based navigation improves the accuracy of pedicle screw placement in deformities of the cervical and thoracic spine. The low incidence of pedicle breach implies increased safety for the patient. PMID:20419003

  1. Influence of varying compressive loading methods on physiologic motion patterns in the cervical spine.

    PubMed

    Bell, Kevin M; Yan, Yiguo; Debski, Richard E; Sowa, Gwendolyn A; Kang, James D; Tashman, Scott

    2016-01-25

    The human cervical spine supports substantial compressive load in-vivo arising from muscle forces and the weight of the head. However, the traditional in-vitro testing methods rarely include compressive loads, especially in investigations of multi-segment cervical spine constructs. Various methods of modeling physiologic loading have been reported in the literature including axial forces produced with inclined loading plates, eccentric axial force application, follower load, as well as attempts to individually apply/model muscle forces in-vitro. The importance of proper compressive loading to recreate the segmental motion patterns exhibited in-vivo has been highlighted in previous studies. However, appropriate methods of representing the weight of head and muscle loading are currently unknown. Therefore, a systematic comparison of standard pure moment with no compressive loading versus published and novel compressive loading techniques (follower load - FL, axial load - AL, and combined load - CL) was performed. The present study is unique in that a direct comparison to continuous cervical kinematics over the entire extension to flexion motion path was possible through an ongoing intra-institutional collaboration. The pure moment testing protocol without compression or with the application of follower load was not able to replicate the typical in-vivo segmental motion patterns throughout the entire motion path. Axial load or a combination of axial and follower load was necessary to mimic the in-vivo segmental contributions at the extremes of the extension-flexion motion path. It is hypothesized that dynamically altering the compressive loading throughout the motion path is necessary to mimic the segmental contribution patterns exhibited in-vivo. PMID:26708967

  2. Prevalence and Distribution of Ossified Lesions in the Whole Spine of Patients with Cervical Ossification of the Posterior Longitudinal Ligament A Multicenter Study (JOSL CT study).

    PubMed

    Hirai, Takashi; Yoshii, Toshitaka; Iwanami, Akio; Takeuchi, Kazuhiro; Mori, Kanji; Yamada, Tsuyoshi; Wada, Kanichiro; Koda, Masao; Matsuyama, Yukihiro; Takeshita, Katsushi; Abematsu, Masahiko; Haro, Hirotaka; Watanabe, Masahiko; Watanabe, Kei; Ozawa, Hiroshi; Kanno, Haruo; Imagama, Shiro; Fujibayashi, Shunsuke; Yamazaki, Masashi; Matsumoto, Morio; Nakamura, Masaya; Okawa, Atsushi; Kawaguchi, Yoshiharu

    2016-01-01

    Ossification of the posterior longitudinal ligament (OPLL) can cause severe and irreversible paralysis in not only the cervical spine but also the thoracolumbar spine. To date, however, the prevalence and distribution of OPLL in the whole spine has not been precisely evaluated in patients with cervical OPLL. Therefore, we conducted a multi-center study to comprehensively evaluate the prevalence and distribution of OPLL using multi-detector computed tomography (CT) images in the whole spine and to analyze what factors predict the presence of ossified lesions in the thoracolumbar spine in patients who were diagnosed with cervical OPLL by plain X-ray. Three hundred and twenty-two patients with a diagnosis of cervical OPLL underwent CT imaging of the whole spine. The sum of the levels in which OPLL was present in the whole spine was defined as the OP-index and used to evaluate the extent of ossification. The distribution of OPLL in the whole spine was compared between male and female subjects. In addition, a multiple regression model was used to ascertain related factors that affected the OP-index. Among patients with cervical OPLL, women tended to have more ossified lesions in the thoracolumbar spine than did men. A multiple regression model revealed that the OP-index was significantly correlated with the cervical OP-index, sex (female), and body mass index. Furthermore, the prevalence of thoracolumbar OPLL in patients with a cervical OP-index ≥ 10 was 7.8 times greater than that in patients with a cervical OP-index ≤ 5. The results of this study reveal that the extent of OPLL in the whole spine is significantly associated with the extent of cervical OPLL, female sex, and obesity. PMID:27548354

  3. Prevalence and Distribution of Ossified Lesions in the Whole Spine of Patients with Cervical Ossification of the Posterior Longitudinal Ligament A Multicenter Study (JOSL CT study)

    PubMed Central

    Hirai, Takashi; Yoshii, Toshitaka; Iwanami, Akio; Takeuchi, Kazuhiro; Mori, Kanji; Yamada, Tsuyoshi; Wada, Kanichiro; Koda, Masao; Matsuyama, Yukihiro; Takeshita, Katsushi; Abematsu, Masahiko; Haro, Hirotaka; Watanabe, Masahiko; Watanabe, Kei; Ozawa, Hiroshi; Kanno, Haruo; Imagama, Shiro; Fujibayashi, Shunsuke; Yamazaki, Masashi; Matsumoto, Morio; Nakamura, Masaya; Okawa, Atsushi; Kawaguchi, Yoshiharu

    2016-01-01

    Ossification of the posterior longitudinal ligament (OPLL) can cause severe and irreversible paralysis in not only the cervical spine but also the thoracolumbar spine. To date, however, the prevalence and distribution of OPLL in the whole spine has not been precisely evaluated in patients with cervical OPLL. Therefore, we conducted a multi-center study to comprehensively evaluate the prevalence and distribution of OPLL using multi-detector computed tomography (CT) images in the whole spine and to analyze what factors predict the presence of ossified lesions in the thoracolumbar spine in patients who were diagnosed with cervical OPLL by plain X-ray. Three hundred and twenty-two patients with a diagnosis of cervical OPLL underwent CT imaging of the whole spine. The sum of the levels in which OPLL was present in the whole spine was defined as the OP-index and used to evaluate the extent of ossification. The distribution of OPLL in the whole spine was compared between male and female subjects. In addition, a multiple regression model was used to ascertain related factors that affected the OP-index. Among patients with cervical OPLL, women tended to have more ossified lesions in the thoracolumbar spine than did men. A multiple regression model revealed that the OP-index was significantly correlated with the cervical OP-index, sex (female), and body mass index. Furthermore, the prevalence of thoracolumbar OPLL in patients with a cervical OP-index ≥ 10 was 7.8 times greater than that in patients with a cervical OP-index ≤ 5. The results of this study reveal that the extent of OPLL in the whole spine is significantly associated with the extent of cervical OPLL, female sex, and obesity. PMID:27548354

  4. Narrative review of the in vivo mechanics of the cervical spine after anterior arthrodesis as revealed by dynamic biplane radiography.

    PubMed

    Anderst, William

    2016-01-01

    Arthrodesis is the standard of care for numerous pathologic conditions of the cervical spine and is performed over 150,000 times annually in the United States. The primary long-term concern after this surgery is adjacent segment disease (ASD), defined as new clinical symptoms adjacent to a previous fusion. The incidence of adjacent segment disease is approximately 3% per year, meaning that within 10 years of the initial surgery, approximately 25% of cervical arthrodesis patients require a second procedure to address symptomatic adjacent segment degeneration. Despite the high incidence of ASD, until recently, there was little data available to characterize in vivo adjacent segment mechanics during dynamic motion. This manuscript reviews recent advances in our knowledge of adjacent segment mechanics after cervical arthrodesis that have been facilitated by the use of dynamic biplane radiography. The primary observations from these studies are that current in vitro test paradigms often fail to replicate in vivo spine mechanics before and after arthrodesis, that intervertebral mechanics vary among cervical motion segments, and that joint arthrokinematics (i.e., the interactions between adjacent vertebrae) are superior to traditional kinematics measurements for identifying altered adjacent segment mechanics after arthrodesis. Future research challenges are identified, including improving the biofidelity of in vitro tests, determining the natural history of in vivo spine mechanics, conducting prospective longitudinal studies on adjacent segment kinematics and arthrokinematics after single and multiple-level arthrodesis, and creating subject-specific computational models to accurately estimate muscle forces and tissue loading in the spine during dynamic activities.

  5. Esophageal perforation after anterior cervical spine surgery: a systematic review of the literature.

    PubMed

    Halani, Sameer H; Baum, Griffin R; Riley, Jonathan P; Pradilla, Gustavo; Refai, Daniel; Rodts, Gerald E; Ahmad, Faiz U

    2016-09-01

    OBJECTIVE Esophageal perforation is a rare but well-known complication of anterior cervical spine surgery. The authors performed a systematic review of the literature to evaluate symptomatology, direct causes, repair methods, and associated complications of esophageal injury. METHODS A PubMed search that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines included relevant clinical studies and case reports (articles written in the English language that included humans as subjects) that reported patients who underwent anterior spinal surgery and sustained some form of esophageal perforation. Available data on clinical presentation, the surgical procedure performed, outcome measures, and other individual variables were abstracted from 1980 through 2015. RESULTS The PubMed search yielded 65 articles with 153 patients (mean age 44.7 years; range 14-85 years) who underwent anterior spinal surgery and sustained esophageal perforation, either during surgery or in a delayed fashion. The most common indications for initial anterior cervical spine surgery in these cases were vertebral fracture/dislocation (n = 77), spondylotic myelopathy (n = 15), and nucleus pulposus herniation (n = 10). The most commonly involved spinal levels were C5-6 (n = 51) and C6-7 (n = 39). The most common presenting symptoms included dysphagia (n =63), fever (n = 24), neck swelling (n = 23), and wound leakage (n = 18). The etiology of esophageal perforation included hardware failure (n = 31), hardware erosion (n = 23), and intraoperative injury (n = 14). The imaging modalities used to identify the esophageal perforations included modified contrast dye swallow studies, CT, endoscopy, plain radiography, and MRI. Esophageal repair was most commonly achieved using a modified muscle flap, as well as with primary closure. Outcomes measured in the literature were often defined by the time to oral intake following esophageal repair. Complications included

  6. Vertebral pain in helicopter pilots

    NASA Technical Reports Server (NTRS)

    Auffret, R.; Delahaye, R. P.; Metges, P. J.; VICENS

    1980-01-01

    Pathological forms of spinal pain engendered by piloting helicopters were clinically studied. Lumbalgia and pathology of the dorsal and cervical spine are discussed along with their clinical and radiological signs and origins.

  7. Conversion paralysis after cervical spine arthroplasty: a case report and literature review.

    PubMed

    Boudissa, M; Castelain, J E; Boissière, L; Mariey, R; Pointillart, V; Vital, J M

    2015-09-01

    We report a case of conversion paralysis after cervical spine arthroplasty performed in a 45-year-old woman to treat cervico-brachial neuralgia due to a left-sided C6-C7 disc herniation. Upon awakening from the anaesthesia, she had left hemiplegia sparing the face, with normal sensory function. Magnetic resonance imaging (MRI) of the brain ruled out a stroke. MRI of the spinal cord showed artefacts from the cobalt-chrome prosthesis that precluded confident elimination of mechanical spinal cord compression. Surgery performed on the same day to substitute a cage for the prosthesis ruled out spinal cord compression, while eliminating the source of MRI artefacts. Findings were normal from follow-up MRI scans 1 and 15days later, as well as from neurophysiological testing (electromyogram and motor evoked potentials). The deficit resolved fully within the next 4days. A psychological assessment revealed emotional distress related to an ongoing divorce. The most likely diagnosis was conversion paralysis. Surgeons should be aware that conversion disorder might develop after a procedure on the spine, although the risk of litigation requires re-operation. Familiarity with specific MRI sequences that minimise artefacts can be valuable. A preoperative psychological assessment might improve the detection of patients at high risk for conversion disorder.

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

    PubMed

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

    2014-08-01

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

  9. Multirigid registration of MR and CT images of the cervical spine

    NASA Astrophysics Data System (ADS)

    Hu, Yangqiu; Haynor, David R.

    2004-05-01

    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.

  10. Evaluation of cervical spine fracture in the elderly: can we trust our physical examination?

    PubMed

    Goode, Terral; Young, Andrew; Wilson, Sean P; Katzen, Judith; Wolfe, Luke G; Duane, Therese M

    2014-02-01

    The purpose of this trial was to compare National Emergency X-Radiography Utilization Study (NEXUS) criteria (NC) with computed tomography (CT) as the gold standard to evaluate cervical spine (C-spine) fractures in elderly blunt trauma patients. We prospectively compared adult blunt trauma patients 65 years or older (E) with younger than 65 years (NE), evaluating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NC compared with CT in these two cohorts. A total of 2785 blunt trauma patients were included of whom 320 were E (average age, 75 years) and 2465 were NE (average age, 36 years). Incidence of C-spine fracture was 12.8 per cent (E) versus 7.4 per cent (NE) (P = 0.002). Age was an independent predictor of fracture (P = 0.01). NC had a sensitivity of 65.9 per cent in E and PPV of 19.3 per cent in E (P = 0.001) versus a sensitivity of 84.2 per cent in NE and PPV of 10.6 per cent (P < 0.0001). The specificity was 59.5 per cent for E versus 42.6 per cent for NE (NPV, 92.2% E vs 97.1% NE). This study suggests that NEXUS criteria are not an appropriate assessment tool when applied to severe blunt trauma patients, particularly in the elderly population who had more missed injures than their younger counterparts. CT should be used in all blunt trauma patients regardless of whether they meet NEXUS criteria.

  11. Cervical spine segmental vertebral motion in healthy volunteers feigning restriction of neck flexion and extension.

    PubMed

    Puglisi, Filadelfio; Strimpakos, Nikolaos; Papathanasiou, Matthildi; Kapreli, Eleni; Bonelli, Aurelio; Sgambetterra, Sergio; Ferrari, Robert

    2007-09-01

    The purpose of this study was to obtain comparative data concerning the percentage contribution of segmental cervical vertebral motion to the cervical range of motion (ROM) in healthy volunteers under two conditions: (1) normal, voluntary neck flexion and extension and (2) feigned restriction of neck flexion and extension. Each healthy subject's angular motion over forward cervical flexion and extension was measured first by X-ray analysis during normal, voluntary motion. Then the subjects were asked to pretend that they had a 50% restricted neck range due to pain or stiffness and thus to move in both flexion and extension only as far as about 50% of their normal range. A total of 26 healthy subjects (ten males and sixteen females, age 28.7+/-7.7 years) participated. The total angular motion from C2 to C7 was normal in the unrestricted condition and was significantly reduced in the feigned restriction condition (p<0.001). The percentage contribution of each of the functional units C2-C3 to C6-C7 to this rotation was different between the normal unrestricted and the feigned restricted conditions. In the feigned restricted neck flexion and extension, a shift occurred in the pattern of how each segment contributes to the total angular range. A greater percentage contribution was made by C2-C3 and C3-C4 than under normal conditions (P<0.01), and the percentage contribution to total rotation made by C6-C7 became much less under the feigned restricted movements than under normal, unrestricted neck range (p<0.001). Thus, simulated or feigned restricted neck ROM affects the percentage contribution of the functional units C2-C3 to C6-C7 by showing a higher percentage contribution of the upper cervical segments and less contribution to the angular rotation by the lowest cervical segment. Feigners of restricted neck range thus produce a pattern different from nonfeigning subjects.

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

    PubMed Central

    2014-01-01

    Background Cervical Spinal Manipulation (CSM) is considered a high-level skill of the central nervous system because it requires bimanual coordinated rhythmical movements therefore necessitating training to achieve proficiency. The objective of the present study was to investigate the effect of real-time feedback on the performance of CSM. Methods Six postgraduate physiotherapy students attending a training workshop on Cervical Spine Manipulation Technique (CSMT) using inertial sensor derived real-time feedback participated in this study. The key variables were pre-manipulative position, angular displacement of the thrust and angular velocity of the thrust. Differences between variables before and after training were investigated using t-tests. Results There were no significant differences after training for the pre-manipulative position (rotation p = 0.549; side bending p = 0.312) or for thrust displacement (rotation p = 0.247; side bending p = 0.314). Thrust angular velocity demonstrated a significant difference following training for rotation (pre-training mean (sd) 48.9°/s (35.1); post-training mean (sd) 96.9°/s (53.9); p = 0.027) but not for side bending (p = 0.521). Conclusion Real-time feedback using an inertial sensor may be valuable in the development of specific manipulative skill. Future studies investigating manipulation could consider a randomized controlled trial using inertial sensor real time feedback compared to traditional training. PMID:24942483

  13. Age-Related Changes Between the Level of Velopharyngeal Closure and the Cervical Spine.

    PubMed

    Mason, Kazlin N; Perry, Jamie L; Riski, John E; Fang, Xiangming

    2016-03-01

    The primary focus of this study was to assess age-related changes in the vertical distance of the estimated level of velopharyngeal closure in relation to a prominent landmark of the cervical spine: the anterior tubercle of cervical vertebra 1 (C1). Midsagittal anatomic magnetic resonance images were examined across 51 participants with normal head and neck anatomy between 4 and 17 years of age. Results indicate that age is a strong predictor (P = 0.002) of the vertical distance between the level of velopharyngeal closure relative to C1. Specifically, as age increases, the vertical distance between the palatal plane and C1 becomes greater resulting in the level of velopharyngeal closure being located higher above C1 (range 4.88-10.55 mm). Results of this study provide insights into the clinical usefulness of using C1 as a surgical landmark for placement of pharyngoplasties in children with repaired cleft palate and persistent hypernasal speech. Clinical implications and future directions are discussed.

  14. Manual therapy for the cervical spine and reported adverse effects: a survey of Irish manipulative physiotherapists.

    PubMed

    Sweeney, Aoife; Doody, Catherine

    2010-02-01

    The purpose of this study was to determine the use of manipulation and mobilisation by the Chartered Physiotherapists (CMPT) in Manipulative Therapy Ireland and to describe adverse effects associated with the use of these techniques. A 44 item postal survey was sent to all 259 members of the CPMT (response rate 49%, n=127). All 127 respondents used non-High Velocity Thrust Techniques (HVTT) and 27% (n=34) used HVTT. Nine percent (n=12) used HVTT on the upper cervical spine. Twenty six percent (n=33) reported an adverse effect in the previous 2 years. The adverse effects were associated with the use of HVTT (4%, n=5), non-HVTT (20%, n=26) and cervical traction (2%, n=2). The most serious adverse effects were associated with non-HVTT and included 1 drop attack, 1 fainting episode and 1 Transient Ischemic Attack (TIA) 4 days post treatment. Fifty three percent (n=18) of HVTT users and 40% (n=44) of non-HVTT users reported carrying out a vertebrobasilar insufficiency (VBI) assessment. The study shows that VBI assessment may not detect every patient at risk of adverse effects. Large scale studies to investigate the risk of serious adverse reactions are needed. A system of reporting adverse effects on a routine basis could be considered.

  15. Role of Diffusion Tensor MR Imaging in Degenerative Cervical Spine Disease: a Review of the Literature.

    PubMed

    Banaszek, A; Bladowska, J; Podgórski, P; Sąsiadek, M J

    2016-09-01

    In the article we review the current role of diffusion tensor imaging (DTI), a modern magnetic resonance (MR) technique, in the diagnosis and the management of cervical spondylotic myelopathy (CSM), the most serious complication of degenerative cervical spine disease (DCSD). The pathogenesis of DCSD is presented first with an emphasis placed on the pathological processes leading to myelopathy development. An understanding of the pathophysiological background of DCSD is necessary for appropriate interpretation of MR images, both plain and DTI. Conventional MRI is currently the imaging modality of choice in DCSD and provides useful information concerning the extent of spondylotic changes and degree of central spinal canal stenosis; however its capability in myelopathy detection is limited. DTI is a state of the art imaging method which recently has emerged in spinal cord investigations and has the potential to detect microscopic alterations which are beyond the capability of plain MRI. In the article we present the physical principles underlying DTI which determine its sensitivity, followed by an overview of technical aspects of DTI acquisition with a special consideration of spinal cord imaging. Finally, the scientific reports concerning DTI utility in DSCD are also reviewed. DTI detects spinal cord injury in the course of DCSD earlier than any other method and could be useful in predicting surgical outcomes in CMS patients, however technical and methodology improvement as well as standardization of acquisition protocols and postprocessing methods among the imaging centers are needed before its implementation in clinical practice.

  16. Methodological quality and outcomes of studies addressing manual cervical spine examinations: a review.

    PubMed

    Hollerwöger, Dieter

    2006-05-01

    The aims of this review were, first to rate the methodological quality of studies which investigate the reliability of manual tests for cervical spine dysfunctions by applying a new quality assessment tool; secondly to compare the outcomes of these studies. The literature search included databases of CINAHL, MEDLINE, AMED, AMI, and SPORT DISCUS, the Cochrane Library, the Physiotherapy Evidence Database (PEDro), the National Library of Medicine (PubMed), Factiva, the EBSCOT HOST Research Database, online journal databases of ELSEVIER Science periodicals, LIPPINCOTT WILLIAMS & WILKINS, ELSEVIER Science @ Direct, THIEME ONLINE, and BLACKWELL SYNERGY. The application of the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS) to the 15 studies which met the inclusion criteria showed methodological weaknesses such as not considering an independent reference standard, or a representative study population. The studies demonstrated methodological strength in describing selection criteria and in interpreting results. The studies' outcomes make the claim to be able to detect segmental cervical dysfunction based on a manual assessment only questionable. Further improvements in quality, uniform study designs, and a valid reference standard would be necessary in order to obtain more reliable data in the future.

  17. A game of two discs: a case of non-contiguous and occult cervical spine injury in a rugby player

    PubMed Central

    O'Sullivan, Michael D.; Piggot, Robert; Jaddan, Mutaz; McCabe, John P.

    2016-01-01

    The aim of this case report was to highlight the application of magnetic resonance imaging (MRI) in elucidating serious and occult injuries in a single case of hyperflextion injury of a patient cervical spine (C-Spine). A chart and radiology review was performed to establish the sequence of care and how the results of imaging studies influenced the clinical management in this trauma case. Plain radiographs and computed tomography (CT) imaging modalities of the C-Spine revealed bilateral C4/C5 facetal subluxation with no obvious fractures; however, the MR imaging of the C-Spine revealed a non-contiguous and occult injury to C6/C7 disc with a posterior annular tear and associated disc extrusion. This altered the operative intervention that was initially planned. MR imaging proved an invaluable diagnostic addition in this particular case of cervical trauma in a rugby player following a hyperflextion injury, by revealing a serious non-contiguous and occult injury of the C-Spine. PMID:26980714

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

    PubMed

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

    2013-03-01

    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.

  19. The Occupancy of the Components in the Cervical Spine and Their Changes with Extension and Flexion

    PubMed Central

    Sayıt, Emrah; Aghdasi, Bayan; Daubs, Michael D.; Wang, Jeffrey C.

    2015-01-01

    Study Design Retrospective case series. Objectives The kinematics of the cervical spine has been investigated by many researchers. However, the occupancy of the disk bulges, spinal cord, ligamentum flavum, and the rest of the canal as well as the changes of these structures with motion have not yet been investigated. The goal of this study is to investigate these dynamic changes. Methods The kinetic magnetic resonance images of 248 patients (124 men and 124 women) were evaluated, and the occupancy of each structure for each cervical level at neutral, flexion, and extension were calculated. Results Whole canal anteroposterior (AP) diameters showed significant differences between neutral-extension and flexion-extension at the C4–C5 and C5–C6 levels (p < 0.05). The mean disk bulges showed significant differences between neutral-flexion and flexion-extension at the C4–C5, C5–C6, C6–C7, and C7–T1 levels (p < 0.01). The mean spinal canal AP diameter showed significant differences between flexion-extension and neutral-extension at the C3–C4, C4–C5, C5–C6, and C6–C7 levels (p < 0.05). There were significant differences between neutral-flexion at the C4–C5, C5–C6, and C6–C7 levels (p < 0.05). The mean thickness of the ligamentum flavum showed significant differences between flexion-extension at the C3–C4, C4–C5, C5–C6, and C6–C7 levels (p < 0.001). There were significant differences between neutral-extension at the C3–C4 and C5–C6 levels (p < 0.05). There were significant differences between neutral-flexion at the C5–C6 and C6–C7 levels (p < 0.05). The mean thickness of the spinal cord showed significant differences between neutral-flexion at the C2–C3 and C3–C4 levels (p < 0.05). There were significant differences between flexion-extension at the C3–C4 and C4–C5 levels (p < 0.01). The rest of the canal showed significant differences between neutral-extension and flexion

  20. The Occupancy of the Components in the Cervical Spine and Their Changes with Extension and Flexion.

    PubMed

    Sayıt, Emrah; Aghdasi, Bayan; Daubs, Michael D; Wang, Jeffrey C

    2015-10-01

    Study Design Retrospective case series. Objectives The kinematics of the cervical spine has been investigated by many researchers. However, the occupancy of the disk bulges, spinal cord, ligamentum flavum, and the rest of the canal as well as the changes of these structures with motion have not yet been investigated. The goal of this study is to investigate these dynamic changes. Methods The kinetic magnetic resonance images of 248 patients (124 men and 124 women) were evaluated, and the occupancy of each structure for each cervical level at neutral, flexion, and extension were calculated. Results Whole canal anteroposterior (AP) diameters showed significant differences between neutral-extension and flexion-extension at the C4-C5 and C5-C6 levels (p < 0.05). The mean disk bulges showed significant differences between neutral-flexion and flexion-extension at the C4-C5, C5-C6, C6-C7, and C7-T1 levels (p < 0.01). The mean spinal canal AP diameter showed significant differences between flexion-extension and neutral-extension at the C3-C4, C4-C5, C5-C6, and C6-C7 levels (p < 0.05). There were significant differences between neutral-flexion at the C4-C5, C5-C6, and C6-C7 levels (p < 0.05). The mean thickness of the ligamentum flavum showed significant differences between flexion-extension at the C3-C4, C4-C5, C5-C6, and C6-C7 levels (p < 0.001). There were significant differences between neutral-extension at the C3-C4 and C5-C6 levels (p < 0.05). There were significant differences between neutral-flexion at the C5-C6 and C6-C7 levels (p < 0.05). The mean thickness of the spinal cord showed significant differences between neutral-flexion at the C2-C3 and C3-C4 levels (p < 0.05). There were significant differences between flexion-extension at the C3-C4 and C4-C5 levels (p < 0.01). The rest of the canal showed significant differences between neutral-extension and flexion-extension at the C3-C4, C4-C5, C5-C6, and C6-C7 levels (p

  1. The Effects of Experimentally Induced Low Back Pain on Spine Rotational Stiffness and Local Dynamic Stability.

    PubMed

    Ross, Gwyneth B; Mavor, Matthew; Brown, Stephen H M; Graham, Ryan B

    2015-09-01

    Local dynamic stability, quantified using the maximum finite-time Lyapunov exponent (λ max), and the muscular contributions to spine rotational stiffness can provide pertinent information regarding the neuromuscular control of the spine during movement tasks. The primary goal of the present study was to assess if experimental capsaicin-induced low back pain (LBP) affects spine stability and the neuromuscular control of repetitive trunk movements in a group of healthy participants with no history of LBP. Fourteen healthy males were recruited for this investigation. Each participant was asked to complete three trials (baseline, in pain, and recovery) of 35 cycles of a repetitive trunk flexion/extension task at a rate of 0.25 Hz. Local dynamic stability and the muscular contributions to lumbar spine rotational stiffness were significantly impaired during the LBP trial compared to the baseline trial (p < 0.05); however, there was a trend for these measures to recover after a 1 h rest. This study provides evidence that capsaicin can effectively induce LBP, thereby altering spine rotational stiffness and local dynamic stability. Future research should directly compare the effects capsaicin-induced LBP and intramuscular/intraligamentous induced LBP on these same variables.

  2. Case studies in cervicothoracic spine function evaluation and treatment of two dancers with mechanical neck pain.

    PubMed

    Sandow, Emily

    2011-03-01

    It has been reported that manual therapy directed at the thoracic spine followed by exercise may improve outcomes in patients with mechanical neck pain. At this point, there is little available data on dancers with neck pain, and it is unclear whether this type of treatment is appropriate for restoring the rigorous level of activity required of the dancer. The purpose of this study was to review the evaluation, clinical decision-making process, and treatment of two dancers-one with acute and the other with chronic neck pain-who fell into the classification of patients who might benefit from an intervention to the thoracic spine. The two participants were a musical theater dancer with an acute onset of neck pain and a retired dancer who was an active dance company director with an 11-year history of chronic neck pain. Both participants went through a standard examination and were treated with mobilizations to the upper thoracic spine followed by therapeutic exercises. In both cases, successful outcomes were achieved immediately after treatment and up to six months after discharge from physical therapy.

  3. Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes.

    PubMed

    Devin, Clinton J; McGirt, Matthew J

    2015-06-01

    Multimodal approaches to pain management have arisen with the goal of improving postoperative pain and reducing opioid analgesic use. We performed a comprehensive literature review to determine grades of recommendation for commonly used agents in multimodal pain management and provide a best practice guideline. To evaluate common drugs used in multimodal treatment of pain, a search was performed on English language publications on Medline (PubMed; National Library of Medicine, Bethesda, MD, USA). Manuscripts were rated as Level I-V according to the North American Spine Society's (NASS) standardized levels of evidence tables. Grades of recommendation were assigned for each drug based on the NASS Clinical Guidelines for Multidisciplinary Spine Care. There is good (Grade A) evidence gabapentinoids, acetaminophen, neuraxial blockade and extended-release local anesthetics reduce postoperative pain and narcotic requirements. There is fair (Grade B) evidence that preemptive analgesia and nonsteroidal anti-inflammatory drugs (NSAID) result in reduced postoperative pain. There is insufficient and/or conflicting (Grade I) evidence that muscle relaxants and ketamine provide a significant reduction in postoperative pain or narcotic usage. There is fair (Grade B) evidence that short-term use of NSAID result in no long-term reduction in bone healing or fusion rates. Comprehensive assessment of the effectiveness of perioperative pain control can be accomplished through the use of validated measures. Multimodal pain management protocols have consistently been demonstrated to allow for improved pain control with less reliance on opioids. There is good quality evidence that supports many of the common agents utilized in multimodal therapy, however, there is a lack of evidence regarding optimal postoperative protocols or pathways. PMID:25766366

  4. SpineData – a Danish clinical registry of people with chronic back pain

    PubMed Central

    Kent, Peter; Kongsted, Alice; Jensen, Tue Secher; Albert, Hanne B; Schiøttz-Christensen, Berit; Manniche, Claus

    2015-01-01

    Background Large-scale clinical registries are increasingly recognized as important resources for quality assurance and research to inform clinical decision-making and health policy. We established a clinical registry (SpineData) in a conservative care setting where more than 10,000 new cases of spinal pain are assessed each year. This paper describes the SpineData registry, summarizes the characteristics of its clinical population and data, and signals the availability of these data as a resource for collaborative research projects. Methods The SpineData registry is an Internet-based system that captures patient data electronically at the point of clinical contact. The setting is the government-funded Medical Department of the Spine Centre of Southern Denmark, Hospital Lillebaelt, where patients receive a multidisciplinary assessment of their chronic spinal pain. Results Started in 2011, the database by early 2015 contained information on more than 36,300 baseline episodes of patient care, plus the available 6-month and 12-month follow-up data for these episodes. The baseline questionnaire completion rate has been 93%; 79% of people were presenting with low back pain as their main complaint, 6% with mid-back pain, and 15% with neck pain. Collectively, across the body regions and measurement time points, there are approximately 1,980 patient-related variables in the database across a broad range of biopsychosocial factors. To date, 36 research projects have used data from the SpineData registry, including collaborations with researchers from Denmark, Australia, the United Kingdom, and Brazil. Conclusion We described the aims, development, structure, and content of the SpineData registry, and what is known about any attrition bias and cluster effects in the data. For epidemiology research, these data can be linked, at an individual patient level, to the Danish population-based registries and the national spinal surgery registry. SpineData also has potential for the

  5. The importance of evaluating all seven cervical vertebrae in the trauma patient: a case report.

    PubMed

    Iş, Merih; Karataş, Ayşe; Akyüz, Fevzullah; Gezen, Ferruh

    2007-04-01

    The cervical spine is injured in approximately 3% of major trauma patients and 10% of patients with serious head injury. We present a patient in whom an unstable cervical spine, without neurological deficit, resulting from a traffic accident was misdiagnosed as normal in the emergency room. Although cervical spine pain or tenderness and neurological deficit have a sensitivity of 93% for cervical spine injury, asymptomatic patients or patients with mild symptoms can have spine injury. All trauma patients with a complaint of mild neck pain require a standard three-view radiological evaluation of the cervical spine demonstrating all seven vertebrae and the top of first thoracic vertebra even if their neurologic examination is normal.

  6. Dexmedetomidine provides optimum conditions during awake fiberoptic intubation in simulated cervical spine injury patients

    PubMed Central

    Chopra, Pooja; Dixit, Madhu Bala; Dang, Aashish; Gupta, Vibhuti

    2016-01-01

    Background and Aims: We undertook this study to assess if a small-dose of dexmedetomidine (DEX) for conscious sedation during awake fiberoptic intubation (AFOI) in simulated cervical spine injury (CSI) patients provides optimum conditions and fulfills the need of postintubation neurological examination required in such patients. The aim was to assess the efficacy of DEX on arousability and patient's comfort during AFOI in simulated CSI patients. Material and Methods: In this prospective, randomized double-blind study, 100 American Society of Anesthesiologists Grade I-II patients aged between 18 and 65 years scheduled for elective surgery under general anesthesia underwent AFOI under conscious sedation with DEX. After locally anesthetizing the airway and applying a cervical collar, patients either received DEX 1 μg/kg over 10 min followed by 0.7 μg/kg/h maintenance infusion or normal saline in the same dose and rate during AFOI. Targeted sedation (Ramsay sedation score [RSS] ≥2) during AFOI was maintained with midazolam [MDZ] in both groups. Statistical Analysis was performed using unpaired Student's t-test, Chi-square test, Mann-Whitney test and Wilcoxon-w test. Results: The total number of patients requiring MDZ and the mean dose of MDZ required to achieve targeted sedation (RSS ≥2) was significantly less in DEX group compared to the placebo group (P < 0.001). Similarly, patient satisfaction score, heart rate, systolic, diastolic and mean arterial pressure and respiratory parameters were significantly better in DEX group (P < 0.001). Postintubation arousability in the two groups was comparable (P = 0.29). Conclusions: Dexmedetomidine provides optimum sedation without compromising airway or hemodynamic instability with better patient tolerance and satisfaction for AFOI. It also preserves patient arousability for the postintubation neurological assessment. PMID:27006542

  7. Quantification of Pediatric Cervical Growth: Anatomical Changes in the Sub-Axial Spine

    PubMed Central

    Lee, Jung Jae; Hong, Jae Taek; Kim, Jong Tae

    2015-01-01

    Objective In order to provide normal values of the pediatric sub-axial cervical spinal canal and vertebral body growth pattern using computed tomographic scans, a total of 318 patients less than 10 years old were included. Methods The growth of the vertebral body and canal space was investigated using four different age groups. The Torg ratio (TR) was calculated and all patients were classified into a low TR group and a high TR group according to a cutoff value of 1.0. To account for spinal curvature, the C3-7 angle was measured. Results Very little axial expansion and growth in height were observed (2.9 mm and 3.4 mm, respectively), and the spinal canal increments (1.8 mm) were much smaller than the dimensions of the vertebral body. The mean TR values were 1.03±0.14 at the C3 vertebral level, 1.02±0.13 at C4, 1.05±0.13 at C5, 1.04±0.13 at C6, and 1.02±0.12 at C7 in all patients. The mean sub-axial angle (C3-7) was 7.9±10.6° (range: -17-47°). Conclusion The upper sub-axial spinal canal continuously increased in size compared to the lower sub-axial spine after 8 years of age. Considerable decrements in the TR was found after late childhood compared to younger ages. Generally, there were no significant differences between boys and girls in vertical length of the cervical vertebrae. However, the axial dimension of the vertebral body and the spinal canal space varied according to gender. PMID:25810858

  8. Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit

    PubMed Central

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

    2008-01-01

    Introduction In blunt trauma, comatose patients (Glasgow Coma Scale score 3 to 8) with a negative comprehensive cervical spine (CS) computed tomography assessment and no apparent spinal deficit, CS clearance strategies (magnetic resonance imaging [MRI] and prolonged cervical collar use) are controversial. Methods We conducted a literature review to delineate risks for coma, CS instability, prolonged cervical collar use, and CS MRI. Results Based on our search of the literature, the numbers of functional survivor patients among those who had sustained blunt trauma were as follows: 350 per 1,000 comatose unstable patients (increased intracranial pressure [ICP], hypotension, hypoxia, or early ventilator-associated pneumonia); 150 per 1,000 comatose high-risk patients (age > 45 years or Glasgow Coma Scale score 3 to 5); and 600 per 1,000 comatose stable patients (not unstable or high risk). Risk probabilities for adverse events among unstable, high-risk, and stable patients were as follows: 2.5% for CS instability; 26.2% for increased intensive care unit complications with prolonged cervical collar use; 9.3% to 14.6% for secondary brain injury with MRI transportation; and 20.6% for aspiration during MRI scanning (supine position). Additional risk probabilities for adverse events among unstable patients were as follows: 35.8% for increased ICP with cervical collar; and 72.1% for increased ICP during MRI scan (supine position). Conclusion Blunt trauma coma functional survivor (independent living) rates are alarming. When a comprehensive CS computed tomography evaluation is negative and there is no apparent spinal deficit, CS instability is unlikely (2.5%). Secondary brain injury from the cervical collar or MRI is more probable than CS instability and jeopardizes cerebral recovery. Brain injury severity, probability of CS instability, cervical collar risk, and MRI risk assessments are essential when deciding whether CS MRI is appropriate and for determining the timing of

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

    PubMed

    Kitagawa, Yuichi; Yasuki, Tsuyoshi; Hasegawa, Junji

    2006-11-01

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

  10. Three-dimensional change in the cervical spine in a cross-legged sitting position after a time lapse.

    PubMed

    Jung, Seo-Young; Choi, Bo-Ram

    2016-05-01

    [Purpose] The purpose of this study was to investigate the kinematic changes of the cervical spine during cross-legged sitting. [Subjects and Methods] In total, 19 healthy participants were recruited from among healthy students of Silla University. Each participant sat cross-legged with the right leg over the left and gazed at a target presented at 45° below the horizontal line of sight or at an object placed directly ahead, at 90° relative to horizontal for 10 minutes. [Results] With the 45° downward gaze, there was no significant difference in cervical angle between the 0-5-min and 5-10-min time periods. However, the angle in the sagittal plane increased with time, while the frontal and transverse plane angles decreased. With the 90° forward gaze, there was no significant difference in cervical angle between the 0-5-min and 5-10-min time periods. However, the frontal plane angle increased as time elapsed, while the sagittal and transverse plane angles increased between 0 and 5 min and decreased between 5 and 10 min. [Conclusion] Our results suggest that prolonged cross-legged sitting could produce malalignment of the cervical spine in three planes of motion. PMID:27313392

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

    PubMed Central

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

    2013-01-01

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

  12. Aspect-Oriented Visualization of the Health Status: An Example in Treatment of Cervical Spine Defect.

    PubMed

    Deng, Yihan; Denecke, Kerstin

    2016-01-01

    Clinical data is often captured in unstructured texts and scattered in different health information systems. This complicates the aggregation of information in the process of clinical decision making. However, having a quick overview and an efficient representation of relevant aspects of a patient's health status are crucial for this process. While accessing patient data and perusing clinical documents, relevant details need to be discovered quickly. In this paper, we introduce an approach to visualize relevant information from clinical documents by tag clouds. The conventional tag clouds visualize the content of a document using the terms they are containing shown in different sizes with the size calculated based on the term frequency. Important facts and diagnostic results with low occurrence in a text may be ignored by this naïve method. In this paper, we therefore adapt the conventional tag clouds by information extraction and a guidelines-based classification schema, so that the clinical concerns can be visualized more correctly. The aspects are extracted according to a classification schema developed by clinical experts. We evaluate the approach on a set of radiology reports for cervical spine treatment.

  13. Aspect-Oriented Visualization of the Health Status: An Example in Treatment of Cervical Spine Defect.

    PubMed

    Deng, Yihan; Denecke, Kerstin

    2016-01-01

    Clinical data is often captured in unstructured texts and scattered in different health information systems. This complicates the aggregation of information in the process of clinical decision making. However, having a quick overview and an efficient representation of relevant aspects of a patient's health status are crucial for this process. While accessing patient data and perusing clinical documents, relevant details need to be discovered quickly. In this paper, we introduce an approach to visualize relevant information from clinical documents by tag clouds. The conventional tag clouds visualize the content of a document using the terms they are containing shown in different sizes with the size calculated based on the term frequency. Important facts and diagnostic results with low occurrence in a text may be ignored by this naïve method. In this paper, we therefore adapt the conventional tag clouds by information extraction and a guidelines-based classification schema, so that the clinical concerns can be visualized more correctly. The aspects are extracted according to a classification schema developed by clinical experts. We evaluate the approach on a set of radiology reports for cervical spine treatment. PMID:27577333

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

    PubMed Central

    Johnson, G

    1996-01-01

    While a full understanding of continuing symptoms following a soft tissue hyperextension injury of the cervical spine remains elusive, recent research has shown that the explanation may lie with occult lesions beyond the musculoskeletal structures of the neck. The balance of the roles of injury, psychological factors, and the effects of litigation has shifted towards the former. However this injury would be unique if the latter two played only a minor role in determining recovery. It seems likely that among the large numbers of patients presenting with symptoms after hyperextension soft tissue injuries, a proportion will have occult bone, joint, or intervertebral disc lesions. Improvements in medical imaging techniques may allow better definition of these specific injuries and the development of more appropriate treatment. The search for a central nervous system lesion in humans continues and until this is demonstrated, many will dispute the existence of an organic brain syndrome. Evidence for significant injury to the temporomandibular joints, ear, and ophthalmic system has been found and this may be amenable to specialist intervention. While there is little evidence for effective treatments of the established injury, reduction in related disability appears most likely to be achieved by prevention. Improvements in automobile design, with particular reference to head restraints, could limit the cost to society of this common and disabling injury. PMID:8821214

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

    PubMed Central

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

    2012-01-01

    Background: When initiating treatment for patients with spinal disorders, we examined the impact of smoking, workers compensation, and litigation on disability and pain scores. Methods: With Institutional Review Board approval, the medical records of 13,704 consecutive patients with spinal disorders treated at two university spine centers were reviewed. Particular attention was focused on the pretreatment impact of three variables: smoking, workers compensation, and litigation. All patients completed a questionnaire that included a modified Oswestry Disability Index (ODI), a visual analog pain scale (VAS) and a history of smoking, workers compensation, and/or litigation issues. Analysis of Variance (ANOVA) with Bonferroni (when appropriate) was used to analyze the data. Results: ODI scores significantly correlated with a smoking history: Current Smoker > Previous Smoker > Never Smoked (44.22 > 38.11 > 36.02, respectively). Pain scores and ODI scores had a direct correlation to workers compensation and litigation status. Workers compensation, litigation and smoking combined created even higher scores. There was no significant difference between previous smokers and nonsmokers. Conclusions: This study demonstrates that a history of smoking, workers compensation, and/or litigation, considered alone or worse, combined, negatively impacted outcomes for patients seeking treatment at our spine centers. For optimal outcomes in spine patients, cessation of smoking and treatment of attendant psychological and social factors prove critical. PMID:23248756

  16. Degenerative Changes in the Cervical Spine Are More Common in Middle-Aged Individuals with Thalidomide Embryopathy than in Healthy Controls

    PubMed Central

    Ghassemi Jahani, Shadi A.; Danielsson, Aina; Ab-Fawaz, Rana; Hebelka, Hanna; Danielson, Barbro; Brisby, Helena

    2016-01-01

    Background Thalidomide was used as a sedative drug for pregnant women in the 1950–60:s and resulted in children born with thalidomide embryopathy (TE), including upper limb malformations. These may alter the motion pattern of the cervical spine by the use of head/shoulder and mouth grip. Aims To compare degenerative changes in the cervical spine in TE individuals with healthy controls (CTR). Methods and Procedures Twenty-seven middle-aged TE individuals and 27 age- and gender-matched CTR were examined by cervical spine MRI. The presence of malformations, disc herniation(s), osteophytes, nerve and medullary compression and the degree of disc degeneration (DD) were evaluated. Outcomes and Results Significantly higher degree of DD was seen in the TE group compared with the controls (p<0.001). Similar frequencies of disc herniation and disc space narrowing were observed in the two groups, but more foraminal narrowing was seen in the TE group (p = 0.002). DD was observed relatively frequently at all cervical levels in the TE group, however, mainly at the two lower levels in the CTR. Conclusions and Implications Middle-aged individuals with TE have a higher frequency of degenerative changes in the cervical spine than controls, possibly caused by an altered load on the cervical spine. PMID:27175919

  17. The relationship between cervical flexor endurance, cervical extensor endurance, VAS, and disability in subjects with neck pain

    PubMed Central

    2014-01-01

    Background Several tests have been suggested to assess the isometric endurance of the cervical flexor (NFME) and extensors (NEE) muscles. This study proposes to determine whether neck flexors endurance is related to extensor endurance, and whether cervical muscle endurance is related to disability, pain amount and pain stage in subjects with neck pain. Methods Thirty subjects (18 women, 12 men, mean ± SD age: 43 ± 12 years) complaining of neck pain filled out the Visual Analogue Scale (VAS) and the Neck Pain and Disability Scale-Italian version (NPDS-I). They also completed the timed endurance tests for the cervical muscles. Results The mean endurance was 246.7 ± 150 seconds for the NEE test, and 44.9 ± 25.3 seconds for the NMFE test. A significant correlation was found between the results of these two tests (r = 0.52, p = 0.003). A positive relationship was also found between VAS and NPDS-I (r = 0.549, p = 0.002). The endurance rates were similar for acute/subacute and chronic subjects, whereas males demonstrated significantly higher values compared to females in NFME test. Conclusions These findings suggest that neck flexors and extensors endurance are correlated and that the cervical endurance is not significantly altered by the duration of symptoms in subjects with neck pain. PMID:24581272

  18. Chronic Neck Pain and Cervico-Craniofacial Pain Patients Express Similar Levels of Neck Pain-Related Disability, Pain Catastrophizing, and Cervical Range of Motion

    PubMed Central

    Muñoz-García, Daniel; Gil-Martínez, Alfonso; López-López, Almudena; Lopez-de-Uralde-Villanueva, Ibai; La Touche, Roy; Fernández-Carnero, Josué

    2016-01-01

    Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P > 0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P > 0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS. PMID:27119020

  19. Chronic Neck Pain and Cervico-Craniofacial Pain Patients Express Similar Levels of Neck Pain-Related Disability, Pain Catastrophizing, and Cervical Range of Motion.

    PubMed

    Muñoz-García, Daniel; Gil-Martínez, Alfonso; López-López, Almudena; Lopez-de-Uralde-Villanueva, Ibai; La Touche, Roy; Fernández-Carnero, Josué

    2016-01-01

    Background. Neck pain (NP) is strongly associated with cervico-craniofacial pain (CCFP). The primary aim of the present study was to compare the neck pain-related disability, pain catastrophizing, and cervical and mandibular ROM between patients with chronic mechanical NP and patients with CCFP, as well as asymptomatic subjects. Methods. A total of 64 participants formed three groups. All participants underwent a clinical examination evaluating the cervical range of motion and maximum mouth opening, neck disability index (NDI), and psychological factor of Pain Catastrophizing Scale (PCS). Results. There were no statistically significant differences between patients with NP and CCFP for NDI and PCS (P > 0.05). One- way ANOVA revealed significant differences for all ROM measurements. The post hoc analysis showed no statistically significant differences in cervical extension and rotation between the two patient groups (P > 0.05). The Pearson correlation analysis shows a moderate positive association between NDI and the PCS for the group of patients with NP and CCFP. Conclusion. The CCFP and NP patient groups have similar neck disability levels and limitation in cervical ROM in extension and rotation. Both groups had positively correlated the NDI with the PCS.

  20. The validity of using an electrocutaneous device for pain assessment in patients with cervical radiculopathy.

    PubMed

    Abbott, Allan; Ghasemi-Kafash, Elaheh; Dedering, Åsa

    2014-10-01

    The purpose of this study was to evaluate the validity and preference for assessing pain magnitude with electrocutaneous testing (ECT) compared to the visual analogue scale (VAS) and Borg CR10 scale in men and women with cervical radiculopathy of varying sensory phenotypes. An additional purpose was to investigate ECT sensory and pain thresholds in men and women with cervical radiculopathy of varying sensory phenotypes. This is a cross-sectional study of 34 patients with cervical radiculopathy. Scatterplots and linear regression were used to investigate bivariate relationships between ECT, VAS and Borg CR10 methods of pain magnitude measurement as well as ECT sensory and pain thresholds. The use of the ECT pain magnitude matching paradigm for patients with cervical radiculopathy with normal sensory phenotype shows good linear association with arm pain VAS (R(2) = 0.39), neck pain VAS (R(2) = 0.38), arm pain Borg CR10 scale (R(2) = 0.50) and neck pain Borg CR10 scale (R(2) = 0.49) suggesting acceptable validity of the procedure. For patients with hypoesthesia and hyperesthesia sensory phenotypes, the ECT pain magnitude matching paradigm does not show adequate linear association with rating scale methods rendering the validity of the procedure as doubtful. ECT for sensory and pain threshold investigation, however, provides a method to objectively assess global sensory function in conjunction with sensory receptor specific bedside examination measures.

  1. Dystrophic calcinosis with both a huge calcified mass in the cervical spine and calcification in the chest wall in a patient with rheumatoid overlap syndrome.

    PubMed

    Nakamura, Tadashi; Hirakawa, Kei; Takaoka, Hirokazu; Iyama, Ken-Ichi

    2016-05-01

    Dystrophic calcinosis in soft tissue occurs in damaged or devitalized tissues in the presence of normal calcium and phosphorous metabolism. It is often noted in subcutaneous tissues in patients with collagen vascular diseases and may involve a relatively localized area or be widespread. A 74-year-old Japanese woman with an overlap of rheumatoid arthritis, Sjögren's syndrome, and systemic sclerosis developed a huge tumor-like mass at the atlanto-axial vertebral joint region that caused severe cervical pain and difficulty in activities of daily living. She also had subcutaneous dystrophic calcification in the soft tissue of the chest wall. Calcinosis associated with systemic sclerosis is a well-recognized phenomenon, but a destructive paraspinal tumor in the cervical spine associated with overlap syndrome is extremely unique. Because calcinosis in spinal locations can be complicated by neurological involvement, patients with progressive symptoms may require surgical intervention. Surgical resection and biological therapy improved this patient's life and activities of daily living. Calcinosis is common in the conditions reviewed here, and different agents have been used for treatment. However, calcinosis management is poorly organized and lacks an accepted classification, systematic studies, and clinical therapeutic trials. The association of calcinosis and collagen vascular diseases is clinically and etiologically important. Although a combination of calcinosis and rheumatoid overlap syndrome is rare, various collagen vascular diseases may occur simultaneously. A perceptive diagnostic approach toward these diseases is critical, and early diagnosis and treatment are needed to prevent dystrophic calcinosis.

  2. The effects of core muscle release technique on lumbar spine deformation and low back pain

    PubMed Central

    Lee, Myounggi; Song, Changho; Jo, Younggwan; Ha, Donghun; Han, Dongwook

    2015-01-01

    [Purpose] The purpose of this study was to examine the effects of the core muscle release technique on correction of lumbar deformation and alleviation of low back pain. [Subjects] Ninety patients diagnosed with lumbar deformation and low back pain participated in this study. [Methods] The participants were divided into three groups according to method of treatment. The first group was treated with the core muscle release technique (CRT), the second group was treated with general exercise, and the third group was treated with electrotherapy. The core muscle release technique group received 50-minute of the core muscle release technique 5 times a week for 2 weeks, and the participants in this group were instructed not to receive any other treatments. After the 2 weeks of treatment, the patients were reexamined. The general exercise group performed Williams flexion exercises and McKenzie extension exercises 5 times a week for 2 weeks. The electrotherapy group was treated by application of electrotherapy with an interferential current therapy machine (TM-301. TOPMED. Seongnam, Republic of Korea) to the abdominal muscles and back muscles of the lumbar region. [Results] The data suggest that the core muscle release technique, general exercise, and electrotherapy all helped to decrease the alignment angle and VAS score. Of these treatment methods, however, the core muscle release technique was the most effective for treatment of lumbar spine deformation and low back pain. [Conclusion] The core muscle release technique was most effective for correction of lumbar spine deformation and pain alleviation. PMID:26157254

  3. Comorbidity of fibromyalgia and cervical myofascial pain syndrome.

    PubMed

    Cakit, Burcu Duyur; Taskin, Suhan; Nacir, Baris; Unlu, Irem; Genc, Hakan; Erdem, Hatice Rana

    2010-04-01

    The aims of this study are to determine the frequency of fibromyalgia syndrome (FMS) in patients with chronic cervical myofascial pain (CMP) and to investigate the FMS characteristics in CMP patients. Ninty-three patients with CMP and 30 age-matched healthy women were included in this study. Main outcome measures included visual analog scale (VAS), Beck Depression Inventory (BDI), and pain pressure thresholds. CMP patients were evaluated for the existence of FMS. The severity of FMS was assessed with total myalgic score (TMS) and control point score (CPS). Most common clinical characteristics of FMS were noted. Of the 93 CMP subjects, 22 (23.6%) patients fulfilled the classification criteria for FMS. Number of tender points were higher (p=0.0), while TMS (p=0.0) and CPS (p=0.0) values were lower in comorbid CMP and FMS patients than regional CMP group. There were statistically significant differences between regional CMP patients and comorbid CMP and FMS patients regarding presence of fatigue (p=0.0) and irritable bowel syndrome (p=0.022). There was no statistically significant difference between patient groups regarding VAS values (p>0.05). BDI values of the regional CMP were significantly lower than comorbid CMP and FMS patients (p=0.011). In conclusion, we found that nearly a quarter of CMP patients were comorbid with FMS, and psychological and comorbid symptoms were more prominent in comorbid patients. We thought that, these two syndromes might be overlapping conditions and as a peripheral pain generator or inducer of central sensitisation, MPS might lead to FMS or precipitate and worsen the FMS symptoms.

  4. Inclusion of thoracic spine thrust manipulation into an electro-therapy/thermal program for the management of patients with acute mechanical neck pain: a randomized clinical trial.

    PubMed

    González-Iglesias, Javier; Fernández-de-las-Peñas, Cesar; Cleland, Joshua A; Alburquerque-Sendín, Francisco; Palomeque-del-Cerro, Luis; Méndez-Sánchez, Roberto

    2009-06-01

    Our aim was to examine the effects of a seated thoracic spine distraction thrust manipulation included in an electrotherapy/thermal program on pain, disability, and cervical range of motion in patients with acute neck pain. This randomized controlled trial included 45 patients (20 males, 25 females) between 23 and 44 years of age presenting with acute neck pain. Patients were randomly divided into 2 groups: an experimental group which received a thoracic manipulation, and a control group which did not receive the manipulative procedure. Both groups received an electrotherapy program consisting of 6 sessions of TENS (frequency 100Hz; 20min), superficial thermo-therapy (15min) and soft tissue massage. The experimental group also received a thoracic manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain (numerical pain rate scale; NPRS), level of disability (Northwick Park Neck Pain Questionnaire; NPQ) and neck mobility. These outcomes were assessed at baseline and 1 week after discharge. A 2-way repeated-measures ANOVA with group as between-subject variable and time as within-subject variable was used. Patients receiving thoracic manipulation experienced greater reductions in both neck pain, with between-group difference of 2.3 (95% CI 2-2.7) points on a 11-NPRS, and perceived disability with between-group differences 8.5 (95% CI 7.2-9.8) points. Further, patients receiving thoracic manipulation experienced greater increases in all cervical motions with between-group differences of 10.6 degrees (95% CI 8.8-12.5 degrees) for flexion; 9.9 degrees (95% CI 8.1-11.7 degrees) for extension; 9.5 degrees (95% CI 7.6-11.4 degrees) for right lateral-flexion; 8 degrees (95% CI 6.2-9.8 degrees) for left lateral-flexion; 9.6 degrees (95% CI 7.7-11.6 degrees) for right rotation; and 8.4 degrees (95% CI 6.5-10.3 degrees) for left rotation. We found that the inclusion of a thoracic manipulation into an electrotherapy/thermal program was effective in

  5. Positive Outcome After a Small-Caliber Gunshot Fracture of the Upper Cervical Spine without Neurovascular Damage

    PubMed Central

    Walter, Thula; Schwabe, Philipp; Schaser, Klaus-Dieter; Maurer, Martin

    2016-01-01

    Summary Background Gunshot wounds to the cervical spine most frequently concur with serious injuries to the spinal cord and cervical vessels and often have a fatal outcome. Case Report We describe the case of a 35-year-old male with a complex fracture of the C2 vertebra body and a mandibular fracture after a penetration gunshot to the cervical spine. Computed tomography (CT) at admission revealed the exact extent of the fractures and the small caliber bullet lodged next to the C2 vertebra. In this rare and extremely lucky case no collateral vascular or neurological damage was detected. Eighteen months after surgical bullet removal and posterior C1–C3 fusion complete bone healing of the C2 vertebra was achieved and there were no secondary neurovascular deficits. Conclusions Immediate surgical C1–C3 fixation resulted in an excellent outcome without secondary neurovascular deficits in this rare case of traumatic complex C2 vertebral fracture caused by a gunshot injury. PMID:27081417

  6. The effect of multi-level laminoplasty and laminectomy on the biomechanics of the cervical spine: a finite element study.

    PubMed

    Kode, Swathi; Kallemeyn, Nicole A; Smucker, Joseph D; Fredericks, Douglas C; Grosland, Nicole M

    2014-01-01

    Laminectomy has been regarded as a standard treatment for multi-level cervical stenosis. Concern for complications such as kyphosis has limited the indication of multi-level laminectomy; hence it is often augmented with an instrumented fusion. Laminoplasty has emerged as a motion preserving alternative. The purpose of this study was to compare the multidirectional flexibility of the cervical spine in response to a plate-only open door laminoplasty, double door laminoplasty, and laminectomy using a computational model. A validated three-dimensional finite element model of a specimen-specific intact cervical spine (C2-T1) was modified to simulate each surgical procedure at levels C3-C6. An additional goal of this work was to compare the instrumented computational model to our multi-specimen experimental findings to ensure similar trends in response to the surgical procedures. Model predictions indicate that mobility was retained following open and double door laminoplasty with a 5.4% and 20% increase in flexion, respectively, compared to the intact state. Laminectomy resulted in 57% increase in flexion as compared to the intact state, creating a concern for eventual kyphosis--a known risk/complication of multi-level laminectomy in the absence of fusion. Increased disc stresses were observed at the altered and adjacent segments post-laminectomy in flexion. PMID:25328475

  7. Unusual cause of neck pain: septic arthritis of a cervical facet.

    PubMed

    Jones, Jaime L; Ernst, Amy A

    2012-11-01

    Neck pain is a common cause for presentation to an emergency department. Most causes are benign and often secondary to arthritis or injuries. We present a case of septic cervical facet arthritis, a very rare cause of neck pain. The clinical presentation of septic cervical facet arthritis includes fever, neck pain that is often unilateral that is worse with movement, nerve root symptoms, and radiation of pain to the shoulder. Consequences may be severe and include joint destruction and infection progression. Symptoms may be indolent, and a high index of suspicion is necessary to make this diagnosis.

  8. Clinical decision-making in the management of cervical spine derangement: a case study survey using a patient vignette

    PubMed Central

    Hahn, Tracy; Kelly, Christina; Murphy, Erin; Whissel, Paul; Brown, Michael; Schenk, Ron

    2014-01-01

    Background: Neck pain is one of the most common, potentially disabling, and costly musculoskeletal conditions seen in outpatient physical therapy (PT). Clinical decision-making involves referral or the selection of intervention based on the results of the PT examination. Despite evidence that suggests that treatment based classification is most efficacious, it is hypothesized that examination and intervention may be heavily influenced by post-graduate training experiences. Purpose: The purpose of this study was to analyze which tests, measures, and interventions are most commonly selected by physical therapists (PTs) holding a credential from the McKenzie Institute and those holding the McKenzie credential plus the credential of Fellow of the American Academy of Orthopaedic Manual Physical Therapy (FAAOMPT). Their responses were based on a simulated case vignette involving a patient with a presentation of cervical spine disk derangement. Methods: A survey administered through Survey Monkey was sent to 714 members of the McKenzie Institute who are certified or hold a diploma in mechanical diagnosis and therapy (MDT) or these credentials with the addition of Fellowship credentialing (MDT+FAAOMPT). Of the 714 surveyed PTs, 83 completed the survey for a response rate of 11.6%. As the PTs were given further information regarding the patient, they were asked to progress through a clinical decision-making process by indicating their sequence of examination techniques, and then indicating which interventions would be performed based on the results of the examination. Results: A descriptive analysis was conducted to determine the most common sequences chosen by the PTs based on their training. To perform the analysis, only respondents who completed the survey were included: clinicians with MDT credentials, (n = 77), and clinicians with both the MDT and FAAOMPT credentials (MDT+FAAOMPT), (n = 6). Initially, the most common examination chosen regardless of credential

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

    NASA Technical Reports Server (NTRS)

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

    2013-01-01

    Introduction: The Integrated Medical Model (IMM) utilizes historical data, cohort data, and external simulations as input factors to provide estimates of crew health, resource utilization and mission outcomes. The Cervical Spine Injury Module (CSIM) is an external simulation designed to provide the IMM with parameter estimates for 1) a probability distribution function (PDF) of the incidence rate, 2) the mean incidence rate, and 3) the standard deviation associated with the mean resulting from injury/trauma of the neck. Methods: An injury mechanism based on an idealized low-velocity blunt impact to the superior posterior thorax of an ISS crewmember was used as the simulated mission environment. As a result of this impact, the cervical spine is inertially loaded from the mass of the head producing an extension-flexion motion deforming the soft tissues of the neck. A multibody biomechanical model was developed to estimate the kinematic and dynamic response of the head-neck system from a prescribed acceleration profile. Logistic regression was performed on a dataset containing AIS1 soft tissue neck injuries from rear-end automobile collisions with published Neck Injury Criterion values producing an injury transfer function (ITF). An injury event scenario (IES) was constructed such that crew 1 is moving through a primary or standard translation path transferring large volume equipment impacting stationary crew 2. The incidence rate for this IES was estimated from in-flight data and used to calculate the probability of occurrence. The uncertainty in the model input factors were estimated from representative datasets and expressed in terms of probability distributions. A Monte Carlo Method utilizing simple random sampling was employed to propagate both aleatory and epistemic uncertain factors. Scatterplots and partial correlation coefficients (PCC) were generated to determine input factor sensitivity. CSIM was developed in the SimMechanics/Simulink environment with a

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

    PubMed Central

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

    2010-01-01

    Scalene myofascial pain syndrome is a regional pain syndrome wherein pain originates over the neck area and radiates down to the arm. This condition may present as primary or secondary to underlying cervical pathology. Although scalene myofascial pain syndrome is a well known medical entity, it is often misdiagnosed as being some other neck pain associated with radiculopathy, such as cervical disc prolapse, cervical spinal stenosis and thoracic outlet syndrome. Because scalene myofascial pain syndrome mimics cervical radiculopathy, this condition often leads to mismanagement, which can, in turn, result in persistent pain and suffering. In the worst-case scenarios, patients may be subjected to unjustifiable surgical intervention. Because the clinical findings in scalene myofascial pain syndrome are “pathognomonic”, clinicians should be aware of ways to recognize this disorder and be able to differentiate it from other conditions that present with neck pain and rediculopathy. We present two cases of unilateral scalene myofascial pain syndrome that significantly impaired the patients’ functioning and quality of life. This case report serves to create awareness about the existence of the syndrome and to highlight the potential morbidity due to clinical misdiagnosis. PMID:22135529

  11. Scalene myofascial pain syndrome mimicking cervical disc prolapse: a report of two cases.

    PubMed

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

    2010-01-01

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

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

    PubMed

    Wytrazek, Marcin; Huber, Juliusz; Lisinski, Przemyslaw

    2011-01-01

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

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

    PubMed Central

    Wytra̦żek, Marcin; Huber, Juliusz; Lisiński, Przemysław

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

  14. Reliability and validity of cervical position measurements in individuals with and without chronic neck pain

    PubMed Central

    Neil, Joseph; Tallon, Allison; Adamo, Diane E.

    2015-01-01

    Objectives The cervical range of motion device (CROM) has been shown to provide reliable forward head position (FHP) measurement when the upper cervical angle (UCA) is controlled. However, measurement without UCA standardization is reflective of habitual patterns. Criterion validity has not been reported. The purposes of this study were to establish: (1) criterion validity of CROM FHP and UCA compared to Optotrak data, (2) relative reliability and minimal detectable change (MDC95) in patients with and without cervical pain, and (3) to compare UCA and FHP in patients with and without pain in habitual postures. Methods (1) Within-subjects single session concurrent criterion validity design. Simultaneous CROM and OP measurement was conducted in habitual sitting posture in 16 healthy young adults. (2) Reliability and MDC95 of UCA and FHP were calculated from three trials. (3) Values for adults over 35 years with cervical pain and age-matched healthy controls were compared. Results (1) Forward head position distances were moderately correlated and UCA angles were highly correlated. The mean (standard deviation) differences can be expected to vary between 1·48 cm (1·74) for FHP and −1·7 (2·46)° for UCA. (2) Reliability for CROM FHP measurements were good to excellent (no pain) and moderate (pain). Cervical range of motion FHP MDC95 was moderately low (no pain), and moderate (pain). Reliability for CROM UCA measurements was excellent and MDC95 low for both groups. There was no difference in FHP distances between the pain and no pain groups, UCA was significantly more extended in the pain group (P<0·05). Discussion Cervical range of motion FHP measurements were only moderately correlated with Optotrak data, and limits of agreement (LOA) and MDC95 were relatively large. There was also no difference in CROM FHP distance between older symptomatic and asymptomatic individuals. Cervical range of motion FHP measurement is therefore not recommended as a clinical outcome

  15. Percutaneous Vertebroplasty in Adult Degenerative Scoliosis for Spine Support: Study for Pain Evaluation and Mobility Improvement

    PubMed Central

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

    2013-01-01

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

  16. Prevalence of the Fibromyalgia Phenotype in Spine Pain Patients Presenting to a Tertiary Care Pain Clinic and the Potential Treatment Implications

    PubMed Central

    Brummett, Chad M.; Goesling, Jenna; Tsodikov, Alex; Meraj, Taha S.; Wasserman, Ronald A.; Clauw, Daniel J.; Hassett, Afton L.

    2014-01-01

    Objective Injections for spinal pain have high failure rates, emphasizing the importance of patient selection. It is possible that detecting the presence of a fibromyalgia-like phenotype could aid in prediction, because in these individuals a peripheral injection would not address pain due to alterations in central neurotransmission. We hypothesized that spine pain patients meeting survey criteria for fibromyalgia would be phenotypically distinct from those who do not meet criteria. Methods 548 patients with a primary spine pain diagnosis were studied. All patients completed validated self-report questionnaires, including the Brief Pain Inventory, PainDETECT, Hospital Anxiety and Depression Scale, measures of physical function, and the American College of Rheumatology survey criteria for fibromyalgia. Results 42% met survey criteria for fibromyalgia (FM+). When compared with criteria negative patients, FM+ patients were more likely to be younger, unemployed, receiving compensation, have greater pain intensity, pain interference and neuropathic pain descriptors, as well as higher levels of depression and anxiety, and lower level of physical function (p < 0.0001 for each comparison). Gender, neuropathic pain, pain interference, physical function, and anxiety were independently predictive of fibromyalgia status in a multivariate analysis (p < 0.01, all variables). ROC analysis showed the strength of association of 0.81 as measured by the cross-validated C-statistic. Conclusion Using the survey criteria for fibromyalgia, we demonstrated profound phenotypic differences in a spine pain population. Although centralized pain cannot be confirmed with a survey alone, the pathophysiology of fibromyalgia may help explain a portion of the variability of responses to spine interventions. PMID:24022710

  17. A randomised cross-over trial comparing the McGrath(®) Series 5 videolaryngoscope with the Macintosh laryngoscope in patients with cervical spine immobilisation.

    PubMed

    Foulds, L T; McGuire, B E; Shippey, B J

    2016-04-01

    We compared the performance of the McGrath® Series 5 videolaryngoscope with the Macintosh laryngoscope in 49 patients without suspected cervical spine pathology, whose cervical spine was immobilised using a semi-rigid collar. The primary outcome was the view obtained at laryngoscopy. Secondary outcomes included time to tracheal intubation, rates of successful intubation and incidence of complications. In all patients, the view was better (92%) or the same (8%) in the McGrath group versus the Macintosh group (p < 0.01). There were no failed intubations in the McGrath group and seven (28%) in the Macintosh group (p < 0.02). There was no statistical difference in time taken to intubate or incidence of complications. We conclude that the McGrath® Series 5 is a superior laryngoscope when cervical spine immobilisation is maintained during tracheal intubation.

  18. Spine day 2012: spinal pain in Swiss school children– epidemiology and risk factors

    PubMed Central

    2013-01-01

    Background The key to a better understanding of the immense problem of spinal pain seems to be to investigate its development in adolescents. Based on the data of Spine Day 2012 (an annual action day where Swiss school children were examined by chiropractors on a voluntary basis for back problems), the aim of the present study was to gain systematic epidemiologic data on adolescent spinal pain in Switzerland and to explore risk factors per gender and per spinal area. Method Data (questionnaires and physical examinations) of 836 school children were descriptively analyzed for prevalence, recurrence and severity of spinal pain. Of those, 434 data sets were included in risk factor analysis. Using logistic regression analysis, psycho-social parameters (presence of parental back pain, parental smoking, media consumption, type of school bag) and physical parameters (trunk symmetry, posture, mobility, coordination, BMI) were analyzed per gender and per spinal area. Results Prevalence of spinal pain was higher for female gender in all areas apart from the neck. With age, a steep increase in prevalence was observed for low back pain (LBP) and for multiple pain sites. The increasing impact of spinal pain on quality of life with age was reflected in an increase in recurrence, but not in severity of spinal pain. Besides age and gender, parental back pain (Odds ratio (OR)=3.26, p=0.011) and trunk asymmetry (OR=3.36, p=0.027) emerged as risk factors for spinal pain in girls. Parental smoking seemed to increase the risk for both genders (boys: OR=2.39, p=0.020; girls: OR=2.19, p=0.051). Risk factor analysis per spinal area resulted in trunk asymmetry as risk factor for LBP (OR=3.15, p=0.015), while parental smoking increased the risk for thoracic spinal pain (TSP) (OR=2.83, p=0.036) and neck pain (OR=2.23, p=0.038). The risk for TSP was further enhanced by a higher BMI (OR=1.15, p=0.027). Conclusion This study supports the view of adolescent spinal pain as a bio

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

    2011-01-01

    Objective To characterize the types of control procedures used in controlled clinical trials of cervical spine manipulation and to evaluate the outcomes obtained by subjects in control groups so as to improve the quality of future clinical trials Methods A search of relevant clinical trials was performed in PubMed 1966-May 2010 with the following key words: "Chiropractic"[Mesh] OR "Manipulation, Spinal"[Mesh]) AND "Clinical Trial "[Publication Type]. Reference lists from these trials were searched for any additional trials. The reference lists of two prior studies, one review and one original study were also searched. Accepted reports were then rated for quality by 2 reviewers using the PEDro scale. Studies achieving a score of >50% were included for data extraction and analysis. Intra-group change scores on pain outcomes were obtained. For determining clinically important outcomes, a threshold of 20% improvement was used where continuous data were available; otherwise, an effect size of 0.30 was employed Results The PubMed search yielded 753 citations of which 13 were selected. Eight (8) other studies were identified by reviewing two systematic reviews and through reference searches. All studies scored >50% on the PEDro scale. There were 9 multi-session studies and 12 single-session studies. The most commonly used control procedure was "manual contact/no thrust". Four (4) studies used a placebo-control (patient blinded). For two of these studies with VAS data, the average change reported was 4.5 mm. For the other control procedures, variable results were obtained. No clinically important changes were reported in 57% of the paired comparisons, while, in 43% of these, changes which would be considered clinically important were obtained in the control groups. Only 15% of trials reported on post-intervention group registration. Conclusions Most control procedures in cervical manipulation trials result in small clinical changes, although larger changes are observed in

  1. Efficacy of coblation technology in treating cervical discogenic upper back pain.

    PubMed

    He, Liangliang; Tang, Yuanzhang; Li, Xiuliang; Li, Na; Ni, Jiaxiang; He, Liangliang

    2015-05-01

    Upper back pain originating from the cervical disk itself is defined as cervical discogenic upper back pain. Coblation procedures can provide therapeutic effects for neck and radicular pain related to contained cervical disk herniation. However, no studies have reported the performance of coblation procedures, particularly for treating cervical discogenic upper back pain. The purpose of this study was to evaluate the efficacy of coblation procedures in treating cervical discogenic upper back pain.In a prospective, clinical, observational study, 28 consecutive patients with discogenic upper back pain underwent coblation procedures on the cervical disk with a percutaneous anterior approach. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, significant (≥50%) reduction in pain medicine intake and Modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 12 months of follow-up.The preoperative pain VAS score was 6.5 ± 1.1 (95% confidence interval [CI] 6.085-6.915), and the pain VAS score significantly decreased to 2.4 ± 1.3 (95% CI 1.929-2.928), 2.5 ± 1.5 (95% CI 1.963-3.109), 2.7 ± 1.4 (95% CI 2.157-3.271), 3.1 ± 1.6 (95% CI 2.457-3.686), and 3.1 ± 1.6 (95% CI 2.471-3.743) at 1 week and 1, 3, 6, and 12 months postoperatively, respectively (P < 0.05). Twenty-two (78.6%), 21 (75.0%), 20 (71.4%), 19 (67.9%), and 18 (64.3%) of the patients expressed significant pain relief at 1 week and 1, 3, 6, and 12 months postoperatively, respectively. 24 (85.7%), 23 (82.1%), 23 (82.1%), and 22 (78.6%) reported significant reduction in pain medication intake at 1, 3, 6, and 12 months postoperatively, respectively. According to the Modified MacNab criteria, the numbers of patients with "excellent" or "good" ratings were 22 (78.6%), 21 (75.0%), 20 (71.4%), and 18 (64.3%) at 1, 3, 6, and 12 months postoperatively, respectively. No serious

  2. Efficacy of coblation technology in treating cervical discogenic upper back pain.

    PubMed

    He, Liangliang; Tang, Yuanzhang; Li, Xiuliang; Li, Na; Ni, Jiaxiang; He, Liangliang

    2015-05-01

    Upper back pain originating from the cervical disk itself is defined as cervical discogenic upper back pain. Coblation procedures can provide therapeutic effects for neck and radicular pain related to contained cervical disk herniation. However, no studies have reported the performance of coblation procedures, particularly for treating cervical discogenic upper back pain. The purpose of this study was to evaluate the efficacy of coblation procedures in treating cervical discogenic upper back pain.In a prospective, clinical, observational study, 28 consecutive patients with discogenic upper back pain underwent coblation procedures on the cervical disk with a percutaneous anterior approach. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, significant (≥50%) reduction in pain medicine intake and Modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 12 months of follow-up.The preoperative pain VAS score was 6.5 ± 1.1 (95% confidence interval [CI] 6.085-6.915), and the pain VAS score significantly decreased to 2.4 ± 1.3 (95% CI 1.929-2.928), 2.5 ± 1.5 (95% CI 1.963-3.109), 2.7 ± 1.4 (95% CI 2.157-3.271), 3.1 ± 1.6 (95% CI 2.457-3.686), and 3.1 ± 1.6 (95% CI 2.471-3.743) at 1 week and 1, 3, 6, and 12 months postoperatively, respectively (P < 0.05). Twenty-two (78.6%), 21 (75.0%), 20 (71.4%), 19 (67.9%), and 18 (64.3%) of the patients expressed significant pain relief at 1 week and 1, 3, 6, and 12 months postoperatively, respectively. 24 (85.7%), 23 (82.1%), 23 (82.1%), and 22 (78.6%) reported significant reduction in pain medication intake at 1, 3, 6, and 12 months postoperatively, respectively. According to the Modified MacNab criteria, the numbers of patients with "excellent" or "good" ratings were 22 (78.6%), 21 (75.0%), 20 (71.4%), and 18 (64.3%) at 1, 3, 6, and 12 months postoperatively, respectively. No serious

  3. Efficacy of Coblation Technology in Treating Cervical Discogenic Upper Back Pain

    PubMed Central

    He, Liangliang; Tang, Yuanzhang; Li, Xiuliang; Li, Na; Ni, Jiaxiang; He, Liangliang

    2015-01-01

    Abstract Upper back pain originating from the cervical disk itself is defined as cervical discogenic upper back pain. Coblation procedures can provide therapeutic effects for neck and radicular pain related to contained cervical disk herniation. However, no studies have reported the performance of coblation procedures, particularly for treating cervical discogenic upper back pain. The purpose of this study was to evaluate the efficacy of coblation procedures in treating cervical discogenic upper back pain. In a prospective, clinical, observational study, 28 consecutive patients with discogenic upper back pain underwent coblation procedures on the cervical disk with a percutaneous anterior approach. Pain visual analogue scale (VAS) scores, patient responses stating significant (≥50%) pain relief, significant (≥50%) reduction in pain medicine intake and Modified MacNab criteria were adopted to evaluate the pain intensity, degree of pain relief, and functional status after 12 months of follow-up. The preoperative pain VAS score was 6.5 ± 1.1 (95% confidence interval [CI] 6.085–6.915), and the pain VAS score significantly decreased to 2.4 ± 1.3 (95% CI 1.929–2.928), 2.5 ± 1.5 (95% CI 1.963–3.109), 2.7 ± 1.4 (95% CI 2.157–3.271), 3.1 ± 1.6 (95% CI 2.457–3.686), and 3.1 ± 1.6 (95% CI 2.471–3.743) at 1 week and 1, 3, 6, and 12 months postoperatively, respectively (P < 0.05). Twenty-two (78.6%), 21 (75.0%), 20 (71.4%), 19 (67.9%), and 18 (64.3%) of the patients expressed significant pain relief at 1 week and 1, 3, 6, and 12 months postoperatively, respectively. 24 (85.7%), 23 (82.1%), 23 (82.1%), and 22 (78.6%) reported significant reduction in pain medication intake at 1, 3, 6, and 12 months postoperatively, respectively. According to the Modified MacNab criteria, the numbers of patients with “excellent” or “good” ratings were 22 (78.6%), 21 (75.0%), 20 (71.4%), and 18 (64.3%) at 1, 3, 6, and 12 months

  4. Pseudoappendicitis: abdominal pain arising from thoracic spine dysfunction-a forgotten entity and a reminder of an important clinical lesson.

    PubMed

    Garo-Falides, Basil; Wainwright, Thomas William

    2016-01-01

    Acute or chronic abdominal pain can be mimicked by thoracic spine dysfunction. However, it is comparatively rare and there is frequently a delay in its diagnosis that may lead to unnecessary surgery, or the patient's symptoms being undiagnosed or labelled psychosomatic. The failure to associate thoracic spine dysfunction with abdominal pain persists, despite it being first recognised over 80 years ago. 2 recent such cases are presented. The clinical presentation and diagnostic tests are described, with clear explanation of the treatment and outcome. The case for including the thoracic spine examination in the assessment of patients presenting with acute abdominal or postappendectomy pain that is of unexplained origin is made. PMID:27651405

  5. Cervical Spine Motion During Football Equipment-Removal Protocols: A Challenge to the All-or-Nothing Endeavor

    PubMed Central

    Jacobson, Bradley; Cendoma, Michael; Gdovin, Jacob; Cooney, Kevin; Bruening, Dustin

    2014-01-01

    Context The National Athletic Trainers' Association position statement on acute management of the cervical spine-injured athlete recommended the all-or-nothing endeavor, which involves removing or not removing both helmet and shoulder pads, from equipment-laden American football and ice hockey athletes. However, in supporting research, investigators have not considered alternative protocols. Objective To measure cervical spine movement (head relative to sternum) produced when certified athletic trainers (ATs) use the all-or-nothing endeavor and to compare these findings with the movement produced using an alternative pack-and-fill protocol, which involves packing the area under and around the cervical neck and head with rolled towels. Design Crossover study. Setting Movement analysis laboratory. Patients or Other Participants Eight male collegiate football players (age = 21.4 ± 1.4 years; height = 1.87 ± 0.02 m; mass = 103.6 ± 12.5 kg). Intervention(s) Four ATs removed equipment under 4 conditions: removal of helmet only followed by placing the head on the ground (H), removal of the helmet only followed by pack-and-fill (HP), removal of the helmet and shoulder pads followed by placing the head on the ground (HS), and removal of the helmet and shoulder pads followed by pack-and-fill (HSP). Motion capture was used to track the movement of the head with respect to the sternum during equipment removal. Main Outcome Measure(s) We measured head movement relative to sternum movement (translations and rotations). We used 4 × 4 analyses of variance with repeated measures to compare discrete motion variables (changes in position and total excursions) among protocols and ATs. Results Protocol HP resulted in a 0.1 ± 0.6 cm rise in head position compared with a 1.4 ± 0.3 cm drop with protocol HS (P < .001). Protocol HP produced 4.9° less total angular excursion (P < .001) and 2.1 cm less total vertical excursion (P < .001) than protocol HS. Conclusions The pack

  6. Kinesiophobia in Pre-Operative Patients with Cervical Discopathy and Coexisting Degenerative Changes in Relation to Pain-Related Variables, Psychological State and Sports Activity

    PubMed Central

    Misterska, Ewa; Jankowski, Roman; Głowacki, Jakub; Shadi, Milud; Walczak, Michał; Głowacki, Maciej

    2015-01-01

    Background No research group has ever investigated the level of kinesiophobia in a well defined group of preoperative patients treated due to cervical discopathy and degenerative spine disease, confirmed by X-ray and magnetic resonance imaging (MRI) examinations. We aimed to investigate the degree of kinesiophobia and the differences in pain-related and psychosocial characteristics between patients with high and low levels of kinesiophobia, in relation to factors commonly associated with neck pain. Material/Methods Sixty-five consecutive patients with cervical discopathy and coexisting degenerative changes were assessed pre-surgically. The mean pain duration was 31.7 SD 34.0 months. Patients completed the Polish versions of the Tampa Scale for Kinesiophobia (TSK-PL) on 2 occasions, and the following once: Neck Disability Index (NDI-PL), State-Trait Anxiety Inventory (STAI-PL), Coping Strategies Questionnaire (CSQ-PL), and the Visual Analogue Scale (VAS-PL). Results A high level of kinesiophobia was indicated in 81.5% and 87.7% of patients in first and second completion, respectively. Patients with high and low kinesiophobia differ in regards to the recreation section of NDI-PL (p=0.012), gender (p=0.043), and sports activity (p=0.024). Correlations were identified between TSK-PL and marital status (p=0.023) and sports activity (p=0.024). Conclusions Kinesiophobia levels are higher in patients with chronic cervical pain before surgical treatment. Fear of movement tends to be higher in women and among patients avoiding sports recreation before surgical treatment. Although sports activity and socio-demographic data are predictors of kinesiophobia, psychological, pain-related, and clinical data are not. These findings should be considered when planning rehabilitation after surgical treatment of cervical discopathy and coexisting degenerative changes. PMID:25598197

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

    PubMed Central

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

    2005-01-01

    Summary An intubating laryngeal mask airway (ILMA) facilitates tracheal intubation with the neck in neutral position, which is similar to the neck position maintained by a rigid cervical collar. However, a cervical collar virtually obliterates neck movement, even the small movements that normally facilitate airway insertion. We therefore tested the hypothesis that the ILMA facilitates tracheal intubation even in patients wearing a rigid cervical collar. In 50 cervical spine surgery patients with a rigid Philadelphia collar in place and 50 general surgery patients under general anaesthesia, we performed blind tracheal intubation via an ILMA. The time required for intubation, intubation success rate, and numbers and type of adjusting manoeuvres employed were recorded. Inter-incisor distance was significantly smaller (4.1 [0.8] cm vs. 4.6 [0.7] cm, mean [SD], P<0.01) and Mallampati scores were significantly greater (P<0.001) in the collared patients. ILMA insertion took longer (30 [25] vs. 22 [6] seconds), more patients required 2 insertion attempts (15 vs. 3; P<0.005), and ventilation adequacy with ILMA was worse (P<0.05) in collared patients. However, there were no significant differences between the collared and control patients in terms of total time required for intubation (60 [41] vs. 50 [30] seconds), number of intubation attempts, overall intubation success rate (96 vs. 98%), or the incidence of intubation complications. Blind intubation through an ILMA is thus a reasonable strategy for controlling the airway in patients who are immobilized with a rigid cervical collar, especially when urgency precludes a fiberoptic approach. PMID:15321932

  8. Motor Cortex Stimulation for the Treatment of Chronic Facial, Upper Extremity, and Throat Pain.

    ClinicalTrials.gov

    2016-08-29

    Trigeminal Neuralgia (Burchiel Type I); Trigeminal Neuralgia (Burchiel Type II); Trigeminal Neuropathic Pain; Trigeminal Deafferentation Pain; Complex Regional Pain Syndrome (Types I and II, Involving the Upper Extremity); Glossopharyngeal Neuralgia; Upper Extremity Pain Due to Deafferentation of the Cervical Spine; Central Pain Syndromes

  9. Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy.

    PubMed

    Thirumala, Parthasarathy D; Muralidharan, Aditya; Loke, Yoon K; Habeych, Miguel; Crammond, Donald; Balzer, Jeffrey

    2016-03-01

    The primary aim of this study was to conduct a systematic review of reports of patients with cervical spondylotic myelopathy and to assess the value of intraoperative monitoring (IOM), including somatosensory evoked potentials, transcranial motor evoked potentials and electromyography, in anterior cervical procedures. A search was conducted to collect a small database of relevant papers using key words describing disorders and procedures of interest. The database was then shortlisted using selection criteria and data was extracted to identify complications as a result of anterior cervical procedures for cervical spondylotic myelopathy and outcome analysis on a continuous scale. In the 22 studies that matched the screening criteria, only two involved the use of IOM. The average sample size was 173 patients. In procedures done without IOM a mean change in Japanese Orthopaedic Association score of 3.94 points and Nurick score by 1.20 points (both less severe post-operatively) was observed. Within our sub-group analysis, worsening myelopathy and/or quadriplegia was seen in 2.71% of patients for studies without IOM and 0.91% of patients for studies with IOM. Variations persist in the existing literature in the evaluation of complications associated with anterior cervical spinal procedures. Based on the review of published studies, sufficient evidence does not exist to make recommendations regarding the use of different IOM modalities to reduce neurological complications during anterior cervical procedures. However, future studies with objective measures of neurological deficits using a specific IOM modality may establish it as an effective and reliable indicator of injury during such surgeries. PMID:26677786

  10. The Biomechanics of Cervical Spondylosis

    PubMed Central

    Ferrara, Lisa A.

    2012-01-01

    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. PMID:22400120

  11. The biomechanics of cervical spondylosis.

    PubMed

    Ferrara, Lisa A

    2012-01-01

    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. PMID:22400120

  12. A biomechanical analysis of decompression and reconstruction methods in the cervical spine. Emphasis on a carbon-fiber-composite cage.

    PubMed

    Shono, Y; McAfee, P C; Cunningham, B W; Brantigan, J W

    1993-11-01

    Biomechanical analysis of three different patterns of instability--that created by fifth and sixth cervical anterior discectomy, that created by one-level (fifth cervical) anterior corpectomy, and that created by two-level (fourth and fifth cervical) corpectomy--was performed in eighteen calf spines. Three types of anterior reconstruction--anterior iliac strut bone-grafting, use of an anterior carbon-fiber-composite cage packed with cancellous bone graft, as well as use of polymethylmethacrylate anteriorly--were cyclically tested in axial compression, torsion, and flexion-extension. Each of these types of reconstruction was also tested with supplemental posterior wire stabilization (the triple-wire technique of Bohlman). Regardless of the type of anterior instability, the carbon-fiber-reinforced cage packed with cancellous bone graft was more rigid than the iliac bone graft alone. The cage resulted in good stiffness in the axial compression and rotation tests and was the most rigid construct in the flexion-extension tests. The superior aspect of the polymethylmethacrylate constructs loosened at the bone-cement interface in eight of the twelve specimens during flexion-extension testing. The addition of the supplemental posterior wiring to the anterior constructs provided additional rigidity in flexion-extension testing.

  13. Accuracy of positioning the cervical spine for radiation therapy and the relationship to GTV, CTV and PTV.

    PubMed

    Kippenes, Hege; Gavin, Patrick R; Sande, Ronald D; Rogers, Dennis; Sweet, Vaughn

    2003-01-01

    The purpose of the study was to evaluate the accuracy and precision of a rigid positioning device for repositioning the cervical spine accurately and precisely during conformal radiation therapy of dogs. Fifteen purpose bred research dogs in a radiation therapy study were included. The dogs were positioned using a head holder and a deflatable pillow attached to the treatment table. Port films were reviewed retrospectively, and repositioning precision was recorded by measurements in three orthogonal planes of the head, 2nd cervical vertebra and 1st thoracic spinous process. Mean treatment position was compared to the planning position for a measurement of systematic set-up error. Mean interfraction position variation of the 2nd cervical vertebra was 0.2, 0.1 and 0.2 cm for the ventrodorsal, caudocranial and laterolateral directions respectively, and the average systematic set up error was 0.2, 0.1 and 0.2 cm for the ventrodorsal, caudocranial and laterolateral directions respectively. Knowledge of the magnitude of reposition errors should be included when determining the margins around the tumor. PMID:14703256

  14. Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali

    PubMed Central

    Mahadewa Tjokorda, G. B.; Nyoman, Golden; Sri, Maliawan; Junichi, Mizuno

    2016-01-01

    This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome.

  15. Anterior cervical discectomy and fusion with titanium cages for simple or multilevel herniated discs and spur of the cervical spine: Report of 2 cases and experience in Bali

    PubMed Central

    Mahadewa Tjokorda, G. B.; Nyoman, Golden; Sri, Maliawan; Junichi, Mizuno

    2016-01-01

    This report presents two cases of cervicobrachialgia and radiculopathy due to multiple cervical herniated discs and spur formation that dealt with anterior cervical discectomy and fusion (ACDF) using different titanium interbody cages. The description of the clinical presentation, magnetic resonance imaging (MRI) appearances and management strategy are discussed. Both cases showed chronic neck pain and radiating pain from the shoulder to the arm. They had a history of blurry vision, cluster head ache, weakness, and numbness on the shoulder for 2 years. MRI revealed multiple herniated discs between C4-7 and accompanied by the spur formation leading to the narrowness of the spinal canal and its foramina bilaterally. ACDF were performed and complete decompression of the spinal canal and its foramina were carried out. Twin M-cages (Ammtec Inc.-Japan) were placed in the first case at C5-7 levels and single cage of Smith Robinson (SR) was placed in the second case at C5-6 levels. There were no more blurry vision, cluster headache, weakness, and numbness, immediately after surgery. To our knowledge, this is the first reported cases of ACDF, using twin M-cages and single SR cage in Indonesia, with improvement immediately after surgery. Cervical spondylosis can present with cervicobrachialgia and radiculopathy and surgical treatment produces good functional outcome. PMID:27695567

  16. Effect of deep cervical flexor muscles training using pressure biofeedback on pain and disability of school teachers with neck pain.

    PubMed

    Iqbal, Zaheen Ahmed; Rajan, Reena; Khan, Sohrab Ahmed; Alghadir, Ahmad H

    2013-06-01

    [Purpose] The job of secondary school teachers involves a lot of head down posture as frequent reading, assignment correction, computer use and writing on a board put them at risk of developing occupational related neck pain. Available studies of neck pain experienced by teachers are limited. The purpose of this study was to determine whether training of deep cervical flexor muscles with pressure biofeedback has any significant advantage over conventional training for pain and disability experienced by school teachers with neck pain. [Subjects] Thirty teachers aged 25-45 years with neck pain and poor craniocervical flexion test participated in this study. [Methods] A pretest posttest experimental group design was used in which experimental group has received training with pressure biofeedback and conventional exercises while control group received conventional exercises only. Measurements of dependent variables were taken at baseline, and after 2 and 4 weeks of training. Pain intensity was assessed using a numeric pain rating scale and functional disability was assessed using the neck disability index. [Results] The data analysis revealed that there was significant improvement in pain and disability in both the groups and the results were better in the experimental group. [Conclusion] Addition of pressure biofeedback for deep cervical flexor muscles training gave a better result than conventional exercises alone. Feedback helps motor learning which is the set of processes associated with practice or experience leading to permanent changes in ability to respond. PMID:24259822

  17. Effect of deep cervical flexor muscles training using pressure biofeedback on pain and disability of school teachers with neck pain.

    PubMed

    Iqbal, Zaheen Ahmed; Rajan, Reena; Khan, Sohrab Ahmed; Alghadir, Ahmad H

    2013-06-01

    [Purpose] The job of secondary school teachers involves a lot of head down posture as frequent reading, assignment correction, computer use and writing on a board put them at risk of developing occupational related neck pain. Available studies of neck pain experienced by teachers are limited. The purpose of this study was to determine whether training of deep cervical flexor muscles with pressure biofeedback has any significant advantage over conventional training for pain and disability experienced by school teachers with neck pain. [Subjects] Thirty teachers aged 25-45 years with neck pain and poor craniocervical flexion test participated in this study. [Methods] A pretest posttest experimental group design was used in which experimental group has received training with pressure biofeedback and conventional exercises while control group received conventional exercises only. Measurements of dependent variables were taken at baseline, and after 2 and 4 weeks of training. Pain intensity was assessed using a numeric pain rating scale and functional disability was assessed using the neck disability index. [Results] The data analysis revealed that there was significant improvement in pain and disability in both the groups and the results were better in the experimental group. [Conclusion] Addition of pressure biofeedback for deep cervical flexor muscles training gave a better result than conventional exercises alone. Feedback helps motor learning which is the set of processes associated with practice or experience leading to permanent changes in ability to respond.

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

    PubMed

    Peolsson, Anneli; Vavruch, Ludek; Hedlund, Rune

    2007-02-01

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

  19. Cervical and thoracic spine injury from interactions with vehicle roofs in pure rollover crashes.

    PubMed

    Bambach, M R; Grzebieta, R H; McIntosh, A S; Mattos, G A

    2013-01-01

    Around one third of serious injuries sustained by belted, non-ejected occupants in pure rollover crashes occur to the spine. Dynamic rollover crash test methodologies have been established in Australia and the United States, with the aims of understanding injury potential in rollovers and establishing the basis of an occupant rollover protection crashworthiness test protocol that could be adopted by consumer new car assessment programmes and government regulators internationally. However, for any proposed test protocol to be effective in reducing the high trauma burden resulting from rollover crashes, appropriate anthropomorphic devices that replicate real-world injury mechanisms and biomechanical loads are required. To date, consensus regarding the combination of anthropomorphic device and neck injury criteria for rollover crash tests has not been reached. The aim of the present study is to provide new information pertaining to the nature and mechanisms of spine injury in pure rollover crashes, and to assist in the assessment of spine injury potential in rollover crash tests. Real-world spine injury cases that resulted from pure rollover crashes in the United States between 2000 and 2009 are identified, and compared with cadaver experiments under vertical load by other authors. The analysis is restricted to contained, restrained occupants that were injured from contact with the vehicle roof structure during a pure rollover, and the role of roof intrusion in creating potential for spine injury is assessed. Recommendations for assessing the potential for spine injury in rollover occupant protection crash test protocols are made. PMID:23149322

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

    PubMed Central

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

    2012-01-01

    Background: Aneurysmal bone cysts are rare occurrences in the cervical spine. Surgical treatment in pediatric patients is a challenge. Complete tumor resection offers the best chance for cure. Description: Diagnosis and surgical management of an expansile aneurysmal bone cyst of the cervical spine involving all three spinal columns in a 10-year-old boy. Results: Surgical treatment included tumor excision and circumferential fusion, and produced no neurological or vascular sequelae. This approach minimizes the risk of recurrence and the possibility of postoperative spinal instability. Conclusion: Spinal instability is preferably addressed with reconstruction and stabilization. Cervical aneurismal bone cyst lesions are ideally treated with complete resection to minimize the chance of recurrence. In pediatric cases, defects created by resection should be corrected by fusion to minimize the risk of postoperative instability and growth abnormality. PMID:23526912

  1. Lumbar Epidural Steroid Injection for Painful Spasticity in Cervical Spinal Cord Injury: A Case Report

    PubMed Central

    Bang, Hyun; Chun, Seong Min; Park, Hee Won; Bang, Moon Suk

    2015-01-01

    We report a case of a 53-year-old male with traumatic cervical spinal cord injury (SCI). He could not maintain a standing position because of painful spasticity in his lower limbs. A magnetic resonance imaging and electromyography indicated chronic lumbosacral radiculopathy, explaining his chronic low back pain before the injury. For diagnostic as well as therapeutic purposes, transforaminal epidural steroid injection (ESI) to the right L5 root was performed. After the intervention, the spasticity decreased and his ambulatory function improved. This case illustrates that lumbar radiculopathy concomitant with a cervical SCI can produce severe spasticity and it can be dramatically improved by ESI. PMID:26361605

  2. Predictors of long-term opioid use among patients with painful lumbar spine conditions

    PubMed Central

    Krebs, Erin E.; Lurie, Jon D.; Fanciullo, Gilbert; Tosteson, Tor D.; Blood, Emily A.; Carey, Timothy S.; Weinstein, James N.

    2009-01-01

    Our objective was to assess predictors of self-reported opioid use among patients with back pain due to lumbar disc herniation or spinal stenosis. Data was from the Spine Patient Outcomes Research Trial (SPORT), a multi-site observational study and randomized trial. We examined characteristics shown or hypothesized to be associated with opioid use. Using generalized estimating equations, we modeled associations of each potential predictor with opioid use at 12 and 24 months. At baseline, 42% of participants reported opioid use. Of these participants, 25% reported continued use at 12 months and 21% reported use at 24 months. In adjusted models, smoking (RR=1.9, p<0.001 at 12 months; RR=1.5, p=0.043 at 24 months) and non-surgical treatment (RR=1.7, p<0.001 at 12 months; RR=1.8, p=0.003 at 24 months) predicted long-term opioid continuation. Among participants not using opioids at baseline, incident use was reported by 8% at 12 and 7% at 24 months. We found no significant predictors of incident use at 12 or 24 months in the main models. In conclusion, nonsurgical treatment and smoking independently predicted long-term continued opioid use. To our knowledge, this is the first longitudinal study to assess predictors of long-term and incident opioid use among patients with lumbar spine conditions. PMID:19628436

  3. Prognostic Value of Preoperative Coping Strategies for Pain in Patients with Residual Neuropathic Pain after Laminoplasty for Compressive Cervical Myelopathy

    PubMed Central

    2015-01-01

    Study Design Single-center retrospective cohort study. Purpose To clarify the prognostic value of preoperative coping strategies for pain due to compressive cervical myelopathy. Overview of Literature Preoperative physical function, imaging and electrophysiological findings are known predictors of surgical outcomes. However, coping strategies for pain have not been considered. Methods Postoperative questionnaires, concerning health-related quality of life (HRQOL) and daily living activities, were sent to 78 patients with compressive cervical myelopathy who had suffered from neuropathic pain before laminoplasty, and been preoperatively assessed with respect to their physical and mental status and coping strategies for pain. Hierarchical multiple regression analysis was performed to clarify the extent to which the patient's preoperative coping strategies could explain the variance in postoperative HRQOL and activity levels. Results Forty-two patients with residual neuropathic pain after laminoplasty were analyzed by questionnaires (28 men, 14 women; mean age, 62.7±10.2 years; symptom duration, 48.0±66.0 months). The valid response rate was 53.8%. Hierarchical multiple regression analysis showed that preoperative coping strategies, which involved coping self-statements, diverting attention, and catastrophizing, were independently associated with postoperative HRQOL and activity level, and could explain 7% to 11% of their variance. Combinations of the coping strategies for pain and upper/lower motor functions could explain 26% to 36% of the variance in postoperative HRQOL and activity level. Conclusions Preoperative coping strategies for pain are good predictors of postoperative HRQOL and activities of daily living in patients with postoperative residual neuropathic pain due to compressive cervical myelopathy. PMID:26435783

  4. Positional Magnetic Resonance Imaging for People With Ehlers-Danlos Syndrome or Suspected Craniovertebral or Cervical Spine Abnormalities: An Evidence-Based Analysis

    PubMed Central

    2015-01-01

    Background Ehlers-Danlos syndrome (EDS) is an inherited disorder affecting the connective tissue. EDS can manifest with symptoms attributable to the spine or craniovertebral junction (CVJ). In addition to EDS, numerous congenital, developmental, or acquired disorders can increase ligamentous laxity in the CVJ and cervical spine. Resulting abnormalities can lead to morbidity and serious neurologic complications. Appropriate imaging and diagnosis is needed to determine patient management and need for complex surgery. Some spinal abnormalities cause symptoms or are more pronounced while patients sit, stand, or perform specific movements. Positional magnetic resonance imaging (pMRI) allows imaging of the spine or CVJ with patients in upright, weight-bearing positions and can be combined with dynamic maneuvers, such as flexion, extension, or rotation. Imaging in these positions could allow diagnosticians to better detect spinal or CVJ abnormalities than recumbent MRI or even a combination of other available imaging modalities might allow. Objectives To determine the diagnostic impact and clinical utility of pMRI for the assessment of (a) craniovertebral or spinal abnormalities among people with EDS and (b) major craniovertebral or cervical spine abnormalities among symptomatic people. Data Sources A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, and EBM Reviews, for studies published from January 1, 1998, to September 28, 2014. Review Methods Studies comparing pMRI to recumbent MRI or other available imaging modalities for diagnosis and management of spinal or CVJ abnormalities were reviewed. All studies of spinal or CVJ imaging in people with EDS were included as well as studies among people with suspected major CVJ or cervical spine abnormalities (cervical or craniovertebral spine instability, basilar invagination, cranial settling, cervical stenosis, spinal cord compression, Chiari

  5. Can emergency nurses use the Canadian cervical spine rule to reduce unnecessary patient immobilisation?

    PubMed

    Miller, Phil; Coffey, Frank; Reid, Anne-Marie; Stevenson, Keith

    2006-07-01

    The Canadian c-spine rule (CCR) allows safe, reproducible use of radiography in alert, stable patients with potential c-spine injury in the emergency setting [Stiell, I., Clement, C., McKnight, R., Brison, R., Schull, M., Lowe, B., Worthington, J., Eisenhauer, M., Cass, D., Greenberg, G., MacPhail, I., Dreyer, J., Lee, J., Bandiera, G., Reardon, M., Holroyd, B., Lesiuk, H., G. Wells, 2003. The Canadian c-spine rule versus the nexus low-risk criteria in patients with trauma. The New England journal of medicine 349 (26), 2510-2518; Stiell, I., Wells, G., Vandemheen, K., Clement, C., 2001. The Canadian c-spine rule for radiography in alert and stable trauma patients. JAMA 286 (15), 1841]. This paper reports on a study of emergency nurses' ability to identify patients requiring immobilisation using the CCR. Emergency department triage nurses (N = 112) were trained in the use of the CCR and then asked to use the tool over the following 14 months in the assessment of 460 patients who presented with potential c-spine injury. Trained medical staff repeated 55% of the clinical assessments independently using the rule. The level of agreement between nurse and medical judgement was calculated. The inter-rater reliability using the kappa statistic was 0.6 (95% CI 0.50-0.62 N = 254) indicating a 'good' level of agreement. The majority of nurses indicated they were comfortable using the rule. The results suggest that UK emergency department nurses were able to use the Canadian c-spine rule to successfully guide selective immobilisation. A 25% reduction in immobilisation rates would have been achieved if the rule had been followed. Further studies are needed to test the reduction in levels of immobilisation that could be achieved in clinical practice.

  6. Impact of McKenzie Method Therapy Enriched by Muscular Energy Techniques on Subjective and Objective Parameters Related to Spine Function in Patients with Chronic Low Back Pain

    PubMed Central

    Szulc, Paweł; Wendt, Michał; Waszak, Małgorzata; Tomczak, Maciej; Cieślik, Krystyna; Trzaska, Tadeusz

    2015-01-01

    Background The high incidence and inconsistencies in diagnostic and therapeutic process of low back pain (LBP) stimulate the continuing search for more efficient treatment modalities. Integration of the information obtained with various therapeutic methods and a holistic approach to the patient seem to be associated with positive outcomes. The aim of this study was to analyze the efficacy of combined treatment with McKenzie method and Muscle Energy Technique (MET), and to compare it with the outcomes of treatment with McKenzie method or standard physiotherapy in specific chronic lumbar pain. Material/Methods The study included 60 men and women with LBP (mean age 44 years). The patients were randomly assigned to 1 of 3 therapeutic groups, which were further treated with: 1) McKenzie method and MET, 2) McKenzie method alone, or 3) standard physiotherapy for 10 days. The extent of spinal movements (electrogoniometry), level of experienced pain (Visual Analogue Scale and Revised Oswestry Pain Questionnaire), and structure of the spinal discs (MRI) were examined prior to the intervention, immediately thereafter, and 3 months after the intervention. Results McKenzie method enriched with MET had the best therapeutic outcomes. The mobility of cervical, thoracic, and lumbar spine normalized at levels corresponding to 87.1%, 66.7%, and 95% of respective average normative values. Implementation of McKenzie method, both alone and combined with MET, was associated with a significant decrease in Oswestry Disability Index, significant alleviation of pain (VAS), and significantly reduced size of spinal disc herniation. Conclusions The combined method can be effectively used in the treatment of chronic LBP. PMID:26418868

  7. Semi-automatic delineation of the spino-laminar junction curve on lateral x-ray radiographs of the cervical spine

    NASA Astrophysics Data System (ADS)

    Narang, Benjamin; Phillips, Michael; Knapp, Karen; Appelboam, Andy; Reuben, Adam; Slabaugh, Greg

    2015-03-01

    Assessment of the cervical spine using x-ray radiography is an important task when providing emergency room care to trauma patients suspected of a cervical spine injury. In routine clinical practice, a physician will inspect the alignment of the cervical spine vertebrae by mentally tracing three alignment curves along the anterior and posterior sides of the cervical vertebral bodies, as well as one along the spinolaminar junction. In this paper, we propose an algorithm to semi-automatically delineate the spinolaminar junction curve, given a single reference point and the corners of each vertebral body. From the reference point, our method extracts a region of interest, and performs template matching using normalized cross-correlation to find matching regions along the spinolaminar junction. Matching points are then fit to a third order spline, producing an interpolating curve. Experimental results demonstrate promising results, on average producing a modified Hausdorff distance of 1.8 mm, validated on a dataset consisting of 29 patients including those with degenerative change, retrolisthesis, and fracture.

  8. Just a drop of cement: a case of cervical spine bone aneurysmal cyst successfully treated by percutaneous injection of a small amount of polymethyl-methacrylate cement.

    PubMed

    Fahed, Robert; Clarençon, Frédéric; Riouallon, Guillaume; Cormier, Evelyne; Bonaccorsi, Raphael; Pascal-Mousselard, Hugues; Chiras, Jacques

    2016-01-01

    Aneurysmal bone cyst (ABC) is a benign hemorrhagic tumor, commonly revealed by local pain. The best treatment for this lesion is still controversial. We report the case of a patient with chronic neck pain revealing an ABC of the third cervical vertebra. After percutaneous injection of a small amount of polymethyl-methacrylate bone cement, the patient experienced significant clinical and radiological improvement.

  9. Painful cervical dystonia triggered by the extension wire of a deep brain stimulator.

    PubMed

    Spagnolo, F; Picozzi, P; Franzin, A; Martinelli, V; Comi, G; Volonte, M A

    2012-11-01

    Deep brain stimulation (DBS) can be complicated by adverse events, which are generally classified as surgical-hardware or stimulation-related. Here we report the onset of a painful cervical dystonia probably triggered by the extension wire of a subthalamic nucleus (STN)-DBS device in a woman suffering from advanced Parkinson's disease (PD). Two months after implantation of the STN-DBS device, our patient developed a painful cervical dystonia, which was not responsive to neurostimulation or to medication. No sign of infections or fibrosis was detected. A patch test with the components of the device was performed, revealing no hypersensibility. The patient was referred back to surgery to reposition the pulse generator in the contralateral subclavian region. A deeper channeling of the wire extensions produced a complete remission of the painful dystonia. PMID:22954791

  10. Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain

    PubMed Central

    Uthaikhup, Sureeporn; Prasert, Romchat; Paungmali, Aatit; Boontha, Kritsana

    2015-01-01

    Background Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders. Methods Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle. Results Elders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p < 0.05). There were no between group differences in heat pain thresholds and suprathreshold heat pain responses (p > 0.05). Conclusion The presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age. PMID:26039149

  11. Cervical Laminoplasty

    MedlinePlus

    ... Treatments for Spinal Pain Surgical Options Anterior Cervical Fusion Artificial Disc Replacement Bone Graft Alternatives Bone Morphogenetic ... Discectomy Percutaneous Vertebral Augmentation Posterior Cervical Foraminotomy Spinal Fusion ... Medicine Cervical Laminoplasty What is ...

  12. In vivo three-dimensional intervertebral kinematics of the subaxial cervical spine during seated axial rotation and lateral bending via a fluoroscopy-to-CT registration approach.

    PubMed

    Lin, Cheng-Chung; Lu, Tung-Wu; Wang, Ting-Ming; Hsu, Chao-Yu; Hsu, Shih-Jung; Shih, Ting-Fang

    2014-10-17

    Accurate measurement of the coupled intervertebral motions is helpful for understanding the etiology and diagnosis of relevant diseases, and for assessing the subsequent treatment. No study has reported the in vivo, dynamic and three-dimensional (3D) intervertebral motion of the cervical spine during active axial rotation (AR) and lateral bending (LB) in the sitting position. The current study fills the gap by measuring the coupled intervertebral motions of the subaxial cervical spine in ten asymptomatic young adults in an upright sitting position during active head LB and AR using a volumetric model-based 2D-to-3D registration method via biplane fluoroscopy. Subject-specific models of the individual vertebrae were derived from each subject's CT data and were registered to the fluoroscopic images for determining the 3D poses of the subaxial vertebrae that were used to obtain the intervertebral kinematics. The averaged ranges of motion to one side (ROM) during AR at C3/C4, C4/C5, C5/C6, and C6/C7 were 4.2°, 4.6°, 3.0° and 1.3°, respectively. The corresponding values were 6.4°, 5.2°, 6.1° and 6.1° during LB. Intervertebral LB (ILB) played an important role in both AR and LB tasks of the cervical spine, experiencing greater ROM than intervertebral AR (IAR) (ratio of coupled motion (IAR/ILB): 0.23-0.75 in LB, 0.34-0.95 in AR). Compared to the AR task, the ranges of ILB during the LB task were significantly greater at C5/6 (p=0.008) and C6/7 (p=0.001) but the range of IAR was significantly smaller at C4/5 (p=0.02), leading to significantly smaller ratios of coupled motions at C4/5 (p=0.0013), C5/6 (p<0.001) and C6/7 (p=0.0037). The observed coupling characteristics of the intervertebral kinematics were different from those in previous studies under discrete static conditions in a supine position without weight-bearing, suggesting that the testing conditions likely affect the kinematics of the subaxial cervical spine. While C1 and C2 were not included owing to

  13. Maintaining endotracheal tube cuff pressure at 20 mm Hg to prevent dysphagia after anterior cervical spine surgery; protocol of a double-blind randomised controlled trial

    PubMed Central

    2013-01-01

    Background In anterior cervical spine surgery a retractor is obligatory to approach the spine. Previous studies showed an increase of endotracheal tube cuff pressure after placement of a retractor. It is known that high endotracheal tube cuff pressure increases the incidence of postoperative dysphagia, hoarseness, and sore throat. However, until now no evidence supports the fact whether adjusting the endotracheal tube cuff pressure during anterior cervical spine surgery will prevent this comorbidity. We present the design of a randomized controlled trial to determine whether adjusting endotracheal tube cuff pressure after placement of a retractor during anterior cervical spine surgery will prevent postoperative dysphagia. Methods/design 177 patients (aged 18–90 years) scheduled for anterior cervical spine surgery on 1 or more levels will be included. After intubation, endotracheal tube cuff pressure is manually inflated to 20 mm Hg in all patients. Patients will be randomized into two groups. In the control group endotracheal tube cuff pressure is not adjusted after retractor placement. In the intervention group endotracheal tube cuff pressure after retractor placement is maintained at 20 mm Hg and air is withdrawn when cuff pressure exceeds 20 mm Hg. Endotracheal tube cuff pressure is measured after intubation, before and after placement and removal of the retractor. Again air is inflated if cuff pressure sets below 20 mmHg after removal of the retractor. The primary outcome measure is postoperative dysphagia. Other outcome measures are postoperative hoarseness, postoperative sore throat, degree of dysphagia, length of hospital stay, and pneumonia. The study is a single centre double blind randomized trial in which patients and research nurses will be kept blinded for the allocated treatment during the follow-up period of 2 months. Discussion Postoperative dysphagia occurs frequently after anterior cervical spine surgery. This may be related to high

  14. Dumbbell lymphoma of the cervical spine in a child. Case report.

    PubMed

    Gezen, F; Akay, K M; Tayfun, C; Günhan, O; Bedük, A; Seber, N

    1998-12-01

    Primary or secondary spinal involvement of lymphoma is a rarely reported entity. An eleven-year-old girl with primary cervical dumbbell non-Hodgkin's lymphoma (NHL) was presented. We could not found any such growth pattern of primary or secondary NHL'S in the literature. For this reason, we reviewed shortly pertinent literature and discussed the pathophysiologic, diagnostic and prognostic features of the lesion with treatment modalities. PMID:10404753

  15. Reliability of Joint Mobility and Pain Assessment of the Thoracic Spine and Rib Cage in Asymptomatic Individuals

    PubMed Central

    Heiderscheit, Bryan; Boissonnault, William

    2008-01-01

    Despite the importance of correctly diagnosing a spinal dysfunction, limited research exists related to physical therapists' ability to reliably identify a joint exhibiting signs of dysfunction. The purpose of this investigation was to determine the inter- and intra-examiner reliability of a thoracic spine and rib cage joint mobility and pain assessment between two experienced manipulative physical therapists. Nine healthy subjects (3 male, 6 female; ages 23–35) without history of mid- or low back pain participated. Posterior-to-anterior pressures were applied to the thoracic spine and rib articulations with anterior-to-posterior pressures applied to the costosternal joints of each subject by two examiners to evaluate joint mobility and pain provocation. Both examiners assessed all subjects twice and were blinded to subject identity. Kappa statistics were calculated using a strict and expanded definition of agreement to determine the between- and within-examiner reliability for each outcome. Intra-examiner reliability of joint mobility assessment ranged from slight to fair based on the strict agreement but improved to good when findings were compared across ± 1 spinal/rib level. Pain provocation reliability increased to very good under the expanded agreement; however, this finding should be viewed with caution due to limited pain prevalence in the subject sample. Selected clinical prediction rules, applied to the care of individuals with back pain, characterize the patient's regional mobility simply as hypomobile, normal, or hypermobile; consequently, we feel the results of an expanded definition of agreement may be more appropriate for clinic practice. Further research is needed to determine the reliability in individuals with thoracic spine and rib cage symptoms. PMID:19771193

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

    PubMed

    Altan, Lale; Bingöl, Umit; Aykaç, Mehtap; Yurtkuran, Merih

    2005-01-01

    Low-energy laser therapy has been applied in several rheumatoid and soft tissue disorders with varying rates of success. The objective of our study was to investigate the effect of laser therapy on cervical myofascial pain syndrome with a placebo-controlled double-blind prospective study model. It was performed with a total of 53 patients (35 females and 18 males) with cervical myofascial pain syndrome. In group 1 (n = 23), GaAs laser treatment was applied over three trigger points bilaterally and also one point in the taut bands in trapezius muscle bilaterally with a frequency of 1000 Hz for 2 min over each point once a day for 10 days during a period of 2 weeks. In group 2 (n = 25), the same treatment protocol was given, but the laser instrument was switched off during applications. All patients in both groups were instructed to perform daily isometric exercises and stretching just short of pain for 2 weeks at home. Evaluations were performed just before treatment (week 0), immediately after (week 2), and 12 weeks later (week 14). Evaluation parameters included pain, algometric measurements, and cervical lateral flexion. Statistical analysis was done on data collected from three evaluation stages. The results were evaluated in 48 patients (32 females, 16 males). Week 2 and week 14 results showed significant improvement in all parameters for both groups. However, comparison of the percentage changes both immediately and 12 weeks after treatment did not show a significant difference relative to pretreatment values. In conclusion, the results of our study have not shown the superiority of GaAs laser therapy over placebo in the treatment of cervical myofascial pain syndrome, but we suggest that further studies on this topic be done using different laser types and dosages in larger patient populations.

  17. Cervical Meningomyelitis After Lumbar Epidural Steroid Injection

    PubMed Central

    Kim, Joon-Sung; Kim, Ji Yeon

    2015-01-01

    Epidural steroid injections (ESI) are a common treatment for back pain management. ESI-related complications have increased with the growing number of procedures. We report a case of cervical meningomyelitis followed by multiple lumbar ESI. A 60-year-old male with diabetes mellitus presented to our hospital with severe neck pain. He had a history of multiple lumbar injections from a local pain clinic. After admission, high fever and elevated inflammatory values were detected. L-spine magnetic resonance imaging (MRI) revealed hematoma in the S1 epidural space. Antibiotic treatment began under the diagnosis of a lumbar epidural abscess. Despite the treatment, he started to complain of weakness in both lower extremities. Three days later, the weakness progressed to both upper extremities. C-spine MRI revealed cervical leptomeningeal enhancement in the medulla oblongata and cervical spinal cord. Removal of the epidural abscess was performed, but there was no neurological improvement. PMID:26161360

  18. Three-dimensional assessment of the intervertebral kinematics after Mobi-C total disc replacement at the cervical spine in vivo using the EOS stereoradiography system

    PubMed Central

    Rousseau, Marc-Antoine; Laporte, Sébastien; Dufour, Thierry; Steib, Jean-Paul; Lazennec, Jean-Yves; Skalli, Wafa

    2011-01-01

    Background Because 3-dimensional computed tomography and magnetic resonance imaging analysis of the spinal architecture is done with the patient in the supine position, stereoradiography may be more clinically relevant for the measurement of the relative displacements of the cervical vertebrae in vivo in the upright position. The innovative EOS stereoradiography system was used for measuring the relative angular displacements of the cervical vertebrae in a limited population to determine its feasibility. The precision and accuracy of the method were investigated. Methods In 9 patients with 16 Mobi-C prostheses (LDR Medical, Troyes, France) and 12 healthy subjects, EOS stereoradiography of the lower cervical spine (C3-7) was performed in the neutral upright position of the neck, flexion, extension, left and right lateral bending, and left and right axial rotation. The angular displacements were measured from the neutral position to every other posture. The random error was studied in terms of reproducibility. In addition, an in vitro protocol was performed in 6 specimens to investigate accuracy. Results The reproducibility and the accuracy variables varied similarly between 1.2° and 3.2° depending on the axis and direction of rotation under consideration. The Mobi-C group showed less mobility than the control group, whereas the pattern of coupling was similar. Conclusions Overall, the feasibility of dynamic EOS stereoradiography was shown. The prosthesis replicates the pattern of motion of the normal cervical spine. PMID:25802670

  19. A Novel Massage Therapy Technique for Management of Chronic Cervical Pain: A Case Series

    PubMed Central

    Thompson, William R.; Carter, Ronald; Rohe, Benjamin; Duncan, Randall L.; Cooper, Carlton R.

    2011-01-01

    Background: Neck pain is a generalized condition resulting from a complex etiology with presentation of a wide variety of symptoms. Neck pain is most often accompanied by decreased range of motion (ROM), muscle and joint stiffness, and limitations in functional capabilities. This condition may result in significant personal and societal burden. Purpose: We evaluated the effectiveness of a novel massage therapy intervention by following the treatment regimen and outcomes of two patients experiencing chronic neck pain. Participants: Two patients (46 and 53 years old) experienced chronic (>5 years) neck pain. Both patients reported pain, limited ROM, and muscle and joint stiffness. Additionally, the first patient reported a lack of sleep, and both patients stated their pain interfered with their quality of life and activities of daily living. Intervention: Patients received the Integrative Muscular Movement Technique (IMMT) intervention approximately twice a week for a total of eight treatments, each approximately 20 minutes in duration. Results: Both patients experienced a reduction in pain and an increase in cervical ROM in flexion, extension, rotation, and sidebending. The first patient also reported an increased ability to sleep. Both patients reported an increased ability to perform activities of daily living, including work-related responsibilities. Conclusions: For the two patients included in this report, therapist observations and patient reports indicate that inclusion of the IMMT treatment in a treatment regimen for chronic neck pain may lead to decreased pain and increased cervical ROM. These positive effects of the IMMT intervention may have a role in enhancing functional outcomes of these patients. PMID:22016757

  20. Posterior cervical spine arthrodesis with laminar screws: a report of two cases.

    PubMed

    Nakanishi, Kazuo; Tanaka, Masato; Sugimoto, Yoshihisa; Ozaki, Toshifumi

    2007-04-01

    We performed fixation using laminar screws in 2 patients in whom lateral mass screws, pedicle screws or transarticular screws could not be inserted. One was a 56-year-old woman who had anterior atlantoaxial subluxation (AAS). When a guide wire was inserted using an imaging guide, the hole bled massively. We thought the re-insertion of a guide wire or screw would thus increase the risk of vascular injury, so we used laminar screws. The other case was an 18-year-old man who had a hangman fracture. Preoperative magnetic resonance angiography showed occlusion of the left vertebral artery. A laminar screw was inserted into the patent side (i.e., the right side of C2). Cervical pedicle screws are the most biomechanically stable screws. However, their use carries a high risk of neurovascular complications during screw insertion, because the cervical pedicle is small and is adjacent laterally to the vertebral artery, medially to the spinal cord, and vertically to the nerve roots. Lateral mass screws are also reported to involve a risk of neurovascular injuries. The laminar screw method was thus thought to be useful, since arterial injuries could thus be avoided and it could also be used as a salvage modality for the previous misinsertion. PMID:17471313

  1. Influence of neck pain on cervical movement in the sagittal plane during smartphone use

    PubMed Central

    Kim, Man-Sig

    2015-01-01

    [Purpose] Smartphone use reportedly changes posture. However, how neck posture is altered in smartphone users with neck pain is unknown. This study examined changes in the posture of young adults with and without mild neck pain (MNP) when using a smartphone. [Subjects] Thirteen control subjects and 14 subjects with MNP who used smartphones were recruited. [Methods] The upper cervical (UC) and lower cervical (LC) angles in the sagittal plane were measured using an ultrasound-based motion analysis system while the seated subjects used a smartphone for 5 min. [Results] During smartphone use, the MNP group exhibited greater UC and LC flexion angles than the control group. [Conclusion] These findings suggest that young adults with MNP are more careful and more frequently utilize a neutral neck posture than young adults without MNP when using a smartphone while sitting. PMID:25642027

  2. Influence of neck pain on cervical movement in the sagittal plane during smartphone use.

    PubMed

    Kim, Man-Sig

    2015-01-01

    [Purpose] Smartphone use reportedly changes posture. However, how neck posture is altered in smartphone users with neck pain is unknown. This study examined changes in the posture of young adults with and without mild neck pain (MNP) when using a smartphone. [Subjects] Thirteen control subjects and 14 subjects with MNP who used smartphones were recruited. [Methods] The upper cervical (UC) and lower cervical (LC) angles in the sagittal plane were measured using an ultrasound-based motion analysis system while the seated subjects used a smartphone for 5 min. [Results] During smartphone use, the MNP group exhibited greater UC and LC flexion angles than the control group. [Conclusion] These findings suggest that young adults with MNP are more careful and more frequently utilize a neutral neck posture than young adults without MNP when using a smartphone while sitting. PMID:25642027

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

    SciTech Connect

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

    1983-12-01

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

  4. Pain and Psychological Outcomes After Rehabilitative Treatment for a Woman With Chronic Pelvic Pain With Stage III Cervical Cancer: A Case Report

    PubMed Central

    Alappattu, Meryl J.

    2016-01-01

    Background Chronic pelvic pain and sexual dysfunction are adverse effects of treatment of cervical cancer. Surgery and radiation therapies may result in soft tissue pain and dysfunction, including spasms and trigger points of the pelvic floor muscles that result in pain. In addition to physical restrictions, negative mood associated with pain is believed to intensify and prolong the pain experience. Study Design The purpose of this case report was to describe outcomes of pelvic physical therapy in a 58-year-old woman with chronic pelvic pain after medical treatments for cervical cancer. Case Description The patient reported dyspareunia, hip pain, and lower abdominal, pelvic pain, and fatigue with activities lasting greater than 30 minutes. Interventions included pelvic floor massage, dilator use, and patient education. Symptoms were assessed at baseline and completion of physical therapy, using the Female Sexual Function Index, Fear of Pain Questionnaire–III, Pain Catastrophizing Scale, and Numerical Pain Rating Scale. Outcomes The Female Sexual Function Index score decreased from 7.8 to 2.8, the Fear of Pain Questionnaire– III score decreased from 85 to 73, the Pain Catastrophizing Scale score decreased from 18 to 8, and lower abdominal and pelvic pain decreased from 4 of 10 to 0 of 10, while bilateral hip pain remained at 4 of 10. In addition, she exhibited increased tolerance to mechanical pressure, evidenced by progression in size of a vaginal dilator. Discussion These results suggest that pelvic physical therapy may be useful in treating chronic pelvic pain after cervical cancer treatments and may also help decrease the magnitude of negative mood aspects such as pain-related fear and catastrophizing. PMID:27134605

  5. Effect of Preoperative Nerve Block on Postthyroidectomy Headache and Cervical Pain: A Randomized Prospective Study

    PubMed Central

    Barua, Sunil Malla Bujar; Kishore, Kamal; Mishra, Saroj Kanta; Agarwal, Gaurav; Agarwal, Amit; Verma, Ashok Kumar

    2016-01-01

    The aim of the current study was to investigate the efficacy of greater occipital nerve (GON) block and bilateral superficial cervical plexuses (BSCP) blocks in alleviating postoperative occipital headache and posterior neck pain after thyroidectomy. This randomized prospective study consisted of 75 women undergoing total thyroidectomy. Patients were randomized into three groups: Group I (n = 25): patients receiving GON, Group II (n = 25): patients receiving bilateral (BSCP) blocks, and Group III (n = 25): patients receiving no block. Assessment of occipital headache, posterior neck, and incision site pains was made at 12 hours and 24 hours after extubation by Visual Analogue Scale (VAS). In comparison to Group III significantly fewer patients in Groups I and II experienced occipital headache at 12 (p = 0.006) and 24 hours (p = 0.005) and also posterior neck pain at 24 hours (p = 0.003). Mean VAS scores at 12 and 24 hours for occipital headache (p = 0.003 and p = 0.041) and posterior neck pain (p = 0.015 and p = 0.008) were significantly lower in Group I. The differences between Groups II and III were not significant except for the occipital headache at 12 hours. The efficacy of GON block is superior to BSCP blocks in alleviating postthyroidectomy occipital headache and posterior cervical pain. PMID:27034886

  6. The role of C2-C7 and O-C2 angle in the development of dysphagia after cervical spine surgery.

    PubMed

    Tian, Wei; Yu, Jie

    2013-06-01

    Dysphagia is a known complication of cervical surgery and may be prolonged or occasionally serious. A previous study showed that dysphagia after occipitocervical fusion was caused by oropharyngeal stenosis resulting from O-C2 (upper cervical lordosis) fixation in a flexed position. However, there have been few reports analyzing the association between the C2-C7 angle (middle-lower cervical lordosis) and postoperative dysphagia. The aim of this study was to analyze the relationship between cervical lordosis and the development of dysphagia after anterior and posterior cervical spine surgery (AC and PC). Three hundred fifty-four patients were reviewed in this retrospective clinical study, including 172 patients who underwent the AC procedure and 182 patients who had the PC procedure between June 2007 and May 2010. The presence and duration of postoperative dysphagia were recorded via face-to-face questioning or telephone interview performed at least 1 year after the procedure. Plain cervical radiographs before and after surgery were collected. The O-C2 angle and the C2-C7 angle were measured. Changes in the O-C2 angle and the C2-C7 angle were defined as dO-C2 angle = postoperative O-C2 angle - preoperative O-C2 angle and dC2-C7 angle = postoperative C2-C7 angle - preoperative C2-C7 angle. The association between postoperative dysphagia with dO-C2 angle and dC2-C7 angle was studied. Results showed that 12.8 % of AC and 9.4 % of PC patients reported dysphagia after cervical surgery. The dC2-C7 angle has considerable impact on postoperative dysphagia. When the dC2-C7 angle is greater than 5°, the chance of developing postoperative dysphagia is significantly greater. The dO-C2 angle, age, gender, BMI, operative time, blood loss, procedure type, revision surgery, most cephalic operative level, and number of operative levels did not significantly influence the incidence of postoperative dysphagia. No relationship was found between the dC2-C7 angle and the degree of

  7. Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy

    PubMed Central

    Nguyen, Ha Son; Doan, Ninh; Shabani, Saman; Baisden, Jamie; Wolfla, Christopher; Paskoff, Glenn; Shender, Barry; Stemper, Brian

    2016-01-01

    Background: Lumbar back pain and radiculopathy are common diagnoses. Unfortunately, conventional magnetic resonance imaging (MRI) findings and clinical symptoms do not necessarily correlate in the lumbar spine. With upright imaging, disc pathologies or foraminal stenosis may become more salient, leading to improvements in diagnosis. Materials and Methods: Seventeen adults (10 asymptomatic and 7 symptomatic volunteers) provided their informed consent and participated in the study. A 0.6T upright MRI scan was performed on each adult in the seated position. Parameters were obtained from the L2/3 level to the L5/S1 level including those pertaining to the foramen [cross-sectional area (CSA), height, mid-disc width, width, thickness of ligamentum flavum], disc (bulge, height, width), vertebral body (height and width), and alignment (lordosis angle, wedge angle, lumbosacral angle). Each parameter was compared based on the spinal level and volunteer group using two-factor analysis of variance (ANOVA). Bonferroni post hoc analysis was used to assess the differences between individual spinal levels. Results: Mid-disc width accounted for 56% of maximum foramen width in symptomatic volunteers and over 63% in asymptomatic volunteers. Disc bulge was 48% greater in symptomatic volunteers compared to asymptomatic volunteers. CSA was generally smaller in symptomatic volunteers compared to asymptomatic volunteers, particularly at the L4-L5 and L5-S1 spinal levels. Thickness of ligamentum flavum (TLF) generally increased from the cranial to caudal spinal levels where the L4-L5 and L5-S1 spinal levels were significantly thicker than the L1-L2 spinal level. Conclusions: The data implied that upright MRI could be a useful diagnostic option, as it can delineate pertinent differences between symptomatic volunteers and asymptomatic volunteers, especially with respect to foraminal geometry. PMID:27041883

  8. Demographics features, clinical findings and functional status in a group of subjects with cervical myofascial pain syndrome.

    PubMed

    Sahin, Nilay; Karataş, Omer; Ozkaya, Murat; Cakmak, Ayşegül; Berker, Ender

    2008-07-01

    Subjects with myofascial pain of muscles of the neck region may present with various clinical symptoms. The aim of this study was to explore the demographics features, clinical findings and functional status in a group of patients presenting with myofascial pain of the cervical muscles. 94 cervical myofascial pain syndrome patients were recruited from the out-patient clinic. Evaluated of patient short form health survey (SF-36), pain, depression, patient demographics and physical examinations. Outcome measures; SF-36 Health Survey, visual analog scale, Beck Depression Inventory, history, physical examination. A total of 82 patients with a diagnosis of cervical myofascial syndrome were included in the study. All patients were in the young age group 37.4+/-9, and 87.8% were females. 53.1% had trigger points in the trapezius muscle with high percentage of autonomic phenomena like skin reddening, lacrimation, tinnitus and vertigo. 58.5% of the series had suffered from former cervical trauma and 40.2% also had fibromyalgia syndrome and 18.5% had benign Joint hypermobility syndrome. Younger female patients presenting with autonomic phenomena and early onset cervical injury should be examined for cervical myofascial pain syndrome and also for fibromyalgia syndrome since this study demonstrated a high percentage of fibromyalgia syndrome in these patients.

  9. Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo.

    PubMed

    Li, Yongchao; Peng, Baogan

    2015-01-01

    Cervical vertigo is characterized by vertigo from the cervical spine. However, whether cervical vertigo is an independent entity still remains controversial. In this narrative review, we outline the basic science and clinical evidence for cervical vertigo according to the current literature. So far, there are 4 different hypotheses explaining the vertigo of a cervical origin, including proprioceptive cervical vertigo, Barré-Lieou syndrome, rotational vertebral artery vertigo, and migraine-associated cervicogenic vertigo. Proprioceptive cervical vertigo and rotational vertebral artery vertigo have survived with time. Barré-Lieou syndrome once was discredited, but it has been resurrected recently by increased scientific evidence. Diagnosis depends mostly on patients' subjective feelings, lacking positive signs, specific laboratory examinations and clinical trials, and often relies on limited clinical experiences of clinicians. 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. Treatment for cervical vertigo is challenging. Manual therapy is recommended for treatment of proprioceptive cervical vertigo. Anterior cervical surgery and percutaneous laser disc decompression are effective for the cervical spondylosis patients accompanied with Barré-Liéou syndrome. As to rotational vertebral artery vertigo, a rare entity, when the exact area of the arterial compression is identified through appropriate tests such as magnetic resonance angiography (MRA), computed tomography angiography (CTA) or digital subtraction angiography (DSA) decompressive surgery should be the chosen treatment.

  10. Clinical effects of deep cervical flexor muscle activation in patients with chronic neck pain

    PubMed Central

    Kim, Jin Young; Kwag, Kwang Il

    2016-01-01

    [Purpose] The purpose of this study was to investigate clinical effects of deep cervical flexor (DCF) muscles exercise on pain, Neck Disability Index (NDI), and neck and shoulder postures in patients with chronic neck pain. [Subjects and Methods] Twenty-eight patients with chronic neck pain were randomly assigned into either the general strengthening exercise (GSE) group or the DCF activation group as control and experimental groups, respectively. All exercises were performed three times per week over 4 weeks. NDI and numeric rating scale (NRS) score for pain were determined and radiological assessment of neck-shoulder postures (head tilt angle [HTA], neck flexion angle [NFA], and forward shoulder angle [FSA]) was performed before (baseline), 4 weeks after, and 8 weeks after exercise in order to directly compare the exercise effects between the groups. [Results] In the DCF group, the NDI, NRS score, and neck-shoulder postures (analyzed by uisng HTA, NFA, and FSA) were significantly improved. [Conclusion] DCF activation exercise was effective to alleviate pain, recover functions, and correct forward head posture in the patients with neck pain. Hence, it might be recommended in the rehabilitation of patients with chronic neck pain. PMID:26957772

  11. Can intraoperative neurophysiologic monitoring during cervical spine decompression predict post-operative segmental C5 palsy?

    PubMed Central

    Blaskiewicz, Donald J.; Ramirez, Bertha; Zhang, Richard

    2016-01-01

    Background C5 nerve root palsy is a known complication after cervical laminectomy or laminoplasty, characterized by weakness of the deltoid and bicep brachii muscles. The efficacy of intraoperative monitoring of these muscles is currently unclear. In the current prospective study, intraoperative monitoring through somatosensory (SSEPs), motor (TcMEPs) evoked potentials and real-time electromyography activity (EMG) were analyzed for their ability to detect or prevent deltoid muscle weakness after surgery. Methods One hundred consecutive patients undergoing laminectomy/laminoplasty with or without fusion were enrolled. Intraoperative SSEPs, TcMEPs and EMGs from each patient were studied and analyzed. Results Intraoperative EMG activity of the C5 nerve root was detected in 34 cases, 10 of which demonstrated a sustained and repetitive EMG activity lasting 5 or more minutes. Paresis of the unilateral deltoid muscle developed in 5 patients, all from the group with sustained C5 EMG activity. None of the patients with weakness of deltoid muscle after surgery demonstrated any abnormal change in TcMEP or SSEP. Conclusions Real-time EMG recordings were sensitive to C5 nerve root irritation, whilst SSEPs and TcMEPs were not. Sustained EMG activity of the C5 nerve root during surgery is a possible warning sign of irritation or injury to the nerve. PMID:27757428

  12. Comparison of intubation times using a manikin with an immobilized cervical spine: Macintosh laryngoscope vs. GlideScope vs. fiberoptic bronchoscope

    PubMed Central

    Ko, Jung-In; Ha, Sang Ook; Koo, Min Seok; Kwon, Miyoung; Kim, Jieun; Jeon, Jin; Park, So Hee; Shim, Sangwoo; Chang, Youjin; Park, Taejin

    2015-01-01

    Objective Airway management in patients with suspected cervical spine injury is classified as a “difficult airway.” The best device for managing difficult airways is not known. Therefore, we conducted an intubation study simulating patients with cervical spine injury using three devices: a conventional Macintosh laryngoscope, a video laryngoscope (GlideScope), and a fiberoptic bronchoscope (MAF-TM). Success rates, intubation time, and complication rates were compared. Methods Nine physician experts in airway management participated in this study. Cervical immobilization was used to simulate a difficult airway. Each participant performed intubation using airway devices in a randomly chosen order. We measured the time to vocal cord visualization, time to endotracheal tube insertion, and total tracheal intubation time. Success rates and dental injury rates were compared between devices. Results Total tracheal intubation time using the Macintosh laryngoscope, GlideScope, and fiberoptic bronchoscope was 13.3 (range, 11.1 to 20.1), 14.9 (range, 12.7 to 22.3), and 19.4 seconds (range, 14.1 to 32.5), respectively. Total tracheal intubation time differed significantly among the devices (P=0.009). Success rates for the Macintosh laryngoscope, GlideScope, and fiberoptic bronchoscope were 98%, 96%, and 100%, respectively, and dental injury rates were 5%, 19%, and 0%, respectively. Conclusion The fiberoptic bronchoscope required longer intubation times than the other devices. However, this device had the best success rate with the least incidence of dental injury. PMID:27752604

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

    PubMed

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

    2014-01-01

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

  14. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.

    PubMed

    Narouze, Samer; Benzon, Honorio T; Provenzano, David A; Buvanendran, Asokumar; De Andres, José; Deer, Timothy R; Rauck, Richard; Huntoon, Marc A

    2015-01-01

    Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine. The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.

  15. The Qualification of Outcome after Cervical Spine Surgery by Patients Compared to the Neck Disability Index

    PubMed Central

    Donk, Roland; Verbeek, Andre; Verhagen, Wim; Groenewoud, Hans; Hosman, Allard

    2016-01-01

    Objective The Neck Disability Index (NDI) is a patient self-assessed outcome measurement tool to assess disability, and that is frequently used to evaluate the effects of the treatment of neck-related problems. In individualized medicine it is mandatory that patients can interpret data in order to choose a treatment. A change of NDI or an absolute NDI is generally meaningless to a patient. Therefore, a correlation between the qualification of the clinical situation rated by the patient and the NDI score was evaluated. Methods Patients who completed an NDI after anterior surgery because of symptomatic single level degenerative cervical disc disease were asked one month after completion of the NDI to qualify their clinical situation of a 5-item Likert scale varying from excellent to bad. Since a clear distinction between the categories was not possible based on the total NDI score, a ROC-curve was built, and the AUC computed in order to estimate best dichotomization in qualification of the clinical situation. The best corresponding cut-off point for the NDI total score was found by studying sensitivity and specificity for all possible cut-off points. Results 102 patients were included. The highest AUC was obtained by dichotomizing the qualification into a group with good outcome and less-good outcome. The highest sensitivity and specificity for the dichotomized qualification as good outcome corresponded to a NDI ≤ 7. Sensitivity was 81.08% and specificity was 78.57%. Conclusion This is the first study that correlated the qualification of the situation by the patients themselves and NDI. An NDI ≤ 7 corresponded to a good outcome according to the patients. This is valuable information to inform patients in their decision for any treatment. PMID:27551964

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

    PubMed Central

    Epstein, Nancy E.

    2012-01-01

    Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the “value-added” of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent “post hoc analysis of data from a prospective multicenter trial” (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the “value added” of these increasingly expensive graft constructs. PMID:22905321

  17. Assessing Incidence and Risk Factors of Cervical Spine Injury in Blunt Trauma Patients Using the National Trauma Data Bank.

    PubMed

    Young, Andrew J; Wolfe, Luke; Tinkoff, Glenn; Duane, Therese M

    2015-09-01

    Despite the potentially devastating impact of missed cervical spine injuries (CI), there continues to be a large disparity in how institutions attempt to make the diagnosis. To better streamline the approach among institutions, understanding incidence and risk factors across the country is paramount. We evaluated the incidence and risk factors of CI using the National Trauma Databank for 2008 and 2009. We performed a retrospective review of the National Trauma Databank for 2008 and 2009 comparing patients with and without CI. We then performed subset analysis separating injury by patients with and without fracture and ligamentous injury. There were a total of 591,138 patients included with a 6.2 per cent incidence of CI. Regression found that age, Injury Severity Score, alcohol intoxication, and specific mechanisms of motor vehicle crash (MVC), motorcycle crash (MCC), fall, pedestrian stuck, and bicycle were independent risk factors for overall injury (P < 0.0001). Patients with CI had longer intensive care unit (8.5 12.5 vs 5.1 7.7) and hospital lengths of stay (days) (9.6 14.2 vs 5.3 8.1) and higher mortality (1.2 per cent vs 0.3%), compared with those without injury (P < 0.0001). There were 33,276 patient with only fractures for an incidence of 5.6 per cent and 1875 patients with ligamentous injury. Just over 6 per cent of patients suffer some form of CI after blunt trauma with the majority being fractures. Higher Injury Severity Score and MVC were consistent risk factors in both groups. This information will assist in devising an algorithm for clearance that can be used nationally allowing for more consistency among trauma providers. PMID:26350665

  18. Morphometric evaluation of the uncinate process and its importance in surgical approaches to the cervical spine: a cadaveric study

    PubMed Central

    Güvençer, Mustafa; Naderi, Sait; Men, Süleyman; Sayhan, Salih; Tetik, Süleyman

    2016-01-01

    INTRODUCTION The uncinate process (UP) has an important role because of its relationship with the vertebral artery and spinal roots. Degenerative diseases cause osteophyte formation on the UP, leading to radiculopathy, myelopathy and vertebral vascular insufficiency, which may require surgical management. This study aimed to evaluate the morphometry of this region to shed light on the anatomy of the UP. METHODS Morphometric data was obtained from 13 male formaldehyde-fixed cadavers. Direct measurements were obtained using a metal caliper. Computed tomography (CT) morphometry was performed with the cadavers in the supine position. RESULTS Direct cadaveric measurements showed that the height of the UP increased from C3 (5.8 ± 1.0 mm) to C7 (6.6 ± 0.5 mm). On CT, the corresponding measurements were 5.9 ± 1.2 mm at C3 and 6.9 ± 0.6 mm at C7. The distance between the left and right apex of the UP from C3 to C7 also increased on both direct cadaveric and CT measurements (C3: 20.8 ± 1.0 mm and C7: 28.1 ± 2.4 mm vs. C3: 23.7 ± 3.4 mm and C7: 29.0 ± 3.0 mm, respectively). On CT, the distance between the UP and superior articular process at the C3 to C7 levels were 9.8 ± 1.7 mm, 7.9 ± 1.8 mm, 7.9 ± 1.6 mm, 7.8 ± 1.3 mm and 8.2 ± 1.7 mm, respectively. CONCLUSION Direct cadaveric and CT measurements of the UP are useful for preoperative evaluation of the cervical spine and may lead to better surgical outcomes. PMID:26778467

  19. Comparison of Hybrid Constructs with 2-Level Artificial Disc Replacement and 2-Level Anterior Cervical Discectomy and Fusion for Surgical Reconstruction of the Cervical Spine: A Kinematic Study in Whole Cadavers

    PubMed Central

    Liu, Baoge; Zeng, Zheng; Van Hoof, Tom; Kalala, Jean Pierre; Liu, Zhenyu; Wu, Bingxuan

    2015-01-01

    Background Multi-level cervical degeneration of the spine is a common clinical pathology that is often repaired by anterior cervical discectomy and fusion (ACDF). The aim of this study was to investigate the kinematics of the cervical spine after hybrid surgery compared with 2-level ACDF. Material/Methods Five freshly frozen, unembalmed whole human cadavers were used including 3 males and 2 females with a mean age of 51±8 years. After evaluating the intact spine for range of motion (ROM), sagittal alignment and instantaneous center of rotation (ICR), each cadaver underwent 4 consecutive surgeries: 2-level artificial disc replacement (ADR) from C4 to C6 (ADR surgery); 2-level ACDF from C4 to C6 (ACDF surgery); hybrid C4–5 ACDF and C5–6 ADR (ACDF+ADR surgery); and hybrid C4–5 ADR and C5–6 ACDF (ADR+ACDF surgery). The ROM and ICR of adjacent intact segments (C3–4; C6–7), and whole sagittal alignment were revaluated. Results Two-level ACDF resulted in increased ROM at C3–4 and C6–7 compared with intact spine. ROM was significantly different to intact spine using ACDF surgery at C3–C4 and C6–C7 and ROM was increased with ACDF+ADR surgery at C6–C7 (all P<0.05). No improvement in sagittal alignment was observed with any approach. The localization of the ICR shifted upwards and anteriorly at C3–C4 after reconstruction. ICR changes at C3–C4 were greatest for ADR+ACDF surgery and were significantly different to ACDF surgery (P<0.05), but not between ADR surgery and ACDF+ADR surgery. At C6–C7, the ICR was more posterior and superior than in the intact condition. The greatest change in ICR was observed in ACDF surgery at the C6–C7 level, significantly different from the other groups (P<0.05). Conclusions For 2-level reconstruction, hybrid surgery and ADR did not alter ROM and minimally changed ICR at the adjacent-level. The type of surgery had a significant impact on the ICR location. This suggests that hybrid surgery may be a viable option for 2

  20. The role of surgery for treatment of low back pain: insights from the randomized controlled Spine Patient Outcomes Research Trials.

    PubMed

    Abraham, Peter; Rennert, Robert C; Martin, Joel R; Ciacci, Joseph; Taylor, William; Resnick, Daniel; Kasper, Ekkehard; Chen, Clark C

    2016-01-01

    Low back pain (LBP) is a common medical problem with high morbidity and healthcare costs. The optimal management strategy, including the role of surgical intervention, remains controversial. The Spine Patient Outcomes Research Trials were randomized controlled studies conducted to assess the effectiveness of surgery for three of the most common conditions implicated in LBP: Intervertebral disc herniation, degenerative spondylolisthesis, and spinal stenosis. Despite challenges in data interpretation related to patient cross over, these studies support the efficacy of surgery as treatment for these three common conditions. PMID:27127703

  1. The role of surgery for treatment of low back pain: insights from the randomized controlled Spine Patient Outcomes Research Trials.

    PubMed

    Abraham, Peter; Rennert, Robert C; Martin, Joel R; Ciacci, Joseph; Taylor, William; Resnick, Daniel; Kasper, Ekkehard; Chen, Clark C

    2016-01-01

    Low back pain (LBP) is a common medical problem with high morbidity and healthcare costs. The optimal management strategy, including the role of surgical intervention, remains controversial. The Spine Patient Outcomes Research Trials were randomized controlled studies conducted to assess the effectiveness of surgery for three of the most common conditions implicated in LBP: Intervertebral disc herniation, degenerative spondylolisthesis, and spinal stenosis. Despite challenges in data interpretation related to patient cross over, these studies support the efficacy of surgery as treatment for these three common conditions.

  2. The role of surgery for treatment of low back pain: insights from the randomized controlled Spine Patient Outcomes Research Trials

    PubMed Central

    Abraham, Peter; Rennert, Robert C.; Martin, Joel R.; Ciacci, Joseph; Taylor, William; Resnick, Daniel; Kasper, Ekkehard; Chen, Clark C.

    2016-01-01

    Low back pain (LBP) is a common medical problem with high morbidity and healthcare costs. The optimal management strategy, including the role of surgical intervention, remains controversial. The Spine Patient Outcomes Research Trials were randomized controlled studies conducted to assess the effectiveness of surgery for three of the most common conditions implicated in LBP: Intervertebral disc herniation, degenerative spondylolisthesis, and spinal stenosis. Despite challenges in data interpretation related to patient cross over, these studies support the efficacy of surgery as treatment for these three common conditions. PMID:27127703

  3. Incidence and Predictive Factors of Pain Flare After Spine Stereotactic Body Radiation Therapy: Secondary Analysis of Phase 1/2 Trials

    SciTech Connect

    Pan, Hubert Y.; Allen, Pamela K.; Wang, Xin S.; Chang, Eric L.; Rhines, Laurence D.; Tatsui, Claudio E.; Amini, Behrang; Wang, Xin A.; Tannir, Nizar M.; Brown, Paul D.; Ghia, Amol J.

    2014-11-15

    Purpose/Objective(s): To perform a secondary analysis of institutional prospective spine stereotactic body radiation therapy (SBRT) trials to investigate posttreatment acute pain flare. Methods and Materials: Medical records for enrolled patients were reviewed. Study protocol included baseline and follow-up surveys with pain assessment by Brief Pain Inventory and documentation of pain medications. Patients were considered evaluable for pain flare if clinical note or follow-up survey was completed within 2 weeks of SBRT. Pain flare was defined as a clinical note indicating increased pain at the treated site or survey showing a 2-point increase in worst pain score, a 25% increase in analgesic intake, or the initiation of steroids. Binary logistic regression was used to determine predictive factors for pain flare occurrence. Results: Of the 210 enrolled patients, 195 (93%) were evaluable for pain flare, including 172 (88%) clinically, 135 (69%) by survey, and 112 (57%) by both methods. Of evaluable patients, 61 (31%) had undergone prior surgery, 57 (29%) had received prior radiation, and 34 (17%) took steroids during treatment, mostly for prior conditions. Pain flare was observed in 44 patients (23%). Median time to pain flare was 5 days (range, 0-20 days) after the start of treatment. On multivariate analysis, the only independent factor associated with pain flare was the number of treatment fractions (odds ratio = 0.66, P=.004). Age, sex, performance status, spine location, number of treated vertebrae, prior radiation, prior surgery, primary tumor histology, baseline pain score, and steroid use were not significant. Conclusions: Acute pain flare after spine SBRT is a relatively common event, for which patients should be counseled. Additional study is needed to determine whether prophylactic or symptomatic intervention is preferred.

  4. SU-E-I-51: Use of Blade Sequences in Cervical Spine MR Imaging for Eliminating Motion, Truncation and Flow Artifacts

    SciTech Connect

    Mavroidis, P; Lavdas, E; Kostopoulos, S; Ninos, C; Strikou, A; Glotsos, D; Vlachopoulou, A; Oikonomou, G; Economopoulos, N; Roka, V; Sakkas, G; Tsagkalis, A; Batsikas, G; Statkahis, S; Papanikolaou, N

    2014-06-01

    Purpose: To assess the efficacy of the BLADE technique to eliminate motion, truncation, flow and other artifacts in Cervical Spine MRI compared to the conventional technique. To study the ability of the examined sequences to reduce the indetention and wrap artifacts, which have been reported in BLADE sagittal sequences. Methods: Forty consecutive subjects, who had been routinely scanned for cervical spine examination using four different image acquisition techniques, were analyzed. More specifically, the following pairs of sequences were compared: a) T2 TSE SAG vs. T2 TSE SAG BLADE and b) T2 TIRM SAG vs. T2 TIRM SAG BLADE. A quantitative analysis was performed using the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and relative contrast (ReCon) measures. A qualitative analysis was also performed by two radiologists, who graded seven image characteristics on a 5-point scale (0:non-visualization; 1:poor; 2:average; 3:good; 4:excellent). The observers also evaluated the presence of image artifacts (motion, truncation, flow, indentation). Results: Based on the findings of the quantitative analysis, the ReCON values of the CSF (cerebrospinal fluid)/SC (spinal cord) between TIRM SAG and TIRM SAG BLADE were found to present statistical significant differences (p<0.001). Regarding motion and truncation artifacts, the T2 TSE SAG BLADE was superior compared to the T2 TSE SAG and the T2 TIRM SAG BLADE was superior compared to the T2 TIRM SAG. Regarding flow artifacts, T2 TIRM SAG BLADE eliminated more artifacts compared to the T2 TIRM SAG. Conclusion: The use of BLADE sequences in cervical spine MR examinations appears to be capable of potentially eliminating motion, pulsatile flow and trancation artifacts. Furthermore, BLADE sequences are proposed to be used in the standard examination protocols based on the fact that a significantly improved image quality could be achieved.

  5. Immediate effects of lower cervical spine manipulation on handgrip strength and free-throw accuracy of asymptomatic basketball players: a pilot study

    PubMed Central

    Humphries, Kelley M.; Ward, John; Coats, Jesse; Nobert, Jeannique; Amonette, William; Dyess, Stephen

    2013-01-01

    Objective The purpose of this pilot study was to collect preliminary information for a study to determine the immediate effects of a single unilateral chiropractic manipulation to the lower cervical spine on handgrip strength and free-throw accuracy in asymptomatic male recreational basketball players. Methods For this study, 24 asymptomatic male recreational right-handed basketball players (age = 26.3 ± 9.2 years, height = 1.81 ± 0.07 m, body mass = 82.6 ± 10.4 kg [mean ± SD]) underwent baseline dominant handgrip isometric strength and free-throw accuracy testing in an indoor basketball court. They were then equally randomized to receive either (1) diversified left lower cervical spine chiropractic manipulative therapy (CMT) at C5/C6 or (2) placebo CMT at C5/C6 using an Activator adjusting instrument on zero force setting. Participants then underwent posttesting of isometric handgrip strength and free-throw accuracy. A paired-samples t test was used to make within-group pre to post comparisons and between-group pre to post comparisons. Results No statistically significant difference was shown between either of the 2 basketball performance variables measured in either group. Isometric handgrip strength marginally improved by 0.7 kg (mean) in the CMT group (P = .710). Free-throw accuracy increased by 13.2% in the CMT group (P = .058). The placebo CMT group performed the same or more poorly during their second test session. Conclusions The results of this preliminary study showed that a single lower cervical spine manipulation did not significantly impact basketball performance for this group of healthy asymptomatic participants. A slight increase in free-throw percentage was seen, which deserves further investigation. This pilot study demonstrates that a larger study to evaluate if CMT affects handgrip strength and free-throw accuracy is feasible. PMID:24396315

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

    PubMed Central

    Villafañe, Jorge H.; Fernandez-de-las-Peñas, Cesar; Pillastrini, Paolo

    2012-01-01

    Objective The purpose of this case study is to present the findings of combining botulinum toxin type A (BoNT-A) and cervical spine manual therapy to address masseter muscle spasticity in a patient with Alzheimer-type dementia. Case Report A 78-year-old woman with bilateral spasticity of the masseteric regions for 2 years was referred for physiotherapy. She had trismus and bruxism, and could neither close nor open her mouth normally; thus, she was unable to be fed orally in a normal manner. Intervention and Outcome The patient underwent combined treatment with BoNT-A and cervical spine manual therapy. A medical physician (neurologist) performed the BoNT-A injections into 2 points at the center of the lower third of the masseter muscle. A physical therapist performed manual therapy interventions targeted at the cervical spine. Manual therapy started the day after the BoNT-A injection and continued for 5 sessions per week for a total period of 2 weeks. Clinical outcomes were measured including spasticity (Modified Ashworth Scale), functionality (Barthel Index), and jaw opening. Outcomes were conducted at baseline, 2 weeks after treatment, and at 2-month follow-up session after finishing the treatment. The patient improved in all of the outcomes at the end of treatment, and these results were maintained during the follow-up. After treatment, the patient was able to feed with minimal caregiver dependency because oral feeding was possible. Conclusion The patient in this study responded positively to a combination of BoNT-A and manual therapy, resulting in decreased masseter muscles spasticity and improved trismus and bruxism. PMID:23843761

  7. The effect of thoracic spine mobilization and stabilization exercise on the muscular strength and flexibility of the trunk of chronic low back pain patients.

    PubMed

    Yang, Seong-Rae; Kim, Kyung; Park, Sun-Ja; Kim, Kyung

    2015-12-01

    [Purpose] To investigate whether thoracic spine mobilization added to stabilization exercises increases the muscular strength and range of motion of the thoracic vertebrae of chronic low-back pain patients. [Subjects] This study enrolled 20 patients with chronic low back pain, who were divided into two groups. Ten subjects were randomly selected for the stabilization exercise group and the remaining 10 subjects received thoracic spine mobilization in addition to performing the stabilization exercises. [Methods] The patients performed stabilization exercises and received thoracic spine mobilization for 12 weeks. The range of motion and isometric muscular strength of the vertebrae of all subjects were measured before and after the intervention. [Results] In the comparison of muscular strength before and after the intervention, the change in muscular strength of the trunk flexors in the stabilization exercise group was 16.0±7.4 Nm, and that of the thoracic spine mobilization group was 34.2±7.6 Nm, a significant difference in each group. In the post-intervention intergroup comparison, the muscular strength of trunk flexors in the stabilization exercise group was 111.1±16.9 Nm, while that of the thoracic spine mobilization group was 125.9±11.3 Nm, a significant difference. Also, the muscular strength of the trunk extensors in the stabilization exercise group was 148.9±31.8 Nm, while that of the thoracic spine mobilization group was 182.9±37.2 Nm, a significant difference. The thoracic spine flexion in the stabilization exercise group was 29.8±9 degrees, while that of the thoracic spine mobilization group was 38.7±6.9 degrees, a significant difference. However, there was no significant difference in lumbar flexion values between the two groups. [Conclusion] Thoracic spine mobilization added to a stabilization exercise increased the muscular strength of patients with chronic low back pain.

  8. The effect of thoracic spine mobilization and stabilization exercise on the muscular strength and flexibility of the trunk of chronic low back pain patients

    PubMed Central

    Yang, Seong-Rae; Kim, Kyung; Park, Sun-Ja; Kim, Kyung

    2015-01-01

    [Purpose] To investigate whether thoracic spine mobilization added to stabilization exercises increases the muscular strength and range of motion of the thoracic vertebrae of chronic low-back pain patients. [Subjects] This study enrolled 20 patients with chronic low back pain, who were divided into two groups. Ten subjects were randomly selected for the stabilization exercise group and the remaining 10 subjects received thoracic spine mobilization in addition to performing the stabilization exercises. [Methods] The patients performed stabilization exercises and received thoracic spine mobilization for 12 weeks. The range of motion and isometric muscular strength of the vertebrae of all subjects were measured before and after the intervention. [Results] In the comparison of muscular strength before and after the intervention, the change in muscular strength of the trunk flexors in the stabilization exercise group was 16.0±7.4 Nm, and that of the thoracic spine mobilization group was 34.2±7.6 Nm, a significant difference in each group. In the post-intervention intergroup comparison, the muscular strength of trunk flexors in the stabilization exercise group was 111.1±16.9 Nm, while that of the thoracic spine mobilization group was 125.9±11.3 Nm, a significant difference. Also, the muscular strength of the trunk extensors in the stabilization exercise group was 148.9±31.8 Nm, while that of the thoracic spine mobilization group was 182.9±37.2 Nm, a significant difference. The thoracic spine flexion in the stabilization exercise group was 29.8±9 degrees, while that of the thoracic spine mobilization group was 38.7±6.9 degrees, a significant difference. However, there was no significant difference in lumbar flexion values between the two groups. [Conclusion] Thoracic spine mobilization added to a stabilization exercise increased the muscular strength of patients with chronic low back pain. PMID:26834367

  9. Cine phase-contrast MRI measurement of CSF flow in the cervical spine: a pilot study in patients with spinal cord injury

    NASA Astrophysics Data System (ADS)

    Negahdar, MJ; Shakeri, M.; McDowell, E.; Wells, J.; Vitaz, T.; Harkema, S.; Amini, A.

    2011-03-01

    MRI velocimetry (also known as phase-contrast MRI) is a powerful tool for quantification of cerebrospinal fluid (CSF) flow in various regions of the brain and craniospinal junction and has been accepted as a diagnostic tool to assist with the diagnosis of certain conditions such as hydrocephalus and chiari malformations. Cerebrospinal fluid is continually produced in the ventricles of the brain, flows through the ventricular system and then out and around the brain and spinal cord and is reabsorbed over the convexity of the brain. Any disease process which either impedes the normal pattern of flow or restricts the area where flow occurs can change the pattern of these waveforms with the direction and velocity of flow being determined by the pressure transmitted from the pulsation of the heart and circulation of blood within the central nervous system. Therefore, we hypothesized that phase-contrast MRI could eventually be used as a diagnostic aid in determining the degree of spinal cord compression following injury to the cervical or thoracic spine. In this study, we examined CSF flow in 3 normal subjects and 2 subjects with non-acute injuries in the cervical spine using Cine phasecontrast MRI. CSF flow analysis was performed using an in-house developed software. The flow waveform was calculated in both normal subjects (n=3) as well as subjects with spinal cord injury in the cervical spine (n=2). The bulk flow at C2 was measured to be 0.30 +/- 0.05 cc, at 5 cm distal to C2, it was 0.19+/- 0.07 cc, and at 10 cm distal to C2, it was 0.17+/- 0.05 cc. These results were in good agreement with previously published results. In patients with spinal cord injury, at the site of injury in the cervical spine, bulk flow was found to be 0.08 +/- 0.12 cc, at 5 cm proximal to the site of injury it was found to be 0.18 +/- 0.07 cc, and at 5 cm distal to the site of injury, it was found to be 0.12 +/- 0.01 cc.

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

    PubMed Central

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

    2012-01-01

    Objectives The purpose of this study was to determine whether the physical properties and vascular environment of active myofascial trigger points associated with acute spontaneous cervical pain, asymptomatic latent trigger points, and palpably normal muscle differ in terms of the trigger point area, pulsatility index, and resistivity index, as measured by sonoelastography and Doppler imaging. Methods Sonoelastography was performed with an external 92-Hz vibration in the upper trapezius muscles in patients with acute cervical pain and at least 1 palpable trigger point (n = 44). The area of reduced vibration amplitude was measured as an estimate of the size of the stiff myofascial trigger points. Patients also underwent triplex Doppler imaging of the same region to analyze blood flow waveforms and calculate the pulsatility index of blood flow in vessels at or near the trigger points. Results On sonoelastography, active sites (spontaneously painful with palpable myofascial trigger points) had larger trigger points (mean ± SD, 0.57 ± 0.20 cm2) compared to latent sites (palpable trigger points painful on palpation; 0.36 ± 0.16 cm2) and palpably normal sites (0.17 ± 0.22 cm2; P < .01). Analysis of receiver operating characteristic curves showed that area measurements could robustly distinguish between active, latent, and normal sites (areas under the curve, 0.9 for active versus latent, 0.8 for active versus normal, and 0.8 for latent versus normal, respectively). Doppler spectral waveform data showed that vessels near active sites had a significantly higher pulsatility index (median, 8.3) compared to normal sites (median, 3.0; P < .05). Conclusions The results presented in this study show that myofascial trigger points may be classified by area using sonoelastography. Furthermore, monitoring the trigger point area and pulsatility index may be useful in evaluating the natural history of myofascial pain syndrome. PMID:21968483

  11. Biomechanical stability of a bioabsorbable self-retaining polylactic acid/nano-sized β-tricalcium phosphate cervical spine interbody fusion device in single-level anterior cervical discectomy and fusion sheep models

    PubMed Central

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

    2012-01-01

    Purpose The aim of this study was to investigate the biomechanical stability provided by a novel, polylactic acid/nano-sized, β-tricalcium phosphate, bioabsorbable, self-retaining cervical fusion cage (BCFC). Methods Quasistatic nonconstraining torques (maximum 1.5 NM) induced flexion, extension, lateral bending (±1.5 NM), and axial rotation (±1.5 NM) on 32 sheep cervical spines (C2–C5). The motion segment C3–C4 was first tested intact; the following groups were tested after complete discectomy: autologous tricortical iliac crest bone graft, Medtronic–Wego polyetheretherketone (PEEK) cage, Solis PEEK cage, and BCFC. The autologous bone graft group was tested with an anterior plate. The mean range of motion (ROM) was calculated from the load-displacement curves. Results BCFC significantly decreased ROM in lateral bending and axial rotation compared to other implants, and no significant difference in ROM between two types of PEEK cages and BCFC could be observed in flexion and extension. Anterior cervical plate (ACP) significantly decreased ROM in flexion and extension, but no significant difference in ROM between BCFC and bone graft plus ACP could be determined in lateral bending and axial rotation. Conclusion The BCFC device showed better stability to autologous tricortical iliac crest bone graft and PEEK cages in single-level anterior cervical discectomy and fusion models and thus may be a potential alternative to the current PEEK cages. PMID:23226018

  12. Botulinum Toxin Type A Injections for Cervical and Shoulder Girdle Myofascial Pain Using an Enriched Protocol Design

    PubMed Central

    Nicol, Andrea L.; Wu, Irene I.; Ferrante, F. Michael

    2014-01-01

    Background Myofascial pain syndrome is a regional condition of muscle pain and stiffness and is classically characterized by the presence of trigger points in affected musculature. Botulinum toxin type A (BoNT-A) has been shown to have antinociceptive properties and elicit sustained muscle relaxation, thereby possibly affording even greater relief than traditional strategies. Our goal in this study was to determine whether direct injection of BoNT-A into painful muscle groups is effective for cervical and shoulder girdle myofascial pain. Methods An enriched protocol design was used wherein 114 patients with cervical and shoulder girdle myofascial pain underwent injection of BoNT-A to determine their response to the drug. Fifty-four responders were then enrolled in a twelve-week, randomized, double-blind, placebo-controlled trial. Pain scales and quality of life measures were assessed at baseline and at routine follow-up visits until completion of the study after 26 weeks. Results Injection of BoNT-A into painful muscle groups improved average visual numerical pain scores in subjects who received a second dose of BoNT-A compared to placebo (p = 0.019 (0.26, 2.78)). Subjects who received a second dose of BoNT-A had a reduced number of headaches per week (p = 0.04 (0.07, 4.55)). Brief Pain Inventory interference scores for general activity and sleep were improved (p = 0.046 (0.038, 3.7) and 0.02 (0.37, 4.33), respectively) in those who received a second dose of BoNT-A. Conclusion Botulinum toxin type A injected directly into painful muscle groups improves average pain scores and certain aspects of quality of life in patients suffering from severe cervical and shoulder girdle myofascial pain. PMID:24842179

  13. Comparison of the C-MAC(®) and GlideScope(®) videolaryngoscopes in patients with cervical spine disorders and immobilisation.

    PubMed

    Brück, S; Trautner, H; Wolff, A; Hain, J; Mols, G; Pakos, P; Roewer, N; Lange, M

    2015-02-01

    In-line stabilisation of the neck can increase the difficulty of tracheal intubation with direct laryngoscopy. We randomly assigned 56 patients with cervical spine pathology scheduled for elective surgery to tracheal intubation using either the C-MAC(®) (n = 26) or GlideScope(®) (n = 30), when the head and neck were stabilised in-line. There was no significant difference in the median (IQR [range]) intubation times between the C-MAC (19 (14-35 [9-90]) s and the GlideScope (23, (15-32 [8-65]) s. The first-attempt failure rate for the C-MAC was 42% (95% CI 23-63%) compared with 7% (95% CI 1-22%) for the GlideScope, p = 0.002. The laryngeal view was excellent and comparable with both devices, with the C-MAC requiring significantly more attempts and optimising manoeuvers (11 vs 5, respectively, p = 0.04). There were no significant differences in postoperative complaints e.g. sore throat, hoarseness and dysphagia. Both devices provided an excellent glottic view in patients with cervical spine immobilisation, but tracheal intubation was more often successful on the first attempt with the GlideScope.

  14. Nonoperative Management of Cervical Radiculopathy.

    PubMed

    Childress, Marc A; Becker, Blair A

    2016-05-01

    Cervical radiculopathy describes pain in one or both of the upper extremities, often in the setting of neck pain, secondary to compression or irritation of nerve roots in the cervical spine. It can be accompanied by motor, sensory, or reflex deficits and is most prevalent in persons 50 to 54 years of age. Cervical radiculopathy most often stems from degenerative disease in the cervical spine. The most common examination findings are painful neck movements and muscle spasm. Diminished deep tendon reflexes, particularly of the triceps, are the most common neurologic finding. The Spurling test, shoulder abduction test, and upper limb tension test can be used to confirm the diagnosis. Imaging is not required unless there is a history of trauma, persistent symptoms, or red flags for malignancy, myelopathy, or abscess. Electrodiagnostic testing is not needed if the diagnosis is clear, but has clinical utility when peripheral neuropathy of the upper extremity is a likely alternate diagnosis. Patients should be reassured that most cases will resolve regardless of the type of treatment. Nonoperative treatment includes physical therapy involving strengthening, stretching, and potentially traction, as well as nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage. Epidural steroid injections may be helpful but have higher risks of serious complications. In patients with red flag symptoms or persistent symptoms after four to six weeks of treatment, magnetic resonance imaging can identify pathology amenable to epidural steroid injections or surgery. PMID:27175952

  15. Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain

    PubMed Central

    Ruivo, Rodrigo M.; Pezarat-Correia, Pedro; Carita, Ana I.

    2014-01-01

    Background: There is sparse literature that provides evidence of cervical and shoulder postural alignment of 15 to 17-year-old adolescents and that analyzes sex differences. Objectives: To characterize the postural alignment of the head and shoulder in the sagittal plane of 15 to 17-year-old Portuguese adolescents in natural erect standing and explore the relationships between three postural angles and presence of neck and shoulder pain. Method: This cross-sectional study was conducted in two secondary schools in Portugal. 275 adolescent students (153 females and 122 males) aged 15 to 17 were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and PAS software. The American Shoulder and Elbow Surgeons Shoulder Assessment (ASES) was used to assess shoulder pain, whereas neck pain was self-reported with a single question. Results: Mean values of sagittal head, cervical, and shoulder angles were 17.2±5.7, 47.4±5.2, and 51.4±8.5º, respectively. 68% of the participants revealed protraction of the head, whereas 58% of them had protraction of the shoulder. The boys showed a significantly higher mean cervical angle, and adolescents with neck pain revealed lower mean cervical angle than adolescents without neck pain. 53% of the girls self-reported regular neck pain, contrasting with 19% of the boys. Conclusions: This data shows that forward head and protracted shoulder are common postural disorders in adolescents, especially in girls. Neck pain is prevalent in adolescents, especially girls, and it is associated with forward head posture. PMID:25054381

  16. Spinal alignment, mobility of the hip and thoracic spine and prevalence of low back pain in young elite cross-country skiers.

    PubMed

    Alricsson, Marie; Björklund, Glenn; Cronholm, Martin; Olsson, Oscar; Viklund, Peter; Svantesson, Ulla

    2016-02-01

    This study investigated the association between spinal alignment, mobility of the hips and the thoracic spine and low back pain in adolescent cross-country skiers. Cohort of 51 elite cross-country skiers from a cross-country skiing high school in Sweden participated in the study. Sagittal spinal alignment, active range of motion in flexion, extension and rotation of the thoracic spine as well as passive and active extension of the hips were measured. The participants also completed a questionnaire regarding training, competition, skiing technique and occurrence of low back pain. A simple linear regression was calculated to predict pain score based on thoraco-lumbar relation, with a significant (P<0.05) regression equation of y=-0.069x+2.280 (standard error of estimate, 0.034). Participants with greater lordosis than kyphosis were more likely to suffer from low back pain than subjects without this offset. Thoracic mobility and passive or active hip extension showed no correlation with low back pain. Sagittal spinal alignment seems to be related with low back pain among young elite cross-country skiers. This study shows that range of motion of the thoracic spine and hips do not have an effect on the prevalence of low back pain in this population.

  17. Spinal alignment, mobility of the hip and thoracic spine and prevalence of low back pain in young elite cross-country skiers

    PubMed Central

    Alricsson, Marie; Björklund, Glenn; Cronholm, Martin; Olsson, Oscar; Viklund, Peter; Svantesson, Ulla

    2016-01-01

    This study investigated the association between spinal alignment, mobility of the hips and the thoracic spine and low back pain in adolescent cross-country skiers. Cohort of 51 elite cross-country skiers from a cross-country skiing high school in Sweden participated in the study. Sagittal spinal alignment, active range of motion in flexion, extension and rotation of the thoracic spine as well as passive and active extension of the hips were measured. The participants also completed a questionnaire regarding training, competition, skiing technique and occurrence of low back pain. A simple linear regression was calculated to predict pain score based on thoraco-lumbar relation, with a significant (P<0.05) regression equation of y=−0.069x+2.280 (standard error of estimate, 0.034). Participants with greater lordosis than kyphosis were more likely to suffer from low back pain than subjects without this offset. Thoracic mobility and passive or active hip extension showed no correlation with low back pain. Sagittal spinal alignment seems to be related with low back pain among young elite cross-country skiers. This study shows that range of motion of the thoracic spine and hips do not have an effect on the prevalence of low back pain in this population. PMID:26933656

  18. Low-dose chemonucleolysis combined with percutaneous nucleotomy in herniated cervical disks.

    PubMed

    Hoogland, T; Scheckenbach, C

    1995-06-01

    The combination of low-dose chemonucleolysis with 500 IU chymopapain followed by an automated percutaneous nucleotomy of the cervical spine is a new procedure. A follow-up of at least 1 year of the first 22 patients showed in 19 patients good or excellent results. In one patient a fair result was obtained, and in two patients the symptoms were unchanged; one of these patients subsequently underwent diskectomy and anterior cervical spine fusion. Preoperatively, all patients showed a clear cervical disk herniation with predominantly radicular pain. The procedure has been performed so far in approximately 100 patients. No intra- or postoperative complications have been noted. PMID:7670215

  19. The Cervical Spine of the American Barn Owl (Tyto furcata pratincola): I. Anatomy of the Vertebrae and Regionalization in Their S-Shaped Arrangement

    PubMed Central

    Krings, Markus; Nyakatura, John A.; Fischer, Martin S.; Wagner, Hermann

    2014-01-01

    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

  20. A Case Report of Locked-in Syndrome Due to Bilateral Vertebral Artery Dissection After Cervical Spine Manipulation Treated by Arterial Embolectomy

    PubMed Central

    Ke, Jiang-Qiong; Yin, Bo; Fu, Fang-Wang; Shao, Sheng-Min; Lin, Yan; Dong, Qi-Qiang; Wang, Xiao-Tong; Zheng, Guo-Qing

    2016-01-01

    Abstract Cervical spine manipulation (CSM) is a commonly spinal manipulative therapies for the relief of cervical spine-related conditions worldwide, but its use remains controversial. CSM may carry the potential for serious neurovascular complications, primarily due to vertebral artery dissection (VAD) and subsequent vertebrobasilar stroke. Here, we reported a rare case of locked-in syndrome (LIS) due to bilaterial VAD after CSM treated by arterial embolectomy. A 36-year-old right-handed man was admitted to our hospital with numbness and weakness of limbs after treating with CSM for neck for half an hour. Gradually, although the patient remained conscious, he could not speak but could communicate with the surrounding by blinking or moving his eyes, and turned to complete quadriplegia, complete facial and bulbar palsy, dyspnea at 4 hours after admission. He was diagnosed with LIS. Then, the patient was received cervical and brain computed tomography angiography that showed bilateral VAD. Aortocranial digital subtraction angiography showed vertebrobasilar thrombosis, blocking left vertebral artery, and stenosis of right vertebral artery. The patient was treated by using emergency arterial embolectomy and followed by antiplatelet therapy and supportive therapy in the intensive care unit and a general ward. Twenty-seven days later, the patient's physical function gradually improved and discharged but still left neurological deficit with muscle strength grade 3/5 and hyperreflexia of limbs. Our findings suggested that CSM might have potential severe side-effect like LIS due to bilaterial VAD, and arterial embolectomy is an important treatment choice. The practitioner must be aware of this complication and should give the patients informed consent to CSM, although not all stroke cases temporally related to SCM have pre-existing craniocervical artery dissection. PMID:26844510

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

    PubMed Central

    Wade, Rodel E.; Houlé, John D.

    2013-01-01

    Abstract Chronic neuropathic pain is a significant consequence of spinal cord injury (SCI) that is associated with evoked pain, including allodynia and/or hyperalgesia. Allodynia is defined as a painful response to normally innocuous stimuli, and hyperalgesia occurs when there is an amplified pain response to normally noxious stimuli. We describe a model of a unilateral cervical level (C5) contusion injury where sensory recovery was assessed weekly for 6 weeks in 32 adult, female, Sprague-Dawley rats. Bilateral thermal hyperalgesia and tactile allodynia are detectable in the fore- and hindpaws as early as 7 days post-injury (dpi) and persist for at least 42 days. Paw withdrawal latency in response to a noxious thermal stimulus significantly intra-animal pre-operative values. Change in paw withdrawal latency plateaued at 21 dpi. Interestingly, bilateral forepaw allodynia develops in fewer than 40% of rats as measured by von Frey monofilament testing. Similar results occur in the hindpaws, where bilateral allodynia occurs in 46% of rats with SCI. The contralesional forepaw and both hindpaws of rats showed a slight increase in paw withdrawal threshold to tactile stimuli acutely after SCI, corresponding to ipsilesional forelimb motor deficits that resolve over time. That there is no difference among allodynic and non-allodynic groups in overall spared tissue or specifically of the dorsal column or ventrolateral white matter where ascending sensory tracts reside suggests that SCI-induced pain does not depend solely on the size or extent of the lesion, but that other mechanisms are in play. These observations provide a valid model system for future testing of therapeutic interventions to prevent the onset or to reduce the debilitating effects of chronic neuropathic pain after SCI. PMID:23216008

  2. [Is there a correlation between back pain and stability of the lumbar spine in pregnancy? A model-based hypothesis].

    PubMed

    Liebetrau, A; Puta, C; Schinowski, D; Wulf, T; Wagner, H

    2012-02-01

    During pregnancy approximately 50% of women suffer from low back pain (LBP), which significantly affects their everyday life. The pain could result in chronic insomnia, limit the pregnant women in their ability to work and produce a reduction of their physical activity. The etiology of the pain is still critically discussed and not entirely understood. In the literature different explanations for LBP are given and one of the most common reasons is the anatomical changes of the female body during pregnancy; for instance, there is an increase in the sagittal moments because of the enlarged uterus and fetus and the occurrence of hyperlordosis.The aim of this study was to describe how the anatomical changes in pregnant women affect the stability and the moments acting on the lumbar spine with the help of a simplified musculoskeletal model.A two-dimensional musculoskeletal model of the lumbar spine in the sagittal plane consisting of five lumbar vertebrae was developed. The model included five centres of rotation and three antagonistic pairs of paraspinal muscles. The concept of altered acting torques during pregnancy was explored by varying the geometrical arrangements. The situations non-pregnant, pregnant and pregnant with hyperlordosis were considered for the model-based approach. These simulations were done dependent on the stability of the erect posture and local countertorques of every lumbar segment.In spite of the simplicity of the model and the musculoskeletal arrangement it was possible to maintain equilibrium of the erect posture at every lumbar spinal segment with one minimum physiological cross-sectional area of all paraspinal muscles. The stability of the musculoskeletal system depends on the muscular activity of the paraspinal muscles and diminishing the muscular activity causes unstable lumbar segments.The relationship between the non-pregnant and the pregnant simulations demonstrated a considerable increase of acting segmental countertorques

  3. Cervical spine CT scan

    MedlinePlus

    ... type of contrast given into a vein contains iodine. If a person with an iodine allergy is given this type of contrast, nausea ... steroids before the test. The kidneys help remove iodine out of the body. People with kidney disease ...

  4. Multi-center, Prospective, Randomized, Controlled Investigational Device Exemption Clinical Trial Comparing Mobi-C Cervical Artificial Disc to Anterior Discectomy and Fusion in the Treatment of Symptomatic Degenerative Disc Disease in the Cervical Spine

    PubMed Central

    Bae, Hyun W.; Davis, Reginald; Gaede, Steven; Hoffman, Greg; Kim, Kee; Nunley, Pierce D.; Peterson, Daniel; Rashbaum, Ralph; Stokes, John

    2014-01-01

    Background Anterior cervical discectomy and fusion (ACDF) is the gold standard for treating symptomatic cervical disc degeneration. Cervical total disc replacements (TDRs) have emerged as an alternative for some patients. The purpose of this study was to evaluate the safety and effectiveness of a new TDR device compared with ACDF for treating single-level cervical disc degeneration. Methods This was a prospective, randomized, controlled, multicenter Food and Drug Administration (FDA) regulated Investigational Device Exemption (IDE) study. A total of 245 patients were treated (164 TDR: 81 ACDF). The primary outcome measure was overall success based on improvement in Neck Disability Index (NDI), no subsequent surgical interventions, and no adverse events (AEs) classified as major complications. Secondary outcome measures included SF-12, visual analog scale (VAS) assessing neck and arm pain, patient satisfaction, radiographic range of motion, and adjacent level degeneration. Patients were evaluated preoperatively and postoperatively at 6 weeks, 3, 6, 12, 18, and 24 months. The hypothesis was that the TDR success rate was non-inferior to ACDF at 24 months. Results Overall success rates were 73.6% for TDR and 65.3% for ACDF, confirming non-inferiority (p < 0.0025). TDR demonstrated earlier improvements with significant differences in NDI scores at 6 weeks and 3 months, and VAS neck pain and SF-12 PCS scores at 6 weeks (p<0.05). Operative level range of motion in the TDR group was maintained throughout follow-up. Radiographic evidence of inferior adjacent segment degeneration was significantly greater with ACDF at 12 and 24 months (p < 0.05). AE rates were similar. Conclusions Mobi-C TDR is a safe and effective treatment for single-level disc degeneration, producing outcomes similar to ACDF with less adjacent segment degeneration. Level of Evidence: Level I. Clinical relevance: This study adds to the literature supporting cervical TDR as a viable option to ACDF in

  5. [Therapy of cervical rheumatoid arthritis].

    PubMed

    Kothe, R; Wiesner, L; Rüther, W

    2004-08-01

    The rheumatoid involvement of the cervical spine can be divided into three phases. In the early stage of the disease there is an isolated atlantoaxial subluxation (AAS), followed by vertical instability and subaxial instability. If patients show clear symptoms of cervical myelopathy, which can occur during any stage of the disease, the progression cannot be stopped by conservative treatment, which is of great importance at the beginning of the cervical manifestation. Patient education, physiotherapy and immobilization with a stiff collar can significantly reduce pain. Early and effective DMARD therapy can have a positive effect on the natural history of the disease. In case of progressive instability, cervical myelopathy or severe pain operative treatment is indicated. If there is an isolated AAS, fusion can be restricted to the C1/C2 segment. The Magerl transarticular screw fixation is the preferred technique for stabilization. If there is evidence for vertical instability or severe destruction of the C0/C1 joints, occipital cervical fusion has to be performed. Durin the preoperative planning it is necessary to look for signs of subaxial instability. If this is the case, fusion should include the entire cervical spine. Transoral decompression may be necessary when there is persistent anterior compression of the myelon, typically seen in fixed AAS. Non-ambulatory myelopathic patients are more likely to develop severe surgical complications. Therefore, it is important to avoid the development of severe cervical instability by early surgical intervention. The right timing for surgery is still a matter of controversy. Future prospective randomized trials should address this topic to improve the treatment concept for the rheumatoid patient.

  6. A Randomized Controlled Trial to Assess Pain and Magnetic Resonance Imaging-Based (MRI-Based) Structural Spine Changes in Low Back Pain Patients After Yoga Practice

    PubMed Central

    Telles, Shirley; Bhardwaj, Abhishek K.; Gupta, Ram K.; Sharma, Sachin K.; Monro, Robin; Balkrishna, Acharya

    2016-01-01

    Background The present study aimed at determining whether 12 weeks of yoga practice in patients with chronic LBP and MRI-based degenerative changes would result in differences in: (i) self-reported pain, anxiety, and spinal flexibility; and (ii) the structure of the discs or vertebrae. Material/Methods Sixty-two persons with MRI-proven degenerative intervertebral discs (group mean ±S.D., 36.2±6.4 years; 30 females) were randomly assigned to yoga and control groups. However, testing was conducted on only 40 subjects, so only their data are included in this study. The assessments were: self-reported pain, state anxiety, spinal flexibility, and MRI of the lumbosacral spine, performed using a 1.5 Tesla system with a spinal surface column. The yoga group was taught light exercises, physical postures, breathing techniques, and yoga relaxation techniques for 1 hour daily for 3 months. No intervention was given to the control group except for routine medical care. A repeated-measures analysis of variance (ANOVA) with post hoc analyses (which was Bonferroni-adjusted) was used. The Ethics Committee of Patanjali Research Foundation had approved the study which had been registered in the Clinical Trials Registry of India (CTRI/2012/11/003094). Results The yoga group showed a significant reduction in self-reported pain and state anxiety in a before/after comparison at 12 weeks. A few patients in both groups showed changes in the discs and vertebrae at post-intervention assessment. Conclusions Within 12 weeks, yoga practice reduced pain and state anxiety but did not alter MRI-proven changes in the intervertebral discs and in the vertebrae.

  7. A Randomized Controlled Trial to Assess Pain and Magnetic Resonance Imaging-Based (MRI-Based) Structural Spine Changes in Low Back Pain Patients After Yoga Practice.

    PubMed

    Telles, Shirley; Bhardwaj, Abhishek K; Gupta, Ram K; Sharma, Sachin K; Monro, Robin; Balkrishna, Acharya

    2016-01-01

    BACKGROUND The present study aimed at determining whether 12 weeks of yoga practice in patients with chronic LBP and MRI-based degenerative changes would result in differences in: (i) self-reported pain, anxiety, and spinal flexibility; and (ii) the structure of the discs or vertebrae. MATERIAL AND METHODS Sixty-two persons with MRI-proven degenerative intervertebral discs (group mean ±S.D., 36.2±6.4 years; 30 females) were randomly assigned to yoga and control groups. However, testing was conducted on only 40 subjects, so only their data are included in this study. The assessments were: self-reported pain, state anxiety, spinal flexibility, and MRI of the lumbosacral spine, performed using a 1.5 Tesla system with a spinal surface column. The yoga group was taught light exercises, physical postures, breathing techniques, and yoga relaxation techniques for 1 hour daily for 3 months. No intervention was given to the control group except for routine medical care. A repeated-measures analysis of variance (ANOVA) with post hoc analyses (which was Bonferroni-adjusted) was used. The Ethics Committee of Patanjali Research Foundation had approved the study which had been registered in the Clinical Trials Registry of India (CTRI/2012/11/003094). RESULTS The yoga group showed a significant reduction in self-reported pain and state anxiety in a before/after comparison at 12 weeks. A few patients in both groups showed changes in the discs and vertebrae at post-intervention assessment. CONCLUSIONS Within 12 weeks, yoga practice reduced pain and state anxiety but did not alter MRI-proven changes in the intervertebral discs and in the vertebrae. PMID:27619104

  8. Solitary Osteochondroma Arising from Cervical Spina Bifida Occulta

    PubMed Central

    Ofluoglu, Ali Ender

    2013-01-01

    Solitary osteochondromas are common benign long bone tumors originating from cartilage. They may produce a wide variety of symptoms and complications depending on their spinal location. These may include compressive myelopathy, nerve root compression, pathologic fracture and malignant degeneration, or in some cases only pain. Solitary cervical spine osteochondromas have been reported mostly in the neural arch or vertebral body. This report describes a patient presenting with neck pain, with a benign osteochondroma arising in the right bifid C5 lamina. PMID:24383028

  9. Radiologic Assessment of Forward Head Posture and Its Relation to Myofascial Pain Syndrome

    PubMed Central

    Sun, An; Yeo, Han Gyeol; Kim, Tae Uk; Hyun, Jung Keun

    2014-01-01

    Objective To assess head posture using cervical spine X-rays to find out whether forward head posture is related to myofascial pain syndrome (MPS) in neck and shoulder. Methods Eighty-eight participants who were diagnosed with MPS in neck and shoulder were evaluated in this study. Four parameters (distance among head, cervical spines, and shoulder, and cervical angle) were measured from lateral view of cervical spine X-ray. The location and number of trigger points in the neck and shoulder and symptom duration were evaluated for each patient. Results Both horizontal distances between C1 vertebral body and C7 spinous process and between the earhole and C7 vertebral body were negatively correlated with cervical angle reflecting cervical lordosis (p<0.05). Younger patients had significantly (p<0.05) less cervical angle with more forward head posture. There was no relationship between MPS (presence, location, and number of trigger points) and radiologic assessments (distance parameters and the cervical angle). Conclusion Forward head posture and reduced cervical lordosis were seen more in younger patients with spontaneous neck pain. However, these abnormalities did not correlate with the location or the number of MPS. Further studies are needed to delineate the mechanism of neck pain in patients with forward head posture. PMID:25566482

  10. Cervical spondylosis

    MedlinePlus

    Cervical osteoarthritis; Arthritis - neck; Neck arthritis; Chronic neck pain; Degenerative disk disease ... pain using stretches. The therapist will teach you exercises that make your neck muscles stronger. The therapist ...

  11. Occipital Condyle Fracture with Accompanying Meningeal Spinal Cysts as a result of Cervical Spine Injury in 15-Year-Old Girl.

    PubMed

    Wiktor, Łukasz; Tomaszewski, Ryszard

    2015-01-01

    The occipital condyle fracture is rare injury of the craniocervical junction. Meningeal spinal cysts are rare tumors of the spinal cord. Depending on location, these lesions may be classified as extradural and subdural, but extradural spinal cysts are more common. We present the case of a 15-year-old girl who suffered from avulsion occipital condyle fracture treated with use of "halo-vest" system. We established that clinical effect after completed treatment is very good. Control MRI evaluation was performed 12 months after removal of "halo-vest" traction, and clinically silent extradural meningeal spinal cysts were detected at the ventral side of the spinal cord in the cervical segment of the spine. Due to clinically silent course of the disease, we decided to use the conservative treatment. The patient remains under control of our department. PMID:26543656

  12. Effect of laser acupuncture versus traditional acupuncture in neck pain of cervical spondylosis

    NASA Astrophysics Data System (ADS)

    El-Kharbotly, Ahmed M.; El-Gendy, Alyaa A.; Mohammed, Mouchira A.; El-Masry, Manal R.; Daoud, Eitedal M.; Hassan, Nagwa; Abdel-Wahab, Khaled G.; Helmy, Ghada; Mostafa, Taymour

    2014-02-01

    This prospective cohort study aimed to compare the efficiency of laser versus traditional acupuncture in treating cervical spondylosis (CS) pain. Forty female patients were randomized into two equal groups that received 3 sessions / week for 4 weeks. Group A received needle acupuncture therapy with electrical stimulation for 20 min at standard acupoints, ear points and Ashi point on the average 3 points. Group B received low level laser therapy (LLLT) acupuncture at the same acupoints. The results demonstrated that tenderness disappeared in 65% of patients in group A and 75% of patients in group B with improved percentage of 85.5% and 89.2%. Pain on VAS related to direction of motion at 6 directions was improved in all cases where with improvement percentage 76.45% and 85.88%. Pain on VAS at rest was improved in all patients with improvement percentage of 80.41% and 84.28%. NDIQ score improved in all patients with improvement percentage of 69.78% and 73.77%. Follow up of VAS after 6 months from the last session revealed persistent improvement in 55% of patients of group A vs 80% of patients of group B. Mean serum TNF-α was decreased in 85% of patients of group A vs 95% of patients of group B where serum beta endorphins was increased in all patients. It is concluded that both modes of treatment for CS gave improvement regarding pain intensity, disability and quality of life being more evident in LLLT followed for 6 months supported with improved serum TNFα and beta endorphin.

  13. Cervical and lumbar pain and radiological degeneration among fighter pilots: a systematic review and meta-analysis.

    PubMed

    Shiri, Rahman; Frilander, Heikki; Sainio, Markku; Karvala, Kirsi; Sovelius, Roope; Vehmas, Tapio; Viikari-Juntura, Eira

    2015-02-01

    To assess the associations of acceleration force indicators (aircraft type and flight hours) with cervical and lumbar pain and radiological degeneration among fighter pilots. The PubMed, Embase, Scopus and Web of Science databases were searched until October 2013. Twenty-seven studies were included in the review and 20 in the meta-analysis. There were no differences in the prevalence of neck pain (pooled OR=1.07, 95% CI 0.87 to 1.33), cervical disc degeneration (OR=1.26, CI 0.81 to 1.96), low back pain (OR=0.80, CI 0.47 to 1.38) or lumbar disc degeneration (OR=0.87, CI 0.67 to 1.13) between fighter pilots and helicopter or transport/cargo pilots. Moreover, the prevalence of cervical (OR=1.14, CI 0.61 to 2.16) or lumbar (OR=1.05, CI 0.49 to 2.26) disc degeneration did not differ between fighter pilots and non-flying personnel. Most studies did not control their estimates for age and other potential confounders. Among high-performance aircraft pilots, exposure to the highest G-forces was associated with a higher prevalence of neck pain compared with exposure to lower G-forces (pooled OR=3.12, CI 2.08 to 4.67). The studies on the association between flight hours and neck pain reported inconsistent findings. Moreover, looking back over the shoulder (check six) was the most common posture associated with neck pain. Fighter pilots exposed to high G-forces may be at a greater risk for neck pain than those exposed to low G-forces. This finding should be confirmed with better control for confounding. Awkward neck posture may be an important factor in neck pain among fighter pilots.

  14. The Nijmegen Decision Tool for Chronic Low Back Pain. Development of a Clinical Decision Tool for Secondary or Tertiary Spine Care Specialists

    PubMed Central

    van Hooff, Miranda L.; van Loon, Jan; van Limbeek, Jacques; de Kleuver, Marinus

    2014-01-01

    Background In Western Europe, low back pain has the greatest burden of all diseases. When back pain persists, different medical specialists are involved and a lack of consensus exists among these specialists for medical decision-making in Chronic Low Back Pain (CLBP). Objective To develop a decision tool for secondary or tertiary spine care specialists to decide which patients with CLBP should be seen by a spine surgeon or by other non-surgical medical specialists. Methods A Delphi study was performed to identify indicators predicting the outcome of interventions. In the preparatory stage evidence from international guidelines and literature were summarized. Eligible studies were reviews and longitudinal studies. Inclusion criteria: surgical or non-surgical interventions and persistence of complaints, CLBP-patients aged 18–65 years, reported baseline measures of predictive indicators, and one or more reported outcomes had to assess functional status, quality of life, pain intensity, employment status or a composite score. Subsequently, a three-round Delphi procedure, to reach consensus on candidate indicators, was performed among a multidisciplinary panel of 29 CLBP-professionals (>five years CLBP-experience). The pre-set threshold for general agreement was ≥70%. The final indicator set was used to develop a clinical decision tool. Results A draft list with 53 candidate indicators (38 with conclusive evidence and 15 with inconclusive evidence) was included for the Delphi study. Consensus was reached to include 47 indicators. A first version of the decision tool was developed, consisting of a web-based screening questionnaire and a provisional decision algorithm. Conclusions This is the first clinical decision tool based on current scientific evidence and formal multidisciplinary consensus that helps referring the patient for consultation to a spine surgeon or a non-surgical spine care specialist. We expect that this tool considerably helps in clinical decision

  15. The immediate effects of sigmoid colon manipulation on pressure pain thresholds in the lumbar spine.

    PubMed

    McSweeney, Terence P; Thomson, Oliver P; Johnston, Ross

    2012-10-01

    Visceral manual therapy is increasingly used by UK osteopaths and manual therapists, but there is a paucity of research investigating its underlying mechanisms, and in particular in relation to hypoalgesia. The aim of this study was to investigate the immediate effects of osteopathic visceral mobilisation on pressure pain thresholds. A single-blinded, randomised, within subjects, repeated measures design was conducted on 15 asymptomatic subjects. Pressure pain thresholds were measured at the L1 paraspinal musculature and 1st dorsal interossei before and after osteopathic visceral mobilisation of the sigmoid colon. The results demonstrated a statistically significant improvement in pressure pain thresholds immediately after the intervention (P<0.001). This effect was not observed to be systemic, affecting only the L1 paraspinal musculature. This novel study provides new experimental evidence that visceral manual therapy can produce immediate hypoalgesia in somatic structures segmentally related to the organ being mobilised, in asymptomatic subjects.

  16. Effect of Cervical Interlaminar Epidural Steroid Injection: Analysis According to the Neck Pain Patterns and MRI Findings

    PubMed Central

    Choi, Ji Won; Lim, Hyung Woo; Lee, Jin Young; Lee, Won Il; Lee, Eun Kyung; Chang, Choo Hoon; Yang, Jae Young

    2016-01-01

    Background It is widely accepted that cervical interlaminar steroid injection (CIESI) is more effective in treating radicular pain than axial neck pain, but without direct comparison. And the differences of effect after CIESI according to MRI findings are inconsistent. In this retrospective study, we evaluated the therapeutic response of CIESI according to pain sites, durations, MRI findings, and other predictive factors altogether, unlike previous studies, which evaluated them separately. Methods The medical records of 128 patients who received fluoroscopy guided CIESI were analyzed. We evaluated the therapeutic response (more than a 50% reduction on the visual analog scale [VAS] by their second visit) after CIESI by (1) pain site; neck pain without radicular pain/radicular pain with or without neck pain, (2) pain duration; acute/chronic (more than 6 month), and (3) findings of MRI; herniated intervertebral disc (HIVD)/spinal stenosis, respectively and altogether. Results Eighty-eight patients (68%) responded to CIESI, and there were no significant differences in demographic data, initial VAS score, or laboratory findings. And there were no significant differences in the response rate relating to pain site, pain duration, or MRI findings, respectively. In additional analysis, acute radicular pain with HIVD patients showed significantly better response than chronic neck pain with spinal stenosis (P = 0.04). Conclusions We cannot find any sole predictive factor of therapeutic response to the CIESI. But the patients having acute radicular pain with HIVD showed the best response, and those having other chronic neck pain showed the worst response to CIESI. PMID:27103964

  17. A diagnostic and therapeutic challenge involving a case of dysphagia in association with cervical osteophytosis and a dental pain

    PubMed Central

    Dable, Rajani A.; Wasnik, Pradnya B.; Nagmode, Sunilkumar L.; Ali, Mukkaram Faridi

    2013-01-01

    Herein, presenting a case of a 42-year-old female with the chief complaint of dysphagia. The problem was assumed to be of dental origin, due to the onset of dental pain followed by dysphagia. A cervical radiograph revealed the presence of osteophytic lipping which proved to be the cause of dysphagia. Confusing and overlapping disease entities showing similar symptoms need thorough investigation. Dysphagia related to cervical spondylosis may have a direct connection with the person's occupation. Dentistry is considered a potentially hazardous occupation with regard to musculoskeletal disorders. However, additional studies are required to understand the occupational hazards faced by dentists. PMID:24250178

  18. Comparison of Clinical Efficacy Between Interlaminar and Transforaminal Epidural Injection in Patients With Axial Pain due to Cervical Disc Herniation.

    PubMed

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-01-01

    Transforaminal (TF) approach is preferred by physician to interlaminar (IL) approach because it can deliver injectates directly around nerve root and dorsal root ganglion, which is regarded as main pain sources. Axial neck pain is originated from sinuvertebral nerve located in ventral epidural spaces, which has been described to be related to central or paramedian disc herniation. It is very questionable that TF injection is also more effective than IL injection in the patients with axial neck or interscapular pain. This study was to evaluate clinical efficacy of cervical epidural injection in patients with axial pain due to cervical disc herniation and to compare the clinical outcomes between TF and IL approaches. Fifty-six and 52 patients who underwent IL and TF epidural injections, respectively, for axial neck/interscapular pain due to central or paramedian cervical disc herniation were included. Numeric Rating Scale (NRS) and Neck Disability Index (NDI) were compared between both groups at 2 and 8 weeks after treatment. Successful pain relief was defined if a 50% or more reduction of NRS score was achieved in comparison with pretreatment one. Successful functional improvement was defined if at least a 40% reduction of NDI was obtained. Overall, 79 (73.1%) and 57 (52.8%) among 108 patients showed successful pain relief at 2 and 8 weeks, respectively. Seventy-six (70.4%) and 52 (48.1%) had successful functional improvement at 2 and 8 weeks, respectively. The IL and TF groups showed no significant difference in proportion of successful results of NRS 2 weeks (73.2% vs 67.3%) and 8 weeks (48.2% vs 48.1%). Also, no significant difference was obtained in proportion of successful NDI between 2 groups at 2 weeks (75.0% vs 71.2%) and 8 weeks (53.6% vs 51.9%). Cervical epidural injection showed favorable results in 2 weeks and moderate results in 8 weeks in patients with axial pain due to cervical disc herniation. IL and TF showed no significant difference in clinical

  19. Spontaneous regression of cervical disc herniation: a case report.

    PubMed

    Han, Seong Rok; Choi, Chan Young

    2014-12-01

    Spontaneous regression of cervical disc herniation is a rare, and such reports are few. A 39 year-old woman complained of severe neck pain associated with tingling and numbness of right upper extremity. The MRI of the cervical spine revealed a posterior disc extrusion at the C4-C5 level in the right para-central location. The patient was treated with conservative management without any surgical treatment. The patient's symptoms were significant improvement. After two years later, we performed follow-up cervical MRI that revealed significant spontaneous regression of the C4-C5 intervertebral disc extrusion. PMID:25620984

  20. Inter-operator Reliability of Magnetic Resonance Image-Based Computational Fluid Dynamics Prediction of Cerebrospinal Fluid Motion in the Cervical Spine.

    PubMed

    Martin, Bryn A; Yiallourou, Theresia I; Pahlavian, Soroush Heidari; Thyagaraj, Suraj; Bunck, Alexander C; Loth, Francis; Sheffer, Daniel B; Kröger, Jan Robert; Stergiopulos, Nikolaos

    2016-05-01

    For the first time, inter-operator dependence of MRI based computational fluid dynamics (CFD) modeling of cerebrospinal fluid (CSF) in the cervical spinal subarachnoid space (SSS) is evaluated. In vivo MRI flow measurements and anatomy MRI images were obtained at the cervico-medullary junction of a healthy subject and a Chiari I malformation patient. 3D anatomies of the SSS were reconstructed by manual segmentation by four independent operators for both cases. CFD results were compared at nine axial locations along the SSS in terms of hydrodynamic and geometric parameters. Intraclass correlation (ICC) assessed the inter-operator agreement for each parameter over the axial locations and coefficient of variance (CV) compared the percentage of variance for each parameter between the operators. Greater operator dependence was found for the patient (0.19 < ICC < 0.99) near the craniovertebral junction compared to the healthy subject (ICC > 0.78). For the healthy subject, hydraulic diameter and Womersley number had the least variance (CV = ~2%). For the patient, peak diastolic velocity and Reynolds number had the smallest variance (CV = ~3%). These results show a high degree of inter-operator reliability for MRI-based CFD simulations of CSF flow in the cervical spine for healthy subjects and a lower degree of reliability for patients with Type I Chiari malformation.

  1. Biomechanics of the flexion of spine

    NASA Astrophysics Data System (ADS)

    Hobbs, H. K.; Aurora, T. S.

    1991-03-01

    Low back pain is a common problem and it involves different kinds of injury to the spine. In this article the forces and torques experienced by the spine are examined in order to understand, and possibly avoid, low back pain.

  2. Postural responses without versus with acute external cervical spine fixation: a comparative study in healthy subjects and patients with acute unilateral vestibular loss.

    PubMed

    Bohne, Silvia; Heine, Sabrina; Volk, G Fabian; Stadler, Joachim; Guntinas-Lichius, Orlando

    2013-01-01

    Using a diagnostic prospective cohort single center study design, the influence of a cervical collar on standing balance during dynamic postural perturbations in healthy adults and patients with acute unilateral vestibular dysfunction was measured in 31 healthy subjects and 27 patients with acute unilateral vestibular loss. The main outcome measures were completed standard protocols on the Sensory Organization Test (SOT) and Motor Control Test (MCT) of the NeuroCom Equitest(®) computerized posturography platform measured without and with acute cervical fixation, respectively. Paired t test showed no significant difference during the six conditions of neither the SOT scores nor analyzing the SOT strategies or during the MCT between the non-fixed and fixed neck in healthy subjects and in the patients (all p > 0.05). Older healthy subjects showed decreased SOT scores but equal MCT results. The age effect was more dominant in the patients when wearing the collar. Gender had no influence whether in healthy individuals nor in patients. In almost all conditions of the SOT but only in some MCT subtests patients had significantly lower scores than healthy subjects without collar and with collar (all p < 0.05). In conclusion, the SOT but only some subtest of the MCT could clearly distinguish between healthy adults and patient with acute unilateral vestibular loss. Equilibrium scores did not change significantly when the cervical spine was fixed with a collar. Acute fixation of the neck with a collar seems not to affect standing balance, even not when vestibular, visual and/or somatosensory input are also reduced. PMID:22237759

  3. Soft tissue artifact evaluation of the cervical spine in motion patterns of flexion and lateral bending: a preliminary study.

    PubMed

    Wang, Jiajia; Lui, Zhongwen; Qian, Zhihui; Ren, Luquan

    2016-01-01

    Background. Soft tissue artifact (STA) is increasingly becoming a focus of research as the skin marker method is widely employed in motion capture technique. At present, medical imaging methods provide reliable ways to investigate the cervical STA. Among these approaches, magnetic resonance imaging (MRI) is a highly preferred tool because of its low radiation. Methods. In the study, the 3D spatial location of vertebral landmarks and corresponding skin markers of the spinous processes of the second (C2), fifth (C5), and sixth (C6) cervical levels during flexion and lateral bending were investigated. A series of static postures were scanned using MRI. Skin deformation was obtained by the Mimics software. Results. Results shows that during flexion, the maximum skin deformation occurs at C6, in the superior-inferior (Z) direction. Upon lateral bending, the maximum skin displacement occurs at C2 level, in the left-right (Y) direction. The result presents variability of soft tissue in the terms of direction and magnitude, which is consistent with the prevailing opinion. Discussion. The results testified variability of cervical STA. Future studies involving large ranges of subject classification, such as age, sex, height, gravity, and etc. should be performed to completely verify the existing hypothesis on human cervical skin deformation.

  4. Soft tissue artifact evaluation of the cervical spine in motion patterns of flexion and lateral bending: a preliminary study

    PubMed Central

    Wang, Jiajia; Lui, Zhongwen; Ren, Luquan

    2016-01-01

    Background. Soft tissue artifact (STA) is increasingly becoming a focus of research as the skin marker method is widely employed in motion capture technique. At present, medical imaging methods provide reliable ways to investigate the cervical STA. Among these approaches, magnetic resonance imaging (MRI) is a highly preferred tool because of its low radiation. Methods. In the study, the 3D spatial location of vertebral landmarks and corresponding skin markers of the spinous processes of the second (C2), fifth (C5), and sixth (C6) cervical levels during flexion and lateral bending were investigated. A series of static postures were scanned using MRI. Skin deformation was obtained by the Mimics software. Results. Results shows that during flexion, the maximum skin deformation occurs at C6, in the superior–inferior (Z) direction. Upon lateral bending, the maximum skin displacement occurs at C2 level, in the left–right (Y) direction. The result presents variability of soft tissue in the terms of direction and magnitude, which is consistent with the prevailing opinion. Discussion. The results testified variability of cervical STA. Future studies involving large ranges of subject classification, such as age, sex, height, gravity, and etc. should be performed to completely verify the existing hypothesis on human cervical skin deformation. PMID:27069821

  5. [Pain following operations of the lumbar spine. The "failed back surgery syndrome"].

    PubMed

    Seelig, W; Nidecker, A

    1989-01-01

    This is a follow up study of 61 patients with a 'failed back surgery syndrome' (FBSS). The mean follow up time is 5.4 years after the first operation on the lumbar spine. The diagnosis before the first operation was in 35 patients an entrapment disease (disc herniation or stenosis of the spinal canal), in 25 patients a segmental instability and once a deformity. The reason for the development of a 'failed back surgery syndrome' was in 18% a perioperative complication, in 24% a late unhappy consequence of the operation, in 40% an assessment- or treatment error. In 18% we were not able to figure out any reason for the failure. The correlating diagnosis were: postoperative infections 3, hematoma 1, disc herniation or instability on a second level 12, a second disc herniation at the same level 3, scarring or arachnoiditis 2, instability 18, lateral spinal stenosis 10. We emphasize the importance to distinguish between a clinical relevant and irrelevant diagnosis and to use special tests for this differentiation. PMID:2526416

  6. A Broken Drill-bit Fragment Causing Severe Radiating Pain after Cervical Total Disc Replacement: A Case Report

    PubMed Central

    Lee, Chong-Suh; Chung, Sung-Soo; Park, Jae-Chul; Shin, Seong-Kee; Park, Yong-Serk

    2011-01-01

    This is a case report of a 38-year-old man with severe radiating pain on upper extremity after cervical total disc replacement (TDR). We faced an unusual complication that has not been reported yet. He underwent cervical TDR for left central disc protrusion on C5-6. After the surgery, preoperative symptom disappeared. However, at postoperative 1 year, he complained severe right-sided radiating pain that had a sudden onset. On postoperative X-ray, a metal fragment which seemed like a broken drill bit was shown within the spinal canal. To remove that, right-sided anterior microforaminotomy on C5-6 was performed and the metal fragment was removed successfully. After that, anterior fusion was done because the motion of the artificial disc was minimal and the removed structure seemed to attenuate stability during cervical motion. The operation resulted in prompt symptomatic relief. During cervical TDR, particular attention should be paid to the procedures that require using drill-bits. PMID:21629488

  7. A Broken Drill-bit Fragment Causing Severe Radiating Pain after Cervical Total Disc Replacement: A Case Report.

    PubMed

    Lee, Chong-Suh; Chung, Sung-Soo; Park, Jae-Chul; Shin, Seong-Kee; Park, Yong-Serk; Kang, Kyung-Chung

    2011-06-01

    This is a case report of a 38-year-old man with severe radiating pain on upper extremity after cervical total disc replacement (TDR). We faced an unusual complication that has not been reported yet. He underwent cervical TDR for left central disc protrusion on C5-6. After the surgery, preoperative symptom disappeared. However, at postoperative 1 year, he complained severe right-sided radiating pain that had a sudden onset. On postoperative X-ray, a metal fragment which seemed like a broken drill bit was shown within the spinal canal. To remove that, right-sided anterior microforaminotomy on C5-6 was performed and the metal fragment was removed successfully. After that, anterior fusion was done because the motion of the artificial disc was minimal and the removed structure seemed to attenuate stability during cervical motion. The operation resulted in prompt symptomatic relief. During cervical TDR, particular attention should be paid to the procedures that require using drill-bits. PMID:21629488

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

    PubMed Central

    Kim, Min-hee; Yoo, Won-gyu

    2013-01-01

    [Purpose] This study investigated the effect of the spacing of backpack shoulder straps on cervical muscle activity, acromion and scapular position, and upper trapezius (UT) pain. [Subjects] Fourteen males aged 20–32 years, were recruited. [Methods] We measured the MPS (midcervical paraspinal) activity, acromial angle, scapular distance, and UT pain after gait carrying a backpack with different shoulder strap spacings. [Results] The MPS, scapular inferior distance, and UT pressure pain threshold was significantly decreased and the acromion angle was significantly increased when carrying a backpack with wide shoulder straps compared to narrow shoulder straps. [Conclusion] A backpack with wide shoulder straps may cause scapular depression syndrome and chronic UT pain. PMID:24259829

  9. Functional Magnetic Resonance Imaging of the Human Brainstem and Cervical Spinal Cord during Cognitive Modulation of Pain.

    PubMed

    Leung, Roxanne H; Stroman, Patrick W

    2016-01-01

    Pain is a complex sensory experience, and cognitive factors such as attention can influence its perception. Modulation of pain involves a network of subcortical structures; however, the role and relationship of these regions in cognitive modulation of pain are not well understood. The aims of this research were to evaluate the behavioral effect of cognitive modulation of pain and investigate the neural correlates of this mechanism in the brainstem and cervical spinal cord (SC), using functional magnetic resonance imaging (fMRI) and structural equation modeling (SEM). We applied noxious thermal stimulation on the C6 dermatome to 12 healthy female participants while they performed the n-Back task. Our findings demonstrate a significant attenuation in pain perception across the group as a result of the task, along with high intersubject variability in the degree of modulation. Using fMRI, our studies characterize neural responses in subcortical regions that are involved in the modulation of pain. SEM analysis reveals connectivity between the brainstem and SC at the group and individual levels, depending on cognitive load and degree of pain modulation, respectively. All together, our research demonstrates the behavioral effect of cognitive modulation on pain and provides insight into the subcortical neural response to the process. PMID:27652451

  10. What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    What are the risks, benefits, alternatives, and pitfalls for operating on cervical ossification of the posterior longitudinal ligament (OPLL)? To successfully diagnose OPLL, it is important to obtain Magnetic Resonance Images (MR). These studies, particularly the T2 weighted images, provide the best soft-tissue documentation of cord/root compression and intrinsic cord abnormalities (e.g. edema vs. myelomalacia) on sagittal, axial, and coronal views. Obtaining Computed Tomographic (CT) scans is also critical as they best demonstrate early OPLL, or hypertrophied posterior longitudinal ligament (HPLL: hypo-isodense with punctate ossification) or classic (frankly ossified) OPLL (hyperdense). Furthermore, CT scans reveal the “single layer” and “double layer” signs indicative of OPLL penetrating the dura. Documenting the full extent of OPLL with both MR and CT dictates whether anterior, posterior, or circumferential surgery is warranted. An adequate cervical lordosis allows for posterior cervical approaches (e.g. lamionplasty, laminectomy/fusion), which may facilitate addressing multiple levels while avoiding the risks of anterior procedures. However, without lordosis and with significant kyphosis, anterior surgery may be indicated. Rarely, this requires single/multilevel anterior cervical diskectomy/fusion (ACDF), as this approach typically fails to address retrovertebral OPLL; single or multilevel corpectomies are usually warranted. In short, successful OPLL surgery relies on careful patient selection (e.g. assess comorbidities), accurate MR/CT documentation of OPLL, and limiting the pros, cons, and complications of these complex procedures by choosing the optimal surgical approach. Performing OPLL surgery requires stringent anesthetic (awake intubation/positioning) and also the following intraoperative monitoring protocols: Somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and electromyography (EMG). PMID:24843819

  11. Non-ejection cervical spine fracture due to defensive aerial combat maneuvering in an RF-4C: a case report.

    PubMed

    Schall, D G

    1983-12-01

    An unusual case report is presented describing an incident in which an RF-4C instructor pilot fractured three cervical vertebrae after impacting the rear canopy top during a negative G defensive maneuver. The pilot subsequently developed an incomplete tetraparesis later in flight and the aircraft had to be recovered by the front seat pilot. No similar cases have ever been reported to the USAF Safety Center or described in the aviation literature. PMID:6661124

  12. EVALUATION OF TERMINAL VERTEBRAL PLATE ON CERVICAL SPINE AT DIFFERENT AGE GROUPS AND ITS CORRELATION WITH INTERVERTEBRAL DISC THICKNESS

    PubMed Central

    Luiz Vieira, Juliano Silveira; da Silva Herrero, Carlos Fernando Pereira; Porto, Maximiliano Aguiar; Nogueira Barbosa, Marcello Henrique; Garcia, Sérgio Britto; Zambelli Ramalho, Leandra Náira; Aparecido Defino, Helton Luiz

    2015-01-01

    To evaluate, by means of histomorphometry, terminal vertebral plate thickness, intervertebral disc thickness and its correlation on different age groups, seeking to identify its correlation. Methods: C4-C5 and C5-C6 cervical segments removed from human cadavers of both genders were assessed and divided into five groups of 10-year age intervals, from 21 years old. TVP and intervertebral disc thickness evaluation was made by means of histomorphometry of histological slides stained with hematoxylin and eosyn. Lower C4 TVP, upper C5 TVP, and upper C6 TVP de were compared between each other and to the interposed intervertebral disc thickness between relevant TVP. Results: The thickness of terminal vertebral plates adjacent to the same ID did not show statistic differences. However, the comparison of upper and lower vertebral plates thickness on the same cervical vertebra (C5), showed statistical difference on all age groups studied. We found a statistical correlation coefficient above 80% between terminal vertebral plate and adjacent intervertebral disc, with a proportional thickness reduction of both structures on the different cervical levels studied, and also on the different age groups assessed. Conclusion: Terminal vertebral plate shows a morphologic correlation with the intervertebral disc next to it, and does not show correlation with the terminal vertebral plate on the same vertebra. PMID:26998448

  13. Spinal surgery -- cervical - series (image)

    MedlinePlus

    The cervical spinal column is made up of vertebral bodies which protect the spinal cord. ... spinal nerves, trauma, and narrowing (stenosis) of the spinal column around the spinal cord. Symptoms of cervical spine ...

  14. A Biomechanical Comparison of Three Different Posterior Fixation Constructs Used for C6–C7 Cervical Spine Immobilization: A Finite Element Study

    PubMed Central

    HONG, Jae Taek; QASIM, Muhammad; ESPINOZA ORÍAS, Alejandro A.; NATARAJAN, Raghu N.; AN, Howard S.

    2014-01-01

    The intralaminar screw construct has been recently introduced in C6–C7 fixation. The aim of the study is to compare the stability afforded by three different C7 posterior fixation techniques using a three-dimensional finite element model of a C6–C7 cervical spine motion segment. Finite element models representing three different cervical anchor types (C7 intralaminar screw, C7 lateral mass screw, and C7 pedicle screw) were developed. Range of motion (ROM) and maximum von Mises stresses in the vertebra for the three screw techniques were compared under pure moments in flexion, extension, lateral bending, and axial rotation. ROM for pedicle screw construct was less than the lateral mass screw construct and intralaminar screw construct in the three principal directions. The maximum von Misses stress was observed in the C7 vertebra around the pedicle in all the three screw constructs. Maximum von Mises stress in pedicle screw construct was less than the lateral mass screw construct and intralaminar screw construct in all loading modes. This study demonstrated that the pedicle screw fixation is the strongest instrumentation method for C6–C7 fixation. Pedicle screw fixation resulted in least stresses around the C7 pedicle-vertebral body complex. However, if pedicle fixation is not favorable, the laminar screw can be a better option compared to the lateral mass screw because the stress around the pedicle-vertebral body complex and ROM predicted for laminar screw construct was smaller than those of lateral mass screw construct. PMID:24418790

  15. The influence of fixed sagittal plane centers of rotation on motion segment mechanics and range of motion in the cervical spine.

    PubMed

    Kelly, Brian P; Zufelt, Nephi A; Sander, Elizabeth J; DiAngelo, Denis J

    2013-04-26

    The center of rotation (CoR) has become an increasingly used metric for biomechanical evaluation of spinal joints however traditional methods of determination remain prone to high degrees of uncertainty. The objective was to use a novel robotic testing protocol to investigate the effects of placement of fixed CoRs in the cervical spine. Human cadaveric C4-C5 (n=3) and C6-C7 (n=5) motion segment units (MSU) were rotated in flexion-extension to limits of 2.5 N m bending or 225 N resultant force about three points in a disc plane (A1, C1, P1) located at 25%, 50% and 75% along the length of the midline of the intervertebral disc respectively in the sagittal view, and three points (A2, C2, P2) in a sub-adjacent plane 5mm below the disc plane. Significant differences in range of rotation occurred between CoRs within the same plane but not between the same points in different planes (e.g. A1-A2). In flexion and extension axial forces at posterior points of rotation (P1, P2) were significantly different from those at anterior and central points. Shear forces were significantly different between points within the same plane except for the disc plane in extension, and between the same points in different planes in flexion and extension. The results indicate that the native cervical MSU is highly sensitive to the CoR location in terms of mechanics and range of motion, and that the CoR location likely varies between flexion and extension. The methodology developed has potential for application towards investigation of optimal CoR locations and in-vitro evaluations of the effects of implantable instrumentation.

  16. Cervical dystonia and pain: characteristics and treatment patterns from CD PROBE (Cervical Dystonia Patient Registry for Observation of OnabotulinumtoxinA Efficacy).

    PubMed

    Charles, P David; Adler, Charles H; Stacy, Mark; Comella, Cynthia; Jankovic, Joseph; Manack Adams, Aubrey; Schwartz, Marc; Brin, Mitchell F

    2014-07-01

    To compare profiles of subjects with and without cervical dystonia (CD)-associated pain, to evaluate the contribution of pain and the motor component of CD on quality of life, and to compare the initial botulinum toxin treatment paradigm between pain groups, baseline data were used from the CD Patient Registry for Observation of OnabotulinumtoxinA Efficacy (CD PROBE), a multicenter, prospective, observational registry designed to capture real-world practices and outcomes for onabotulinumtoxinA CD treatment. Subjects were divided into no/mild pain [Pain Numeric Rating Scale (PNRS) score 0-3] and moderate/severe pain groups (PNRS score 4-10). Descriptive and differential statistics were utilized to compare groups. 1,037 subjects completed the first treatment session, reported baseline botulinum toxin status, and completed baseline PNRS. Those with no/mild pain were significantly older at baseline. Those subjects with moderate/severe pain had higher Toronto Western Spasmodic Torticollis Rating Scale Severity (17.7 ± 5.1 vs. 16.2 ± 5.6, p < 0.0001) and Disability (12.7 ± 6.1 vs. 7.5 ± 5.6, p < 0.0001). CD subjects with moderate/severe pain received a higher mean dose (177.3 ± 82.9 vs. 158.0 ± 67.1 U, p = 0.0001) of onabotulinumtoxinA and were injected in more muscles (4.1 ± 1.4 vs. 3.7 ± 1.2, p < 0.0001) at initial treatment. CD PROBE clearly demonstrates the frequency of pain in CD and substantiates its importance when determining an optimal treatment paradigm. Future analyses of CD PROBE will further our understanding of the treatment patterns and outcomes related to onabotulinumtoxinA therapy for this disabling condition.

  17. The effects of black soybean (Glycine max var.) on chronic cervical pain of sedentary office workers in a northern Chinese population.

    PubMed

    Li, Xiaochuan; Tian, Feng; Wang, Fei

    2015-11-01

    Chronic cervical pain is a common symptom of sedentary office workers. Black soybean (Glycine max var.) has rich necessary nutrients for the therapy of chronic pain. Thus, it may ease chronic cervical pain. To prove our claim, 260 sedentary office workers with chronic pain were recruited and they consumed the defined diets at breakfast, lunch, and dinner with 1 g, 5 g and 10 g (3 g, 15 g, 30 g daily) cooked black soybean for 24 weeks. Visual analog scale (VAS), neck disability index (NDI) pain scores and short-form 36 (SF-36) health survey questionnaires were applied in the study. The levels of N-methyl-D-aspartate receptors (NMDAR) were measured. The VAS and NDI pain scores reduced and SF-36 scores increased in a 15 or 30 g black soybean daily group compared with a 3 g black soybean daily group after a 24-week therapy (P < 0.05). The 30 g black soybean daily group was better than the 15 g black soybean daily group in relieving chronic cervical pain of sedentary office workers (p < 0.05). The levels of NMDAR were lower in the 15 or 30 black soybean daily group than those in the 3 g black soybean daily group (P < 0.05). Black soybean can ameliorate chronic cervical pain by down-regulating the levels of NMDAR.

  18. The effects of black soybean (Glycine max var.) on chronic cervical pain of sedentary office workers in a northern Chinese population.

    PubMed

    Li, Xiaochuan; Tian, Feng; Wang, Fei

    2015-11-01

    Chronic cervical pain is a common symptom of sedentary office workers. Black soybean (Glycine max var.) has rich necessary nutrients for the therapy of chronic pain. Thus, it may ease chronic cervical pain. To prove our claim, 260 sedentary office workers with chronic pain were recruited and they consumed the defined diets at breakfast, lunch, and dinner with 1 g, 5 g and 10 g (3 g, 15 g, 30 g daily) cooked black soybean for 24 weeks. Visual analog scale (VAS), neck disability index (NDI) pain scores and short-form 36 (SF-36) health survey questionnaires were applied in the study. The levels of N-methyl-D-aspartate receptors (NMDAR) were measured. The VAS and NDI pain scores reduced and SF-36 scores increased in a 15 or 30 g black soybean daily group compared with a 3 g black soybean daily group after a 24-week therapy (P < 0.05). The 30 g black soybean daily group was better than the 15 g black soybean daily group in relieving chronic cervical pain of sedentary office workers (p < 0.05). The levels of NMDAR were lower in the 15 or 30 black soybean daily group than those in the 3 g black soybean daily group (P < 0.05). Black soybean can ameliorate chronic cervical pain by down-regulating the levels of NMDAR. PMID:26295483

  19. Cervical spondylosis. An update.

    PubMed Central

    McCormack, B M; Weinstein, P R

    1996-01-01

    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. PMID:8855684

  20. A Biomechanical Comparison of Intralaminar C7 Screw Constructs with and without Offset Connector Used for C6-7 Cervical Spine Immobilization : A Finite Element Study

    PubMed Central

    Qasim, Muhammad; Natarajan, Raghu N.; An, Howard S.

    2013-01-01

    Objective The offset connector can allow medial and lateral variability and facilitate intralaminar screw incorporation into the construct. The aim of this study was to compare the biomechanical characteristics of C7 intralaminar screw constructs with and without offset connector using a three dimensional finite element model of a C6-7 cervical spine segment. Methods Finite element models representing C7 intralaminar screw constructs with and without the offset connector were developed. Range of motion (ROM) and maximum von Mises stresses in the vertebra for the two techniques were compared under pure moments in flexion, extension, lateral bending and axial rotation. Results ROM for intralaminar screw construct with offset connector was less than the construct without the offset connector in the three principal directions. The maximum von Misses stress was observed in the C7 vertebra around the pedicle in both constructs. Maximum von Mises stress in the construct without offset connector was found to be 12-30% higher than the corresponding stresses in the construct with offset connector in the three principal directions. Conclusion This study demonstrated that the intralaminar screw fixation with offset connector is better than the construct without offset connector in terms of biomechanical stability. Construct with the offset connector reduces the ROM of C6-7 segment more significantly compared to the construct without the offset connector and causes lower stresses around the C7 pedicle-vertebral body complex. PMID:24003366

  1. The Effect of Various Types of Motorcycle Helmets on Cervical Spine Injury in Head Injury Patients: A Multicenter Study in Taiwan

    PubMed Central

    Lin, Mau-Roung; Chu, Shu-Fen; Tsai, Shin-Han; Bai, Chyi-Huey; Chiu, Wen-Ta

    2015-01-01

    Introduction. The relationship between cervical spine injury (CSI) and helmet in head injury (HI) patients following motorcycle crashes is crucial. Controversy still exists; therefore we evaluated the effect of various types of helmets on CSI in HI patients following motorcycle crashes and researched the mechanism of this effect. Patients and Methods. A total of 5225 patients of motorcycle crashes between 2000 and 2009 were extracted from the Head Injury Registry in Taiwan. These patients were divided into case and control groups according to the presence of concomitant CSI. Helmet use and types were separately compared between the two groups and the odds ratio of CSI was obtained by using multiple logistic regression analysis. Results. We observed that 173 (3.3%) of the HI patients were associated with CSI. The HI patients using a helmet (odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.19−0.49), full-coverage helmet (0.19, 0.10−0.36), and partial-coverage helmet (0.35, 0.21−0.56) exhibited a significantly decreased rate of CSI compared with those without a helmet. Conclusion. Wearing full-coverage and partial-coverage helmets significantly reduced the risk of CSI among HI patients following motorcycle crashes. This effect may be due to the smooth surface and hard padding materials of helmet. PMID:25705663

  2. A pilot evaluation of an educational program that offers visualizations of cervical spine injuries: medical students' self-efficacy increases by training.

    PubMed

    Hedman, Leif; Fahlstedt, Madelen; Schlickum, Marcus; Möller, Hans; von Holst, Hans; Felländer-Tsai, Li

    2014-01-01

    In this pilot study, a new method for visualization through imaging and simulation (VIS-Ed) for teaching diagnosis and treatment of cervical spine trauma was formatively evaluated. The aims were to examine if medical students' self-efficacy would change by training using VIS-Ed, and if so these changes were related to how they evaluated the session, and the user interface (UI) of this program. Using a one-group, pre-post course test design 43 Swedish medical students (4th year, 17 males, 26 females) practiced in groups of three participants. Overall the practice and the UI were considered as positive experiences. They judged VIS-Ed as a good interactive scenario-based educational tool. All students' self-efficacy increased significantly by training (p < 0.001). Spearman's rank correlation tests revealed that increased self-efficacy was only associated with: how the session was compared to as expected (p < 0.007). Students' self-efficacy increased significantly by training, but replication studies should determine if this training effect is gender-related.

  3. Quantitative sensory testing somatosensory profiles in patients with cervical radiculopathy are distinct from those in patients with nonspecific neck-arm pain.

    PubMed

    Tampin, Brigitte; Slater, Helen; Hall, Toby; Lee, Gabriel; Briffa, Noelle Kathryn

    2012-12-01

    The aim of this study was to establish the somatosensory profiles of patients with cervical radiculopathy and patients with nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). Sensory profiles were compared to healthy control (HC) subjects and a positive control group comprising patients with fibromyalgia (FM). Quantitative sensory testing (QST) of thermal and mechanical detection and pain thresholds, pain sensitivity and responsiveness to repetitive noxious mechanical stimulation was performed in the maximal pain area, the corresponding dermatome and foot of 23 patients with painful C6 or C7 cervical radiculopathy, 8 patients with NSNAP in a C6/7 dermatomal pain distribution, 31 HC and 22 patients with FM. For both neck-arm pain groups, all QST parameters were within the 95% confidence interval of HC data. Patients with cervical radiculopathy were characterised by localised loss of function (thermal, mechanical, vibration detection P<.009) in the maximal pain area and dermatome (thermal detection, vibration detection, pressure pain sensitivity P<.04), consistent with peripheral neuronal damage. Both neck-arm pain groups demonstrated increased cold sensitivity in their maximal pain area (P<.03) and the foot (P<.009), and this was also the dominant sensory characteristic in patients with NSNAP. Both neck-arm pain groups differed from patients with FM, the latter characterised by a widespread gain of function in most nociceptive parameters (thermal, pressure, mechanical pain sensitivity P<.027). Despite commonalities in pain characteristics between the 2 neck-arm pain groups, distinct sensory profiles were demonstrated for each group.

  4. A case report of rod migration into cerebellum through foramen magnum after lateral mass fixation of cervical spine.

    PubMed

    Kiran, Belsare; Sharma, Ayush; Prashant, Gedam; Parekh, Aseem

    2016-04-01

    We report on a rare case of connecting rod migration into the posterior cranial fossa after posterior cervical decompression and lateral mass screw fixation. A 55-year-old male patient who was operated on for ossification of posterior longitudinal ligament complained of sudden-onset giddiness followed by loss of consciousness one and half year following surgery. CT scan showed migration of left-sided connecting rod into the right cerebellum through foramen magnum. The patient was operated on for rod removal but he sustained a cardiorespiratory arrest and died on the eighth postoperative day. Autopsy confirmed damage to the right cerebellum due to rod migration. The clinician should be aware that superior rod migration is a rare but potentially disastrous complication. Regular follow-up with radiological evaluation should be done to look for implant loosening, migration, and non-union even in asymptomatic patients. The implant should be subsequently removed after it has served its purpose. PMID:26748502

  5. The Impact of Spinal Cord Nerve Roots and Denticulate Ligaments on Cerebrospinal Fluid Dynamics in the Cervical Spine

    PubMed Central

    Heidari Pahlavian, Soroush; Yiallourou, Theresia; Tubbs, R. Shane; Bunck, Alexander C.; Loth, Francis; Goodin, Mark; Raisee, Mehrdad; Martin, Bryn A.

    2014-01-01

    Cerebrospinal fluid (CSF) dynamics in the spinal subarachnoid space (SSS) have been thought to play an important pathophysiological role in syringomyelia, Chiari I malformation (CM), and a role in intrathecal drug delivery. Yet, the impact that fine anatomical structures, including nerve roots and denticulate ligaments (NRDL), have on SSS CSF dynamics is not clear. In the present study we assessed the impact of NRDL on CSF dynamics in the cervical SSS. The 3D geometry of the cervical SSS was reconstructed based on manual segmentation of MRI images of a healthy volunteer and a patient with CM. Idealized NRDL were designed and added to each of the geometries based on in vivo measurments in the literature and confirmation by a neuroanatomist. CFD simulations were performed for the healthy and patient case with and without NRDL included. Our results showed that the NRDL had an important impact on CSF dynamics in terms of velocity field and flow patterns. However, pressure distribution was not altered greatly although the NRDL cases required a larger pressure gradient to maintain the same flow. Also, the NRDL did not alter CSF dynamics to a great degree in the SSS from the foramen magnum to the C1 level for the healthy subject and CM patient with mild tonsillar herniation (∼6 mm). Overall, the NRDL increased fluid mixing phenomena and resulted in a more complex flow field. Comparison of the streamlines of CSF flow revealed that the presence of NRDL lead to the formation of vortical structures and remarkably increased the local mixing of the CSF throughout the SSS. PMID:24710111

  6. Cervical radiculopathy.

    PubMed

    Iyer, Sravisht; Kim, Han Jo

    2016-09-01

    Cervical radiculopathy is a common clinical scenario. Patients with radiculopathy typically present with neck pain, arm pain, or both. We review the epidemiology of cervical radiculopathy and discuss the diagnosis of this condition. This includes an overview of the pertinent findings on the patient history and physical examination. We also discuss relevant clinical syndromes that must be considered in the differential diagnosis including peripheral nerve entrapment syndromes and shoulder pathology. The natural history of cervical radiculopathy is reviewed and options for management are discussed. These options include conservative management, non-operative modalities such as physical therapy, steroid injections, and operative intervention. While the exact indications for surgical intervention have not yet been elucidated, we provide an overview of the available literature regarding indications and discuss the timing of intervention. The surgical outcomes of anterior cervical decompression and fusion (ACDF), cervical disc arthroplasty (CDA), and posterior cervical foraminotomy (PCF) are discussed. PMID:27250042

  7. Surgical Treatment of Aneurysmal Bone Cysts of the Spine

    PubMed Central

    Mesfin, Addisu; McCarthy, Edward F.; Kebaish, Khaled M.

    2012-01-01

    Objective Our goal was to document the presentation, location, diagnostic modalities, preoperative embolization status, treatment, histology, complications, and recurrence rates for aneurysmal bone cysts of the mobile spine. Methods We reviewed our institution's database to identify patients diagnosed with aneurysmal bone cysts of the mobile spine (excluding the sacrum) from 1995 through 2006. Of those 17 patients, three were treated elsewhere and 14 underwent surgical treatment at our institution. Of those 14 patients, the nine (mean age at presentation, 17.2 years; range, 5‥32 years) with at least 2 years of follow-up (average, 49.6 months; range, 24‥88 months) formed our study group. For those nine patients, we tabulated the presentation, location, diagnostic modalities, preoperative embolization status, treatment, histology, complications, and recurrence rates. Results Pain was the presenting symptom in all nine patients. The lesion most commonly occurred in the cervical spine (five); two occurred in the lumbar spine, and two occurred in the thoracic spine. Patients underwent resection and combined anterior and posterior spinal arthrodesis (six) or resection and posterior spinal arthrodesis (three). There were four complications: one iliac crest donor site infection, one incidental durotomy, and two neurologic defcits. We noted two recurrences (both within 3 months). Conclusions Aneurysmal bone cysts of the spine can be successfully treated with surgical resection and instrumentation. PMID:23576920

  8. Randomized comparative trial of cervical block protocols for pain management during hysteroscopic removal of polyps and myomas

    PubMed Central

    Lukes, Andrea S; Roy, Kelly H; Presthus, James B; Diamond, Michael P; Berman, Jay M; Konsker, Kenneth A

    2015-01-01

    Purpose To evaluate the efficacy of two cervical block protocols for pain management during hysteroscopic removal of intrauterine polyps and myomas using the MyoSure® device. Patients and methods This was a randomized, comparative treatment trial conducted by five private Obstetrics and Gynecology practices in the USA. Forty premenopausal women aged 18 years and older were randomized to receive either a combination para/intracervical block protocol of 37 cc local anesthetic administered at six injections sites in association with the application of topic 1% lidocaine gel, or an intracervical block protocol of 22 cc local anesthetic administered at three injections sites without topical anesthetic, for pain management during hysteroscopic removal of intrauterine polyps and/or a single type 0 or type 1 submucosal myoma ≤3 cm. The main outcomes were a composite measure of procedure-related pain and pain during the postoperative recovery period, assessed by the Wong-Baker Faces Rating Scale (0= no pain to 10= maximum pain). The lesion characteristics, procedure time, and adverse events were summarized. Results A total of 17 polyps and eight myomas were removed in the para/intracervical block group, with diameters of 1.3±0.5 cm and 1.8±0.8 cm, respectively. In the intracervical block group, 25 polyps with a mean diameter of 1.2±0.7 cm and 7 myomas with a mean diameter of 1.9±0.9 cm were removed. The mean tissue resection time was 1.2±2.0 minutes and 1.2±1.4 minutes for the para/intracervical and intracervical block groups, respectively. The mean composite procedure-related pain score was low for both cervical block protocols, 1.3±1.4 in the para/intracervical block group vs 2.1±1.5 in the intracervical block group. During the postoperative recovery period, the mean pain scores were 0.3±0.7 vs 1.2±1.7 for the para/intracervical and intracervical block groups, respectively. There were no serious adverse events. Conclusion The MyoSure procedure for removal of

  9. Internal morphology of human facet joints: comparing cervical and lumbar spine with regard to age, gender and the vertebral core

    PubMed Central

    Wilke, Hans-Joachim; Zanker, Daniel; Wolfram, Uwe

    2012-01-01

    Back pain constitutes a major problem in modern societies. Facet joints are increasingly recognised as a source of such pain. Knowledge about the internal morphology and its changes with age may make it possible to include the facets more in therapeutic strategies, for instance joint replacements or immobilisation. In total, 168 facets from C6/7 and L4/5 segments were scanned in a micro-computed tomography. Image analysis was used to investigate the internal morphology with regard to donor age and gender. Additional data from trabecular bone of the vertebral core allowed a semi-quantitative comparison of the morphology of the vertebral core and the facets. Porosity and pore spacing of the cortical sub-chondral bone does not appear to change with age for either males or females. In contrast, bone volume fraction decreases in females from approximately 0.4 to 0.2 , whereas it is constant in males. Trabecular thickness decreases during the ageing process in females and stays constant in males , whereas trabecular separation increases during the ageing process in both genders. The results of this study may help to improve the understanding of pathophysiological changes in the facet joints. Such results could be of value for understanding back pain and its treatment. PMID:22257304

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

    SciTech Connect

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

    1999-11-15

    Purpose: Evaluation of short- and extended-term results of repeated epidural/perineural injections (EDT/PRT) of corticoids in painful afflictions of the lumbar spine. Methods: Thirty-two patients who had persistent radicular or low back pain for more than 6 weeks were treated with CT-guided injection therapy. By EDT/PRT, 40 mg of triamcinolonacetonid was injected either periradicularly or by a direct intraspinal epidural method at intervals of 3 weeks. Altogether, 140 EDT/PRT were performed in 32 patients (mean 4.4, range 2-8). In nine patients partial facet joint denervation with 1-2 ml of 50% alcohol solution was combined with EDT/PRT to reduce low back pain. Before and after treatment and at follow-up (mean 9.6 months), treatment success was evaluated on a visual analog scale and by physical examination (good = >50% improvement, moderate = 20%-50%, no improvement <20%).Results: Short-term (end of therapy) good or moderate improvement was achieved in 91% of patients, extended-term (mean 9.6 months) in 56%. Regarding certain subgroups, those with disc herniations of the lumbar spine showed a better outcome with good or moderate improvement in 95% short-term and 69% extended-term than those with spinal stenosis who had 72% short-term and 28% long-term. Conclusion: Results indicate that CT-guided EDT/PRT in combination with partial facet joint denervation is a safe and effective outpatient treatment.

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

    PubMed Central

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

    2009-01-01

    Background Thoracic spine pain (TSP) is experienced across the lifespan by healthy individuals and is a common presentation in primary healthcare clinical practice. However, the epidemiological characteristics of TSP are not well documented compared to neck and low back pain. A rigorous evaluation of the prevalence, incidence, correlates and risk factors needs to be undertaken in order for epidemiologic data to be meaningfully used to develop evidence-based prevention and treatment recommendations for TSP. Methods A systematic review method was followed to report the evidence describing prevalence, incidence, associated factors and risk factors for TSP among the general population. Nine electronic databases were systematically searched to identify studies that reported either prevalence, incidence, associated factors (cross-sectional study) or risk factors (prospective study) for TSP in healthy children, adolescents or adults. Studies were evaluated for level of evidence and method quality. Results Of the 1389 studies identified in the literature, 33 met the inclusion criteria for this systematic review. The mean (SD) quality score (out of 15) for the included studies was 10.5 (2.0). TSP prevalence data ranged from 4.0–72.0% (point), 0.5–51.4% (7-day), 1.4–34.8% (1-month), 4.8–7.0% (3-month), 3.5–34.8% (1-year) and 15.6–19.5% (lifetime). TSP prevalence varied according to the operational definition of TSP. Prevalence for any TSP ranged from 0.5–23.0%, 15.8–34.8%, 15.0–27.5% and 12.0–31.2% for 7-day, 1-month, 1-year and lifetime periods, respectively. TSP associated with backpack use varied from 6.0–72.0% and 22.9–51.4% for point and 7-day periods, respectively. TSP interfering with school or leisure ranged from 3.5–9.7% for 1-year prevalence. Generally, studies reported a higher prevalence for TSP in child and adolescent populations, and particularly for females. The 1 month, 6 month, 1 year and 25 year incidences were 0–0.9%, 10.3%, 3

  12. Effect of cervical mobilization and ischemic compression therapy on contralateral cervical side flexion and pressure pain threshold in latent upper trapezius trigger points.

    PubMed

    Ganesh, G Shankar; Singh, Harshita; Mushtaq, Shagoofa; Mohanty, Patitapaban; Pattnaik, Monalisa

    2016-07-01

    Studies have shown a clinical relationship between trigger points and joint impairments. However the cause-and effect relationship between muscle and joint dysfunctions in trigger points could not be established. The purpose of this study was to investigate effects of mobilization and ischemic compression therapy on cervical range of motion and pressure pain sensitivity in participants with latent trigger point in the upper trapezius muscle. Ninety asymptomatic participants with upper trapezius latent trigger point were randomized in to 3 groups: mobilization, ischemic compression and a control. The outcomes were measured over a 2 week period. Repeated measures ANOVA showed statistically and clinically significant pre to post improvement in both the interventional groups compared to control (p < 0.05). However the effect sizes between the intervention groups were small (<0.3) revealing minimal clinical detectable difference. PMID:27634068

  13. Effect of Hamstring Flexibility on Hip and Lumbar Spine Joint Excursions During Forward Reaching Tasks in Individuals With and Without Low Back Pain

    PubMed Central

    Johnson, Erica N.; Thomas, James S.

    2010-01-01

    Objective To examine the correlation between hamstring flexibility and hip and lumbar spine joint excursions during standardized reaching and forward bending tasks. Design Retrospective analysis of data obtained during two previous prospective studies that examined kinematics and kinetics during forward bending tasks in individuals with and without low back pain (LBP). Setting The two previous studies were conducted in the Motor Control Lab at Ohio University. Participants Data from a total of 122 subjects from two previous studies. Study 1: 86 subjects recovered from an episode of acute LBP (Recovered). Study 2 (unpublished findings): 18 chronic low back pain subjects (LBP) and 18 healthy matched controls (Healthy). Interventions Not Applicable. Main Outcome Measure Correlation values between hamstring flexibility as measured by straight leg raise (SLR) and amount of hip and lumbar spine joint excursions used during standardized reaching and forward bending tasks. Results No significant correlation was found between hamstring flexibility and hip and lumbar joint excursions during forward bending tasks in the LBP or Recovered groups. Straight leg raise had a significant negative correlation with lumbar spine excursions during reaching tasks to a low target in the Healthy group (Right SLR: P=.011, Left SLR: P=.004). Conclusions Hamstring flexibility is not strongly related to the amount of lumbar flexion used to perform forward bending tasks in individuals who have chronic LBP or who have recovered from LBP. More research needs to be conducted to examine the influence of hamstring flexibility on observed movement patterns to further evaluate the efficacy of flexibility training in the rehabilitation of patients with low back pain. PMID:20599054

  14. Neck pain from a rheumatologic perspective.

    PubMed

    Oberstein, Elana M; Carpintero, Maria; Hopkins, Aviva

    2011-08-01

    This article provides a comprehensive review of rheumatologic considerations for a clinician when evaluating a patient with neck pain. Clearly, anatomic derangements of the cervical spine should be considered when a patient complains of cervicalgia. However, one must also entertain the possibility of a systemic illness as the cause of the pain. Examples of diseases that may present with a prominent feature of neck pain are discussed, including rheumatoid arthritis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, myositis, and fibromyalgia. Evidence of an underlying rheumatic illness may guide the clinician in a different therapeutic direction. PMID:21824589

  15. An epidemiologic study of sports and weight lifting as possible risk factors for herniated lumbar and cervical discs. The Northeast Collaborative Group on Low Back Pain.

    PubMed

    Mundt, D J; Kelsey, J L; Golden, A L; Panjabi, M M; Pastides, H; Berg, A T; Sklar, J; Hosea, T

    1993-01-01

    The associations between participation in several specific sports, use of free weights, and use of weight lifting equipment and herniated lumbar or cervical intervertebral discs were examined in a case-control epidemiologic study. Specific sports considered were baseball or softball, golf, bowling, swimming, diving, jogging, aerobics, and racquet sports. Included in the final analysis were 287 patients with lumbar disc herniation and 63 patients with cervical disc herniation, each matched by sex, source of care, and decade of age to 1 control who was free of disc herniation and other conditions of the back or neck. Results indicated that most sports are not associated with an increased risk of herniation, and may be protective. Relative risk estimates for the association between individual sports and lumbar or cervical herniation were generally less than or close to 1.0. There was, however, a weak positive association between bowling and herniation at both the lumbar and cervical regions of the spine. Use of weight lifting equipment was not associated with herniated lumbar or cervical disc, but a possible association was indicated between use of free weights and risk of cervical herniation (relative risk, 1.87; 95% confidence interval, 0.74 to 4.74).

  16. Cervical epidural abscess caused by brucellosis.

    PubMed

    Lampropoulos, Christos; Kamposos, Panagiotis; Papaioannou, Ioanna; Niarou, Vasiliki

    2012-01-01

    A 70-year-old Greek lady presented with fever, arthralgias of knees, cervical and lumbar pain during the last month. On clinical examination the patient was found to have tenderness of the cervical and the lumbar spine with great motion restriction. The blood tests revealed high erythrocyte sedimentation rate and C-reactive protein, abnormal liver function tests and a positive rheumatoid factor. Serological test for Brucella was positive while cervical MRI revealed epidural abscess and spondylodiscitis. Conservative treatment with streptomycin (it was substituted by rifampicin after the third week) and doxycyclin for 4 months significantly improved her symptoms. The frequency as well as the diagnosis and management of this manifestation are discussed. PMID:23188848

  17. Simultaneous Three-Dimensional Analysis of Cervical Spine Kinematics in the Axial and Sagittal Views during a Simulated Frontal Impact: Differences between Tensed and Relaxed States

    PubMed Central

    Sakane, Masataka; Ejima, Susumu; Ito, Daisuke; Nishino, Tomofumi; Kitajima, Sou; Yamazaki, Masashi

    2015-01-01

    Study Design Prospective experimental study on humans. Purpose To determine whether postural differences during a low-speed impact are observed in the sagittal and axial views, particularly in a relaxed state. Overview of Literature: Three-dimensional motion capture systems have been used to analyze posture and head-neck-torso kinematics in humans during a simulated low-speed impact, yet little research has focused on the axial view. Since a seatbelt asymmetrically stabilizes a drivers right shoulder and left lower waist into the seat, it potentially creates movement in the axial view. Methods Three healthy adult men participated in the experimental series, which used a low-speed sled system. The acceleration pulse created a full sine shape with a maximum acceleration of 8.0 m/s2 at 500 ms, during which the kinematics were evaluated in relaxed and tensed states. The three-dimensional motion capture system used eight markers to record and analyze body movement and head-neck-torso kinematics in the sagittal and axial views during the low-speed impact. Head and trunk rotation angles were also calculated. Results Larger movements were observed in the relaxed than in the tensed state in the sagittal view. The cervical and thoracic spine flexed and extended, respectively, in the relaxed state. In the axial view, larger movements were also observed in the relaxed state than in the tensed state, and the left shoulder rotated. Conclusions During simulated frontal impact, the rotation angle between the head and trunk was significantly larger in the relaxed state. Therefore, we recommend also observing movement in the axial view during impact tests. PMID:26713119

  18. Permanent endovascular balloon occlusion of the vertebral artery as an adjunct to the surgical resection of selected cervical spine tumors: A single center experience

    PubMed Central

    Elwell, Vivien; Choi, David; Robertson, Fergus

    2015-01-01

    Background and purpose Complete surgical resection of cervical spine tumors is often challenging when there is tumor encasement of major neck vessels. Pre-operative endovascular sacrifice of the major vessels can facilitate safe tumor resection. The use of transarterial detachable coils has been described in this setting, but it can be time-consuming and costly to occlude a patent parent vessel using this method. Our aim was to evaluate the safety and effectiveness of our endovascular detachable balloon occlusion technique, performed without prior balloon test occlusion in the pre-operative management of these tumors. Methods We retrospectively reviewed 18 consecutive patients undergoing pre-operative unilateral permanent endovascular balloon occlusion of tumor-encased vertebral arteries in our institution. Procedure-related ischemic or thromboembolic complication was defined as focal neurologic deficit attributable to the endovascular occlusion which occurs before subsequent surgical resection. Results Successful pre-operative endovascular vertebral artery sacrifice using detachable balloons was achieved in 100% (n = 18) of cases without prior balloon test occlusion. Procedural complication rate was 5.6% as one patient developed transient focal neurology secondary to a delayed cerebellar infarct at home on day 11 and subsequently made a full recovery. There were no cases of distal balloon migration. Complete macroscopic resection of tumor as reported by the operating surgeon was achieved in 89% of cases. Conclusion Pre-operative endovascular sacrifice of the vertebral artery using detachable balloons and without prior balloon test occlusion is a safe procedure with low complication rates and good surgeon reported rates of total resection. PMID:26092437

  19. Paraplegia following cervical epidural catheterization using loss of resistance technique with air: a case report.

    PubMed

    Chae, Yun Jeong; Han, Kyung Ream; Park, Hyung Bae; Kim, Chan; Nam, Si Gweon

    2016-02-01

    We report a case of paraplegia without neurologic deficit of upper extremities following cervical epidural catheterization using air during the loss of resistance technique. A 41-year-old woman diagnosed with complex regional pain syndrome had upper and lower extremity pain. A thoracic epidural lead was inserted for a trial spinal cord stimulation for treating lower extremity pain and cervical epidural catheterization was performed for treating upper extremity pain. Rapidly progressive paraplegia developed six hours after cervical epidural catheterization. Spine CT revealed air entrapment in multiple thoracic intervertebral foraminal spaces and surrounding epidural space without obvious spinal cord compression before the decompressive operation, which disappeared one day after the decompressive operation. Her paraplegia symptoms were normalized immediately after the operation. The presumed cause of paraplegia was transient interruption of blood supply to the spinal cord through the segmental radiculomedullary arteries feeding the spinal cord at the thoracic level of the intervertebral foramen caused by the air.

  20. Applying psychological theories to evidence-based clinical practice: identifying factors predictive of lumbar spine x-ray for low back pain in UK primary care practice

    PubMed Central

    2011-01-01

    Background Psychological models predict behaviour in a wide range of settings. The aim of this study was to explore the usefulness of a range of psychological models to predict the health professional behaviour 'referral for lumbar spine x-ray in patients presenting with low back pain' by UK primary care physicians. Methods Psychological measures were collected by postal questionnaire survey from a random sample of primary care physicians in Scotland and north England. The outcome measures were clinical behaviour (referral rates for lumbar spine x-rays), behavioural simulation (lumbar spine x-ray referral decisions based upon scenarios), and behavioural intention (general intention to refer for lumbar spine x-rays in patients with low back pain). Explanatory variables were the constructs within the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Implementation Intention (II), Weinstein's Stage Model termed the Precaution Adoption Process (PAP), and knowledge. For each of the outcome measures, a generalised linear model was used to examine the predictive value of each theory individually. Linear regression was used for the intention and simulation outcomes, and negative binomial regression was used for the behaviour outcome. Following this 'theory level' analysis, a 'cross-theoretical construct' analysis was conducted to investigate the combined predictive value of all individual constructs across theories. Results Constructs from TPB, SCT, CS-SRM, and OLT predicted behaviour; however, the theoretical models did not fit the data well. When predicting behavioural simulation, the proportion of variance explained by individual theories was TPB 11.6%, SCT 12.1%, OLT 8.1%, and II 1.5% of the variance, and in the cross-theory analysis constructs from TPB, CS-SRM and II explained 16.5% of the variance in simulated behaviours. When predicting intention, the proportion of variance

  1. Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation.

    PubMed

    Li, Jian; Yan, Deng-lu; Zhang, Zai-Heng

    2008-12-01

    Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors' clinic and treated by PCN. The patients' gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 +/- 10.2 years). The levels of involvement were 21 cases at C3-4, 30 cases at C4-5, 40 cases at C5-6, and 35 cases at C6-7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) > or =11 degrees or horizontal displacement (HD) > or =3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no

  2. Influence of the actions observed on cervical motion in patients with chronic neck pain: a pilot study.

    PubMed

    de-la-Puente-Ranea, Lucía; García-Calvo, Beatriz; La Touche, Roy; Fernández-Carnero, Josué; Gil-Martínez, Alfonso

    2016-08-01

    The aim of the present pilot study was to prove if the action-observation (AOb) improved the cervical range of motion (CROM) in patients with nonspecific chronic neck pain (CNP). Double blind pilot study. A total of 28 subjects were randomly assigned to an effective-movement group (n=14) and an ineffective-movement group (n=14). The follow-up consisted of: pretreatment, posttreatment and 10 min after second measurement (motor imagery). Outcome measures were CROM, and pres-sure pain detection thresholds (PPDTs). No statistical differences were found in baseline on CROM and on the PPDT. Test for independent groups revealed significant changes in cervical rotation movement. Both groups in posttreatment (P=0.042; Cohen d=0.81) and after 10 min (P=0.019; Cohen d=0.9). For intragroup PPDT, the Wilcoxon test revealed significant effects in the effective movement at C2 of the pre to 10-min post (P=0.040). However, the ineffective movement revealed a significant reduction in PPDT in zygapophyseal joint of C5-C6 as the pre to post (P=0.010) as the pre to 10-min post (P=0.041) periods. In conclusions this pilot study demonstrated that the effective AOb produced significant changes versus ineffective AOb in the CROM and it could influences in PPT in subject with CNP immediately. PMID:27656633

  3. Influence of the actions observed on cervical motion in patients with chronic neck pain: a pilot study

    PubMed Central

    de-la-Puente-Ranea, Lucía; García-Calvo, Beatriz; La Touche, Roy; Fernández-Carnero, Josué; Gil-Martínez, Alfonso

    2016-01-01

    The aim of the present pilot study was to prove if the action-observation (AOb) improved the cervical range of motion (CROM) in patients with nonspecific chronic neck pain (CNP). Double blind pilot study. A total of 28 subjects were randomly assigned to an effective-movement group (n=14) and an ineffective-movement group (n=14). The follow-up consisted of: pretreatment, posttreatment and 10 min after second measurement (motor imagery). Outcome measures were CROM, and pres-sure pain detection thresholds (PPDTs). No statistical differences were found in baseline on CROM and on the PPDT. Test for independent groups revealed significant changes in cervical rotation movement. Both groups in posttreatment (P=0.042; Cohen d=0.81) and after 10 min (P=0.019; Cohen d=0.9). For intragroup PPDT, the Wilcoxon test revealed significant effects in the effective movement at C2 of the pre to 10-min post (P=0.040). However, the ineffective movement revealed a significant reduction in PPDT in zygapophyseal joint of C5–C6 as the pre to post (P=0.010) as the pre to 10-min post (P=0.041) periods. In conclusions this pilot study demonstrated that the effective AOb produced significant changes versus ineffective AOb in the CROM and it could influences in PPT in subject with CNP immediately. PMID:27656633

  4. Influence of the actions observed on cervical motion in patients with chronic neck pain: a pilot study

    PubMed Central

    de-la-Puente-Ranea, Lucía; García-Calvo, Beatriz; La Touche, Roy; Fernández-Carnero, Josué; Gil-Martínez, Alfonso

    2016-01-01

    The aim of the present pilot study was to prove if the action-observation (AOb) improved the cervical range of motion (CROM) in patients with nonspecific chronic neck pain (CNP). Double blind pilot study. A total of 28 subjects were randomly assigned to an effective-movement group (n=14) and an ineffective-movement group (n=14). The follow-up consisted of: pretreatment, posttreatment and 10 min after second measurement (motor imagery). Outcome measures were CROM, and pres-sure pain detection thresholds (PPDTs). No statistical differences were found in baseline on CROM and on the PPDT. Test for independent groups revealed significant changes in cervical rotation movement. Both groups in posttreatment (P=0.042; Cohen d=0.81) and after 10 min (P=0.019; Cohen d=0.9). For intragroup PPDT, the Wilcoxon test revealed significant effects in the effective movement at C2 of the pre to 10-min post (P=0.040). However, the ineffective movement revealed a significant reduction in PPDT in zygapophyseal joint of C5–C6 as the pre to post (P=0.010) as the pre to 10-min post (P=0.041) periods. In conclusions this pilot study demonstrated that the effective AOb produced significant changes versus ineffective AOb in the CROM and it could influences in PPT in subject with CNP immediately.

  5. Influence of the actions observed on cervical motion in patients with chronic neck pain: a pilot study.

    PubMed

    de-la-Puente-Ranea, Lucía; García-Calvo, Beatriz; La Touche, Roy; Fernández-Carnero, Josué; Gil-Martínez, Alfonso

    2016-08-01

    The aim of the present pilot study was to prove if the action-observation (AOb) improved the cervical range of motion (CROM) in patients with nonspecific chronic neck pain (CNP). Double blind pilot study. A total of 28 subjects were randomly assigned to an effective-movement group (n=14) and an ineffective-movement group (n=14). The follow-up consisted of: pretreatment, posttreatment and 10 min after second measurement (motor imagery). Outcome measures were CROM, and pres-sure pain detection thresholds (PPDTs). No statistical differences were found in baseline on CROM and on the PPDT. Test for independent groups revealed significant changes in cervical rotation movement. Both groups in posttreatment (P=0.042; Cohen d=0.81) and after 10 min (P=0.019; Cohen d=0.9). For intragroup PPDT, the Wilcoxon test revealed significant effects in the effective movement at C2 of the pre to 10-min post (P=0.040). However, the ineffective movement revealed a significant reduction in PPDT in zygapophyseal joint of C5-C6 as the pre to post (P=0.010) as the pre to 10-min post (P=0.041) periods. In conclusions this pilot study demonstrated that the effective AOb produced significant changes versus ineffective AOb in the CROM and it could influences in PPT in subject with CNP immediately.

  6. Measurement of Intervertebral Cervical Motion by Means of Dynamic X-Ray Image Processing and Data Interpolation

    PubMed Central

    Bifulco, Paolo; Cesarelli, Mario; Romano, Maria; Sansone, Mario

    2013-01-01

    Accurate measurement of intervertebral kinematics of the cervical spine can support the diagnosis of widespread diseases related to neck pain, such as chronic whiplash dysfunction, arthritis, and segmental degeneration. The natural inaccessibility of the spine, its complex anatomy, and the small range of motion only permit concise measurement in vivo. Low dose X-ray fluoroscopy allows time-continuous screening of cervical spine during patient's spontaneous motion. To obtain accurate motion measurements, each vertebra was tracked by means of image processing along a sequence of radiographic images. To obtain a time-continuous representation of motion and to reduce noise in the experimental data, smoothing spline interpolation was used. Estimation of intervertebral motion for cervical segments was obtained by processing patient's fluoroscopic sequence; intervertebral angle and displacement and the instantaneous centre of rotation were computed. The RMS value of fitting errors resulted in about 0.2 degree for rotation and 0.2 mm for displacements. PMID:24288523

  7. Minimally invasive posterior cervical decompression using tubular retractor: The technical note and early clinical outcome

    PubMed Central

    Hur, Jung-Woo; Kim, Jin-Sung; Shin, Myeong-Hoon; Ryu, Kyeong-Sik

    2014-01-01

    Background: The aim of this work is to present a novel decompression technique that approaches cervical spine posteriorly, but through minimal invasive method using tubular retractor avoiding detachment of posterior musculature. Methods: Six patients underwent minimally invasive posterior cervical decompression using the tubular retractor system and surgical microscope. Minimally invasive access to the posterior cervical spine was performed with exposure through a paramedian muscle-splitting approach. With the assistance of a specialized tubular retraction system and deep soft tissue expansion mechanism, multilevel posterior cervical decompression could be accomplished. This approach also allows safe docking of the retractor system on the lateral mass, thus avoiding the cervical spinal canal during exposure. A standard operating microscope was used with ×10 magnification and 400 mm focal length. The hospital charts, magnetic resonance imaging studies, and follow-up records of all the patients were reviewed. Outcome was assessed by neurological status and visual analog scale (VAS) for neck and arm pain. Results: There was no significant complication related to operation. The follow-up time was 4-12 months (mean, 9 months). Muscle weakness improved in all patients; sensory deficits resolved in four patients and improved in two patients. Analysis of the mean VAS for radicular pain and VAS for neck pain showed significant improvement. Conclusions: The preliminary experiences with good clinical outcome seem to promise that this minimally invasive technique is a valid alternative option for the treatment of cervical spondylotic myelopathy. PMID:24778922

  8. Post laminoplasty cervical kyphosis—Case report

    PubMed Central

    Dugoni, D.E.; Mancarella, C.; Landi, A.; Tarantino, R.; Ruggeri, A.G.; Delfini, R.

    2014-01-01

    INTRODUCTION Cervical kyphosis is a progressive cervical sagittal plane deformity that may cause a reduction in the ability to look horizontally, breathing and swallowing difficulties, sense of thoracic oppression and social isolation. Moreover, cervical kyphosis can cause myelopathy due to a direct compression by osteo-articular structures on the spinal cord or to a transitory ischaemic injury. The treatment of choice is surgery. The goals of surgery are: nervous structures decompression, cervical and global sagittal balance correction and vertebral stabilization and fusion. PRESENTATION OF CASE In October 2008 a 35 years old woman underwent surgical removal of a cervical-bulbar ependymoma with C1–C5 laminectomy and a C2–C5 laminoplasty. Five months after surgery, the patient developed a kyphotic posture, with intense neck and scapular girdle pain. The patients had a flexible cervical kyphosis. Therefore, we decided to perform an anterior surgical approach. We performed a corpectomy C4–C5 in order to achieve the anterior decompression; we placed a titanium expansion mesh. DISCUSSION Cervical kyphosis can be flexible or fixed. Some authors have reported the use of anterior surgery only for flexible cervical kyphosis as discectomy and corpectomy. This approach is useful for anterior column load sharing however it is not required for deformity correction. CONCLUSION The anterior approach is a good surgical option in flexible cervical kyphosis. It is of primary importance the sagittal alignment of the cervical spine in order to decompress the nervous structures and to guarantee a long-term stability. PMID:25462050

  9. [Cervical radiculopathy].

    PubMed

    Kuijper, B

    2014-10-01

    Cervical radiculopathy is a common cause of pain in the arm. It is caused by nerve root compression in the neck, as a consequence of a herniated disc, or spondyliotic foraminal stenosis. It causes severe pain, especially during the first few weeks, and paraesthesias in the forearm and hand. Patients also suffer from neck pain and loss of strength in the relevant arm. The arm pain can be exacerbated by certain movements of the head; these should be avoided as much as possible. Diagnosis can be made on the basis of history and physical examination. The pain generally disappears without active patient treatment. A semi-rigid cervical collar is recommended to accelerate pain relief. In cases of persistent pain, surgery will be considered. In such cases an MRI should be performed to show the cause and level of nerve root compression. PMID:26185991

  10. [Cervical radiculopathy].

    PubMed

    Kuijper, B

    2014-10-01

    Cervical radiculopathy is a common cause of pain in the arm. It is caused by nerve root compression in the neck, as a consequence of a herniated disc, or spondyliotic foraminal stenosis. It causes severe pain, especially during the first few weeks, and paraesthesias in the forearm and hand. Patients also suffer from neck pain and loss of strength in the relevant arm. The arm pain can be exacerbated by certain movements of the head; these should be avoided as much as possible. Diagnosis can be made on the basis of history and physical examination. The pain generally disappears without active patient treatment. A semi-rigid cervical collar is recommended to accelerate pain relief. In cases of persistent pain, surgery will be considered. In such cases an MRI should be performed to show the cause and level of nerve root compression.

  11. Is there a relationship between head posture and craniomandibular pain?

    PubMed

    Visscher, C M; De Boer, W; Lobbezoo, F; Habets, L L M H; Naeije, M

    2002-11-01

    An often-suggested factor in the aetiology of craniomandibular disorders (CMD) is an anteroposition of the head. However, the results of clinical studies to the relationship between CMD and head posture are contradictory. Therefore, the first aim of this study was to determine differences in head posture between well-defined CMD pain patients with or without a painful cervical spine disorder and healthy controls. The second aim was to determine differences in head posture between myogenous and arthrogenous CMD pain patients and controls. Two hundred and fifty persons entered the study. From each person, a standardized oral history was taken and blind physical examinations of the masticatory system and of the neck were performed. The participants were only included into one of the subgroups when the presence or absence of their symptoms was confirmed by the results of the physical examination. Head posture was quantified using lateral photographs and a lateral radiograph of the head and the cervical spine. After correction for age and gender effects, no difference in head posture was found between any of the patient and non-patient groups (P > 0.27). Therefore, this study does not support the suggestion that painful craniomandibular disorders, with or without a painful cervical spine disorder, are related to head posture. PMID:12453255

  12. Cervical spondylosis (image)

    MedlinePlus

    Cervical spondylosis is a disorder that results from abnormal growth of the bones of the neck and ... Progressive neck pain is a key indication of cervical spondylosis. It may be the only symptom in ...

  13. Cervical nucleolysis: indications, technique, results. 190 patients.

    PubMed

    Krause, D; Drape, J L; Jambon, F; de Souza-Lima, A; Tongio, J; Maitrot, D; Orenstein, D; Giannetti, A; Boyer, P; Srour, R

    1993-03-01

    For many years now percutaneous techniques have proved effective in the curative treatment of lumbar disc herniation, mostly in young subjects. This technique, however, is seldom indicated, let alone performed, in the cervical spine for a variety of reasons: a) the neck contains several closely arranged structures such as the vasculo-nervous bundles, the airway-digestive tract and the cervical spine around the spinal cord; b) the disc is approached by the anterior route, in contrast with the lumbo-sacral spine where the approach is posterolateral; c) the manufacturers insist on restrictions in the use of chymopapain in view of the potential risk of spinal cord damage, either by possible breaks in the meninges of by accidental diffusion of the enzyme into perimedullary epidural structures which support a particularly developed venous plexus; d) legal protection may be denied to operators who perform cervical chemonucleolysis, since the product has not yet been officially authorized, in France and perhaps elsewhere*, for treatment of cervical disc herniation. Several years of experience in the practice of cervical nucleolysis have convinced the authors that this method is remarkably effective and can be used in the treatment of cervicobrachial neuralgia (CBN) occurring in young subjects. Radiculalgia is essentially due to a disc fragment being positioned within the vertebral canal or a foramen, thereby compressing the nerve roots. During several years microsurgery of the disc has been effective in the treatment of refractory radiculalgia, and to compete with this procedure familiar to neurosurgeons cervical nucleolysis must convincingly demonstrate that its therapeutic value is at least as good as that of surgery. Finally, the vast majority of cervical disc herniations is made up of free disc fragments located within the meshes of the posterior longitudinal ligament of the spine (transligamentous fragment). Cervical nucleolysis was introduced in France by Bonafe and

  14. Anaplastic extramedullary cervical ependymoma with leptomeningeal metastasis.

    PubMed

    Pomeraniec, I J; Dallapiazza, R F; Sumner, H M; Lopes, M B; Shaffrey, C I; Smith, J S

    2015-12-01

    We present a rare extramedullary ependymoma with diffuse spinal metastatic disease, and review the previous reports of extramedullary spinal ependymomas. Ependymomas are the most common intramedullary spinal cord tumor in adults. These tumors rarely present as extramedullary masses. We treated a 23-year-old man with a history of progressive neck, shoulder and arm pain, with sensory and motor symptoms in the C7 dermatome. MRI of the cervical spine demonstrated a ventral contrast-enhancing lesion with evidence of enhancement along the dura and spinal cord of the upper cervical spine, thoracic spine, and cauda equina. He underwent a tumor debulking procedure without complications. Following surgery, he received craniospinal radiation to treat the remaining tumor and diffuse leptomeningeal disease. The final pathology of the tumor revealed that is was a World Health Organization Grade III anaplastic ependymoma. At the 1 year follow-up, the patient had stable imaging and had returned to his preoperative functional status. Of the 19 reported patients with primary intradural, extramedullary spinal ependymomas, two had extradural components and seven had anaplastic grades. Only one tumor with an anaplastic grade resulted in metastatic disease, but without spinal recurrence. To our knowledge, this is the first report of an intradural, extramedullary spinal ependymoma with an anaplastic grade, presenting with concomitant diffuse, nodular leptomeningeal metastasis involving the upper cervical spine, thoracic spine, conus medullaris, and cauda equina. Similar to the treatment of intramedullary ependymomas with metastasis, this patient underwent an aggressive debulking procedure followed by radiation therapy to the entire neuroaxis. PMID:26601808

  15. Facial nerve paralysis after cervical traction.

    PubMed

    So, Edmund Cheung

    2010-10-01

    Cervical traction is a frequently used treatment in rehabilitation clinics for cervical spine problems. This modality works, in principle, by decompressing the spinal cord or its nerve roots by applying traction on the cervical spine through a harness placed over the mandible (Olivero et al., Neurosurg Focus 2002;12:ECP1). Previous reports on treatment complications include lumbar radicular discomfort, muscle injury, neck soreness, and posttraction pain (LaBan et al., Arch Phys Med Rehabil 1992;73:295-6; Lee et al., J Biomech Eng 1996;118:597-600). Here, we report the first case of unilateral facial nerve paralysis developed after 4 wks of intermittent cervical traction therapy. Nerve conduction velocity examination revealed a peripheral-type facial nerve paralysis. Symptoms of facial nerve paralysis subsided after prednisolone treatment and suspension of traction therapy. It is suspected that a misplaced or an overstrained harness may have been the cause of facial nerve paralysis in this patient. Possible causes were (1) direct compression by the harness on the right facial nerve near its exit through the stylomastoid foramen; (2) compression of the right external carotid artery by the harness, causing transient ischemic injury at the geniculate ganglion; or (3) coincidental herpes zoster virus infection or idiopathic Bell's palsy involving the facial nerve.

  16. The optimized acupuncture treatment for neck pain caused by cervical spondylosis: a study protocol of a multicentre randomized controlled trial

    PubMed Central

    2012-01-01

    Background Neck pain is one of the chief symptoms of cervical spondylosis (CS). Acupuncture is a well-accepted and widely used complementary therapy for the management of neck pain caused by CS. In this paper, we present a randomized controlled trial protocol evaluating the use of acupuncture for CS neck pain, comparing the effects of the optimized acupuncture therapy in real practice compared with sham and shallow acupuncture. Methods/Design This trial uses a multicentre, parallel-group, randomized, sham acupuncture and shallow acupuncture, controlled single-blind design. Nine hospitals are involved as trial centres. 945 patients who meet inclusion criteria are randomly assigned to receive optimized acupuncture therapy, sham acupuncture or shallow acupuncture by a computerized central randomization system. The interventions past for 4 weeks with eight to ten treatments in total. The group allocations and interventions are concealed to patients and statisticians. The Northwick Park Neck Pain Questionnaire (NPQ) is used as the primary outcome measure, and the McGill Pain Questionnaire (MPQ) and The Short Form (36) Health Survey (SF-36) are applied as secondary outcome measures. The evaluation is performed at baseline, at the end of the intervention, and at the end of the first month and the third month during follow-up. The statistical analyses will include baseline data comparison and repeated measures of analysis of variance (ANOVA) for primary and secondary outcomes of group and time differences. Adverse events (AEs) will be reported if they occur. Discussion This trial is a multicentre randomized control trial (RCT) on the efficacy of acupuncture for CS neck pain and has a large sample size and central randomization in China. It will strictly follow the CONSORT statement and STRICTA extension guideline to report high-quality study results. By setting the control groups as sham and shallow acupuncture, this study attempts to reveal the effects of real acupuncture

  17. Tumors of the spine

    PubMed Central

    Ciftdemir, Mert; Kaya, Murat; Selcuk, Esref; Yalniz, Erol

    2016-01-01

    Spine tumors comprise a small percentage of reasons for back pain and other symptoms originating in the spine. The majority of the tumors involving the spinal column are metastases of visceral organ cancers which are mostly seen in older patients. Primary musculoskeletal system sarcomas involving the spinal column are rare. Benign tumors and tumor-like lesions of the musculoskeletal system are mostly seen in young patients and often cause instability and canal compromise. Optimal diagnosis and treatment of spine tumors require a multidisciplinary approach and thorough knowledge of both spine surgery and musculoskeletal tumor surgery. Either primary or metastatic tumors involving the spine are demanding problems in terms of diagnosis and treatment. Spinal instability and neurological compromise are the main and critical problems in patients with tumors of the spinal column. In the past, only a few treatment options aiming short-term control were available for treatment of primary and metastatic spine tumors. Spine surgeons adapted their approach for spine tumors according to orthopaedic oncologic principles in the last 20 years. Advances in imaging, surgical techniques and implant technology resulted in better diagnosis and surgical treatment options, especially for primary tumors. Also, modern chemotherapy drugs and regimens with new radiotherapy and radiosurgery options caused moderate to long-term local and systemic control for even primary sarcomas involving the spinal column. PMID:26925382

  18. Repeated Applications of Thoracic Spine Thrust Manipulation do not Lead to Tolerance in Patients Presenting with Acute Mechanical Neck Pain: A Secondary Analysis

    PubMed Central

    Fernández-De-Las-Peñas, Cesar; Cleland, Joshua A; Huijbregts, Peter; Palomeque-Del-Cerro, Luis; González-Iglesias, Javier

    2009-01-01

    It has been demonstrated that patients receiving mobilization techniques do not exhibit tolerance to repeated applications. However, this phenomenon has not been investigated for thoracic manipulation. Our aim was to determine if patients receiving thoracic thrust manipulation exhibit tolerance to repeated applications in acute mechanical neck pain. Forty-five patients were randomly assigned to two groups. The control group received electro- and thermotherapy for 5 sessions, and the experimental group received the same program and also received a thoracic thrust manipulation once a week for 3 consecutive weeks. Outcome measures included neck pain and cervical mobility. Within-session change scores for pain and mobility during treatment sessions #1, 3, and 5 were examined with a one-way repeated measured ANOVA. A 2-way ANOVA with session as within-subject variable and group as between-subject variable was used to compare change scores for each visit between groups to ascertain if there were significant between-group differences in within-session changes for the experimental versus the control group. The ANOVA showed that for either group the 3 within-session change scores were not significantly different (P > 0.1). The 2-way ANOVA revealed significant differences between groups for both pain and neck mobility in within-session change scores (all, P < 0.001). Change scores in each session were superior in the experimental group as compared to those in the control group. The results suggest that patients receiving thoracic manipulation do not exhibit tolerance to repeated applications with regard to pain and mobility measures in acute mechanical neck pain. Further studies should investigate the dose-response relationship of thoracic thrust manipulation in this population. PMID:20046622

  19. Design of a mechanism to simulate the quasi-static moment-deflection behaviour of the osteoligamentous structure of the C3-C4 cervical spine segment in the flexion-extension and lateral bending directions.

    PubMed

    Chen, Samuel; Arsenault, Marc; Moglo, Kodjo

    2012-11-01

    The human neck is susceptible to traumatic injuries due to impacts as well as chronic injuries caused by loads such as those attributed to the wearing of heavy headgear. To facilitate the analysis of the loads that cause injuries to the cervical spine, it is possible to replicate the human neck's behaviour with mechanical devices. The goal of this work is to lay the foundation for the eventual development of a novel mechanism used to simulate the behaviour of the cervical spine during laboratory experiments. The research presented herein focuses on the design of a mechanism capable of reproducing the non-linear relationships between moments applied to the C3 vertebra and its corresponding rotations with respect to the C4 vertebra. The geometrical and mechanical properties of the mechanism are optimized based on the ability of the latter to replicate the load-deflection profile of the osteoligamentous structure of the C3-C4 vertebral pair in the flexion-extension and lateral bending directions. The results show that the proposed design concept is capable of faithfully replicating the non-linear behaviour of the motion segment within acceptable tolerances.

  20. The Association between the Cross-Sectional Area of the Dural Sac and Low Back Pain in a Large Population: The Wakayama Spine Study

    PubMed Central

    Iwahashi, Hiroki; Yoshimura, Noriko; Hashizume, Hiroshi; Yamada, Hiroshi; Oka, Hiroyuki; Matsudaira, Ko; Shinto, Kazunori; Ishimoto, Yuyu; Nagata, Keiji; Teraguchi, Masatoshi; Kagotani, Ryohei; Muraki, Shigeyuki; Akune, Toru; Tanaka, Sakae; Kawaguchi, Hiroshi; Nakamura, Kozo; Minamide, Akihito; Nakagawa, Yukihiro; Yoshida, Munehito

    2016-01-01

    Objective The purpose of this study was to evaluate the relations between the degree of encroachment, measured as the cross-sectional area of the dural sac, and low back pain in a large population. Methods In this cross-sectional study, data from 802 participants (247 men, 555 women; mean age, 63.5 years) were analyzed. The measurement of the cross-sectional area of the dural sac from the level of L1/2 to L4/5 was taken using axial T2-weighted images. The minimum cross-sectional area was defined as the cross-sectional area of the dural sac at the most constricted level in the examined spine. Participants were divided into three groups according to minimum cross-sectional area measurement quartiles (less than the first quartile, between the first and third quartiles, and greater than the third quartile). A multivariate logistic regression analysis was used to estimate the association between the minimum cross-sectional area and the prevalence of low back pain. Results The mean minimum cross-sectional area was 117.3 mm2 (men: 114.4 mm2; women: 118.6 mm2). A logistic regression analysis adjusted for age, sex, body mass index, and other confounding factors, including disc degeneration, showed that a narrow minimum cross-sectional area (smaller than the first quartile) was significantly associated with low back pain (odds ratio, 1.78; 95% confidence interval, 1.13–2.80 compared to the wide minimum cross-sectional area group: minimum cross-sectional area greater than the third quartile measured). Conclusion This study showed that a narrow dural sac cross-sectional area was significantly associated with the presence of low back pain after adjustment for age, sex, and body mass index. Further investigations that include additional radiographic findings and psychological factors will continue to elucidate the causes of low back pain. PMID:27486899

  1. Multiple cervical spinous process fractures in a novice golf player.

    PubMed

    Kim, Sei-Yoon; Chung, Sang Ki; Kim, Dong-Yun

    2012-12-01

    Avulsion of spinous process, also called Clay-shoveler's fracture, is most prevalent among those engaged in hard physical labor. To the best of the author's knowledge, only one case of multiple spinous process fractures of the upper thoracic spine in a novice golfer has been reported. A 45-year-old female presented with intractable posterior neck pain. The patient experienced a sharp, sudden pain on the neck while swinging a golf club, immediately after the club head struck the ground. Dynamic cervical radiographic findings were C6 and C7 spinous process fractures. Magnetic resonance imaging revealed C6 and C7 spinous process fractures without spinal cord pathology. The patient was treated with pain medications and cervical bracing. The patient's pain gradually improved. The injury mechanism was speculated to be similar to Clay-shoveler's fracture. Lower cervical spinous process fractures can be associated with a golf swing. If the patient complains of long lasting neck pain and has a history of golf activity, further study should be conducted to rule out lower cervical spinous fracture. PMID:23346334

  2. Guidelines for lumbar spine radiography in acute low back pain: effect of implementation in an accident and emergency department.

    PubMed Central

    Tracey, N. G.; Martin, J. B.; McKinstry, C. S.; Mathew, B. M.

    1994-01-01

    Guidelines for lumbar spine radiography were agreed by consultation between staff in the radiology, accident and emergency and neurosurgical departments of a large teaching hospital. Study of 322 consecutive patients over an eight month period showed that the proportion of patients referred for radiography was reduced from 48.4% to 27.2% following introduction of the guidelines (p = 0.0002). Successful use of such guidelines requires cooperation between clinical and radiological staff and frequent review of performance. PMID:8658989

  3. [The forensic medical evaluation of the injuries to the cervical spine in the driver and the front-seat passenger of a modern motor vehicle after the frontal crash].

    PubMed

    Pigolkin, I; Dubrovin, A; Sedykh, E p; Mosoyan

    2015-01-01

    The objective of the present study was to elucidate the specific features of the lesions of the cervical spine in the driver and the front-seat passenger of a modern car after the frontal crash. We made use of the archival materials of forensic medical expertises concerning the traffic accidents carried out in the city of Moscow during the period from 2005 to 2012. The study was focused on the analysis of the character of the fractures of cervical vertebrae in the drivers (n = 55) and the front-seat passengers (n = 85) of a modern motor vehicle involved in a traffic accident. It was shown that the drivers most frequently suffer bending-extension fractures of the cervical vertebrae, with the II-IV vertebrae being especially frequently subject to multiple fractures resulting in the damage to the anterior support column, sometimes to both the anterior and posterior columns, and much rarer to the posterior column. The front-seat passengers also suffer bending-extension fractures. The IV-VI vertebrae are most frequently affected in them with isolated damages to either the anterior or the posterior support column of the neck vertebrae. PMID:26856055

  4. [The forensic medical evaluation of the injuries to the cervical spine in the driver and the front-seat passenger of a modern motor vehicle after the frontal crash].

    PubMed

    Pigolkin, I; Dubrovin, A; Sedykh, E p; Mosoyan

    2015-01-01

    The objective of the present study was to elucidate the specific features of the lesions of the cervical spine in the driver and the front-seat passenger of a modern car after the frontal crash. We made use of the archival materials of forensic medical expertises concerning the traffic accidents carried out in the city of Moscow during the period from 2005 to 2012. The study was focused on the analysis of the character of the fractures of cervical vertebrae in the drivers (n = 55) and the front-seat passengers (n = 85) of a modern motor vehicle involved in a traffic accident. It was shown that the drivers most frequently suffer bending-extension fractures of the cervical vertebrae, with the II-IV vertebrae being especially frequently subject to multiple fractures resulting in the damage to the anterior support column, sometimes to both the anterior and posterior columns, and much rarer to the posterior column. The front-seat passengers also suffer bending-extension fractures. The IV-VI vertebrae are most frequently affected in them with isolated damages to either the anterior or the posterior support column of the neck vertebrae.

  5. Spine Conditioning Program

    MedlinePlus

    ... which exercises will best help you meet your rehabilitation goals. Strength: Strengthening the muscles that support your spine will help keep your back and upper body stable. Keeping these muscles strong can relieve back pain and prevent further injury. Flexibility: Stretching the muscles ...

  6. Exercise: The Backbone of Spine Treatment

    MedlinePlus

    Exercise: The Backbone of Spine Treatment | View Video Back About Video Struggling with Low Back Pain? Many people are surprised to learn that carefully selected exercise can actually reduce back pain. Some exercises can ...

  7. Stand-Alone Cages for Anterior Cervical Fusion: Are There No Problems?

    PubMed Central

    Han, Sang Youp; Lee, Cheol Young; Kim, Hong Rye; Park, Dong Ho

    2016-01-01

    Objective There are complications in stand-alone cage assisted anterior cervical discectomy and fusion (ACDF), such as cage subsidence and kyphosis. Here we report our clinical result on ACDF, comparing with stand-alone cages and with cervical plate system for degenerative cervical spine diseases. Methods Patients with degenerative cervical disease who were diagnosed and treated in Konyang University Hospital between January 2004 and December 2014 were included in this study. Patients who had operation in single level ACDF were selected. Patients scored the degree of pain using visual analog scale before and after the surgery. Subsidence was defined as ≥3-mm decrease of the segmental height, and cervical kyphosis was defined as progression of ≥5° at 12 months after postoperative follow-up compared to that measured at the immediate postoperative period. Results A total of 81 patients were enrolled for this study. Forty-five patients were included in a cervical plate group and the others were in stand-alone cage group. There was no statistical difference in pain score between the 2 groups. Segmental subsidence was observed in 7 patients (15.6%) in plate-assisted cervical fusion group, and 13 patients (36.1%) in stand-alone cage group. Segmental kyphosis was observed in 4 patients (8.9%) in plate-assisted cervical fusion group, and 10 patients (27.8%) in stand-alone cage group. There was statistical difference between the 2 groups. Conclusion There was no difference in pain between 2 groups. But stand-alone case group showed higher incidence rate than plate-assisted cervical fusion group in segmental subsidence and cervical kyphosis. When designing cervical fusion, more attention should be given selecting the surgical technique. PMID:27123025

  8. Correlation of Computed Tomography Imaging Features With Pain Response in Patients With Spine Metastases After Radiation Therapy

    SciTech Connect

    Mitera, Gunita; Probyn, Linda; Ford, Michael; Donovan, Andrea; Rubenstein, Joel; Finkelstein, Joel; Christakis, Monique; Zhang, Liying; Campos, Sarah; Culleton, Shaelyn; Nguyen, Janet; Sahgal, Arjun; Barnes, Elizabeth; Tsao, May; Danjoux, Cyril; Holden, Lori; Yee, Albert; Khan, Luluel; Chow, Edward

    2011-11-01

    Purpose: To correlate computed tomography (CT) imaging features of spinal metastases with pain relief after radiotherapy (RT). Methods and Materials: Thirty-three patients receiving computed tomography (CT)-simulated RT for spinal metastases in an outpatient palliative RT clinic from January 2007 to October 2008 were retrospectively reviewed. Forty spinal metastases were evaluated. Pain response was rated using the International Bone Metastases Consensus Working Party endpoints. Three musculoskeletal radiologists and two orthopaedic surgeons evaluated CT features, including osseous and soft tissue tumor extent, presence of a pathologic fracture, severity of vertebral height loss, and presence of kyphosis. Results: The mean patient age was 69 years; 24 were men and 9 were women. The mean worst pain score was 7/10, and the mean total daily oral morphine equivalent was 77.3 mg. Treatment doses included 8 Gy in one fraction (22/33), 20 Gy in five fractions (10/33), and 20 Gy in eight fractions (1/33). The CT imaging appearance of spinal metastases included vertebral body involvement (40/40), pedicle involvement (23/40), and lamina involvement (18/40). Soft tissue component (10/40) and nerve root compression (9/40) were less common. Pathologic fractures existed in 11/40 lesions, with resultant vertebral body height loss in 10/40 and kyphosis in 2/40 lesions. At months 1, 2, and 3 after RT, 18%, 69%, and 70% of patients experienced pain relief. Pain response was observed with various CT imaging features. Conclusions: Pain response after RT did not differ in patients with and without pathologic fracture, kyphosis, or any other CT features related to extent of tumor involvement. All patients with painful spinal metastases may benefit from palliative RT.

  9. [Comparative roentgenographical study on the incidence of ossification of the posterior longitudinal ligament and other degenerative changes of the cervical spine among Japanese, Koreans, Americans and Germans (author's transl)].

    PubMed

    Izawa, K

    1980-05-01

    Ossification of the posterior longitudinal liagment (OPLL) of the cervical spine which causes narrowing of the spinal canal has been reported to occur in about three percent of adult Japanese, whereas only sporadical cases have been reported outside Japan. Whether this indicates a real ethnic difference of the disease incidence or simply reflects a difference of attention toward this disease has been one of the questions raised by many workers. In order to clarify this, the author reviewed a large number of roentgenograms of the cervical spine in Japan (Juntendo University Hospital), Korea (Sebrance Hospital and Hanko Sacred Heart Hospital), the United States (Mayo Clinic and Dr. Cloward's Office in Hawaii), and West Germany (Mainz University Hospital). The rate of appearance of OPLL was compared between these ethnic groups. In addition to this, the rate of appearance of calcification of the nuchal ligament and other degenerative changes of the cervical spine such as osteophyte formation and narrowing of the intervertebral disc space was also studied and statistically analysed. Results 1. OPLL: The author found OPLL in 143 out of 6,994 (2.06%) Japanese individuals above 20 years of age. The incidence was lower in Koreans being 0.95%. This was much more pronounced and significant in the United States (Mayo Clinic) and in Germany, where only a few cases were found (Table 6). However, it is interesting to note that six cases found at Dr. Cloward's office in Hawaii included two Japanese. The author concludes that the incidence of OPLL is significantly higher in Japanese than in Caucasians, although the reason for this still remains to be studied. 2. Calcification of the nuchal ligament: This calcification (Barsony) was found in 10.2% among Japanese and in 11.3% among Koreans, whereas in 6.1% among Americans and in 4.5% among GErmans (Table 13). The author proposes that this significantly higher incidence of this calcification among Japanese and Koreans may have

  10. Effect of backpack shoulder straps length on cervical posture and upper trapezius pressure pain threshold

    PubMed Central

    Abdelraouf, Osama Ragaa; Hamada, Hamada Ahmed; Selim, Ali; Shendy, Wael; Zakaria, Hoda

    2016-01-01

    [Purpose] This study was performed to investigate the effect of the length of backpack shoulder straps on upper trapezius muscle pain threshold and craniovertebral angle. [Subjects and Methods] There were 25 participants, with ages from 15 to 23 years old. Upper trapezius pain threshold and craniovertebral angle were measured for all subjects without the backpack then re-measured after walking on a treadmill for 15 min under 2 conditions: 1) wearing a backpack with short straps; and 2) wearing a backpack with long straps. [Results] there was a significant reduction in upper trapezius pain threshold and craniovertebral angle while carrying a backpack with long shoulder straps, compared to use of a backpack with short shoulder straps or no backpack. [Conclusion] A backpack with short straps is less harmful than a backpack with long straps. This result should be considered in ergonomic design of backpacks to reduce the incidence of various physiological and biomechanical disorders. PMID:27799665

  11. Osteopathic manipulative treatment for facial numbness and pain after whiplash injury.

    PubMed

    Genese, Josephine Sun

    2013-07-01

    Whiplash injury is often caused by rear-end motor vehicle collisions. Symptoms such as neck pain and stiffness or arm pain or numbness are common with whiplash injury. The author reports a case of right facial numbness and right cheek pain after a whiplash injury. Osteopathic manipulative treatment techniques applied at the level of the cervical spine, suboccipital region, and cranial region alleviated the patient's facial symptoms by treating the right-sided strain of the trigeminal nerve. The strain on the trigeminal nerve likely occurred at the upper cervical spine, at the nerve's cauda, and at the brainstem, the nerve's point of origin. The temporal portion of the cranium played a major role in the strain on the maxillary.

  12. Should routine MRI of the lumbar spine be required prior to lumbar epidural steroid injection for sciatica pain?

    PubMed Central

    Ghaly, Ramis F.; Lissounov, Alexei; Candido, Kenneth D.; Knezevic, Nebojsa Nick

    2015-01-01

    Background: We describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies an